肺炎双球菌肺炎老龄大鼠小肠组织自由基和前列腺素代谢变化

目的：研究老年肺炎的小肠损伤病理生理特点。方法：复制肺炎双球菌肺炎大鼠模型，分为青年和老龄对照组及模型组。主要观察肺脏和小肠组织含水量，小肠组织6-酮-前列腺素F1α(6-keto-PGF1α)、血栓素B2(TXB2)、一氧化氮(NO)、丙二醛(MDA)含量及超氧化物歧化酶(SOD)活性。结果：肺炎大鼠的肺组织损伤明显，肺脏和小肠组织含水量增高。青年模型组和老龄模型组小肠组织6-keto-PGF1α含量、SOD活性的降低和TXB2、NO、MDA含量的增高均较青年对照组和老龄对照组显著。与青年对照组比较，老龄对照组SOD活性降低，MDA含量升高。老龄模型组SOD活性的降低和MDA含量的增高较青年模型组显著。结论：前列腺素及自由基介导的损伤参与肺炎小肠组织损伤的发生和发展。由于增龄变化，肺炎老龄大鼠小肠自由基损伤较青年大鼠尤为严重。     

毒素清对大肠杆菌肺炎老龄大鼠小肠组织自由基

目的研究老年肺炎时小肠损伤的病理生理特点与中药毒素清的作用机制。方法复制大肠杆菌肺炎模型,分为老龄对照组、模型组、毒素清高低剂量组和氟哌酸组5组。主要观察肺脏和小肠组织病理改变及其含水量,小肠组织6-酮-前列腺素F1α(6-keto-PGF1α)和血栓素B2(TXB2)含量,一氧化氮(NO)、丙二醛(MDA)含量及超氧化物歧化酶(SOD)活性。结果肺炎时肺、小肠组织损伤明显,含水量增高。老龄模型组SOD活性、6-keto-PGF1α含量的降低和NO、MDA、TXB2含量的增高均较老龄对照组显著。与老龄模型组比较,毒素清用药各组MDA和NO含量降低,SOD活性和6-keto-PGF1α含量提高。结论前列腺素及自由基介导的损伤参与肺炎时小肠组织损伤的发生、发展。毒素清对老龄大鼠肺炎的小肠损伤改善作用明显,其机制与其拮抗自由基损伤和调节前列腺素代谢平衡有关。     

毒素清对大肠杆菌肺炎老龄大鼠小肠组织自由基和前列腺素代谢变化的影响

目的：研究老年肺炎时小肠损伤的病理生理特点与中药毒素清的作用机制。方法：复制大肠杆菌肺炎模型,分为老龄对照组、模型组、毒素清高低剂量组和氟哌酸组5组。主要观察肺脏和小肠组织病理改变及其含水量,小肠组织6－酮－前列腺素F1α（6-keto-PGF1α）和血栓素B2（TXB2）含量,一氧化氮（NO）、丙二醛（MDA）含量及超氧化物歧化酶（SOD）活性。结果：肺炎时肺、小肠组织损伤明显,含水量增高。老龄模型组SOD活性、6－keto-PGF1α含量的降低和NO、MDA、TXB2含 量的增高均较老龄对照组显著。结论：前列腺素及自由基介导的损伤参与肺炎时小肠组织损伤的发生、发展。毒素清对老龄大鼠肺炎的小肠损伤改善作用明显,其机制与其拮抗自由基损伤和调节前列腺素代谢平衡有关。     

补肾活血和泻下方药及其配伍对老龄大鼠脑缺血自由基损伤的影响

目的 :从自由基损伤方面研究老年大鼠脑缺血的发病机制和中药的防治作用。方法 :青年大鼠分为青年对照组、青年模型组 ;老龄大鼠分为老龄对照组、老龄模型组、尼莫地平组、大黄组、益元活血组及益元活血大黄组。观察脑缺血模型大鼠脑电图幅值、脑含水量、超氧化物歧化酶 (SOD)、丙二醛 (MDA)和一氧化氮 (NO)含量的变化。结果 :1青年和老龄模型组脑电图幅值以及血清与脑组织 SOD活性分别较青年和老龄对照组降低(P<0 .0 5或 P<0 .0 1) ,而脑含水量、MDA和 NO含量增高 (P<0 .0 5或 P<0 .0 1)。 2与青年模型组比较 ,老龄模型组脑电图幅值以及血清与脑组织 SOD活性降低 ,脑含水量、脑组织 MDA及血清 NO含量增高(P<0 .0 5或 P<0 .0 1)。 3与老龄模型组比较 ,用药各组脑电图幅值以及血清 SOD活性提高 (P均 <0 .0 1) ,脑含水量、脑组织 MDA含量下降 (P均 <0 .0 5 )。大黄组血清和脑组织 NO水平降低 (P均 <0 .0 1)。结论 :青年和老龄大鼠脑缺血损伤与自由基损伤有关 ,老龄大鼠较青年大鼠严重 ,其机制与增龄有一定的关系。补肾活血方药和泻下方药及其配伍通过拮抗自由基损伤、改善 NO代谢而对老龄大鼠脑缺血损伤有一定的保护作用。     

大肠杆菌肺炎模型老龄大鼠的小肠分泌型IgA和肿瘤坏死因子的观测

目的：探讨老年肺炎时小肠损伤的发病机制。方法：复制大鼠大肠杆菌肺炎模型,分为青年对照组、青年模型组、老龄对照组和老龄模型组。观测肺脏和小肠组织病理改变及其组织含水量,肠内容物分泌型IgA（sIgA),IgA含量,血清和小肠组织肿瘤坏死因子（TNF）含量。结果：青年和老龄模型组肺和小肠组织损伤和含水量增高明显,其中老龄模型组大鼠肺组织损伤较青年模型组严重。青年模型组肠内容物sIgA含量的增高较青年对照组显著,老龄对照组sIgA高于青年对照组,老龄模型组sIgA低于老龄对照组。青年模型组和老龄模型组血清和小肠组织TNF的增高分别较青年对照组和老龄对照组显著,老龄模型组和血清和小肠组织TNF含量高于青年模型组。结论：TNF含量增多和sIgA含量变化与肺炎的肠道损伤发生发展有关密切关系,TNF增多及sIgA含量减少在老龄肺炎大鼠的变化更为显著。     

细胞因子在肺炎双球菌肺炎老龄大鼠的变化意义

目的：研究老年肺炎的病理生理特点。方法：复制肺炎双球菌肺炎模型，分为青年对照组和模型组，老龄对照组和模型组。观察肺脏组织病理改变，肺泡灌洗液中性粒细胞计数和外周血IL－8、IL－6、TNF含量。结果：肺炎老龄大鼠肺组织损伤较青年大鼠明显。青年模型组和老龄模型组肺泡灌洗液白细胞和中性粒细胞分别高于青年对照组和老龄对照组。与青年对照组比较，青年模型组血清IL－8含量降低和IL－6、TNF含量增高，老龄对照组IL－8、TNF含量降低和IL－6含量增高。老龄模型组IL-8、IL-6、TNF含量的增高较老龄对照组显著。老龄模型组IL－8、TNF的增高较青年模型组显著。结论：细胞因子紊乱参与老龄大鼠肺炎的病理过程。细胞因子的增龄变化影响老龄大鼠肺炎的病理生理，使老龄大鼠肺炎有显著的特点。     

川芎嗪和参麦注射液对脑缺血-再灌注损伤老龄大鼠心肌组织ATP酶和自由基代谢的影响

目的：从ATP酶活性变化和自由基损伤方面探讨川芎嗪和参麦注射液及其配伍而成的川芎参麦注射液对老龄大鼠脑缺血－再灌注心肌损伤防护作用的机制。方法：老龄（20月龄以上）大鼠分为正常对照组、模型组、尼莫通组、川芎嗪组、参麦组和川参组,观察大鼠全脑缺血30分钟及再灌注60分钟后超氧化物歧化酶（SOD）、乳酸脱氢酶（LDH）、肌酸磷酸激酶（CPK）、ATP酶活性和丙二醛（MDA）含量变化。结果：与老龄对照组比较,老龄模型组血清CPK、LDH活性和血清、心肌组织MDA／SOD明显增高,心肌组织Na^ －K^ -ATP酶和Ca^2 -ATP酶活性降低。与老龄模型组比较, 川参组、尼莫通组、川芎嗪组CPK水平和参麦组、尼莫通组、川芎嗪组LDH活性降低;川参组、尼莫通组、川芎嗪组心肌Na^ -K^ -ATP酶活性和川参组Ca^2 －ATP酶、SOD活性增高;川参组心肌组织MDA／SOD比值、MDA含量降低。结论：老龄大鼠脑缺血－再灌注心肌组织损伤与ATP酶活性降低和自由基损伤有关。川芎嗪注射液、参麦注射液、川芎参麦注射液及尼莫通对心肌损伤均有一定的保护作用。种芎嗪提高Na^ -K^ -ATP酶活生效果显著,川芎参麦注射液能提高Ca^2 -ATP酶活性和抑制自由基的损伤及其引起的脂质过氧化反应,这可能是其拮抗脑缺血－再灌注引起心肌损伤的机制。     

老龄大鼠脑缺血再灌注肺损伤机制研究

目的从ATP酶活性变化和自由基损伤方面研究老龄大鼠脑缺血再灌注肺脏损伤机制。方法青年(5月龄)和老龄(20月龄以上)大鼠均分为模型组和对照组,观察大鼠全脑缺血30min再灌注60min后肺脏组织形态和丙二醛(MDA)含量及超氧化物岐化酶(SOD)、ATP酶活性的变化。结果青年和老龄模型组大鼠肺脏组织均出现明显的病理改变,老龄模型组较青年模型组严重。老龄对照组肺组织MDA/SOD比值高于青年对照组组。青年模型组肺Ca2+-ATP酶活性低于青年对照组和老龄模型组。结论脑缺血再灌注肺损伤老龄大鼠较青年大鼠严重,Ca2＋-ATP酶活性的降低和自由基损伤可能是肺损伤发生的机制之一。     

老龄大鼠脑缺血再灌注肺损伤机制研究

目的：从ATP酶活性变化和自由基损伤方面研究老龄大鼠脑缺血再灌注肺脏损伤机制。方法：青年（5月龄）和老龄（20月龄以上）大鼠均分为模型组和对照组,观察大鼠全脑缺血30min再灌60min后肺脏组织形态和丙二醛（MDA）含量及超氧化物岐化酶（SOD）、ATP酶活性的变化。结果：青年和老龄模型组大鼠肺脏组织均出现明显的病理改变,老龄模型组较青年模型组严重。老龄对照组肺组织MDA/SOD比值高于青年对照组。青年模型组肺Ca^2 -ATP酶活性低于青年对照组和老龄模型组。结论：脑缺血再灌注肺损伤老龄大鼠较青年大鼠严重,Ca^2 -ATP酶活性的降低和自由基损伤可能是肺损伤发生的机制之一。     

茶氨酸对脑缺血损伤大鼠自由基代谢的影响

目的:从对自由基代谢影响方面探讨茶氨酸对脑缺血损伤的保护作用机制。方法:选用30只SD雄性大鼠,线栓阻塞大鼠大脑中动脉制备局灶性脑缺血模型,观察脑缺血损伤大鼠神经症状改变,测定脑组织含水量、脑组织病理及钙离子含量;观察其血清和脑组织超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量变化以及茶氨酸对上述变化的影响。结果:脑缺血组大鼠的神经症状评分、脑组织含水量及钙离子含量均显著增高,病理损伤明显,正常神经元细胞数目减少;茶氨酸可显著降低神经症状评分、脑组织含水量及钙离子含量,增加正常神经元细胞数目。脑缺血组大鼠的血清、脑组织SOD活性显著降低,茶氨酸组大鼠血清、脑组织SOD活性较脑缺血组显著增高;脑缺血组大鼠的血清、脑组织MDA含量显著增高,茶氨酸组脑组织MDA含量较脑缺血组下降明显。结论:茶氨酸对大鼠脑缺血损伤具有显著的保护作用,可能与调节脑缺血损伤引起的自由基代谢失调有关。     

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.     

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.     

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.     

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.