碱性成纤维细胞生长因子对大鼠牵张性脊髓损伤后脊髓功能影响的研究

目的：观察bFGF对大鼠牵张性脊髓损伤后脊髓功能恢复的作用。方法：大鼠脊髓T13-L2经牵张损伤．皮层体感诱发电位CSEP监测P1-N1波幅下降至术前波幅70％后，于损伤平面以下经蛛网膜下腔置细导管，治疗组分别于即刻、1、2、3、4、8、12、24h经细导管注入bFGF溶液20μl(含bFGF20μg)，对照组在相同时间注入等量生理盐水。术后1、2、3、6周进行联合行为评分及CSEP检查。结果：bFGF治疗组大鼠CBS评分、CSEP波幅及潜伏期恢复均好于对照组。结论：bFGF对大鼠牵张损伤脊髓的功能恢复有明显的促进作用。     

碱性成纤维细胞生长因子对大鼠脊髓损伤后神经细胞凋亡的抑制

目的探讨大鼠脊髓损伤后应用碱性成纤维细胞生长因子(basicfibrob-1ast growthfactor,bFGF)对脊髓损伤区细胞凋亡的影响.方法利用Allen氏WD(Weight drop,WD)技术,以10 g×2.5 cm致伤力造成SD大白鼠T8脊髓损伤模型,并于损伤平面以下蛛网膜下腔置细塑料导管.bFGF治疗组(A组)分别于术后即刻,1,2,4,8,12,24,及48 h经导管注入bFGF溶液20μL(含bFGF100u),以后每周经导管注入20 μL bFGF;对照组(B组)则在同时间注入等量生理盐水.损伤后1,3,7,14,28 d对脊髓损伤区进行细胞凋亡的检测(TUNEL),采用计算机图像分析技术进行定量分析并计算凋亡指数(AI),AI=凋亡细胞核数/总细胞核数计算.结果A,B两组中均发现凋亡细胞,A组损伤后不同时间段神经细胞凋亡指数分别为(4.57±0.43),(5 38±1.16),(3.43±0.65),(3.38±0.58),(2.63±0.43);B组分别为(7.36±0.68),(13.96±2.74),(9.26±1.03),(7.25±0.73),(5.79±0.57).B组细胞凋亡率大于A组结论bFGF能抑制脊髓损伤后脊髓损伤区的细胞凋亡.     

大鼠慢性渐进性脊髓损伤减压后脊髓诱发电位的变化

目的研究对大鼠慢性渐进性脊髓损伤减压后诱发电位的变化,探讨减压后神经功能恢复的规律。方法将动物随机分为正常组,慢性渐进性脊髓损伤组,慢性渐进性脊髓损伤组+减压后1、2、3、5、7、10、14、20、28d组,分别观察其皮层体感诱发电位(CSEP)和运动诱发电位(MEP)的变化,用Tarlov评分及斜板试验来评价神经功能。结果慢性渐进性脊髓损伤减压后CSEP和MEP潜伏期明显缩短,波幅明显升高,其中前7d变化较快,7d后CSEP和MEP潜伏期分别缩短了39%、34%,波幅分别增加了62%、48%,以后变化不明显,脊髓的神经功能于前10d恢复较快,以后有升高但变化不明显。结论慢性渐进性脊髓损伤减压后脊髓神经功能于减压早期即10d左右有一迅速的恢复,以后变化不明显。     

皮层体感诱发电位监测脊髓牵张性损害的实验研究

目的　探讨术中及术后皮层体感诱发电位 (CSEP)对脊髓牵张性损害的监测作用。方法　切除大鼠T13 ～L2 双侧椎板显露脊髓 ,用特制的脊柱撑开器放置在大鼠T12 ～L3 椎体横突上纵向牵张 ,同时用CSEP进行术中、术后监测。 40只SD大鼠随机分成对照组和CSEPP1 N1波幅下降 3 0 % ,5 0 % ,70 %组 ,观察术中、术后CSEP的变化 ,比较各组术后神经功能和病理检查结果。结果　随着撑开距离的增加 ,波幅下降至术前波幅 3 0 %组及正常组的CBS评分分别为 (14 .80± 3 .98)和 0分 ,神经元计数分别为 (79.60± 3 .5 3 )个和 (82 .70± 3 .41)个 ,二者相比差异无显著性意义。光镜下脊髓神经元体积稍小 ,神经纤维形态正常 ;波幅下降 5 0 %及 70 %组的CBS评分分别为 (5 2 .10± 6.12 )和 (74.60± 8.97)分 ,神经元计数分别为 (67.80± 3 .85 )个和 (4 5 .70± 4.42 )个。与正常组及 3 0 %组相比差异有显著性意义 (P <0 .0 1)。光镜观察神经元间隙增大 ,神经元退变、减少、溶解或坏死 ,脊髓结构破坏 ,出现片状出血灶 ,大量胶质细胞浸润。结论　CSEP对脊髓牵张性损害具有良好的监测作用 ,对脊髓神经功能和预后判断具有重要价值     

大剂量甲基强的松龙对大鼠脊髓急性损伤细胞凋亡和bFGF变化的影响

目的 应用大剂量甲基强的松龙(MP)干预急性大鼠脊髓损伤，以探讨其对神经细胞凋亡和碱性成纤维细胞生长因子(bFGF)的影响。方法 采用改良Allen氏WD法制造急性脊髓损伤(ASCI)模型，时104只雌性wister大白鼠随机分为A、B、C三个组，其中A为细胞凋亡组，B为bc1-2组，C为bFGF组。每组又分为两个亚组：大剂量MP治疗组和生理盐水组。术后d2、d5、d28取损伤部位脊髓组织做以下检测：①HE染色进行形态学观察；②TUNEL法检测凋亡细胞比例；③免疫组化检测bc1-2基因蛋白和bFGF。结果 所有动物HE染色组织形态学观察和TUNEL法均证实有凋亡现象的存在，d2开始出现，d5达高峰，d28开始下降；应用大剂量MP可以减少脊髓组织神经细胞发生凋亡的比例；在各个时间点上，大剂量MP可以显著地提高bc1-2和bFGF蛋白的表达。结论 大剂量MP可以通过提高bc1-2和bFGF的表达，来发挥抑制ASCI神经细胞凋亡和营养神经细胞的作用，从而减轻了ASCI后的继发性损害程度。     

碱性成纤维细胞生长因子对大鼠脊髓损伤后神经细胞凋亡的抑制

目的：探讨大鼠脊髓损伤后应用碱性成纤维细胞生长因子（basic fibroblast growth factor bFGF)对脊髓损伤区细胞凋亡的影响。方法：利用Allen氏WD(Weight drop，WD)技术，以10g&;#215;2．5cm致伤力造成SD大白鼠Ts脊髓损伤模型，并于损伤平面以下蛛网膜下腔置细塑料导管。bFGF治疗组(A组)分别于术后即刻，1，2，4，8，12，24，及48h经导管注入bFGF溶液20μL(含bFGF100u），以后每周经导管注，20μL bFGF：对照组(B组)则在同时间注入等量生理盐水：损伤后1，3．7，14，28d对脊髓损伤区进行细胞凋亡的检测(TuNEL)，采用计算机图像分析技术进行定量分析并计算凋亡指数(AI)，AI=凋亡细胞核数，总细胞核数计算：结果：A，B两组中均发现凋亡细胞，A组损伤后不同时间段神经细胞凋亡指数分别为(4.57&;#177;0．43)，15．38&;#177;1.16)，(3．43&;#177;0．65)．(3.38&;#177;058)．(2．63&;#177;0．43)；B组分别为(7.36&;#177;0．68)，(13.96&;#177;2．74),(9．26&;#177;1．03)，(7．25&;#177;0．73)，(5．79&;#177;0．57).B组细胞凋亡率大于A组结论：bFGF能抑制脊髓损伤后脊髓损伤区的细胞凋亡。     

诱发电位在GDNF与MSCs联合移植法治疗猴脊髓损伤评价中的应用*

目的：应用诱发电位技术评价控释胶质细胞源性神经营养因子（GDNF）与骨髓间充质干细胞(MSCs)源性神经元样细胞联合移植对猴脊髓损伤的治疗效果是否优于单纯细胞移植。方法：应用改良Allen′s法制作猴脊髓损伤模型,实验组（4只）给予控释GDNF与MSCs源性神经元样细胞移植,对照组（4只）给予单纯MSCs源性神经元样细胞移植。进行运动诱发电位（MEP）和皮质体感诱发电位（CSEP）检测,比较两组间治疗4—5个月后诱发电位的差异。结果：联合移植组MEP潜伏期较单纯细胞移植组缩短（P<0.05）、波幅较单纯细     

全脑缺血再灌后bFGF对小鼠额叶、海马神经元保护作用的研究

目的探讨碱性成纤维细胞生长因子（Basic fibroblast growth factor，bFGF）在全脑缺血再灌流后不同时期对小鼠额叶皮层、海马神经元的保护作用。方法选择健康雄性昆明小鼠45只，随机分为假手术组5只、对照组20只、bFGF治疗组20只。用组织病理学方法检测全脑缺血后对照组及治疗组小鼠额叶皮层、海马组织病理学改变。结果bFGF治疗组额叶皮层、海马损伤神经元明显减少，与对照组比较P〈0．05。结论bFGF对脑缺血后神经元有保护及修复作用，bFGF能有效降低缺血后脑组织损伤程度。     

神经干细胞移植促进脊髓损伤大鼠脊髓功能的恢复

目的：观察神经干细胞移植对脊髓损伤大鼠功能恢复的作用。方法：30只Wistar大鼠随机分为对照组、损伤组和移植组，每组10只；损伤组和移植组制作成L4平面的脊髓全横断模型，将培养的大鼠NSCs悬液注入移植组损伤脊髓处，损伤组注射等量的生理盐水。术后2个月，采用BBB评分、皮层体感诱发电位(CSEP)和辣根过氧化物酶(HRP)逆行示踪技术观察大鼠脊髓运动和传导功能的恢复程度。结果：术后2个月BBB评分损伤组、移植组大鼠有所恢复，但都未达到正常水平，其中移植组的大鼠恢复较好，评分较高，与损伤组有显著性差异。脊髓损伤后，损伤组、移植组的CSEP波消失，术后2个月移植组的波形有所恢复，但潜伏期延长。对照组脊髓前角可见到许多HRP标记阳性神经元，损伤组未见阳性神经元，移植组可见有阳性神经元，但数目较对照组少。结论：NSCs脊髓内移植能促进损伤脊髓运动和传导功能的部分恢复。     

自体肋间神经联合酸性成纤维细胞生长因子移植治疗高位脊髓损伤

背景:酸性成纤维细胞生长因子具有调节细胞增殖、移行、分化和生存的作用,也可以下调已知轴突再生的抑制因子如蛋白聚糖等,帮助轴突克服这些抑制因子,对神经纤维再生有重要作用.目的:观察酸性成纤维细胞生长因子联合周围神经移植治疗大鼠高位脊髓损伤的可行性及效果.方法:健康成年雌性SD大鼠108只随机抽签法分为自体神经组、自体神经联合生长因子组、高位脊髓横断组.咬除大鼠T_(8-10)棘突、椎板,显露硬膜囊,水平切断高位脊髓并切除3 mm,显微镜下确认无神经纤维相连.自体神经组、自体神经联合生长因子组取双侧第8～10对肋间神经各2 cm,将肋间神经交叉移植入高位脊髓缺损处(近端白质与远端灰质、远端白质与近端灰质),分别以纤维蛋白凝胶、含有酸性成纤维细胞生长因子的纤维蛋白凝胶固定植入的肋间神经,缝合硬膜.高位脊髓横断组断端间旷置.术后90 d,行体感诱发电位及运动诱发电位检测观察神经电生理恢复情况.术后76 d,生物素葡聚糖胺顺行神经示踪观察运动传导束恢复情况.术后60 d,后肢BBB运动功能评分观察肢体运动恢复情况.结果与结论:高位脊髓横断组大鼠均未引出体感及运动诱发电位波形.自体神经组、自体神经联合生长因子组均可引出体感及运动诱发电位,自体神经联合生长因子组体感诱发电位及运动诱发电位的平均潜伏期和波幅、BBB评分均明显优自体神经组(P＜0.01).自体神经组和自体神经联合生长因子组在损伤区有较多生物素葡聚糖胺标记阳性神经纤维通过,明显多于高位脊髓横断组(P＜0.01),自体神经联合生长因子组多于自体神.经组(P＜0.01).示自体周围神经移植酸性成纤维细胞生长因子能更好地恢复高位脊髓损伤后大鼠肢体运动功能.     

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.