乳酸和氢盐水联合后适应减轻心肌细胞凋亡

目的 探讨乳酸和饱和氢盐水能否模拟后适应通过丝裂原活化蛋白激酶途径(MAPK)减轻心肌细胞凋亡.方法 在济南军区总医院108只SD大鼠随机(随机数字法)分为假手术组、缺血-再灌注组(R/Ⅰ组,移除球囊后立即在缺血部位分三点注射生理盐水共计60μL,而后持续再灌注)、后适应组(M-Post组,后适应处理方案为20/20 s × 4,移除球囊后立即在缺血部位分三点注射生理盐水共计60 μL,而后持续再灌注)、乳酸组(Lac组,再灌注即刻微量注射器在缺血心肌部位分三点注射乳酸60 μL,而后持续再灌注)、饱和氢盐水组(Hyd组,再灌注即刻微量注射器在缺血心肌部位分三点注射氢盐水60μL,而后持续再灌注)、乳酸+饱和氢盐水组(Lac+ Hyd组,再灌注即刻微量注射器在缺血心肌部位分三点注射乳酸和氢盐水各60μL,而后持续再灌注),每组18只.心肌缺血45 min制作急性心肌梗死模型,测定每只大鼠再灌注3min后右心房血浆pH值.再灌注3min后每组取6只处死,取心肌组织采用硫代巴比妥酸法和分光光度计法测定心肌组织MDA含量和SOD活性.另再灌注30 min后每组取6只处死,取心肌组织用Western blot方法分别测定磷酸化MAPK(p38/JNK和ERK)、TNF-α、Caspase-8的表达.另再灌注24h后各组剩余6只大鼠测定血流动力学,处死后取心脏进行TUNEL凋亡检测.统计学多组间比较应用单因素方差分析,如组间差异显著则两两比较应用q检验.结果 Lac+ Hyd组再灌注后3rain右心房血浆pH值显著低于R/I组(7.32±0.06)vs.(7.43 ±0.03),P＜0.05; MDA含量显著低于R/I组(1.14±0.16) nmol/mgpro vs..(1.56±0.21)nmol/mgpro,P＜0.05;SOD含量显著高于R/I组(57.92±15.12) U/mgpro vs.(35.48 ±12.46) U/mgpro,P＜0.05.Lac+ Hyd组再灌注30 min后心肌组织P-p38 (0.46±0.06)vs.(2.18±0.32),P＜0.05;和P-JNK含量(0.59±0.03)vs.(1.62±0.29),P＜0.05,显著低于R/I组,TNF-α含量(0.34±0.08)vs..(1.78±0.31),P＜0.05;和Caspase-8含量(0.31±0.07)vs.(1.52±0.28),P＜0.05,均显著低于R/I组;心肌细胞凋亡指数显著低于R/I组(9.50±1.51)％vs.(15.21±1.91)％,P＜0.05.以上指标均与M-Post组相比均差异无统计学意义(P＞0.05).再灌注30 min后缺血心肌组织P-ERK含量Lac+ Hyd组与R/I组相似(0.55 ±0.13)vs.(0.57±0.05),P＞0.05;Hyd组显著低于R/I组(0.30 ±0.09)vs(0.57±0.05),P＜0.05;Lac、Hyd和Lac+Hyd组P-ERK表达均显著低于M-Post组(1.21±0.13),(0.30±0.09),(0.55±0.13)vs.(1.96±0.39),P＜0.05.结论 乳酸和饱和氢盐水联合使用可较好模拟后适应上游触发因子,抑制p38/JNK和ERK的磷酸化,减轻心肌细胞凋亡.     

内毒素预处理对兔肝脏缺血-再灌注后肺损伤的保护效应

目的 探讨内毒素预处理对肝脏缺血-再灌注后肺损伤的影响及机制.方法 将48只新西兰大白兔随机分为一般对照组(C一般组)和预处理对照组(C预处理组),缺血-再灌注组(IR组)和预处理再灌注组(LPS+IR组),每组12只.C一般组仅行手术解剖;C预处理组手术解剖前3 d分别经腹腔注射0.5、0.5和1.0 mg/kg脂多糖(LPS)进行内毒素预处理;IR组夹闭肝门30 rmn,再灌注4 h,进行肝脏缺血.再灌注;LPS+IR组行内毒素预处理后再行肝脏缺血.再灌注.检测各组再灌注后4 h血清内毒素、肿瘤坏死因子-α(TNF-α)、肺湿干比、灌洗液蛋白含量、组织匀浆丙二醛(MDA)、超氧化物歧化酶(SOD)、肺损伤率及肺泡巨噬细胞核因子-KB(NF-kB)活性的变化.组间比较采用单因数方差分析.结果 C一般组和C预处理组各项检测指标差异无统计学意义(P>0.05).LPS+IR组血清TNF-α[(48.31±5.31)pg/ml vs.(56.47±5.09)pg/ml,P<0.01]、肺湿干比[(4.98±0.33)vs.(5.22±0.31),P=0.03]、灌洗液蛋白含量[(0.68±0.11)g/L vs.(0.76±0.10)g/L,P:0.04]、MDA[(0.86±0.06)mnol/mg vs.(0.93±0.07)nmoL/mg,P=0.02]、肺损伤率[(13.4±4.3)%vs.(17.4±4.1)%,P=0.03]及肺泡巨噬细胞NF-kB活性[(5.82±1.12)OD/m2 vs.(7.40±1.26)OD/mm2,P<0.01]明显低于IR组;同时LPS+IR组SOD[(90.30±7.38)U/mg vs.(84.44±7.90)U/mg,P=0.04]明显高于IR组.结论 内毒素预处理可以减轻肝脏缺血.再灌注后肺损伤,其机制与降低了血清TNF-α产生及抑制肺泡巨噬细胞中NF-kB活化有关.     

三硝基丙酸预处理对缺血-再灌注兔心肌细胞凋亡的影响

目的 观察三硝基丙酸(3-NPA)预处理对缺血-再灌注兔心肌细胞凋亡的影响及其机制.方法 24只新两兰大耳兔随机分为对照组(C组)、实验组(3-NPA组)和阻滞剂组(5-HD)组),每组8只.5-HD组在开胸前24 h通过耳缘静脉注射特异性线粒体NIP敏感钾通道阻滞剂5-羟基癸酸(5 mg·kg-1),C组和3-NPA组注射同样体积的生理盐水.10 min后3-NPA组和5-HD组注射3-硝基丙酸(3mg·kg-1),C组注射同样体积的生理盐水.通过结扎兔左冠状动脉建立心肌缺血-再灌注动物模型,三组缺血 30 min再灌注120 min.检测再灌注120 min后心肌梗死面积、心肌细胞凋亡指数、Bcl-2和Bax蛋白的表达.对实验数据进行方差分析榆验.结果 3-NPA组的心肌梗死面积显著低于其它C组[(0.26±0.07)vs.(0.45±0.09),P＜0.01]和5-HD组[(0.26±0.07)vs.(0.40±0.07),P＜0.01];C组和5-HD组之间没有显著性差异[(0.45±0.09)vs.(0.40±0.07),P＞0.05].3-NPA组心肌细胞凋亡指数明显小于C组[(27.72±5.18)vs.(45.91±10.54),P＜0.01]和5-HD组[(27.72±5.18)vs.(43.44±7.33),P＜0.01].3-NPA组bcl-2表达高于另外两组[(0.123±0.046)vs.(0.079±0.019),(0.080±0.019),P＜0.05],而Bax明显低于另外两组[(0.095±0.020)vs.(0.14±0.05) and(0.15±0.05),P＜0.05].结论 3-NPA预处理对缺血-再灌注心肌具有良好的扰凋亡作用,这与其开放断线粒体ATP敏感钾通道有关.     

羟乙基淀粉对兔缺血-再灌注心肌的保护作用

目的 观察羟乙基淀粉(HES130/0.4)对兔心肌缺血一再灌注损伤的白细胞介素-8(IL-8)、内皮素-1(ET-1)和髓过氧化物酶(MPO)活性的影响,探讨其可能的保护机制.方法 36只大白兔随机分为乳酸林格氏液组(A组,n=12);白蛋白组(B组,n:12);羟乙基淀粉组(C组,n=12).A,B,C三组再灌注前15 min分别静脉注入6 mL/kg乳酸林格氏液、5%人体白蛋白或6%羟乙基淀粉,于缺血前(I_0)、缺血30 min(I_1)、再灌注60 min(R_1)、180 min(R_2)四个时点采血,检测血清乳酸脱氢酶(LDH)、肌酸磷酸激酶(CPK)、白细胞介素-8(IL-8)和内皮素-1(ET-1)的浓度.再灌注180 min处死大白兔测定心肌水含量、心肌梗死面积及髓过氧化物酶(MPO)活性.组间比较采用单因素方差分析(SNK-q检验),采用SPSS 12.0统计软件处理,以P＜0.05为差异有统计学意义.结果 三组血清LDH,CPK,IL-8和ET-1随再灌注时间延长而逐渐升高,在R2时点,C组增高的程度明显低于A组[(181±17)U/L vs.(334±39)U/L;(1927±205)U/L v8.(2987±326)U/L;(5.03±1.16)ng/L vs.(6.96±1.21)ng/L;(380.9±78.4)ng/L vs.(667.2±82.1)ng/L,P＜0.05]和B组[(181±17)u/Lvs.(320±38)U/L;(1927±205)U/L vs.(2218±290)U/L;(5.03±1.16)ng/L vs.(5.90±1.03)ng/L;(380.9±78.4)ng/L vs.(615.6±80.2)ng/L,P＜0.05];C组缺血区MPO活性(0.20±0.09)ng/L明显低于A组(0.48±0.15)ng/L和B组(0.37±0.12)ng/L(P＜0.05);C组的心肌含水量(76±8.23)%和心肌梗死面积(11.53±1.02)%分别显著低于A组[(86±5.66)%,(26.48±2.33)%]和B组[(82±6.42)%,(19.76±4.32)%](P＜0.05).结论 羟乙基淀粉对通过抑制IL-8及ET-1的生成和释放,降低缺血区MPO活性和毛细血管通透性,对缺血-再灌注损伤的心肌具有保护作用.     

黄芩茎叶总黄酮预处理对缺血再灌注心肌超氧化物歧化酶活性和丙二醛含量的影响

目的:分析黄芩茎叶总黄酮预处理对缺血再灌注心肌过氧化损伤的保护作用。方法:实验于2005-02/12在承德医学院解剖学研究室完成,选择雄性Wistar大鼠40只,按随机数字表法分为5组,即黄芩茎叶总黄酮预处理0.05,0.1,0.2g/(kg·d)组、缺血再灌注组和假手术组,每组8只。术前分别给予黄芩茎叶总黄酮预处理0.05,0.1,0.2g/(kg·d)组大鼠黄芩茎叶总黄酮0.05,0.1,0.2g/(kg·d)灌胃,连用1周;缺血再灌注组和假手术组给予等量生理盐水,至手术前24h。除假手术组外,其余大鼠均麻醉开胸暴露心脏,穿线结扎冠状动脉缺血30min,再灌注1h,制备缺血再灌注模型。假手术组只穿线不结扎。将实验过程中不符合要求的动物剔除。实验结束后,摘取大鼠心脏,测定心肌组织超氧化物歧化酶活性和丙二醛含量。结果:实验过程中将不符合要求的动物剔除,并予以补足,进入结果分析40只大鼠。①各组大鼠心肌组织超氧化物歧化酶活性比较:缺血再灌注组大鼠心肌组织中超氧化物歧化酶活性显著低于假手术组[(3.68±1.35,4.83±1.33)μkat/g(P<0.01)],黄芩茎叶总黄酮预处理0.05,0.1,0.2g/(kg·d)组均显著高于缺血再灌注组[(4.49±1.44,4.84±1.67,4.81±1.56)μkat/g(P<0.05～0.01)]。②各组大鼠心肌组织丙二醛含量比较:缺血再灌注组大鼠心肌组织中丙二醛含量显著高于假手术组[(6.77±4.38,3.86±1.76)nmol/g(P<0.01)],黄芩茎叶总黄酮预处理0.05,0.1,0.2g/(kg·d)组均显著低于缺血再灌注组[(2.73±1.99,3.81±2.10,2.82±2.29)nmol/g(P<0.05～0.01)]。结论:黄芩茎叶总黄酮预处理能通过增强心肌抗氧化酶的活性,抵制脂质过氧化反应,减轻自由基损害,对缺血再灌注心肌产生保护作用。3种剂量的黄芩茎叶总黄酮对缺血再灌注心肌均有不同程度的保护作用,其中0.1g/(kg·d)剂量组效果较好。     

瑞舒伐他汀对兔心肌缺血-再灌注损伤内皮功能的影响

目的 研究兔心肌缺血-再灌注损伤中内皮功能改变及瑞舒伐他汀对其影响.方法 将16只新西兰大白兔随机分为两组:心肌缺血-再灌注损伤组(对照组),瑞舒伐他汀干预组(药物组).建立心肌缺血-再灌注模型,心电图显示ST段明显弓背向上抬高(≥0.2 mV)表示结扎左前降支成功;40 min后剪断结扎线,心电图ST段回落1/2以上,标志再灌注成功.分别在缺血前,缺血40 min,再灌注60 min和再灌注180 min四个时相点留取血标本,检测一氧化氮(nitric oxide,NO)、内皮素-1(endothe-lin-1,ET-1)含量.运用SPSS 11.5软件,采用重复测量资料的方差分析,以P<0.05为差异具有统计学意义.结果 对照组与药物组血清NO含量随缺血及再灌注时间的延长而降低,血浆ET-1含量随缺血及再灌注时间的延长而增高;缺血前对照组与药物组血清N0含量[(109.875±32.255)μmol/Lvs.(114.500±37.405)μmol/L,P>0.05]及血浆ET-1含量[(221.111±28.125)pg/mL vs.(204.594±31.790)pg/mL,P>0.05]差异无统计学意义;缺血40 min、再灌注60 min、再灌注180 min时,药物组血清NO含量[分别为(63.125±18.962)、(43.500±16.518)、(29.625±14.162)μmol/L vs.(82.000±13.825)、(63.375±17.541)、(50.250±18.987)μmol/L,P<0.05]均显著高于对照组,药物组血浆ET-1含量[分别为(331.785±35.341)、(375.914±45.204)、(459.829±70.110)pg/mL vs.(282.541±38.928)、(315.152±55.263)、(377.795±60.427)pg/mL,P<0.05]均显著低于对照组.结论 瑞舒伐他汀通过升高血清中NO,降低血浆ET-1,从而改善兔心肌缺血-再灌注损伤时内皮功能.     

全反式维A酸对大鼠肝脏缺血再灌注损伤肝组织锰超氧化物歧化酶的影响

目的探讨全反式维A酸对大鼠肝脏缺血再灌损伤时肝脏组织锰超氧化物歧化酶(MnSOD)的影响。方法将18只雄性Sprague-Dawley(SD)大鼠随机分成3组(每组6只):假手术组、对照组、实验组。实验组腹腔注射全反式维A酸15mg.kg-1.d-1,对照组腹腔注射同体积中介液二甲基亚砜(DMSO),共14d。建立肝脏70%缺血再灌注模型,缺血1h复流24h后采集各组大鼠肝脏和血清,测定血清中ALT和AST,HE染色光镜下观察肝组织的变化;采用比色法检查肝组织丙二醛(MDA)含量和超氧化物歧化酶(SOD)的活性;Western blot和实时RT-PCR检测MnSOD蛋白含量和mRNA表达。结果相对于对照组,全反式维A酸能明显降低缺血再灌注后血清ALT水平[(138.61±54.63)U/Lvs.(458.53±83.17)U/L,P=0.001)]和AST水平[(355.57±70.92)U/Lvs.(1152.48±135.86)U/L,P=0.001)];明显改善缺血再灌注引起的肝脏组织学损伤;明显降低MDA的活性[(0.47±0.03)nmol/mgvs.(0.77±0.04)nmol/mg,P=0.001)],增加SOD的活性[(221.36±14.18)U/mgvs.(158.01±13.17)U/mg,P=0.001)];增加肝脏缺血再灌注后MnSOD的蛋白水平和MnSOD mRNA的表达(1.39±0.22vs.0.40±0.07,P=0.001)。结论全反式维A酸可以明显增加缺血再灌注时肝组织MnSOD表达,增加SOD的活性,减少细胞脂质过氧化,降低MDA的水平,从而减轻肝脏缺血再灌注损伤。     

缺血预处理程序中心肌环磷酸腺苷含量及环磷酸腺苷依赖蛋白激酶活性的变化

目的:制备大鼠在体缺血再灌注模型,观察缺血预处理程序中心肌环磷酸腺苷含量及环磷酸腺苷依赖蛋白激酶活性的变化。方法:实验于2005-03/2006-10在解放军沈阳军区总医院医学实验动物中心和全军心血管研究所实验室完成。实验分组:选用健康雌性SD大鼠36只,根据预适应程序分为第1,2,3次缺血,第1,2,3次再灌注,每一时间点6只大鼠。实验过程:用手术套管法造成左冠状动脉主干缺血及再灌注。所有实验动物在实验程序结束后,取出心脏迅速置液氮保存备用。实验评估:用放射免疫法测环磷酸腺苷水平,生化法测环磷酸腺苷依赖蛋白激酶活性变化。结果:36只大鼠均进入结果分析。①环磷酸腺苷含量:第1次再灌注组低于第1次缺血组[(0.325±0.015),(0.395±0.024)pmol/g,t=6.06,P<0.001],第2次再灌注组低于第2次缺血组[(0.523±0.017),(0.708±0.067)pmol/g,t=6.56,P<0.001],第3次再灌注组低于第3次缺血组[(0.567±0.031),(0.712±0.038)pmol/g,t=7.24,P<0.001]。②环磷酸腺苷依赖蛋白激酶活性:第1次再灌注组低于第1次缺血组[(10.115±1.000),(16.351±0.849)pkat/g,t=11.12,P<0.001],第2次再灌注组低于第2次缺血组[(11.877±2.213),(14.869±0.619)pkat/g,t=3.31,P<0.01],第3次再灌注组低于第3次缺血组[(11.745±0.987),(14.766±0.329)pkat/g,t=7.09,P<0.001]。③缺血预处理程序中心肌环磷酸腺苷含量及环磷酸腺苷依赖蛋白激酶活性随缺血及再灌注呈周期性波动。在5min缺血预处理时表现为明显增高,而在间隔的再灌注程序中恰呈相反改变,有明显下降的趋势。结论:环磷酸腺苷及环磷酸腺苷依赖蛋白激酶的周期性波动变化可能是激发心肌缺血预处理的机制之一,环磷酸腺苷可能在预处理保护作用中起一些作用。     

高压氧预处理对缺血-再灌注诱导糖尿病大鼠心肌细胞凋亡的影响

目的 探讨高压氧预处理对糖尿病大鼠心肌细胞凋亡的影响.方法 雄性Wistar大鼠45只,糖尿病造模成功后随机分为糖尿病对照组、糖尿病缺血-再灌注组、糖尿病高压氧预处理组,检测心肌凋亡及心肌Bax、Bcl-2蛋白表达.结果 与糖尿病缺血-再灌注组比较,糖尿病高压氧预处理组凋亡指数、Bcl-2蛋白灰度显著降低[(52.73±6.71)%vs(41.69±5.79)%,(183.33±9.15)vs(166.00±10.53),P<0.05],Bax蛋白灰度显著升高[(134.00±4.73)vs(141.17±6.77),P<0.05].结论 高压氧预处理有减少糖尿病大鼠心肌细胞凋亡的作用,其机制可能与下调Bax蛋白的表达,上调Bcl-2蛋白表达有关.     

缺血后处理对急性心肌梗死患者介入治疗后心肌组织水平灌注的影响

目的研究缺血后处理对急性心肌梗死患者介入治疗后冠状动脉血流速度及预后的影响。方法选取12h内接受急诊冠状动脉介入治疗的心肌梗死患者92例,分为两组:单纯再灌注组和缺血后处理组,测定校正TIMI帧数(CTFC)、血肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶(CK-MB)、丙二醛(MDA),术后8周测定室壁运动记分。结果缺血后处理组CTFC明显高于单纯再灌注组[(25.38±5.35)vs29.23±5.54,P<0.05];CK与CK-MB峰值明显低于单纯再灌注组[(1236.57±813.21)U/Lvs(1697.36±965.74)U/L,P<0.05;(116.92±75.83)U/Lvs(172.41±92.64)U/L,P<0.05];缺血后处理组术后各时点MDA水平均低于单纯再灌注组。术后8周缺血后处理组室壁运动恢复优于单纯再灌注组[(1.20±0.22)vs(1.32±0.25),P<0.05)]。结论缺血后处理可以改善介入治疗后冠状动脉血流速度,减少自由基的生成,改善心功能。     

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.