大鼠→小鼠异种骨髓移植耐受诱导的研究

目的 探索适合临床应用的有效诱导异种骨髓移植耐受的方案。方法 给亚致死照射（５Ｇｙ） 的Ｃ５７ＢＬ／ ６ （Ｂ６） 小鼠尾静脉注射４ ×１０７ Ｌｅｗｉｓ 大鼠骨髓细胞,２ 天后腹腔注射环磷酰胺１５０ｍｇ／ｋｇ 。分别于骨髓移植后３０ 天、６０ 天、９０ 天,对受体小鼠外周血、脾脏及胸腺中的淋巴细胞进行间接免疫荧光染色, 作ＦＡＣＳ 分析, 检测大鼠源性的骨髓细胞在小鼠体内植活情况,并于３０ 天后,对受体小鼠作混合淋巴细胞反应（ ＭＬＲ） 及迟发超敏反应（ＤＴＨ） 检查。结果 经处理的Ｂ６ 小鼠外周血、脾脏及胸腺中检测出了大鼠源性的骨髓嵌合体, 嵌合体可长期存在（ ＞ ３ 个月） 。ＭＬＲ 及ＤＴＨ 检查证明Ｂ６ 小鼠对Ｌｅｗｉｓ 大鼠的脾细胞产生特异性耐受, 对无关第３ 者ＤＡ 大鼠及ＢＡＬＢ／ ｃ 小鼠的脾细胞仍表现出强烈的免疫应答。结论 在Ｂ６ 小鼠体内成功地诱导出了供者特异性的大鼠→小鼠异种骨髓移植耐受。     

大鼠脊髓5－羟色胺1A受体和1C／2受体亚型参与高频电针镇痛

通过脊髓蛛网膜下腔慢性埋植导管分别注射５－ＨＴ受体的多种拮抗剂，分析了大鼠脊髓５－ＨＴ受体的三个主要类型５－ＨＴ１、５－ＨＴ２和５－ＨＴ３受体在高频电针镇痛中的作用。实验结果表明：ｉ．ｔ．注射５－ＨＴ１Ａ受体拮抗剂ｓｐｉｐｅｒｏｎｅ２５μｇ不影响１００Ｈｚ电针的平均针效（Ｐ＞０．０５），但可阻断电针后效应（Ｐ＜０．０１）；ｉ．ｔ．注射５－ＨＴ１ｃ／２受体拮抗剂ｍｉａｎｓｅｒｉｎ５０μｇ可阻断１００Ｈｚ电针的平均针效，也可阻断电针后效应（Ｐ＜０．０１）；ｉ．ｔ．注射５－ＨＴ２受体拮抗剂１－ＮＰ２０μｇ和５－ＨＴ３受体拮抗剂ＩＣＳ２０５－９３０１００μｇ对１００Ｈｚ电针镇痛没有显著影响（Ｐ＞０．０５）。提示大鼠脊髓５－ＨＴ１Ａ受体和５－ＨＴ１ｃ／２受体参与介导１００Ｈｚ电针镇痛，而５－ＨＴ３受体可能不起主要作用。     

生脉注射液在阿霉素诱导大鼠心肌损伤中的抗氧化作用

观察生脉注射液对阿霉素诱导大鼠心肌损伤的抗氧作用。方法：Ｗｉｓｔａｒ大鼠３０只，随机分为３组，每组１０只。生理盐水组腹腔注射生理盐水５ｍｌ．ｋｇ＾－１．ｄ＾－１，共９日；阿霉素组腹腔注射阿霉素３ｍｇ／ｋｇ，隔日１次，共７日；生脉注射液组腹腔注身一脉注射液５ｍｌ．ｋｇ＾－１．ｄ＾－１，共９日．。     

L—精氨酸对异丙肾上腺素致害心肌的影响

目的研究Ｌ－精氨酸（Ｌ－Ａｒｇ）对异丙肾上腺素（ＩＳＰ）致害心肌的影响。方法大鼠分四组;①ＩＳＰ组ＩＳＰ４０ｍｇ／ｋｇ／ｄａｙ×２,皮下注射;②对照组体重匹配的大鼠注射同容量的生理盐水;③Ｌ－Ａｒｇ组腹腔注射Ｌ－Ａｒｇ１５ｇ／ｋｇ／ｄａｙ×２;④ＩＳＰ＋Ｌ－Ａｒｇ组。结果ＩＳＰ处理的大鼠心重／体重比值、心肌内ＮＯ、钙的水平以及血清ＬＤＨ水平高于对照组（Ｐ＜００１）,而心肌中ＧＳＨ－ＰＸ及Ｌ－Ａｒｇ水平低于对照组（Ｐ＜００１）结论Ｌ－Ａｒｇ可部分逆转ＩＳＰ致心肌肥厚,心肌中ＮＯ、钙、Ｌ－Ａｒｇ、ＧＳＨ－ＰＸ及血清ＬＤＨ水平的变化     

急性肺损伤的炎症反应机制与药物治疗探讨

目的：探讨急性肺损伤的炎症反应机制以及雷公藤单体Ｔ４（Ｔ４）对炎症反应的影响。方法：小鼠腹腔注射内毒素（ＬＰＳ）复制急性肺损伤模型。动物分为生理盐水对照组、ＬＰＳ组、Ｔ４组（腹腔注射Ｔ４ ８５ μｇ／ｋｇ）和地塞米松组（地塞米松７０ ｍ ｇ／ｋｇ）。酶联免疫吸附法测定肿瘤坏死因子 α（ＴＮＦ α）、白细胞介素 １β（ＩＬ １β）、ＩＬ ６ 和ＩＬ １０ 浓度。一氧化氮（ＮＯ）的产物ＮＯ－２ 浓度以Ｇｒｉｅｓｓ法测定。以肺湿重与干重比值反映肺含水量。结果：Ｔ４组小鼠肺湿重与干重比值（３．９０±０．６２）与ＬＰＳ组（５．９５±０．９９）比较显著降低（Ｐ＜ ０．０５）。ＬＰＳ组血浆ＴＮＦ α、ＩＬ １β和ＩＬ ６浓度分别为（１３２．５±５．０）ｎｇ／Ｌ、（１８３．７±５８．６）ｎｇ／Ｌ和（３ ２９０．１±９２４．２）ｎｇ／Ｌ，Ｔ４组血浆ＴＮＦ α（０ ｎｇ／Ｌ）与ＬＰＳ组比较显著降低，Ｔ４ 组血浆ＩＬ １β和ＩＬ ６〔（３９．１±３１．８）ｎｇ／Ｌ和（８５９．６±８２９．９）ｎｇ／Ｌ〕与ＬＰＳ组比较亦显著降低。与ＬＰＳ组比较，Ｔ４ 组小鼠肺泡灌洗液中ＴＮＦ α浓度从（２２９．３±２０．３）ｎｇ／Ｌ显著降低到（２８．５±３３．４）ｎｇ／Ｌ。     

黄芪多糖对小鼠粒巨噬系祖细胞的影响

本文观察了黄芪多糖对小鼠ＣＦＵ－ＧＭ生成的影响，结果显示，剂量２０ｍｇ／ｋｇ的黄芪多糖连续注射三天，能提高小鼠ＣＦＵ－ＧＭ的生成（Ｐ〈０．０５），而１００ｍｇ／ｋｇ的剂量则抑制ＣＦＵ－ＧＭ的生成（Ｐ〈０．０１），注射环磷酰胺（ＣＴＸ）后小鼠ＣＦＵ－ＧＭ生成受抑，与ＣＴＸ同步一次性注射黄芪多糖１００ｍｇ／ｋｇ，或２０ｍｇ／ｋｇ的剂量连续注射三天，均不能逆转抑制作用，只有黄芪多糖１００ｍｇ／ｋｇ连续注     

从免疫调节的角度对5-氟尿嘧啶治疗急性胰腺炎机理的再认识

为探讨５－氟尿嘧啶治疗性胰腺炎是否与其抑制高炎症细胞因子的作用有关。我们通过动物实验观察了５－ＦＵ对急性胰腺炎发病时的高炎症性细胞因子血症的影响，使用雄性ＳＤ大鼠，共分３组。１组：正常对照组；２组：“胰岛炎组采用开腹胰管注射５％的牛黄胆酸钠（１．０ｍｌ／ｋｇ）制备急性胰腺炎动物模型。以后分别于２，６，２４小时处死；３组：５－ＦＵ治疗组（ｎ＝８为胰腺炎诱导成功后０．５小时静脉注５－ＦＵ４０ｍｇ／ｋｇ     

镉对大鼠四种器官乳酸脱氢酶同工酶的影响

目的：观察镉对大鼠器官乳酸脱氢酶（ＬＤＨ）同工酶的影响；方法：采用聚丙稀酰胺凝胶垂直板电泳法结合光密度扫描法，分析在四咱镉中毒浓度（０．２ｍｇ／ｋｇ、０．４ｍｇ／ｋｇ、０．８ｍｇ／ｋｇ和１．６ｍｇ／ｋｇ）下的ＳＤ大鼠心、肝、肾和脑中ＬＤＨ同工酶的变化。结果：随着镉中毒浓度的升高，心脏ＬＳＨ各同工酶的活性显著升高，而肾脏ＬＤＨ各同工酶的活性显著下降，脑中的ＬＤＨ１和ＬＤＨ２的活性出现选知高后下降现象     

反复注射吗啡使大鼠脑内前强啡肽原mRNA和κ受体mRNA表达增强

为探讨急性吗啡耐受的分子机制，本研究观察隐急性吗啡耐受对大鼠脑内与奖赏关核团中前脑啡肽原、前强啡肽原和κ受体基因表达的影响。２４只雄性Ｗｉｓｔａｒ大鼠连续注射６次硫酸吗啡（６．２５ｍｇ／ｋｇ）或等体积生理盐水（１ｍｌ／ｋｇ），每两次注射间期为２ｈ。在最后一次注射后３０ｍｉｎ，断头取检测样品：全脑（除去皮层、小脑和低位脑干）、伏核、尾壳核、黑质。用灵敏的液相杂交ＲＮＡ酶保护分析法检测ｍＲＮＡ水平（ｐ     

间歇大剂量环磷酰胺冲击治疗重症狼疮性肾炎临床研究

目的Ｌ：探讨间歇静脉注射大剂量环磷酰胺（ＩＶ－ＣＴＸ）治疗重症狼疮性肾炎（ＬＮ）的疗效。方法：将１４６例重症ＬＮ患者随机分为３组,Ａ组５６例,采用ＩＶ－ＣＴＸ０．６～１．０ｇ加强的松１ｍｇ．ｋｇ＾－１／ｄ口服。Ｂ组４６例,口服强的松１．５ｍｇ．ｋｇ＾－１／ｄ）,明显狼活动时给予静脉注射甲基强的松龙１ｇ／ｄ,共３d。间歇 ４d,间歇期口服强的松（剂量同前）,７d为１疗程,可连用２～３个疗程。Ｃ组４４例,     

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.     

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.     

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.     

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.