脑出血大鼠脑组织膜型基质金属蛋白酶、基质金属蛋白酶2和基质金属蛋白酶9表达及益气活血中药的干预效应

目的:观察益气活血中药对脑出血大鼠脑组织中膜型基质金属蛋白酶、基质金属蛋白酶2和基质金属蛋白酶9表达量的影响,从脑出血损伤区微血管系统重建的角度,探讨益气活血中药治疗脑出血的作用机制。方法:实验于2006-03/10在中南大学湘雅医院中西医结合研究所实验室完成。实验材料:补阳还五汤全方(黄芪,当归,赤芍,红花,川芎,地龙,桃仁按20∶3∶3∶3∶2∶3∶3的比例);补阳还五汤益气成分(黄芪按上述比例);补阳还五汤活血成分(当归,赤芍,地龙,川芎,桃仁,红花按3∶3∶3∶2∶3∶3的比例)。用蒸馏水两次水煎,分别浓缩为1.54,0.81和0.73g/mL。实验分组:155只SD大鼠随机分为正常对照组、假手术组、模型组、益气活血组、益气组、活血组。正常对照组5只大鼠,其余每组30只,再随机分为术后灌胃2,4,7,14,21,28d6个观察时间点,各个时间点5只大鼠。实验干预:造模:采用立体定位技术将胶原酶Ⅶ注入大鼠大脑右苍白球制成脑出血大鼠模型。假手术组大鼠仅注入2μL生理盐水,其余手术过程相同。给药:正常对照组:普通饲养,自由饮水;假手术组和模型组术后予蒸馏水灌胃2次/d,2mL/次;益气活血组、益气组、活血组分别给予补阳还五汤全方、补阳还五汤益气成分、补阳还五汤活血成分30.80,16.20,14.60g/(kg·d)(按体表面积计算为临床70kg成人剂量的3倍)灌胃,2次/d,2mL/次。各组大鼠分别于灌胃2,4,7,14,21,28d麻醉下取脑,制备切片;正常组动物于28d处死。实验评估:免疫组织化学染色方法检测各组灌胃不同时间脑组织基质金属蛋白酶2、基质金属蛋白酶9和膜型基质金属蛋白酶的阳性微血管数。结果:155只大鼠均进入结果分析。①正常组、假手术组皮质偶见膜型基质金属蛋白酶、基质金属蛋白酶2和基质金属蛋白酶9表达。②模型组膜型基质金属蛋白酶、基质金属蛋白酶2呈双峰表达,4d为最高峰,至14～21d再有小高峰出现。③益气活血组给药4d时,膜型基质金属蛋白酶、基质金属蛋白酶2为表达低谷,低于模型组(P<0.01)、益气组和活血组(P<0.05);在中后期,益气活血组膜型基质金属蛋白酶表达高峰为7～14d,较模型组提前出现,21d后与模型组比,各治疗组膜型基质金属蛋白酶已表达极少(P<0.01);益气活血组基质金属蛋白酶2在7d后一直呈高水平维持,高于其他各组(P<0.05),28d后开始逐渐下降。④模型组基质金属蛋白酶9在造模后4d达最高峰(P<0.01),两周后几乎无表达。益气活血组基质金属蛋白酶9高峰推迟至7d出现(P<0.05),之后逐渐下降。结论:益气活血中药可通过调节脑出血后膜型基质金属蛋白酶、基质金属蛋白酶2和基质金属蛋白酶9表达,改善出血后脑组织的微环境,有利于微血管系统重建,促进组织修复。     

骨纤维结构不良的诊断和治疗进展

目的:对长期以来关于骨纤维结构不良大量相关研究及文献进行回顾,综述骨纤维结构不良的诊断和治疗的最新进展。资料来源:通过计算机互联网检索OVID数据库1966-01/2006-10关于骨纤维结构不良的文献,检索词:Osteofibrous dysplasia,限定语言种类为English。同时检索1994-01/2006-10中国全文期刊数据库有关骨纤维结构不良的文献,检索词为:骨纤维结构不良,限定语言种类为中文。资料选择:选择与骨纤维结构不良相关的观察对比研究、经验总结、个案报道、最新研究进展等文献,力求资料全面,排除重复研究。资料提炼:共收集相关国内外文献41篇,排除重复性研究11篇,采用30篇,包括关于骨纤维结构不良定义、发病机制、病理、诊断及治疗等。资料综合:①骨纤维结构不良是一种起源于纤维组织的良性骨肿瘤。发病率低、误诊率高。目前具体发病机制不明,现认为与常染色体显性遗传有关。②骨纤维结构不良好发于胫骨,症状为局部肿块。特征性影像学表现为胫骨中段前侧皮质膨胀性密度减低。确诊方法为病理检查。重点与骨纤维异常增殖症、造釉细胞瘤相鉴别,现有大量研究证明该病与造釉细胞瘤有联系。③治疗上过去认为10岁以前应保守治疗,10岁后选择手术治疗,目前倾向于早期骨膜外切除手术治疗。结论:骨纤维结构不良发病率低,对该病认识较少,误诊率较高,重点需与骨纤维异常增殖症、造釉细胞瘤相鉴别,应提高对该病的认识与重视程度,对可疑者行病理检查,确诊者行骨膜外切除,切除范围较大的病例行重建手术。     

白藜芦醇对动物离体心房收缩力和心率作用的种属差异性比较

目的:观察白藜芦醇对豚鼠、小鼠和家兔离体心肌收缩力和心率的影响。方法:实验于2005-08/2006-12在河北医科大学西校区实验中心完成。①实验分组:离体豚鼠、小鼠和家兔心肌各分为9组:空白对照组、溶剂对照组、递增累积浓度白藜芦醇组(浓度为10-6,3×10-6,10-5,3×10-5,10-4,3×10-4mol/L),白藜芦醇对照组(5×10-5mol/L),ATP敏感性钾通道阻断剂格列苯脲(5×10-5mol/L)预孵育 白藜芦醇组,钙激活钾通道阻断剂四乙胺(10-3mol/L)预孵育 白藜芦醇组,电压依赖性钾通道阻断剂4-氨基吡啶(10-3mol/L)预孵育 白藜芦醇组,内向整流钾通道阻断剂氯化钡(10-4mol/L)预孵育 白藜芦醇组,乙酰胆碱调节钾通道阻断剂阿托品(10-5mol/L)预孵育 白藜芦醇组。②实验方法:不同类型的钾通道阻断剂均预孵育15min后,分别加入白藜芦醇(终浓度为5×10-5mol/L),连续记录30min,与相应动物白藜芦醇对照组相比较。③评估指标:分析不同阻断剂与白藜芦醇联用对心房收缩力下降率及心率抑制率的影响。结果:①白藜芦醇可降低豚鼠和小鼠离体心肌收缩力和心率(P<0.05),并被ATP敏感性钾通道阻断剂格列苯脲和钙激活钾通道阻断剂四乙胺部分阻断。②白藜芦醇可降低家兔离体心肌心率,格列苯脲可阻断白藜芦醇的负性变时作用。③电压依赖性钾通道阻断剂4-氨基吡啶、内向整流钾通道阻断剂氯化钡、乙酰胆碱调节钾通道阻断剂阿托品均不能阻断白藜芦醇对3种不同动物离体心房收缩力和心率的作用(P>0.05)。结论:白藜芦醇可呈剂量依赖性减慢豚鼠、小鼠和家兔的心率,白藜芦醇可减弱豚鼠心肌收缩力,其作用是与开放ATP敏感性钾通道有关,而与电压依赖性钾通道、内向整流钾通道和乙酰胆碱调节钾通道无关。同时,钙激活钾通道也参与了白藜芦醇对豚鼠和小鼠离体心房收缩力和/或心率的抑制作用。白藜芦醇对离体心肌收缩力和心率的作用有种属差异性。     

超声和微泡造影剂介导细胞基因转染的实验研究

目的 探讨低频超声对细胞基因转染的作用。方法 超声治疗仪频率1MHz，脉冲重复频率100Hz，占空系数20％。质粒DNA为含编码绿荧光蛋白的pEGFP。应用荧光显微镜和流式细胞仪评价细胞基因转染率，台盼蓝染色计算细胞成活率。选用C2C12、3T3-MDEI和CHO3种细胞系为研究对象，加入DNA后辐照不同声强、时间或加入超声造影剂，观察各条件下的细胞基因转染率和成活率。结果 ①超声介导的基因转染与声强和辐射时间有关，最佳剂量为1w／cm^2 20s；②同样超声剂量，较高的声强较早达到最大基因转染率；③较低剂量时，微泡造影剂可使超声介导的基因转染提高2～3倍并可显著提高最高基因转染率。结论 低频超声可介导细胞基因转染，基因转染率不但与超声辐射剂量有关，而且同样剂量时，高声强较早达到最大基因转染率，最佳剂量是1w／cm^2 20s。同时，微泡造影剂可提高超声介导基因转染的最高转染率。     

Mice lacking sulfonylurea receptor 2 (SUR2) ATP-sensitive potassium channels are resistant to acute cardiovascular stress

Adenosine triphosphate-sensitive potassium (K(ATP)) channels are thought to mediate the stress response by sensing intracellular ATP concentration. Cardiomyocyte K(ATP) channels are composed of the pore-forming Kir6.2 subunit and the regulatory sulfonylurea receptor 2 (SUR2). We studied the response to acute isoproterenol in SUR2 null mice as a model of acute adrenergic stress and found that the episodic coronary vasospasm observed at baseline in SUR2 null mice was alleviated. Similar results were observed following administration of a nitric oxide donor consistent with a vasodilatory role. Langendorff-perfused hearts were subjected to global ischemia, and hearts from SUR2 null mice exhibited significantly reduced infarct size (54+/-4 versus 30+/-3%) and improved cardiac function compared to control mice. SUR2 null mice have hypertension and develop cardiac hypertrophy. However, despite longstanding hypertension, fibrosis was absent in SUR2 null mice. SUR2 null mice were administered nifedipine to block baseline coronary vasospasm, and hearts from nifedipine-treated SUR2 null mice exhibited increased infarct size compared to untreated SUR2 null mice (42+/-3% versus 54+/-3%). We conclude that conventional sarcolemmal cardiomyocyte K(ATP) channels containing full-length SUR2 are not required for mediating the response to acute cardiovascular stress.     

An analysis of features of respiratory therapy departments that are avid for change

BACKGROUND: Models of organizational change-readiness have been developed, but little attention has been given to features of change-avid health-care institutions, and, to our knowledge, no attention has been given to features of change-avid respiratory therapy (RT) departments. METHODS: We conducted an exploratory study to compare RT departments we deemed change-avid or non-change-avid, to identify differentiating characteristics. Our assessments regarding change-readiness and avidity were based on structured, in-person interviews of the technical directors and/or medical directors of 8 RT departments. Based on a priori criteria, 4 of the 8 RT departments were deemed change-avid, based on the presence of > or = 2 of the following 3 criteria: (1) uses a management information system, (2) uses a comprehensive RT protocol program, (3) uses noninvasive ventilation in > 20% of patients with exacerbation of chronic obstructive pulmonary disease. Our ratings of the departments were based on 2 scales: one from Integrated Organizational Development Inc, and the 8-stage change model of Kotter. RESULTS: The ratings of the 4 change-avid departments differed significantly from those of the 4 non-change-avid departments, on both the Integrated Organizational Development Inc scale and the Kotter scale. We identified 11 highly desired features of a change-avid RT department: a close working relationship between the medical director and the RT staff; a strong and supportive hospital "champion" for change; using data to define problems and measure the effectiveness of solutions; using redundant types of communication; recognizing resistance and minimizing obstacles to change; being willing to tackle tough issues; maintaining a culture of ongoing education; consistently rewarding change-avid behavior; fostering ownership for change and involving stakeholders; attending to RT leadership succession planning; and having and communicating a vision for the department. CONCLUSIONS: In this first exploratory study we found that change-avid RT departments can be differentiated from non-change-avid RT departments with available assessment tools. Highly desired features of a change-avid RT department were identified but require further study, as does the relationship between change-avidity and clinical outcomes.     

Assessing the effectiveness of an Internet-based videoconferencing platform for delivering intensified substance abuse counseling

Enhanced schedules of counseling can improve response to routine opioid-agonist treatment, although it is associated with increased time demands that enhance patient resistance and nonadherence. Internet-based counseling can reduce these concerns by allowing patients to participate from home. This study assesses treatment satisfaction and response to Internet-based (CRC Health Group's e-Getgoing) group counseling for partial responders to methadone maintenance treatment. Patients testing positive for an illicit substance (n = 37) were randomly assigned to e-Getgoing or onsite group counseling and followed for 6 weeks. Patients in both conditions responded favorably to intensified treatment by achieving at least 2 consecutive weeks of abstinence and 100% attendance to return to less-intensive care (e-Getgoing: 70% vs. routine: 71%, ns). Treatment satisfaction was good and comparable across conditions. E-Getgoing patients expressed a preference for the Internet-based service, reporting convenience and increased confidentiality as major reasons. Integrating Internet-based group counseling with on-site treatment services could help expand the continuum of care in methadone maintenance clinics.     

Quantification of knee joint fluid volume by MR imaging and CT using three-dimensional data processing

A noninvasive, quantitative technique to estimate joint fluid volume using three-dimensional (3D) processing of magnetic resonance (MR) imaging and CT data was evaluated. The mean accuracy error of this 3D approach with MR imaging, performed on five fresh cadaver knees, was -2.4 +/- 5.1% SD when volume estimates were based on heavily T2-weighted transverse images. A considerably higher mean accuracy error of -12.5 +/- 16.9% SD was found when the 3D approach with CT was used (four fresh cadaver knees), probably because of the small attenuation differences between articular soft-tissue structures and joint fluid. A mean precision error of 4.9 +/- 2.3% SD was found when two radiologists independently evaluated in vivo MR imaging studies of 12 knees with joint effusion. Because of the low CT accuracy, no in vivo studies were performed using CT. Thus, this preliminary study shows that quantification of joint fluid volume with 3D data processing offers more accuracy with MR imaging than with CT. The 3D approach with MR imaging provides a potential tool for clinical studies.