任务导向性训练对局灶性脑梗死大鼠前肢运动功能及缺血区突触素和生长相关蛋白-43 表达的影响

目的观察任务导向性训练对局灶性脑缺血大鼠前肢运动功能和缺血区周围皮质突触素和生长相关蛋白(GAP)-43 表达的影响。方法采用内皮素-1(ET-1)诱导局灶性脑缺血大鼠前肢损伤模型。将大鼠随机分为假手术组、模型组、任务导向组和跑台组,每组又分为3 d、7 d、14 d、21 d 4 个亚组,每个亚组各6 只。造模后24 h 对任务导向组进行前肢抓取训练,跑台组给予跑台训练,模型组不给予任何干预。用网屏实验分析大鼠的运动功能,应用免疫组化方法观察各组不同时间点缺血灶周围皮质突触素和GAP-43 表达。结果造模后14 d 和21 d 任务导向组大鼠前肢运动功能优于模型组(P<0.01)和跑台组(P<0.05)。任务导向组缺血区周围皮质突触素平均光密度值在造模后14 d 和21 d 优于模型组和跑台组(P<0.05);任务导向组缺血区周围皮质GAP-43 阳性细胞数量在造模后7 d 和14 d 优于模型组和跑台组(P<0.05)。结论任务导向性训练法可促进局灶性脑缺血大鼠前肢运动功能的恢复,疗效优于动物跑台训练,其机制可能是与增强脑缺血区周围皮质突触素和GAP-43 的表达有关。     

跑台训练对慢性脑缺血大鼠海马区Notch1和突触素表达的影响

目的:研究跑台训练对慢性脑缺血大鼠海马区Notch1和突触素(SYN)表达的影响,从而探讨跑台训练对慢性脑缺血的康复作用及其可能的分子机制。方法:选取雄性的SD大鼠90只,随机分为9组,3个假手术对照组(7d、14d、28d)、3个模型组(7d、14d、28d)和3个跑台训练组(7d、14d、28d),每组10只。采用双侧颈总动脉永久性结扎法制备慢性脑缺血模型,假手术组仅分离双侧颈总动脉不结扎。跑台训练组于术后第3天开始跑台训练,1周训练6d。在各个时间点,应用Western-blot和免疫组化分析各组大鼠海马区Notch1和突触素表达的变化情况。结果:与同时段的假手术组相比较,模型组和跑台训练组海马组织Notch1蛋白含量和表达在28d时都发生明显降低(P0.05);其中,模型组对比跑台组降低更为明显(P0.05)。模型组和跑台训练组较假手术组突触素(synaptophysin,SYN)蛋白含量和表达也发生降低。其中,跑台训练组Notch1和SYN蛋白含量和表达在28d时要明显高于模型组(P0.05)。结论:跑台训练可以增加慢性脑缺血大鼠海马区Notch1和突触素的表达。     

神经生长因子对大鼠缺血性脑损伤急性期的疗效研究

目的:观察神经生长因子(NGF)对脑缺血急性期大鼠脑组织超微结构及突触素(Syp)表达的影响。方法:健康雄性SD大鼠36只,随机分为假手术组、缺血组和NGF组各12只,后2组线栓法制备MCAO模型,NGF组给予NGF腹腔注射治疗14d,其余2组腹腔注射等量生理盐水治疗14d。术后14d,WesternBlot测定各组脑组织中Syp的表达;术后28d,透射电镜观察各组脑组织超微结构。结果:术后14d,缺血组和NGF组脑组织Syp蛋白含量均显著高于假手术组(P<0.01),NGF组脑组织Syp蛋白含量高于缺血组(P<0.05);术后28d,电镜显示NGF组脑组织超微结构损伤较轻,突触数目较多,突触形态基本正常。结论:急性期腹腔注射NGF可减轻大鼠脑缺血性损伤程度,可能通过增加脑组织Syp的表达来促进脑缺血性损伤后突触的形成。     

跑台训练对大鼠脑缺血再灌注损伤后胶质纤维酸性蛋白和脑源性神经营养因子表达的影响

目的观察跑台训练对大鼠脑缺血再灌注损伤后胶质纤维酸性蛋白(GFAP)和脑源性神经营养因子(BDNF)表达的影响。方法成年雄性Wistar大鼠30只随机分为假手术组、模型组和跑台训练组,每组10只。采用线栓法制备大脑中动脉阻塞2 h再灌注模型。假手术组插线10 mm后即刻退出。跑台训练组在造模成功后第3天进行跑台训练12 d,在造模后第4、8、15天采用改良神经功能缺损评分(m NSS)对各组大鼠评分,造模后第15天HE染色观察脑组织病理学变化,Western blotting检测BDNF和GFAP表达。结果造模后15 d,与模型组比较,跑台训练组m NSS评分明显降低(F=9.931,P0.01),缺血侧皮质脑组织病理损伤减轻,GFAP(t=6.73)和BDNF(t=3.78)表达明显升高(P0.01)。结论跑台训练可促进大鼠脑缺血再灌注损伤后GFAP和BDNF的表达,促进神经功能的恢复。     

中风康对局灶性脑缺血大鼠脑组织超微结构的影响

目的:探讨中药中风康对局灶性脑缺血大鼠脑组织超微结构的影响.方法:采用线栓法复制局灶性脑缺血大鼠模型.以步长脑心通为对照,于脑缺血48 h观察中风康(主要成分:枸杞子、怀牛膝、川芎、水蛭、地龙、橘络、胆南星、石菖蒲、冰片等)对局灶性脑缺血大鼠脑组织含水量和超微结构的影响.结果:与假手术组比较,模型组出现明显的血-脑屏障和神经元超微结构损害,脑组织含水量增加(P<0.01);与模型组比较,各治疗组脑组织超微结构损害均有不同程度减轻,脑组织含水量均下降(P均<0.01).结论:中风康可减轻缺血时脑组织超微结构的损害,维护血-脑屏障的完整性,有效减轻脑水肿和神经元的缺血坏死.     

康复训练对脑缺血大鼠突触体素表达的影响

目的研究康复训练对脑缺血大鼠突触体素表达的影响。 方法将80只SD大鼠随机分为脑缺血组、制动组、康复训练组及假手术组。脑缺血组、制动组及康复训练组大鼠均制成脑缺血动物模型,假手术组制模方法同上,但不阻断大脑中动脉血流。假手术组及脑缺血组大鼠于制模结束后均置于普通笼内饲养,制动组大鼠术后则置于网状笼内固定,康复训练组大鼠术后每天给予康复训练,包括滚笼、平衡木、转棒及网屏训练。于实验进行1,7,14及21 d时各组分别取5只大鼠检测神经、运动功能以及大脑皮质突触体素表达水平。 结果从术后第7天开始,康复训练组大鼠神经及运动功能均明显优于脑缺血组及制动组。假手术组大鼠脑皮质内可见突触体素免疫产物呈点状分布,密度较高;脑缺血组大鼠随缺血时间延长,其脑皮质内突触体素免疫产物逐渐减少,密度降低;制动组大鼠随缺血时间延长,其脑皮质内突触体素免疫产物减少程度更显著;康复训练组随缺血时间延长,其脑皮质内突触体素免疫产物减少幅度逐渐趋缓,明显高于制动组水平。 结论脑缺血能显著降低实验大鼠脑皮质突触体素水平,康复训练能明显增强大鼠脑皮质突触体素表达,促进神经突触再生及神经、运动功能恢复。     

跑台训练对大鼠脑缺血再灌注后脑组织基质金属蛋白酶-2和血管内皮生长因子表达的影响

摘要 目的：探讨跑台训练对大鼠脑缺血再灌注神经功能恢复和缺血脑组织中MMP-2和VEGF表达的影响。 方法：用线栓法制作Wistar大鼠大脑中动脉梗死再灌注模型,35只大鼠随机分为假手术组、跑台训练组和手术对照组。跑台训练和手术对照组又分为跑3天、跑7天、跑14天3个亚组,各亚组及假手术组每组5只大鼠。跑台组于术后第3天开始给予跑台训练,假手术组及手术对照组不予跑台训练。于跑3天、跑7天、跑14天3个时间点进行神经功能评估后处死大鼠。采用RT-PCR技术测定缺血区脑组织中MMP-2及VEGF的水平。 结果：跑台训练组在跑7天、跑14天神经功能评分明显低于对照组(P＜0.05)。跑台训练组缺血区脑组织在跑7天、跑14天MMP-2水平高于对照组（P＜0.05）,各时间点VEGF水平均高于对照组(P＜0.05)。 结论：跑台训练能通过上调MMP-2及VEGF的表达,促进血管形成和神经再生等,有利于脑损伤后神经功能的恢复。     

缺氧缺血脑损伤大鼠脑神经结构与突触素表达的变化

目的 研究大鼠缺氧缺血性脑损伤（HIBD）后脑神经结构与突触素表达的变化.方法 将7日龄SD大鼠分为HIBD组和假手术对照组.采用单侧颈总动脉结扎术建立缺氧缺血性脑损伤大鼠模型,于脑缺氧缺血后1,4,7,14,28 d采集脑组织标本,进行HE染色和透射电镜观察其组织病理学及神经超微结构变化,并用免疫组化技术检测大鼠脑皮质及海马CA1区突触素的表达.结果 HIBD组脑损伤后神经元突起呈灶性坏死,突触数量减少、结构破坏;同时突触素的表达逐渐增高,至7 d达到高峰;而后开始下降,至28 d明显低于相应对照组（P〈0.001）.假手术对照组突触素表达水平则随日龄增加逐渐增高（P〈0.001）.结论 缺氧缺血性脑损伤可影响发育期脑组织神经结构与突触素的表达,损伤后两周内脑神经具有较强的突触可塑性.     

针康法对局灶性脑缺血大鼠前肢运动功能及缺血区突触素和生长相关蛋白-43表达的影响

目的观察针康法对局灶性脑缺血大鼠前肢运动功能及缺血区周围皮质突触素和相关蛋白-43(GAP-43)表达的影响。方法采用内皮素-1(ET-1)诱导局灶性脑缺血大鼠前肢损伤模型。将大鼠随机分为5组:假手术组、模型组、康复组、针刺组、针康组,每组又分为3d、7d、14d、21d4个亚组。造模后24h对针康组进行头穴丛刺结合前肢抓取训练,康复组给予前肢抓取训练,针刺组仅头穴丛刺法,模型组不给予任何干预。分析前肢抓取成功率及应用免疫组化方法观察各组不同时间点缺血灶周围皮质突触素和GAP-43表达。结果造模后各时间点,针康组大鼠前肢抓取成功率优于模型组、康复组和针刺组(P<0.05)。针康组缺血区周围皮质突触素平均光密度在造模后14d和21d优于模型组、康复组和针刺组(P<0.05);针康组缺血区周围皮质GAP-43阳性细胞数量在造模后7d和14d优于模型组、康复组和针刺组(P<0.05)。结论针康法可促进局灶性脑缺血大鼠前肢运动功能的恢复,其机制可能与增强脑缺血区周围皮质突触素和GAP-43的表达有关。     

P-选择素在大鼠脑缺血-再灌注损伤中表达的实验研究

目的研究P-选择素在大鼠局灶性脑缺血再灌注后的表达规律,探讨P-选择素在脑缺血再灌注损伤中的作用.方法 36只雄性SD大鼠随机分为假手术组和脑缺血2h再灌注组(3h,6h,12h,24h,48h),采用尼龙线栓法建立大鼠局灶性脑缺血再灌注模型,用免疫组化方法检测脑组织缺血再灌注不同时间点P-选择素的表达.结果假手术组未见P-选择素的表达,P-选择素在脑缺血再灌注后3h出现少量表达,12h达高峰,48h仍有表达.结论大鼠局灶性脑缺血再灌注损伤中,P-选择素的表达明显上调,根据炎症反应的机理,说明其介导了白细胞、脑微血管内皮细胞的粘附,参与了脑缺血再灌注损伤的病理过程.     

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.     

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.     

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.