紫外线照射诱导人外周血淋巴细胞凋亡的研究

目的　探讨紫外线照射充氧自血疗法（ＵＢＩＯ）引起的免疫抑制机制。方法　使用不同剂量中、短波紫外线（ＵＶＢ、ＵＶＣ） 照射诱导人外周血淋巴细胞凋亡,采用电镜、ＤＮＡ 电泳、流式细胞仪ＴＵＮＥＬ凋亡定量检测,了解被照射细胞凋亡情况。结果　ＵＶＢ照射细胞发生典型凋亡。定量检测证实ＵＶＢ２００ Ｊ／ｍ２ 照射淋巴细胞凋亡发生率４８ ．２％ ,５００ Ｊ／ｍ２ 凋亡发生率７８．５ ％ 。ＵＶＣ照射细胞未见凋亡改变。双标记检测发现ＵＶＢ照射诱导的淋巴细胞凋亡几乎全部发生于ＣＤ３ ＋ Ｔ 细胞,随着照射剂量的加大,ＣＤ４＋ ／ＣＤ８ ＋ 比值逐渐减小。表明ＵＶＢ照射可诱导人Ｔ 细胞,特别是ＣＤ４ ＋ Ｔ 细胞发生凋亡,ＵＶＣ照射无凋亡诱导作用。结论　诱导淋巴细胞凋亡可能是ＵＢＩＯ引起免疫抑制机制之一,建议ＵＢＩＯ 采用短波紫外线。     

紫外线照射充氧自血回输对脑梗塞患者红细胞免疫功能和T细胞亚群的影响

紫外线照射充氧血液回输治疗脑梗塞１８例，每次治疗紫外线照射８分钟。照射后血液体外检测，红细胞Ｃ３ｂ受体花环形成率（ＲＣＲ１）、红细胞免疫粘附肿瘤花环率（ＴＲＲ）均显著升高（Ｐ＜０．０１），而Ｔ细胞各亚群数目均明显下降，照射１、４次后，ＲＣＲＩ、ＴＲＲ显著升高，红细胞免疫复合物花环率（ＲＣＩＣ）无明显变化，Ｔ细胞亚群中的辅助性Ｔ细胞（ＣＤ）、全Ｔ细胞（ＣＤ）及自然杀伤细胞（ＮＫ）数目显著降低。停止照射３０天后，ＣＤ、ＣＤ、ＮＫ细胞数国恢复到照射前水平。实验表明，紫外线照射充氧血液回输可显著增强脑梗塞患者的红细胞免疫功能，同时可短期抑制Ｔ细胞免疫力。     

紫外线照射充氧自血回输对脑梗塞患者红细胞免疫功能和T细胞亚群…

紫外线照射充氧血液回输治疗脑梗塞１８例，每次治疗紫外线照射８分钟。照射后血液体外检测，红细胞Ｃ３ｂ受体花环形成率（ＲＣＲ１）、红细胞免疫粘附肿瘤花环率（ＴＲＲ）均显著升高（Ｐ〈０．０１），而Ｔ细胞各亚群数目均明显下降，照射１、４次后，ＲＣＲ１、ＴＲＲ显著升高，红细胞免疫复合物花环率（ＲＣＩＣ）无明显变化，Ｔ细胞亚群中的辅助性Ｔ细胞（ＣＤ４＾＿）、全Ｔ细胞（ＣＤ３＾＋）及自然杀伤细胞（ＮＫ）数目显著     

SLE病人T淋巴细胞亚群及体液免疫功能分析

为探讨系统性红斑狼疮（ＳＬＥ）病人Ｔ淋巴细胞亚群的改变及免疫球蛋白含量的变化，为临床诊治提供理论依据，应用流式细胞仪和酶联检测仪，分析ＳＬＥ患者Ｔ细胞亚群及免疫球蛋白。结果显示与正常对照组比较， ＳＬＥ患者外周血中 ＣＤ_２~＋、 ＣＤ_２~＋、 ＣＤ_２~＋细胞显著增加（ Ｐ ＜０． ０１）， Ｔ细胞表面 ＴＩＡ－１含量增加（ Ｐ＜０． ０５），血清中 ＩｇＧ、 ＩｇＭ、 ＩｇＡ含量也都显著升高（ Ｐ＜０．０１），但外周血中ＣＤＪ_３~＋、 ＣＤ_４~＋、 ＣＤ_４５ＲＡ~＋细胞显著降低（Ｐ＜０．０１）， ＣＤ_４~＋／ＣＤ_８~＋明显倒置（Ｐ＜０． ０１）， Ｔ细胞表面 Ｔ细胞抗原受体（ＴＣＲ）含量及血清中 Ｃ_３、 Ｃ_４也明显降低（ Ｐ ＜０．０１）。提示ＳＬＥ患者存在Ｔ细胞亚群紊乱，体液免疫功能亢进，抗感染能力下降。     

紫外线波段B对脐血免疫活性和造血活性抑制的体外研究

目的：探讨紫外线波段Ｂ（ＵＶＢ）对脐血淋巴细胞和造血细胞的作用差别。方法：选择０，５，１０，２０，５０ｍＪ／ｃｍ２等不同剂量ＵＶＢ照射脐血单个核细胞（ＭＮＣ），分别进行活力检测，混合淋巴细胞培养（ＭＬＣ），粒－单系祖细胞集落（ＣＦＵ－ＧＭ）培养和ＣＤ３４＋细胞比率检测。结果：脐血细胞ＭＬＣ的免疫增殖反应活性、免疫激活能力及ＣＦＵ－ＧＭ数均呈照射剂量依赖性下降（Ｐ＜０．０１），但在１０ｍＪ／ｃｍ２照射范围内脐血免疫活性下降幅度显著高于ＣＦＵ－ＧＭ。在脐血ＭＮＣ悬液内加入２０％小牛血清后不仅使ＵＶＢ的作用减弱，还加大了ＵＶＢ对脐血淋巴细胞和造血细胞失活作用的差别。ＵＶＢ照射前后ＣＤ３４＋细胞比率无明显变化。结论：小剂量ＵＶＢ照射可选择性降低脐血淋巴细胞的增殖反应活性，而对造血细胞活性影响少，提示运用ＵＶＢ预防脐血移植引起的移植物抗宿主病是可能的。     

紫外线照射自血回输对脑梗塞患者外周血淋巴细胞亚群和血浆纤维连接蛋白的影响

对２４例脑梗塞患者紫外线照射自血回输（ＵＢＩＯ）治疗前、后外周血淋巴细胞亚群及血浆纤维连接蛋白（Ｆｎ）含量变化进行了观察．结果ＵＢＩＯ治疗前脑梗塞患者外周血中总Ｔ细胞（ＣＤ）、Ｔ抑制细胞（ＣＤ）数均较正常人明显减少，ＣＤ４／ＣＤ８比值上升；Ｂ＋和人类白细胞抗原（ＨＬＡ－ＤＲ＋）细胞数增多；白细胞介素Ⅱ受体（ＩＬ－２Ｒ＋）和Ｔ辅助（ＣＤ＋）细胞数则与正常人无差异。血浆Ｆｎ含量低于正常人。提示脑梗塞患者存在免疫功能紊乱．ＵＢＩＯ治疗后，外周血中ＣＤ、ＣＤ细胞和Ｆｎ水平上升，ＣＤ４／ＣＤ８比值下降，Ｂ细胞数下降，ＨＬＡ－ＤＲ＋细胞数无明显变化．提示ＵＢＩＯ具有免疫调节作用．     

亚临床维生素A缺乏儿童免疫功能损害

测定５２例亚临床维生素Ａ缺儿童外周血Ｔ淋巴细胞增殖反应，Ｔ细胞亚群，血清ＩｇＧ，ＩｇＡ，ＩｇＭ和补体Ｃ３，部分病例测定了ＩｇＧ亚类。４８例血清ＶＡ正常的同龄儿童作对照。结果表明：ＳＶＡＤ儿童Ｔ淋巴细胞增殖反应，ＣＤ４，ＣＤ４／ＣＤ８比值，血清ＩｇＧ，ＩｇＭ，ＩｇＧ１，ＩｇＧ３，ＩｇＧ４均明显下降，血清ＶＡ与ＩｇＧ１呈正相关。结果提示ＳＶＡＤ儿童伴有部分细胞及体液免疫功能受损。     

供鼠的活化自然杀伤细胞对小鼠异基因骨髓移植的影响

目的　研究供鼠的活化自然杀伤细胞（ Ｎ Ｋ 细胞） 对小鼠异基因骨髓移植的影响。方法　将荷瘤鼠照射后,于输注骨髓细胞（ 含 Ｔ细胞） 之前４ 小时或之后７２ 小时,注射供鼠的活化 Ｎ Ｋ 细胞,观察荷瘤鼠 Ｃ Ｆ Ｕ Ｓ、 Ｃ Ｆ Ｕ Ｇ Ｍ、生存期、体重、病理组织学和双肺瘤结节等指标。结果　输注供鼠的活化 Ｎ Ｋ细胞能显著促进荷瘤鼠 Ｃ Ｆ Ｕ Ｓ和 Ｃ Ｆ Ｕ Ｇ Ｍ 增殖。输注骨髓细胞前４ 小时输注供鼠的活化 Ｎ Ｋ 细胞能显著提高荷瘤鼠生存率,减轻移植物抗宿主病（ Ｇ Ｖ Ｈ Ｄ） 的病理损伤程度,并使肺瘤结节数量减少;而输注骨髓细胞后７２ 小时输注供鼠的活化 Ｎ Ｋ 细胞能显著加重 Ｇ Ｖ Ｈ Ｄ 病理损伤程度。结论　①在小鼠异基因骨髓移植的初始阶段,输注供鼠的活化 Ｎ Ｋ 细胞能促进造血重建,预防 Ｇ Ｖ Ｈ Ｄ 并同时增强移植物抗肿瘤（ Ｇ Ｖ Ｔ） 效应;输注骨髓细胞之后,输注供鼠的活化 Ｎ Ｋ 细胞则起到加重 Ｇ Ｖ Ｈ Ｄ 的不良作用;② Ｇ Ｖ Ｔ和 Ｇ Ｖ Ｈ Ｄ 是能够被分开的。     

移植物抗白血病

本文从移植物抗白血病（ＧＶＬ）与移植物抗宿主病（ＧＶＨＤ）、ＧＶＬ与Ｔ细胞、ＧＶＬ与ＣＤ４＾＋、ＣＤ８＾＋Ｔ细胞亚群、ＧＶＬ与ＩＬ－２以及ＧＶＬ与移植后免疫抑制治疗等的关系方面，对ＧＶＬ的作用机制和影响因素进行了综述。     

不同剂量紫外线照射对血液抗氧化作用的影响

实验用不同剂量短波紫外线（ＵＶ－Ｃ）照射家兔离体血液，采用化学发光法（ＣＬ）和分光光度法分别测定血浆超氧化物歧化酶（ＳＯＤ）活力和丙二醛（ＭＤＡ）含量。未照射血液血浆ＳＤＯ活力、ＭＤＡ含量分别为９４６．６７±５７．６５Ｕ／ｍｌ、１７．７６±３．３９ｎｍｏｌ／ｍｌ。小剂量（１５秒）照射后ＳＯＤ活力显著高于未照射血液（Ｐ＜０．０１），剂量增加后（３０秒）ＳＯＤ活力下降并接近未照射水平，照射１分钟后活力明显下降（Ｐ＜０．０５），并随短波ＵＶ－Ｃ剂量（３、６分钟）增大下降增多（Ｐ＜０．００１）。较小剂量ＵＶ－Ｃ（１５秒、３０秒、１分钟）照射后ＭＤＡ含量无明显变化，ＵＶ－Ｃ照射３分钟时ＭＤＡ含量开始出现明显升高（Ｐ＜０．０５），并随剂量加大（６分钟）进一步增高（Ｐ＜０．００１）。结果提示小剂量ＵＶ－Ｃ照射能够增强机体抗氧化能力，大剂量照射则使机体抗氧化能力下降，氧化损伤作用增强；并且说明ＵＶ－Ｃ照射所致机体脂质过氧化损伤与抗氧化能力下降，自由基生成增多、消除不足有关     

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.