渐进延长后适应通过MAPK途径减轻再灌注损伤

目的 探讨后适应不同模式对大鼠急性心肌缺血-再灌注损伤的影响,并进一步研究丝裂原活化蛋白激酶途径(MAPK)在其中的作用.方法 60只SD大鼠随机(随机数字法)分为假手术组(Sham)、缺血-再灌注组(I/R)、渐进缩短后适应组(GDR,后适应处理方案短暂再灌注/缺血时间为30/10-25/15-15/25-10/30s)、标准后适应组(ER,后适应处理方案为20/20s×4)和渐进延长后适应组(GIR,后适应处理方案短暂再灌注/缺血时间为10/30-15/25-25/15-30/10s)5组,建立急性心肌梗死和缺血后适应模型.再灌注6h后每组取3只处死,取心肌组织用Western Blot方法测定磷酸化细胞外信号调节蛋白激酶(P-ERK)、磷酸化应激活化蛋白激酶(stress activated protein kinase,P-JNK)、磷酸化p38 MAPK (P-p38)、肿瘤坏死因子-α(TNF-α)、半胱氨酸天冬氨酸蛋白酶-8 (Caspase-8)在心肌组织中的表达及细胞色素c在胞浆中的表达;各组其余大鼠再灌注24 h后测定血流动力学,抽血测心肌酶,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,组间差异两两比较应用q检验.结果 三种后适应处理组均有显著的心肌保护作用(P＜0.05),其中GIR组最为明显,其次是ER组,GDR组最不明显.GIR组同ER组相比,细胞凋亡指数和血清标志物水平更低;P-ERK表达水平高于ER组[(1.82±0.22)vs.(1.54±0.32),P＜0.05],同时P-p38[(0.82±0.26) vs.(1.63±0.24)],P-JNK[(0.76±0.28) vs.(1.33±0.21),TNF-α[(0.62±0.20)vs.(1.00±0.12)],Caspase-8[(0.61±0.21)vs.(1.00±0.30)],Cyt-c[(0.66±0.16) vs.(1.68±0.22)]表达水平低(以上P＜0.05).在以上指标中渐进延长后适应组均显著优于渐进缩短后适应组.结论 渐进延长后适应较标准后适应能显著减轻心肌再灌注损伤,MAPK途径在其中发挥了重要作用.     

Anxiety-control strategies: Is there room for neutralization in successful exposure treatment?

Cognitive-behavioral theory suggests that anxiety-control strategies such as neutralization, distraction and various forms of safety behavior have the potential to diminish the effectiveness of and/or interfere with exposure treatment. Yet, it is common practice when treating individuals with anxiety disorders to employ various anxiety-control strategies as a means of assisting clients/patients with difficult exposure situations. Questions surrounding the issue of which anxiety-control strategies help vs. hinder exposure-based treatments (and under which circumstances) have been a topic of much investigation and continue to be a focus of theoretical debate. The present article reviews several key studies which collectively shed some light on this debate. The evidence suggests that clients' anxiety-control strategies may be less likely to become counter-productive when: (i) they promote increases in self-efficacy, (ii) they do not demand excessive attentional resources, (iii) they enable greater approach behavior and integration of corrective information (via 'disconfirmatory experiences'), and (iv) they do not promote misattributions of safety. Theoretical and clinical implications of these findings are discussed, and future directions for research in this area are suggested.     

Distraction techniques for children undergoing procedures: a critical review of pediatric research

Pediatric patients are often subjected to procedures that can cause pain and anxiety. Although pharmacologic interventions can be used, distraction is a simple and effective technique that directs children's attention away from noxious stimuli. However, there is a multitude of techniques and technologies associated with distraction. Given the range of distraction techniques, the purpose of this article was to provide a critical assessment of the evidence-based literature that can inform clinical practice and future research. Recommendations include greater attention to child preferences and temperament as a means of optimizing outcomes and heightening awareness around child participation in health care decision making.     

Distraction osteogenesis for bone repair in the 21st century: lessons learned

Bone regeneration obtained by distraction osteogenesis is influenced by a series of factors. These include factors that are related to the mechanical stability of the system of distraction (internal or external devices), and to factors directly depending on the biology of the bone tissue, such as the method of bone interruption (osteotomy), the delay and rhythm of distraction, the anatomical site of the osteotomy, and the histological characteristics of the bone requiring reconstruction. The stability of the system of bone fixation depends on the rigidity of the frame, the connexion of the apparatus to the bone (wires, pins) and the intrinsic stability of the segment (length and level of maturation of bone regenerate). The radiological characteristics of bone regeneration (hypo- or hypertrophy) lead to the adaptation of the rhythm of distraction. Following more than 28 years of experience of application of the Ilizarov method for bone reconstruction, the authors describe the technique of frame assembly and the methods of evaluation and treatment of the complications of new bone formation.     

Installing an original sleeve for rod unaccessible pain from a distraction device in a hemifacial microsomia patient

IntroductionLengthening of the mandible by distraction osteogenesis using an internal device is the preferred method for the treatment of hemifacial microsomia. Despite its advantages, this technique can lead to various complications after the surgery.Presentation of caseWe report the case of an 8-yr-old Japanese girl whose case presented practical difficulties in device activation because of rod unaccessible pain after the initial mandibular distraction with an internal device, and this complication was addressed with the installation of an original sleeve.DiscussionIn the present patient, the region of the bend rod was located at the inferior border of the right mandible, causing rod unaccessible pain by contacting the surrounding tissue including a sensory nerve. Careful vertical ramus distractor position planning and tools to resolve complications are the key factors for accomplishing the scheduled elongation.ConclusionAlternative techniques using a sleeve for safer and gentle distraction for rod unaccessible pain on activation should be considered.     

Effects of a projector-based hybrid virtual reality on pain in young children with burn injuries during hydrotherapy sessions: A within-subject randomized crossover trial

AimThe aim of this study was to examine the effect of a water-friendly Projector-Based Hybrid Virtual Reality (VR) dome environment combined with standard pharmacological treatment on pain in young children undergoing burn wound care in hydrotherapy.MethodsThis study was a prospective, within-subject crossover trial of 38 children aged 6 months to 7 years old (mean age = 1.8 years old). Each hydrotherapy procedure was divided into two equivalent wound care segments (No hybrid VR during one segment vs. Hybrid VR during the other segment, treatment order was randomized). Pain was measured using the 0–10 FLACC (Face, Legs, Activity, Cry Consolability scale) and the 0–10 NRS-obs (Numerical Rating Scale-obs).ResultsProjector-Based Hybrid VR significantly reduced procedural pain levels measured by the FLACC (p = 0.026) and significantly increased patients' comfort levels (p = 0.002). Patients' pain levels rated by the nurses using the NRS-obs were non-significant between both groups (p = 0.135). No side effects were reported.ConclusionProjector-Based Hybrid VR helped in reducing the pain related to hydrotherapy procedures in young children with burn wound injuries. This is the first study using virtual reality distraction with young children, and our findings are especially important because a large percentage of pediatric burn patients are very young. Additional research and development are recommended.Trial registrationClinicalTrials.gov, NCT02986464, registered on June 12, 2016.     

Obliteration of the pulp canal caused by mandibular distraction: a case report

We present a 16-year-old boy with a history of ankylosis of the temporomandibular joint (TMJ) who had been treated with a costochondral graft and mandibular distraction. The distraction seems to have caused pulp canal obliteration of the lower right second premolar and lower right first molar on radiographic examination. To our knowledge this is the only reported instance of such damage related to mandibular distraction. We aim to highlight the risks of this complication and the importance of discussing it with patients as part of the process of informed consent.     

Alterations of upper airway volume caused by Le Fort III osteodistraction in children

PurposeThe aim of the study was to assess changes in the upper respiratory tract and sleep quality in patients who were suffering from midfacial hypoplasia and treated with the movement of underdeveloped middle segment of the face with an Le Fort III osteotomy and distraction.MethodsIn this study patients aged 7–19, suffering from Crouzon syndrome, Apert syndrome, or other craniosynostosis were treated with Le Fort III osteotomy and midface distraction. Patients were subjected to radiological examination and polysomnography before and after the treatment. Typical anthropometric points were identified on lateral cephalograms, and were used to take linear and angular measurements. The surface and the volume of the upper respiratory tract were measured with the Dolphin Imaging software. Apnoea Hypopnea Index (AHI) was used to assess the sleep quality.ResultsIn all 18 patients the analysis showed statistically significant changes of the AHI and in the linear, angular and volumetric measurements. Mean change of the volume of the upper respiratory tract was 12,4 ± 11,3cm3(p = 0,0001) and of the surface was 615 ± 521 mm² (p = 0,0000000002). Mean improvement of AHI was 9 ± 6,2 (p = 0,00006). In three cases patients had tracheostomy prior to operation and none of them required tracheostomy after the operation.ConclusionsThe use of distraction osteogenesis of the middle segment of the face combined with Le Fort III osteotomy results in dilation of the upper respiratory tract at the nasopharyngeal level and at the soft palate level resulting in elimination of sleep and respiration disorders. Further studies with polysomnography are necessary, as well as observation of patients over time and monitoring of treatment stability.