经皮电刺激对大鼠脊髓损伤后白细胞介素-1α、肿瘤坏死因子-α表达变化的影响

摘要 目的：探究经皮电刺激对大鼠脊髓损伤后白细胞介素-1α( IL-1α) 、肿瘤坏死因子-α(TNF-α) 表达变化的影响及意义。 方法：48只SD大鼠,随机分为对照组、电刺激组,采用改良Allen脊髓损伤打击模型,术后不同时间点采用BBB评分进行行为功能评估,用病理学和免疫组织化学方法定位、定性的检测对照组、电刺激组的损伤段脊髓组织中IL-1α、TNF-α的变化情况。 结果：BBB评分显示,术后第1—3天,对照组及电刺激组BBB评分值均为0—1分,电刺激组在损伤后第5天及第7天时BBB评分值与对照组相应时间点比较,组间差异明显(P<0.05);免疫组织化学显示,损伤后第1—7天,两组IL-1α、TNF-α免疫反应阳性神经元数目和平均积分光密度值强度呈递增趋势,且于第7天时达峰值,进一步分析得出,电刺激组IL-1α、TNF-α免疫反应阳性神经元数目及平均积分光密度值强度均明显低于对照组(P<0.05)。 结论：经皮电刺激可抑制脊髓损伤后IL-1α、TNF-α表达,减轻脊髓继发性炎症反应,促进功能恢复。     

来氟米特对糖尿病肾病大鼠炎性因子的影响研究

目的研究免疫抑制剂来氟米特对糖尿病肾病(DN)模型大鼠血清及肾组织白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)与肿瘤坏死因子-α(TNF-α)表达的影响。方法成年健康清洁级SD雄性大鼠45只,随机分为假手术组(15只)、模型组(15只)和来氟米特组(15只)。制作DN大鼠模型成功后,采用ELISA法检测血清IL-1β、IL-6、TNF-α水平,并采用RT-PCR方法检测3组大鼠肾组织IL-1β、IL-6、TNF-αmRNA表达。结果 ELISA法检测结果显示,模型组与来氟米特组大鼠血清IL-1β、IL-6、TNF-α均显著高于假手术组,差异有统计学意义(P0.05);来氟米特组大鼠血清IL-1β、IL-6、TNF-α水平较模型组降低,差异有统计学意义(P0.05)。RT-PCR检测结果表明,与假手术组大鼠比较,模型组和来氟米特组肾组织IL-1β、IL-6、TNF-αmRNA的表达量均显著升高,差异有统计学意义(P0.05),而来氟米特组肾组织IL-1β、IL-6、TNF-αmRNA的表达则明显低于模型组,差异有统计学意义(P0.05)。结论来氟米特可以抑制DN大鼠肾组织炎性因子IL-1β、IL-6、TNF-α表达,从而延缓DN进展。     

隔日限食疗法对脊髓损伤大鼠的保护作用及其机制

目的探讨隔日限食(EODF)对脊髓损伤大鼠脊髓组织病理变化和运动功能恢复的影响及其相关机制。方法将36只Sprague-Dawley大鼠随机分为假手术组、假手术+EODF组、脊髓损伤组和脊髓损伤+EODF组,每组9只,采用医用动脉瘤夹制备T10脊髓钳夹损伤大鼠模型。于术前1 d及术后1 d、术后第2、4、6、8、10、12周对各组进行BBB评分,术后第12周进行甲苯胺蓝染色。另取180只Sprague-Dawley大鼠,分组同前,每组45只,各组又分为6 h、12 h、1 d、3 d、7 d五个时间点,每个时间点各9只。采用酶联免疫吸附试验检测血清肿瘤坏死因子-α(TNF-α)和白细胞介素-10(IL-10)水平。结果脊髓损伤组和脊髓损伤+EODF组BBB评分在术后1 d降至最低(P0.05),随时间逐渐增加,术后第8、10、12周,脊髓损伤+EODF组优于脊髓损伤组(P0.05)。术后第12周,脊髓损伤+EODF组较脊髓损伤组脊髓损伤病变程度轻。与假手术组相比,脊髓损伤组术后12 h开始血清TNF-α水平升高(P0.05),呈先升后降趋势,7 d恢复;术后各时间点血清IL-10水平均升高(P0.05)。术后1 d,脊髓损伤+EODF组血清TNF-α表达水平低于脊髓损伤组(P0.05);术后各时间点,脊髓损伤+EODF组与脊髓损伤组间血清IL-10水平无显著性差异(P0.05)。结论长期EODF可促进脊髓损伤大鼠后肢运动功能障碍的恢复,减轻脊髓损伤后的病理损害程度,对脊髓损伤急性期炎性反应有一定的抑制作用,可能是其发挥神经保护作用的基础。     

脊髓损伤后炎症性细胞因子表达的变化及甲基强的松龙的影响

目的 观察大鼠脊髓损伤(SCI)后,甲基强的松龙(MP)对炎症性细胞因子白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α) mRNA表达及运动功能恢复的影响。方法 采用改良 Allen氏法建立大鼠脊髓(T9、T10)中度损伤模型,56只SD大鼠随机分为假手术组(n=4)、SCI组(n=24)、生理盐水组(n=14)和 MP组(n=14),分别于损伤后 1 h、4 h、12 h、24 h、72 h和7 d取材,利用半定量RT PCR方法观察损伤段脊髓组织中上述 3 种细胞因子 mRNA表达的变化规律;于 SCI后30 min经尾静脉给予MP(30 mg/kg),利用半定量RT-PCR方法检测 SCI后 4 h时 MP对各炎症性细胞因子 mRNA表达的影响;利用BBB评分检测MP对大鼠SCI后运动功能恢复的影响。结果 假手术组动物脊髓组织中炎症性细胞因子mRNA仅有微弱表达。SCI后1h,各炎症性细胞因子mRNA表达明显升高,其中 IL-1β,IL-6表达于损伤后 12 h达峰值,TNF-α于损伤后 4 h达峰值,至损伤后72 h仍高于假手术组( P <0.05)。SCI后4 h时,MP组大鼠 IL-1β和TNF-αmRNA的表达明显受到抑制,但MP并未对运动功能的恢复产生有益的影响。结论 MP可明显抑制SCI后的炎症反应。     

硫化氢在脓毒症大鼠心肌损伤中的作用

目的 研究硫化氢(H2S)在脓毒症大鼠心肌损伤中的作用.方法 雄性SD大鼠60只,月龄3～4个月,体质量180 ～220 g,随机(随机数字法)分为4组:对照组(Ⅰ组)、脓毒症组(Ⅱ组)、脓毒症+ NaHS(H2S供体)预处理组(Ⅲ组)、脓毒症+PAG(H2S代谢酶CSE抑制剂)组(Ⅳ组),每组各15只.采用盲肠结扎穿孔法制作脓毒症大鼠模型,观察各组大鼠血流动力学改变,测定心肌组织中H2S的变化,采用RT-PCR方法观察CSE mRNA表达,采用髓过氧化物酶(MPO)测定试剂盒测定各组心肌组织MPO含量,用ELISA方法检测心肌组织TNF-α、IL-1β的表达,光学显微镜下观察心肌形态学改变.结果 与Ⅰ组相比,Ⅱ组血压下降,心肌组织中H2S、TNF-α、IL-1β、MPO含量出现不同程度增加(P＜0.01或P＜0.05),CSE mRNA表达水平提高(P＜0.05);与Ⅱ组相比,Ⅲ组血压下降更为显著,心肌组织中H2S、TNF-α、IL-1β含量增加,MPO活性增强(P＜0.05),但CSE mRNA表达水平并无显著改变;与Ⅱ组相比,Ⅳ组血压水平接近,心肌组织中H2S、TNF-α、IL-1β 含量均降低,MPO活性减弱(P＜0.05),CSE mRNA表达水平下降(P＜0.05).四组心肌组织形态学损伤由轻到重依次为Ⅰ、Ⅳ、Ⅱ、Ⅲ.结论 脓毒症大鼠心肌组织CSE/H2S体系上调,给予H2S可以升高脓毒症大鼠心肌组织中MPO、TNF-α、IL-1β水平,加重心肌损伤,给予H2S抑制剂可以减轻心肌损伤.     

藏红花素对脊髓损伤大鼠运动功能、炎症的影响及机制研究

目的 探讨藏红花素对脊髓损伤大鼠运动功能、炎症及Ras同源基因家族成员A(RhoA)/Rho相关卷曲螺旋蛋白激酶(ROCK)信号通路的影响。方法 构建脊髓损伤大鼠模型,将建模成功的48只大鼠随机分为模型组、藏红花素低(25 mg/kg)、高(50 mg/kg)剂量组、甲泼尼龙琥珀酸钠(30 mg/kg)组,每组12只;另取12只大鼠作为假手术组。各组给予对应药物干预14 d(每天1次)。评估大鼠运动功能,并采用苏木素-伊红和脱氧核糖核苷酸末端转移酶介导的缺口末端标记法染色分别观察脊髓组织病理变化和细胞凋亡,酶联免疫吸附试验法检测脊髓组织肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β、IL-6水平;荧光定量PCR和蛋白质印迹法分别检测脊髓组织RhoA、ROCK1、ROCK2信使RNA(mRNA)和蛋白水平。结果 假手术组大鼠脊髓组织结构正常,无明显变化;与假手术组相比,模型组大鼠脊髓组织出现坏死灶,伴随嗜伊红色素颗粒生成,可见较多胶质瘢痕及空洞,BBB评分显著降低(P<0.05),脊髓组织细胞凋亡率、TNF-α、IL-1β、IL-6、RhoA、ROCK1、ROCK2 mRNA...     

隔日限食疗法对大鼠急性脊髓损伤后血清TNF-α的影响

目的:观察隔日限食疗法(EODF)对大鼠急性脊髓损伤后血清肿瘤坏死因子-α(TNF-α)的影响。方法:48只雌性成年Wistar大鼠,随机分成EODF组(A组)、正常饮食对照组(B组)、假手术组(C组);A、B组采用改良Aleln's打击法建立Wistar大鼠胸段脊髓损伤模型,C组仅行椎板切除术而不损伤脊髓;A组于术后立即给予EODF,B组及C组给予正常饮食。3组大鼠分别于术后6 h、1 d、3 d、7 d行动物行为学BBB评分观察大鼠运动功能变化;处死大鼠取血清,运用ELISA法检测各组大鼠血清TNF-α的水平。结果:(1)A、B组大鼠术后均出现严重后肢功能障碍,BBB评分早期(6 h、1 d)差异无统计学意义(P0.05),术后3 d、7 d2组评分差异有统计学意义(P0.01);(2)A、B组大鼠术后血清TNF-α含量均出现升高,但2组TNF-α含量在6 h时差异无统计学意义(P0.05),术后1 d、3 d、7 d 2组含量差异有统计学意义(P0.05)。结论:EODF能有效改善急性脊髓损伤大鼠后肢运动功能,其作用机制可能与其抑制炎性因子TNF-α产生,发挥抗炎作用,减轻继发性损伤有关。     

超短波促进巨噬细胞表型转化并抑制大鼠脊髓损伤后炎症反应的作用

目的探讨超短波治疗对巨噬细胞表型转化及大鼠脊髓损伤的保护作用。方法 Sprague-Dawley大鼠96只随机分为假手术组、模型组和超短波组,每组32只。模型组和超短波组采用改良Allen法构建大鼠脊髓损伤模型,超短波组于术后第1天起于损伤部位行小剂量超短波治疗。采用BBB评分评估各组大鼠运动功能;HE染色评估各组脊髓空洞大小;免疫组织化学染色、实时PCR及Western blotting法检测各组脊髓组织中诱导型一氧化氮合酶(i NOS)、精氨酸酶-1(Arg-1)和肿瘤坏死因子-α(TNF-α)m RNA及蛋白表达。结果与模型组比较,超短波组BBB评分升高(P0.05),i NOS和TNF-α表达减少,Arg-1表达增加(P0.05)。结论超短波治疗可促进脊髓损伤周围巨噬细胞从M1型向M2型转化,抑制炎症反应并促进脊髓损伤后修复。     

饱和氢气盐水对大鼠急性肺损伤的保护作用

目的 探讨饱和氢气盐水在油酸导致的大鼠急性肺损伤(ALI)中的作用及其机制.方法 将健康成年SD大鼠80只随机分为4组:对照(Ⅰ)组、肺损伤(Ⅱ)组、肺损伤静脉H2干预(Ⅲ)组和肺损伤腹腔H2干预(Ⅳ)组,每组20只.检测血气分析;肺组织髓过氧化物酶(MPO)活性、丙二醛(MDA)以及肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和NF-kB p65含量;并观察肺组织病理变化.结果 与注射油酸前比较,Ⅱ、Ⅲ和Ⅳ组在注射油酸3h后PaO2显著降低(P＜0.05).同时与Ⅰ组比较也存在PaO2显著降低(P＜0.05).此外,Ⅲ和Ⅳ组PaO2显著高于Ⅱ组(P＜0.05),且Ⅳ组PaO2高于Ⅲ组(P＜0.05).与Ⅰ组比较,Ⅱ组肺组织MPO活性及MDA水平显著增加(P＜0.01),Ⅲ和Ⅳ组肺组织MPO活性及MDA水平明显增加(P＜0.05),Ⅲ和Ⅳ组肺组织MPO活性及MDA水平与Ⅰ组比较显著降低(P＜0.05),且Ⅳ组肺组织MPO活性及MDA水平较Ⅲ组低(P＜0.05).Ⅱ、Ⅲ、Ⅳ组大鼠肺组织TNF-α、IL-1β和NF-κB p65水平明显高于Ⅰ组(P＜0.05).与Ⅱ组比较饱和氢气盐水治疗可降低油酸致肺损伤大鼠肺组织TNF-α、IL-1β和NF-κB p65水平(P＜0.05),且腹腔给药治疗较尾静脉给药治疗可更进一步降低油酸致肺损伤大鼠肺组织TNF-α、IL-1β和NF-κB p65水平(P＜0.05).结论 饱和氢气生理盐水能够降低大鼠油酸肺损伤模型中肺的损伤程度,且经腹腔注射给药效果更好,其机制可能与氢分子在体内的选择性抗氧化作用以及对肺组织内炎细胞浸润和炎症级联反应的抑制有关.     

亚低温对急性脊髓损伤后炎症性细胞因子表达的影响

目的 观察大鼠脊髓损伤(SCI)后亚低温对炎症性细胞因子白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)mRNA表达及运动功能恢复的影响.方法 采用改良Allen法建立大鼠脊髓 (T9、T10)中度损伤模型,56只SD大鼠随机分为假手术组(n=4)、SCI组(n=24)、常温组(n=14)和亚低温组(n=14),分别于损伤后1 h、4 h、12 h、24 h、72 h和7 d取材,利用半定量 RT-PCR方法观察损伤段脊髓组织中上述三种细胞因子mRNA 表达的变化规律;于SCI后即刻行亚低温治疗4 h,利用半定量 RT-PCR方法检测SCI后4 h时亚低温对各炎症性细胞因子mRNA表达的影响;利用 Tarlor评分检测亚低温对大鼠SCI后运动功能恢复的影响.结果 假手术组动物脊髓组织中炎症性细胞因子mRNA仅有微弱表达.SCI后1 h时,各炎症性细胞因子mRNA表达明显升高,其中IL-1β和IL-6表达于损伤后12 h达峰值,TNF-α于损伤后4 h达峰值,至损伤后72 h仍高于假手术组(P<0.05).SCI后4 h时,亚低温组大鼠IL-1β和 TNF-α mRNA 的表达明显受到抑制,但亚低温对运动功能的恢复产生显著的有益影响.结论 亚低温可明显抑制SCI后的炎症反应,对运动功能的恢复产生显著的有益影响.     

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.     

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.     

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.     

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.