特异诱导脐血CD8+抗白血病细胞毒淋巴细胞的研究

微小残留病灶(minimal residual disease,MRD)的存在是导致白血病复发的主要根源,特异性免疫治疗能有效地清除MRD,其中的策略之一就是诱导并回输白血病特异性的细胞毒性T淋巴细胞(cytotoxic T lymphocyte,CTL).本实验的目的是研究脐血能否在体外诱导生成CD8+ CTL,所生成的CD8+ CTL能否特异性杀伤白血病细胞,从而确定脐血淋巴细胞的利用价值及用于特异性免疫治疗的可行性.通过联合细胞因子体外诱导脐血单个核细胞(mononuclear cells,MNC)分化为树突状细胞(dendritic cells,DC),同时负载U937冻融抗原;成熟DC刺激同源的脐血T淋巴细胞成为CTL,经MACS磁珠分选出CD8+ CTL.用倒置显微镜、扫描电镜及流式细胞仪等方法检测DC,四甲基偶氮唑蓝(methyl thiazolyl tetrazolium,MTT)法测定杀伤活性.结果显示,10份人脐血标本均可培养出形态典型、功能成熟的DC.3组效应细胞CD8+ CTL、CD8- CTL和T淋巴细胞(TL)组在相同效靶比(40∶1)对U937细胞株的杀伤率分别为(66.36±12.43)%、(34.47±8.19)%和(15.79±4.64)%,以CD8+ CTL组最高;效靶比为40∶1时,CD8+ CTL对U937细胞株的杀伤率(66.36%)高于对K562细胞株的杀伤率(41.97%)(P＜0.05);而CD8- CTL对U937细胞株和K562细胞株的杀伤率无显著差异(P＞0.05).结论用负载U937白血病细胞株抗原的成熟脐血DC可使脐血淋巴细胞诱导产生特异性的CD8+ CTL;CD8+ CTL对U937白血病细胞株的杀伤活性强于CD8- CTL的作用;CD8+ CTL对U937白血病细胞株杀伤具有特异性.     

特异诱导脐血CD8+抗白血病细胞毒淋巴细胞的研究

目的研究体外诱导脐血CD8+细胞毒性T淋巴细胞(CTL)特异性杀伤白血病细胞的作用,探讨脐血淋巴细胞用于特异性免疫治疗的可行性.方法联合细胞因子体外诱导10份脐血单个核细胞(MNC)分化为树突细胞(DC),同时负载U937冻融抗原;成熟DC刺激同源的脐血T淋巴细胞成为CTL,经MACS磁珠分选出CD8+CTL.倒置显微镜、扫描电子显微镜及流式细胞术等方法检测DC细胞特性.MTT法测定细胞杀伤活性.结果10份脐血标本均可培养出形态典型、功能成熟的DC.CD8+CTL、CD8-CTL和淋巴细胞(TL)组对U937细胞不同效靶比的杀伤率以CD8+CTL组最高;CD8+CTL在401效靶比时对靶细胞U937细胞的杀伤率高于对K562细胞的杀伤率[分别为(66.36±12.43)%和(41.97±14.24)%,(P《0.05)];而CD8-CTL在401效靶比时对U937细胞和K562细胞的杀伤率差异无统计学意义[分别为(34.47±8.19)%和(22.45±4.00)%(P》0.05)].结论用负载U937细胞抗原的成熟脐血DC,诱导出脐血淋巴细胞特异性的CD8+CTL;CD8+CTL对U937细胞的杀伤活性强于CD8-CTL;CD8+CTL对U937细胞的杀伤活性具有特异性.     

体外诱导人脐血树突状细胞介导T细胞抗白血病的细胞毒性效应研究

为了研究脐血淋巴细胞能否在体外培养成为特异性杀伤白血病细胞的杀伤性T细胞(CTL),联合细胞因子体外诱导脐血单个核细胞分化为树突状细胞(DC),再吞噬凋亡白血病细胞并将其抗原呈递给相同脐血的T淋巴细胞,得到杀伤性T细胞。用形态学及流式细胞术检测DC。CTL细胞的杀伤功能用乳酸脱氢酶(LDH)释放法测定。结果表明:12份脐血标本均可培养出形态典型的DC,DC的表面标志CD1a 、HLA DR 、CD86 、CD83 表达水平显著升高(P<0.05)。CTL可以杀伤未经培养的白血病细胞(效∶靶=50∶1对AML细胞的平均杀伤率为44.76±17.42%,对ALL细胞的平均杀伤率为8.50±4.25%),对相同患者缓解期的骨髓细胞杀伤率极低。结论: 在外体应用多种细胞因子刺激可诱导脐血单个核细胞分化成典型的DC;负载有白血病抗原的DC可诱导同一脐血的淋巴细胞生成白血病特异的杀伤性T细胞(CTL),所得CTL可特异性杀伤未经培养的白血病细胞而不严重伤害相同患者缓解期的骨髓细胞。     

转染慢性粒细胞白血病总RNA对树突状细胞介导的抗白血病作用的体外研究

目的体外诱导和鉴定慢性粒细胞白血病-树突状细胞（CML—DC）,并探讨人慢性粒细胞白血病（CML）总RNA体外转染对其介导的特异性细胞毒T淋巴细胞（CTLl对慢性粒细胞白血病细胞杀伤作用的影响。方法分离14例CML患者骨髓单个核细胞．加入rhIL-4、rhGbl—CSF、rhTNF-α诱导培养CML—DC。分别于培养第1、3、6、14d用倒置显微镜进行形态学观察．流式细胞术检测免疫学表型,染色体G显带技术检测其染色体核型,逆转录聚合酶链反应（RT—PCRIl检测bcr—abl融合基因。并于CML-DC培养第5d,加人CML细胞总RNA脂质体转染,或裸总RNA转染,或不加任何试剂继续培养的DC,共三种CML—DC．分别致敏T淋巴细胞．另设以IL-2培养的T淋巴细胞为对照组,比较不同组别的致敏T淋巴细胞的杀伤活性。结果CML骨髓单个核细胞诱导前CDlct、CD83表达均在5％以下。而诱导成熟的CML—DC细胞CDla、CD83阳性表达率分别为20．13~3．43％、26．76＋2．79％,较诱导前均明显增高（P〈0．01）。CML-DC细胞均存在Phl染色体,并表达bcr-abl融合基因。总RNA脂质体转染CML—DC、裸总RNA转染CML—DC、单纯CML—DC分别致敏的T淋巴细胞在效：靶比为20：1时对CML单个核细胞的杀伤效率分别为75．33±3．11％、37．23±2．92％、29．62±1．61％,均明显高于对照组f9．87＋3．43％,P〈0．01）。总RNA脂质体转染的CML—DC所诱导的CTL杀伤活性最强．与后三组杀伤活性均有显著性差异（P〈0．001）。结论CML—DC既具有CML白血病源性．又具有DC细胞的特性,并能诱导特异性CTL杀伤白血病细胞。经脂质体转染CML细胞总RNA可以提高CML-DC介导的CTL特异性杀伤慢性粒细胞白血病细胞。     

致敏的脐血源树突状细胞诱导CTL特异杀伤白血病细胞的实验研究

探讨脐血单个核细胞（MNC）诱导的树突状细胞（DC）通过负载冻融的HL-60、K562细胞抗原体外诱导产生细胞毒性T淋巴细胞（CTL）对HL-60、K562的杀伤作用。取脐血12份,分离MNC。在MNC中加入细胞因子GM-CSF（granulocyte monocyte colony-stimulating factor）、IL-3（interleukin 3）、SCF（stemcell factor）和EPO培养4周。使用CD83、CD1a、CD11C和CDw123单克隆抗体、流式细胞仪测定培养前后脐血DC抗原变化及扩增情况。DC通过负载HL-60、K-562白血病细胞抗原致敏T淋巴细胞产生CTL^3H-TdR掺入试验测定DC免疫刺激活性,MTT法观察CTL对HL-60、K562细胞的特异性杀伤活性。结果表明：新鲜脐血CD1a^＋、CD11c^＋、CD83^＋、CDw123^＋细胞数分别为0．27×10^5／ml、5．87×10^5／ml、1．94×10^5／ml、2．73×10^5／ml。加入上述细胞因子培养的脐血MNC分化为CD1a^＋、CD11C^＋、CD83^＋、CDw123^＋DC,经培养2—4周,DC数明显增多,分别达11．02×10^5／ml、28．24×10^5／ml、10．57×10^5／ml、18．7×10^5／ml,此后逐渐减少。细胞因子诱导脐血DC具有免疫刺激活性,且DC与CBMNC细胞比例为1：40时的刺激活性最佳。冻融法得到的HL-60、K562白血病细胞抗原致敏DC诱导的CTL对HL-60、K562细胞的杀伤率分别为（42．04±8．46）％和（31．25±11．07）％,与实验组比较有显著性差异（P〈0．01）。结论：加入细胞因子GM—CSF、IL-3、SCF和EPO培养2-4周的脐血MNC可分化为cD1a^＋、CD11C^＋、CD83^＋、CDw123^＋DC。冻融法得到的HL-60、K562白血病细胞抗原致敏DC,其诱导的CTL对HL-60、K562细胞具有特异的杀伤作用。脐血DC作为抗原呈递细胞在肿瘤免疫治疗上将起到重要作用。     

含癌胚抗原片段的重组腺相关病毒转染树突状细胞疫苗的体外杀伤作用

目的：观察研究人外周血单核细胞来源的树突状细胞（DC）转染含癌胚抗原（CEA）片段的重组腺相关病毒后所诱导的特异性T细胞对直肠癌细胞株LOVO和SW480的体外杀伤作用。方法：抽取HLA表型为A11的健康志愿者外周血，分离单核细胞，体外培养，使用含CEA片断的重组腺相关病毒转染未成熟DC，诱导特异性T细胞。检测体外培养的DC和CTL活性，并使用MTT法检测细胞毒性T细胞（CTL）对LOVO细胞的杀伤作用。结果：转染或未转染的体外培养的成熟DC高表达CD40、CD86、IL-12，诱导的细胞毒性T细胞高表达IFN-γ；转染后DC诱导特异性细胞毒性T细胞可有效识别并杀伤HLA-A11阳性的LOVO细胞。结论：重组腺相关病毒转染DC，不明显改变DC表型和刺激淋巴细胞增殖、分化功能，可诱导自体细胞毒性T细胞增殖，含CEA片断的腺相关病毒转染DC诱导自体细胞毒性T细胞对LOVO细胞有明显杀伤作用，DC疫苗可以作为直肠癌患者免疫治疗的有效补充。     

VEGF对白血病树突状细胞诱导CTL杀伤活性的影响

目的观察血管内皮生长因子(VEGF)对白血病树突状细胞(DC)激活的CTL体外杀伤活性的影响。方法K562白血病细胞经5μmol/L VEGF反义寡核苷酸作用24 h后诱导生成DC。流式细胞术检测DC特征性表型(CD40、CD86、HLA-DR和CD83)的表达,MTT法检测DC激发的细胞毒T淋巴细胞(CTL)对靶细胞的杀伤活性。ELISA法检测DC上清中IL-12的表达。结果与正常K562诱生的DC(K562-DC)相比,K562经反义寡核苷酸下调VEGF表达后培养出具有典型特征的DC(AS-K562-DC),它不仅高表达DC免疫表型,而且激活的CTL对K562细胞具有更强的杀伤效应,同时具有更强的IL-12分泌能力(P均<0.05)。结论抑制白血病细胞VEGF表达,能够促进白血病源DC的分化和成熟,激活的CTL在体外具有更强的抗白血病效应。     

外周血单核细胞来源树突状细胞体外扩增及诱导抗乳腺癌免疫的研究

目的研究外周血来源树突状细胞(DC)的体外扩增及诱导特异性抗乳腺癌细胞的免疫效应。方法(1)从外周血中分离单个核细胞后,获得单核细胞(monocyte,Mo)。粒-单集落刺激因子(GM-CSF)和白介素4(IL-4)诱导分化扩增培养7d后,应用流式细胞术进行表型分析。(2)诱导单核细胞分化的第3天加入人乳腺癌细胞株3A0的冻融抗原培养4d后,获得负载肿瘤抗原的成熟DC;将致敏DC与从外周血中分离的同种异体T淋巴细胞共培养3d,获得细胞毒T淋巴细胞(CTL);四甲基偶氮唑蓝法检测CTL及上清液对人乳腺癌细胞株3A0、人胚肾细胞株293T(对照细胞)、人肝癌细胞株HCCC-9810的细胞毒作用。结果(1)外周血来源Mo在GM-GSF和IL-4作用下,第7天后可分化生成成熟的DC,高表达DC特异性抗原CDla、CD80(B7-1)、CD86(B7-2)HLA-DR、CD83。(2)DC可负载并递呈肿瘤抗原,激活同种异体T淋巴细胞,诱导肿瘤特异性CTL产生。不同浓度CTL及上清液对乳腺癌细胞3A0有特异性杀伤、抑制作用(P<0.05)。结论外周血中Mo可体外分化扩增为成熟的功能性DC,并诱导出特异性杀伤乳腺癌细胞的免疫效应。     

白介素21对树突状细胞诱导的CTL抗白血病作用的影响

本研究探讨白介素21（IL-21）对树突状细胞（DC）诱导的CTL抗白血病的体外作用。以不同细胞因子诱导培养急性白血病（AL）患者缓解期外周血单个核细胞产生DC，自体AL细胞RNA作为抗原负载DC，与自体T淋巴细胞共培养诱导白血病特异性CTL产生；用LDH释放法检测CTL杀伤自体AL细胞的作用，并检测CTL产生IFN-γ和TNF-α的变化。实验共分2组：实验组，在DC—CTL共培养过程中加用IL-21（200ng／ml）；对照组，不加IL-21。同时对IL-21单独作用培养后成熟DC，检测其表面抗原表达变化以及诱导同种混合淋巴细胞反应能力。结果表明：对照组和实验组的CTL产生率分别为：（56．73±10．21）％，（73．43±18．01）％（P〈0．01）；培养上清中IFN-γ和TNF-α分别为：（154．91±67．20）ng／L，（310．62±141．15）ng／L（p〈0．01）和（8．77±5．09）μg/L，（15．25±6．56）μg／L（p〈0．01）。在效靶比为20：1时，两组对自体AL细胞的杀伤作用分别为（50．22±5．07）％，（75．38±9．47）％（P〈0．01）；IL-21作用后的成熟DC的CD1a、CD83、CD86、CD80和HLA—DR表达没有明显变化；诱导同种混合淋巴细胞反应能力亦没有明显不同。结论：IL-21可促进DC诱导的CTL增殖、增加IFN--γ和TNF—α产生从而增强其抗白血病作用；IL-21对成熟DC表面抗原表达及其免疫功能无明显影响；提示IL-21在白血病免疫治疗中发挥一定的作用，具有潜在的临床应用价值。     

K562细胞RNA负载人树突状细胞后体外诱导特异性CTL的研究

目的探讨人的树突状细胞(dendriticcell,DC)体外经K562细胞株总RNA转染后,能否诱导出p210蛋白表达,并诱导特异性细胞毒T淋巴细胞(CTL)。方法自健康人浓缩白细胞制品(白膜)分离有粘附特性的单核细胞(PBMC),经GMCSF、IL4培养5d后,获得未成熟的DC(imatureDC,imDC);体外以脂质体DOTAP或直接电穿孔转染K562细胞总RNA。抽提转染前后以及转染24h后的DC内RNA进行RTPCR检测,Westernblot分析p210蛋白表达,以及诱导CTL杀伤K562细胞功能检测等。PBMC以每组5×106/ml,分别在不同组分的培养液中培养DC,通过细胞计数、流式细胞仪测定CD1a表达、细胞纯度来估计制备效果。结果RTPCR检测表明DC经K562总RNA转染后,细胞内出现BcrAbl的cDNA条带,24h后消失。Westernblot试验表明转染24h后,开始表达p210特征性蛋白;并且明显促进T细胞对K562的杀伤活性。1%自体血浆体积分数RPMI1640培养的DC的CD1a表达量最高,并且细胞获得数量也仅屈居第二,为总体评价较高的一组。结论应用肿瘤总RNA负载DC来制备DC疫苗具有可行性,预示改良的DC疫苗抗肿瘤的广泛应用前景。     

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.