纳洛酮与甲基泼尼松龙联用对急性肺损伤大鼠肺组织核转录因子-κB表达的影响

目的探讨联合应用甲基泼尼松龙和纳洛酮对内毒素(LPS)所致急性肺损伤(ALI)大鼠肺组织核转录因子κB(NFκB)表达的作用。方法建立大鼠LPS吸入性ALI模型(LPS3mg/kg气管内注射)。85只大鼠随机分为5组:生理盐水对照组,LPS损伤组,甲基泼尼松龙组(LPS+甲基泼尼松龙),纳洛酮组(LPS+纳洛酮),联合用药组(LPS+甲基泼尼松龙+纳洛酮)。采用放射免疫法检测大鼠血清白细胞介素8(IL8)水平,并应用免疫组化法观察肺组织NF-κBp65蛋白表达的变化。结果经气道吸入LPS可致大鼠发生ALI。ALI大鼠肺组织NFκBp65蛋白表达明显升高(P<0.05或P<0.01),IL-8水平亦明显增高(P<0.05或P<0.01),单用甲基泼尼松龙或纳洛酮组肺组织NF-κBp65蛋白表达率及IL-8水平均较LPS损伤组明显降低,以联合用药组更为明显(P<0.05或P<0.01)。结论联合应用甲基泼尼松龙和纳洛酮可降低LPS吸入性ALI大鼠血清IL-8升高,并显著抑制肺组织NF-κBp65蛋白表达。     

丹参与甲基泼尼松龙联用对急性肺损伤大鼠肺组织水通道蛋白-1表达的影响

目的:观察联合应用丹参和甲基泼尼松龙对急性肺损伤(AII)大鼠肺组织水通道蛋白-l(AQP-1)表达的影响及其机制.方法:使用内毒素(LPS)3 mg/kg气管内滴入建立大鼠LPS吸入性ALI模型.50只大鼠随机分为:生理盐水对照组、LPS损伤组、甲基泼尼松龙组(LPS+甲基泼尼松龙)、丹参组(LPS+丹参)、联合用药组(LPS+甲基泼尼松龙+丹参).观察支气管肺泡灌洗液(BALF)中蛋白含量、肺组织湿/干重(W/D)比、肺脏病理改变,免疫组化法测定AQP-1表达.结果:经气管滴入LPS可致大鼠发生ALI.与LPS损伤组相比,单用甲基泼尼松龙或丹参组BALF中蛋白含量、肺组织W/D比值均明显降低(P＜0.01),肺组织AQP-1表达则明显升高(P＜0.01),以联合用药组更为明显(P＜0.01).结论:联合应用甲基泼尼松龙和丹参对ALI大鼠具有良好的治疗作用,其机制可能与促进肺组织AQP-1高表达有关.     

大鼠重症急性胰腺炎时急性肺损伤的实验研究

目的　研究内毒素 (endotoxin ,ET)、细胞因子 (cytokine,CK)、氧自由基 (oxygenfreeradi cals ,OFR)等在重症急性胰腺炎 (severeacutepancreatitis,SAP)时急性肺损伤 (acutelunginjury ,ALI)发病机制中的作用。方法　采用胰管逆行注射 1 5 %去氧胆酸钠制成大鼠重症急性胰腺炎时ALI模型。选用纯雄性健康Wistar大鼠共 4 0只 ,体重 2 2 0～ 2 5 0g,随机分成两组 :假手术对照组 (Sham ,n =10 ) ;SAP模型组(SAP ,n =30 ) ,分别于造模后 2 4h活杀。测定动脉血气 ,血清淀粉酶的含量 ,血清内毒素及血清和肺组织匀浆中的TNF α、IL 6、MDA、SOD的含量 ,肺湿 /干系数以及肺组织病理学改变。结果　SAP组血清内毒素 ,血淀粉酶 ,血清及肺组织匀浆中TNF α、IL 6、OFR均较Sham组明显升高 (P <0 0 1) ;动脉血气显示肺损伤严重 ,肺湿 /干比值较Sham组明显升高 ,肺通透性明显升高 ,肺病理学形态改变加重。结论　ET、TNF、IL 6、OFR在SAP时ALI发生发展中起了重要作用     

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。     

白细胞介素-10对内毒素诱导急性肺损伤大鼠炎症因子的影响

目的研究白细胞介素-10(IL-10)对内毒素诱导急性肺损伤(ALI)大鼠肺组织炎症因子mRNA表达的影响,探讨IL-10对急性肺损伤的保护作用。方法24只SD大鼠随机分为3组:对照组,实验组,治疗组。实验组于尾静脉注射内毒素,治疗组注射内毒素和IL10,对照组注射生理盐水。测定各组肺组织肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)和白介素-6(IL-6)mRNA表达和血浆TNF-α、IL-1β和IL-6水平,观察各组大鼠肺组织的病理改变。结果TNF-α、IL-1β和IL6mRNA的表达:实验组、治疗组高于对照组,P<0.01;实验组高于治疗组,P<0.05。血浆TNF-α、IL1-β、IL-6:实验组高于治疗组对照组,P<0.05。肺组织病理改变:治疗组明显轻于实验组。结论IL10能抑制内毒素诱导ALI大鼠肺组织中TNF-α、IL-1β和IL6mRNA的表达,降低血浆炎症因子水平,减轻肺组织的病理损害,能起到治疗ALI的作用。     

槲皮素对内毒素急性肺损伤的保护作用

目的　探讨槲皮素 (quercetin)对内毒素急性肺损伤 (ALI)的保护作用。方法　 2 4只SD大鼠 ,随机分成ALI模型组、槲皮素干预组、正常对照组 (n =8只 )。各组大鼠均于注射LPS或生理盐水 6h后测定PaO2 、pH值、PaCO2 ,血清TNF α、IL 8、P 选择素浓度和肺组织匀浆髓过氧化物酶 (MPO)含量及TNF α、IL 8、P 选择素浓度 ;观察肺病理改变、肺湿 /干重比 (W /D)。结果　与ALI模型组比较 ,槲皮素干预组的肺水肿病理改变明显减轻 ,PaO2 改善 ,MPO、P 选择素及TNF α、IL 8降低 (P <0 0 1)。结论　槲皮素能改善ALI大鼠的气体交换功能 ,抑制炎性介质的释放 ,对内毒素诱导的ALI有保护作用     

亚低温对急性肺损伤大鼠高迁移率族蛋白1表达的影响

目的 观察亚低温对急性肺损伤(ALI)大鼠肺组织高迁移率族蛋白1(HMGB1)及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)表达的影响.方法 将24只雄性SD大鼠采用随机数字表法分为生理盐水组、ALI组和亚低温治疗组,每组8只.ALI组、亚低温治疗组分别给予内毒素(LPS)5 mg/kg尾静脉注射;亚低温治疗组同时采用体表降温法使大鼠肛温维持在(33.0±1.0)℃,持续4 h.观察12 h后各组大鼠肺组织病理,测定肺湿干质量比(W/D)、PaO2,并采用逆转录-PCR反应检测肺组织HMGB1 mRNA的表达,ELISA法测定血清TNF-α、IL-10浓度.结果 ①ALI组TNF-α浓度显著高于生理盐水组和亚低温治疗组(P<0.01);ALI组IL-10浓度显著高于生理盐水组(P<0.01),但低于亚低温治疗组(P<0.05).②ALI组HMGB1 mRNA的表达水平显著高于生理盐水组和亚低温治疗组(P<0.01).③ALI组肺组织出现充血、水肿、中性粒细胞浸润,亚低温治疗组肺部炎症较ALI组减轻.结论 亚低温可能通过抑制HMGB1 mRNA、TNF-α的表达,并上调抗炎介质IL-10的表达,从而减轻内毒素性大鼠肺损伤.     

创伤性休克致急性肺损伤大鼠肺泡巨噬细胞TNF-α IL-18mRNA表达的变化及地塞米松的影响

目的　探讨创伤性休克致急性肺损伤大鼠肺泡巨噬细胞TNF -α、IL - 18mRNA表达水平的变化及地塞米松对其的影响。方法　将大鼠随机分为正常对照组、创伤性休克生理盐水处理组、创伤性休克地塞米松治疗组 3组 ,在创伤性休克打击前予地塞米松 (10mg/kg)对治疗组预处理 ,测定正常对照组、创伤性休克生理盐水处理组及地塞米松治疗组 1、2、4、6、8h各时点肺泡巨噬细胞TNF -α、IL - 18mRNA表达水平。结果　大鼠遭受创伤性休克打击后 ,肺泡巨噬细胞TNF -αmRNA表达明显增加 ,2h即达高峰 (P <0 0 1) ,然后逐步下降 ,但 8h仍高于正常水平 (P <0 0 5 ) ;IL - 18mRNA表达亦显著增加 ,4h达高峰 (P <0 0 1) ,然后逐步下降 ,8h恢复至正常水平 ;地塞米松能显著降低肺泡巨噬细胞TNF -α、IL - 18mRNA的峰值浓度及各时点值 ,并能一定程度改善PaO2 及肺组织损伤。结论　创伤性休克早期大鼠肺泡巨噬细胞TNF -α、IL - 18mRNA表达均增加 ,地塞米松能抑制TNF -α、IL - 18mRNA的表达 ,在ALI早期应用能减轻病变。     

参附注射液对大鼠内毒素性急性肺损伤的保护作用

目的:观察参附注射液(SF)对大鼠内毒素性急性肺损伤(ALI)时肺组织湿/干重比(W/D)等的影响,探讨其对ALI是否具有保护作用.方法:采用大鼠气管内滴注内毒素诱导ALI模型,30只大鼠随机分为NS组、LPS组、SF组,每组10只.观察每组肺组织W/D、肺泡灌洗液中性粒细胞比、蛋白含量、血清NO、肺组织丙二醛(MDA)含量及比较动脉血气分析的结果.同时观察肺组织病理形态学改变.结果:与NS组比较,LPS组、SF组的肺组织W/D、肺泡灌洗液中性粒细胞比、蛋白含量、肺组织MDA和血清NO显著增加,而PaO2和HCO3-明显降低(P<0.01);与LPS组比较,SF组以上指标显著降低而PaO2和HCO3-明显升高(P<0.05或P<0.01).病理学检查显示SF组肺组织损伤程度较LPS组明显减轻.结论:SF对内毒素性ALI具有防治作用.     

丹参多酚酸盐对急性肺损伤防治作用的实验研究

目的:探讨丹参多酚酸盐对急性肺损伤/急性呼吸窘迫综合征(ALL/ARDS)的防治作用.方法:大耳白兔24只,随机分为正常对照组、内毒素组、丹参多酚酸盐干预组,每组8只.内毒素组于0及12 h由气管内滴入内毒素(1 mL/kg),复制ALI/ARDS动物模型;正常对照组气管内滴入等量生理盐水;丹参多酚酸盐干预组第一次滴入内毒素后6、12、18 h静推丹参多酚酸盐(50mg/kg).其后分别测定各组TNF-α、IL-1、动脉血氧分压、外周血白细胞计数、肺系数(肺湿重/体重)、肺湿/干比,并取肺活组织行HE染色.结果:丹参多酚酸盐干预组氧分压、肺系数和肺湿/干比、外周血白细胞、TNF-α、IL-1与对照组及内毒素组比较差异均有显著性(P<0.05).病理学显示,丹参多酚酸盐干预组肺损伤程度减轻.结论:丹参多酚酸盐对ALI/ARDS有防治作用.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."