兔动脉粥样硬化斑块巨噬细胞表达动态变化

目的:检测巨噬细胞在兔动脉粥样硬化模型斑块中表达的动态变化。方法:24只健康雄性新西兰大耳白兔随机分为试验组(15只)和对照组(9只),试验组在球囊损伤腹主动脉内膜后喂养高脂饮食,对照组喂养普通饲料,于6,12,18周分别处死动物,分离腹主动脉,检测脂质和脂蛋白,应用光学显微镜观察动脉粥样硬化进程,采用免疫组织化学方法分析巨噬细胞在斑块处的表达及定位。结果:高脂饮食喂养后6周,兔动脉内皮受损,12周和18周可见明显动脉粥样硬化斑块形成。与对照组比较,巨噬细胞在动脉粥样硬化斑块处表达增高,主要位于内膜斑块的中下部分;巨噬细胞表达量随着动脉粥样硬化斑块的进展而增多。结论:巨噬细胞的表达随着斑块进展而增多,可能与动脉粥样硬化进展及斑块不稳定相关。     

瑞舒伐他汀和阿司匹林对兔腹主动脉粥样硬化斑块疗效的磁共振研究

目的应用磁共振成像评价瑞舒伐他汀、阿司匹林以及二者联合用药对兔动脉粥样硬化斑块的疗效,并探讨其对炎症细胞的抑制作用。方法 160只新西兰兔行高脂饮食联合腹主动脉内膜损伤术,诱导动脉粥样硬化斑块的发生。所有动物随机分成对照组(高脂饮食)、A组(高脂饮食+阿司匹林)、T组(高脂饮食+瑞舒伐他汀)和AT组(高脂饮食+阿司匹林+瑞舒伐他汀),每组各40只;每组动物又随机分成1周组、2周组、1个月组和2个月组,每组各10只。分别于相应时间点行腹主动脉MR检查,分析斑块负荷即管壁标准化指数(NWI)的变化。MR检查后立即处死动物,尸检取得腹主动脉标本,行HE染色和巨噬细胞免疫组化染色,分析腹主动脉斑块形态学、斑块巨噬细胞含量的变化。结果 A组、T组和AT组NWI在各时间点均较对照组减低(1周、1个月及2个月时,P0.05)。随时间延长对照组动脉内膜逐渐增厚;在各时间点A组、T组和AT组动脉内膜增厚程度均较对照组减轻。在2个月时,A组、T组和AT组的巨噬细胞含量较对照组减少。结论瑞舒伐他汀、阿司匹林和两药联合均能抑制斑块进展,减轻斑块内炎症反应;高分辨MRI可用于对药物治疗效果的评估。     

高脂饲料喂养加静脉注射小牛血清白蛋白建立兔动脉粥样硬化模型

背景:目前单纯饲喂高脂饲料建立动脉粥样硬化狭窄模型较常见。目的:采用高脂饲料喂养加静脉注射小牛血清白蛋白建立兔动脉粥样硬化模型。方法:分别单纯高脂饮食、高脂饲料+脂肪乳灌胃以及高脂饲料+小牛血清白蛋白3种不同的方法喂养兔构建动脉硬化模型,设立正常对照组,予普通饲料喂养。结果与结论:各组兔血清胆固醇、三酰甘油、低密度脂蛋白和高密度脂蛋白水平较正常对照组显著升高(P<0.01)。单纯高脂组可出现高脂血症,未发现典型的动脉粥样硬化病变;高脂+脂肪乳灌胃组可形成纤维斑块;高脂+小牛血清白蛋白组可形成较成熟的动脉粥样硬化斑块。结果证实,高脂饲料加静脉注射小牛血清白蛋白可形成较成熟的动脉粥样硬化斑块,可成功建立动脉粥样硬化兔模型。     

辛伐他汀对兔动脉粥样硬化斑块结构及巨噬细胞移动抑制因子的影响

目的:通过研究辛伐他汀干预治疗兔动脉粥样硬化过程中,斑块组成结构及兔血清中巨噬细胞移动抑制因子(MIF)水平及其二者的相关性,探讨MIF在动脉粥样硬化过程中的意义及辛伐他汀的作用.方法:研究对象为新西兰大白兔,随机分为正常对照组,腹主动脉球囊拉伤、高脂饲养构建的兔动脉粥样硬化模型组,辛伐他汀干预动脉粥样硬化治疗组;观测各组实验对象腹主动脉斑块纤维帽厚度,并获得纤维帽的厚度与脂核横截面厚度的比值;采用ELISA法检测其血清巨噬细胞移动抑制因子水平.结果:动脉粥样硬化模型组斑块纤维帽较薄,脂核相对较大,他汀干预治疗组斑块纤维帽厚度明显高于动脉粥样硬化模型组,而脂核厚度则相对较小;动脉粥样硬化模型组MIF水平较对照组升高,干预治疗组MIF水平较模型组低,其差异有统计学意义(P＜0.05).结论:辛伐他汀干预可以改变斑块的组成结构,降低MIF水平,使动脉粥样硬化斑块更加趋于稳定.     

FIZZ1与动脉粥样硬化关系探讨

目的 探讨FIZZ1在ApoE基因敲除鼠粥样斑块表达情况并探讨其可能的表达细胞.方法 C57BL/6J ApoE基因敲除鼠及C57BL/6J野生型小鼠各9只,分别喂食高脂饲料及普通饲料,24周后处死小鼠,自主动脉根部至腹主动脉离断整个血管,石蜡包埋后作连续切片,行HE染色及FIZZ1免疫组化.检测血管斑块内FIZZ1表达情况,体外模拟粥样斑块内Th2型细胞因子环境,检测斑块内FIZZ1表达是否与Th2型细胞因子刺激平滑肌细胞或巨噬细胞有关.结果 免疫组化可见FIZZ1在粥样硬化斑块内明显表达,Th2型细胞因子可以刺激巨噬细胞FIZZ1表达,但不能刺激平滑肌细胞FIZZ1表达.结论 正常血管壁内未见FIZZ1表达,ApoE基因敲除鼠粥样斑块表达FIZZ1,动脉粥样硬化斑块内Th2型细胞因子刺激巨噬细胞可能为FIZZ1表达机理之一.     

动脉粥样硬化家兔VCAM-1表达及黄精多糖对其表达的影响

【目的】探讨实验性动脉粥样硬化家兔主动脉血管细胞粘附分子（VCAM-1）表达及黄精多糖时其表达的调节作用。【方法】纯种新西兰大白兔30只．随机分为正常对照组、高脂模型组和黄精多糖组,各组按不同饲料喂养8周。实验前、实验第4周及第8周末采用酶法测定血清脂质含量;实验第8周末处死动物．取各组降主动脉进行免疫组化染色观察其VCAM-1的表达。【结果】实验前各组血清脂质含量无显著性差异（P〉0．05）。实验第4周,高脂模型组及黄精多糖组血清总胆固醇、低密度脂蛋白胆固醇和脂蛋白（a）含量显著高于正常时照组（P〈0．01）。实验第8周,黄精多糖组血清脂质各指标显著低于实验第4周及高脂模型组（P〈0．01）;高脂模型组主动脉VCAM-1阳性细胞面积显著大于时照组（p〈0．01）．而黄精多糖组VCAM-1阳性细胞面积明显低于高脂模型组（P〈0．05）。【结论】动脉粥样硬化家兔主动脉VCAM-1表达增加．黄精多糖除降低血脂外．还可抑制VCAM-1的高表达。     

隔药饼灸对兔动脉粥样硬化斑块中基质金属蛋白酶-2,9 mRNA表达的影响

目的观察隔药饼灸对兔动脉粥样硬化(AS)中基质金属蛋白酶-2,9(MMP-2,9)表达的影响,探讨隔药饼灸对兔动脉粥样硬化斑块稳定性的影响。方法将75只新西兰大耳白兔,通过高脂饲料喂养及免疫损伤法建立兔AS模型。然后随机分为5组,每组15只,即：空白组(空白对照组);模型组(AS模型组);直接灸组(AS模型+艾炷直接灸);隔药饼灸组(AS模型+隔药饼灸);西药组(AS模型＋阿托伐他汀)。运用原位杂交法检测兔动脉粥样硬化斑块中MMP-2,9 mRNA的表达。结果隔药饼灸、直接灸和西药均能抑制兔动脉粥样硬化斑块中MMP-2和MMP-9 mRNA的表达(P<0.01或P<0.05);隔药饼灸组和西药组MMP-2和MMP-9 mRNA的表达低于直接灸组(P<0.01或P<0.05)。结论隔药饼灸、直接灸和西药通过抑制兔动脉粥样硬化斑块中MMPs的表达,起到稳定动脉粥样硬化斑块的作用,且隔药饼灸和西药抑制MMPs表达的作用优于直接灸。     

建立动脉粥样硬化蚀损斑块模型的实验研究

目的蚀损斑块是急性冠脉综合征的重要病理基础,本研究旨在建立其新西兰兔模型。方法雄性纯种新西兰兔24只,球囊拉伤加高脂喂养3个月。3个月后,随机分组,分别腹主动脉内注入星形环孢素(实验组)和生理盐水(对照组)。3 d后,腹主动脉造影血栓评分,然后,取处理段血管连续切片,行病理学检查。结果腹主动脉造影示,实验组7只兔有明显血栓形成(血栓评分3～4分),对照组一只未见；病理切片发现,实验组10只有血栓形成,对照组仅1只。造影显示的明显血栓形成和病理切片发现的血栓形成差异在两组差异均有显著性(P＜0．01)。在实验组,HE染色未见斑块纤维帽破裂,CD31抗体染色显示斑块表面有不同程度内皮剥脱,尤其以血栓形成处最为明显,α-actin抗体染色显示斑块富含平滑肌细胞、纤维帽无破裂,油红O染色显示斑块无表浅的脂质核心,脂质与管腔内血栓不相连。实验组内皮完整性评分显著低于对照组(P＜0．01),而凋亡评分显著高于对照组(P＜0．01)。结论在新西兰兔稳定动脉粥样硬化斑块模型基础上,通过星形环孢素诱导,可成功建立与人类相似的蚀损斑块模型。并且,内皮细胞凋亡可能在蚀损斑块并血栓形成中发挥重要作用。     

中药复合抗氧化剂对实验性高脂血症家兔的降脂作用

目的：在家兔动脉粥样硬化的模型上观察复合抗氧化剂对实验性高血脂家兔的影响并探讨其可能的作用机制。方法：将雌雄各半，体质量约(1．5&;#177;O．2)kg，3．O～4．O月龄的24只家兔采用完全随机方法分为正常对照组、高脂模型组和复合抗氧化剂组3组。分别给予普通饲料(正常对照组)和在普通饲料中加入lOOg／L蛋黄粉、lOg／L胆固醇、50g／L猪油组成的高脂饲料(其他两组)喂养；复合抗氧化剂组动物在喂饲高脂饲料的同时，每兔每天按照O．06g／kg标准灌胃给予30g／L复合抗氧化剂液。喂养第12周末检测各组血清中总胆固醇、三酰甘油和高密度脂蛋白胆固醇。观察动脉粥样硬化(atherosclerosis，As)斑块病变。结果：高脂模型组显示有不同程度的As形成，中膜平滑肌细胞增生、排列不规则。3组TC、TG和LDL-C含量之间差别非常显著，X^2=l8．25，P(0．001；r=15．37，P&;lt;0．001；r=19．Ol，P&;lt;0．001。HDL—C含量在对比组之间的差别具有显著性的意义，r=9．04，P&;lt;0。05。给予高脂饮食，模型组1℃，TG，HDL-C和LDL—C增至29。34(23。70)，0．87(0．28)，3。83(12．72)，25．57(11．30)mmol／L。在复合抗氧化剂灌胃后，减至14.55(4．30)，0．11(0．21)，2．41(1。59)，12．29(6．51)mmol／L。除HDL-C外，两组间TC，TG和LDL—C差别具有显著性的意义，分别为X^2=6．36，P&;lt;0．05；X^2=11．31，P&;lt;0．01；X^2=8.04，P&;lt;O．01。结论：该复合抗氧化剂对已形成的高脂血症兔具有明显的降血脂及防止动脉粥样硬化形成的作用。     

环氧化酶-2在动脉粥样硬化中的表达及血清炎性细胞因子的变化

目的：观察动脉粥样硬化时环氧化酶－2（COX－2）的表达及血清炎性细胞因子6－酮－前列腺素F1α（6－keto-PGF1α)、血栓素B2（TXB2）和肿瘤坏死因子－α（TNF－α）的变化。方法：在高脂兔动脉粥样硬化模型中应用COX－2抑制剂干预,观察粥样硬化斑块形成的病理变化,用单克隆抗体免疫组织化学法观察COX－2在动脉粥样硬化斑块中的表达,并检测各组血脂及血清6－keto-PFG1α、TXB2和TNF－α的变化。结果：高脂饲料组较正常饮食对照组胆固醇（CH）、甘油三酯（TG）、高密度脂蛋白（HDL）及低密度脂蛋白（LDL）血清含量明显增高;两高脂饮食组COX－2在动脉粥样斑块中高度表达,粥样斑块下的平滑肌细胞中有少量表达,对照组动脉无COX－2表达;高脂饲料组（B组）和高脂饲料加美洛昔康组（C组）较对照组（A组）6-keto-PEF1α、TXB2和TNF－α含量明显增高,B组6－keto-PGF1α、TXB2和TNF－α亦较C组含量高。结论：COX－2在动脉粥样斑块中高度表达,并参与动脉粥样硬化病变的炎症过程。COX－2抑制剂可能干预由氧化LDL诱导的前列环素、血栓素及炎症因子的产生。     

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."