miR-34a调控下游基因FUT8表达介导乳腺癌多药耐药的实验验证

目的探究miR-34a及FUT8的异常表达对乳腺癌多药耐药性的调控机制,明确乳腺癌耐药的诊疗靶点。方法采用Real-time PCR及western blot技术检测MCF-7和MCF-7/ADR中miR-34a和FUT8的表达水平; Real-time PCR技术检测乳腺癌细胞系中miR-34a的转染效率;通过生物信息学方法预测并采用双荧光素酶报告实验验证FUT8与miR-34a之间的靶向关系;特异性调控miR-34a的表达后,分别通过Real-time PCR、western blot以及免疫荧光染色检测转染细胞系中FUT8基因及蛋白质水平变化;采用CCK8实验、免疫荧光实验检测其对MCF-7和MCF-7/ADR细胞增殖、耐药性的调控作用。结果 miR-34a在MCF-7中的表达水平明显高于MCF-7/ADR(P=0.002 6);FUT8基因在MCF-7/ADR中的表达水平明显高于MCF-7(P=0.001 6);FUT8是miR-34a调控乳腺癌耐药性的靶点(P=0.001 9);特异性上调MCF-7/ADR细胞中miR-34a的水平可明显抑制FUT8的表达,并抑制该细胞的多药耐药性及增殖性;而下调MCF-7细胞中miR-34a表达后,FUT8的表达水平明显升高,同时增强了细胞多药耐药及增殖能力。结论 miR-34a通过调控下游基因FUT8的表达介导乳腺癌多药耐药。     

β-elemene通过调节耐药特异性miRNA逆转乳腺癌细胞耐药性的机制研究

目的:探讨β-榄香烯逆转乳腺癌细胞耐药性的机制,明确其抗肿瘤作用。方法:通过向MCF-7细胞株培养基内逐渐增加临床上最常用于乳腺癌化学治疗的药物多西紫杉醇(Doc)或阿霉素(Adr),逐渐提高培养基中药物浓度的方法成功地构建出亲本细胞株MCF-7中耐药亚型,选择乳腺癌阿霉素耐药细胞(MCF-7/Adr)和乳腺癌多西紫杉醇(MCF-7/Doc)耐药细胞株,采用MTT-cytotoxic、miRNA微阵列、实时定量PCR、双荧光素酶活性测定等方法,研究β-elemene对乳腺癌耐药细胞生存率、耐药特异性miRNA29a、miRNA452、miRNA34a及miRNA222表达的影响。结果:β-elemene明显降低耐药乳腺癌细胞株细胞生存率和增殖率,β-elemene显著调节MCF-7/Adr和MCF-7/Doc细胞内miRNAs的表达水平,其中6个miRNAs上调,12个miRNAs下调显著。结论:β-elemene是一种从植物中提取的天然抗肿瘤中药成分,可以逆转乳腺癌细胞的耐药性。证实了中药β-elemene可以通过调控耐药相关miRNA表达的机制抗乳腺癌耐药细胞的耐药性。     

MicroRNA-29a在脂多糖诱导人单核细胞凋亡中的作用和机制

目的 探讨microRNA-29a (miR-29a)对人单核细胞株THP-1凋亡的作用及其机制.方法 体外培养人单核细胞株THP-1和人胚肾细胞株293T,合成人miR-29a的拟似物(mimic)和抑制剂(inhibitor).用脂质体Lipofectamine RNAiMAX转染miR-29a的mimic或inhibitor进入THP-1细胞,分组处理后收集细胞标本.第1组细胞转染mimic (100 nmol/L) 48 h;第2组细胞先转染inhibitor(100 nmol/L) 24 h,再用脂多糖(LPS)诱导24h,分别用流式细胞仪方法检测两组细胞凋亡,用real time RT-PCR方法检测抗凋亡基因Bcl-2和Mcl-1的表达变化.构建Bcl-2和Mcl-1的荧光素酶报告基因载体,用脂质体Lipofectamine 2000转染293T细胞(DNA质粒和miRNA片段共转染),双荧光素酶报告基因系统(luciferase)检测荧光素酶的表达变化.应用SPSS 13.0统计软件,采取单因素方差分析或t检验进行数据统计分析.结果 THP-1细胞转染miR-29a的mimic48 h后,细胞凋亡较对照组增加(17.38％增加至42.06％);单独用LPS诱导THP-1细胞,24 h后细胞凋亡较对照组增加;THP-1细胞先转染inhibitor 24 h后,再用LPS诱导24 h,细胞凋亡较单独用LPS诱导组减少(由51.50％降至38.09％);THP-1细胞转染miR-29a的mimic后,抗凋亡基因Bcl-2和Mcl-1的表达水平降低明显(P＜0.05).另外,Luciferase检测结果显示,在293T细胞中,双萤光报告系统显示miR-29a可特异抑制带有Bcl-2和Mcl-13'UTR上野生型识别元件的报告基因表达(P＜0.05).结论 上调miR-29a的表达水平能促进THP-1细胞发生凋亡,下调miR-29a的表达水平则能抑制LPS诱导的THP-1细胞凋亡,miR-29a调控THP-1的凋亡水平是通过靶向于两个抗凋亡基因Bcl-2和Mcl-1实现的,提示miR-29a在调控免疫细胞的凋亡过程中具有重要的作用.     

成人急性淋巴细胞白血病骨髓中miR-34a的表达及其在细胞耐药中的意义

目的:探讨miR-34a在成人急性淋巴细胞白血病(ALL)骨髓中的表达及其与耐药性的关系。方法:47例初诊ALL患者,分别于初诊和复发或完全缓解时留取骨髓样品,初诊-完全缓解组标本26对,初诊-复发组标本21对。利用实时荧光定量PCR对患者骨髓样品、人CCRF-CEM细胞株及其耐药株CEM-C1细胞中miR-34a表达水平进行检测。利用电穿孔转染法抑制CCRF-CEM细胞并上调CEM-C1细胞中miR-34a表达,分别用不同浓度喜树碱进行培养,利用CCK-8法对细胞存活情况进行分析,计算细胞增殖抑制率(%)和耐药指数(RI)。结果:初诊-完全缓解组中,初诊时患者骨髓样品中miR-34a表达水平显著低于完全缓解时和对照组,差异具有统计学意义(P0.05),初诊-复发组中,初诊时和复发时患者骨髓样品中miR-34a相对表达量均低于对照组,差异均有统计学意义(P0.05);miR-34a在CEM-C1细胞中表达水平为(2.64±1.37),显著低于CCRF-CEM细胞中的(5.14±2.06)(P0.05);转染miR-34a抑制物的CCRF-CEM细胞中miR-34a表达水平为(3.14±1.15),显著低于miRNA抑制剂阴性对照CCRF-CEM细胞(P0.05),转染miR-34a抑制物的CCRF-CEM细胞增殖抑制率显著高于转染阴性对照细胞(P0.05),IC_(50)分别为28.73和2167.00 ng/ml,RI=75.43;转染miR-34a模拟物的CEM-C1细胞中miR-34a表达水平(5.06±1.73),显著高于miRNA模拟物阴性对照CEM-C1细胞(P0.05),转染miR-34a模拟物的CCRF-C1细胞增殖抑制率显著低于转染阴性对照细胞(P0.05),IC_(50)分别为112.57 ng/m L和1.27 ng/m L,RI=88.64。结论:miR-34a在成人ALL骨髓样品中呈低表达,可能与ALL复发及耐药性的发生有关。     

miR-29a在乳腺癌组织中的表达及其对乳腺癌细胞增殖和迁移的影响

摘要：目的：检测miR-29a在乳腺癌组织中的表达水平并探讨其对人乳腺癌细胞增殖和迁移的影响。 方法：用荧光定量RT-PCR检测乳腺癌组织及癌旁组织中miR-29a的表达水平;用脂质体法将miR-29a mimic及miR-29a inhibitor分别转染乳腺癌细胞系MDA-MB-231,通过MTT实验和 Transwell实验观察miR-29a对MDA-MB-231细胞增殖和迁移能力的影响;miRanda软件预测miR-29a的靶基因,western blot验证其表达结果。 结果：荧光定量RT-PCR检测结果表明,与癌旁组织（2.17±0.89）比较,miR-29a在乳腺癌组织（5.65±1.45）中的表达水平上调（t=3.94,P＜0.01）;MTT实验和Transwell实验结果显示,与mimics阴性对照组［（106.36±5.15)%,(216.70±7.20）个］相比,miR-29a mimics组［（133.32±6.31）%,(294.30±8.60)个］乳腺癌细胞的增殖和迁移能力增加（t分别为3.36和6.85,P均＜0.01）;与inhibitor阴性对照组［（105.35±3.42）%,(240.30±9.50）个］相比,miR-29a inhibitor组［（66.63±3.82）%,(156.30±7.80）个］乳腺癌细胞的增殖和迁移能力降低（t分别为8.18和6.81,P均＜0.01）。miRanda软件预测人第10号染色体缺失的同源性磷酸酶-张力蛋白基因（PTEN）可能为miR-29a的靶基因。western blot结果显示,与mimics阴性对照组（0.55±0.01）相比,乳腺癌细胞转染miR-29a mimic后,其PTEN蛋白质的表达水平（0.22±0.01）下调（t=14.29,P＜0.01）;与inhibitor阴性对照组（0.49±0.02）相比,转染miR-29a inhibitor后,PTEN蛋白质的表达水平（1.25±0.02）上调（t=19.39,P＜0.01）。 结论：miR-29a在乳腺癌组织中的表达水平增高,并可能通过下调PTEN蛋白的表达促进乳腺癌细胞的增殖和转移。     

miR-497在乳腺癌中的表达及其机制研究

目的检测miR-497在乳腺癌组织中的表达水平,探讨其在乳腺癌细胞中的作用机制。方法 qRT-PCR法检测36例乳腺癌患者癌组织及癌旁组织中miR-497的表达水平;采用脂质体法将miR-497 mimics、mimics NC、miR-497 inhibitor和inhibitor NC分别转入MDA-MB-231乳腺癌细胞系,通过MTT实验和细胞迁移实验分析miR-497对MDA-MB-231细胞增殖和迁移能力的影响;采用靶基因预测软件Targetscan human release7.1预测miR-497的靶基因,western blot验证miR-497 mimics、mimics NC、miR-497 inhibitor和inhibitor NC对靶基因蛋白的影响。结果 qRT-PCR结果显示,与癌旁组织(7.76±1.58)比较,miR-497在乳腺癌组织中的表达水平(2.12±1.04)明显降低(t=17.85,P0.01);MTT实验结果显示,与mimics NC组[(104.36±3.25)%]比较,转染miR-497 mimics组[(67.56±4.11)%]的细胞增殖能力明显减弱(t=13.1,P0.01);细胞迁移实验证实,与mimics NC组比较,转染miR-497 mimics后的细胞迁移能力减弱(272.3±8.5 vs 173.6±7.1,P0.05);与inhibitor NC组比较,转染miR-497 inhibitor后细胞迁移能力增强(269.5±7.3 vs 346.1±13.5,P0.01);靶基因预测软件预测HSP40可能是miR-497的靶基因;western blot结果显示,与mimics NC组比较,miR-497 mimics转染后的HSP40蛋白表达水平下调(P0.01);而与inhibitor NC组比较,转染miR-497 inhibitor后其HSP蛋白的表达水平升高(P0.01)。结论 miR-497可能通过靶向HSP40抑制乳腺癌细胞的增殖和迁移,从而对乳腺癌进程起到调节作用。     

转染miR-544a对肺癌细胞侵袭和转移能力的影响

摘要：目的：探讨miR-544a对肺癌细胞的侵袭和转移能力的影响及其分子机制。 方法：用miRNA芯片对非小细胞肺癌(NSCLC)细胞系95C和95D进行miRNA谱系分析,并用荧光定量PCR验证其miR-544a表达水平;用Targetscan软件预测miR-544a的靶基因;Transwell实验观察细胞的侵袭转移能力的变化; western blot验证其表达。 结果：miRNA芯片及荧光定量PCR结果显示,与95C细胞（1.00±0.00）比较,miR-544a在95D细胞中表达上调（2.95±0.26,t=12.94,P<0.05）;Transwell实验结果显示,95C转染miR-544a mimic后增加（32.00±1.00,q=18.67,P<0.01）,95D转染miR-544ainhibitor后,侵袭和转移能力降低（11.00±1.00,q=13.67, P<0.01）;Targetscan软件预测E 钙粘连素（CDH1）可能为miR-544a的靶基因;western blot显示,95C转染miR-544amimic 后,CDH1表达下调,vimentin表达上调（0.202±0.017,0.574±0.009,q分别为63.86, 9.45,P均<0.01）;而 95D转染miR-544a inhibitor后,CDH1表达上调,而vimentin表达下调(0.769±0.014,0.320±0.020,q分别为18.67, 5.99,P均<0.01）。 结论：miR-544a可能通过下调CDH1和上调vimentin的表达来促进肺癌细胞的侵袭和转移。     

mir-17-5p、mir-92a、let-7b表达水平与非小细胞肺癌顺铂耐药的关系

目的探讨mir-17-5p、mir-92a、let-7b表达水平与非小细胞肺癌顺铂耐药关系。 方法以人非小细胞肺癌细胞系A549及其耐药株A549/DDP为研究对象,采用RT-PCR法检测mir-17-5p、mir-92a及let-7b在细胞中的表达水平,采用cck8检测其细胞存活情况,采用细胞克隆平台方法,检测转染前后细胞的增殖情况,采用流式细胞仪检测转染前后细胞的凋亡情况。 结果（1） A549/DDP细胞mir-17-5p的表达水平是A549细胞的2.11±0.25倍（P＜0.05）;A549/DDP细胞mir-92a的表达水平是A549细胞的 7.40 ± 1.05 倍（P＜0.05）;而A549/DDP 细胞let-7b 的表达水平是A549 细胞的（26.54 ± 2.90）%（P＜0.05）;（2）A549 转染mir-17-5pmimic,mir-92a mimic 以及let-7b inhibitor 后对顺铂的敏感性下降（P＜0.05）;A549/ddp 转染mir-17-5p inhibitor, mir-92a inhibitor以及let-7b mimic后对顺铂的敏感性增加（P＜0.05）;（3）A549转染mir-17-5p mimic,mir-92a mimic以及let-7b inhibitor 后,细胞形成克隆集落数量数量多于对照组（P＜0.05）;而A549/ddp 转染mir-17-5p inhibitor,mir-92a inhibitor 以及 let-7b mimic 后,细胞形成克隆集落数量数量少于对照组（P＜0.05）;（4）A549 转染mir-17-5p mimic,mir-92a mimic 以及let-7b inhibitor后,细胞凋亡率明显低于对照组（P＜0.05）;而a549/ddp转染mir-17-5p inhibitor,mir-92a inhibitor以及let-7b mimic后, 细胞凋亡率明显高于对照组（P＜0.05）。结论Mir-17-5p、mir-92a表达水平升高,let-7b表达水平下降,可以促进肺癌细胞增殖, 抑制其凋亡以及使肺癌细胞对顺铂敏感性下降。      

miR-181a在急性淋巴细胞白血病患儿中的表达及其功能研究

目的 检测microRNA-181a(miR-181a)在急性淋巴细胞白血病(ALL)患儿中的表达水平,并研究其在ALL细胞株CCRF-CEM细胞及耐药株CEM-C1细胞中的功能.方法 采用实时荧光定量PCR方法检测ALL患儿骨髓样本、ALL细胞株CCRF-CEM细胞及其耐药株CEM-C1细胞中miR-181a的表达水平.采用电穿孔转染的方法抑制耐药株CEM-C1细胞并上调非耐药株CCRF-CEM细胞中miR-181a的表达,予不同浓度梯度(终浓度分别为0.01、0.1、1、10、100、1 000 ng/ml)喜树碱处理后,采用CCK-8法观察各浓度梯度喜树碱处理后细胞的存活情况,绘制细胞增殖抑制曲线并计算半数抑制浓度(IC50).结果 初诊-复发组患儿初诊及复发骨髓样本miR-181a相对表达水平(4.84±2.71及6.53±2.20)均高于对照组(1.41±0.53)(P=0.017、0.001),初诊-完全缓解组患儿初诊骨髓样本miR-181a水平(7.58±2.50)较对照组明显升高(P=0.000),而完全缓解后miR-181a水平下降至1.35±0.35,与对照组比较差异无统计学意义(P=0.863).CEM-C1细胞miR-181a相对表达水平(-4.39±0.08)较CCRF-CEM细胞(-2.32±0.03)明显升高(P=0.000).转染miR-181a抑制剂CEM-C1细胞较转染阴性对照组增殖抑制率明显升高(P＜0.05),IC50分别为30.61、2 255.00 ng/ml,耐药指数(RI) =73.67.miR-181a过表达CCRF-CEM细胞较阴性对照组增殖抑制率明显降低(P＜0.05),IC50分别为126.60、1.34 ng/ml,RI=94.26.结论 ALL患儿骨髓及CEM-C1细胞中miR-181a异常高表达,抑制CEM-C1细胞中miR-181a的表达可明显增加CEM-C1细胞的药物敏感性,在CCRF-CEM细胞中上凋miR-181a的表达能明显增加CCRF-CEM细胞的耐药性.     

微小RNA-221在宣威肺癌细胞中对靶基因p53正向凋亡调控因子调控机制的研究

目的探讨宣威肺癌细胞中微小RNA-221(miR-221)对靶基因p53正向凋亡调控因子(PUMA)的调控机制。方法在宣威肺癌细胞株(XWLC-05)中转染miR-221过表达/抑制表达载体后,将实验分为4组,Control组:未转染任何质粒;Scramble组:转染PUMA质粒;Over-miR-221+PUMA组:转染miR-221过表达载体、PUMA质粒;In-miR-221+PUMA组:转染miR-221抑制表达载体、PUMA质粒。应用实时荧光定量PCR技术检测各组PUMA在mRNA水平的表达差异。荧光素酶报告实验验证PUMA是否为miR221的靶基因。四甲基偶氮唑蓝(MTT)比色法分析miR221对细胞增殖的影响。检测Caspase3/7、9活性分析miR221对细胞凋亡的影响。结果 miR-221可以直接作用于PUMA基因的3’UTR端(t=-8.662,12.761,P<0.001);过表达转染组能够有效地促进宣威细胞增殖,抑制表达转染组能够有效地抑制宣威细胞增殖(24 h:F=98.181,P<0.001;48 h:F=109.561,P<0.001;72 h F=143.782,P<0.001)。在抑制表达转染组中Caspase3/7、9的酶活性是升高的(t=12.851,15.491,P<0.001);而过表达转染组中Caspase 3/7、9酶活性与Control组及Scramble组差异无统计学意义(t=-2.181,P=0.061;t=-2.056,P=0.074);各组PUMA基因的表达差异无统计学意义(H=1.262,P=0.532)。结论 PUMA为miR-221的靶基因之一,miR-221可能通过负向调控靶基因PUMA参与宣威肺癌的发生、发展。     

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.     

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.     

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.     

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.