脊髓背角P2Y_(12)受体/P38MAPK参与MRS2395对CCI大鼠的镇痛作用

目的:观察鞘内注射P2Y12受体拮抗剂MRS2395对慢性坐骨神经结扎(chronic constriction injury,CCI)大鼠机械痛阈及脊髓背角P2Y12受体、P2X4受体和P38MAPK表达变化的影响,探讨P2Y12受体参与神经病理性疼痛的相关机制。方法:成年SD大鼠随机分为3组(n=8):假手术组、CCI模型vehicle组(鞘内注射0.005%DMSO生理盐水)、MRS2395处理组(CCI+鞘内注射MRS2395 100 pmol/L)。CCI及MRS2395处理组大鼠均于鞘内置管7天之后行坐骨神经结扎,连续14天鞘内注射0.005%DMSO生理盐水、MRS2395(100 pmol/L),每天2次,在术前1天、术后第1、3、5、7、10、14天测定给药1 h后机械缩足反射阈值(mechanical withdraw threshold,MWT);在第7、14天处死大鼠,取脊髓背角,免疫印迹观察P2Y12受体、P2X4受体和P38 MAPK表达变化。结果:大鼠CCI术后1天即可出现机械痛敏;与假手术组相比,CCI组第1、3、5、7、10、14天MWT明显降低(P<0.01);与CCI组相比,MRS2395处理组术后第1,3,5,7天MWT明显升高(P<0.01);术后10天和14天MWT升高较缓(P<0.05)。与假手术组相比,CCI组第7、14天背角P2X4受体、P2Y12受体和P38 MAPK表达明显上调(P<0.05);与CCI组相比,MRS2395处理组第7、14天P2Y12受体和P38MAPK表达上调均明显减弱(P<0.05);MRS2395处理组不影响CCI组第7天P2X4受体表达,但可以明显抑制CCI组第14天P2X4受体表达上调(P<0.05)。各组大鼠脊髓背角P2Y12受体和P2X4受体表达之间存在正相关。结论:鞘内注射P2Y12拮抗剂MRS2211可以明显抑制CCI大鼠机械痛敏症状;而且脊髓背角P2X4受体和P38 MAPK表达下调。这提示P2Y12受体拮抗剂可能通过影响脊髓背角小胶质细胞P2X4受体和P38 MAPK表达,在脊髓水平发挥镇痛作用。     

N-甲基D-天门冬氨酸受体2B亚型反义寡核苷酸鞘内注射对骨癌痛模型大鼠痛行为的改善作用

目的:在大鼠骨癌痛模型上观察鞘内注射N-甲基-D-天冬氨酸受体2B亚基(NR2B)反义寡核苷酸的镇痛效果.方法:将含2 × 105个SHZ-88大鼠乳腺癌细胞注射到SD大鼠左侧股骨远端骨髓腔,制作骨癌痛模型(T组).同时设假手术组(S组,n=8).所有大鼠均于接种前1 d,接种后第3、5、7、10、14天检测痛行为学指标.骨癌痛模型制作成功的T组大鼠在接种后第14天,进一步分为鞘内注射反义寡核苷酸(TA组)、正义寡核苷酸(TS组)、生理盐水(TN组),分别鞘内注射相应剂寡核苷酸和溶媒,鞘内注射后第1、3、5天再进行行为学检测.并在最后一次行为学测定后将大鼠处死,取其L4～6脊髓组织,检测术侧的NR2BmRNA.结果:与S组和术前基础值相比.造模后第7天,T组大鼠自由行走痛行为评分显著增高(P＜0.05),机械痛缩足阈值(PWT)显著降低(P＜0.05);在鞘内给药后第3、5天,TA组大鼠自由行走痛行为评分显著降低(P＜0.05),PWT增高(P＜0.05);而TS组和TN组在鞘内注射前后无显著变化(P＞0.05);TA、TS组及TN组L4～6脊髓组织的NR2B mRNA表达均高于S组(P＜0.05,P＜0.01);鞘内注射后5 d,TA组L4～6脊髓组织的NR2B mRNA表达低于TS组和TN组降低(P＜0.01).结论:鞘内注射NR2B反义寡核苷酸能下调脊髓NR2B mRNA表达.有效改善骨癌痛大鼠的痛行为学反应.     

靶向抑制脊髓5-羟色胺能通路对大鼠骨癌痛的影响

目的:探讨靶向抑制脊髓5-羟色胺能通路对大鼠骨癌痛的影响。方法:雌性SD大鼠70只,体重160~180 g,随机分组。骨癌痛组大鼠于胫骨骨髓腔注射Walker 256大鼠乳腺癌细胞悬液10μl制备癌痛模型。假手术组于骨髓腔注射D-hank's液10μl。大鼠造模后第10天行鞘内置管,第14天鞘内注射生理盐水或5-羟色胺选择性神经毒素5,7-DHT。鞘内给药前1天和给药后5天每天测定机械痛阈。鞘内给药后第3天取脊髓背角组织采用高效液相色谱法检测5-羟色胺含量。大鼠测痛结束后行胫骨X线摄片,观察肿瘤导致的骨破坏程度。结果:X线片显示骨癌痛大鼠术侧胫骨可见肿瘤生长导致的骨皮质大片缺损。与鞘内给予生理盐水的骨癌痛组大鼠相比,骨癌痛组大鼠鞘内给予5,7-DHT后机械性痛觉超敏显著缓解(P<0.05),缩爪持续时间明显缩短(P<0.05)。与鞘内给予等体积生理盐水的大鼠相比,鞘内给予60μg的5,7-DHT可以显著的降低脊髓背角中5-羟色胺含量。结论:本实验证实了鞘内注射5,7-DHT选择性消除脊髓5-羟色胺可显著缓解骨癌痛大鼠的疼痛,说明脊髓背角中5-羟色胺含量的增加参与了大鼠骨癌痛的维持。     

KCNQ/M(Kv7)钾通道参与骨癌痛大鼠中枢敏化的电生理学研究

目的:研究骨癌痛大鼠脊髓背角广动力范围(wide dynamic range,WDR)神经元兴奋性的改变,探讨KCNQ/M(Kv7)钾通道在骨癌痛中枢敏化中的作用。方法:在雌性SD大鼠,采用胫骨骨髓腔内注射MRMT-1乳腺癌细胞(4×104,4μl)的方法建立骨癌痛大鼠模型,术后14天用von Frey纤维丝测定大鼠同侧后爪的50%缩足阈值(paw withdrawal threshold,PWT)以检测造模是否成功。对照组注射等体积的磷酸盐缓冲液(PBS组)。造模后14天,通过在体细胞外记录的电生理学方法,观察造模前后脊髓背角WDR神经元的放电变化以及脊髓背表面给予KCNQ钾通道的激动剂瑞替加滨(retigabine,RTG)5 mM对骨癌痛大鼠脊髓背角WDR神经元C-纤维诱发放电的影响。结果:建立模型后14天,(1)与PBS组相比,模型组WDR神经元的C-纤维诱发放电明显增多(P<0.001,n=11);(2)与DMSO组相比,脊髓背表面给予瑞替加滨可以显著抑制骨癌痛大鼠WDR神经元的C-纤维诱发放电(P<0.001,n=14)。结论:骨癌大鼠脊髓背角WDR神经元的兴奋性显著升高(即发生了中枢敏化);KCNQ/M(Kv7)钾通道的功能性下调可能与骨癌大鼠的中枢敏化和骨癌痛的发生有关。     

丙戊茶碱对趾部切口痛大鼠脊髓ERK1/2磷酸化的影响

目的:研究丙戊茶碱对趾部切口痛模型大鼠脊髓细胞外信号调节激酶1/2 (extracellular signalregulated kinase 1/2, ERK1/2)磷酸化的影响,探讨丙戊茶碱缓解术后急性痛觉过敏的分子机制。方法:雄性SD大鼠100只,随机分为4组(n=25):空白对照组(C组);切口痛模型组(IP组);生理盐水组(NS组);丙戊茶碱组(PPF组)。IP组、NS组和PPF组均制备趾部切口痛(incisional pain, IP)模型。NS组和PPF组分别于术前30 min鞘内注射生理盐水(10μl)和丙戊茶碱(10μg/10μl)。各组分别在术前、术后2、4、8、24、72 h测定机械缩足阈值(mechanical withdrawal threshold, MWT)和热缩足潜伏期(thermal withdrawal latency, TWL)。各组于术前、术后2、4、24、72 h行为学测定后随机留取大鼠L4-6节段脊髓,应用蛋白印迹法检测磷酸化ERK1/2 (phospho-ERK1/2, p-ERK1/2)表达水平。各组于术后p-ERK1/2表达量最高时,取大鼠脊髓应用免疫荧光法检测丙戊茶碱对ERK1/2磷酸化的影响,同时检测p-ERK1/2与脊髓神经元、星型胶质细胞和小胶质细胞标记物的共表达情况。结果:各组术前MWT、TWL及p-ERK1/2表达量差异无统计学意义。与C组比较,IP组术后各时间点MWT和TWL均明显降低(P <0.001),p-ERK1/2表达量在术后2 h (P <0.01)、4 h (P <0.001)、24 h (P <0.005)增加,术后72 h (P <0.01)减少;与IP组比较,NS组术后各时间点MWT、TWL及p-ERK1/2表达量差异无统计学意义;与IP组比较,PPF组术后各时间点MWT和TWL升高(P <0.01),术后2、4、24 h的p-ERK1/2表达量减少(P <0.01),术后72 h表达量差异无统计学意义;与NS组比较,PPF组术后各时间点MWT和TWL均升高(P <0.001),术后2、4、24 h的p-ERK1/2表达量减少(P <0.01),术后72 h表达量差异无统计学意义。免疫荧光结果显示,术后4 h的IP组大鼠脊髓p-ERK1/2在背角浅层的神经元、星型胶质细胞和小胶质细胞内均有表达。结论:丙戊茶碱缓解趾部切口痛模型大鼠术后急性痛觉过敏的作用可能与抑制脊髓背角ERK1/2磷酸化有关。     

骨癌痛大鼠脊髓背角pCREB表达的变化

目的:观察脊髓背角磷酸化环磷酸腺苷反应元件结合蛋白(pcREB,phosphorylated cAMP re-sponse element binding protein)在骨癌痛大鼠中的表达变化,探讨其在骨癌痛中枢敏化中的作用.方法:雌性SD大鼠32只,随机分为4组(n=8),分别为对照组,骨癌痛6d、12d、18d组.对照组和骨癌痛各组分别于左胫骨上端注射Hank's液和walker256肿瘤细胞5μl.分别于术前(基础值)、术后6d、12d、18d测定机械性痛阈值.对照组于术后18d,其余三组在各时点测定机械性痛阈值后立即处死大鼠,取L4～L6脊髓组织,采用免疫组化法计数pcREB免疫反应阳性细胞数量.结果:骨癌痛术后6d、12d、18d组机械性痛阈值进行性下降(P<0.01),对照组差异无统计学意义(P>0.05);与对照组比较,骨癌痛术后6d、12d、18d组脊髓pcREB免疫反应阳性细胞数逐渐增多(P<0.01).结论:骨癌痛大鼠脊髓背角pcREB表达的增加,可能是产生中枢敏化的机制之一.     

氯胺酮对神经病理性疼痛大鼠脊髓P2X_4受体mRNA表达的影响

目的:研究氯胺酮对神经病理性疼痛大鼠脊髓P2X_4受体mRNA表达的影响.方法:雄性SD大鼠45只,体重180～220g,随机分为假手术组(S组)、对照组(C组)和氯胺酮Ⅰ、Ⅱ、Ⅲ组(KⅠ、Ⅱ、Ⅲ组),每组9只.S组大鼠仅分离坐骨神经但不结扎,其余组建立坐骨神经慢性压迫性损伤(CCI)模型,K Ⅰ、Ⅱ、Ⅲ组分别于CCI后3d开始至取材点每天腹腔注射氯胺酮5mg/kg、10mg/kg、20mg/kg;S组和C组注射相同体积的生理盐水.各组大鼠分别于术前1d,术后3d、7d、14d、21d测定大鼠机械性痛觉过敏(MWT)和热痛觉过敏(TWL).各组均分别于CCI术后7d、14d、21d取3只大鼠,测定痛阈后处死,取L_(4～5)脊髓组织,用逆转录PCR(RT-PCR)方法测定P2X_4受体mRNA表达水平.结果:与术前及S组比较,C组、K Ⅰ、Ⅱ、Ⅲ组术后3d开始热痛阈及机械痛阈显著降低(P＜0.05).与C组比较,K Ⅰ、Ⅱ、Ⅲ组术后7d,14d,21d热痛阈及机械痛阈显著升高(P＜0.05).与S组比较,C组、K Ⅰ、Ⅱ、Ⅲ组大鼠脊髓P2X_4受体表达在术后7d、14d、21d均显著增加(P＜0.05);与C组大鼠比较,K Ⅰ、Ⅱ、Ⅲ组脊髓P2X_4受体表达明显减少(P＜0.05).结论:腹腔注射氯胺酮可抑制慢性神经痛大鼠痛觉过敏,该作用可能是通过作用于P2X_4受体介导的.     

骨癌痛大鼠脊髓背角趋化因子受体5的表达变化

目的:探讨骨癌痛大鼠脊髓背角趋化因子受体5(CC chemokine receptor 5,CCR5)表达的变化。方法:雌性SD大鼠32只,体重150~180 g,采用随机数字表法,将其分为2组(n=16):对照组(C组)和骨癌痛组(BCP组)。采用左胫骨骨髓腔内注入Walker 256细胞的方法制备胫骨癌痛模型。行为学(n=8):于术前1 d和术后1、3、6、9、12、15 d测定各组大鼠左后肢压爪缩爪阈值(paw withdrawal pressure threshold,PWPT);于术前1 d及术后15 d,行大鼠左胫骨X线摄片检查。Real-time PCR(n=4):术前1 d和术后15 d,测定各组大鼠左侧脊髓背角CCR5 m RNA的表达。Western blot(n=4):术前1 d和术后15 d,测定各组大鼠左侧脊髓背角CCR5蛋白的表达。结果:行为学:与C组相比,术后6~15 d BCP组PWPT明显降低;与术前1 d比较,BCP组术后6~15 d PWPT呈进行性降低。与术前1 d比较,术后15 d BCP大鼠左胫骨X线检查显示有明显的骨皮质破坏及骨小梁缺损。Real-time PCR:与术前1 d及C组比较,BCP组术后15 d左侧脊髓背角CCR5 m RNA表达明显增加。Western blot:与术前1 d及C组比较,BCP组术后15 d左侧脊髓背角CCR5蛋白的表达也显著增加。结论:骨癌痛大鼠脊髓背角CCR5 m RNA及蛋白的表达上调,该变化可能参与了骨癌痛的形成和维持。     

鞘内注射维生素B_6对大鼠慢性神经痛的镇痛作用及对DRG神经元p-ERK表达的影响

目的:观察维生素B_6(VitB_6)对神经病理性疼痛大鼠机械痛敏、热痛敏及L4～L5背根神经节(DRG)磷酸化细胞外信号调节激酶(P-ERK)表达的影响.方法:选择6只正常SD大鼠作为对照组(control),另选择鞘内置管3天后无神经损伤症状的SD雄性大鼠54只,随机分为3组(n=18):假手术组(sham):只分离坐骨神经;CCI组:结扎坐骨神经;CCI+Vit B6组:坐骨神经结扎后鞘内注射VitB_610mg/kg/d,连续两周.各组术前2天和术后1、3、5、7、10、14天测定各组大鼠热缩足反射潜伏期(TWL)、机械缩足反射阈值(MWT).除control组外其余各组分别在术后3d、7d和14d处死大鼠,采用免疫组织化学法观察L4～5 DRG和p-ERK的表达.结果:与sham组比较,CCI组术后各天TWL、MWT明显降低(P＜0.01);与CCI组比较,CCI+VitB_6组术后3、5、7、10、14天TWL明显增高(3天P＜0.05,5、7、10、14天P＜0.01),而术后各天MWT无明显差别.术后3、7、14天,CCI组结扎侧L4,5背根节p-ERK阳性细胞率明显高于sham组(P＜0.01),CCI+Vit B_6组结扎侧L4,5背根节p-ERK阳性细胞率明显低于CCI组(P＜0.01).结论:背根神经节ERK活化参与神经病理性疼痛信号传递,鞘内注射Vit B_6抑制CCI大鼠热痛敏,其机制可能包括通过上游机制抑制ERK激活.     

鞘内注射NF-κ B抑制剂对骨癌痛大鼠的抗伤害效应

目的:研究鞘内注射(it)NF-κB活化抑制剂二硫代氨基甲酸吡咯烷(pyrrolidine dithiocarbamate,PDTC)对骨癌痛大鼠机械痛敏及脊髓NF-κB表达的影响,探讨NF-κB在大鼠骨癌痛中的作用。方法:按照本实验室建立的大鼠胫骨癌痛模型建模。雌性SD大鼠96只,体重150¹80 g,按照数字表随机化的原则将大鼠分为4组(n=24):正常对照组(N组)、骨癌痛组(BP组)、生理盐水组(S组)和NF-κB抑制剂组(PDTC组)。BP组于大鼠左侧胫骨干骺端骨髓腔内注射5μl Walker256(1×105)乳腺癌细胞制备骨癌痛模型,N组仅左胫骨上端注入5μl Hank's液。于接种后9 d鞘内注射生理盐水10μl或PDTC 20μg/10μl(生理盐水溶解),2次/d,共3 d。于接种前、后2、4、6、9和12 d、鞘内给药后1、3、6、12、24 h采用von Frey丝测定大鼠术侧后爪机械缩足反射阈值(paw withdrawal threshold,PWT),PWT测定结束后处死大鼠,取L4180 g,按照数字表随机化的原则将大鼠分为4组(n=24):正常对照组(N组)、骨癌痛组(BP组)、生理盐水组(S组)和NF-κB抑制剂组(PDTC组)。BP组于大鼠左侧胫骨干骺端骨髓腔内注射5μl Walker256(1×105)乳腺癌细胞制备骨癌痛模型,N组仅左胫骨上端注入5μl Hank's液。于接种后9 d鞘内注射生理盐水10μl或PDTC 20μg/10μl(生理盐水溶解),2次/d,共3 d。于接种前、后2、4、6、9和12 d、鞘内给药后1、3、6、12、24 h采用von Frey丝测定大鼠术侧后爪机械缩足反射阈值(paw withdrawal threshold,PWT),PWT测定结束后处死大鼠,取L4⁶脊髓,采用real time-PCR法测定NF-κB p65 mRNA表达,免疫组化法测定NF-κB p65蛋白表达。结果:接种后6 d BP组大鼠的PWT值与基础值相比开始降低,且差异有统计学意义(P<0.05),随着接种时间的延长其下降更加显著。鞘内注射PDTC可显著提高骨癌痛大鼠的PWT值,且与没注射PDTC前PWT值比,差异有统计学意义(P<0.05)。与接种后6 d时相比较,骨癌痛大鼠脊髓NF-κB p65 mRNA和蛋白质的表达在接种后9 d(P<0.01)和12 d(P<0.01)时均显著上调,而鞘内注射PDTC可显著降低大鼠脊髓NF-κB p65 mRNA和蛋白质的表达(P<0.01)。结论:鞘内注射PDTC可减轻大鼠骨癌痛引起的痛敏,NF-κB的激活可诱导或促进大鼠的胫骨癌痛。     

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.