制备结合链酶亲和素超声造影剂的实验研究

目的：探索制备一种结合链酶亲和素的脂膜超声微泡，以适用于亲和素－生物素法制备靶向超声造影剂，并评价其理化性质。方法：分4组于机械或超声振荡之前或之后，加入链酶亲和素完成超声造影剂的制备，采用浮选法洗涤。观察并检测洗涤前后各组微泡大小、形态、浓度、荧光亮度、微泡与链酶亲和素的结合情况。结果：机械或超声振荡制备的各组结合链酶亲和素的超声造影剂其浓度、形态与普通微泡比较无明显差异，但易静置分层。超声振荡法制备的微泡粒径稍大、浓度偏低。荧光显微镜观察：洗涤前各种不同方法所制备的微泡均能激发出明亮的红色荧光；洗涤后微泡浓度由1010左右降到107左右，微泡荧光亮度仍为“3级”。微泡与链酶亲和素的结合率，各种制备方法间比较差异无显著性意义（P>0.05），其结合率高达98%以上。结论：机械和超声振荡均可制备结合链酶亲和素的负电荷超声造影剂，微泡与其结合率高，为完成亲和素－生物素法制备靶向超声造影剂提供了重要基础。     

携带凝血酶原复合物的阴离子脂膜微泡的制备

目的 探索一种携带凝血酶原复合物(PCC)的阴离子脂膜微泡的制备方法。方法 首先制备阴离子脂膜微泡并评价其理化性质;继而采用直接连接法(黏附法、整合法)和亲和素-生物素法分别使阴离子微泡携带PCC,观察并检测洗涤前、后微泡的理化性质、PCC与微泡的结合情况,并对所结合PCC中Ⅸ因子的凝血活性进行评价。结果 阴离子脂膜微泡稳定,微泡表面电位均值－62.70 mV;采用直接连接法(黏附法、整合法)制备的携带PCC的阴离子脂膜微泡洗涤前、后微泡与FITC-PCC的结合率均较高,且能在洗涤前保持较高活性,组间差异均无统计学意义(P均>0.05);亲和素-生物素法制备的携带PCC阴离子脂膜微泡,各种制备方法间比较,微泡与链酶亲和素的结合率均较高,洗涤前、后各组间差异均无统计学意义(P均>0.05),但生物素化后PCC中Ⅸ因子活性明显减低(降低约93.07%)。结论 直接连接法可成功制备携带PCC的阴离子脂膜微泡,且能保持较高的活性。直接连接法可使链酶亲和素与阴离子脂膜微泡很好地结合,但生物素化可能破坏PCC的活性。     

含生物素化脂膜超声造影剂的制备与初步评价

目的 制备一种含生物素化脂膜的超声造影剂,并对其功能进行初步评价.方法 以冷冻干燥法在自制＂脂氟显＂（对照微泡）的基础上制备含生物素化脂膜超声造影剂微泡,检测其理化性质和造影功能,同时应用激光共聚焦显微镜和平行板流动腔法观察含生物素化脂膜微泡与链亲和素的黏附性.结果 ①含生物素化脂膜微泡造影剂在理化性质与小鼠肝脏造影显像方面能力与对照微泡比较差异无统计学意义（P〉0.05）;②与异硫氰酸荧光素（FITC）标记的链亲和素孵育后,含生物素化脂膜微泡荧光检测呈阳性,对照微泡为阴性;③含生物素化脂膜微泡可结合于链亲和素包被的培养皿上,且随着链亲和素包被浓度的增加其结合稳定性也相应提高.结论 应用冷冻干燥法在制备＂脂氟显＂微泡造影剂的基础上,可成功制备含生物素化脂膜超声微泡造影剂,为今后制备靶向显影及载药（基因）超声造影剂奠定了基础.     

低频超声联合微泡造影剂诱导人胆囊癌GBC-SD细胞凋亡的实验研究

目的探讨低频超声联合微泡造影剂对人胆囊癌GBC-SD细胞凋亡的影响。 方法将培养的人胆囊癌GBC-SD细胞分为4组,每组设5个复孔。其中空白对照组不进行任何处理;微泡组加200 μl的微泡造影剂混匀,使微泡浓度为20%,不进行超声辐照;低频超声组以超声辐照声强为0.45 W/cm²、超声脉冲波频率为1 MHz的低频超声连续波辐照,连续辐照30 s,不加造影剂;联合组加入200 μl的微泡造影剂,混匀后以1 MHz低频超声,连续波辐照30 s。各组以CCK-8法检测细胞增殖活性,并用流式细胞仪测定各组细胞的凋亡情况。 结果空白对照组、微泡组、低频超声组、联合组GBC-SD细胞增殖活性分别为0.9272±0.1173、1.0088±0.0628、0.2116±0.0101、0.1470±0.0029。联合组细胞增殖活性低于空白对照组、微泡组、低频超声组,差异均有统计学意义（t=14.846、30.637、13.661,P均<0.05）。各处理组间细胞凋亡率差异有统计学差异（F=2390.900,P<0.05）,联合组细胞凋亡率为0.682±0.022,显著高于空白对照组的0.073±0.005、微泡组的0.031±0.003、低频超声组的0.259±0.012,差异均有统计学意义（P均<0.05）。 结论低频超声联合微泡造影剂能降低体外培养的人胆囊癌GBC-SD细胞增殖活性,明显诱导人胆囊癌GBC-SD细胞凋亡。     

机械振荡法制备负电荷超声造影剂的探讨

目的机械振荡法制备并评价适用于超声空化栓塞肿瘤微循环的负电荷脂膜超声造影剂。方法采用机械振荡法在不改变脂质及辅料总量前提下,通过改变配方中脂质成分比例以及聚乙二醇(PEG)的用量,制备三种配方超声造影剂,分别观察并检测超声造影剂的浓度、表面电位、pH值、粒径及分布。结果三种配方对造影剂的浓度、稳定性几乎无影响,但对其的电荷特性有明显影响。三种配方所制备微泡的粒径均值分别为1066.6nm、1605.4nm、1552.5nm;微泡表面电位均值:在蒸馏水中分别为-33.8mV、-57.6mV、-66.7mV,在生理盐水中分别为0.1mV、-37.5mV、-37.8mV。与配方1比较,配方2、3所制备微泡大小适中、表面带有更多负电荷(P<0.01),配方2、3间比较无明显差异(P>0.05)。结论采用机械振荡法,增加脂质成分中负电荷磷脂的比例,可以制备出表面带有更多负电荷的超声造影剂,为超声空化栓塞肿瘤微循环提供了实验基础。     

载重组腺病毒Ad-EGFP/HIF-1α的超声造影剂的制备及其特性检测

目的 制备一种载重组腺病毒的脂质超声微泡造影剂,对其物理特性、载病毒的能力及在兔肝脏的显影效果进行研究.方法 采用机械振荡法及分层吸附法制备一种载重组腺病毒Ad-EGFP/HIF-1α的脂质超声微泡造影剂,用DFY-Ⅱ型超声图像定量分析诊断仪检测微泡粒径和浓度;检测其结合腺病毒的能力及观察对正常兔肝脏的显影效果.结果 载重组腺病毒Ad-EGFP/HIF-1α的超声微泡分布均匀,平均粒径为(1.17±0.82)μm,浓度为(2.50±0.12)×10~9/mL;该造影剂的最大腺病毒结合的效率为30%;体内造影显示该造影剂能够有效增强兔肝脏实质回声.结论 自制载重组腺病毒的微泡造影剂符合理想超声造影剂的要求,性质稳定,制备简易,载腺病毒效率高,为超声靶向微泡破裂基因释放技术的发展开辟新思路.     

纳米级超声造影剂制备及成像的实验研究

目的 探讨纯度较高的纳米级超声微泡造影剂的理化性质及体内成像效果.方法 机械振荡法与低速离心法结合制备纳米级微泡,观察微泡形态,检测其平均粒径,并观察其增强正常兔肝显影的情况,并与微米级微泡造影剂进行比较.结果 光镜以及透射电镜观察,微泡呈圆形,分布均匀,无聚集现象.Zeta SIZIER 3000测定微泡粒径均值为623.4 nm,微泡表面电位均值1.3 mV.注射纳米级造影剂于新西兰大白兔体内能持续增强肝的显像效果,与微米级造影剂对比无明显差异.结论 纳米级的微泡造影剂大小合理,分布均匀,显像效果强,为下一步研制小型化靶向造影剂奠定了基础.     

一种载基因脂质超声造影剂的制备及特性的实验研究

目的制备一种可作为基因载体的脂质超声造影剂,对其理化性质和兔肾显影效果及载基因的能力进行研究。方法采用机械振荡法制备一种可作为基因载体脂质超声微泡造影剂,观察60Coγ射线灭菌前后造影剂外观、形态、浓度、平均粒径和电位改变,并观察其对正常兔肾显影效果,检测其结合基因的能力。结果自制脂质微泡的平均粒径范围为2.11~6.43μm,平均粒径2.79μm,粒径分布均匀,浓度约为(3.16±0.29)×109/ml;经60Coγ射线灭菌后在显微镜下观察微泡形态,粒径大小无明显变化;体内造影显示该造影剂能够有效增强兔肾实质回声;基因结合量效优化结果显示,造影剂的最大基因结合的效率为22%,最大基因结合量为0.45μg/ml。结论自制脂质超声造影剂符合理想超声造影剂的要求,性质稳定,制备简易,载基因效率高,可望成为一种新型的超声微泡造影剂以及基因或药物治疗的载体。     

微泡造影剂与超声消融子宫肌瘤能效关系的研究

目的 研究微泡造影剂对超声消融人子宫肌瘤能效因子的影响.方法 因切除子宫肌瘤而的新鲜离体子宫20个,体外灌注造影剂与林格氏液混悬液,分为三组.浓度A组：微泡浓度2×108/ml;浓度B组：微泡浓度1×108/ml,对照组：单纯林格氏液.超声观察到肌瘤内部出现回声增强时,立即用聚焦超声肿瘤治疗系统以定点方式消融,消融深度分别为20 mm、30 mm及40 mm.超声消融结束后测量坏死区域体积,计算能效因子.结果 浓度A组能效因子为（6.85±3.16）J/mm3,浓度B组为（14.79±5.24）J/mm3,对照组为（29.11±10.76）J/mm3,三者依次增大,差异有统计学意义（P〈0.01）.结论 加入微泡造影剂后,消融单位体积子宫肌瘤组织所需能量明显降低.     

JAR细胞靶向微泡造影剂的体外研究

目的探讨体外靶向SonoVue微泡与人绒毛膜癌细胞（JAR细胞）的结合特性、结合率及靶向微泡的稳定性,为在体研究肿瘤细胞抗原的超声定位显像奠定基础。 方法用SonoVue微泡与兔抗人HCG抗体作用制成靶向造影剂、然后分别与JAR细胞及子宫内膜间质细胞（ESC）作用,比较各自的结合率及冲洗前后的结合率。 结果SonoVue微泡与兔抗人HCG抗体的结合率为67.6%;JAR细胞与靶向SonoVue微泡的花环形成率为（84.3±5.5）%,明显高于ESC的花环形成率（11.4±1.5）%（P〈0.05）;靶向SonoVue微泡与贴壁生长的JAR细胞结合率为（85.8±3.3）%,冲洗后结合率为（82.4±3.7）%（P〉0.05）;流式细胞仪检测JAR细胞与靶向SonoVue微泡的结合率为81.0%。 结论在体外靶向SonoVue微泡与JAR细胞特异性结合力具有一定的强度,可望实现靶向显影。     

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.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.