重症胰腺炎并急性肺损伤大鼠肺组织蛋白激酶C与细胞外信号调节激酶的表达

目的探讨重症胰腺炎并急性肺损伤大鼠肺组织蛋白激酶C（PKC）与细胞外信号调节激酶（ERK）的表达及意义。方法健康成年雄性SD大鼠40只,随机分为对照组（n=8）与胰腺炎组,胰腺炎组再按6、12、24、48h分（B1、B2、B3、B4）亚组。以大鼠重症胰腺炎所致ALI为模型,采用酶联免疫吸附（ELISA）法检测血清TNF-α、IL-1β及IE-6,Western blot检测肺组织PKC与ERK的蛋白表达,EMSA检测NF-κB活性变化,观察肺脏含水量、肺脏病理变化。结果内毒素致重症胰腺炎并发急性肺损伤早期即发生肺血管通透性增高,肺脏含水量上升,组织学显示肺脏出现明显的病理损害,血清TNF-α、IL-1β及IL-6增高,肺组织PKC、ERK与NF-κB DNA活性同步增强。结论PKC与ERK的活化参与了重症胰腺炎时ALI的发病,即ERK／NF-κB信号通路的活化。     

失血性休克诱导小鼠肺组织巨噬细胞TLR4原位表达的变化

目的 复制失血性休克致急性肺损伤(ALI)模型,原位观察其肺组织巨噬细胞TLR4表达的变化及其意义.方法 32只C57BL/6雄性小鼠随机分为两组:NCG组为空白对照组,PCG组为单纯失血性休克组,分别于失血性休克后1、2、4、6 h处死小鼠.观察肺组织病理变化,EMSA检测肺组织核转录因子-κB(NF-κB)活性,ELISA检测肺组织肿瘤坏死因子-α(TNF-α)水平,激光共聚焦观察肺巨噬细胞TLR4原位表达的变化.结果 失血性休克诱导的ALI肺组织病理显示,随时间变化肺部损伤逐渐加重,NF-κB活性及TNF-α水平均随时间变化逐渐增加,与NCG组比较差异有统计学意义(P<0.05),原位观察肺巨噬细胞TLR4的表达亦随时间变化逐渐增加.结论 失血性休克诱导小鼠肺部的炎症反应,肺巨噬细胞TLR4的表达随时间变化逐渐增加,调控肺巨噬细胞TLR4的表达可能成为早期治疗失血性休克诱导ALI的一个新的途径.     

阻断toll样受体对脂多糖致急性肺损伤的保护作用

目的：本文旨在探讨阻断toll样受体（TRL4）对脂多糖（LPS）致急性肺损伤（ALI）的保护作用。方法将60只健康雄性清洁级SD大鼠分为正常组、损伤组和阻断组,每组20只。损伤组大鼠采用尾静脉注射LPS（6mg/kg）复制ALI模型;阻断组同时注射TLR4抗体（10mg/mL）;正常组给予等容积生理盐水。3h后处死大鼠,采用凝胶滞留法检测核因子-κB（NF-κB）活性;Westernblot印记分析法检测抑制蛋白（IκB-α）水平;检测肺组织匀浆肿瘤坏死因子α细胞因子（TNF-α）、白细胞介素-1β（IL-1β）和白细胞介素-10（IL-10）水平。结果与正常组相比,损伤组和阻断组肺组织湿质量/干质量比值增高,NF-κB活性升高,IκB-α、TNF-α、IL-1β水平升高（P＜0．05）,而IL-10水平降低（P＜0．05）。而比较损伤组与阻断组发现,阻断组肺组织湿质量/干质量比值降低,NF-κB活性降低,IκB-α、TNF-α、IL-1β水平明显低于损伤组（P＜0．05）,IL-10水平高于损伤组（P＜0．05）。结论采用抗TLR4单克隆抗体阻断TLR4介导的信号传导可明显降低NF-κB活性和IκB-α、TNF-α、IL-1β水平,同时提高IL-10水平阻断TLR4,对LPS致ALI有一定的保护作用。     

粒细胞-巨噬细胞集落刺激因子对失血性休克诱导急性肺损伤小鼠器官组织核转录因子-κB活化的影响

目的探讨特异性抗粒细胞-巨噬细胞集落刺激因子（GM—CSF）的抗体（22E9）和地塞米松（DEX）对失血性休克诱导急性肺损伤（ALI）小鼠肾、肝、心、肺组织核转录因子-κB（NF-κB）活化的影响，为失血性休克继发的多器官损伤防治提供理论依据。方法C57BL／6雄性小鼠20只，用心脏穿刺致失血性休克诱导ALI小鼠模型。制模前经鼻分别滴入磷酸盐缓冲液（PBS，PCG组）、PBS＋1μg 22E9（HS1组）、PBS＋10pg22E9（HS10组）、PBS＋20μgDEX（DEX组）进行干预，阴性空白对照组（NCG组）经鼻滴入PBS后仅予心脏穿刺。休克4h时采用凝胶电泳迁移率改变分析法（EMSA）检测肺、心、肝、肾组织NF—κB活性；用酶联免疫吸附法（ELISA）检测肺、心组织肿瘤坏死因子-α（TNF—α）含量。结果与PCG组比较，高、低剂量22E9均可显著抑制肝、心、肺组织NF—κB活性，且低剂量的抑制效果比高剂量明显，同时可增加肾组织NF—κB活性（P均〈0．05）。DEX可增强肾、肝组织NF—κB活性（P均〈0．05），但与PCG组比较，DEX对肾、肝、肺组织NF—κB活性未见明显的抑制作用。22E9干预可显著抑制心、肺组织TNF—α含量的升高，DEX仅能有效抑制心组织TNF—α含量（P均〈0．05）。结论22E9能显著抑制失血性休克诱导ALI小鼠多器官组织NF-κB的活化及炎症反应，减少失血性休克引起的多器官损伤；DEX的抑制作用不显著。     

乌司他丁对失血性休克复合内毒素模型兔肺组织中核因子-κB的影响

目的 探讨失血性休克复合内毒素打击兔急性肺损伤(ALI)中核因子-KB(NF-κB)的活化和肿瘤坏死因子-α(TNF-α)的释放及乌司他丁的抑制作用.方法 失血性休克复合内毒素打击法复制AU兔模型:90只兔随机分为对照组(A组)、创伤组(B组)和乌司他丁组(C组).各时相点检测动脉血氧分压(PaO2)、肺干质量/湿质量比值(D/W)、血清TNF-α浓度、肺组织内NF-κB的变化情况,并进行肺大体外观及组织病理学光镜检查.结果 与A组比较,B组PaO2进行性下降,C组Pao2于4 h达到最低值后逐渐上升;B组血清TNF-α含量及肺组织NF-κB p65的表达升高,并均于4 h达到最高峰(P<0.01),C组24 h、48 h时TNF-α含量及NF-κBp65的表达较B组明显降低(P<0.05).C组动物肺损伤程度明显减轻.结论 乌司他丁可通过抑制NF-κB活化,减少TNF-α等炎性介质的释放从而减轻肺损伤.     

抑制核因子-κB对Toll样受体4在急性坏死性胰腺炎大鼠胰腺组织中表达的影响

目的：观察急性坏死性胰腺炎（ANP）大鼠胰腺组织中Toll样受体4（TLR4）的表达情况。并且应用核因子（NF）-κB活化抑制剂四氢化吡咯二硫代氨基甲酸酯（PDTC）进行干预，观察阻断NF-κB以后，TLR4在ANP大鼠胰腺组织中表达的变化，探讨ANP中TLR4与NF-κB的关系及NF-κB的活性对TLR4表达的影响。方法：72只SD大鼠随机分为假手术组、ANP组和PDTC预处理组。采用胆胰管内逆行注射5%牛磺胆酸钠溶液诱导大鼠ANP模型。PDTC预处理组在建立模型前1h按100mg&#183;kg^-1腹腔注射给药。分别于建模后3h、6h、12h将大鼠分批处死。观察胰腺病理，用免疫组化及WesternBlot检测胰腺组织TLR4与NF-κB表达变化，RT-PCR检测胰腺组织TNFα、IL-1β和IL-6mRNA表达。结果：同假手术组相比，ANP组胰腺组织TLR4、NF-κB表达及TNFα、IL-1β和IL-6mRNA表达明显升高（P〈0.05）；同ANP组相比，PDTC预处理组胰腺组织炎症明显减轻，胰腺组织TLR4、NF-κB表达及TNFα、IL-1β和IL-6mRNA表达明显降低（P〈0.05）。结论：TLR4和NF-κB在ANP大鼠胰腺组织中的表达水平明显增高，PDTC抑制ANP大鼠胰腺组织中NF-κB表达的同时，下调TLR4蛋白水平表达和TNFα、IL-1β和IL-6mRNA表达。TLR4和NF-κB是介导炎症反应的枢纽，因而它们在ANP发生发展中起重要作用。TLR4和NF-κB可能不是简单的上下游关系，其关系还需进一步研究。     

硫化氢对大鼠内毒素性急性肺损伤炎性细胞因子的影响

目的 观察硫化氢(H2S)对脂多糖(LPS)所致大鼠内毒素性急性肺损伤(ALI)炎性细胞因子的影响,探讨其对肺脏的作用机制.方法 雄性SD 大鼠共48只,随机分为六组,每组8只:空白对照组、LPS 组、LPS+NaHS 低剂量组、LPS+NaHS 中剂量组、LPS+NaHS 高剂量组及LPS+PPG 组.所有大鼠均检测血清中白细胞介素-1β(IL-1β)和IL-10浓度的变化,取肺组织检测肺组织中IL-1β、IL-10、黏附分子-1(ICAM-1)mRNA基因表达变化及肺组织NF-κB p65活性变化.结果 与空白对照组比较,LPS组大鼠血清中IL-1β和IL-10浓度,肺组织中IL-1β、IL-10和ICAM-1 mRNA基因表达和NF-κB p65活性均明显升高(P<0.01).与LPS组比较,LPS+NaHS低、中、高剂量组血清中IL-1β浓度、肺组织中IL-1βmRNA基因表达和NF-κB p65活性均明显降低;LPS+NaHS中、高剂量组血清中IL-10浓度和IL-10 mRNA基因表达明显升高,ICAM-1 mRNA基因表达明显降低(P<0.05或P<0.01).与LPS组比较,LPS+PPG组血清中IL-1β浓度、肺组织中IL-1β和ICAM-1 mRNA基因表达及NF-κB p65活性均明显升高,血清中IL- 10浓度和肺组织中IL-10 mRNA基因表达明显降低(P<0.05或P<0.01).结论 H2S对内毒素诱导的ALI大鼠有保护性作用,其作用机制可能与H2S调节炎性细胞因子的生成有关.     

核因子-κB活化在急性肺损伤发病中的作用

目的 探讨核因子-κB(NF-κB)活化在炎症反应及其内毒素致伤大鼠急性肺损伤(acute lung injury，ALI)发病中的作用，为临床ALI防治提供理论依据。方法 观察内毒素(LPS)对大鼠血气分析和肺组织损伤的影响，采用凝胶电泳迁移率改变(EMSA)法检测肺组织核蛋白提取物中NF-κB活性及其特异性；并应用ELISA法检测肺组织匀浆TNFα含量的改变。结果 LPS静注可致大鼠急性肺损伤，肺组织核蛋白的NF-κB活性显著增强，肺组织匀浆TNFα含量显著升高。结论 LPS激活NF-κB启动TNFα表达，释放的TNFα与LPS进一步共同激活效应细胞的NF-κB活化，进而启动一系列参与炎症反应的炎症分子表达而参与大鼠急性肺损伤的发生。     

生长激素对急性肺损伤的影响

目的探讨应激反应阶段生长激素（GH）对脂多糖（LPS）诱导急性肺损伤（ALI）的影响及其机制。方法112只雄性SD大鼠随机均分为ALI组和GH组，按致伤与否及致伤后的观察时间又随机均分为0、0．5、1、2、4、6和24h7个亚组。分别测定大鼠肺泡隔面积密度（PASAD），肺泡隔中性粒细胞数，肺局部肿瘤坏死因子（TNF）和白细胞介素-6（IL-6）水平，肺组织核转录因子-κB（NF-κB）阳性细胞数和肺匀浆液中NF-κB抑制蛋白（I-κBα）含量。结果致伤后ALI组大鼠PASAD进行性增大，肺泡隔中性粒细胞数进行性增多，两者均于6h达峰值，24h基本恢复正常；GH组大鼠PASAD较ALI组同时间点进一步增大，中性粒细胞数增多更明显。ALI组致伤后0．5h肺局部TNF水平开始迅速升高，1h达峰值，其后维持在较高水平，6h后逐渐恢复；致伤后1h IL-6水平开始明显升高，4h达峰值，6h后逐渐恢复；GH组大鼠IL-6水平升高更明显。ALI组致伤后0．5h肺组织中NF-κB阳性细胞数明显增多，4h达峰值，6h开始恢复；GH组大鼠肺组织NF-κB阳性细胞数明显多于ALI组同时间点。伤后0．5h I-κBn含量开始明显下降，4h达最低值，6h后开始回升；GH组大鼠肺组织I-κBa含量下降更明显。相关性分析显示，PASAD、肺组织TNF和IL-6水平及肺泡隔中性粒细胞浸润程度与NF-κB的表达、活化程度呈正相关。结论NF-κB表达、活化在LPS诱导ALI的发病过程中有重要作用。应激反应阶段应用GH可加剧LPS诱导的ALI。其机制与促进肺局部NF-κB表达与活化而加剧肺局部炎症反应有关。     

过氧化物酶增殖体激活受体β激动剂对急性肺损伤NF-κB信号通路的影响

目的:研究过氧化物酶增殖体激活受体β(PPARβ)的激动剂对失血性休克诱导的急性肺损伤(ALI)大鼠肺组织NF-κB信号通路产生的影响。方法:复制失血性休克大鼠ALI模型,按完全随机原则将18只SD大鼠分为正常对照组(对照组)、失血性休克致ALI模型组(模型组)和PPARβ激动剂给药组(实验组)3组,每组6只大鼠。对照组不做任何处理;模型组先给大鼠静脉注射10%DMSO 3ml/kg,再复制失血性休克致ALI模型;实验组先给大鼠静脉注射PPARβ激动剂3ml/kg,再复制失血性休克致ALI模型。观察记录3组大鼠一般情况,观察动脉血气、肺湿/干(W/D)比值、肺组织病理改变,ELISA方法检测肺组织匀浆上清中IL-1和IL-10浓度水平,并使用Western blot方法检测肺组织NF-κB p65蛋白水平变化。结果:复制模型后1、2h,实验组大鼠PaO2高于模型组(P0.05)。实验组和模型组大鼠W/D比值明显高于对照组(P0.01),且实验组大鼠W/D比值明显低于模型组(P0.01)。苏木精-伊红染色显示,对照组大鼠肺泡结构清晰,未见明显炎性细胞浸润和渗出;模型组大鼠肺泡腔内有大量炎性细胞浸润,可见微血栓及透明膜形成;实验组大鼠肺泡腔内有少量炎性细胞浸润,可见少量微血栓及透明膜形成。实验组和模型组大鼠肺组织匀浆中IL-1浓度水平均高于对照组(P0.05),且实验组大鼠肺组织IL-1浓度水平低于模型组(P0.05)。实验组大鼠肺组织匀浆中IL-10浓度水平高于对照组和模型组(P0.05)。Western blot检测结果显示,模型组NF-κB p65蛋白相对表达量高于对照组(P0.05),实验组NF-κB p65蛋白相对表达量低于模型组和对照组(P0.05)。结论:PPARβ激动剂能明显抑制ALI后NF-κB的表达,抑制炎性反应,可能对ALI具有治疗价值。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.