联合转染mdr1和mcl1基因短发夹RNA干扰表达质粒逆转K562/A02细胞耐药的实验研究

目的构建针对mdr1和mcl1基因的短发夹RNA(shRNA)干扰表达质粒,并探讨联合转染对K562/A02细胞耐药的逆转作用.方法根据mdr1和mcl1基因表达序列设计有效的RNA干扰片段,分别将其构建入质粒表达空载体中,以获得两种基因特异性shRNA干扰表达质粒;然后在脂质体介导下分别和联合转染K562/A02细胞,用G418和(或)Hygro B筛选出稳定表达的细胞克隆.用RT-PCR分析mdr1和mcl1 mRNA的表达;MTT法检测阿霉素对K562/A02细胞的半数抑制浓度(IC50);流式细胞术测定细胞P-糖蛋白表达水平以及细胞凋亡率.结果成功构建两个基因的shRNA干扰表达质粒.mdr1、mcl1 shRNA干扰表达质粒单独和联合转染K562/A02细胞可有效封闭相应基因表达,联合转染组mdr1基因和mcl1基因的mRNA相对表达水平分别是未转染细胞的52%,44%.mdr1、mcl1 shRNA干扰表达质粒单独和联合转染后K562/A02细胞耐药逆转率分别为63.8%,71.1%,83.1%,转染两种质粒组对K562/A02细胞耐药逆转率最高,P糖蛋白相对表达量由未转染组的19.70±1.15降至6.40±0.92(P《0.01),阿霉素诱导的细胞凋亡率由(1.53±0.42)%提高至(7.77±0.42)%(P《0.01).联合转染两种质粒组和单独转染组比较,细胞对阿霉素敏感性和阿霉素诱导的细胞凋亡率差异亦有统计学意义(P《0.05).结论转染mdr1或mcl1基因的shRNA干扰表达质粒可有效抑制相应基因表达,皆不同程度逆转K562/A02细胞对阿霉素的耐药性;联合转染两种质粒可显著增加逆转耐药的效果.mcl1基因可能与K562/A02耐药相关.     

联合转染mdrl和mcll基因短发夹RNA干扰表达质粒逆转K562/A02细胞耐药的实验研究

目的构建针对 mdrl 和 mell 基因的短发夹 RNA(shRNA)干扰表达质粒,并探讨联合转染对 K562/A02细胞耐药的逆转作用。方法根据 mdrl 和 mell 基因表达序列设计有效的 RNA 干扰片段,分别将其构建入质粒表达空载体中,以获得两种基因特异性 shRNA 干扰表达质粒;然后在脂质体介导下分别和联合转染 K562/A02细胞,用 G418和(或)Hygro B 筛选出稳定表达的细胞克隆。用RT-PCR 分析 mdrl 和 mcll mRNA 的表达;MTT 法检测阿霉素对 K562/A02细胞的半数抑制浓度(IC_(50));流式细胞术测定细胞 P-糖蛋白表达水平以及细胞凋亡率。结果成功构建两个基因的 shRNA干扰表达质粒。mdrl、mell shRNA 干扰表达质粒单独和联合转染 K562/A02细胞可有效封闭相应基因表达,联合转染组 mdrl 基因和 mell 基因的 mRNA 相对表达水平分别是未转染细胞的52%,44%。mdrl、mell shRNA 干扰表达质粒单独和联合转染后 K562/A02细胞耐药逆转率分别为63.8%,71.1%,83.1%,转染两种质粒组对 K562/A02细胞耐药逆转率最高,P 糖蛋白相对表达量由未转染组的19.70±1.15降至6.40±0.92(P<0.01),阿霉素诱导的细胞凋亡率由(1.53±0.42)%提高至(7.77±0.42)%(P<0.01)。联合转染两种质粒组和单独转染组比较,细胞对阿霉素敏感性和阿霉素诱导的细胞凋亡率差异亦有统计学意义(P<0.05)。结论转染 mdrl 或 mell 基因的 shRNA 干扰表达质粒可有效抑制相应基因表达,皆不同程度逆转 K562/A02细胞对阿霉素的耐药性;联合转染两种质粒可显著增加逆转耐药的效果。mell 基因可能与 K562/A02耐药相关。     

人端粒酶反转录酶小发夹RNA质粒表达载体的构建及鉴定

背景:端粒酶反转录酶是端粒酶的活性亚基,已成为肿瘤研究的热点。RNA干扰技术作为一种基因沉默方法,具有高效、特异等优点,现已广泛应用于肿瘤、病毒等研究领域。目的:构建针对人端粒酶反转录酶的小发夹RNA质粒表达载体,并观察其对乳腺癌T47D细胞人端粒酶反转录酶基因的表达和端粒酶活性的影响。方法:以Genbank中人端粒酶反转录酶基因的mRNA序列为基础,设计人端粒酶反转录酶基因的小干扰RNA序列,将其连接到具有G418抗性的质粒pBAsi-hU6-Neo(BamHⅠ/HindⅢ)中,应用基因测序加以验证,扩增提取质粒,以脂质体转染表达小发夹RNA的质粒到乳腺癌T47D细胞,抗生素G418筛选出转染成功的各组细胞。结果与结论:实验所构建的人端粒酶反转录酶的小发夹RNA质粒表达载体,经测序验证无误。将pBAsi-hU6-Neo重组质粒转染入T47D细胞,经G418筛选获得了转染成功的细胞。经RT-PCR和Western blot检测,转染后的人端粒酶反转录酶基因在mRNA和蛋白水平的表达均明显降低(P<0.01),经TRAP-ELISA法检测实验组细胞端粒酶活性出现显著下降(P<0.01)。结果证实,实验成功构建人端粒酶反转录酶的小发夹RNA质粒表达载体,实验所设计的小干扰RNA能有效抑制肿瘤细胞人端粒酶反转录酶基因的表达,进而降低细胞的端粒酶活性。     

RNA特异性干扰bcr-abl融合基因联合p27基因克隆对K562细胞的影响

本研究旨在探讨RNA干扰抑制慢性髓系白血病bcr-abl融合基因表达,以及RNAi和p27基因克隆联合作用对K562细胞的细胞增殖、细胞周期及凋亡等的调控作用。以细胞系K562为研究对象,合成并转染针对K562细胞bcr-abl融合基因融合位点的21nt siRNA,应用Northern blot法检测bcr-abl融合基因的表达,Western blot法检测BCR-ABL蛋白及凋亡相关蛋白BCL-xL的表达;同时应用RT-PCR扩增p27基因,构建P27-pcDNA3.1载体,转染p27基因入缺失p27基因的K562细胞,经筛选得到G418抗性的K562细胞株;经Western blot证实有P27蛋白表达后,联合应用RNA干扰及p27基因克隆,通过MTT法及流式细胞仪等检测联合作用后对K562细胞的细胞增殖、细胞周期及凋亡等的调控作用。结果表明,RNA干扰组K562细胞bcr-abl融合基因的表达水平明显下降,转染24小时时有18.4%的K562细胞发生凋亡,细胞凋亡相关蛋白BCL-xL的表达水平下调,出现明显的G1期阻滞;表达外源性P27蛋白的P27-pcDNA3.1-K562细胞株生长速度明显慢于对照K562细胞株。流式细胞仪检测显示,G0/G1期细胞增多,S期细胞明显减少;RNA干扰与p27基因克隆联合作用于K562细胞后,凋亡细胞比例明显上升(33.4%)。MTT法显示,细胞存活率较单纯p27-K562细胞组及RNA干扰-K562细胞组均明显下降(p0.01和p0.05)。结论:特异性siRNA分子可以抑制bcr-abl融合基因的表达,诱导K562细胞分化或凋亡。RNA干扰联合p27基因克隆对抑制K562细胞增殖及促凋亡方面具有协同作用。     

WT1基因表达下调对K562/A02细胞阿霉素敏感性的影响

目的 探讨WT1基因表达下调对人红白血病耐药细胞系K562/A02阿霉素敏感性的影响.方法 将WT1mRNA的短发夹RNA(short hair RNA,shRNA)构建至真核表达载体后转染K562/A02细胞,流式细胞术检测转染效率;荧光定量RT-PCR和Western blot法分析WT1基因在转染前后表达的差异;pWT1shRNA转染K562/A02细胞48 h并经阿霉素作用后,MTT法检测各组细胞阿霉素IC50值;流式细胞术检测细胞阿霉素累积量及细胞凋亡率.结果 与未转染对照组及空载体组相比,转染WT1shRNA质粒的K562/A02细胞WT1mRNA和蛋白水平均明显降低;经阿霉素诱导24 h后,其对阿霉素的敏感性明显增高,相对逆转率为71.5%,细胞内阿霉素的累积量较各对照组明显增高(P值均<0.05),细胞凋亡率明显升高(P<0.05).结论 靶向WT1shRNA干扰质粒可有效抑制K562/A02细胞WT1基因表达,增强K562/A02细胞对阿霉素的敏感性.     

肌醇5'磷酸酶基因突变对K562细胞周期蛋白和Akt磷酸化的影响

目的 从分子水平探讨肌醇5'磷酸酶(SHIP)基因突变对人白血病细胞系K562细胞周期及其相关基因表达的影响.方法 应用携带野生型和突变型SHIP及绿色荧光蛋白的慢病毒及空载体慢病毒质粒转染K562细胞,通过流式细胞术检测K562/SHIP细胞转染效率、细胞增殖指数及细胞周期变化;MTT法检测细胞增殖活性改变,实时荧光定量PCR(FQ-PCR)检测SHIP mRNA水平变化,Western blot检测各组K562细胞SHIP、细胞周期蛋白(cyclin)D1、p21WAF1/CIPI、P27KIP1蛋白表达水平及Akt磷酸化变化.结果 野生型SHIP基因能明显抑制K562细胞增殖,并产生明显的G0/G1期阻滞[G0/G1期细胞分别为(34.2±7.8)%和(0.7±8.3)%,P<0.01];但SHIP基因点突变并未影响K562细胞增殖及细胞周期改变[G0/G1期细胞分别为(33.4±4.2)%和(36.3±6.7)%,P>0.05].Western blot结果发现转染野生型SHIP基因后K562细胞Akt磷酸化和cyclin D1表达水平明显下降(P<0.01),p21WAF1/CIPI、p27KIP1表达增高,而突变型SHIP基因对Akt磷酸化水平和细胞周期蛋白表达几乎没有影响(P>0.05).结论 ①野生型SHIP基因通过下调K562细胞Akt磷酸化水平,进而抑制其下游cyclin D1表达,上调p21WAF1/CIPI和p27KIP1基因表达,导致细胞周期阻滞在G0/G1期,抑制K562细胞增殖;②SHIP基因突变体(TTC→CTC,Phe→Leu)丧失了对K562细胞的增殖抑制作用,提示SHIP基因对K562细胞增殖的负调控作用有赖于其基因结构和功能正常.     

K562细胞nm23-H1基因沉默对其向巨核细胞分化的影响

目的 探讨nm23-H1沉默对K562细胞向巨核细胞分化的影响.方法 采用Lipofectamine2000将靶向nm23-H1基因的RNA干扰质粒pSileneerTM 4.1-CMV-sinm23及空质粒转染K562细胞,经G418筛选建立该基因稳定下调的K562细胞(K562-sinm23细胞)及空质粒转染K562细胞(K562-siNC细胞),实时定量PCR、免疫组织化学、蛋白印迹反应等方法证实了nm23基因沉默细胞构建成功.NBT还原比色试验检测细胞分化能力.流式细胞术检测在诱导剂佛波酯作用下K562-sinm23细胞表面巨核细胞分化抗原GP Ⅱ b-Ⅲa(CD41)的表达.蛋白印迹法检测细胞在佛波酯诱导后ERK1/2磷酸化活性.结果 与K562细胞和K562-siNC细胞比较,pSilencerTM 4.1-CMV-sinm23能够沉默内源性nm23-H1 mRNA的表达,基因水平和蛋白水平的沉默效率分别达到75%和70%.经佛波酯诱导,与K562-siNC细胞比较K562-sinm细胞的分化能力明显增强(NBT还原能力A值分别为0.23±0.05和0.31±0.07).nm23-H1基冈调控K562细胞向巨核细胞分化与ERK1/2磷酸化活性增强有关.结论 成功构建了nm23-H1基因稳定下调表达的K562细胞株,并且证明nm23-H1参与了K562细胞向巨核细胞系的分化.     

siRNA特异性抑制K562细胞Livin基因表达及其诱导凋亡作用

本研究探讨小分子RNA干扰技术抑制livin基因表达对白血病细胞系K562细胞凋亡的影响。设计合成livin特异性小干扰RNA(siRNA),核转染K562细胞,培养转染后的K562细胞,用RT-PCR检测livin mRNA的表达,Western blot检测Livin蛋白的表达。以未转染细胞作对照,同时转染带有增强型绿色荧光蛋白的载体作为阳性对照,用流式细胞术检测其细胞绿色荧光以确定转染效率。用膜联蛋白Ⅴ及碘化丙锭双染法检测细胞凋亡率。结果表明,电穿孔的转染效率可达50%。siRNA既可以抑制livin mRNA表达,也可以抑制livin蛋白表达。特异性siRNA转染细胞后48 h细胞凋亡率为(27.41±2.30)%,与对照组(9.63±0.89%)比较明显提高(P<0.05)。结论:SiRNA可以抑制livin基因的表达,并能抑制livin基因的抗凋亡作用。     

WAVE1基因在K562/A02白血病细胞多药耐药中的作用

目的 探讨WASP家族Verprolin同源蛋白1（WAVE1）基因在K562／A02白血病细胞多药耐药机制中的作用。方法 将pEFBOS—WAVE1真核表达质粒转染K562细胞构建WAVE1高表达的K562细胞，将WAVE1基因的特异性小片段干扰RNA（WAVE1siRNA）转染K562／A02细胞构建WAVE1低表达的K562／A02细胞。Western blot和RT-PCR法检测基因转染前后K562／A02细胞及K562细胞WAVE1基因及蛋白的表达；可溶性噻唑盐WST-8染色法检测阿霉素对转染前后细胞的半数抑制浓度（IC50）；Hoechest33258染色法检测细胞形态学改变并计算凋亡细胞百分率；RT—PCR检测多药耐药基因mdrl mRNA表达；Western blot检测Bcl-2表达。结果 ①与K562细胞相比，K562／A02细胞WAVE1 mRNA表达水平增加70％，蛋白表达水平增加63％。②转染WAVE1基因的K562细胞WAVE1过表达，并降低了对阿霉素的药物敏感性，使IC50从转染前的（0．05±0．00）μg／ml，增加到（2．99±0．12）μg／ml，在阿霉素浓度为1.5μg／ml时，凋亡细胞分别下降30％、35％。③转染WAVE1 siRNA的K562／A02细胞WAVE1蛋白表达水平与未转染组相比明显降低，并可增强对阿霉素的药物敏感性，使IC50从转染前的（4．29±0．15）μg／ml下降到（1．85±0．07）μg／ml，阿霉素浓度为1.5μg／ml时，凋亡细胞分别增加24％、21％。④转染WAVE1的K562细胞mdr1基因和Bcl-2蛋白表达水平均增高，而转染WAVE1 siRNA的K562／A02细胞mdr1基因和Bcl-2蛋白表达水平比转染前明显降低。结论 WAVE1参与了K562／A02细胞多药耐药的形成，其机制可能与调控mdr1和Bcl-2水平有关。     

WAVE1对K562细胞侵袭能力的影响及其机制研究

目的 研究WASP家族富含脯氨酸同源蛋白1(WAVE1)对K562细胞侵袭的影响及其机制.方法 免疫荧光观察WAVE1与基质金属蛋白-2(MMP-2)在细胞中的分布.利用PeDNA3.1WAVE1重组真核表达质粒转染K562细胞,将WAVE1基因特异性小片段干扰RNA(WAVEI siRNA)转染K562细胞,Transwell法检测细胞侵袭能力;实时PCR和Western blot检测转染前后WAVE1及MMP-2的表达.结果 ①WAVEI与MMP-2主要表达于K562细胞的细胞膜上且两者有共定位.②与对照组K562细胞相比,转染pcDNA3.1-WAVE1 24 h及48 h后K562细胞MMP-2 mRNA表达分别增加295%和198%,蛋白表达水平分别增加80%和23%;转染特异性WAVE1 siRNA 24 h及48 h后K562细胞MMP-2 mRNA表达分别下降81%和28%,蛋白表达分别下调36%和53%.③与对照组K562细胞相比转染pcDNA3.1-WAVE1后细胞侵袭能力增强,而干扰WAVE1表达后K562细胞侵袭能力减弱.结论 WAVE1与MMP-2在K562细胞可能具有协同作用;WAVE1参与了K562细胞的侵袭转移过程,其机制可能与调控MMP-2的表达相关.     

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.