羟乙基淀粉对内毒素感染大鼠血浆细胞因子表达和单个核细胞NF—κB活性的影响

目的　研究羟乙基淀粉溶液 (HES 2 0 0 /0 5 )对内毒素腹腔感染大鼠炎症反应的影响 ,并探讨分子机制。方法　雄性Wistar大鼠随机分为对照组、内毒素组 (LPS 6mg/kg)、LPS HES组 (HES 3 75、7 5、15、30mL/kg)及HES对照组 (30mL/kg)。分别于LPS注入后 4h检测血浆肿瘤坏死因子 (TNF -α)和细胞因子诱导的中性粒细胞趋化因子 (CINC)浓度 ,2h检测循环血单个核细胞核转录因子kappaB(NF -κB)水平。结果　大鼠内毒素感染时血浆TNF -α和CINC浓度及单个核细胞NF -κB活性明显上升 (P <0 0 5 )。 3 75和 7 5mL/kgHES能明显降低TNF -α和NF -κB水平 (P <0 0 5 ) ;3 75、7 5和 15mL/kgHES能明显降低CINC水平 (P <0 0 5 )。结论　较低剂量HES具有抑制内毒素腹腔感染大鼠炎症反应的作用 ,这种作用的产生与其对NF -κB的抑制有关。HES对感染状态有保护作用。     

核因子-κB活化在急性肺损伤发病中的作用

目的 探讨核因子-κB(NF-κB)活化在炎症反应及其内毒素致伤大鼠急性肺损伤(acute lung injury，ALI)发病中的作用，为临床ALI防治提供理论依据。方法 观察内毒素(LPS)对大鼠血气分析和肺组织损伤的影响，采用凝胶电泳迁移率改变(EMSA)法检测肺组织核蛋白提取物中NF-κB活性及其特异性；并应用ELISA法检测肺组织匀浆TNFα含量的改变。结果 LPS静注可致大鼠急性肺损伤，肺组织核蛋白的NF-κB活性显著增强，肺组织匀浆TNFα含量显著升高。结论 LPS激活NF-κB启动TNFα表达，释放的TNFα与LPS进一步共同激活效应细胞的NF-κB活化，进而启动一系列参与炎症反应的炎症分子表达而参与大鼠急性肺损伤的发生。     

罗格列酮对内毒素血症大鼠肺损伤的保护作用

目的探讨过氧化物酶体增殖物激活受体(PPARγ)激动剂罗格列酮(ROSI)对内毒素血症大鼠肺损伤的保护作用.方法雄性Wistar大鼠24只随机分为四组:正常对照组、单纯ROSI组、内毒素组和ROSI预处理组.内毒素组静脉注射6 mg/kg脂多糖(LPS),ROSI预处理组在给予LPS前30 min静脉注射0.3 mg/kg ROSI.注射LPS后4 h,测定肺组织湿/干重比(W/D)、髓过氧化物酶(MPO)活性、丙二醛(MDA)和细胞因子诱导的中性粒细胞趋化因子-1(CINC-1)浓度,并评价肺组织病理学变化.结果ROSI预处理组肺组织W/D、MPO活性、MDA和CINC-1含量较内毒素组显著降低(P＜0.01),肺组织学改变明显减轻.结论ROSI对内毒素血症大鼠的肺损伤有保护作用.     

大黄对脓毒症大鼠核因子-κB活化的抑制作用

目的 :探讨脓毒症时肠道组织肿瘤坏死因子 α( TNFα)、单核细胞趋化蛋白 1( MCP 1)及核因子 κB( NFκB)活性的相关性 ,揭示大黄治疗脓毒症的有效机制。方法 :采用盲肠结扎穿孔术制备大鼠脓毒症模型。分别在术后 1、3、6、12、2 4、4 8h活杀大鼠取肠黏膜组织 ,用酶联免疫吸附法测 TNFα、MCP 1的含量 ,用凝胶电泳迁移法测 NFκB的活性。在脓毒症模型基础上加用大黄治疗 ,分别于治疗后 12、2 4、4 8、72 h活杀大鼠 ,用同样的方法检测 TNFα、MCP 1含量及 NFκB活性。结果 :脓毒症大鼠肠黏膜 NFκB活性及TNFα、MCP 1含量均较相应对照组明显升高 ( P均 <0 .0 1) ;大黄治疗后能明显抑制升高的 NFκB活性和TNFα、MCP 1含量 ( P均 <0 .0 5 )。结论 :TNFα、MCP 1是脓毒症早期激活的细胞因子 ,其释放与NFκB活性密切相关 ;大黄可通过抑制 NFκB活性、减少炎症细胞因子释放而达到抑制炎症反应的作用     

羟乙基淀粉对内毒素感染大鼠血浆细胞因子表达和单个核细胞NF-кB活性的影响

目的研究羟乙基淀粉溶液(HES 200/0.5)对内毒素腹腔感染大鼠炎症反应的影响,并探讨分子机制.方法雄性Wistar大鼠随机分为对照组、内毒素组(LPS 6 mg/kg)、LPS+HES组(HES 3.75、7.5、15、30 mL/kg)及HES对照组(30 mL/kg).分别于LPS注入后4 h检测血浆肿瘤坏死因子(TNF-α)和细胞因子诱导的中性粒细胞趋化因子(CINC)浓度,2 h检测循环血单个核细胞核转录因子kappaB(NF-кB)水平.结果大鼠内毒素感染时血浆TNF-α和CINC浓度及单个核细胞NF-кB活性明显上升(P＜0.05).3.75和7.5 mL/kg HES能明显降低TNF-α和NF-кB水平(P＜0.05);3.75、7.5和15 mL/kg HES能明显降低CINC水平(P＜0.05).结论较低剂量HES具有抑制内毒素腹腔感染大鼠炎症反应的作用,这种作用的产生与其对NF-кB的抑制有关.HES对感染状态有保护作用.     

参附注射液对内毒素所致大鼠全身炎症反应综合征的作用

目的:探讨参附注射液对内毒素所致大鼠全身炎症反应综合征(SIRS)的治疗作用及其机制.方法:静脉注射脂多糖(LPS)建立大鼠SIRS模型.健康雄性Wistar大鼠45只,按随机数字表法分为假手术对照组(C组)、LPS致伤组(L组)和参附注射液治疗组(T组).L、T组动物制模后分为1、2、4和6 h 4个亚组.在4个时间点分别取血,采用酶联免疫吸附法(ELISA)检测单个核细胞中核转录因子-κB(NF-κB)活性、血清肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平,观察肺脏和肝脏的病理学变化,并与C组比较.结果:L组单个核细胞中NF-κB活性明显增高,2 h最明显(0.604±0.020),显著高于对照组(0.112±0.017);血清TNF-α浓度明显升高,2 h最明显[(1 644.8±25.9)ng/L],显著高于对照组[(55.9±19.2)ng/L];血清IL-6浓度随时间推移不断升高,显著高于对照组.病理结果显示,L组肺泡出血、水肿、大量炎症细胞浸润;肝脏毛细血管扩张、充血、水肿和炎症细胞浸润.参附注射液可以显著降低NF-κB活性、TNF-α及IL-6水平,减轻肺脏和肝脏病理损伤.结论:参附注射液可通过抑制NF-κB活性对大鼠SIRS起保护作用.     

前列腺素E1对急性肺损伤肺组织核因子κB表达的干预作用

目的建立急性肺损伤(ALI)大鼠模型,通过观察脂微球前列腺素E1(1ipoPGEl)对肺组织核因子-κB(NF-κB)活化的调控作用和对血清中细胞因子表达的调控作用,探讨PGE1对ALI的保护作用机制。方法雄性SD健康大鼠45只随机分成3组,A组:生理盐水组;B组:LPS模型组;C组:LPS lipoPGE1治疗组。各组分1、2、4h3个时间点各5只观察肺组织变化,测定肺组织NF-κB的表达及血清细胞因子TNFα、IL-12、IL-10浓度。结果治疗组肺组织充血出血情况较模型组明显改善,NF-κB表达显著降低,血清TNF-α、IL-12浓度显著降低,IL-10浓度明显增高。结论前列腺素E1通过下调NFκB的活性,抑制炎症因子的表达从而减轻急性肺损伤。     

核因子-κΒ活化在急性肺损伤发病中的作用

目的　探讨核因子 κΒ (NF κΒ)活化在炎症反应及其内毒素致伤大鼠急性肺损伤 (acutelunginjury ,ALI)发病中的作用 ,为临床ALI防治提供理论依据。方法　观察内毒素 (LPS)对大鼠血气分析和肺组织损伤的影响 ,采用凝胶电泳迁移率改变 (EMSA)法检测肺组织核蛋白提取物中NF κΒ活性及其特异性 ;并应用ELISA法检测肺组织匀浆TNFα含量的改变。结果　LPS静注可致大鼠急性肺损伤 ,肺组织核蛋白的NF κΒ活性显著增强 ,肺组织匀浆ΤΝFα含量显著升高。结论　LPS激活NF κΒ启动ΤΝFα表达 ,释放的ΤΝFα与LPS进一步共同激活效应细胞的NF κΒ活化 ,进而启动一系列参与炎症反应的炎症分子表达而参与大鼠急性肺损伤的发生     

地塞米松对脓毒症大鼠急性肾功能衰竭核因子-κB和炎症细胞因子的影响

目的：研究脓毒症大鼠急性肾功能衰竭时肾组织核因子-κB（NF—κB）的活性、血清炎症细胞因子的变化以及地塞米松（DXM）对它们的影响。方法：雄性SD大鼠72只随机分成对照组（A组）、LPS模型组（B组）、DXM＋LPS治疗组（C组）,各组在2、4、6h时观察8只大鼠肾组织大体外观及病理学变化,测定血肌酐浓度的变化,检测肾组织NF—κB的活性,以及用ELISA法检测血清肿瘤坏死因子-α（TNF-α）和自介素-6（IL-6）的浓度。结果：B组肉眼观肾脏表面色泽暗红,可见包膜下点、片状出血;C组肾脏表面有轻度充血、水肿;和A组比较,B组肾脏病理呈急性炎症改变．C组肾脏病变较B组明显减轻。在4、6h时点,B组和C组血肌酐浓度与A组比较明显上升（P〈0．05）．且B组血肌酐浓度高于C组（P〈0．05）。B组中肾组织NF—κB的活性、血清TNF—α和IL-6的浓度较A组明显升高（P〈0．05）,C组肾组织NF—κB的活性、血清TNF-α和IL-6的浓度较B组显著降低（P〈0．05）。结论：DXM可以通过抑制NF-κB的活性．下调炎症因子的表达,抑制中性粒细胞在肾脏的浸润而保护脓毒症大鼠的肾功能。     

核因子-κB在小鼠急性肺损伤发病中的作用及治疗干预研究

目的　探讨核因子 (NF) -κB在内毒素 (LPS)诱导的急性肺损伤 (ALI)小鼠发病中的作用以及地塞米松 (Dex)的干预作用。方法　腹腔内注射LPS诱导小鼠ALI模型 ,随机分为LPS组、LPS +Dex组 ,LPS注射后 0、1、3、6、12h测定肺湿重 干重比值 (W D)、肺组织NF -κB活性、肺组织匀浆中肿瘤坏死因子 (TNF)α及白细胞介素 (IL) - 10浓度 ,检测mRNA表达 ,并观察肺组织光镜、电镜病理改变。结果　LPS注射后 ,W D明显增高 ,3h开始明显升高 ,6h达到高峰 ( 4 82± 0 10 ) ,显著高于注射前 ( 3 6 7± 1 0 4,P <0 0 5 ) ;肺组织核蛋白NF -κB活性 1h开始明显升高 ,6h达到峰值 ( 40 5 7± 6 2 4) ,显著高于注射前( 44 8± 30 9,P <0 0 5 ) ;肺组织匀浆TNF -α和IL - 10浓度分别在注射后 6h和 12h升高最明显 ,分别为 ( 197 1± 5 2 4)pg mL和 ( 16 4 9± 39 7)pg mL ,显著高于注射前。地塞米松明显抑制NF -κB活化 ,肺组织匀浆中TNF -α、IL - 10及其mRNA表达明显下降。肺组织病理显示LPS可导致肺泡出血、水肿 ,大量炎症细胞浸润 ,电镜下见Ⅰ型肺泡上皮细胞断裂 ,Ⅱ型肺泡上皮细胞变性 ,地塞米松可明显改善肺损伤。结论　LPS导致肺组织NF -κB的活化 ,介导炎症介质大量表达 ,参与ALI发生 ,地塞米松通过抑制炎症反     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.