维生素E联合单唾液酸神经节苷脂对脊髓损伤大鼠运动功能恢复的影响

目的:观察维生素E(VitE)联合单唾液酸神经节苷脂(GM1)对脊髓损伤(SCI)大鼠运动功能恢复的影响。方法:健康成年SD大鼠48只,采用Allen法(10g×12.5mm)在T9造成急性脊髓损伤动物模型。动物随机分为4组:对照组(A组)、VitE治疗组(B组)、GM1治疗组(C组)和VitE+1/2GM1治疗组(D组),每组12只。伤后第1天、第7天和第14天分别用BBB评分和斜板试验观察大鼠运动功能的恢复情况。结果:大鼠SCI后B、C、D组BBB评分和斜板试验优于对照组,第1天、第7天BBB评分和斜板试验D组明显优于B、C组(P0.05)。结论:大鼠脊髓损伤后早期使用VitE联合GM1对其运动功能的恢复有促进作用,效果优于VitE或GM1单独用药。     

不同波形电针对脊髓损伤大鼠运动功能恢复的影响

目的:比较不同波形电针对脊髓损伤大鼠运动功能恢复的影响,并初步探讨相应机制。方法:将48只健康成年大鼠均制成T9水平脊髓损伤模型,随机分为疏密波电针组(A组)、连续波电针组(B组)、断续波电针组(C组)、造模组(D组)4组,每组12只。于术后第1天、第3天、第7天对各组大鼠进行后肢功能的BBB评分、斜板试验、血清中丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性测定。结果:大鼠脊髓损伤后第1天,A、C组BBB评分优于造模组(P<0.05),斜板试验角度A组优于造模组(P<0.05)和C组(P<0.01);第3天,BBB评分A、B、C组优于造模组(P<0.05),斜板试验角度A组显著优于造模组(P<0.05);第7天,BBB评分A、B、C组优于造模组(P<0.05),斜板试验角度A、B、C组均优于造模组(P<0.05),其余两组间比较无显著性差异。大鼠脊髓损伤后第1天,SOD活性A、B、C组较造模组明显增高(P<0.05),MDA含量较造模组显著降低(P<0.01);第3天,A、B、C组较造模组SOD活性显著升高(P<0.05),A组明显高于C组(P<0.05),A、B、C组MDA含量低于造模组(P<0.05);第7天,A、B、C组SOD活性优于造模组(P<0.05),MDA含量低于造模组(P<0.05),其余两组间比较无显著性差异。结论:三种波形电针对于脊髓损伤大鼠运动功能的恢复均具有促进作用,其中疏密波能明显通过促进脊髓损伤大鼠神经的再生和修复,加快自由基的清除,加强血液循环,减少脊髓损伤的继发损伤等方面促进脊髓损伤大鼠运动功能的恢复。     

原花青素对脊髓损伤大鼠运动功能的影响

目的观察原花青素对脊髓损伤大鼠运动功能恢复的影响。方法健康成年SD大鼠36 只,采用Allen 法(250 g·mm)在T9复制急性脊髓损伤模型,分为A、B、C 3 组,每组12 只。造模型成功后30 min,A组腹腔注射原花青素40 mg/kg,B 组腹腔注射甲基强的松龙30 mg/kg,C 组腹腔注射等体积生理盐水。于术后1 d、3 d、7 d 对各组进行后肢功能BBB 评分、斜板试验,血清丙二醛(MDA)和超氧化物歧化酶(SOD)测定。结果BBB 评分和斜板试验结果均显示,术后3 d 和7 d,A、B 两组较C 组后肢运动功能恢复更好(P<0.05)。与C 组相比,A、B 两组术后1 d 和3 d SOD 活性升高,MDA 含量降低(均P<0.05);7 d 时,A 组较C 组SOD活性增高,MDA降低(P<0.05)。结论原花青素可有效抑制脂质过氧化反应,对脊髓损伤大鼠运动功能的恢复具有促进作用。     

原花青素对急性脊髓损伤大鼠核因子-кB和白细胞介素-6 表达的影响

目的观察原花青素对脊髓损伤后大鼠核因子-кB (NF-кB)、白细胞介素-6 (IL-6)表达变化的影响。方法36 只健康成年Sprague-Dawley 大鼠均分为3 组：原花青素治疗组(A组)、甲基泼尼松龙治疗组(B 组)和对照组(C 组)。采用Allen 法复制大鼠T9急性脊髓损伤模型,于术后1 d、3 d 和7 d 对各组大鼠行后肢运动功能BBB评分和斜板试验;免疫组织化学染色检测脊髓NF-кB和IL-6 的表达。结果术后3 d、7 d,A组、B组大鼠BBB评分和斜板试验成绩均优于C组(P<0.05)。A组术后各时间点NF-кB表达均明显低于C组(P<0.01),B组术后3 d、7 d 的NF-кB表达强度明显低于C组(P<0.01)。术后各时间点,A、B两组IL-6 表达均低于C组(P<0.05)。结论原花青素可抑制脊髓损伤后大鼠脊髓组织NF-кB、IL-6 的表达,有效抑制炎症反应,从而促进大鼠后肢运动功能的恢复。     

原花青素对大鼠脊髓损伤后神经胶质酸性蛋白和脑源性神经营养因子表达的影响

目的观察原花青素对脊髓损伤后大鼠胶质纤维酸性蛋白(GFAP)、脑源性神经营养因子(BDNF)表达变化的影响。方法48只健康成年Sprague-Dawley大鼠分为原花青素组(A组)和对照组(B组)。采用Allen法复制大鼠T9急性脊髓损伤模型,于术后1 d、3 d和7 d对各组大鼠行后肢运动功能BBB评分和斜板试验;测定血清丙二醛(MDA)和超氧化物歧化酶(SOD);以及免疫组织化学染色检测脊髓GFAP和BDNP的表达。结果术后3 d、7 d,A组大鼠BBB评分和斜板试验成绩均优于B组(P0.05)。术后1d、3 d及7 d,A组大鼠血清SOD活性和MDA含量优于B组(P0.05)。术后各时间点,A组GFAP表达均明显低于B组(P0.01);A组BDNF表达均显著高于B组(P0.001)。结论原花青素可有效抑制脂质过氧化反应,抑制脊髓损伤后大鼠脊髓组织GFAP的表达,促进内源性BDNF的合成,从而促进脊髓损伤大鼠功能恢复。     

经皮电刺激夹脊穴对大鼠脊髓损伤后神经胶质纤维酸性蛋白及炎症反应的影响

目的观察经皮电刺激对脊髓损伤后大鼠胶质纤维酸性蛋白(GFAP)、核因子-κB(NF-κB)及白细胞介素-6(IL-6)表达的影响。方法 90只健康成年Sprague-Dawley大鼠分为正常对照组(A组,n=30)、经皮电刺激组(B组,n=30)和对照组(C组,n=30)。采用Allen法复制大鼠T_9急性脊髓损伤模型,于术后1 d、3 d和7 d对各组大鼠行后肢运动功能BBB评分和斜板试验;免疫组织化学染色检测脊髓GFAP、NF-κB及IL-6的表达。结果术后3 d、7 d,B组大鼠BBB评分和斜板试验成绩均明显优于C组(t3.349,P0.01)。术后各时间点,B组GFAP、NF-κB及IL-6表达均显著低于C组(t20.815,P0.001)。结论经皮电刺激可有效抑制炎症反应,抑制脊髓损伤后大鼠脊髓组织GFAP的表达,从而促进脊髓损伤大鼠运动功能恢复。     

番茄红素抗氧化应激效应对大鼠脊髓损伤后运动功能恢复的影响

目的观察番茄红素抗氧化应激效应对大鼠脊髓损伤后运动功能恢复的影响。方法健康成年Sprague-Dawley大鼠36只,采用Allen法(10 g×25 mm)在T9造成大鼠脊髓损伤模型,并随机分为对照组(A组)、甲泼尼龙琥珀酸钠(MP)治疗组(B组)和番茄红素治疗组(C组),每组12只。造模成功30 min后,A组不给予治疗,B组腹腔注射MP 30 mg/kg,C组灌胃番茄红素20 mg/kg。于术后1 d、3 d、7 d分别对各组进行斜板试验、后肢功能BBB评分、血清中的超氧化物歧化酶(SOD)和丙二醛(MDA)测定。结果与A组相比,C组1 d、3 d和B组1 d、3 d、7 d斜板试验评分升高(P<0.05);C组1 d、3 d、7 d和B组1 d、7 d BBB评分升高(P<0.05);C组1 d、3 d、7 d和B组3 d、7 d SOD活性升高(P<0.05);C组3 d、7 d和B组1 d、7 d MDA含量降低(P<0.05)。结论番茄红素可以降低急性脊髓损伤后的氧化应激水平,促进大鼠运动功能恢复。     

自体富血小板血浆对大鼠脊髓损伤后神经功能的影响

目的 研究自体富血小板血浆对大鼠脊髓损伤后神经功能恢复的影响。方法 SD大鼠30只,随机分为PRP组(A组)和对照组(B组)各15只。采用改良Nystr?m法后路压迫大鼠胸段脊髓模型,A组予自体富血小板血浆灌注于损伤脊髓处,B组予自体血浆灌注于损伤脊髓处。术后第3、7、14天采用斜板试验和BBB运动功能评分观察大鼠后肢运动功能恢复情况、检测体感诱发单位(SSEP)检测神经传导功能。结果 大鼠脊髓损伤后7、14天,A组后肢运动功能评分明显高于B组,两者间差别有统计学意义(p<0.05)。SSEP潜伏期及波幅值变化：术后14天A组潜伏期12.37±1.689ms、波幅0.54±0.056mv；B组潜伏期14.14±1.553ms、波幅0.32±0.031mv,两组差别有统计学意义(P<0.05)。结论 自体富血小板血浆能促进大鼠神经功能的早期恢复。     

维生素B6对大鼠脊髓损伤后神经功能的影响及相关机制研究

目的探究维生素B6对大鼠脊髓损伤后氧化应激及炎性反应的影响。方法选择160只SPF级健康SD大鼠,将其随机分为假手术组(A组)、模型组(B组)、小剂量维生素B6组(20 mg/kg,C组)和大剂量维生素B6组(40 mg/kg,D组),每组各40只SD大鼠,采用Allen's打击法制作大鼠脊髓损伤模型,分别于术后第3天、第7天、第14天和第28天对4组大鼠实施BBB评分及斜板实验,电镜下观察4组大鼠脊髓尼氏小体形态学变化,检测4组大鼠脊髓沉默信息调节因子相关酶1(SIRT1)、诱生型一氧化氮合酶(iNOS)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、环氧化酶-2(COX-2)水平并实施组间比较。结果术后各时间点C、D两组大鼠术后BBB评分均优于B组大鼠,但劣于A组大鼠,且D组各时间点BBB评分显著高于C组(P 0. 05)。术后不同时间点C、D两组大鼠斜板实验评分均明显高于B组大鼠,但低于A组大鼠,且D组各时间点斜板实验评分显著高于C组(P 0. 05)。A组大鼠尼氏小体形态清晰,B组大鼠尼氏小体出现明显融合、模糊不清,C、D两组大鼠神经元内尼氏小体融合相比B组有明显减少,D组融合最轻。B、C、D三组大鼠的SIRT1蛋白表达量均明显低于A组大鼠,各组间比较差异具有统计学意义(P 0. 05),C、D三组大鼠的iNOS、IL-6、TNF-α、COX-2的表达均明显低于B组大鼠,且各组间比较差异具有统计学意义(P 0. 05)。结论维生素B6对脊髓损伤大鼠具有较好的神经元保护作用,其机制可能与显著缓解氧化应激及炎性反应,降低各类炎性因子分泌有关,且大剂量维生素B6对大鼠神经元损伤保护作用更优。     

联合应用免疫抑制剂治疗大鼠急性脊髓损伤效果观察

目的探讨联合应用免疫抑制剂他克莫司(FK506)和FTY720对大鼠急性脊髓损伤的神经保护作用。方法采用Allen′s打击法制备大鼠脊髓损伤模型,84只大鼠分成4组:FK506+FTY720联合治疗组(A组)、FK506治疗组(B组),脊髓损伤组(C组)和正常对照组(D组)。A组通过尾静脉注射0.3 mg/kg FK506,并予鼻饲0.3 mg/kg FTY720,B组通过尾静脉注射0.5 mg/kg FK506,C组注射生理盐水。伤后6 h、24 h和48 h取伤段脊髓行HE染色分析和Tunel凋亡分析;伤后第1、3和7天行体感诱发电位(SEP)检测;伤后第1、3、7和14天行BBB评分和斜板试验评分。结果联合治疗组和FK506治疗组伤后各个时间取材点的脊髓损伤出血坏死区均轻于损伤组,在第6、24和48小时时间点脊髓Tunel神经细胞凋亡检测明显轻于损伤组,有显著差异性(P<0.05),但2组之间比较无显著差异性(P>0.05)。联合治疗组和FK506治疗组伤后各时间点SEP、BBB评分和斜板试验评分均优于损伤组,有显著性差异(P<0.05),但是2组之间差异无统计学意义(P>0.05)。结论大鼠急性脊髓损伤早期联合应用FK506和FTY720具有良好的保护神经功能和促进神经功能恢复的作用。     

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.     

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.     

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.