八肽胆囊收缩素抑制脂多糖诱导急性肺损伤小鼠的炎症反应

目的探讨八肽胆囊收缩素(cholecystokinin octapeptide,CCK-8)对脂多糖(lipopo- lysaccharide,LPS)诱导急性肺损伤(acute lung injury,ALI)小鼠炎症反应的影响。方法复制LPS致ALI小鼠模型。实验动物随机分为生理盐水对照组、LPS组(腹腔注射LPS)、LPS CCK-8组(注射LPS前30 min腹腔注射CCK-8)及CCK-8组(单独注射CCK-8)。用酶联免疫吸附法(ELISA)及逆转录-聚合酶链反应(PT-PCR)检测不同时间点各组小鼠血清、肺组织中白细胞介素-1β(IL-1β)、IL-6的含量及mRNA表达情况。观察各组肺组织光镜病理改变。结果腹腔注射LPS可成功复制ALI小鼠模型,肺组织病理显示,在LPS组12h时可见肺间质充血、水肿,大量炎性症细胞浸润,腹腔预注射CCK-8可明显改善肺组织病理变化;腹腔注射LPS可使小鼠血清及肺组织中IL-1β、IL-6表达增加,分别于注射后2h及4h达到高峰,预先注入CCK-8可显著抑制IL-1β、IL-6的表达。结论CCK-8可能通过抑制ALI小鼠IL-1β、IL-6的表达参与抗炎反应过程,从而减轻LPS诱导的ALI小鼠肺组织炎症反应。     

基于中性粒细胞胞外诱捕网探究丹参酮ⅡA对脓毒症小鼠肠损伤的影响及机制

目的 探究丹参酮ⅡA(TanⅡA)对脓毒症小鼠肠损伤的影响和中性粒细胞胞外诱捕网(NETs)在其中的作用及可能机制。方法 24只健康雄性C57BL/6小鼠随机分为对照组(Control组)、脂多糖组(LPS组)、LY294002组(LPS+LY组)、丹参酮ⅡA组(LPS+TanⅡA组),每组6只。除Control组注射等量磷酸盐缓冲液(PBS)外，其余各组腹腔注射LPS 10 mg/kg建立脓毒症模型。LPS+LY组于造模前30 min腹腔注射LY294002 30 mg/kg, LPS+TanⅡA组于造模前30 min腹腔注射TanⅡA 30 mg/kg,其余两组于上述时间点腹腔注射等量PBS[含1‰二甲基亚砜(DMSO)]。给药12 h后采集标本。苏木精-伊红(HE)染色观察小肠组织病理学变化并进行Chiu′s评分；酶联免疫吸附实验(ELISA)检测血清D-乳酸(D-Lac)水平、小肠组织髓过氧化物酶(MPO)-DNA复合物(MPO-DNA)及瓜氨酸化组蛋白H3(CitH3)含量；蛋白免疫印迹法(Western blotting)检测小肠组织闭合蛋白(Claudin)-1、磷酸化(...     

双调蛋白对小鼠损伤肺组织的修复作用及机制研究

目的探讨双调蛋白(amphiregulin, Areg)对急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)小鼠损伤肺组织的修复作用及机制。方法使用脂多糖(lipopolysaccharide, LPS)气管滴注制作小鼠ARDS模型, 连续7 d提取支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF)。将成年雄性C57BL/6小鼠用随机数字法分为5组(n=4/组):①空白组;②Areg组(腹腔注射重组Areg蛋白);③LPS+PBS组;④LPS+Areg组;⑤LPS+Anti-Areg组(③④⑤组小鼠气管滴注LPS, 30 min后腹腔注射PBS、重组Areg或Areg中和抗体)。于ARDS后1、3、5、7 d提取肺组织与BALF, HE染色评估肺组织病理变化, BCA法检测BALF中总蛋白含量, ELISA法检测肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-1β(IL-1β)与免疫球蛋白M(IgM)浓度, Western Blot检测表皮生长因子受体(epidermal gro...     

间充质干细胞上清液调控腺苷酸活化蛋白激酶保护脂多糖诱导的急性肺损伤北大核心CSCD

目的研究脐带间充质干细胞上清液对脂多糖(lipopolysaccharide,LPS)诱导的急性肺损伤(acute lung injury,ALI)的保护作用及机制。方法选择6周龄C57BL/6雄性小鼠共40只,随机数字法分为假手术(sham)组,LPS模型组,LPS+人脐带间充质干细胞上清液(HucMSC-cm)(LPS+cm)治疗组,LPS+HucMSC-cm+Compound C(LPS+cm+cc)干预组,每组10只。通过气管内注射LPS 5 mg/kg构建ALI模型,4 h后予以气管内注射HucMSC-cm 50μL/只构建治疗组;干预组在LPS及HucMSC-cm前30 min予腹腔注射Compound C 15 mg/kg;72 h后留取小鼠外周血检测中性粒细胞比例,并处死小鼠留取肺组织。通过苏木精-伊红染色检测小鼠肺组织病理学改变,Western Blot及免疫组化法分析肺组织中IL-6、ICAM-1、VCAM-1和磷酸化腺苷酸活化蛋白激酶(phosphate AMP-activated protein kinase,p-AMPK)的表达。体外培养人肺微血管内皮细胞(HuLEC-5a),将细胞分为三组:control组、LPS组(10μg/mL)、LPS+HucMSC-cm组。处理24 h后,Western Blot检测p-AMPK及AMPK蛋白表达水平,RT-PCR检测IL-6及IL-8的mRNA表达。多组间比较采用单因素方差分析,两组比较采用Tukey法检验。结果与sham组相比,LPS组小鼠肺组织充血水肿加重,肺间隔增厚和炎性细胞浸润增多,肺组织IL-6(P=0.003)、ICAM-1(P<0.001)及VCAM-1(P=0.001)蛋白水平明显上升,p-AMPK蛋白水平表达下降(P=0.013),外周血中性粒细胞比例上升(P<0.001),LPS+HucMSC-cm组肺组织充血水肿及病理学损伤较LPS组得到改善,肺组织中IL-6(P=0.003)、ICAM-1(P=0.001)及VCAM-1(P=0.006)蛋白水平下降,p-AMPK蛋白水平表达上升(P=0.002),外周血中性粒细胞比例下降(P<0.001),而LPS+cm+cc组肺组织病理学损伤较LPS+HucMSC-cm组再次加重,肺组织IL-6、ICAM-1及VCAM-1蛋白水平明显上升,p-AMPK蛋白水平表达下降,免疫组化法得到与蛋白相一致的结果。体外实验中,LPS处理后,IL-6(P<0.001)及IL-8(P=0.027)的mRNA表达较control组上升,且p-AMPK蛋白水平下降(P=0.005);LPS+HucMSC-cm组较LPS组IL-6(P=0.003)及IL-8(P=0.002)的mRNA表达下降,p-AMPK蛋白水平上升(P=0.003)。结论人脐带间充质干细胞上清液通过激活AMPK活性改善LPS诱导的ALI。     

中和IL-17A对输血相关急性肺损伤小鼠的保护作用

目的观察IL-17A在输血相关急性肺损伤小鼠中的表达,探讨中和IL-17A对输血相关急性肺损伤小鼠的影响。方法采用"二次打击"(LPS+MHC-Ⅰm Ab)模型,8~10周BALB/C雄性小鼠32只,应用随机数据表完全随机分成4组:正常(normal)组、LPS+MHC-Ⅰm Ab组、LPS+isotype组、LPS+PBS组,每组8只。腹腔注射LPS 0.1 mg/kg,24 h后尾静脉分别给予MHC-Ⅰm Ab(1 mg/kg)或等体积的isotype和PBS,2 h后检测肺泡灌洗液和外周血中IL-17的表达。另选取32只BALB/C雄性小鼠,观察anti-IL-17A抗体预处理对肺损伤的影响,随机分为4组:normal组、LPS+MHC-Ⅰm Ab+anti-IL-17A组、LPS+MHC-Ⅰm Ab+isotype组、LPS+MHC-Ⅰm Ab+PBS组,提前1 h尾静脉注射anti-IL-17A(50μg/只)、isotype(50μg/只)或等体积的PBS,二次打击造模后2 h取材,测定肺泡灌洗液中蛋白浓度和肺干湿重比,检测肺泡灌洗液和外周血中细胞因子水平,计数肺脏中性粒细胞,评估各组小鼠肺损伤和炎症反应程度。数据采用Prism5.0(Graph Pad Software,USA)软件包进行统计学处理。结果与其他三种相比,二次打击模型(LPS+MHC-Ⅰm Ab)组小鼠肺泡灌洗液和外周血中IL-17A表达显著升高,且肺组织中性粒细胞数明显增多。anti-IL-17A预处理后,肺组织中性粒细胞浸润减少,肺干湿重比减小,肺泡灌洗液蛋白含量降低,外周血促炎因子水平显著下调。结论 IL-17A在输血相关急性肺损伤中显著升高,anti-IL-17A预处理后显著改善输血相关急性肺损伤小鼠炎症反应和肺组织损伤。     

αDR3抗体活化DR3信号通路预防抗体介导输血相关急性肺损伤

目的探索死亡受体3(DR3)受体激动剂(αDR3)抗体活化DR3信号通路干预抗体-介导输血相关急性肺损伤(TRALI)的有效性及可能机制。方法 1)8～10周龄Balb/c小鼠40只随机均分为正常组、同型对照组、模型组、干预组;正常组不做任何处理;小鼠腹腔注射脂多糖(LPS)0.1 mg/kg及尾静脉注射4.5 mg/kg IgG2a同型对照抗体或抗-MHC-Ⅰ分别构建同型对照组与抗体介导TRALI模型组;小鼠腹腔单剂量注射αDR3抗体1 mg/kg 3 d后,再注射LPS 0.1 mg/kg及4.5 mg/kg抗-MHC-Ⅰ构建TRALI干预组。2)注射抗-MHC-Ⅰ后小鼠死亡或观察2 h处死小鼠取肺脏和脾脏,通过免疫病理评估肺损伤、流式细胞术检测脾脏调节性T细胞(Treg)、分别使用免疫组织化学(IHC)结合光密度定量分析分别检测小鼠肺组织Treg、M1巨噬细胞、M2巨噬细胞特异性标记物Foxp3、iNOS、CD206表达,CBA定量分析IL-6、IL-1β、TNF-α、IL-10,评估αDR3抗体对小鼠TRALI模型的干预效果。结果 TRALI干预组与模型组比较,1)小鼠肺组织损伤明显减轻;2)Treg比例(%)脾脏为9.295±1.349 vs 2.257±0.610;肺脏Foxp3平均光密度0.302 6±0.052 6 vs 0.230 2±0.016 3(P0.05);Treg来源细胞因子IL-10浓度(pg/mL)为29.52±8.885 vs 8.045±1.911(P0.05);3)肺脏iNOS平均光密度为0.209 6±0.013 9 vs 0.279 6±0.045 2,其来源的细胞因子浓度(pg/mL)IL-6为23.22±19.35 vs 301.1±157.7、IL-1β为46.76±25.34 vs 307.6±183.8、TNF-α为45.99±14.16 vs 143.9±44.43(P0.05);肺脏CD206平均光密度为0.291 2±0.032 1 vs 0.221 5±0.012 7,其来源的细胞因子IL-10(pg/mL)为29.52±8.885 vs 8.045±1.911(P0.05)。结论αDR3抗体可能通过活化DR3信号通路扩增小鼠的Treg,进而Treg分泌IL-10调节M1巨噬细胞极化为M2巨噬细胞起到预防小鼠发生TRALI的作用。     

法舒地尔调控RhoA/ROCK1通路改善脓毒症小鼠肺损伤

目的探讨法舒地尔对脓毒症小鼠急性肺损伤的保护作用。方法 4～6周龄雄性C57BL小鼠45只随机(随机数字法)分为对照组(Control组)、脂多糖组(LPS组)、法舒地尔干预组(FAS+LPS组), 每组15只。LPS溶液腹腔注射及气道内滴注建立脓毒症小鼠急性肺损伤模型。法舒地尔干预组分别于腹腔注射LPS前30 min和气道滴注LPS后1 h, 腹腔内注射盐酸法舒地尔溶液(10 mg/kg)。造模后4 h处死小鼠取肺组织。HE染色观察病理形态学变化;测定肺组织湿重/干重比(W/D);TBA比色法测定MDA含量及MPO活性;IHC测定caspase-3表达水平;Western Blot法检测肺组织中RhoA、ROCK1、eNOS及p-eNOS的蛋白表达水平。结果 FAS预处理后肺组织中炎性细胞浸润和红细胞渗出显著减少, 间质水肿及肺泡结构破坏显著减轻。与LPS组相比, FAS+LPS组的W/D值、MDA含量及MPO活性较LPS组均显著降低(P<0.01)。FAS+LPS组的Caspase-3表达较LPS组显著下降(P<0.01)。与Control组比, LPS组的RhoA、R...     

间充质干细胞上清液调控腺苷酸活化蛋白激酶保护脂多糖诱导的急性肺损伤

目的研究脐带间充质干细胞上清液对脂多糖(lipopolysaccharide, LPS)诱导的急性肺损伤(acute lung injury, ALI)的保护作用及机制。方法选择6周龄C57BL/6雄性小鼠共40只, 随机数字法分为假手术(sham)组, LPS模型组, LPS+人脐带间充质干细胞上清液(HucMSC-cm)(LPS+cm)治疗组, LPS+HucMSC-cm+Compound C(LPS+cm+cc)干预组, 每组10只。通过气管内注射LPS 5 mg/kg构建ALI模型, 4 h后予以气管内注射HucMSC-cm 50 μL/只构建治疗组;干预组在LPS及HucMSC-cm前30 min予腹腔注射Compound C 15 mg/kg;72 h后留取小鼠外周血检测中性粒细胞比例, 并处死小鼠留取肺组织。通过苏木精-伊红染色检测小鼠肺组织病理学改变, Western Blot及免疫组化法分析肺组织中IL-6、ICAM-1、VCAM-1和磷酸化腺苷酸活化蛋白激酶(phosphate AMP-activated protein kinase, p-AMPK)的表达。体外培...     

丹参对小鼠急性肺损伤的保护作用研究

目的:探讨丹参对内毒素(LPS)诱导的小鼠急性肺损伤(ALI)保护作用及其机制。方法:通过腹腔注射大肠杆菌LPS(5ml/kg)诱导小鼠ALI。30只雄性C57小鼠随机均分为正常组、模型组和丹参组,每组各10只。丹参组于LPS注射前1h腹腔注射丹参(10mg/kg),模型组和正常组注射等量生理盐水。LPS注射后6h,观察各组血气、肺组织病理形态、肺湿/干比(W/D),支气管肺泡灌洗液、肺组织和血清中肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、白细胞介素6(IL-6)的表达,以及IκB-α、TLR-4、MyD88、p-p65和p65蛋白表达。结果:丹参能有效降低LPS所致肺组织血气和病理学改变,减少肺W/D以及TNF-α、IL-1β、IL-6、TLR-4、MyD88和p-p65的表达,增加IκB-α的表达。结论:丹参对ALI小鼠有保护作用,其作用机制与抑制TLR-4/NF-κB介导的炎症相关。     

PRP通过NRF2/HO-1通路对LPS诱导的BV2小胶质细胞神经炎症的保护作用

目的 探究富血小板血浆(platelet-rich plasma, PRP)对脂多糖(lipopolysaccharide, LPS)诱导的BV2细胞炎症反应保护作用与机制。方法 BV2小胶质细胞分成正常对照组、10%PRP对照组、LPS组(LPS诱导)、3%PRP+LPS组(LPS诱导，3%PRP预处理)、5%PRP+LPS组(LPS诱导，5%PRP预处理)和10%PRP+LPS组(LPS诱导，10%PRP预处理),CCK-8测定BV2细胞增殖。共聚焦显微镜测定BV2细胞线粒体膜电位水平，荧光法检测ROS生成情况，Griess法测定NO水平。Western blot检测IL-6、TNF-α、BACH1、GPX4、NRF2和HO-1蛋白表达。此外，用HO-1抑制剂处理BV2小胶质细胞后实验分为正常对照组，LPS组，ZnPP+LPS组，10%PRP+LPS组，ZnPP+LPS+10%PRP,Western blot检测HO-1、IL-6和TNF-α蛋白表达。结果 与正常对照组相比，PRP促进BV2细胞增殖(P<0.01);LPS组线粒体膜电位下降，ROS生成增多，NO、IL-6、T...     

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.     

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.     

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.     

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.