大鼠严重烫伤并发心肌损害时肿瘤坏死因子的变化

目的：探讨炎症介质在严重烧伤后心肌损害中的作用。方法：采用大鼠３０％ 体表面积Ⅲ度烫伤模型,随机分为对照组（１０ 只）和烫伤组（５０ 只）,于烫伤后１、３、６、１２ 和２４ 小时检测大鼠血浆肿瘤坏死因子（ＴＮＦ）和肌钙蛋白Ｔ（ＴｎＴ）及心肌组织中ＴＮＦ的含量。结果：烫伤后６ 小时血浆ＴＮＦ水平〔（３．３８±０．９０）μｇ／Ｌ〕较正常对照组〔（１．０８±０．０１）μｇ／Ｌ〕显著升高（Ｐ＜ ０．０１）,１２ 小时达峰值〔（８．０２±１．０５）μｇ／Ｌ〕,伤后２４ 小时〔（６．４４±１．４３）μｇ／Ｌ〕虽有所下降,但仍显著高于正常对照组（Ｐ＜ ０．０１）。心肌组织ＴＮＦ含量伤后１２ 小时〔（２．１５±０．０９）ｎｇ／ｍ ｇ〕显著高于正常对照组〔（０．８８±０．０１）ｎｇ／ｍ ｇ,Ｐ＜ ０．０１〕。血浆ＴＮＦ水平与反映心肌损伤的敏感指标血浆ＴｎＴ的变化密切相关。结论：炎症介质ＴＮＦ在烧伤后心肌损害的发生发展中起重要作用     

急性脑血管病患者血与脑脊液中肿瘤坏死因子含量的变化及其临床意义

目的：探讨肿瘤坏死因子（ＴＮＦ）与急性脑血管病（ＡＣＶＤ）的关系。方法：采用酶联免疫吸附法检测了６０例ＡＣＶＤ患者血与脑脊液（ＣＳＦ）中ＴＮＦ水平。结果：ＡＣＶＤ组血及ＣＳＦ中ＴＮＦ水平分别为（２．３９１±０．５１９）μｇ／Ｌ和（３．２９４±１．４１８）μｇ／Ｌ，对照组血及ＣＳＦ中ＴＮＦ水平分别为（１．７６９±０．２７２）μｇ／Ｌ和（１．２３６±０．３９９）μｇ／Ｌ，ＡＣＶＤ组血及ＣＳＦ中ＴＮＦ含量均显著高于对照组（Ｐ＜０．０１，Ｐ＜０．００１）。轻、中、重型ＡＣＶＤ组患者血ＴＮＦ水平分别为（２．１１３±０．４１２）μｇ／Ｌ、（２．４１７±０．３１０）μｇ／Ｌ和（２．９４６±０．４３４）μｇ／Ｌ，ＣＳＦ中ＴＮＦ水平分别为（２．７６３±１．１０８）μｇ／Ｌ、（３．４１７±０．９４２）μｇ／Ｌ和（４．２１９±１．２５３）μｇ／Ｌ，轻、重型组分别与中型组比较，血和ＣＳＦ中ＴＮＦ含量均有显著性差异（Ｐ＜０．０５，Ｐ＜０．０１）。结论：ＴＮＦ参与了ＡＣＶＤ的炎性反应过程，抑制ＴＮＦ产生及抗炎性反应的治疗可能具有潜在的临床价值。     

多器官衰竭患者临终前血浆肿瘤坏死因子和白细胞介素6的变化

探讨多器官衰竭（ＭＯＦ）患者临终前血浆肿瘤坏死因子（ＴＮＦα）和白细胞介素６（ＩＬ６）含量变化及其临床意义。测定２１例ＭＯＦ患者临终前血浆ＴＮＦα和ＩＬ６水平。结果发现，ＭＯＦ患者临终前血浆ＴＮＦα（３．１７±１．０６μｇ／Ｌ）和ＩＬ６（９８±１７μｇ／Ｌ）显著高于正常对照组（Ｐ＜０．０５和Ｐ＜０．０１）。提示：ＭＯＦ患者临终前体内细胞因子网络系统仍处于激活状态。作者认为，深入研究ＭＯＦ患者血浆ＴＮＦα和ＩＬ６产生规律，在适当时机选用相应单克隆抗体改变体内细胞因子网络活性，可能有助于ＭＯＦ患者的抢救。     

脑梗塞头痛患者血浆肿瘤坏死因子（TNF）水平的变化

采用酶联免疫吸附法测定大脑中动脉区脑梗塞（ＣＩ）急性期１８例头痛患者与２２例非头痛患者和２８例对照组血浆ＴＮＦ含量，发现脑梗塞头痛组、非头痛组血浆ＴＮＦ含量（２．３３±０．２２μｇＬ、２．１１±０．２２μｇＬ）均显著（Ｐ＜０．０１）高于对照组（１．６４±０．２２μｇＬ），ＣＩ头痛血浆ＴＮＦ含量显著高于非头痛组（Ｐ＜０．０５）。研究结果提示：ＴＮＦ可能参与了ＣＩ头痛的发病过程。     

脑出血患者血浆血小板α—颗粒膜蛋白的变化及其临床意义

目的：探讨脑出血患者血浆血小板α颗粒膜蛋白（ＧＭＰ１４０）含量的变化和临床意义。方法：用放射免疫分析法测定９０例脑出血患者和７０例正常人血浆ＧＭＰ１４０的含量。结果：脑出血患者血浆ＧＭＰ１４０含量于发病１周内达高峰〔（２６．５４±７．２１）μｇ／Ｌ〕，明显高于正常对照组〔（９．０２±２．８９）μｇ／Ｌ，Ｐ＜０．０１〕，以后逐渐下降，第３周末多数降为正常〔（９．６５±３．４０）μｇ／Ｌ〕。出血量＞５０ｍｌ组血浆ＧＭＰ１４０含量〔（３９．５８±７．２９）μｇ／Ｌ〕显著高于出血量＜２０ｍｌ组〔（１５．３５±３．９０）μｇ／Ｌ，Ｐ＜０．０１〕；重型组血浆ＧＭＰ１４０含量〔（３２．１８±６．８１）μｇ／Ｌ〕明显高于轻型组〔（１３．０２±３．２１）μｇ／Ｌ，Ｐ＜０．０１〕；恶化死亡组血浆ＧＭＰ１４０含量〔（３３．３１±８．４５）μｇ／Ｌ〕明显高于治愈组〔（１４．６５±５．３４）μｇ／Ｌ，Ｐ＜０．０１〕。结论：测定脑出血患者血浆ＧＭＰ１４０含量可作为临床上估计出血量、监测病情和判断预后的一个指标。     

新生儿休克时血浆肿瘤坏死因子的测定及其意义

目的：探讨肿瘤坏死因子（ＴＮＦ）在新生儿休克中的作用。方法：应用放射免疫方法检测３６例新生儿休克患儿血浆ＴＮＦ水平。结果：休克组治疗前血浆ＴＮＦ浓度〔（６０４．２６±１．２６）ｎｇ／Ｌ〕显著高于正常对照组〔（３２８．３８±１．１５）ｎｇ／Ｌ〕，Ｐ＜０．０１；感染性休克组〔（６５６．１４±１．４６）ｎｇ／Ｌ〕高于非感染性休克组〔（４６８．７９±１．３２）ｎｇ／Ｌ〕，Ｐ＜０．０５；死亡组〔（６８６．１３±１．１９）ｎｇ／Ｌ〕高于存活组〔（４７１．２３±１．２９）ｎｇ／Ｌ〕，Ｐ＜０．０５。血浆ＴＮＦ浓度与患儿器官损伤数呈正相关趋势，ｒ＝０．３１，Ｐ＞０．０５。结论：ＴＮＦ参与新生儿休克的病理生理过程，且与休克预后有关     

地塞米松对肺损伤大鼠肺泡巨噬细胞释放肿瘤坏死因子-α和白细胞介素6的影响

目的：观察博莱霉素（ＢＬＭ）诱发大鼠肺损伤后肺泡巨噬细胞（ＡＭ）释放肿瘤坏死因子 α（ＴＮＦ α）和白细胞介素 ６（ＩＬ ６）的变化及地塞米松（ＤＭ）对ＡＭ 释放ＴＮＦ α和ＩＬ ６的影响。方法：采用生物活性法测定ＴＮＦ α和ＩＬ ６。结果：灌注ＢＬＭ 后ＡＭ 释放ＴＮＦ α〔（５８．９５±１３．２１）ｋＵ／Ｌ〕和ＩＬ ６〔（３５．００±１０．００）ｋＵ／Ｌ〕明显高于对照组〔ＴＮＦ α为（２３．６３±５．５０）ｋＵ／Ｌ,Ｐ＜ ０．００１;ＩＬ ６ 为（２１．１７±６．０４）ｋＵ／Ｌ,Ｐ＜０．０１〕,ＤＭ 能够抑制ＡＭ 释放ＴＮＦ α和ＩＬ ６,并且与其剂量相关（随ＤＭ 浓度的增加,ＡＭ 分泌ＴＮＦ α和ＩＬ ６ 水平逐渐降低）。ＢＬＭ 组支气管肺泡灌洗液（ＢＡＬＦ）中细胞总数（４．８８±０．６５）×１０６ 也明显高于对照组〔（１．４７±０．４１）×１０６,Ｐ＜ ０．００１〕。结论：ＤＭ 能以剂量依赖方式抑制ＡＭ 释放ＴＮＦ α和ＩＬ ６     

人工虫草对慢性肾功能衰竭患者肾功能及免疫功能的影响

目的：探讨人工虫草对慢性肾功能衰竭患者肾功能及免疫功能的影响。方法：５３例慢性肾功能衰竭患者随机分为２组,治疗组２９例给予人工虫草菌丝粉（金水宝胶囊）及常规西药对症治疗;对照组２４例单用相同西药治疗。结果：５３例慢性肾功能衰竭患者与健康人比较,单克隆抗体ＯＫＴ３、ＯＫＴ４及ＯＫＴ８均明显降低（Ｐ均＜０．０１）。治疗组治疗后ＯＫＴ８明显降低（０．１４±０．０９比０．２４±０．１０）,ＯＫＴ４／ＯＫＴ８明显升高（１．９７±０．５４比１．０２±０．４８）,Ｐ均＜０．０１;对体液免疫无影响。治疗组患者血红蛋白升高〔（７８．５０±０．５３）ｇ／Ｌ升至（８７．２０±０．４４）ｇ／Ｌ〕,血肌酐明显下降〔（４７８．５±１９６．４）μｍｏｌ／Ｌ比（３５１．７±１３７．３）μｍｏｌ／Ｌ〕,Ｐ均＜０．０５。结论：人工虫草具有调整慢性肾功能衰竭患者细胞免疫的作用,并能改善肾性贫血及肾功能。     

血清白细胞介素6和肿瘤坏死因子与多发性骨髓瘤相关性的初步探讨

采用ＩＬ－６依赖细胞株ＫＤ８３增殖实验检测２３例多发性骨髓瘤（ＭＭ）患者血清ＩＬ－６活性；用ＥＬＩＳＡ法测定相应患者血清ＴＮＦ水平，结果显示ＭＭ患者血清ＩＬ－６和ＴＮＦ水平分别为０．２０±０．１０（ＯＤ值）与８．８±２．４μｇ／Ｌ，而正常组分别为０．１０±０．０６（ＯＤ值）与０．５±１．１μｇ／Ｌ，两组相比Ｐ＜０．０ｌ，ＭＭ患者血清ＩＬ－６和ＴＮＦ水平显著高于正常组，并与疾病分期相关。对１３例初治患者进行动态观察，发现ＩＬ－６、ＴＮＦ水平和变化情况与疗效有关。结果提示ＩＬ－６和ＴＮＦ都可作为ＭＭ临床分期、反映疗效和估计预后的重要指标。     

银杏苦内酯治疗急性颈髓损伤患者疗效观察

目的：探讨血小板活化因子（ＰＡＦ）受体拮抗剂——银杏苦内酯对颈髓损伤患者早期治疗的效果及其机制。方法：３６例颈髓损伤患者随机分为地塞米松组和银杏苦内酯组，每组１８例，观察２组颈髓损伤患者全血ＰＡＦ、血浆血栓素Ｂ２（ＴＸＢ２）、６酮前列腺素Ｆ１α（６ｋｅｔｏＰＧＦ１α）含量和ＴＸＢ２／６ｋｅｔｏＰＧＦ１α（Ｔ／Ｋ）比值的变化，多器官衰竭（ＭＯＦ）发生率及脊髓神经功能恢复状况。结果：银杏苦内酯组血液中ＰＡＦ和ＴＸＢ２含量及Ｔ／Ｋ比值〔用药后３日分别为（５５２．４５±１１８．１２）μｇ／Ｌ，（６７２．７４±１３４．３６）ｎｇ／Ｌ，９．０４±１．５５〕均较地塞米松组〔用药后３日分别为（８４６．５７±１２７．５１）μｇ／Ｌ，（９２４．０５±１８８．３５）ｎｇ／Ｌ，１１．８４±１．７１〕明显降低（Ｐ均＜０．０５）；ＭＯＦ发生率低于地塞米松组（５．６％和２２．２％），但无显著性差异（Ｐ＞０．０５）；脊髓神经功能恢复亦优于地塞米松组。结论：ＰＡＦ受体拮抗剂——银杏苦内酯对颈髓损伤后神经功能具有较好的保护作用，并且是早期治疗脊髓损伤的理想药物     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.