培养星形胶质细胞缺氧/复氧时水通道蛋白4表达的变化

目的:探讨缺氧/复氧对体外培养星形胶质细胞水通道蛋白4(AQP4)表达的影响.方法:培养的大鼠脑皮层星形胶质细胞分成两组:正常对照组和缺氧/复氧组.缺氧8 h后复氧.根据复氧时间不同,又分为复氧0、4、6、8、12、24 h 6个亚组.于各时间点以检测细胞存活率、乳酸脱氢酶(LDH)的漏出率,Western blot法检测AQP4的表达.结果:缺氧8 h后随着复氧时间的延长,细胞存活率逐渐降低,至复氧12 h时,达最低,仅有对照组的81.3%,至复氧24 h,又有轻度增加;LDH的漏出率逐渐增多,至复氧24 h达最高峰.AQP4表达随着复氧时间延长而逐步增多,至复氧12 h时达最高峰,为正常对照组的(2.52±0.35)倍,24 h时略有下降.结论:缺氧/复氧过程能对体外培养的星形胶质细胞产生损伤作用的同时,发生了AQP4的表达时程变化.     

腺苷A_1受体拮抗剂DPCPX对低氧复氧脑星形胶质细胞影响的实验研究

目的:观察腺苷A1受体拮抗剂1,3-二丙基-环戊黄嘌呤(8-cyclopentyl-1,3-dipropylxanthine,DPCPX)对体外培养低氧复氧(hypoxia and reoxygenation,H/R)大鼠脑星形胶质细胞促红细胞生成素(erythropoietin,EPO)释放量、谷氨酰胺合成酶(glutamine synthase,GS)、超氧化物歧化酶(superoxide dimutase,SOD)和谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-PX)活性的影响,探讨腺苷A1受体在H/R星形胶质细胞神经保护中的作用。方法:对大鼠大脑皮层星形胶质细胞进行体外培养并建立H/R模型,在低氧同时加入终浓度为100nmol/L DPCPX12h后复氧1,6,12,24h,检测EPO释放量,GS,SOD和GSH-PX活性的变化。结果:与对照组比较,DPCPX组H/R星形胶质细胞的EPO释放量显著减少;GS,SOD和GSH-PX的活性降低。结论:腺苷A1受体参与H/R星形胶质细胞的神经保护作用。     

TLR4基因小干扰RNA对缺氧复氧诱导BV-2细胞炎症因子分泌的影响

目的 研究Toll样受体4(TLR4)基因小干扰RNA(siRNA)对体外缺氧复氧条件下诱导BV-2细胞分泌TNF-α的抑制作用.方法 小鼠小胶质细胞株BV-2置于六扎培养板培养,随机分为N组(正常培养组)、H组(缺氧复氧组)、T组(缺氧复氧+TLR4-siRNA转染组,转染质粒pEGFP-H1/TLR4-siRNA)、C组(缺氧复氧+对照siRNA转染组,转染含对照序列的质粒pEGFP-H1/对照-siR-NA)和B组(缺氧复氧+空白质粒转染组,转染pEGFP-H1空质粒)共5组.其中H组、T组、C组和B组细胞缺氧培养3 h后复氧培养24 h,运用脂质体转染技术介导质粒转染,流式细胞术检测转染后BV-2细胞EGFP的表达率,RT-PCR方法检测各组BV-2细胞TLR4 mRNA和NF-кB p65 mRNA的表达水平,Western blot方法检测各组BV-2细胞TLR4蛋白表达变化,ELISA方法检测各组上清液中TNF-α含量.采用方差分析进行统计分析.结果 转染后BV-2细胞EGFP的表达率为(67.58±7.16)%;经缺氧复氧处理后,H组、T组、C组和B绀的TLR4 mRNA、NF-кB p65 mRNA、TLR4蛋白水平较N组均明显上调(P＜0.01),各组卜清液TNF-α含量较N组也明显升高(P＜0.01);而T组TLP4 mRNA、NF-кBp65 mRNA、TLR4蛋白表达量和上清液TNF-α含量较H组、C组和B组均明显下凋(P＜0.01);C组和B组分别与H组相比,各项检测指标表达均无明显变化(P＞0.05).结论 针对TLR4 mRNA的小干扰RNA可以有效的抑制缺氧复氧诱导的BV-2细胞的炎症反应.     

鼠骨髓间充质干细胞对缺氧/复氧心肌细胞的影响

目的:观察在体外培养条件下骨髓间充质干细胞(mesenchymal stem cell,MSC)对缺氧/复氧新生大鼠心肌细胞的保护作用.方法:无菌条件下分离、培养、传代Wistar大鼠MSC,细胞融合达90%时更换培养基培养24 h,收集细胞培养液作为MSC条件培养基;原代培养新生Wistar大鼠心肌细胞,先用5% CO2、10% H2、85% N2混合气造成细胞缺氧24 h,再给予95% O2 和 5% CO2混合气复氧2 h,建立缺氧/复氧模型.MSC 处理组于复氧时加入MSC 条件培养基,正常细胞作为对照组,分别于复氧后用MTT法、乳酸脱氢酶(lactated dehydrogenase)法测定各组心肌细胞活性的改变;RT-PCR观察细胞凋亡蛋白Bcl-2和Bax的表达.结果: 与对照组比较,缺氧/复氧组细胞活力显著降低(P ＜ 0.01).与缺氧/复氧组比较,MSC处理组细胞活力明显增加(P ＜ 0.01).缺氧/复氧组抗凋亡基因Bcl-2的表达明显降低,促凋亡基因Bax的表达明显增加,而MSC条件培养基可以减少Bax基因的表达,提高Bcl-2/Bax值,与缺氧/复氧组比较差异具有显著性(P ＜ 0.01).结论:MSC对体外缺氧-复氧诱导的心肌细胞的凋亡有保护作用.     

白藜芦醇对心肌微血管内皮细胞缺氧/复氧的保护及作用机制

目的探讨白藜芦醇在抑制缺氧/复氧诱导心肌微血管内皮细胞凋亡中的作用机制。方法体外培养大鼠心肌微血管内皮细胞,建立细胞缺氧/复氧损伤模型,随机分为正常对照组、缺氧/复氧组(H/R,2h/4h)、缺氧/复氧+白藜芦醇组(H/R+Res)。白藜芦醇分别选择5、10、20、30、40μmol/L浓度,通过TUNEL法检测心肌微血管内皮细胞的凋亡率以确定药物的最适浓度,确定最适浓度后进行后续实验,分组:正常对照组、缺氧/复氧组(H/R,2h/4h)、H/R+白藜芦醇组(最适浓度20μmol/L)、H/R+白藜芦醇(最适浓度20μmol/L)+LY294002(20μmol/L)组。MTT比色法检测细胞的增殖能力,Transwell法检测细胞迁移能力,流式细胞仪检测细胞的凋亡率。结果与缺氧/复氧组(H/R,2h/4h)相比,不同浓度的白藜芦醇可抑制细胞凋亡,并呈剂量依赖性,20μmol/L白藜芦醇组出现明显保护作用(P<0.01);LY294002处理后,细胞的增殖及迁移能力明显减弱(P<0.05,P<0.01),细胞凋亡率明显升高(P<0.01)。结论白藜芦醇可减少缺氧/复氧诱导的心肌微血管内皮细胞凋亡,其机制可能与通过PI3K/Akt信号通路表达有关。     

羟基红花黄色素A对人肾小管上皮细胞冷缺氧/复氧凋亡的影响

目的:探讨羟基红花黄色素A(hydroxysafflor yellow A,HSYA)预处理组对人肾小管上皮细胞(HK2细胞)冷缺氧/复氧(冷H/R)损伤导致的细胞凋亡的影响。方法:HK2细胞株消化传代后采用计算机随机方法分为sham组(对照组)、冷缺氧/复氧组(冷H/R组,细胞冷缺氧4 h,复氧4 h)、HSYA预处...     

HSP70基因转染对缺氧-再复氧肠上皮细胞生长能力影响的研究

目的 :研究重组腺病毒介导的热休克蛋白 70转染对缺氧再复氧损伤后肠上皮细胞生长能力的影响。方法 :将重组含人全长 HSP70基因的腺病毒转染体外培养的肠上皮细胞株 IEC 6 ,检测转染细胞 HSP70的 m RNA表达水平。 IEC 6细胞经缺氧再复氧处理后 ,对未转染组 ,转染 2 4 h、4 8h及 72 h组细胞的细胞活力、生长曲线、增殖能力进行检测分析。结果 :腺病毒转染组细胞 HSP70 m RNA表达呈阳性。经缺氧再复氧处理后 ,IEC 6转染细胞活力较未转染组活力明显增强 (P<0 .0 1) ,生长能力提高 (P<0 .0 5 ) ,分裂指数增高(P<0 .0 5 )。结论 :重组腺病毒介导的 HSP70转染可增强肠上皮细胞生长及增殖能力 ,从而保护其抵抗缺氧再复氧损伤。     

沉默ski基因对大鼠星形胶质细胞活化增殖及Cyclin D1表达的影响

目的研究ski基因对大鼠星形胶质细胞增殖的影响及其分子机制。方法分离3日龄Sprague-Dawley大鼠脑皮质星形胶质细胞,体外培养。合成ski和阴性对照小干扰片段。设置ski-si RNA组、阴性对照组和空白对照组,采用脂质体法将特异性针对ski基因的si RNA和阴性对照si RNA转入ski-si RNA组、阴性对照组星形胶质细胞中。Western blotting分析ski、胶质纤维酸性蛋白(GFAP)和Cyclin D1蛋白表达;CCK8法检测星形胶质细胞增殖活力;流式细胞仪检测细胞周期。结果 ski-si RNA组星形胶质细胞ski蛋白表达明显降低(F=38.611,P0.01),GFAP(F=7.547,P0.05)和Cyclin D1蛋白(F=3.901,P0.05)表达降低;培养12 h后,ski-si RNA组增殖活力明显降低(F30.507,P0.01),G1期细胞比例明显增加,S期明显减少(F48.425,P0.01)。结论沉默ski基因可能通过下调Cyclin D1表达,抑制星形胶质细胞增殖。     

丹参素对缺氧/复氧诱导H9C2心肌细胞损伤和内质网应激的改善作用

目的观察丹参素(DLA)通过抑制内质网应激和凋亡对H9C2心肌细胞缺氧/复氧(H/R)后损伤的保护作用。方法将离体培养的H9C2心肌细胞随机分为3组:对照组、缺氧/复氧组(H/R组)、DLA+H/R组(DLA组)。H/R组先缺氧6h后复氧24h;DLA组于缺氧时给予DLA(10-6M)培养6h,再复氧24h。对照组心肌细胞正常培养至实验结束。ELISA测定细胞中乳酸脱氢酶(LDH)、肌酸激酶MB同工酶(CK-MB)和丙二醛(MDA)的含量;Western blot检测细胞中内质网应激蛋白葡萄糖调节蛋白78(GRP78)、Caspase-12、Bax、Bcl-2和SOD的蛋白含量。结果与对照组比较,H/R组细胞LDH、CK-MB和MDA的含量显著升高(P<0.05),GRP78、Caspase-12和Bax蛋白表达明显增加(P<0.05),而Bcl-2和SOD的蛋白含量明显降低(P<0.05);给予DLA可明显改善上述指标的变化。结论H/R可诱导H9C2心肌细胞发生凋亡、氧化应激和内质网应激,引起细胞损伤和凋亡;DLA可以通过抑制凋亡、氧化应激和内质网应激,减少细胞损伤,发挥保护细胞的作用。     

基于Wnt/β-catenin信号通路探究丹参素减轻滋养细胞氧化应激反应的机制

目的 探讨丹参素通过经典Wnt/β-catenin信号通路改善滋养细胞氧化损伤中的作用机制。方法 将人绒毛滋养细胞系HTR-8/SVneo置于缺氧/复氧(hypoxia/reoxygenation, H/R)条件下,通过CCK-8以确定丹参素对细胞活力的影响以及后续实验的最佳处理浓度。设置正常对照组(normal control, NC)、正常培养+丹参素处理组(normal culture condition with danshensu treatment, NC+DS)、缺氧/复氧处理组(H/R condition, HR)和缺氧/复氧+丹参素处理组(H/R condition with danshensu treatment, HR+DS)。检测各组活性氧物质(reactive oxygen species, ROS)的水平差异。Western blot技术检测各组Wnt/β-catenin信号通路蛋白表达水平。结果 根据CCK-8的检测结果,丹参素最佳处理浓度为10μmol·L^-1,处理48 h后可显著恢复细胞活力。HTR-8/SVneo在H/R处理后R...     

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.