超声靶向微泡破裂联合PEI增强小鼠EGFP基因心肌转染

目的探讨超声靶向微泡破裂(UTMD)联合聚乙烯亚胺(PEI)增强BALB/c小鼠心肌绿色荧光蛋白基因(EG-FP)转染的可行性和应用价值。方法实验分为7组:PBS组、裸质粒组、质粒 超声辐照组(P US)、质粒 SonoVue 超声辐照组(P UTMD)、质粒 PEI组(P PEI)、质粒 PEI 超声辐照组(P PEI US)、质粒 PEI SonoVue 超声辐照组(P PEI UTMD)。由BALB/c小鼠尾静脉注入EGFP质粒和SonoVue微泡或PEI的复合物,处理4d后检测心肌基因表达效率及HE染色,并对超声辐照后的质粒完整性进行分析。结果电泳显示超声辐照不会损坏DNA或PEI/DNA复合物。非超声辐照时,EGFP只在心内膜下层表达;而超声辐照时,表达最强的位置为靠近探头的左室前壁;超声联合PEI时,EGFP的分布差异不明显。P PEI UTMD组的转染率最高,荧光强度最强。结论UTMD联合PEI可高效、靶向地将质粒DNA输送至心肌,这种非侵入性的技术在心脏基因治疗上很有前景,有望应用于迅速发展的心脏病基因疗法。     

超声靶向微泡破坏联合聚乙烯亚胺增强裸鼠移植瘤基因输送的初步研究

目的 探讨超声靶向微泡破坏(UTMD)联合聚乙烯亚胺(PEI)增强裸鼠Hela细胞(人宫颈癌)移植瘤基因输送的可行性和应用价值.方法 分别将2种质粒DNA[红色荧光蛋白质粒(RFP)和荧光素酶质粒(pCMV-LUC)]与PEI以不同氮/磷酸盐比(N/P比)混合,利用凝胶阻滞实验对PEI/DNA复合物进行分析.经荷瘤裸鼠尾静脉分别注入PBS、质粒、质粒+Sono Vue微泡、PEI/DNA复合物+Sono Vue微泡,仅对一侧肿瘤行超声辐照(3 MHz、2 W/cm2、2 min、20%占空比),另一侧肿瘤作为对照,并对该转染方法 的靶向性进行分析.超声辐照3 d后处死动物,行RFP表达观察、荧光素酶活性检测和组织学检查.结果 琼脂糖凝胶电泳显示PEI可有效地缩合质粒DNA.与裸质粒组比较,UTMD(超声辐照+Sono Vue微泡)能明显提高RFP转染率.与非辐照对照侧比较,UTMD的运用使RFP表达明显增强,荧光素酶活性增加了14倍(P＜0.01).UTMD联合PEI可显著增强基因转染,受辐照移植瘤的荧光素酶活性增加了10倍(P＜0.01);与非联合PEI时比较,荧光素酶表达增加了111倍(P＜0.01).无论有否超声照射,裸鼠其他器官组织中均无明显的基因表达(P＞0.05),且未观察到明显的组织损伤.结论 UTMD联合PEI可显著增强报告基因在肿瘤组织的靶向传输和转染,是一种很有前景、新型而安全的体内基因输送方法.     

超声微泡靶向破坏转染shRNA沉默Survivin表达诱导裸鼠宫颈癌移植瘤凋亡的研究

目的 通过超声微泡靶向破坏(UTMD)对靶向存活素的短发夹状重组质粒(Survivin-shRNA)进行转染,探讨其凋亡诱导效应、增殖抑制作用及其安全性.方法 将荷人宫颈癌(Hela)裸鼠随机分为三组:质粒+超声辐照(P+US)组,注入质粒溶液后予以超声辐照;质粒+微泡+超声辐照(P+UTMD)组,注入质粒/微泡复合物后辐照;对照组,不予任何处理.对组织样本行组织学检查,采用免疫组化SABC法检测移植瘤增殖细胞核抗原(PCNA)、Survivin、Bcl-2、Bax、Caspase-3、Ki-67、核干细胞因子(NS)、p53蛋白在各组肿瘤标本中的表达.结果 P+UTMD组的PCNA、Ki-67、Bcl-2、Survivin及NS蛋白表达下降,而Bax、Caspase-3、p53蛋白表达明显增加,与对照组及P+US组比较差异均有统计学意义(P＜0.05).结论 UTMD联合Survivin-shRNA能有效沉默Survivin基因表达,具有抑制增殖和促分化的作用,并诱发细胞凋亡,无明显副作用,为癌症基因疗法提供一种高效、无创、有前景的新方法.     

超声靶向微泡破坏联合聚乙烯亚胺增强小鼠肌肉基因转染的实验研究

目的 探讨超声(US)靶向微泡(MB)破坏(UTMD)联合聚乙烯亚胺(PEI)对小鼠肌肉基因转染的增强效果.方法 30只Balb/c小鼠随机分为6组,每组5只.绿色荧光蛋白(GFP)质粒DNA (20μg)按下列分组与SonoVue微泡和(或)PEI混合,注入小鼠后肢胫前肌内,然后予以治疗性超声辐照(声强2 W/cm2,占空比50％,超声辐照声强与占空比在实验前予以优化).A组:PBS组(空白对照组);B组:质粒+ US;C组:质粒+MB+ US;D组:质粒+PEI组;E组:质粒+PEI+ US组;F组:质粒+PEI+ MB+US组.10d后处死小鼠,立即取小鼠双后肢胫前肌冰冻切片,荧光显微镜计数GFP阳性肌纤维数.组织同时送检石腊切片,HE染色光镜观察有无炎性损伤及坏死.结果 A组肌肉组织内未见明显绿色荧光;B组可见绿色荧光表达肌纤维,计数为(14±3)个;C组GFP阳性纤维个数(58±6)个,D组(96±7)个,E组(119±11)个,F组(158±18)个.F组的GFP阳性纤维数最多,与其他各组比较差异均有统计学意义 (P＜0.05).各组石腊切片未显示明显的炎症反应和坏死.结论 UTMD联合PEI可显著提高小鼠肌肉组织的基因转染效率.     

载自杀基因的靶向微泡联合超声辐照抑制视网膜母细胞瘤的实验研究

目的探讨载自杀基因的靶向微泡联合超声辐照对视网膜母细胞瘤(RB)的抑制作用。方法制备携带单纯疱疹病毒Ⅰ型胸苷激酶(HSV1-tk)质粒和血管内皮细胞生长因子受体2抗体的靶向微泡,分为空白对照组、细胞+质粒组、细胞+质粒+Sono Vue组、细胞+靶向微泡组、细胞+质粒+超声辐照组、细胞+质粒+Sono Vue+超声辐照组及细胞+靶向微泡+超声辐照组进行实验。荧光显微镜观察各组基因转染情况,流式细胞仪检测转染率,加入丙氧鸟苷(GCV)后检测细胞的抑制率。结果细胞+靶向微泡+超声辐照组的转染率为(24.78±1.04)%,高于细胞+质粒+Sono Vue+超声辐照组(14.31±0.69)%,差异有统计学意义(P0.05)。随着GCV浓度的增加和培养时间的延长,各组抑制率逐渐升高。当GCV浓度为100 mg/L,培养96 h后,细胞+靶向微泡+超声辐照组对RB细胞的抑制率达(92.91±1.71)%。结论加入GCV后,携带HSV1-tk基因的靶向微泡联合超声能有效地抑制RB细胞。     

超声靶向微泡破坏技术介导基因JNK1在小鼠肝癌细胞株中表达及对细胞迁移和侵袭作用的研究

目的探讨应用超声靶向微泡破坏(UTMD)技术介导小鼠肝癌细胞株Hca-P JNK1基因的表达以及肝癌细胞迁移和侵袭。方法构建并鉴定pCDNA3.1-JNK1载体。将小鼠肝癌细胞株Hca-P分组如下:A组(空白对照组),B组(质粒组),C组(脂质体+质粒组),D组(超声微泡+质粒+超声辐照组),E组(脂质体+超声微泡+质粒+超声辐照组)。采用倒置荧光显微镜观察各组细胞的转染率,荧光定量PCR和Western Blot法检测JNK1的基因和蛋白质表达水平,以CCK-8法检测5组细胞的细胞活性,应用Transwell实验检测各组细胞的体外迁移和侵袭能力。结果成功构建了pCDNA3.1-JNK1载体。各组转染率比较:E组均大于B、C、D组(P均0.05),C、D组转染率均高于B组(P均0.05),C、D组之间差异无统计学意义(P0.05)。E组JNK1 mRNA和蛋白表达水平均高于其他各组(P均0.05);E组细胞活性、迁移和侵袭能力均高于其他各组(P均0.05)结论 UTMD技术结合脂质体转染法可以提高pCDNA3.1-JNK1载体转染小鼠肝癌细胞株Hca-P的效率,加大基因JNK1表达的上调幅度,增强细胞活性、迁移和侵袭能力。     

自制阳离子纳米泡介导HepG2细胞基因转染的实验研究

目的 观察自制阳离子纳米泡作为基因转染载体体外转染肝癌细胞系HepG2细胞的可行性.方法 将脂质体、聚乙烯亚胺(PEI)和全氟丙烷声振后制得微囊带有PEI的阳离子脂质体纳米泡(PNB),评价其基本特性,用其转染HepG2细胞,并辐照超声,荧光显微镜观察绿色荧光蛋白表达情况,流式细胞仪检测细胞转染率,CCK-8法评估其细胞活性.结果 制备的PNB表面带有正电荷,能阻碍质粒DNA在电场作用下发生迁移,且能有效地转染HepG2细胞,转染效率达30％～45％,辐照超声后转染效率明显提高(P＜0.05).结论 新型阳离子纳米泡在体外可作为基因转染载体,有效地携带质粒DNA并促进转染,辐照超声可使转染效率显著提高.     

载自杀基因的靶向微泡联合超声抑制视网膜母细胞瘤的实验研究

目的 探讨载自杀基因的靶向微泡联合超声对视网膜母细胞瘤（RB）的抑制作用。方法 制备携带单纯疱疹病毒Ⅰ型胸苷激酶（HSV1-tk）质粒和VEGFR2抗体的靶向微泡,分为空白对照组、细胞+质粒组、细胞+质粒+SonoVue组、细胞+靶向微泡组、细胞+质粒+超声辐照组、细胞+质粒+SonoVue+超声辐照组和细胞+靶向微泡+超声辐照组进行实验。荧光显微镜观察基因转染情况,流式细胞仪检测转染率,加入丙氧鸟苷（GCV）后,检测细胞的抑制率。结果 细胞+靶向微泡+超声辐照组的转染率为（24.78±1.04）%,较细胞+质粒+SonoVue+超声辐照组（14.31±0.69）%高。随着GCV浓度的增加,培养时间的延长,各组的抑制率逐渐升高。当GCV浓度在100 mg/l,培养96h后,细胞+靶向微泡+超声辐照组对RB细胞的抑制率达（92.91±1.71）%。结论 在加入GCV后,携带HSV1–tk的靶向微泡联合超声能有效的抑制RB细胞。     

超声靶向微泡破碎联合半乳糖聚乙烯亚胺介导凋亡素基因诱导肝癌细胞凋亡的研究

目的:探讨超声靶向微泡破碎(ultrasound targeted microbubble destruction,UTMD)联合半乳糖聚乙烯亚胺(PEI-Gal)介导凋亡素基因(VP3)诱导肝癌细胞HepG2凋亡的影响。方法:体外培养HepG2细胞,随机分为4组:(1)对照组;(2)PEI-Gal组;(3)PEI-Gal+超声组;(4)PEI-Gal+超声+微泡组。转染24h后荧光显微镜观察pEGFP-VP3在HepG2细胞中的表达,流式细胞仪检测转染效率,RT-PCR和Western blot分别检测VP3 mRNA和蛋白表达水平,AnnexinV-FITC/PI检测细胞凋亡率。结果:流式细胞仪、RT-PCR和Western blot分析表明,PEI-Gal+超声+微泡组的转染效率为(28.83±2.07)%、VP3 mRNA水平为0.92±0.02,蛋白水平为1.65±0.06,HepG2凋亡率为(37.40±2.12)%,均显著高于其他各组(均P<0.01)。结论:UTMD联合PEI-Gal可明显提高VP3基因转染HepG2细胞的效率及在HepG2细胞内的表达,增加HepG2细胞的凋亡率。     

超声辐照联合PEI介导基因转染的实验研究

目的 探讨超声联合聚乙烯亚胺(PEI)在促进肝癌细胞(HepG2)的基因转染中有无协同作用.方法 选用工业用和实验用PEI为研究对象.用锥虫蓝拒染法检测细胞成活率,选取合适的PEI浓度与绿色荧光蛋白基因(EGFP)质粒DNA共孵育,制备阳离子复合物(PEI/DNA)导入HepG2细胞中和/或辐照超声.24 h后荧光显微镜观察绿色荧光蛋白表达,流式细胞仪定量分析转染率.结果 超声可促进质粒DNA在HepG2细胞的基因转染.PEI对细胞有毒性,当PEI浓度为0.001%时细胞成活率约为70%,选此浓度用于基因转染实验.2种PEI复合物均能显著促进质粒DNA基因转染,其转染率高于单纯辐照超声介导的基因转染,差异有统计学意义(P＜0.01),2种PEI的转染率工业用组(15.42士4.71)%、实验用组(12.27±3.58)%之间的差异无统计学意义(P＞0.05),加入PEI联合辐照超声后转染率下降(P＜0.01).结论PEI和超声均能促进HepG2细胞基因转染,但PEI联合辐照超声后转染率明显下降,二者没有协同作用.工业用与实验用PEI一样具有促进基因转染的作用.     

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.