阿托伐他汀对大鼠心肌梗死后AngⅡ、TNF-α及心功能的影响

目的：探讨阿托伐他汀对大鼠心肌梗死后血管紧张素Ⅱ（AngⅡ）和肿瘤坏死因子-α（TNF-α）及心功能的影响。方法：急性心肌梗死雄性大鼠30只，随机分为心肌梗死对照组（AMI）和阿托伐他汀治疗组各15只，另设15只为假手术组，阿托伐他汀治疗组于手术后第2d起灌胃给药，假手术组及对照组只给予等量清水灌胃，6周后检测心肌AngⅡ、TNF-α及超声心动图，以了解心功能，最终获得完整资料大鼠于上述各组分别为10，11，14只。结果：与假手术组相比，心肌梗死对照组及阿托伐他汀治疗组心）lrt,AngⅡ、TNF-α和左室舒张末期内径（LVEDd）均明显升高（P均〈0．05），左室射血分数（LVEF）、短轴缩短率（FS）明显降低（P均〈0.05）。与心肌梗死对照组相比，阿托伐他汀治疗组心肌AngⅡ、TNF-α和LVEDd明显下降（P均〈0．05），LVEF、FS明显增高（P均〈0．05），左室功能改善明显。结论：阿托伐他汀能降低心肌AngⅡ，TNF-α水平，减轻心室重塑，保护心功能。     

阿托伐他汀对心肌梗死大鼠心肌纤维化和细胞外信号调节激酶表达的影响

目的观察阿托伐他汀对大鼠急性心肌梗死后心室重塑和心肌组织中细胞外信号调节激酶(ERK)1/2蛋白表达的影响。方法 20只雄性SD大鼠通过前降支动脉结扎法建立大鼠急性心肌梗死模型后随机分为心肌梗死组(AM I),心肌梗死阿托伐他汀组(ATV),另设假手术组(sham),每组n=10。阿托伐他汀组每天给予阿托伐他汀(10 mg/kg)灌胃,持续4周。假手术组和心肌梗死组每天给予同等量的0.9%氯化钠注射溶液灌胃。应用real-tim e PCR法检测梗死周边区心肌组织中Ⅰ型、Ⅲ型胶原mRNA表达,应用westernb lot方法检测p-ERK1/2、ERK1/2蛋白的表达。结果与假手术组比较,心肌梗死组和阿托伐他汀组中Ⅰ型、Ⅲ型胶原表达高于假手术组(P<0.01),阿托伐他汀组Ⅰ型、Ⅲ型胶原表达显著低于心肌梗死组(P<0.01)。心肌梗死组和阿托伐他汀组中p-ERK1/2表达高于假手术组(P<0.01),阿托伐他汀组p-ERK1/2表达低于心肌梗死组(P<0.01)。结论阿托伐他汀可以改善大鼠心肌梗死后心室重塑,其机制可能与下调心肌组织中p-ERK1/2表达有关。     

阿托伐他汀对大鼠急性心肌缺血-再灌注无复流现象的影响

目的:探讨阿托伐他汀对大鼠急性心肌缺血-再灌注无复流现象的影响。方法:8周龄健康SD大鼠48只,随机分为3组。其中缺血再灌注组(MIR)和阿托伐他汀组,进行造模;假手术组:仅穿线,不结扎。MIR组和假手术组:在造模前每日1次生理盐水2ml灌胃,连续7d。阿托伐他汀组:在造模前每日1次阿托伐他汀15mg/kg与生理盐水2ml混合灌胃,连续7d。造模完成后,血清心肌肌酸激酶同工酶(CK-MB)和乳酸脱氢酶(LDH);检测HR、主动脉收缩压(SBP)、主动脉舒张压(DBP)、左心室收缩压(LVSP)、左心室舒张压(LVEDP)。大鼠心肌采用伊文蓝染色和2,3,5-氯化三苯基四氮唑染色,计算心肌缺血率、心肌梗死率和心肌无复流率。结果:MIR组和阿托伐他汀组CK-MB、LDH、HR和LVEDP均高于假手术组,而LVSP、SBP和DBP低于假手术组(P0.01)。阿托伐他汀组HR和LVEDP高于MIR组,而CK-MB、LDH、LVSP、SBP和DBP低于MIR组(P0.05)。阿托伐他汀组心肌梗死率和心肌无复流率均小于MIR组(P0.05)。MIR组和阿托伐他汀组心肌缺血风险率比较差异无统计学意义。结论:阿托伐他汀预处理心肌缺血-再灌注大鼠,减少心肌损伤、血流动力学紊乱、心肌梗死面积。     

阿托伐他汀联合辅酶Q10对心肌梗死后心力衰竭大鼠解偶联蛋白2基因表达的影响

目的研究阿托伐他汀及辅酶Q10通过抗氧化作用改善心衰大鼠的作用机制。方法结扎大鼠左冠状动脉前降支并饲养6周的24只存活大鼠随机分为假手术组（Shamgroup,n=6）、模型组（Model group,n=6）、阿托伐他汀组（atorvastatin group,n=6）、阿托伐他汀＋辅酶Q10组（atorvastatin＋coenzyme Q10 group,n=6）,连续灌胃给药5周后测定大鼠血流动力学参数,全心及左室肥厚指数（HW/BW,LVHW/BW）,血清SOD活性及MDA含量,RT-PCR法测定非梗死区心肌组织UCP2 mRNA表达水平。结果联合应用阿托伐他汀及辅酶Q10更能明显升高左心室内压最大上升、最大下降速率（±dp/dtmax）及SOD活性,降低左心室收缩压（LVSP）、左心室舒张末压（LVEDP）、心肌肥厚指数、血清MDA的含量及下调UCP2 mRNA表达水平（P〈0.05-0.001）,但对心率（HR）、收缩压（SBP）、舒张压（DBP）无明显影响（P〉0.05）。结论阿托伐他汀联合辅酶Q10可能通过抗氧化作用,下调心肌梗死后心衰大鼠心肌细胞内UCP2 mRNA的表达水平改善心衰心室重构过程中能量代谢。     

阿托伐他汀对大鼠心肌梗死后心室重塑和心功能的影响

目的观察阿托伐他汀对大鼠急性心肌梗死后心室重塑和心功能的影响。方法 20只雄性SD大鼠通过前降支动脉结扎法建立大鼠急性心肌梗死模型后随机分为心肌梗死组(AMI),阿托伐他汀组(ATV),另设假手术组,每组n=10。阿托伐他汀组每天给予阿托伐他汀钙片(10 mg.kg-1.d-1)灌胃,持续4周。假手术组和心肌梗死组每天给予同等量的0.9%氯化钠注射溶液灌胃。治疗前后分别测量3组大鼠的左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)和短轴缩短率(LVFS)。大鼠处死后,测量左心室重量及左心重量指数。采用羟胺氧化法测定大鼠血清超氧化物歧化酶活力(SOD)。采用TBA法测定血清丙二醛(MDA)水平。结果治疗4周后,与正常组比较,心肌梗死组和阿托伐他汀组的左心室重量及左心室重量指数均显著增加。与心肌梗死组比较,阿托伐他汀组的左心室重量及左心室重量指数均显著降低,LVEDD、LVESD明显降低,LVEF显著升高。血清超氧化物歧化酶活力显著增强,血清丙二醛水平下降。结论阿托伐他汀可能通过抗氧化作用,改善心肌梗死后大鼠心室重构和左心室功能,防治心室重塑。     

Ser473-Akt磷酸化介导阿托伐他汀保护大鼠脑缺血再灌注损伤

目的探讨Akt之Ser473位点(Ser473-Akt)磷酸化在阿托伐他汀保护大鼠脑缺血再灌注损伤中的作用。方法 40只雄性Sprague-Dawley大鼠随机分成正常组(n=10)、假手术组(n=10)、缺血再灌注(I/R)组(n=10)和干预组(n=10)。采用线栓法制作大鼠脑缺血2 h再灌注72 h模型。正常组和假手术组不做任何处理,I/R组仅生理盐水灌胃,干预组在再灌注后大鼠苏醒时、24 h、48 h分别予生理盐水配制的阿托伐他汀10 mg/kg灌胃。72 h时处死所有大鼠,留取脑标本分别行HE染色及TUNEL染色,Western blotting检测脑前额叶皮质Akt及其Ser473-Akt表达。结果缺血再灌注72 h后,干预组神经细胞形态学变化较I/R组减轻;干预组凋亡阳性细胞数显著少于I/R组(t=-6.014,P0.001);I/R组前额叶皮质Ser473-Akt较正常组和假手术组显著增加(t20.327,P0.001),而干预组明显高于I/R组(t=3.649,P=0.007)。结论 Ser473-Akt磷酸化在阿托伐他汀的神经细胞保护中起重要作用,通过抑制凋亡减轻大鼠脑缺血再灌注损伤。     

不同剂量阿托伐他汀预处理对高脂兔心梗后hs-CRP的影响

目的：观察不同剂量阿托伐他汀预处理对高脂兔急性心肌梗死（AMI）后高敏C-反应蛋白（hs-CRP）的影响,明确其在防治心梗中的作用机制。方法：雄性高脂兔47只,随机分为对照组、AMI组、假手术组、阿托伐他汀大剂量组10 mg/（kg.d）、阿托伐他汀小剂量组5 mg/（kg.d）。灌胃给药连续14 d,末次给药后1 h结扎左冠状动脉前降支,24 h后测定hs-CRP含量。结果：与对照组比较,AMI组血清hs-CRP含量明显升高（P〈0.01）;与AMI组比较,阿托伐他汀组hs-CRP含量显著降低（P〈0.01）,以大剂量组降低显著。结论：阿托伐他汀预先给药可以降低高脂兔心梗后hs-CRP含量,对急性心梗起到预防和保护作用。     

CT-1,AngⅡ在心肌梗死大鼠心室重塑中的表达及罗格列酮对其的影响

目的:观察罗格列酮对心肌梗死后大鼠心室重塑过程中CT-1,AngⅡ表达的影响。方法:45只雄性Wistar大鼠随机分为假手术组(A组,n=15)和心肌梗死组(n=30),通过结扎左冠状动脉前降支制作急性心肌梗死模型。模型制作成功24 h后,心肌梗死组再随机分为心肌梗死对照组(B组,n=15)和罗格列酮干预组(C组,n=15)。罗格列酮干预组每日给以罗格列酮灌胃(4 mg/kg),假手术组和心肌梗死对照组每日给以等量生理盐水灌胃,持续8周。利用Real Time PCR法检测非梗死区心肌营养素-1的表达,放射免疫法检测非梗死区血管紧张素Ⅱ的含量。结果:给药8周后,B组非梗死区心肌中心肌营养素-1mRNA的表达,血管紧张素Ⅱ的含量及左心重量指数与A、C组相比显著升高,差异有统计学意义(P<0.05);C组与A组相比,非梗死区心肌中心肌营养素-1mRNA的表达,血管紧张素Ⅱ的含量及左心室重量指数显著升高,差异有统计学意义(P<0.05)。结论:罗格列酮可能通过抑制心肌营养素-1,血管紧张素Ⅱ的表达来改善大鼠心肌梗死后心室重塑。     

单剂量阿托伐他汀对兔急性心肌梗死再灌注后内皮素-1及无复流的影响

目的：评价单剂量阿托伐他汀对兔急性心肌梗死（AMI）再灌注无复流的防治作用。方法：新西兰大白兔24只随机分成对照组、阿托伐他汀组(10mg．kg-1 )和假手术组。冠状动脉结扎60min，松解120min制备AMI再灌注模型。采用酶联免疫吸附法（ELISA）测定血清白介素-6（IL-6），用放射免疫方法测定AMI前5 min、AMI 60min和再灌注后120min血浆内皮素-1 (ET-1)的含量及正常、复流、无复流区心肌组织ET-1的变化，最终行病理学分析。结果：与对照组相比，阿托伐他汀能有效降低兔AMI再灌注后循环IL-6及ET-1(分别P < 0.01)；而心肌组织ET-1含量阿托伐他汀组仅复流区显著降低( P < 0.01) 。阿托伐他汀组与对照组相比，结扎区范围无明显差异（35.6%与36.2%，P=0.624），无复流范围显著减少(36.5％LA与75.3％LA，P < 0.001)。结论: 单剂量阿托伐他汀具有抗炎及内皮保护作用；能有效防治AMI再灌注后无复流的发生。     

急诊PCI术前口服阿托伐他汀对STEMI患者MCP-1、MIF及预后的影响

目的：探讨急诊PCI术前单次口服大剂量阿托伐他汀对ST段抬高性心肌梗死（STE—MI）患者外周静脉血、病变相关冠状动脉血单核细胞趋化蛋白（MCP）-1、巨噬细胞迁移抑制因子（MIF）和患者预后的影响。方法：选取稳定型心绞痛患者36例和STEMI患者69例,并将后者随机分为阿托伐他汀组（术前口服阿托伐他汀80mg,n=36）和STEMI对照组（n=33）。分别于PCI术中抽取3组患者的病变相关冠状动脉血,术后立即抽取外周静脉血,测定各组MCP—1和MIF水平;并统计术后3个月内各组心血管急性事件的发生率。结果：STEMI组外周和病变相关冠状动脉血MCP-1、MIF水平明显高于稳定型心绞痛组,阿托伐他汀组上述指标水平明显低于STEMI对照组（P〈0．05）;阿托伐他汀组和STEMI对照组患者病变相关冠状动脉血MCP-1水平明显高于静脉血（P〈0．05）,而MIF水平无明显区别;阿托伐他汀组术后3个月心血管急性事件的发生率明显低于STEMI对照组。结论：STEMI患者术前单次大剂量应用阿托伐他汀可以降低外周血和病变相关冠状动脉血MCP-1和MIF水平及3个月内急性心血管事件的发生率。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."