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。     

丰富环境对卒中后认知障碍小鼠认知功能及突触可塑性的影响

目的探讨丰富环境干预对卒中后认知障碍小鼠认知功能的影响及相关作用机制。 方法采用光栓法制作小鼠卒中后认知障碍模型,采用随机数字表法将实验小鼠分为假手术标准环境组（Sham+SE组）、卒中后认知障碍标准环境组（PSCI+SE组）和卒中后认知障碍丰富环境组（PSCI+EE组）。各组小鼠在相应环境下分别饲养28d后,采用水迷宫检测小鼠认知功能,采用电生理方法检测小鼠海马长时程增强,采用Western blot法检测海马突触素表达情况,采用电镜定量检测海马CA1区神经元突触超微结构变化。 结果与Sham+SE组小鼠比较,PSCI+SE组小鼠水迷宫成绩显著下降（P<0.05）,卒中对侧海马长时程增强诱导障碍（P<0.05）,海马CA1区突触素表达显著降低（P<0.05）,海马CA1区神经元突触数量、突触间隙宽度、突触后膜致密物厚度及突触界面曲率均发生明显不良改变（P<0.05）;PSCI+EE组小鼠水迷宫成绩、海马长时程增强、CA1区突触素表达、CA1区神经元突触结构均较PSCI+SE组有显著改善（P<0.05）,但与Sham+SE组间差异仍具有统计学意义（P<0.05）。 结论丰富环境干预可改善卒中后小鼠认知功能,其作用机制与提高卒中对侧海马突触可塑性有关。     

电针百会、大椎、肾俞穴对SAMP8小鼠学习记忆与海马CA1区神经元突触的影响北大核心CSCD

目的观察电针百会、大椎、肾俞穴对SAMP8小鼠学习记忆与海马CA1区神经元突触的影响,探讨电针治疗阿尔茨海默病(AD)的机制。方法 7月龄SAMP8小鼠24只随机分为模型组和电针组,同龄正常老化SAMR1小鼠12只为对照组。电针组电针百会、大椎、肾俞穴30 d。Morris水迷宫检测小鼠学习记忆能力,免疫组织化学观察小鼠海马CA1区突触素(SYN)及突触后致密区蛋白95(PSD95)的表达,透射电镜观察小鼠海马CA1区突触超微结构的变化。结果与模型组相比,电针组逃避潜伏期缩短(P<0.05),原平台象限停留时间延长(P<0.05),穿越原平台次数增加(P<0.05),海马CA1区SYN与PSD95表达显著提高(P<0.001),突触结构较完整,数量增加。结论电针能提高小鼠海马CA1区神经元突触蛋白的表达,改善突触的超微结构,从而有效改善SAMP8小鼠的学习记忆能力。     

成对关联刺激对脑梗死大鼠突触可塑性和神经元凋亡及脑源性神经营养因子的影响

目的 观察成对关联刺激（PAS）对缺血性脑梗死大鼠缺血半暗带皮质突触超微结构、神经元凋亡的影响,并探讨其可能作用机制。 方法 健康雄性Sprague-Dawley大鼠45只,随机分为三组：假手术组、手术对照组及PAS组,每组15只。手术对照组和PAS组采用线栓法行右侧MCAO造模,假手术组行同样操作,但不栓塞大脑中动脉。造模成功后24 h,PAS组给予0.05 Hz、共90对脉冲的PAS干预,持续30 min,每天1次,连续28 d（周围神经电刺激强度为6 mA,波宽200 μs;经颅磁刺激强度120%RMT）,手术对照组及假手术组大鼠正常饲养但不给予任何干预。术后28 d取大鼠脑组织,采用透射电镜观察缺血半暗带皮质突触超微结构的变化、TUNEL法检测缺血半暗带皮质神经元凋亡情况、实时荧光定量PCR（RT-PCR）检测缺血半暗带皮质BDNF mRNA表达水平。 结果 ①术后28 d,与假手术组相比,手术对照组和PAS组突触界面曲率、突触活性区长度及突触后膜致密物质厚度减小（P<0.05）;与手术对照组相比,PAS组突触界面曲率、突触活性区长度及突触后膜致密物质厚度增加（P<0.05）。②术后28 d,与假手术组相比,手术对照组和PAS组皮质神经元凋亡比率明显增加（P<0.05）;PAS组皮质神经元凋亡比率明显低于手术对照组（P<0.05）。③术后28 d,PAS组BDNF mRNA表达水平明显高于假手术组及手术对照组（P<0.05）,手术对照组BDNF mRNA表达水平显著低于假手术组（P<0.05）。 结论 PAS可调节缺血性脑梗死大鼠神经可塑性、抑制神经元凋亡,而上调缺血半暗带皮质BDNF mRNA的表达水平可能是其作用机制之一。     

丰富环境通过激活Wnt/β-catenin信号通路促进脑缺血小鼠海马区的突触重塑

目的 探讨丰富环境饲养促进脑缺血小鼠海马区突触重塑的作用机制。 方法 清洁级成年雄性小鼠（C57BL/6）60只,按随机数字表法选取16只设为假手术组,剩余44只接受永久性左侧大脑中动脉栓塞(pMCAO)手术。将造模成功的32只小鼠随机分为标准饲养组和丰富环境组,每组16只。术后3 d行丰富环境干预,假手术组和标准环境组置于标准环境鼠笼中饲养,丰富环境组置于丰富环境鼠笼中饲养,持续干预28 d;干预28 d后,采用透射电镜技术及蛋白免疫印迹检测技术,分别检测和观察分析3组小鼠海马CA3区的突触数量以及海马区Wnt7a、Dvl1、β-catenin、突触素、PSD-95蛋白表达水平的变化。 结果 与标准环境组相比,丰富环境组海马区突触素、PSD-95、Wnt7a、Dvl1、β-catenin的蛋白表达水平显著升高,与标准饲养组比较,差异均有统计学意义(P<0.05)。丰富环境组海马CA3区的突触数量亦明显高于标准饲养组（P<0.05）。 结论 丰富环境可以激活脑缺血小鼠海马区Wnt7a-β-catenin-Dvl1信号通路,从而促进脑缺血小鼠海马区突触重塑。     

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。     

缺氧缺血性脑损伤对新生大鼠发育期间额叶皮质突触质量的影响

目的：探讨缺氧缺血性脑损伤(hvpoxia ishemia brain damage，HIBD)对新生大鼠发育期间额叶皮质突触质量的影响：方法：取7日龄Wistai仔鼠80只，采用抽签法将每窝仔鼠随机分成实验组(E组)和假手术组(对照组C组)。实验组鼠在乙醚麻醉下行颈前正中切口，分离右侧颈总动脉，1号手术线结扎，保温2h后，放人含8％氧气的氮氧混合气体的容器内2h，制成HIBD模型。假手术组只分离该血管，不结扎也不低氧处理。从生后7d到2个月(成年)分8个时段对额叶皮质的发育，采用形态学和形态计量法的方法进行长期跟踪研究，结果：实验组6h～7d各组可见神经元、胶质细胞及毛细血管间隙变大，神经元胞质内出现空泡，线粒体肿胀、嵴模糊，RER肿胀脱颗粒，核皱缩不规则甚至溶解，神经元突起比假手术组稀疏。脑损伤后仔鼠额叶皮质神经元及神经纤维的密度显著降低(P&;lt;0．05，P&;lt;0．01)，突触的体视学参数，表面积密度和面数密度降低，突触后膜致密层变薄(P&;lt;0．05．P&;lt;0．01)。结论：缺氧缺血性脑损伤对新生大鼠发育期间额叶皮质中突触的质量，神经元及神经纤维密度的影响，是影响智力发育的重要因素。     

慢病毒介导EPhrinB2基因转染骨髓间充质干细胞对脑瘫大鼠脑损伤的保护作用

目的 观察慢病毒介导EPhrinB2基因转染骨髓间充质干细胞（BMSCs）对脑瘫大鼠脑损伤的保护作用及相关机制。 方法 从大鼠中分离、培养BMSCs,以慢病毒为载体介导EPhrinB2转染BMSCs。采用随机数字表法将96只大鼠分为假手术组、溶剂对照组（简称PBS组）、空载慢病毒组（简称EGFP/BMSCs组）及EPhrinB2重组慢病毒组（简称EPhrinB2/BMSCs组）。选用改良缺氧缺血脑病（HIE）造模方法将PBS组、EGFP/BMSCs组及EPhrinB2/BMSCs组大鼠制成脑瘫模型,于术后7 d时分别将PBS溶液、BMSCs或慢病毒介导EPhrinB2基因转染BMSCs注射到PBS组、EGFP/BMSCs组、EPhrinB2/BMSCs组大鼠侧脑室内。于脑损伤28 d后采用免疫组织化学法检测各组大鼠海马组织EPhrinB2蛋白表达;采用HE染色方法观察细胞移植后大鼠海马CA1区神经元密度;采用TUNEL法检测大鼠海马神经元凋亡情况;采用免疫荧光法检测大鼠海马区Nestin及CD31表达水平。于脑损伤28 d后采用Morris水迷宫检测各组大鼠学习、记忆能力变化。 结果 脑损伤28 d后,发现EPhrinB2/BMSCs组海马组织EPhrinB2蛋白表达均显著高于假手术组、PBS 组及EGFP/BMSCs组,组间差异均具有统计学意义（P<0.05）;另外EPhrinB2/BMSCs组海马CAl区病理改变明显轻于PBS 组及EGFP/BMSCs组;EPhrinB2/BMSCs组海马区神经元凋亡率明显低于其它各组(P<0.05)。另外免疫荧光检查显示EPhrinB2/BMSCs组海马Nestin及CD31阳性率均显著高于其它各组。远期行为学测试结果显示EPhrinB2/BMSCs组Morris水迷宫实验平均潜伏期明显优于PBS 组及EGFP/BMSCs组(P<0.05)。 结论 慢病毒介导EPhrinB2转染BMSCs移植到脑瘫大鼠侧脑室海马区能高效表达EPhrinB2基因,有助于神经元细胞分化及血管新生,抑制细胞凋亡,加速受损神经功能恢复。     

外源性神经生长因子对血肿灶周神经元再生的影响

目的:观察神经生长因子作用下血肿灶周神经元再生状况。方法:实验于2003-03/2004-04在河北医科大学第二医院影像科分子影像学实验室完成。健康家犬21只,随机分为3组:神经生长因子组(n=9):注血后0.5h,将神经生长因子2000AU立体定向导入血肿灶周区。脑出血对照组(n=6):只注血,不注药。对照组(n=3):只进针,不注血和注药。3组动物进入实验程序后前3d进行BrdU标记,在脑出血后3,10,28d3个时间点进行激光共聚焦显微镜检测,观察血肿灶周BrdU荧光单标和BrdU-NSE及BrdU-GFAP荧光双标细胞的数目和所在位置(BrdU为新生神经元的标记物,NSE为成熟神经元的标记物,GFAP为成熟星形胶质细胞的标记物)。结果:实验动物21只均进入结果分析。①新生神经元数目:神经生长因子组3,10,28d时BrdU单标阳性细胞数多于脑出血对照组(2.31±0.24,9.52±1.87,4.43±0.56;0.12±0.14,3.85±1.87,1.41±0.32,P<0.05),10和28d时BrdU-NSE和BrdU-GFAP双标阳性细胞数明显多于脑出血对照组(BrdU-NSE:3.84±0.24和6.23±1.92,1.35±0.71和1.39±0.24;BrdU-GFAP:4.51±2.08和10.53±2.47,1.65±0.08和1.37±0.13,P<0.05);神经生长因子组10d时BrdU单标阳性细胞数最多,28d时BrdU-NSE和BrdU-GFAP双标阳性细胞数明显增多。②新生神经元分布:神经生长因子组双标细胞的分布多位于血肿靠近额叶皮质面,在皮质与皮质下移行区内可见双标细胞,而脑出血对照组极罕见。结论:外源性神经生长因子立体定向导入血肿灶周区,能够通过刺激额叶皮质内源性神经干细胞再生、迁徙和分化的机制,促进血肿灶周神经功能的修复。     

脐带间充质干细胞移植治疗大鼠脑缺血损伤

背景:对于缺血性脑卒中至今尚无确实有效的药物治疗,干细胞因其具有高度自我更新能力和多向分化潜能,使其重建中枢神经系统结构与功能成为可能。目的:观察脐带间充质干细胞移植治疗缺血性脑卒中模型鼠的效果及安全性,并探讨其可能机制。方法:体外分离人脐带间充质干细胞,移植前以BrdU标记。将SD雄性大鼠制作大脑中动脉闭塞模型后随机分为3组:移植组于造模后第7天,移植脐带间充质干细胞到损伤侧纹状体,PBS组给予等量PBS,模型组大鼠不做处理。结果与结论:①人脐带间充质干细胞移植组大鼠mNSS评分恢复优于模型组(P<0.05);模型组mNSS评分在损伤后35d内恢复速度慢于模型组(P<0.05),至第56天与模型组比较差异无显著性意义(P>0.05)。②移植组大鼠损伤中心及周围均可见Brdu染色阳性细胞及与Nestin、微管缔合蛋白2、胶原纤维酸性蛋白、Ⅷ因子、血管内皮生长因子免疫组织化学双染阳性细胞。表明脐带间充质干细胞可以在体外分离培养,移植后能在鼠宿主脑内存活、分化,促进大脑中动脉闭塞模型鼠神经功能的恢复。推测其机制可能与移植后细胞分化为神经元样和神经胶质细胞样细胞,并分泌或促进宿主分泌神经营养因子、促进新生血管形成有关。     

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.