阻断BDNF-TrkB信号通路后运动训练对脊髓损伤后大鼠痉挛状态及腰髓内GAD65表达的影响

目的:探讨阻断脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)-酪氨酸激酶受体B(tropomyosinrelated kinase B,Trk B)信号通路后运动训练对脊髓损伤(spinal cord injury,SCI)大鼠后肢痉挛以及腰髓内谷氨酸脱羧酶65(glutamic acid decarboxylase 65,GAD65)表达的影响。方法:将60只雌性SD大鼠随机分为假手术组(Sham组)、损伤+磷酸盐缓冲液组(Sed-PBS组)、运动+磷酸盐缓冲液组(TT-PBS组)、损伤+Trk B阻滞剂组(Sed-Trk B/Fc组)以及运动+Trk B阻滞剂组(TT-Trk B/Fc组)。采用改良Allen撞击法建立T10不完全脊髓损伤后痉挛模型,在SCI后第7天,于Sed-Trk B/Fc组和TT-Trk B/Fc组植入灌有Trk B阻滞剂(Trk B/Fc)的Alzet渗透压泵,其余三组渗透压泵中则注入0.01M磷酸盐缓冲液(phosphate-buffered saline,PBS)进行对照。SCI后第8天,TT-PBS组和TT-Trk B/Fc组进行减重平板训练(treadmill training),每周使用H反射的H_(max)/M_(max)比值对术后大鼠后肢的痉挛状态进行评估,于术后5周采用Western Blot和免疫组化技术检测各组大鼠损伤远段脊髓GAD65的表达情况,并对大鼠小腿三头肌H_(max)/M_(max)比值与脊髓前角GAD65相对表达量之间的相关性进行分析。结果:术后,除假手术组外,其余4组大鼠后肢痉挛程度均逐渐加重。从第3周开始,与Sed-PBS组、Sed-Trk B/Fc组和TT-Trk B/Fc组相比,TT-PBS组H_(max)/M_(max)比值明显降低(P0.05);在术后第4—5周,TT-Trk B/Fc组比值也有下降(P0.05)。5组大鼠GAD65免疫组化和Western Blot结果显示,各组GAD65的相对蛋白含量均低于假手术组(P0.05),但TT-PBS组明显多于除Sham组外的其他3组(P0.05);TT-Trk B/Fc组GAD65的相对蛋白表达量与SedPBS组和Sed-Trk B/Fc组相比也有所增加(P0.05)。相关性分析显示,SCI后第35天,大鼠小腿三头肌H_(max)/M_(max)比值与脊髓前角GAD65相对表达量之间呈负相关(P0.001)。结论:运动训练可以改善SCI后的痉挛状态,而阻断BDNF-Trk B信号通路可抑制运动训练对不完全性SCI大鼠后肢痉挛的缓解和损伤远段脊髓GAD65表达的促进作用,且SCI后的痉挛状态的改善可能与脊髓前角GAD65相对表达量相关。     

人脐静脉内皮细胞来源外泌体有助于促进缺血性脑卒中小鼠的康复

目的:探讨人脐静脉内皮细胞(HUVECs)来源的外泌体对缺血性脑卒中小鼠的治疗效果。方法:提取并鉴定HUVECs细胞来源的外泌体(HUVECs-exo),尾静脉注射30μg(溶于100μL PBS中)外泌体至短暂性大脑中动脉缺血性模型小鼠体内,对照组注射同等体积的PBS。术后第1、3、7、14、21、28天对小鼠进行mNSS评分,磁共振成像检测小鼠的梗死范围,在第28天将小鼠断头取脑,CD31/BrdU、DCX/BrdU、NeuN/BrdU免疫荧光双染评价小鼠梗死边缘区血管及神经元的新生,Western印迹法检测小鼠梗死边缘区突触前膜蛋白Synaptophysin及突触后膜蛋白PSD-95的表达情况,进而检测突触重塑。结果:HUVECs-exo组小鼠梗死范围显著小于PBS对照组(P0.05),梗死边缘区新生血管、神经前体细胞及成熟神经元显著高于PBS对照组(P0.05),HUVECs-exo组突触前膜蛋白Synaptophysin及后膜蛋白PSD-95表达含量显著高于PBS对照组(P0.05)。HUVECs-exo组及PBS对照组在造模后第1、3、7天,神经功能评分无明显差异,在第14、21、28天HUVECs-exo组神经功能评分显著低于PBS对照组(P0.05)。结论:HUVECs-exo尾静脉注射能够减小缺血性脑卒中后的梗死范围,促进梗死边缘区血管及神经元新生,促进突触重塑,改善卒中后的神经功能预后。     

跑台训练对阿尔茨海默病模型大鼠记忆能力和突触可塑性的影响

目的:观察8周跑台运动对阿尔茨海默病模型大鼠记忆能力和突触可塑性的影响及内在机制。方法:60只雄性SD大鼠随机分为正常对照组(NC组)、AD模型对照组(AC组)、AD模型训练组(AE组)。通过向大鼠两侧海马区注射Aβ25-35制造AD模型,Morris水迷宫实验检测各组大鼠记忆能力,Golgi法检测海马神经元树突密度;Western blot法检测海马组织中BDNF、SYP、PSD-95、P-Akt、P-CREB的表达。结果:与AC组比较,AE组大鼠逃避潜伏期明显减少,穿越平台区域次数明显增加(P0.01);Golgi染色结果表明,AE组海马神经元侧树突密度明显增加(P0.01);Western blot检测结果表明,与AC组相比,AE组BDNF、SYP、PSD-95、P-Akt表达都明显增强(P0.01),但P-CREB表达无显著性变化(P0.05)。结论:8周跑台训练可增加AD模型大鼠海马组织BDNF、SYP、PSD-95、P-Akt的蛋白表达,可能与海马神经元树突密度增加有关,或许是AD模型大鼠的记忆能力改善和突触可塑性变化的基础。     

不同形式的运动训练对血管性痴呆大鼠学习记忆及海马区突触可塑性的影响

目的:观察自主运动、强迫运动和功能性电刺激诱导的运动对血管性痴呆(vascular dementia,VD)大鼠学习记忆、海马区突触可塑性的影响。方法:成年Wistar雄性大鼠,体重250—300g;用10%水合氯醛(300mg/kg)行腹腔注射麻醉,采用双侧颈总动脉永久性结扎法制作血管性痴呆模型。造模成功后大鼠在跑轮中适应3天(剔除运动量不能达到每天270m的大鼠),采用随机数字法分为假手术组、模型组、自主运动组、强迫运动组和功能性电刺激组,每组各8只。假手术组:仅暴露双侧颈总动脉,但不接扎,术后大鼠置于笼中自由活动;模型组:采用双侧颈总动脉永久性结扎法制作VD模型,术后大鼠置于笼中自由活动;自主运动组:造模1周后大鼠在跑轮(直径31.8cm,宽度10cm,旋转阻力约相当于100g物体的重力)上自由运动,用传感器记录跑过的圈数,每天270圈;强迫运动组:造模1周后大鼠在电动跑轮(直径31.8cm,长度40cm,转速9r/min)上运动,每天治疗30min;功能性电刺激组:造模1周后开始治疗,诱导大鼠前肢产生以9m/min行走时的动作,每天治疗30min。以上五组于治疗14d后,采用新奇事物识别实验测试大鼠学习记忆能力。取大鼠海马组织采用Western blot技术检测上述各组SYN、SYP、PSD-95及MAP-2、TAU蛋白表达。采用免疫组织化学染色法检测海马CA1区微管结合蛋白的变化。结果:(1)新奇事物识别实验:训练阶段各组大鼠对两个相同物体的探寻指数无显著性差异,24h后进行测试,自主运动组、强迫运动组和功能性电刺激组新奇事物认知指数与模型组比较,差异均具有显著性(P0.05),自主运动组新奇事物认知指数与强迫运动组、功能性电刺激组比较,差异均有显著性(P0.05),而功能性电刺激组与强迫运动组比较无显著性差异。(2)海马区SYN、SYP、PSD-95、MAP-2、TAU蛋白表达水平:自主运动组、强迫运动组和功能性电刺激组SYN、PSD-95、MAP-2、TAU蛋白表达水平均明显高于模型组(P0.05),功能性电刺激组、自主运动组和强迫运动组两两比较无显著性差异;上述5组SYP蛋白表达组间无显著性差异。结论:自主运动、强迫运动和功能性电刺激诱导的运动均可促进VD大鼠学习记忆能力的恢复,其可能机制为运动训练促进海马区SYN、PSD-95、MAP-2、TAU蛋白表达,改善海马区突触可塑性。     

乙酰左旋肉碱对急性脊髓损伤大鼠细胞自噬、凋亡及运动功能的影响

目的旨在检测乙酰左旋肉碱(ALC)对大鼠急性脊髓损伤(SCI)后微管相关蛋白1轻链3(LC3)-Ⅱ、细胞凋亡及运动功能的影响。方法成年雌性Sprague-Dawley大鼠36只随机分为假手术组(Sham组)、单纯脊髓损伤组(SCI组)、ALC治疗组,每组12只。Allen法建立大鼠T10脊髓损伤模型。损伤后3 d行BBB运动评分;取脊髓组织,Western blotting和免疫荧光标记技术检测LC3-Ⅱ表达,TUNEL法观察细胞凋亡。结果与Sham组相比,SCI组LC3-Ⅱ明显升高(P0.01),细胞凋亡显著增加(P0.001),BBB评分显著降低(P0.001);与SCI组相比,ALC组LC3-Ⅱ显著升高(P0.001),细胞凋亡显著降低(P0.001),BBB评分明显提高(P0.01)。结论 ALC可能通过增强大鼠脊髓损伤后细胞自噬,减少细胞凋亡,促进大鼠运动功能恢复。     

骨髓间充质干细胞静脉移植对脊髓损伤大鼠生长相关蛋白-43表达的影响

目的观察骨髓间充质干细胞(BMSCs)静脉移植对脊髓损伤(SCI)大鼠生长相关蛋白(GAP)-43基因及蛋白表达的影响,探讨BMSCs静脉移植治疗SCI的作用机制。方法采用SCI打击器建立大鼠T11脊髓撞击损伤模型,造模成功后,将大鼠随机分为对照组(n=18)和观察组(n=18)。SCI后1周,对照组大鼠自尾静脉注射无血清的DMEM/F12培养液0.1 ml,观察组大鼠自尾静脉注射BMSCs悬液0.1 ml。SCI后1、2、4、8周,两组大鼠均进行BBB后肢运动功能评分;SCI后2、4、8周,采用RT-PCR检测GAP-43 m RNA的表达,采用免疫组化染色检测GAP-43蛋白的表达。结果与对照组比较,观察组SCI后2、4、8周BBB评分显著升高(P0.001),GAP-43阳性表达显著增强(P0.001),GAP-43 m RNA的相对表达量升高(P0.05)。结论 BMSCs移植能增强SCI大鼠GAP-43在基因及蛋白水平的表达,从而促进SCI的再生修复。     

电针“曲池”-“阳陵泉”缓解脑卒中大鼠痉挛状态脑突触结构可塑性的实验研究

目的:通过动物实验观察电针治疗对脑卒中痉挛状态下SD大鼠的神经损伤与肌张力情况,皮质运动区突触超微形态变化及大脑皮质内突触可塑性相关蛋白(synaptophysin, SYN;GABA transporter, GAT-1;post-synaptic density-95, PSD-95)表达的影响,揭示电针"曲池"-"阳陵泉"缓解痉挛的疗效及其作用机制。方法:将77只SD大鼠经两次随机分组分为电针组、假手术组、模型组、空白对照组,采用改良Zea-Longa线栓法+内囊注射NMDA受体法制备脑卒中肢体痉挛大鼠模型,行为学评分确认模型成功后,开始在双侧曲池、阳陵泉行电针治疗,每次30min,每日1次,持续5d。行为学检测神经功能与肌张力,电镜观察各组皮质突触的超微结构变化,采用逆转录-聚合酶链反应检测皮质中SYN、GAT-1、PSD-95相应mRNA的表达,采用蛋白质印迹法检测皮质中SYN、GAT-1、PSD-95相应蛋白的表达。结果:①Zea-longa神经功能评分与改良Ashworth肌张力评分结果显示,模型组评分增高(P0.01);与模型组相比,电针组评分降低(P0.05)。②电镜图像观察,模型组较空白组、假手术组突触数量减少明显,囊泡数量减少密度不均,前后膜及间隙发生融合界限模糊,突触后细胞终末胞质变性溶解显著,突触后致密带的密度也下降;电针组较模型组的突触数量明显增多也相对密集,囊泡数量增多,新生的凹形突触增加,突触后致密物增厚,间隙变得规则紧致。未进行统计学分析。③同模型组比较,电针组SYN、GAT-1、PSD95蛋白与受体基因的表达均有升高(P0.01);而与空白对照组、假手术组比较,模型组SYN、GAT-1、PSD95蛋白与受体基因的表达均降低(P0.05)。结论:电针"曲池"-"阳陵泉"能够改善了脑卒中后痉挛状态,其作用机制可能是调节大脑皮质内突触可塑性相关蛋白与基因的表达,促进了皮质突触的重塑,从而改善中枢神经系统的运动功能。     

超短波对急性脊髓损伤大鼠神经功能及BDNF-TrkB表达的影响

目的:观察无热量超短波对急性脊髓损伤大鼠神经功能恢复和BDNF-TrkB表达的影响,并探讨其可能作用机制。方法:成年雌性SD大鼠72只,随机分为Sham组(24只)、SCI组(24只)和USW组(24只)。应用改良Allen法制备大鼠脊髓损伤模型。Sham组仅行椎板切除术暴露硬脊膜,不予打击,直接缝合,术后不给予任何治疗。USW组在脊髓损伤造模后24h给予受损部位无热量超短波治疗(最大输出功率40W,实际输出功率11.58W),10min/次,1次/d,至取材前。SCI组造模后不给予任何治疗。在造模后1d、7d、14d和21d用BBB评分、体感诱发电位(SEPs)和运动诱发电位(MEPs)评定脊髓损伤后后肢功能恢复情况并获取损伤段脊髓标本,术后4周取材,用免疫组织化学方法检测SCI组和USW组脊髓在损伤后不同时段BDNF及TrkB的表达,并行阳性细胞计数。结果:BBB评分结果提示,USW组大鼠7d、14d、21d时的运动功能恢复较SCI组明显提高(P0.01);SEPs和MEPs结果显示,USW组大鼠7d、14d、21d时的神经功能较SCI组明显改善(P0.05);免疫组织化学方法提示,与SCI组相比,USW组在一定时间段能上调损伤脊髓区BDNF-TrkB的表达(P0.05)。结论:无热量超短波能在一定程度上促进损伤脊髓的神经功能恢复,其机制可能与超短波上调损伤区脊髓BDNF-TrkB的表达有关。     

法舒地尔对SH-SY5Y细胞氧糖剥夺后突触损伤的影响

目的:探讨法舒地尔(Fasudil)对人神经母细胞瘤细胞(SH-SY5Y)氧糖剥夺(OGD)后突触损伤的影响。方法:培养SH-SY5Y细胞,分为空白对照组、OGD组、OGD+法舒地尔组,各3皿。相差光学显微镜下观察细胞突触损伤及修复的细胞形态;Western-Blot检测ROCKⅡ、磷酸化肌球蛋白磷酸酶(p-MYPT1)、突触后致密物-95(PSD-95)、突触素(Synaptophysin)等蛋白的表达情况。结果:形态学显示法舒地尔可有效修复OGD诱导的神经突触损伤。OGD组ROCKⅡ及p-MYPT1的表达明显高于空白对照组(P0.05),突触素及PSD-95的表达明显低于空白对照组(P0.01)。OGD+法舒地尔组ROCKⅡ及p-MYPT1表达水平低于OGD组(P0.05),而与对照组差异无统计学意义(P0.05);突触素和PSD-95表达水平高于OGD组(P0.01);PSD-95表达水平高于空白对照组(P0.05),突触素的表达与空白对照组差异无统计学意义(P0.05),结论:法舒地尔可有效修复OGD诱导的神经突触损伤,增加PSD-95、突触素的表达,抑制ROCKⅡ及p-MYPT1的表达。     

甲状旁腺激素用于预防脊髓损伤后骨质疏松的实验研究

目的探讨甲状旁腺激素对预防脊髓损伤(SCI)后骨质疏松的作用及机制。方法建立SCI模型,将实验分为空白对照组、SCI模型组、SCI甲状旁腺激素组和SCI阿伦磷酸钠组。空白对照组及SCI模型组不做处理,SCI甲状旁腺激素组每3天按照60μg/kg注射甲状旁腺激素一次,SCI阿伦磷酸钠组术后1 h开始灌服阿伦磷酸钠药液。BBB评分法记录术后的1 d、3 d、7 d、14 d、28 d、42 d、56 d大鼠的行为学运动评分;血钙和碱性磷酸酶试剂盒分别检测4和8周大鼠血钙(Ca)和碱性磷酸酶(ALP)含量,X线骨密度仪测定股骨和胫骨的骨密度;原位DNA片段法(TUNEL)检测细胞凋亡指数;Western blot检测Cleaved caspase3、β-catenin、GSK-3β蛋白表达。结果在各个时间点SCI模型组BBB评分均显著低于空白对照组(P0.05),SCI甲状旁腺组和SCI阿伦磷酸钠组在各个时间点BBB评分均显著高于SCI模型组(P0.05);SCI模型组在4周和8周ALP含量、股骨和胫骨骨密度及β-catenin蛋白表达均显著低于空白对照组,Ca含量、细胞凋亡指数及Cleaved caspase3和GSK-3β蛋白表达均显著高于空白对照组(P0.05);SCI甲状旁腺激素组和SCI阿伦磷酸钠组在4周和8周ALP含量、股骨和胫骨骨密度及β-catenin蛋白表达显著高于SCI模型组,Ca含量、细胞凋亡指数及Cleaved caspase3和GSK-3β蛋白表达显著低于SCI模型组(P0.05);SCI甲状旁腺激素组和SCI阿伦磷酸钠组在8周的ALP含量、股骨和胫骨骨密度及β-catenin蛋白表达显著高于4周,Ca含量、细胞凋亡指数及Cleaved caspase3和GSK-3β蛋白表达显著低于4周(P0.05)。结论甲状旁腺激素可通过调控Wnt/β-catenin信号通路对脊髓损伤后骨质疏松有一定的治疗作用。     

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.     

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.