高氧液对家兔心肌缺血／再灌注细胞凋亡的影响

目的 观察高氧液对心肌缺血／再灌注心肌梗死面积、心肌结构和细胞凋亡参数的影响，探讨高氧液抗心肌缺血／再灌注损伤的保护作用机制。方法 家兔心脏左冠状动脉前降支缺血／再灌注动物模型，缺血30min，再灌注2h，60只家兔随机数字表法分成3组：对照组(Ⅰ组，n=20)只暴露左冠状动脉前降支，不结扎；缺血／再灌注组(Ⅱ组，I／R组，n=20)，在缺血再灌注前10min静脉注射生理盐水(20ml／kg)；高氧液治疗组(Ⅲ组，n=20)，在缺血前10min静脉注射高氧液(20ml／kg)。分别按TCC法染色，用图像分析系统计算梗死面积；原位末端TUNEL法检测细胞凋亡指数；免疫组化ABE法检测Fas、Bel-2的含量，同时电镜观察心肌细胞的超徽结构。结果 Ⅲ组心肌梗死细胞面积为(2．29&;#177;0．02)cm，与Ⅱ组的(3．38&;#177;0．07)cm比较，梗死面积明显缩小。Ⅱ组的AI(20．8&;#177;0．36)，明显高于Ⅰ组(4．1&;#177;0．25)，P&;lt;0．01，t=170．4，Ⅲ组的AI(13．3&;#177;0．35)显著低于Ⅱ组，P&;lt;0．01，t=66．8，但仍高于Ⅰ组，P&;lt;0．01，t=92．8。Ⅰ组Fas的OD值为2．80&;#177;0．07，Ⅱ组3．70&;#177;0．05，Ⅲ组3．10&;#177;0．04。Ⅰ组Bcl—2的OD值为2．7&;#177;0．02，Ⅱ组0．60&;#177;0．03，Ⅲ组2．90&;#177;0．02。结论 高氧液具有抗心肌缺血／再灌注损伤的作用，其作用机制可能是通过调节Fas和Bcl—2介导的心肌缺血/再灌注细胞凋亡而实现。     

胰岛素对缺血再灌注心肌超微结构和细胞凋亡的影响

目的:探讨极化液(胰岛素)对家兔心肌缺血再灌注损伤的保护作用。方法:选择健康雄性家兔48只,按随机抽签法分为3组:对照组,胰岛素组,葡萄糖-钾-胰岛素(glucose-insulin-potassium,GIK)组,每组16只。制备兔心肌缺血再灌注损伤模型,分别用GIK、胰岛素、生理盐水干预分组。再灌注结束后检测心肌梗死面积,在电镜下观察心肌细胞的超微结构,原位末端标记(TUNEL)法测定凋亡心肌细胞,免疫组化SP法测定原癌基因蛋白(Bcl-2),Fas的含量。结果:与对照组比较,GIK及胰岛素组家兔心肌细胞超微结构表现为损伤减轻,心肌梗死面积明显减少犤GIK组(38.9±4.33)%,胰岛素组(40.8±5.22)%,对照组(54.42±4.27)%犦(q=4.32,3.95,P<0.05),凋亡指数犤GIK组(1.38±0.82),胰岛素组(1.28±0.54),对照组(2.15±0.19)犦(q=0.65,0.72,P<0.05)和Fas含量显著减少(q=0.07,0.06,P<0.05),Bcl-2含量增加(q=0.14,0.11,P<0.05)。GIK组和胰岛素组心肌细胞凋亡指数及Fas,Bcl-2蛋白含量比较,差异无显著性意义(P>0.05)。结论:GIK具有抗缺血再灌注损伤的作用,其机制可能是通过胰岛素调节Bcl-2和Fas介导的心肌缺血再灌注细胞凋亡而实现。     

人参皂甙Re对大鼠急性缺血再灌注心肌细胞凋亡及相关基因蛋白表达的影响

背景心肌细胞缺血再灌注损伤近来已成为临床研究的热点,但人参及其提取物对急性缺血再灌注损伤后心肌细胞凋亡的作用尚未阐明.目的观察人参皂甙Re对急性缺血再灌注心肌细胞凋亡及Bcl-2,Bax,Bad和Fas基因蛋白表达的影响,探讨人参皂甙Re抑制心肌细胞凋亡的可能机制.设计随机对照实验研究.地点、对象和干预本实验在湖北省武汉市同济医院动物实验中心完成.实验共用Wistar大鼠15只,雌雄不分.按随机数字表法分为假手术组、缺血再灌注组、人参皂甙Re治疗组,每组各5只.建立Wistar鼠缺血再灌注心脏模型.应用原位末端标记法检测心肌凋亡细胞,并进行细胞计数;原位杂交和免疫组化检测Bcl-2mRNA和基因表达产物的蛋白质,通过图像分析系统测量阳性染色区域的平均吸光度值进行量化分析,以观察人参对大鼠心肌缺血再灌注心肌细胞凋亡的影响及基因表达.主要观察指标人参皂甙Re治疗与否对急性大鼠缺血再灌注心肌细胞凋亡及Bcl-2,Bax,Bad和Fas基因蛋白表达的影响.结果①假手术组未发现心肌凋亡细胞.缺血再灌注组心肌凋亡细胞数为(134±46)个/视野,人参皂甙Re治疗组为(91±19)个/视野,两组间差异有显著性意义(t=4.63,P＜0.01).②免疫组织化学检测发现缺血再灌注组及人参皂甙Re治疗组Bcl-2,Bax,Bad和Fas基因蛋白的表达较假手术组明显增加(t=2.79,P＜0.05),人参皂甙Re治疗组bcl-2的表达与缺血再灌注组比较,差异无显著性意义(t=2.67,P＞0.05),而Bax,Bad,Fas的表达明显下降(t=2.81,P＜0.05),人参皂甙Re治疗组Bcl-2/Bad,Bcl-2/Bad,Bcl-2/Fas比值均较假手术组与缺血再灌注组明显增大(t=2.84,P＜0.05).结论人参皂甙Re治疗可以抑制急性缺血再灌注诱导的心肌细胞凋亡,其作用机制可能是抑制了促凋亡基因bax,bad,fas的表达,从而使Bcl-2/Bax,Bcl-2/Bad,Bcl-2/Fas比值增大.     

大剂量硝酸甘油对大鼠离体缺血再灌注心肌细胞凋亡和Bax及Bcl-2的影响

目的:研究硝酸甘油是否对大鼠离体缺血再灌注心肌细胞凋亡和Bcl-2/Bax水平存在直接的影响。方法:实验选用SD大鼠30只,随机分为硝酸甘油组和对照组,每组15只。制备大鼠离体心肌缺血再灌注模型(缺血30min,再灌注120min)在再灌注开始时分别给以大剂量硝酸甘油(15μg/h,以950mL/L乙醇为溶剂)或950mL/L乙醇(3μL/h)。再灌注结束后,将缺血区剪下,制备石蜡切片,采用TUNEL技术检测心肌凋亡,免疫组化技术检测心肌组织的Bcl-2和Bax水平。结果:硝酸甘油组细胞发生凋亡数犤(35.2±6.7)%犦明显多于对照组细胞犤(5.2±0.8)%犦(t=28.1,P<0.01)。对照组Bcl-2表达(5.7±1.3)明显强于硝酸甘油组(1.8±0.8)(t=11.9,P<0.01)。对照组Bax表达(5.9±1.3)明显弱于硝酸甘油组(9.1±1.3)(t=9.2,P<0.01)。结论:大剂量的硝酸甘油促进了大鼠离体缺血/再灌注心肌细胞凋亡,提高了Bax蛋白的水平,降低了Bcl-2蛋白水平;大剂量硝酸甘油对Bcl-2/Bax的调节可能是其促凋亡的主要机制之一。     

胰岛素对大鼠脑缺血再灌注时神经元凋亡及其相应基因的调控

目的观察胰岛素(insulin,RI)对缺血再灌注损伤后细胞凋亡及其相应基因的调控作用,评估RI对脑缺血再灌注损伤的保护作用。方法将健康wistar大鼠56只,随机分为对照组、缺血再灌注盐水组(NS)、缺血再灌注胰岛素组(RI)。采用pulsinelli4血管阻塞模型,观察RI、NS在4,24,48h海马CA1区存活神经元数目,TUNEL阳性细胞数目,Bcl-2蛋白的表达,以观察比较缺血再灌注阶段细胞凋亡的变化。结果再灌注NS组CA1区神经元数目(36±6)个/mm2较再灌注RI组(88±9)个/mm2少(t=3.34,P<0.01)。再灌注后CA1区细胞凋亡数:4h时再灌注NS组(12±3)个/mm2高于再灌注RI(8±1)个/mm2和假手术组(2±1)个/mm2:组间比较,F=127.66,P<0.001。Bcl-2对海马CA1细胞凋亡评估4h时,再灌注NS组43.0±9.8,高于再灌注RI组24.0±5.4和假手术组2.7±0.8。结论全脑缺血再灌注时急用RI可减轻脑缺血再灌注神经元凋亡,对脑缺血再灌注损伤引起的神经元延迟性坏死有保护作用。     

血液稀释和缺血预处理对猪心脏缺血再灌注损伤的保护作用

目的在猪心肌缺血再灌注模型上,观察等容血液稀释和缺血预处理对再灌注损伤心肌的保护作用. 方法 18头小型猪建立急性心肌缺血模型,随机分为 3组对照组 (组Ⅰ, n=6),缺血预处理组 (组Ⅱ, n=6),缺血预处理加血液稀释组 (组Ⅲ, n=6),测定心排血量( CO) ,混合静脉血氧饱和度( SvO2,) 、冠状动脉血流量,计算心肌氧供,氧耗量.于钳扎前、解除钳扎后 20,60 min分别测定血浆中丙二醛 (MDA),SOD活性、磷酸激酶( CPK)及肌酸磷酸激酶同功酶( CK-MB) ,自左心耳剪下标本,测定 HSP 70 mRNA表达率. 结果①缺缺血 20 min 时 3组 MAP、 CI及 SVRI明显减低( P< 0.01) ,但 I组下降幅度明显大于 II,III组.再灌注 60 min时, II组 ,III组 HR明显低于对照值( P< 0.01) ,III组 HR的变化则无统计学意义, I组 MAP,CI的下降幅度明显大 I组和 II组 (P< 0.05).②再灌注 20 min及 60 min时, III组的冠脉血流量明显大于 I组( P< 0.05).③再灌注 20 min和 60 min时, 3组 CPK, CPK-MB均较对照值明显升高( P< 0.05- 0.01) ,组 I的升高幅度明显大于组 II, 组 III.组Ⅰ SOD值在再灌注 20 min, 60 min时逐步降低( P< 0.05),组 II, 组 III SOD值有升高趋势,与对照值比较,无统计学意义.再灌注 60 min时,组Ⅰ MDA值明显高于组Ⅱ,组Ⅲ.④组Ⅰ HSP 70 mRNA表达低于组Ⅱ和组Ⅲ. 结论等容血液稀释可明显增强预适应拮抗心肌缺血再灌注造成的心肌损伤.     

人参皂甙Re对大鼠急性缺血再灌注心肌细胞凋亡及相关基因蛋白表达的影响

背景：心肌细胞缺血再灌注损伤近来已成为临床研究的热点，但人参及其提取物对急性缺血再灌注损伤后心肌细胞凋亡的作用尚未阐明。目的：观察人参皂甙Re对急性缺血再灌注心肌细胞凋亡及Bcl-2，Bax，Bad和Fas基因蛋白表达的影响，探讨人参皂甙Re抑制心肌细胞凋亡的可能机制。设计：随机对照实验研究。地点、对象和干预：本实验在湖北省武汉市同济医院动物实验中心完成。实验共用Wastar大鼠15只，雌雄不分。按随机数字表法分为假手术组、缺血再灌注组、人参皂甙Re治疗组，每组各5只。建立Wistar鼠缺血再灌注心脏模型。应用原位末端标记法检测心肌凋亡细胞，并进行细胞计数；原位杂交和免疫组化检测Bcl-2mRNA和基因表达产物的蛋白质，通过图像分析系统测量阳性染色区域的平均吸光度值进行量化分析，以观察人参对大鼠心肌缺血再灌注心肌细胞凋亡的影响及基因表达。主要观察指标：人参皂甙Re治疗与否对急性大鼠缺血再灌注心肌细胞凋亡及Bcl-2，Bax，Bad和Fas基因蛋白表达的影响。结果：①假手术组未发现心肌凋亡细胞。缺血再灌注组心肌凋亡细胞数为(134&;#177;46)个／视野，人参皂甙Re治疗组为(91&;#177;19)个／视野，两组间差异有显著性意义(t=4.63，P&;lt;0．01)。②免疫组织化学检测发现缺血再灌注组及人参皂甙Re治疗组Bcl-2，Bax，Bad和Fas基因蛋白的表达较假手术组明显增加(t=2．79，P&;lt;0．05)，人参皂甙Re治疗组bcl-2的表达与缺血再灌注组比较，差异无显著性意义(t=2．67，P&;gt;0.05)，而Bax，Bad，Fas的表达明显下降(t=2．8l，P&;lt;0．05)，人参皂甙Re治疗组Bcl-2／Bad，Bcl-2／Bad，Bcl-2／Fas比值均较假手术组与缺血再灌注组明显增大(t=2．84．P&;lt;0．05)。结论：人参皂甙Re治疗可以抑制急性缺血再灌注诱导的心肌细胞凋亡，其作用机制可能是抑制了促凋亡基因bax，bad，fas的表达，从而使Bcl-2／Bax，Bcl-2／Bad，Bcl-2／Fas比值增大。     

胰岛素对缺血再灌注心肌超微结构和细胞凋亡的影响

目的：探讨极化液(胰岛素)对家兔心肌缺血再灌注损伤的保护作用。方法：选择健康雄性家兔48只，按随机抽签法分为3组：对照组，胰岛素组，葡萄糖-钾-胰岛素(gluecose-insulin-potassmm，GIK)组，每组16只。制备兔心肌缺血再灌注损伤模型，分别用GIK、胰岛素、生理盐水干预分组。再灌注结束后检测心肌梗死面积，在电镜下观察心肌细胞的超微结构，原位末端标记(TUNEL)法测定凋亡心肌细胞，免疫组化SP法测定原癌基因蛋白(Bcl-2)，Fas的含量。结果：与对照组比较，GIK及胰岛素组家兔心肌细胞超微结构表现为损伤减轻，心肌梗死面积明显减少[GIK组(38.9&;#177;4．33)％，胰岛素组(40．8&;#177;5．22)％，对照组(54．42&;#177;4．27)％](q=4．32，3．95．P&;lt;0.05)，凋亡指数[GIK组(1．38&;#177;0，82)，胰岛素组(1．28&;#177;0．54)，对照组(2．15&;#177;0，19)](q=0，65，0．72，P&;lt;0．05)和Fas含量显著减少(q=0.07，0．06，P&;lt;0．05)，Bcl-2含量增加(q=0．14，0．11．P&;lt;0．05)。GIK组和胰岛素组心肌细胞凋亡指数及Fas，Bcl-2蛋白含量比较，差异无显著性意义(P&;gt;0．05)。结论：GIK具有抗缺血再灌注损伤的作用，其机制可能是通过胰岛素调节Bcl-2和Fas介导的心肌缺血再灌注细胞凋亡而实现。     

微量去甲肾上腺素预处理对大鼠缺血再灌注心肌细胞凋亡的影响

目的　探讨微量去甲肾上腺素预处理对大鼠缺血再灌注心肌细胞凋亡的影响并与缺血预处理比较.方法　采用大鼠在体缺血再灌注(I/R)模型,分别以缺血前去甲肾上腺素预处理(NE-P),缺血预处理(IP),采用末端脱氧核苷酸转换酶介导的生物素平移缺口末端标记技术(TUNEL)检测各组心肌细胞凋亡情况;同时检测心肌梗死范围.结果　I/R组细胞凋亡率[(43.33±4.92)%]较高,NE-P组及IP组虽然也有一定的心肌细胞凋亡率[(25.24±1.56)%、(24.44±2.96)%],但较I/R组明显降低(P＜0.001).IP组及NE-P组心肌梗死范围较I/R组明显减少,IP组及NE-P组两项指标无显著差异.结论　心肌缺血再灌注损伤可诱发心肌细胞凋亡,NE-P能明显减少缺血再灌注诱导的心肌细胞凋亡的发生率,能明显减少心肌梗死范围,减轻缺血再灌注损伤;NE-P减少心肌梗死范围、减轻缺血再灌注损伤的机理可能与其能明显减少心肌细胞凋亡有关.     

参附注射液对再灌注期间肠黏膜上皮细胞凋亡的抑制

背景肠上皮细胞异常凋亡是缺血再灌注期间肠黏膜损伤的主要原因,参附注射液对小肠黏膜损伤有良好的防治作用.目的建立大鼠肠缺血再灌注模型,观察缺血再灌注时给予参附注射液对肠上皮细胞凋亡数目、凋亡相关基因半胱氨酸天冬氨酸蛋白酶-3、Bcl-2的表达及肿瘤坏死因子水平的影响.设计随机对照实验.单位武汉大学人民医院麻醉科.材料实验于2002-12/2003-06在武汉大学人民医院麻醉科实验室完成.选取健康清洁级SD大鼠24只,随机分为空白对照组、肠缺血再灌注组、参附注射液组,8只/组.方法各组大鼠给予氨基甲酸乙酯1 mg/kg腹腔注射麻醉,肠缺血再灌注组和参附注射液组用血管钳夹闭肠系膜上动脉1 h然后再灌注2 h,空白对照组不用血管钳夹闭肠系膜上动脉.参附注射液组于阻断前30 min静注参附注射液0.02 mL/g,空白对照组和肠缺血再灌注组静脉输注等量生理盐水.制备切片进行半胱氨酸天冬氨酸蛋白酶-3、Bcl-2蛋白的表达及细胞凋亡检测.主要观察指标①各组大鼠细胞凋亡指数的比较.②各组大鼠肠上皮细胞半胱氨酸天冬氨酸蛋白酶-3及Bcl-2基因的表达.③各组肠粘膜匀浆中肿瘤坏死因子含量的比较.结果实验选用24只大鼠,全部进入结果分析.①各组大鼠细胞凋亡指数的比较参附注射液组的凋亡指数明显低于肠缺血再灌注组,但比空白对照组高[(7.75±1.89)%,(28.25±8.50)%,(4.25±2.63)%,P均＜0.01].②各组大鼠肠上皮细胞半胱氨酸天冬氨酸蛋白酶-3及Bcl-2基因的表达参附注射液组组半胱氨酸天冬氨酸蛋白酶-3的表达低于肠缺血再灌注组,但高于空白对照组[(0.211 6±0.087 5),(0.354 7±0.077 8),(0.194 1±0.057 4),P＜0.01,P＞0.05];Bcl-2的表达在肠缺血再灌注组比空白对照组显著增高(P＜0.05),参附注射液组的表达比肠缺血再灌注组明显降低(P＜0.01).③各组肠黏膜匀浆中肿瘤坏死因子含量的比较砀缺血再灌注组肿瘤坏死因子的表达显著高于空白对照组和参附注射液组[(189.7±56.3),(38.6±10.4),(47.5±18.7)mg/L,P均＜0.01],参附注射液组和空白对照组基本相似(P＞0.05).结论参附注射液通过抑制肿瘤坏死因子的含量、降低半胱氨酸天冬氨酸蛋白酶-3的表达、上调Bcl-2基因而抑制缺血再灌注期间肠黏膜上皮细胞的凋亡,从而减轻肠黏膜缺血再灌注损伤.     

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.     

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.     

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.     

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.