有机磷中毒家兔呼吸肌麻痹的病理机制和分子基础探讨

目的　探讨有机磷中毒家兔呼吸肌麻痹 (RMP)形成的分子基础和病理机制。方法　 2 4只青紫蓝家兔分 4组 :敌百虫 (10LD ,1112 0mg kg)组 ,久效磷 (10LD ,2 2 2 4mg kg)组 ,甲基对硫磷(10LD ,74 10mg kg)组及正常对照组 ,每组 6只。家兔中毒经腹部皮下给药 ,中毒后 6h、 2 4h取血及肋间外肌 ,苏木精 伊红染色观察肋间外肌病理改变。用酶抑制法测肋间外肌组织匀浆中游离有机磷毒质(FOP)含量。用放射免疫法测血浆中肿瘤坏死因子α (TNF 浕) ,白细胞介素 1 β (IL 1β)及血栓素B2(TXB2 )含量。结果　中毒后 2 4h ,肋间外肌组织出现严重的病理损伤 ,可见肌纤维变性、坏死、横纹消失 ,肌原纤维崩解断裂。同时 ,肋间外肌组织匀浆中可检出不同浓度的FOP ,血浆中TNF 浕及ＴＸＢ2 含量显著高于正常 (TNF 浕 :T =2 5 ,P <0 0 0 5 ;TXB2 :T =2 1,P <0 0 0 5 )。结论　重度有机磷中毒可致动物呼吸肌出现严重的病理损伤 ,FOP和TXA2及TNF 浕在呼吸肌损伤中起重要作用 ,这些改变对RMP的形成具有重要意义     

不同致死量久效磷中毒家兔体内游离毒质储存库的研究

目的探讨不同致死量久效磷中毒家兔体内是否存在游离毒质(FOP)的储存库。方法48只青紫蓝家兔分为2组:久效磷5LD50(11.12mg/kg)组24例,10LD50(22.24mg/kg)组24例。家兔中毒经皮下给药。于中毒后1、6、24、96h,取血、胆汁、肝、肾、脑、肺、肠、肌肉和脂肪组织,分离血细胞和血浆,制备组织匀浆。用DTNB酶动力学法测乙酰胆碱酯酶(AChE)活力,酶抑制法测游离有机磷毒质(FOP)含量。结果5LD50中毒后1、6、24、96h时间点,血浆、血细胞、胆汁FOP含量比较差异有显著性(P<0.05)。各组织间FOP含量比较1、6h,P<0.05;24、96h,P>0.05;中毒后96h,血、各组织中无FOP残留时,胆汁中仍有高浓度的FOP。10LD50组与5LD50组比较,FOP在血、胆汁、组织中的含量增加(P<0.05)。结论久效磷中毒FOP在血、胆汁及各组织中的动态分布差异有显著性,中毒早期,血和各组织是FOP的重要储存库,随中毒时相延长,胆囊中的胆汁成为OP中毒动物体内FOP最重要的贮存库。中毒剂量增加,FOP在体内的储存量增加。     

不同水溶性有机磷染毒家兔血及脂肪组织中游离毒质的动态分布

目的 探讨不同水溶性有机磷杀虫剂(OP)其游离毒剂(FOP)在染毒家兔血及脂肪组织中的分布过程和意义.方法 72只雄性青紫兰家兔分为3组:久效磷5 LD50组(11.12mg/kg),敌百虫5 LD50组(556.0mg/kg),甲基对硫磷5LD50组(37.05mg/kg).每组24只,每小组6只.家兔染毒经皮下给药.染毒后1,6,24,96 h取血和脂肪组织,分离血细胞和血浆,制备脂肪组织匀浆,用DTNB酶动力学法测乙酰胆碱酯酶(AChE)活力,酶抑制法测游离有机磷毒质(FOP)含量.结果 染毒后1,6,24h,久效磷、敌百虫、甲基对硫磷染毒血浆间比较,血细胞间比较和脂肪组织间比较,FOP浓度差异具有统计学意义(血浆:P＜0.05;血细胞:P＜0.05;脂肪:P＜0.05);相同时相久效磷脂肪组织FOP浓度与血浆和血细胞比较差异无统计学意义(P＞0.05),敌百虫脂肪组织FOP含量为血浆和血细胞的数倍(P＜0.05),而甲基对硫磷FOP浓度在1、6h与血细胞接近(P＞0.05)但低于血浆(P＜0.05),染毒后24h脂肪组织、血细胞、血浆FOP浓度接近平衡(P＞0.05).三种OP血浆、脂肪组织清除率不同,久效磷＞敌百虫＞甲基对硫磷.结论 有机磷杀虫剂随水溶性的降低,对脂肪组织的亲和性增强,FOP由血和脂肪组织被清除的时间相应延长.脂肪组织是水溶性差的有机磷杀虫剂的储存库.     

急性一氧化碳中毒患者TNF-α和IL-8水平的变化及临床意义

目的　探讨急性一氧化碳中毒 (ACOP)患者血清中肿瘤坏死因子α(TNF -α)、白细胞介素 8(IL - 8)的水平 ,进一步加深对ACOP病理机制的认识。方法　选择不同中毒程度的ACOP患者 6 0例分别于入院即刻、12、2 4、4 8和 72h抽血测定血清中TNF -α、IL - 8的浓度。结果　中度一氧化碳中毒组与轻度中毒组比较 ,TNF -α、IL - 8水平有差异 ,但不具有显著性(P>0 0 5 ) ,中度中毒组与重度中毒组比较 ,TNF -α、IL - 8水平变化具有显著性差异 (P <0 0 1) ,2 4、4 8h后重度中毒组血清TNF -α、IL - 8浓度仍维持在较高水平。结论　ACOP时存在血清TNF -α、IL - 8水平的升高 ,重度中毒组显著高于轻、中度中毒组 ,且高水平维持较长时间 ,提示TNF -α、IL - 8在ACOP的病理过程中起着重要作用 ,两者可作为病情评估的指标。     

纳洛酮对心肺复苏后犬肺组织炎症因子水平及其mRNA表达的影响

目的　检测犬心肺复苏后 6h ,肺组织TNF α、IL 6浓度和肺中TNF αmRNA、IL 6mRNA、IL 10 mRNA的表达变化 ,以探讨纳洛酮对肺组织中TNF α、IL 6、IL 10含量的影响。方法　 18只健康杂种犬 ,随机分成 3组 ,空白组 (n =6 ) :不诱发室颤 ,6h后取肺组织 ;对照组 (n =6 ) :心跳骤停后予常规心肺复苏术 ,实验组 (n =6 ) :心跳骤停后予常规心肺复苏术 纳洛酮。于复苏后 6h取肺组织行TNF α、IL 6浓度和肺TNF α;mRNA、IL 6mRNA、IL 10mRNA的表达的测定以及行肺形态学检查。结果　实验组TNF α浓度明显低于对照组 (P <0 0 1) ,实验组、对照组、空白组IL 6浓度无差别 (P >0 0 5 )。实验组IL 10mRNA的表达明显高于对照组 (P <0 0 5 ) ,实验组和对照组的TNF αmRNA、IL 6mRNA的表达无差别 (P >0 0 5 )。实验组肺组织的病理损害低于对照组。结论　纳洛酮可减轻心跳骤停后肺组织的TNF α的生成 ,使IL 10mRNA的表达增加 ,从而减轻心肺复苏后肺的再灌流损伤。     

重复经颅磁刺激治疗脑出血家兔的实验研究

目的　探讨重复经颅磁刺激 (rTMS)对脑出血家兔的治疗作用及其相关机制。方法　家兔 3 6只 ,随机分为A、B、C组。A组 (治疗组 )和B组 (模型组 )采用家兔自体血注射制作脑出血模型 ,C组 (对照组 )注射生理盐水。A组家兔于造模后 12h开始实施rTMS ,每日 3次 ;B组和C组不进行rTMS。各组家兔分别于模型制作后 12h、2 4h、48h、72h、1周、2周处死。采用TUNEL法和免疫组化技术 ,检测出血灶周围脑组织中细胞凋亡及bcl 2、TNF α和IL 6的表达。结果　 3组均未见自发性出血。C组未见凋亡细胞及bcl 2阳性表达 ;A组和B组均有凋亡细胞和bcl 2表达水平增高 ,2组相比 ,A组的凋亡细胞较少 ,bcl 2表达水平更高(P <0 .0 5 )。C组无TNF α和IL 6阳性细胞 ;A组和B组均有TNF α和IL 6表达 ,2组相比 ,A组的TNF α表达水平较低 ,IL 6表达较高 (P均 <0 .0 5 )。结论　rTMS刺激可通过调控炎症因子表达、减轻炎性损伤以及上调bcl 2的表达、减少细胞凋亡 ,在脑出血中发挥治疗作用。     

添加剂红细胞悬液保存期间炎性细胞因子水平动态观察

目的　观察添加剂红细胞悬液 (PRC)保存期间白细胞介素 (IL) 1 β、IL 6、IL 8和肿瘤坏死因子 (TNF) α水平变化 ,探讨非溶血性发热反应 (FNHTR)可能发生的机制 ;观察滤除白细胞对上述细胞因子水平的影响 ,为选择滤除白细胞时间提供依据。方法　 1 0U添加剂红细胞各分为 2等份 ,其中 1份滤除白细胞 ,分别于 0周和 1 ,3 ,5周末采用ELISA法测定IL 1 β、IL 6、IL 8和TNF α水平。 结果　新鲜PRC中IL 1 β、IL 6、IL 8和TNF α含量较低 ,随保存时间延长增高 ,尤以 3周后明显 ;保存前滤除白细胞后PRC保存期间IL 1 β、IL 6、IL 8和TNFα水平无明显升高 ;保存期末 4种炎性细胞因子水平与保存前WBC数量间呈正相关。结论　未去除白细胞的PRC在保存期间能够自发产生和积聚IL 1 β、IL 6、IL 8和TNF α ,部分FNHTR的发生可能与此有关 ;保存前滤除白细胞可防止这种现象发生     

失血性休克肝枯否氏细胞Ⅰ—kB激酶的表达及意义

目的　探讨IκB激酶 - β(IKK - β)在失血性休克继发肝脏损伤中的作用。 方法　采用失血性休克家兔模型 ;分离培养肝脏枯否氏细胞 (KC) ,用原位杂交方法 (ISH)、凝胶电泳迁移率改变分析法 (EMSA)和酶联免疫吸附实验 (ELISA)分别检测KC中IKK - βmRNA表达、核因子 (NF) -κB活性和KC培养液上清中TNF -α含量。并进行肝脏组织的病理学光镜检查。结果　模型组KC中IKK - β的mRNA表达 (0 1 7± 0 0 4 )、NF -κB活性 (1 72± 0 36 )和培养液上清中TNF -α含量 (30 0 0 5± 30 86 )ng/L较对照组 [IKK - β(0 0 2± 0 0 1 )、NF -κB(0 31± 0 1 0 )、TNF -α(1 34 85± 1 2 0 9)ng/L]明显增高 (P均 <0 0 1 )。模型组肝脏组织病理损伤严重。结论　IKK - β介导NF -κB活化诱发细胞因子释放在失血性休克诱发肝脏损害的病理机制中发挥重要作用     

咪达唑仑对兔心肌再灌注损伤的细胞因子和病理形态学的影响

目的　观察咪达唑仑对家兔心肌缺血再灌注损伤期间细胞因子和病理形态学的影响。方法　 2 4只家兔随机分为 3组 (每组 8只 ) ,假手术对照组 (C组 ) :未予心肌缺血处理 ;缺血再灌注组 (IR组 ) :建立缺血再灌注模型 ;咪达唑仑组 (M组 ) :静脉注射咪达唑仑。测定各时点心肌IL - 6、TNF -α、乳酸脱氢酶 (LDH)、肌酸磷酸激酶 (CPK)浓度 ,在光、电镜下观察心肌病理形态学变化。结果　M组TNF -α在I1、R1升高 ,但显著低于IR组 (P <0 0 5 ) ;IR组 ,心肌TNF -α含量是M组的 1 87倍 ;M组血清IL- 6水平在R2 时才增加 ,且明显低于IR组 ,心肌组织IL - 6含量也显著低于IR组 ;M组LDH、CPK增高程度及心肌病理形态学损伤明显低于IR组。结论　咪达唑仑通过抑制TNF -α和IL - 6的合成或释放 ,从而对心肌组织有保护作用。     

大鼠急性全脑缺血再灌注时NF-κB表达及意义

【目的】观察全脑缺血再灌注时核因子κB(NF κB)、IL 1β、TNF α和存活神经元数目水平的变化 ,探讨NF κB在全脑缺血再灌注时的作用。【方法】采用Pulsinelli法建立大鼠全脑缺血再灌注模型 2 5例 ,分别于缺血再灌注后 2h、6h、12h、2 4h、4 8h时取脑海马CA1区组织切片行HE染色和免疫组化方法测定NF κB ,原位杂交方法测定IL 1β、TNF α并进行图像分析。【结果】大鼠脑海马CA1区NF κB和IL 1β、TNF α水平在全脑缺血再灌注后均明显增加 (P <0 .0 5 ) ,且三者间的变化呈显著正相关 (P <0 .0 1) ;NF κB与存活神经元数目呈显著负相关 (P <0 .0 5 )。【结论】NF κB在全脑缺血再灌注时与IL 1β、TNF α间可相互促进表达 ,并显著降低存活神经元数目 ,提示NF κB可能参与了脑缺血再灌注损伤的病理生理过程。     

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.