肥厚性瘢痕的基因表达

肥厚性瘢痕是影响烧伤和创伤后患康复的一大难题，其发病机制至今仍不清楚。肥厚性瘢痕Ⅰ、Ⅲ型胶原基因表达明显增高，可能是其形成的重要原因；另一方面肥厚性瘢痕基质金属蛋白酶表达降低，金属蛋白酶组织抑制因子表达增高，可能是胶原降解减少，瘢痕形成的另一重要原因。生长因子在瘢痕的形成中可能具有重要的作用。转化生长因子β、血小板衍化生长因子、胰岛素样生长因子、成纤维细胞生长因子、白介素1和白介素15在瘢痕中的高表达，与瘢痕的形成密切相关。     

肥厚性瘢痕组织中胶原酶表达和活性的实验研究

目的 探讨胶原降解在肥厚性瘢痕形成中的作用。方法 应用原位杂交和ＳＤＳ－聚丙烯酰胺凝胶加胶原底物电泳观测了肥厚性瘢痕组织中胶原酶表达、酶活性及胶原的降解。结果 肥厚性瘢痕组织中胶原栈表达校正常皮肤略增加，但酶活性却明显下降，胶原降解减少。结论 胶原酶活性降低，胶原降解不足可能是肥厚性瘢痕形成的又一重要原因。     

基质金属蛋白酶7和转化生长因子β1在病理性瘢痕中的表达：与正常瘢痕及正常皮肤组织比较

背景：从基因和蛋白角度深入探讨病理性瘢痕的发病机制具有重要价值。目的：检测病理性瘢痕中基质金属蛋白酶7和转化生长因子β1蛋白的表达。方法：选择2004/2009年唐山市工人医院烧伤整形科手术后保存的病理性瘢痕标本,其中瘢痕疙瘩54例,增生性瘢痕42例。选取同期45例因非感染性疾病行手术切除的正常瘢痕组织作为对照组,选取同期45例正常皮肤组织作为正常对照组。采用流式细胞术半定量检测组织中基质金属蛋白酶7和转化生长因子β1的表达。结果与结论：基质金属蛋白酶7和转化生长因子β1在病理性瘢痕中的表达量明显高于正常瘢痕组织和正常皮肤组织,基质金属蛋白酶7和转化生长因子β1在正常瘢痕组织中的表达明显高于正常皮肤组织,病理性瘢痕和正常瘢痕中基质金属蛋白酶7和转化生长因子β1的表达呈正相关。结果表明基质金属蛋白酶7和转化生长因子β1的高表达及协同作用,可能促进病理性瘢痕的发生发展。     

肥厚性瘢痕胶原降解的研究

目的：研究肥厚性瘢痕中胶原累积和清除两方面的相对关系。方法：实验方法有临床观察、动物模型和细胞培养。观察方法有：光镜与电镜、组织化学、原位杂交、斑点杂交等等。结果：①肥厚性瘢痕的自然形成极慢，而用药物干预可以在一个月以内使其消退１／３～２／３。②肥厚性瘢痕中的胶原合成速度有所增加，但其降解速度减慢更为显著。③肥厚性瘢痕中胶原酶的表达有所增加，但其实际生成量和活性则为降低。④肥厚性瘢痕中Ｃｈ－４－Ｓ明显增加，一方面包绕胶原纤维，阻碍胶原酶的接触和降解作用，另一方面也通过ＴＩＭＰ降低胶原酶的活性。⑤肥厚性瘢痕中ＴＩＭＰ增加，降低胶原酶的活性。⑥肥厚性瘢痕中ＴＧＢ－β显著增加，其表达量与ＴＩＭＰ表达成正相关，与凋亡细胞数成负相关。ＴＧＦ－β使ＭＭＰ－１表达减少，活性下降。⑦肥厚性瘢痕中的成纤维细胞绝大多数为肌成纤维细胞，增殖期凋亡极少，成熟期显著增多。结论：①肥厚性瘢痕中成纤维细胞凋亡减缓和胶原酶数量和活性降低，胶原被Ｃｈ－４－Ｓ包绕而降解减慢，以致胶原累积，是肥厚性瘢痕形成的主要方面。②加速细胞凋亡和胶原降解可能是防治肥厚性瘢痕比较容易而快捷的途径     

基质金属蛋白酶13和转化生长因子β1在瘢痕疙瘩和增生性瘢痕中的表达

背景：与瘢痕疙瘩和增生性瘢痕发生机制相关的基质金属蛋白酶13和转化生长因子β1信号传递通路研究多集中在体外成纤维细胞的培养上,而在组织中的相关研究少见报道。目的：观察瘢痕疙瘩和增生性瘢痕中基质金属蛋白酶13和转化生长因子β1蛋白的表达。方法：取自2004/2008唐山市工人医院烧伤整形科手术患者,瘢痕疙瘩54例,增生性瘢痕42例。选取同期45例因非感染手术切除的正常瘢痕组织作为对照组,选取同期45例正常皮肤组织作为正常对照组。应用流式细胞仪检测4组中基质金属蛋白酶13和转化生长因子β1的表达,分析两者的相关性。结果与结论：瘢痕疙瘩和增生性瘢痕中转化生长因子β1的表达明显高于正常瘢痕组织和正常皮肤组织;正常瘢痕组织中转化生长因子β1的表达明显则高于正常皮肤组织,而基质金属蛋白酶13的表达与之相反。瘢痕疙瘩、增生性瘢痕和正常瘢痕组织中基质金属蛋白酶13和转化生长因子β1表达呈负相关。由此推测基质金属蛋白酶13和转化生长因子β1在瘢痕组织中异常表达,二者可能具有协同负向作用,共同参与病理性瘢痕的发生发展。     

基质金属蛋白酶13和转化生长因子β1在瘢痕疙瘩和增生性瘢痕中的表达

背景:与瘢痕疙瘩和增生性瘢痕发生机制相关的基质金属蛋白酶13和转化生长因子β1信号传递通路研究多集中在体外成纤维细胞的培养上,而在组织中的相关研究少见报道.目的:观察瘢痕疙瘩和增生性瘢痕中基质金属蛋白酶13和转化生长因子β1蛋白的表达.方法:取自2004/2008唐山市工人医院烧伤整形科手术患者,瘢痕疙瘩54例,增生性瘢痕42例.选取同期45例因非感染手术切除的正常瘢痕组织作为对照组,选取同期45例正常皮肤组织作为正常对照组.应用流式细胞仪检测4组中基质金属蛋白酶13和转化生长因子β1的表达,分析两者的相关性.结果与结论:瘢痕疙瘩和增生性瘢痕中转化生长因子β1的表达明显高于正常瘢痕组织和正常皮肤组织;正常瘢痕组织中转化生长因子β1的表达明显则高于正常皮肤组织,而基质金属蛋白酶13的表达与之相反.瘢痕疙瘩、增生性瘢痕和正常瘢痕组织中基质金属蛋白酶13和转化生长因子β1表达呈负相关.由此推测基质金属蛋白酶13和转化生长因子β1在瘢痕组织中异常表达,二者可能具有协同负向作用,共同参与病理性瘢痕的发生发展.     

转化生长因子β抑制胶原酶表达及其在增生性瘢痕形成中的作用

目的:观察转化生长因子(transforminggrowthfactor-β,TGF-β)、透明质酸和4-硫酸软骨质(chondroitin-4-sulfate,Ch-4-S)对增生性瘢痕(hypertrophicscar,HTS)成纤维细胞胶原酶和金属蛋白酶组织抑制因子(tissueinhibitorofmetalloproteinase-1,TIMP-1)表达的影响,探讨它们在HTS形成中的作用。方法:应用组织块培养法培养成纤维细胞,用原位杂交检测胶原酶和TIMP-1的表达。结果:TGF-β抑制胶原酶表达,其阳性细胞百分率为36%,明显低于对照组(t=4.52,P<0.05)。TGF-β促进TIMP-1的表达,其阳性细胞百分率为69.25%,明显高于对照组(t=3.62,P<0.05)。透明质酸上调胶原酶的表达,阳性细胞百分率为72.75%,显著高于对照(t=5.86,P<0.01)。结论:TGF-β抑制胶原酶表达,阻止胶原降解可能是增生性瘢痕形成的重要原因。透明质酸促进胶原酶表达,减轻瘢痕形成。     

肥厚性瘢痕胶原降解代谢的初步探讨

探讨肥厚性瘢痕形成及药物治疗的部分机理。方法：测定正常皮肤、瘢痕治疗前后的胶原代谢变化。结果：瘢痕的胶原合成明显高于正常皮肤,降解略增高。药物治疗后,其降解显著增高,合成无明显变化。结论：肥厚性瘢痕的合成与降解代谢的增高,以降解为主。药物治疗瘢痕的机制主要是增加其降解代谢。     

肥厚性瘢痕胶原降解代谢的初步探讨

目的：探讨肥厚性瘢痕形成及药物治疗的部分机理。方法：测定正常皮肤、瘢痕治疗前后的胶原代谢变化。结果：瘢痕的胶原合成明显高于正常皮肤,降解略增高。药物治疗后,其降解显增高,合成无明显变化。结论：肥厚性瘢痕的合成与降解代谢的增高,以降解为主。药物治疗瘢痕的机制主要是增加其降解代谢。     

碱性成纤维细胞生长因子与瘢痕成纤维细胞Ⅰ、Ⅲ型胶原蛋白的代谢

背景:研究证实碱性成纤维细胞生长因子有促进创面愈合的作用,然而其在促进创面愈合的同时是否会引起成纤维细胞的增殖而导致瘢痕增生已受到学者的广泛关注.目的:探讨碱性成纤维细胞生长因子对瘢痕成纤维细胞Ⅰ、Ⅲ型胶原蛋白合成和降解的调控作用.方法:增生性瘢痕组织取自中山大学附属第一医院烧伤科行瘢痕整复术的患者,组织块法培养瘢痕成纤维细胞.取第2代细胞,采用氯胺T法、RT-PCR和Western blot法检测不同浓度(0～500μg/L)碱性成纤维细胞生长因子对瘢痕来源的成纤维细胞Ⅰ、Ⅲ型胶原蛋白及细胞基质金属蛋白酶1合成和分泌的影响.结果与结论:碱性成纤维细胞生长因子对瘢痕成纤维细胞羟脯氨酸及Ⅰ、Ⅲ型胶原蛋白mRNA的表达均无促进作用.低质量浓度碱性成纤维细胞生长因子对细胞基质金属蛋白酶1的表达无明显影响,但随着质量浓度的升高表现为增高趋势,以50,100,500μg/L组增高最显著(P<0.05或P<0.01).同时,细胞基质金属蛋白酶1的表达在细胞与上清中变化一致.说明高质量浓度碱性成纤维细胞生长因子可以通过增加细胞基质金属蛋白酶1的合成来促进胶原蛋白降解,从而避免细胞外基质的过度沉积.     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。