大鼠全脑缺血再灌注损伤过程中细胞凋亡研究

目的：探讨在大鼠全脑缺血再灌注损伤过程中细胞凋亡的作用与意义。方法：采用四血管闭塞法复制大鼠全脑缺血再灌注模型,在光镜,电镜水平观察损伤病灶形态学改变,利用原位末端标记（TUNEL）法定量检测细胞凋亡指数。结果;大鼠全脑缺血30min后再灌注,细胞凋亡的发生随着缺血再灌注损伤时间变化,呈动态性改变,凋亡指数在再灌注24h达高峰,形态学观察预见细胞凋亡与坏死并存,结论：急性全脑缺血再灌注损伤过程中细胞凋亡与坏死同时存在,表明细胞凋亡参与急生全脑缺血再灌注的损伤过程。     

大鼠全脑缺血再灌注损伤过程中细胞凋亡研究

目的探讨在大鼠全脑缺血再灌注损伤过程中细胞凋亡的作用与意义。方法采用四血管闭塞法复制大鼠全脑缺血再灌注模型,在光镜、电镜水平观察损伤病灶形态学改变,利用原位末端标记(TUNEL)法定量检测细胞凋亡指数。结果大鼠全脑缺血30min后再灌注,细胞凋亡的发生随着缺血再灌注损伤时间变化,呈动态性改变,凋亡指数在再灌注24h达高峰,形态学观察可见细胞凋亡与坏死并存。结论急性全脑缺血再灌注损伤过程中细胞凋亡与坏死同时存在,表明细胞凋亡参与急性全脑缺血再灌注的损伤过程。     

大鼠前脑缺血再灌注后海马神经元细胞凋亡及 Bcl-2表达研究

目的：观察Bcl-2蛋白在前脑缺血再灌注后细胞凋亡中的变化,探讨脑缺血再灌注后细胞凋亡的分子机制。方法：21只雄性SD大鼠随机分为7组,即对照组,脑缺血再灌注后1、3、6、12、24、48h组。大鼠断头处死后,解剖取材,固定、包埋、切片。用原位末端标记法（TUNEL）检测前脑缺血再灌注模型海马的细胞凋亡情况,用免疫组化方法检测相关基因Bcl-2表达的变化。结果：前脑缺血再灌注1、3h海马区未见凋亡细胞出现,6h开始出现,24h 达高峰,之后开始下降。Bcl-2阳性表达在前脑缺血再灌注1h即出现,12h达高峰,之后下降至低水平。结论：Bcl-2蛋白表达在海马神经元凋亡过程中起重要作用。[著者文摘]     

神经节苷脂对大鼠急性脑缺血再灌注损伤后细胞凋亡的影响

背景：大鼠急性脑缺血再灌注损伤后有细胞凋亡及凋亡相关基因的表达。 目的：观察神经节苷脂对大鼠脑缺血再灌注损伤后细胞凋亡的影响。 设计：随机对照动物实验。 单位：吉林大学中日联谊医院神经内科。材料：实验于2002—04在吉林大学中13联谊医院动物实验室完成。健康雄性Wistar大鼠48只，鼠龄三四个月，体质量（220&;#177;50）g。大鼠随机分为缺血再灌注组和缺血再灌注＋给药组（缺血前30min腹腔注射神经节甘脂GM—1），24只／组。其中又根据再灌注时间不同，每组分别分为3个时相点，即3h、6h和24h点，每个时相点8只大鼠。 方法：①建立大鼠全脑缺血再灌注模型。②应用二苯胺法测定大鼠脑缺血后3h、6h、24h脑组织DNA裂解率变化，取大脑皮质100mg加0．9mL裂解液制成lO％匀浆，加入离心管中，反复冻融，收集上清和沉淀，DNA裂解率=上清吸收值／（上清吸收值＋沉淀吸收值）。③免疫组织化学方法观察蛋白激酶C8表达，以及神经节苷脂给药后的变化。主要观察指标：大鼠脑皮质DNA裂解率的变化及蛋白激酶C8表达强度的变化。结果：实验过程中盐水对照组再灌注6h时死亡1只，麻醉过量死亡，再灌注24h时死亡2只，分别予以补充。随着再灌注时间的延长，DNA裂解率变化明显增加，24h达高峰，蛋白激酶C8表达于再灌注6h达高峰，以后逐渐呈下降趋势；神经节苷脂组相应时间点的DNA裂解率及蛋白激酶C8表达明显减少。 结论：神经节苷脂能抑制脑缺血再灌注后细胞凋亡的发生，并减少蛋白激酶C8的表达，对脑缺血再灌注损伤具有明显的保护作用。     

流式细胞术检测局灶性脑缺血再灌注Bcl-xL和Bax蛋白表达

目的：探讨Bcl-xL、Bax在局灶性脑缺血－再灌注中的表达及作用。方法：用线栓法复制大脑中动脉脑缺血－再灌注模型,流式细胞术（FCM）检测Bcl-xL、Bax蛋白表达。结果：缺血3小时再灌注,随缺血－再灌注时间延长,半影区Bax表达逐渐增强,再灌注24和48小时达高峰,而Bcl-xL表达早期增强后即呈下降趋势,Bcl-xL/Bax比率呈动态变化。结论：Bcl-xL表达增高,有利于促进神经细胞存活,Bcl-xL与Bax比率的转变,可促进神经细胞凋亡。     

大鼠局灶性脑缺血再灌注时c－fos、bcl－2蛋白的动态变化

目的:探讨细胞凋亡在脑缺血再灌注时脑损伤过程中的作用。方法 :采用免疫组化法检测大鼠脑缺血再灌注不同时间内c -fos、bcl -2蛋白表达的水平。结果 :(1)脑缺血再灌注时在缺血侧皮层和基底节区可见c -fos阳性表达 ,并于缺血30min再灌注1h时阳性表达达高峰 ;(2)脑缺血再灌注时缺血侧皮层和基底节区均有bcl-2阳性表达 ,并随再灌注时间不同 ,其阳性表达率亦不同。于缺血2h再灌注3h时阳性表达达高峰。结论 :c -fos和bcl-2参与大鼠脑缺血再灌注时缺血性细胞损伤(包括细胞凋亡)的发生     

兔脑缺血再灌注后细胞凋亡与TIMP-1表达的特点

目的 探讨兔脑缺血再灌注后细胞凋亡和基质金属蛋白酶抑制因子-1（TIMP-1）表达的特点.方法 成年健康新西兰兔103只,应用线栓法建立大脑中动脉闭塞（MCAO）动物模型,将成功的60只兔MCAO模型随机分为永久性缺血组和缺血再灌注组,各30只.原位末端标记法检测两组脑组织细胞凋亡的情况,免疫组织化学方法检测脑组织TIMP-1表达的情况.结果 脑缺血后脑组织细胞凋亡数逐渐增多,缺血12 h达高峰,以后逐渐减少（F=14.48,q=4.79～9.39,P〈0.01）.缺血1 h时脑组织TIMP-1阳性细胞数逐渐增多,48 h达高峰（F=52.05,q=4.98～19.43,P〈0.01）.动物缺血1 h再灌注后,各时间点凋亡细胞数和TIMP-1表达都低于永久性缺血组,再灌注23 h阳性细胞数最多,再灌注47 h下降（F=8.34、53.34,q=3.10～18.70,P〈0.01）.结论 急性脑缺血再灌注后,细胞凋亡与TIMP-1表达一致.     

阿托伐他汀钙对大鼠脑缺血再灌注后NF-κB、表达及神经细胞凋亡的影响

目的：探讨阿托伐他汀钙对大鼠脑缺血再灌注后脑组织中NF-κBp65表达水平及神经细胞凋亡的影响。方法：Wistar大鼠105只,分为假手术组、再灌注组及干预组各35只。干预组阿托伐他汀灌胃20d后,与再灌注组采用大脑中动脉线栓法制备局灶性脑缺血再灌注模型,参考Longa的5分制法在大鼠麻醉清醒后进行评分,应用免疫组化、TUNEL法检测阿托伐他汀钙对大鼠脑缺血再灌注后NF-κBp65表达及对神经细胞凋亡的影响。结果：与假手术组比较,再灌注组及干预组大鼠脑缺血再灌注后缺血脑组织中NF-κBp65表达明显增加（P〈0．01）,缺血再灌注24h达高峰;干预组给予阿托伐他汀钙干预后与再灌注组比较能减少缺血脑组织中NF-κBp65表达（P〈0．01）,减少神经元凋亡（P〈0．01）,降低神经功能缺损评分（P〈0．01）。结论：阿托伐他汀钙能抑制大鼠脑缺血再灌注后脑组织中NF-κBp65表达,并能减少神经元凋亡,减轻缺血再灌注损伤。     

神经节苷脂QM-1对大鼠急性脑缺血再灌注损伤后细胞凋亡的影响

目的：研究神经节苷脂GM-1对大脑缺血再灌注损伤后细胞凋亡的影响。方法：建立全脑缺血再灌注模型，应用二苯胺法和免疫组织化学方法观察脑缺血后3h、6h、24h脑组织DNA裂解率变化及PKC6表达，以及GM-1给药后的变化。结果：随着再灌注时间的延长，DNA裂解率变化明显增加，24h达高峰，PKC5表达于再灌注6h达高峰，以后逐渐呈下降趋势；GM-1给药组相应时间点的DNA裂解率及PKC6表达明显减少。结论：GM-1能抑制脑缺血再灌注后细胞凋亡的发生，并减少PKC6的表达，对脑缺血再灌注损伤具有明显的保护作用。     

大鼠局灶性脑缺血再灌注时c—fos,bcl—2蛋白的动态变化

目的：探讨细胞凋亡在脑缺血再灌注时脑损伤过程中的作用。方法：采用免疫组化法检测大鼠脑缺血再灌注不同时间内ｃ－ｆｏｓ、ｂｃｌ－２蛋白表达的水平。结果：（１）脑缺血再灌注时在缺血侧皮层和基底节区可见ｃ－ｆｏｓ阳性表达,并于缺血３０ｍｉｎ再灌注１ｈ时阳性表达达高峰;（２）脑缺血再灌注时缺血侧皮层和基底节区均有ｂｃｌ－２阳性表达,并随再灌注时间不同,其阳性表达率亦不同。于缺血２ｈ再灌注３ｈ时阳性表达达高峰     

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.