急性结石性胆囊炎与一氧化氮、氧化和脂质过氧化关系的研究

目的：从自由基医学的角度探讨一氧化氮、氧化和脂质过氧化与急性结石性胆囊炎之间的关系。方法：用分光光度法检测了97例急性结石性胆囊炎患者（ALC）和100例健康志愿者（HVT）血浆中的一氧化氮（）P－NO）、维生素C（P－VC）、维生素E（PVE）、β－胡萝卜素（P- β-CAR）和过氧化脂质（P－LPO）含量及红细胞超化物歧化酶（E－SOD）、过氧化氢酶（E－CAT）、谷胱甘肽过氧化物酶（E－CSH－Px)活性和过氧化脂质（E－LPO）含量,分析比较了ALC组与HVT组各平均检测（AV）之间的差异及患者组手术前后各AV之间的差异。结果与HCT组上述各AV比较,ALC组P－NO、P－LPO和E－LPO的AV均显著增高（P＝0．001）,P－VC、P－VE、P-β-CAR、E-SOD、E-CAT和E－GSH－Px的AV均显著降低（P＝0．0001）;与ALC组手术前上述各AV比较,ALC组手后P＝NO、P－LPO和E－LPO的AV均显著降低（P＜0．001）,P－VC、E－SOD、E－CAT和E－CSH－Px的AV均显著增高（P＜0．001）,但PVE和P－β-CAR的AV在手术前后无显著性差异（P＞0．05）。结论：ALC患者体内的一氧化氮代谢严重紊乱,一系列自由基连锁反应病理性加剧,氧化抗氧化平衡严重失调。     

氧化、脂质过氧化在食管癌患者中的变化

目的：探讨氧化、脂质过氧化在食管癌患中的变化。方法：检测45例食管癌患（患组）和50例健康人（对照组）血浆维生素C（P－VC）、维生素E（P－VE）、β－胡萝卜素（P－β－CAR）和过氧化脂质（P－LPO）含量及红细胞超氧化物歧化酶（E－SOD）、过氧化氢酶（E－CAT）、谷胱甘肽过氧化物酶（E－GSH－PX）活性和过氧化脂质（E－LPO）含量。结果：与对照组比较，P－VC、P－VE、P－β－CAR、E－SOD、E－CAT、E－GSH－PX值显降低（p＜0．001）P－LPO、E－LPO值显增高（p＜0．001）。结论：食管癌患氧化、脂质过氧化损伤加剧。     

急性甲胺磷口服中毒与自由基损伤关系的初步研究

目的：探讨急性甲胺磷口服中毒（AMP）患者体内的一系列自由基异常反应及其对患者机体损伤程度的关系。方法：采用独立样本随机对照设计，用分光光度比色分析法检测了41例AMP患者和40例健康成人志愿者（HAV）的血浆过氧化脂质（LPO）、一氧化氮（NO）、维生素C（VitC）、维生素E（VitE）、β－胡萝卜（β-CAR）含量及红细胞超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GPX）活性，结果：与HAV组的相应生化参数均值比较，AMP组的血浆LPO和NO均值显著升高（P＜0．0001），血浆Vit、VitE、β－CAR和红细胞SOD、CAT、GPX均值显著降低（P＜0．0001），对41例AMP患者红细胞乙酰胆碱酯酶（AChE)活性与上述各生化参数的直线回归和相关分析表明，随着AChE值的降低，LPO和NO值逐渐升高（P＜0．001），而VitC、VitE、β－CAR、SOD、CAT和GPX值逐渐降低（P＜0．01），逐步回归分析表明，AChE值与GPX和LPO的相关最密切，结论：AMP患者体内的一系列自由基反应病理性加剧，其中毒程度与GPX和LPO的相关最密切。     

丹参对老年难治性心力衰竭患者氧化／抗氧化系统的作用

目的：探讨丹参注射液对老年人心力衰竭患者血中GSHPx、CAT、SOD酶活性及LPO含量的影响。方法：选取健康老年人36例。检测静脉血全血超氧化物歧化酶(SOD)、全血谷胱甘肽过氧化物酶(GSH—Px)和过氧化氢酶(CAT)的活性及血浆脂质过氧化物(LPO)和丙二醛(MDA)的浓度．然后与老年难治性心力衰竭组治疗前的此五项指标进行对应比较；选择78例老年难治性心力衰竭患者，随机分成两组，试验前均监测静脉血SOD、GSH—Px和CAT的活性及LPO和MDA的浓度并评价心功能。然后试验组在给予常规治疗的同时合并给予丹参注射液，16g／d，qd，疗程2周；对照组只给予常规治疗，2周后。复测上述指标，比较各组前后的变化。结果：(1)老年难治性心力衰竭患者SOD、GSH—Px和CAT的活性比健康对照组低，而LPO及MDA的浓度比健康对照组高，均P＜0．01。(2)丹参组试验前后比较，SOD、GSH—Px和CAT活性明显增高，且LPO和MDA浓度明显降低，均P＜0．05；而对照组则无显著变化，P＜0．05。(3)丹参组心力衰竭纠正的有效率显著高于对照组，P＜0．05。结论：老年难治性心力衰竭患者机体的抗氧化防御能力降低，丹参注射液可通过提高机体的抗氧化能力，消除氧自由基和脂质过氧化物起到纠正心力衰竭的作用。     

部分性脾栓塞对肝硬化患者氧化和抗氧化失衡的影响

目的　探讨部分性脾动脉栓塞术 (PSE)对肝硬化患者氧化和抗氧化系统的影响及其临床意义。方法　测定 30例肝硬化PSE后 2个月患者、30例肝硬化非PSE患者和 6 0例正常人血浆维生素C(P VitC ) ,维生素E(P VitE) ,β 胡萝卜素 (P β CAR)和一氧化氮 (P NO)含量 ,红细胞超氧化物歧化酶 (E SOD)、过氧化氢酶 (E CAT)和谷胱甘肽过氧化物酶 (E GSH Px)活力 ,血浆及红细胞过氧化脂质 (P LPO ,E LPO)水平的变化。结果　肝硬化非PSE组、PSE后 2个月组 (PSE组 )和对照组的P VitC、P VitE、P β CAR、E SOD、E CAT和E GSH Px水平依次升高 (均 P <0 .0 0 1) ;3组的P NO、P LPO和E LPO含量依次降低 (均P <0 .0 0 1) ;除了PSE组和对照组E SOD的差异无统计学意义外 ,3组之间其他检测值的两两比较差异均具有统计学意义。结论　PSE有利于纠正肝硬化患者体内一氧化氮代谢异常、氧化和抗氧化的失衡     

长期木兰拳运动对中老年女性自由基代谢和NO的影响

目的 观察长期规律木兰拳运动对中老年女性自由基代谢和一氧化氮的影响。方法 自愿参加本次测试的50～60岁女性49人，其中长期坚持规律木兰拳练习2年以上者27人为实验组；无运动习惯，平时极少参加体育锻炼者22人为对照组。对血清丙二醛（MDA）含量、血清超氧化物歧化酶（SOD）活性、血清谷胱甘肽过氧化物酶（GSH—Px）活性、血清过氧化氢酶（CAT）活性、血清一氧化氮（NO）含量进行定量测定。结果 ①实验组血清MDA含量低于对照组，差异有统计学意义（P＜0．01）；实验组血清SOD活性、GSH—Px活性高于对照组，差异有统计学意义（P＜0．01）；两组血清CAT活性差异无统计学意义；实验组血清NO含量高于对照组，差异有统计学意义（P＜0．05）。②血清NO含量与血清SOD活性、GSH—Px活性、SOD／MDA值正相关，与血清MDA含量负相关。结论 长期木兰拳运动能有效抑制中老年女性体内脂质过氧化反应，使自由基抗氧化酶系维持在较高机能水平，从而增加NO的释放，缓解中老年女性内皮依赖的血管舒张功能的减退，有利于血压的调节，对心血管疾病的预防有重要意义。     

急性CO中毒患者血清SOD、GSH-Px活性及MDA水平的变化及其意义

目的：探讨急性一氧化碳中毒（ACOP）患者血清丙二醛（MDA）水平、谷胱甘肽过氧化物酶（GSH－Px）及超氧化物歧化酶（SOD）活性的变化，了解ACOP时自由基氧化损伤在其病理机制中的作用。方法：选择不同中毒程度的ACOP患者70例，分别于入院即刻、12、24、48、72h抽血测定血清中MDA水平及SOD、GSH－Px的活性。结果：ACOP时，中度CO中毒组与轻度中毒组比较，血清MDA水平升高，但不具有显著性意义（P＞0．05）；重度中毒组与中度中毒组比较，MDA水平显著性升高（P＜0．05），且24,48h仍维持在较高水平。中度中毒组与轻度中毒组比较，血清SOD及GSH－Px在性水平降低，但不具有显著性意义（P＞0．05）；重度中毒组与中度中毒组比较，SOD及GSH－Px活性水平显著降低（P＜0．05）。结论：ACOP时血清MDA水平升高，SOD及GSH－Px活性降低，提示ACOP时存在着严重自由基氧化损伤的病理过程，为ACOP治疗过程中抗氧化治疗提供了依据，SOD及GSH－Px活性降低，提示ACOP时存在着严重自由基氧化损伤的病理过程，为ACOP治疗过程中抗氧化治疗提供了依据。同时，血清MDA水平和SOD及GSH－Px活性也可作为中毒损伤程度评估，预后判定的指标之一。     

雾化吸入L—精氨酸治疗高原肺水肿患者自由基代谢的研究

目的：探讨左旋精氨酸（L－Arg）对高原肺水肿自由基代谢的影响,在海拔3700m采用氧气驱动雾化吸入L－Arg治疗高原肺不肿患者9例（L－Arg组）,并与吸入低浓度一氧化氮（NO）混合气体治疗8例高原肺水肿患者（NO组）作对照,分别检测血中超氧化物歧化酶（SOD）、谷胱苷肽过氧化物酶（GSH－Px)及丙二醛（MDA）含量,结果：NO组和L－Arg组治疗前较治愈后SOD、GSH－Px均增高非常显著,MDA降低非常显著（P＜0．01）,吸入NO组和L－Arg组比较,各指标均无统计学差异（P＞0．05）。结论：L－Arg治疗高原肺水肿有效,可提高患者SOD活性,且经济简便,易于推广应用,是一种有前途的治疗高原肺水肿药物。     

急性肾功能衰竭与氧化损伤

目的测定急性肾功能衰竭患者体内自由基异常反应诱导的氧化损伤。方法采用随机对照研究设计,选择50例急性肾功能衰竭患者(ARF)和50例健康成人志愿者(HAV)。用分光光度测量法分别检测血浆一氧化氮(NO),维生素C(V_C),维生素E(V_E),β-胡萝卜素(β-CAR),血浆和红细胞过氧化脂质(LPO)以及红细胞超氧化物歧化酶(SOD)、过氧化氢酶(CAT)和谷胱甘肽过氧化物酶(GPX)的活性。结果与HAV比较,ARF的血浆NO浓度、血浆和红细胞LPO浓度明显增高(P＜0．01),而血浆V_C、V_E、β-CAR浓度和红细胞SOD、CAT、GPX活性明显下降(P＜0．01)。直线相关分析显示,ARF随着血浆NO水平、血浆和红细胞LPO水平增高,以及血浆V_C、V_E、β-CAR水平和红细胞SOD、CAT和GPX活性下降,血清尿素氮和肌酐水平逐渐增高(P＜0．01)。判别分析显示,ARF的判别正确率为75．3%～93%,HAV为70%～91．3%,逐步判别分析显示,ARF的判别正确率提高到99．2%,HAV提高到100%。可靠性分析显示,ARF的可靠系数(α)为0．816,标准系数α为0．972,P＜0．01。结论在ARF体内,一系列自由基连锁反应呈现严重病理变化,其结果导致氧化损伤,加速肾功能恶化。因此,在ARF的治疗上,加用抗氧化剂非常必要。     

银杏叶制剂的抗氧自由基作用

本文以邻苯三酚自氧化抑制法和硫代巴比妥酸反应产物比色分析法检测经服用。天保宁”（银杏叶制剂）前后58例心绞痛患者的红细胞超氧化歧化酶（E－SOD）活性，血浆过氧化服质（P－LPO）和红细胞过氧化脂质（E－LPO）含量。结果表明，与治疗前相比，治疗后的E－SOD平均活性显著升高（Pwto．0of），P－LPO和E－LPO平均含量均显著降低（P＜0．001），提示心绞痛患者体内的毒性氧自由基反应和脂质过氧化反应在治疗后明显减缓，银杏叶制剂具有较强的抗氧自由基损伤和抗脂质过氧化损伤作用。     

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."