不同器官细胞因子在多细菌感染性炎症时的基因表达和临床意义

目的探讨肝、肺细胞因子基因表达与腹腔吞噬细胞上清液、循环血中细胞因子含量的关系,为临床诊治多细菌感染引发的炎症提供实验依据.方法将30只小鼠分为假手术对照组(sham组)和盲肠结扎组(CLP组).采用RT-PCR法检测肝脏和肺脏肿瘤坏死因子α(TNF-α)和白细胞介素10(IL-10)的基因表达情况,采用ELISA法检测腹腔巨噬细胞上清液和循环血液中相应细胞因子含量.结果CLP组的TNF-α、IL-10基因表达和腹腔巨噬细胞上清液、循环血液中的相应细胞因子含量均高于sham组.CLP后18h组与4h组比较,TNF-α在腹腔巨噬细胞上清液、循环血液中的活性均有显著性差异(P＜0.05),在肝、肺中基因表达有非常显著性差异(P＜0.01);IL-10在腹腔巨噬细胞上清液和循环血液中的含量无显著性差异,而在肝、肺中基因表达有显著性差异.结论发生多细菌感染性炎症时,肝、肺参与细胞因子的表达;血液中细胞因子含量不能完全代表组织器官内的基因表达情况;多细菌感染性炎症治疗应考虑靶器官细胞因子的表达状态.     

Ein medizinisch-anthropologisches Krankheitsmodell in der Psychiatrie

Zusammenfassung Angesichts der derzeitigen Situation der psychiatrischen Praxis und von erkenntniskritischen Überlegungen zu einem für die Psychiatrie gültigen Krankheitsmodell, wird ein medizinisch-anthropologisches Modell vorgeschlagen, das die Einheit des gesunden und kranken Menschen in Situation und Umwelt zugrunde legt und eine Skizze einer 'medizinischen Anthropopsychiatrie sein soll.Das vorgeschlagene Modell ist multidimensional angelegt (biologische, psychologische, sozio-historisch-kulturelle Parameter in synchroner und diachroner Verknüpfung) und zielt auf die Organisation der gesamten verschiedenen funktionellen und strukturellen Daten der gesunden und gestörten Persönlichkeit. Es ist ein offenes Modell, das eine dialektische Konvergenz der Phänomene, Dynamismen und Strukturen in integrierter und umfassender Weise versucht und die Komplexität ihrer Wechselwirkungen auf verschiedenen Ebenen berücksichtigt.Es werden unterschieden: 1. allgemeine Störungsformen der Persönlichkeit mit ihren dynamischen Kompensationen des Gesundheitsgleichgewichtes, 2. die psychopathologischen Grundstrukturen und ihre Restrukturierungsgradienten.Auf der Grundlage dieser Bezugssysteme wird ein pathogenetisches Schema aufgestellt, das die Gesamtheit von dynamischen und strukturellen Komponenten, im Hinblick auf pathogene Prozesse, aber auch unter Berücksichtigung therapeutischer Wirksamkeit, synchron und diachron erklären soll. Es wird unter anderem versucht, motivierende Situationen mit der ihnen zugrunde liegenden ätio-pathogenen Konstellationen sowie ihre Kompensationsmöglichkeiten im Sinne der Gesundheit zu erfassen. Die Anwendungen des Modells für Diagnose, Therapie und Gesundheitsprävention werden auch von der persönlichen Situation des einzelnen Kranken hier diskutiert.     

Hepatoprotective Activity of Xanthones and Xanthonolignoids Against tert-Butylhydroperoxide-Induced Toxicity in Isolated Rat Hepatocytes—Comparison with Silybin

Purpose. Synthesize and evaluate the protective activity against tert-butylhydroperoxide-induced toxicity in freshly isolated rat hepatocytes of trans-kielcorin, trans-isokielcorin B, as well as their respective building blocks 3,4-dihydroxy-2-methoxyxanthone and 2,3-dihydroxy-4-methoxyxanthone. Methods. Wistar rats, weighing 200-250g were used. Hepatocyte isolation was performed by collagenase perfusion. Incubations were performed at 37°C, using 1 million cells per milliliter in modified Krebs—Henseleit buffer. The protective activity was evaluated by measuring reduced and oxidized glutathione, lipid peroxidation and cell viability after inducing toxicity with tert-butylhydroperoxide (1.0 mM, 30 min), with or without the studied compounds in the concentrations of 0.025, 0.050, 0.100 and 0.200 mM. Silybin was tested in the same experimental conditions to serve as a positive control. Results. Using these concentrations, the tested compounds prevented tert-butylhydroperoxide-induced lipid peroxidation and cell death in freshly isolated rat hepatocytes. All compounds were also effective in preventing perturbation of cell glutathione homeostasis in some extent. 3,4-Dihydroxy-2-methoxyxanthone and 2,3-dihydroxy-4-methoxyxanthone were more effective than trans-kielcorin and trans-isokielcorin B respectively. Silybin was less effective in protecting cells against lipid peroxidation and loss of cell viability than the four xanthonic derivatives. Conclusions. The tested compounds protected the freshly isolated rat hepatocytes against tert-butylhydroperoxide-induced toxicity.     

electrical stimulation of tooth pulp in humans. II. Qualities of sensations

Individual premolar teeth of 22 normal volunteers were stimulated via intradentinal electrodes using brief electrical pulses. Questionnaires were used to determine the qualities of sensations produced by this stimulation. Operationally defined “innocuous’ sensations predominated between 1 and 10 dB SL, and were absent above 30 dB SL. Similarly defined ”painful’ sensations were observed throughout the range of suprathreshold intensities but were most common above 20 dB SL.‘Uncomfortable’ sensations were especially frequent between 1 and 20 dB SL. These findings demonstrate that non-painful sensations can arise from electrical tooth pulp excitation in circumstances in which spread of the stimulating current to periodontal and gingival structures is most unlikely. Two interpretations of these results are considered: (1) that tooth pulp afferents may have some unspecified sensory function besides mediation of painful sensations and (2) that they may be specialized in the mediation of nociceptive impulses but may give rise to innocuous sensations under special circumstances.     

Transthecal digital block: an underutilized technique in the ED

The transthecal digital block is a simple, safe, and effective anesthesia technique that can be used in many digital injuries. It is contraindicated only in cases of infection. The purposes of this article are to (1) discuss the indications for the transthecal digital block, (2) describe the technique, and (3) review the literature. The transthecal technique is used on appropriate patients almost to the exclusion of more traditional digital blocks by many hand surgeons. The advantages of this method are that it requires only a single injection, has a rapid onset of action, and requires only a small amount of anesthetic. It also has virtually no risk of direct mechanical trauma to the neurovascular bundles. This technique has been shown to be exceptionally effective. We encourage emergency physicians to use the transthecal technique when indicated.