白介素-10对内毒素诱导肺泡巨噬细胞核因子-κB活化及肿瘤坏死因子释放的调节

目的 探讨白介素-10对内毒素(LPS)诱导肺泡巨噬细胞核因子-κB(NF-κB)活化及肿瘤坏死因子α(TNF-α)基因表达的调节,为临床运用白介素-10提供理论依据。方法 用支气管肺泡灌洗法收集肺泡巨噬细胞(PAM)进行培养,分正常对照组、LPS组、IL-10＋LPS组。用凝胶电泳迁移率改变分析(EMSA)法和ELISA法分别检测核提取物中NF-κB活性和细胞培养上清中TNF-α含量。结果 LPS组NF-κB活性和TNF-α含量在刺激后0.5～4h明显高于正常对照组;IL-10＋LPS组NF-κB活性和TNF-α含量均显著低于LPS组。结论 LPS诱导PAM的NF-κB活化,导致TNF-α基因表达增强;白介素-10可抑制NF-κB活化而减少TNF-α的释放。     

一氧化氮和白介素—10抑制核因子—kB活化的实验研究

目的探讨一氧化氮(NO)和白介素-10(IL-10)对内毒素(LPS)诱导的肺泡巨噬细胞核因子-κB(NF-κB)活化的调节,为临床运用提供理论依据.方法用支气管肺泡灌洗法收集肺泡巨噬细胞(PAM)进行培养,分正常对照组、LPS组、NO+LPS组和IL-10+LPS组.用凝胶电泳迁移率改变分析(EMSA)法和ELISA法分别检测提取物中NF-κB活性和细胞培养上清中TNF-α含量.结果LPS组NF-κB活性和TNF-α含量在刺激后0.5～4h显著高于正常对照组(P＜0.01);NO+LPS组和IL-10+LPS组的NF-κB活性和TNF-α含量与LPS组相比均明显下降,尤在刺激后1h最显著(P＜0.01).结论LPS诱导PAM的NF-κB活化,导致TNF-α基因表达增强;NO和IL-10可抑制NF-κB活化,减少TNF-α的释放,缓解LPS诱导的ALI.     

一氧化氮和白介素-10抑制核因子-κB活化的实验研究

目的探讨一氧化氮(NO)和白介素-10(IL-10)对内毒素(LPS)诱导的肺泡巨噬细胞核因子-κB(NF-κB)活化的调节,为临床运用提供理论依据.方法用支气管肺泡灌洗法收集肺泡巨噬细胞(PAM)进行培养,分正常对照组、LPS组、NO+LPS组和IL-10+LPS组.用凝胶电泳迁移率改变分析(EMSA)法和ELISA法分别检测提取物中NF-κB活性和细胞培养上清中TNF-α含量.结果 LPS组NF-κB活性和TNF-α含量在刺激后0.5～4 h显著高于正常对照组(P＜0.01);NO+LPS组和IL-10+LPS组的NF-κB活性和TNF-α含量与LPS组相比均明显下降,尤在刺激后1 h最显著(P＜0.01).结论 LPS诱导PAM的NF-κB活化,导致TNF-α基因表达增强;NO和IL-10可抑制NF-κB活化,减少TNF-α的释放,缓解LPS诱导的ALI.     

白介素10和一氧化氮对内毒素诱导肺泡巨噬细胞核因子κB活化及肿瘤坏死因子释放的调节

目的：探讨白介素-10和外源性一氧化氮(NO)对内毒素（LPS）诱导肺泡巨噬细胞(PAM)核因子-κB(NF-κB)活化及肿瘤坏死因子-α（TNF-α）基因表达的调节,为临床运用提供理论依据。方法：用支气管肺泡灌洗法收集PAM进行培养,分为正常对照组、LPS组、IL-10+LPS组和NO+LPS组。用凝胶电泳迁移率改变分析（EMSA）法和酶联免疫吸附(ELISA)法分别检测核提取物中NF-κB活性和细胞培养上清中TNF-α含量。结果：LPS组NFκB活性和TNF-α含量在刺激后3小时显著高于正常对照组;IL-10+LPS组和NO+LPS组NF-κB活性和TNF-α含量均显著低于LPS组。结论：LPS诱导PAM的NF-κB活化,导致TNFα基因表达增强;白介素-10和外源性NO可抑制NF-κB活化而减少TNF-α的释放。     

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。     

川芎嗪对肺损伤肺泡巨噬细胞中NF-κB活化的影响

目的探讨川芎嗪(Lig)在失血性休克合并内毒素诱发急性肺损伤时对肺泡巨噬细胞(PAM)核因子(NF)-κB活化的调节干预作用。方法采用家兔失血性休克合并内毒素诱发肺损伤时模型,30只家兔随机分为:模型组、川芎嗪干预组和对照组。测动脉血气、肺湿/干质量比(W/D),提取PAM中核蛋白并用凝胶电泳迁移率(EMSA)法测NF-κB活性,原位杂交法(ISH)结合原位定量检测PAM中IKK-β的mRNA表达,并用酶联免疫吸附试验(ELSA)测PAM培养上清液中TNF-α含量。结果干预组W/D、PaCO2低于模型组,而PaO2高于模型组;模型组和干预组的IKK-βmRNA的表达、NF-κB活性、TNF-α含量均高于对照组(Ρ<0·01),干预组与模型组比较有差异(Ρ<0·05)。讨论川芎嗪可减轻失血性休克并内毒素诱发的急性肺损伤,可能与川芎嗪干预抑制肺泡巨噬细胞NF-κB的活化有关。     

红景天苷对脂多糖诱导的急性肺损伤的保护机制研究

目的:研究红景天苷(SDS)在脂多糖(LPS)诱导的急性肺损伤(ALI)中的抗炎作用及调节机制。方法:运用Western blot及Real-time PCR检测SDS对LPS诱导的大鼠肺组织及人肺泡上皮细胞(HPAEpiC)促炎因子IL-1、IL-6、TNF-α及TGF-β1表达的影响;Western blot、Real-time PCR、免疫组织化学筛选SDS可能参与的细胞信号通路;MTT检测SDS对HPAEpiC存活率的影响;利用RNA干扰阻断NF-κB通路后,采用Western blot及Real-time PCR检测SDS对促炎因子IL-1、IL-6、TNF-α及TGF-β1表达的影响。结果:SDS可有效抑制LPS诱导的大鼠肺组织及HPAEpiC促炎因子IL-1、IL-6、TNF-α及TGF-β1的表达;SDS降低细胞通路相关因子NF-κB和p38的表达;SDS可增强HPAEpiC存活率;阻断NF-κB通路后,SDS抑制IL-1、IL-6、TNF-α及TGF-β1的表达效果减弱。结论:SDS可以抑制LPS诱导的炎症反应,减轻ALI的症状。     

NG-硝基-L-精氨酸对脂多糖诱导大鼠肺损伤炎症反应和核因子-κB信号通路的影响

目的 观察非选择性一氧化氮合酶(NOS)抑制剂NG-硝基-L-精氨酸(NG-nitro-L-arginine, L-NA)对脂多糖诱导大鼠肺损伤炎症反应和核因子-κB(NF-κB)信号通路的影响.探讨L-NA对肺组织损伤的保护作用及其机制.方法 健康雄性SD大鼠随机分为正常对照组、模型组(LPS组)和L-NA治疗组(L-NA组).模型组和L-NA组静脉注射脂多糖(LPS)5 mg/kg复制内毒素性肺损伤模型,3 h和6 h后腹腔注射L-NA(L-NA组)和生理盐水(对照组及LPS组),治疗3 h.免疫组化染色分析肺组织中核因子-κB(NF-κB)的核移位和肺组织细胞间黏附分子-1(ICAM-1)表达;放射免疫法分别测定肺组织中肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)的含量;光镜、电镜观察肺组织病理变化.结果 与对照组比较,大鼠肺损伤后NF-κB活化,明显从细胞浆移位于细胞核,表达量也显著增加;ICAM-1蛋白表达上调;肺组织中TNF-α、IL-6含量明显升高.肺损伤3 h用L-NA治疗3 h后, NF-κB从细胞浆向细胞核的移位被明显限制,NF-κB的表达量、肺组织中ICAM-1的表达明显低于相应的LPS组,肺组织病理改变减轻;但TNF-α、IL-6含量没有明显的变化,肺损伤6 h用L-NA治疗3 h对LPS引起的ICAM-1的表达和TNF-α、IL-6含量变化没有明显影响.结论 肺损伤3 h后给予L-NA可减轻内毒素性肺损伤、抑制核因子的活化,在一定程度上阻断NF-κB相关信号通路的传导是其机制之一.     

阻断toll样受体对脂多糖致急性肺损伤的保护作用

目的：本文旨在探讨阻断toll样受体（TRL4）对脂多糖（LPS）致急性肺损伤（ALI）的保护作用。方法将60只健康雄性清洁级SD大鼠分为正常组、损伤组和阻断组,每组20只。损伤组大鼠采用尾静脉注射LPS（6mg/kg）复制ALI模型;阻断组同时注射TLR4抗体（10mg/mL）;正常组给予等容积生理盐水。3h后处死大鼠,采用凝胶滞留法检测核因子-κB（NF-κB）活性;Westernblot印记分析法检测抑制蛋白（IκB-α）水平;检测肺组织匀浆肿瘤坏死因子α细胞因子（TNF-α）、白细胞介素-1β（IL-1β）和白细胞介素-10（IL-10）水平。结果与正常组相比,损伤组和阻断组肺组织湿质量/干质量比值增高,NF-κB活性升高,IκB-α、TNF-α、IL-1β水平升高（P＜0．05）,而IL-10水平降低（P＜0．05）。而比较损伤组与阻断组发现,阻断组肺组织湿质量/干质量比值降低,NF-κB活性降低,IκB-α、TNF-α、IL-1β水平明显低于损伤组（P＜0．05）,IL-10水平高于损伤组（P＜0．05）。结论采用抗TLR4单克隆抗体阻断TLR4介导的信号传导可明显降低NF-κB活性和IκB-α、TNF-α、IL-1β水平,同时提高IL-10水平阻断TLR4,对LPS致ALI有一定的保护作用。     

烧伤后磷酸化酪氨酸和核因子-κB表达及细胞因子分泌改变的研究

目的探讨烧伤后早期腹腔巨噬细胞表达磷酸化酪氨酸(Tyr-P)、核因子-Kappa B(NF-κB)mRNA及分泌细胞因子的动态变化。方法采用小鼠20%体表面积的Ⅲ度烫伤模型,分离和培养小鼠腹腔巨噬细胞。用免疫组织化学方法观察烫伤后24小时内不同时间Tyr-P的变化;用逆转录聚合酶链反应(RT-PCR)方法观察NF-κB mRNA表达的情况;用酶联免疫吸附(ELISA)方法测定上述细胞培养上清中肿瘤坏死因子-α(TNF-α)、白介素6(IL-6)的水平。结果烫伤后1小时腹腔巨噬细胞的Tyr-P表达就明显增高,与假烫伤组比较差异显著(P<0.01),这种改变在伤后24小时内持续存在;烫伤后1小时NF-κB mRNA表达明显增强,以伤后2小时为明显(P<0.01),伤后4、6小时表达逐步减弱,但仍较假烫伤组高(P均<0.05);烫伤小鼠腹腔巨噬细胞培养上清中TNF-α和IL-6水平明显增高,烫伤后其含量在不同时期有所不同,与假烫伤组比较差异显著(P均<0.01)。烫伤小鼠腹腔巨噬细胞Tyr-P、NF-κB mRNA与TNF-α、IL-6呈正相关。结论烫伤可使巨噬细胞中Tyr-P、NF-κB mRNA表达增强,分泌TNF-α、IL-6增多,在介导内毒素所致多脏器损害中可能起一定作用。     

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.