烟雾吸入性损伤大鼠肺泡巨噬细胞吞噬功能与炎症消散关系研究

目的：探讨烟雾吸入性损伤大鼠肺泡巨噬细胞吞噬功能与炎症消散关系。方法：建立大鼠烟雾吸入损伤模型后于伤后2、6、12、24h及2、3、4、5d各时相点动态观察（1）肺泡巨噬细胞体外对鸡红细胞吞噬功能；（2）肺泡巨噬细胞体内对凋亡中性粒细胞吞噬功能。结果：（1）致伤后2－6h肺泡巨噬细胞对鸡红细胞吞噬率、吞噬指数下降，12h后逐渐恢复正常，2－5d仍保持较高的吞噬功能。（2）肺泡巨噬细胞对凋亡中性粒细胞吞噬在伤后2h即开始逐渐升高，24h达峰值，然后逐渐下降。结论：（1）烟雾吸入伤早期（2－6h）肺泡巨噬细胞吞噬功能受损害，然后逐渐恢复正常，并保持较高吞噬活性，它有利于清除异物、细菌等。（2）肺内中性粒细胞发生凋亡，然后被巨噬细胞吞噬参与了恢复期肺内炎症消散的过程。     

烟雾吸入性损伤大鼠肺泡巨噬细胞吞噬功能与炎症消散关系研究

目的 :探讨烟雾吸入性损伤大鼠肺泡巨噬细胞吞噬功能与炎症消散关系。方法 :建立大鼠烟雾吸入损伤模型后于伤后 2、6、12、2 4h及 2、3、4、5d各时相点动态观察 (1)肺泡巨噬细胞体外对鸡红细胞吞噬功能 ;(2 )肺泡巨噬细胞体内对凋亡中性粒细胞吞噬功能。结果 :(1)致伤后 2～ 6h肺泡巨噬细胞对鸡红细胞吞噬率、吞噬指数下降 ,12h后逐渐恢复正常 ,2～ 5d仍保持较高的吞噬功能。 (2 )肺泡巨噬细胞对凋亡中性粒细胞吞噬在伤后 2h即开始逐渐升高 ,2 4h达峰值 ,然后逐渐下降。结论 :(1)烟雾吸入伤早期 (2～ 6h)肺泡巨噬细胞吞噬功能受损害 ,然后逐渐恢复正常 ,并保持较高吞噬活性 ,它有利于清除异物、细菌等。 (2 )肺内中性粒细胞发生凋亡 ,然后被巨噬细胞吞噬参与了恢复期肺内炎症消散的过程     

白细胞介素8与慢性阻塞性肺疾病的研究进展

白细胞介素8（IL-8）是强有力的中性粒细胞、T淋巴细胞及嗜碱性粒细胞趋化因子,并可激活嗜中性粒细胞,是一种重要的炎症介质。IL-8主要来源于单核巨噬细胞,对中性粒细胞有较强的趋化和激活作用,参与局部炎症的形成,是一种新发现的炎症细胞因子。慢性阻塞性肺疾病（COPD）是一种以气流受限为特征的疾病状态,气流受限通常呈进行性发展,不完全可逆,多与肺部对有害气体和异常炎症反应有关。这种气道炎症性疾病,系中性粒细胞与气管壁相互作用结果,炎症过程受细胞因子的调节,而IL-8在慢性气道炎症过程中起着重要的作用。     

炎症致组织损伤中PMN的作用及治疗体会

多形核中性粒细胞(PMN)在宿主防御及炎症反应中有重要作用。通常进入组织的PMN吞噬杀菌后发生凋亡以非炎症方式清除,一般不致组织损伤,炎性反应过于剧烈则造成组织     

在炎症过程中活化补体成分的主要作用有哪些？

答：在炎症过程中活化补体成分主要有五个方面的作用：（1）有舒张小血管、增高血管通透性和使非血管平滑肌收缩等激肽样作用；（2）免疫粘连，从而激活吞噬细胞。加强炎症过程的吞噬作用；（3）刺激肥大细胞和嗜碱性粒细胞释放组胺，以及吸引中性粒细胞和单核细胞的作用；（4）吸引中性粒细胞、单核细胞和巨噬细胞，使其游走并集中到炎症灶；     

白介素-17与慢性阻塞性肺疾病

慢性阻塞性肺病(COPD)患者在肺的不同部位有肺泡巨噬细胞、T淋巴细胞和中性粒细胞增加,并激活炎症细胞释放多种介质,包括IL-1β、IL-6、IL-8、GM-CSF、PGE2、TNFα等,这些介质能破坏肺的结构和促进中性粒细胞炎症反应.近来研究注意到,IL-17是一种能由活化的CD 4和CD 8+记忆T细胞分泌的细胞因子,能刺激支气管上皮细胞、基质细胞、成纤维细胞和巨噬细胞产生IL-8、GM-CSF、PGE2、TNFα等多种介质在气道中性粒细胞炎症募集及活化过程中发挥重要作用,并通过增加肺组织弹性蛋白酶和髓过氧化物酶活性,刺激气道黏液过度分泌,加重气道内炎症进程.IL-17在COPD的发生发展过程中起着重要作用.     

慢性阻塞性肺疾病并发呼吸衰竭患者外周血白三烯B4的表达研究

白三烯B4（LTB4）是强有力的细胞趋化剂,能吸引中性粒细胞、巨噬细胞、血小板、嗜酸粒细胞和淋巴细胞,使其在炎症区域募集和激活,参与炎症过程。     

利多卡因对中性粒细胞介导性脏器损伤的保护作用

越来越多的临床和基础研究表明，中性粒细胞（PMN）在严重烧创伤、急性重症胰腺炎、休克后多脏器功能障碍的病理生理过程中起着重要的作用。PMN的功能相当复杂，在接受机体发生组织损伤或感染的信息后，PMN游出血管，向炎症部位趋化游走，最先到达炎症部位发挥其吞噬和杀菌功能。应当讲，PMN是一把双刃剑，正常时杀灭病原体、清除坏死组织、促进伤口愈合，对机体起保护作用；而某些病理改变如严重烧伤、创伤、急性重症胰腺炎、休克等可引起大量PMN向炎症部位趋化并被活化，释放大量活性氧、水解酶及多种促炎介质和细胞因子，从而引起局部或对远隔脏器的损害。     

糖皮质激素治疗慢性阻塞性肺疾病的新进展

慢性阻塞性肺疾病（COPD）是具有气流受限为特征的慢性呼吸系统疾病,病理特征与气道慢性炎症反应有关。其炎症以中性粒细胞、肺巨噬细胞、淋巴细胞浸润为主。糖皮质激素（GC）具有广泛的抗炎效果,可抑制炎性细胞的激活及炎症因子的表达等,因此可以用来治疗COPD。但GC治疗有相应的不良反应,笔者就针对GC治疗COPD的功与过作一综述。     

中性粒细胞与脓毒症

中性粒细胞作为机体抗击病原微生物最重要的固有免疫细胞，从其粘附、渗出、活化到凋亡均对脓毒症发挥着重要作用。在脓毒症患者体内，中性粒细胞第一时间到达炎症部位，发挥吞噬病原微生物的作用，同时释放出一些生物活性物质（蛋白水解酶、花生四烯酸代谢产物、活性氧族和细胞因子等）以增强机体清除病原微生物的能力。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.