^60Co辐照血红细胞CR1分子数目的变化

目的：研究不同剂量^60Coγ射线辐照全血在保存期内红细胞CR1分子数目的变化。方法：应用酶联法定量测定经15－35GY五个照射剂量辐照全血在保存期内红细胞CR1分子数目。结果：照射后1d，15－25GY剂量组红细胞CR1分子数目相互间比较及分别与对照组比较无明显差异（P＞0．05）；经30、35GY辐照红细胞CR1分子数目分别与其他剂量组和对照组比较有明显差异（P＜0．05－0．01）。另外，随着保存期的延长，各剂量组和对照组红细胞CR1分子数目呈阶梯式下降，尤其在照射后3d，30和35GY剂量组红细胞CR1分子数目接近于照射后7d水平，二者相互比较无明显差异（P＞0．05）。结论：在一定范围内（15－25GY）^60Coγ射线剂量辐照对红细胞CR1分子数目无明显影响。     

~(60)Co辐射血红细胞CR_1分子基因组密度多态性分布与分子数目的研究

目的　研究60 Co辐射对血红细胞CR1分子基因组密度多态性分布与分子数目的影响。方法　应用PCR和HindⅢ酶切技术测定红细胞CR1分子基因组密度多态性分布以及应用酶联法定量测定红细胞CR1分子数目。结果　经 30GY60 Coγ射线辐照血红细胞CR1分子基因组密度多态性分布和分子数目与未照射组比较无明显差异(P >0 .0 5 )。随着保存期延长红细胞CR1分子数目逐渐下降 ,直至 2 1d为最低。结论　应用 30GY60 Coγ射线辐照不会导致红细胞CR1分子基因组密度多态性分布与红细胞CR1分子数目的变化。     

^60Co输射血红细胞CR1分子基因组密度多态性分布与分子数目的研究

目的：研究^60Co辐射对血红细胞CR1分子基因组密度多态性分布与分子数目的影响。方法：应用PCR和HindⅢ酶切技术测定红细胞CR1分子基因组密度多态性分布以及应用酶联法定量测定红细胞CR1分子数目。结果：经30GY^60Coγ射线辐照血红细胞CR1分子基因组密度多态性分布和分子数目与未照射组比较无明显差异（P＞0．05）。随着保存期延长红细胞CR1分子数目逐渐下降，直至21d为最低。结论：应用30GY^60Coγ射线辐照不会导致红细胞CR1分子基因组密度多态性分布与红细胞CR1分子数目的变化。     

~(137)Csγ射线辐照对红细胞ATP、SOD、2,3-DPG含量及T淋巴细胞亚群的影响

目的探讨不同剂量γ射线辐照、不同保存期对ACD-全血中红细胞活性(ATP酶)、SOD值、2,3-DPG含量(红细胞携氧能力)及γ射线辐照对T淋巴细胞亚群的影响。方法20份ACD-全血(保质期21d)200ml分为4组,于采血后当天进行0、15、25、35Gy射线辐照。所有样本于-4℃保存,在辐照后0、7、14、21d分别测定红细胞ATP酶活性、SOD值、2,3-DPG含量,同时测定辐照前后T淋巴细胞亚群的变化。结果在各保存期,各辐照剂量组的红细胞ATP酶活性、SOD值、2,3-DPG含量,与对照组比较差异均无显著性意义(P>0.05);不同剂量的γ-射线照射新鲜全血,照射前后T淋巴细胞亚群数的变化差异无显著性(P>0.05),CD4/CD8比值无改变(P>0.05)。结论25、35Gy剂量的γ射线辐照能有效杀灭淋巴细胞而对红细胞的功能无破坏。     

γ射线辐照对保存血红细胞质量的影响

输血相关的移植物抗宿主病 ( TA- GVHD)的病死率高 ,且缺乏特异的治疗手段 ,目前以预防为主。 γ-射线辐照血液是预防 TA- GVHD的主要方法 ,γ-射线辐照对红细胞的损伤是照射瞬间产生的 ,长时间储存是否会加重其损伤 ,对辐照血的保存期等尚无统一标准 ,美国 FDA血制品建议委员会推荐照射红细胞保存期不超过 2 8d[1] ,而日本对辐射血液的保存期则定为采血后 2 1 d[2 ] ,国内目前尚无标准。笔者对经13 7铯 ( Cs)γ-射线 (照射剂量 2 5Gy)照射后的 ACD- B方、CPD方全血在不同保存时间的理化指标进行了测定 ,现报告如下。材料与方法1…     

γ射线辐照对血液保存质量的影响

目的　探讨降低淋巴细胞增殖能力较强 ,对红细胞保存质量影响较小的γ射线辐照剂量。方法　采用Biobeam 80 0 0辐照仪 ,对每份标本用 10、2 5、35、4 5Gy辐照与未辐照 (对照组 )比较。用ConA刺激及3 H TdR参入分析淋巴细胞增殖效果。红细胞保存质量影响观察 ,设 0d辐照组和 2 1d辐照组 ,观察不同辐照剂量对红细胞保存期间pH、红细胞数量、RDW、ATP、血浆游离血红蛋白、血浆Na+ 、K+ 的影响。结果　淋巴细胞增殖率随辐照剂量的增加而降低 ,35Gy组淋巴细胞增殖率 <5 %。辐照后红细胞保存期间数量、RDW、ATP ,各组间无显著差别 (P >0 .0 5 )。溶血率、血浆K+ 、Na+ ,0d辐照组与 2 1d辐照组 ,辐照当天与各自对照组无显著性差别 (P >0 .0 5 )。溶血率除 10Gy、2 5Gy外 ,保存期间辐照组均显著性高于对照组 (P <0 .0 1)。保存期间血浆K+ ,辐照组显著高于对照组(P <0 .0 1)。K+ 随保存期延长漏出增加 ,最高均值 >30mmol/L。结论　建议采用 35Gy辐照 ,并应选择 2 1d保存期内血液辐照 ;推荐辐照后当天输注 ,新鲜血液辐照后保存期不得超过一周。     

低剂量γ射线辐照对红细胞抗氧化能力的影响

目的 探讨低剂量γ射线辐照全血对红细胞抗氧化能力的影响.方法 20份人全血,以剂量为1Gy的γ射线进行辐照,吸收剂量率为17Gy/min,分别于照射前及照射后1 h,2 h取样检测红细胞超氧化物歧化酶(SOD)、谷胱甘肤过氧化物酶(GSH-Px)活力及血浆中丙二醛(MDA)含量.结果 低剂量γ射线辐照1 h,2 h红细胞中SOD及GSH-PX活力明显高于照射前(P<0.01),血浆中MDA含量明显低于照射前(P<0.01).结论 全血经1GY的γ射线辐照后,增强红细胞抗氧化能力,阻止自由基对免疫细胞膜的损伤.     

137Csγ射线照射全血后对淋巴细胞Fas、FasL及Fas／FasL表达的影响

目的 应用不同剂量的137Csγ-射线(0～35 Gry)照射新鲜全血,观察照射前后淋巴细胞Fas/FasL表达的变化。方法 将20份每份容量为200ml的ACD-B配方保存的新鲜全血(保质期21天)取样后分为4组,分为用15 Gry、25 Gry、30Gry、35Gry不同剂量г-射线照射的实验组及未照射的对照组,用流式细胞仪检测照射前后及不同照射剂量之间淋巴细胞Fas/FasL表达的变化。结果 淋巴细胞Fas、FasL抗原表达在辐照后均明显升高(P <0.05),且Fas、FasL抗原表达率与照射剂量呈正相关(r=0.94、0.97) ,Fas/FasL的比值无显著性差异(P >0.05),且与剂量无关。结论 137Csγ-射线辐照可促使离体全血淋巴细胞凋亡,辐照量增加细胞凋亡率呈线性增加,可应用凋亡相关Fas、FasL表达作为判断离体全血淋巴细胞经137Cs辐照后是否灭活的参考指标。 【关键词】137Csγ射线辐照 淋巴细胞 Fas/FasL     

不同保存期全血辐照后红细胞保存损伤的研究

目的 观察全血在不同保存期辐照的红细胞的活性及功能的变化,确定不同保存时期的红细胞制品辐照后可保存的时间。方法 每袋CPDA-全血分成若干份,于采血后1、8、15、22d进行25Gy辐照,并设不辐照对照组。于辐照后即刻及辐照后7、14、21、28、35d取样测定各项红细胞活性、功能指标。结果 CPDA-全血于采血后1、8、15、22d不同保存期进行辐照,在继续保存至36d过程中,与对照组相比,均未引起其红细胞ATP含量、2,3-DPG含量的明显降低及血浆游离Hb的明显升高,表明不论是新鲜血或是库存血,25Gy辐照对红细胞活性、功能均无明显影响;各辐照组保存至36d时,其红细胞ATP含量仍保持在76.6％以上,表明仍有良好的细胞活性;但所有辐照组血浆K~+含量均于辐照后的一周内升高迅速,表明辐照对红细胞膜有一定的损伤,可引起红细胞内K~+的渗漏。结论 初步的体外研究表明,采集的血液无论何时进行辐照处理,与不辐照血比较,在35d有效期内,均未影响红细胞制品的活性和功能。建议25Gy辐照CPDA-全血保存期与不辐照CPDA-全血相同,也可保存35d;但由于血液在辐照后的一周内K~+升高迅速,因此对于不能耐受较高K~+的新生儿、早产儿、肾功能不全患者及快速大量输血的患者等,血液辐照后应立即输用。     

25～45Gyγ射线辐照对红细胞制品质量的影响

目的　研究不同剂量辐照对红细胞的活性及功能的即刻损伤及保存损伤 ,确定辐照血液的保存时间。方法　将CPDA 全血 4 0 0ml分成 4组 ,于采血后 1d进行 0 (为对照组 )、2 5、35、4 5Gyγ射线辐照。在辐照后 0、4、7、1 4、2 1、2 8、35d取样测定红细胞活性、功能指标。结果　 0～ 35d保存过程中 ,①红细胞功能 :各辐照组的 2 ,3 DPG含量与对照组比较均无显著性差异 (P >0 .0 5 ) ;②红细胞活性 (ATP含量 ) :2 5Gy辐照组在 35d保存过程中与对照组差异无显著性 (P >0 .0 5 ) ;35、4 5Gy组分别于 35d(84 .7% )及 2 8d(83.6 % )起低于对照组 (P <0 .0 5 ) ;③红细胞脆性 :红细胞最小抵抗力 ,2 5、35、4 5Gy组分别自 35、2 8、2 1d起低于对照组 (P <0 .0 5 ) ;红细胞最大抵抗力 ,保存过程中 2 5Gy组与对照组差异无显著性 (P >0 0 5 ,35、4 5Gy组分别自 35及 1 4d起低于对照组 (P <0 .0 5 ) ;④游离K+ :2 5Gy组自辐照后 1d ,35、4 5Gy组自辐照后 0d起即高于对照组 (P <0 .0 5 ) ;K+ 含量与剂量呈正相关性 (r为 0 .96 6～ 0 .999) ;⑤游离血红蛋白 :在保存过程中显示出一定的剂量关系 ,但差异尚无统计学意义。结论　辐照对红细胞有一定的损伤 ,损伤程度与剂量有一定的相关性 ,但总体来说损伤不大 ,对红细胞活性     

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.     

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.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.