亚低温治疗及选择时机对窒息大鼠心肺复苏后的脑保护作用

【目的】探讨亚低温治疗及选择时机对窒息大鼠心肺复苏后的脑保护作用。【方法】36只成年 SD 大鼠随机分为假手术组(6只,A 组)、常温组(6只,B 组)和亚低温治疗组(24只,C 组),C 组随机分为 C1、C2、C3和 C4组四个亚组,每组6只。A 组仅进行麻醉、气管切开及血管穿刺操作,不进行心肺复苏;B 组不行低温治疗;C1~4组分别于心脏骤停后2、4、6、8 min 立即实施心肺复苏。统计各组复苏成功率;免疫组化法检测皮质及海马组织 Nrf2及 HO-1蛋白表达;按 Elliott 法计算脑组织百分水含量。【结果】C 组皮质、海马组织 Nrf2及 HO-1蛋白表达水平均显著高于 A 组和 B 组(P <0.05);C1、C2、C3和 C4四个亚组比较差异无统计学意义(P >0.05)。B 组和 C 组脑组织含水量均显著高于 A 组(P <0.05),但 B 组和 C 组比较差异无统计学意义(P >0.05),C1、C2、C3和 C4四个亚组比较差异也无统计学意义(P >0.05)。【结论】亚低温干预对心肺复苏大鼠的脑保护作用可能是通过激活 Nrf2-ARE 信号通路,上调 Nrf2及其下游基因 HO-1表达实现的,对窒息性心脏骤停心肺复苏后应早期进行亚低温治疗以减轻脑损伤,提高心肺复苏的成功率。     

依达拉奉对心肺复苏后脑水通道蛋白-4表达的影响

目的 探讨大鼠心肺复苏后脑水通道蛋白-4(AQP4)表达与脑水肿动态变化的关系,评价依达拉奉的干预作用.方法 72只雄性SD大鼠随机分为4组:正常对照组(A组,6只),假手术组(B组,6只),复苏组(C组,按ROSC后1 h,6 h、12 h、24 h、72 h各时点分5亚组,各6只),依达拉奉处理组(D组,亚组同C组),复苏即刻予以依达拉奉干预.分别测定脑组织含水量,免疫组化法检测其AQP4蛋白表达,行神经功能缺损评分(neurodeficit score,NDS)及脑组织病理形态学观察.结果 C组大鼠ROSC后脑组织含水量呈上升趋势,24 h达高峰,各时点均高于B组(P<0.01).AQP4表达呈现与脑含水量同样趋势改变,积分光密度(iOD)、显色面积比(△S)增加(P<0.01),相关性分析表明iOD(r=0.858,P<0.01)、AS(r=0.870,P<0.01)与脑组织含水量呈正相关.与C组相比,依达拉奉干预处理后脑组织含水量明显下降(P<0.05);AQP4蛋白iOD、△S显著下调(P<0.01);病理学损伤程度减轻,NDS评分显著提高(P<0.05).结论 大鼠心肺复苏后脑AQP4表达上调,与脑水肿变化正相关,AQP4可能参与心肺复苏后脑水肿形成.依达拉奉可抑制AQP4表达,减轻大鼠心肺复苏后脑水肿,具有脑保护作用     

白细胞介素-1受体拮抗剂对大鼠心肺复苏后脑水肿及MMP-9 mRNA表达的影响

目的 观察重组人白细胞介素-1受体拮抗剂(recombinant human interleukin-1 receptor antagonist,rhIL-1ra)对大鼠心肺复苏后脑水肿及腩组织MMP-9 mRNA表达的影响,探讨心肺复苏后rhIL-1ra的脑保护作用及其机制.方法 健康雄性SD大鼠72只,随机分为假手术组(A组)、生理盐水对照组(B组)和药物干预组(C组),每组各24只.各组均行左侧股动静脉置管及气管捕管,B组和C组用窒息法建立心搏骤停模型并进行心肺复苏,C组复苏即刻及ROSC后4、8、12及18 h给予rhIL-1ra干预,B组以等量生理盐水对照,A组于术后3、6、12及24 h处死留取标本,B组和C组于ROSC后3、6、12及24 h处死.利用干-湿质量法测定脑组织含水量,免疫组织化学染色法检测脑海马区白细胞介素1β(IL-1β)表达水平,逆转录聚合酶链反应(RT-PCR)检测脑组织基质金属蛋白酶9(MMP-9)mRNA的表达.结果 B组大鼠于ROSC后各观察时间点均出现脑组织IL-1β显著表达,以海马区明显,与A组相比差异具有统计学意义(P＜0.01),且于ROSC后12 h达高峰;各观察时间点脑组织含水量呈上升趋势,于24 h达高峰;MMP-9 mRNA表达较A组显著升高(ROSC 3 h,P＜0.05;ROSC 6、12、24 h,P＜0.01),24 h达高峰,相关性分析显示MMP-9 mRNA表达与IL-1β表达及脑组织含水量变化呈显著正相关(r=0.867,P＜0.01;r=0.800,P＜0.01).与B组相比,C组经药物干预后于ROSC 6、12、24 h各时间点脑组织含水量均较B组显著降低(P＜0.01),MMP-9 mRNA表达水平下降,(ROSC 6 h,P＜0.05;ROSC 12、24 h,P＜0.01).结论 rhIL-1ra能降低心肺复苏后早期脑水肿程度及脑组织MMP-9 mRNA的表达.     

乌司他丁对大鼠心肺复苏后血清与海马CA1 区S100β蛋白变化的作用

目的 探讨乌司他丁对大鼠心肺复苏(CPR)后脑含水含量、血清S100β蛋白及海马CA1区S100β蛋白表达变化的影响.方法 成年雄性SD大鼠120只,随机分为假手术对照组(n=40)、复苏组(n=40)、乌司他丁组(n=40),每组按气管切开后(对照组)或自主循环恢复(ROSC)后(复苏组、乌司他丁组)0.5 h,3 h,6 h,12 h和24 h分为5个亚组(n=8).复苏组和乌司他丁组采用窒息致大鼠心脏骤停(CA)和心肺复苏(CPR)模型,乌司他丁组于ROSC后2 min内经颈动脉推注注射用乌司他丁(10万u/k).对照组仅行麻醉、气管切开和血管穿刺.分别于各时间点取血和组织标本,以干湿比质量法测定脑组织含水量;ELISA法检测血清S100β蛋白质量浓度,免疫组化测定海马S100β蛋白的表达.数据处理应用SPSS 10.0软件,多组比较采用方差分析.方差齐性检验采用用Levene's 法,方差齐性时采用LSD法,方差不齐时采用Tamhane's检验,相关分析采用Person's法.结果 与对照组比较,复苏组Rose后各亚组脑含水量显著升高(P<0.05或P<0.01),与复苏组比较,乌司他丁组12 h,24 h脑含水量显著降低(P<0.05).与对照组比较,复苏组血清S100β蛋白ROSC后0.5 h起即明显升高,并持续上升至12 h达峰值,24 h有所回落,差异具有统计学意义(P<0.01);与复苏组比较,乌司他丁组ROSC后6 h、12 h、24 h显著降低(P<0.01).免疫组化显示对照组海马CA1区S100β蛋白阳性细胞均维持在较低水平,复苏组ROSC后各时相海马CA1区S100β蛋白阳性细胞数均显著高于对照组(P<0.05或P<0.01);与复苏组比较,乌司他丁组从ROSC后6 h起S100β蛋白阳性细胞表达显著降低(P<0.05).且复苏后各时相海马CA1区S100β蛋白与脑含水量密切相关(r=0.862,P:0.015).结论 乌司他丁能降低大鼠心肺复苏后血清S100β蛋白、海马CA1区星形胶质细胞S100β蛋白表达和脑水肿程度,从而减轻脑损伤.     

高迁移率族蛋白B1和神经元烯醇化酶对心脏骤停大鼠复苏后脑损伤评价的研究

目的观察高迁移率族蛋白B1(HMGB1)和神经元烯醇化酶(NSE)在心脏骤停大鼠复苏后海马组织和血清中的表达变化,并探讨其可能意义。方法 40只SD大鼠随机分为假手术组和复苏组(按复苏后自主循环恢复后2、6、12、24和48 h各时间点分5亚组)。在相应的时间点断头处死,取海马组织,HE染色观察海马病理变化,干湿称重法测定脑组织含水量,Western blot检测海马HMGB1变化,ELISA法分别检测血清HMGB1、NSE表达变化。结果假手术组海马组织结构未见明显变化,复苏组存在缺血病理改变,24 h最为显著。与假手术组比较:复苏组脑组织含水量、血清中HMGB1和NSE表达均呈先上升后下降的趋势,24 h达峰值(P<0.01);复苏组海马组织HMGB1表达在自主循环恢复后2 h显著降低,6、12 h逐渐增高,24 h达到峰值(P<0.01)。结论 HMGB1和NSE水平对评价心肺复苏后大鼠的脑损伤程度具有诊断意义,两者联合动态观察,对严重而持续的脑损伤更有诊断价值。     

活血化瘀药对大鼠脑缺血再灌注损伤的保护作用时效量效关系对照验证

背景脑缺血后再灌注性血脑屏障损伤是脑缺血和再灌注损伤的重要病理生理基础.目的观察以活血化瘀的4个最基本中药(红花、桃仁、川芎、赤芍)作为施加因素对脑缺血再灌注大鼠血清和脑组织匀浆中的一氧化氮、免疫球蛋白、C反应蛋白、补体等免疫指标及脑组织细胞形态和超微结构产生的变化,并验证其时效和量效关系.设计随机对照实验,单盲法评估.材料实验于2001-01/2002-12在广州市红十字会医院创伤研究所实验室完成.红花、川芎、桃仁、赤芍为单味中药饮片浓缩颗粒,按1112比例制成含2.5 g/mL生药汤剂(活血化瘀药).实验动物选择成年雌性SD大鼠138只,体质量280～300 g,由广州中医药大学实验动物中心提供.干预采用线栓法制备大鼠大脑中动脉阻塞模型(经2 h大脑中动脉阻断后再灌注24h).138只大鼠随机分为6组,每组23只.假手术组结扎各血管,不阻塞大脑中动脉.灌药1组术前30 min灌胃给予2 g/kg活血化瘀药.灌药2组术前30 min灌胃给予2.5 g/kg活血化瘀药.灌药3组术前连续7 d灌胃给予2 g/kg活血化瘀药.灌药4组术前连续7 d灌胃给予2.5 g/kg活血化瘀药.对照组给予等容积生理盐水.①全部大鼠清醒后于缺血2 h再灌注24 h进行神经功能缺损评分(5分制,0～1分为神经功能轻度缺损,2～4分为神经功能重度缺损).②再灌注24 h后从各组大鼠中随机选取10只,检测脑匀浆、血清C反应蛋白及补体C3和C4水平采用速率散射比浊法,检测脑匀浆和血清中一氧化氮浓度采用硝酸还原酶法.③再灌注24 h后从各组大鼠中随机选取10只,麻醉后迅速断头取脑,然后在110℃烘箱中烘干至恒重,计算脑组织含水量.④光学显微镜下观察各组大鼠脑组织细胞形态.⑤再灌注24 h后从各组中随机选取3只大鼠,制备脑组织冠状切片,采用透射电镜观察各组大鼠脑组织超微结构.主要观察指标①各组大鼠神经功能缺损评分结果.②各组大鼠脑匀浆及血清中C反应蛋白及补体C3和C4水平,一氧化氮浓度.③各组大鼠脑组织含水量.④各组大鼠脑组织细胞形态和脑组织超微结构.结果138只大鼠全部进入结果分析.①各组大鼠神经功能缺损程度比较灌药各组大鼠缺血再灌注24 h后重度缺损所占比例明显低于对照组(P＜0.01),灌药4组低于灌药2组(P＜0.05).②各组大鼠脑组织含水量比较假手术组和灌药各组大鼠脑组织含水量低于对照组(P＜0.05).③各组大鼠脑匀浆一氧化氮浓度比较假手术组和灌药各组大鼠低于对照组(P＜0.01).灌药3组低于灌药1组(P＜0.05).灌药4组低于灌药2,3组(P＜0.01).④各组大鼠血清一氧化氮浓度比较假手术组和灌药各组血清一氧化氮浓度均高于对照组(P＜0.01).灌药3组高于灌药l组(P＜0.05).灌药4组高于灌药2,3组(P＜0.05).⑤各组大鼠脑匀浆和血清C反应蛋白水平比较假手术组和灌药各组低于对照组(P＜0.05～0.01),灌药3组低于灌药1组(P＜0.01),灌药4组低于灌药2,3组(P＜0.05～0.01).⑥各组大鼠脑匀浆和血清补体C3水平比较假手术组和灌药各组低于对照组(P＜0.05～0.01).灌药3组低于灌药1组(P＜0.05).灌药4组低于灌药2,3组(P＜0.01).⑦各组大鼠脑匀浆和血清血清补体C4水平比较假手术组和灌药各组低于对照组(P＜0.05～0.01).灌药3组低于灌药l组(P＜0.05).灌药4组低于灌药2,3组(P＜0.01).⑧各组大鼠脑水肿情况比较对照组脑组织明显充血水肿,表明炎症反应明显.灌药组脑水肿、病理损害较对照组轻.⑨各组大鼠脑组织超微结构的改变假手术组超微结构正常,对照组皮质坏死边缘区的细胞、毛细血管、髓鞘水肿明显,神经元细胞器减少,灌药3,4组细胞膜界限清楚,结构完整,线粒体丰富,大小均匀,有髓纤维形态正常,灌药1,2组介于两者之间.结论①给予活血化瘀药大鼠神经功能缺损评分降低,用药时间长的大鼠神经功能缺损评分低,提示大鼠神经功能缺损程度改善与用药时间延长有关.②给予活血化瘀中药大鼠脑组织一氧化氮浓度降低,血清中一氧化氮浓度增高,说明活血化瘀中药可以逆转缺血再灌注后一氧化氮浓度在不同组织中的异常改变来减轻脑损伤.③给予活血化瘀中药大鼠脑组织和血清中补体C3和C4水平明显降低,说明该药可通过启动补体系统而减轻对脑组织的损伤,C反应蛋白也明显降低,更进一步提示该药可抑制炎症反应.④用药时间越长脑损伤越轻,且用药剂量以2.5 g/L效果较好.     

大鼠心肺复苏后脑损伤研究

目的:探讨大鼠心肺复苏(CPR)后脑功能及病理组织学变化.方法:42只雄性SD大鼠随机分为3组:正常对照组(A组,6只),假手术组(B组,6只),复苏组(C组,按ROSC后1 h、6 h、12 h、24 h、72 h各时点分5亚组,6只).分别行神经功能缺损评分(NDS),测定脑组织含水量及病理形态学观察.结果:C组大鼠NDS评分降低,随ROSC时间延长,NDS水平逐渐上升,但72 h仍低于正常;大鼠ROSC后脑组织含水量呈上升趋势,24 h达高峰,各时点均高于B组(P<0.01);脑组织存在缺血性病理改变,神经元细胞坏死、胶质细胞增生、血管周水肿、尼氏体减少或消失,以24 h最明显,72 h损伤仍较重;体视学分析显示C组神经元细胞比表面、数面密度下降,平均体积增加(P<0.01).结论:大鼠CPR后出现神经元细胞坏死、脑水肿、整体行为学评分下降,存在脑功能损害.     

磷酸肌酸对大鼠心肺复苏后脑能量代谢的影响

目的 观察外源性磷酸肌酸(CP)对大鼠心肺复苏(CPR)后脑损伤的影响.方法 成年雄性SD大鼠160只,随机(随机数字法)分为4组:假手术对照组(A组)、常规复苏组(B组)、小剂量CP组(C组)、大剂量CP组(D组),各组再分别按自主循环恢复(ROSC)后(B、C、D组)或气管切开后(A组)0.5、3、6、12、24h时间点分为5亚组(n=8).B、C、D组采用窒息法建立大鼠CPR模型,ROSC后即刻C组静注CP0.5 g/kg,D组静注CP 1.0 g/kg.A组仅施行麻醉、气管切开、血管穿刺等操作,不行窒息及复苏.各亚组在相应时间点取材大脑额叶.采用高效液相色谱法( HPLC)测定脑组织三磷酸腺苷(ATP)、二磷酸腺苷(ADP)、一磷酸腺苷(AMP)含量,并计算总腺苷酸(TAN)及能倚(EC)值;采用吸光度法测定脑组织Na+ -K+ -ATP酶、Ca2+ - Mg2+ - ATP酶活性;HE染色观察光镜下大脑皮层病理变化.应用SPSS 16.0软件包进行数据统计,组间比较采用方差分析.结果 与A组比较,B组C组各时间点ATP、TAN、EC、Na+-K+-ATPase、Ca2+ -Mg2+ -ATPase均降低(P＜0.05或P＜0.01),D组0.5、3、6、12 h时间点的ATP、TAN、EC、Na+ -K+ -ATPase、Ca2 -Mg2 -ATPase均降低(P＜0.05或P＜0.01),B组各时间点AMP均升高(P＜0.01),C组D组0.5h和3h时间点的AMP升高(P＜0.01);与B组比较,C组D组6、12、24h时间点的ATP、TAN、EC、Na+ -K+ -ATP酶、Ca2+ -Mg2+ -ATP酶均升高(P＜0.05或P＜0.01),C组D组6、12、24h时间点的AMP均降低(P＜0.05或P＜0.01);与C组比较,D组6、12、24h时间点的TAN、Na+ -K+ -ATPase、Ca2 -Mg2 -ATPase以及24h的ATP均升高(P＜0.05或P＜0.01).大脑皮层病理变化B组严重,C组D组较轻.结论 心肺复苏后存在脑能量代谢障碍,CP可以增加CPR后脑组织中的ATP含量,提高Na+ -K+ -ATPase和Ca2 -Mg2+ -ATPase的活性,减轻脑组织病理损伤,具有脑保护作用,在大剂量给药时作用更明显.     

葛根素预处理对大鼠脑缺血再灌注损伤后脑组织含水量的影响

目的 观察葛根素预处理对大鼠局灶性脑缺血再灌注损伤后脑组织含水量的影响,为葛根素的临床应用提供依据.方法 制作大脑中动脉缺血2 h后再灌注损伤模型.将SD大鼠72只随机分为假手术组(S组)﹑致死性缺血再灌注组(IR组)、葛根素预处理组(P组)各24只,各组大鼠分别按脑缺血再灌注后24 h、72 h、120 h处死动物时间的不同,每组再分为3个亚组,每个亚组8只大鼠.采用干湿重法测定脑组织含水量,观察预处理对缺血2 h再灌注损伤24 h、72 h、120 h脑组织含水量的影响.结果 IR组及P组实验术后24 h、72 h、120 h各亚组脑组织含水量均显著高于S组各亚组(P 均＜0.01);但P组各亚组脑组织含水量均低于同期IR组各亚组(P＜0.05).结论 葛根素预处理能显著减少大鼠局灶性脑缺血后脑组织含水量,对脑组织具有保护作用.     

不同复苏方式对失血性休克大鼠脑组织S100B及糖基化终产物受体的影响

目的 探讨不同复苏方式对未控制出血致失血性休克大鼠脑组织中晚期糖基化终产物受体(RAGE)及其配体S100B蛋白的影响.方法 54只SD大鼠随机分成空白对照(C)组、限制性液体复苏(LR)组、常规液体复苏(TR)组,模拟未控制出血的失血性休克大鼠模型,进行不同方式的液体复苏,分别经历造模休克期、急救复苏期、止血治疗期、观察期,并在观察期1、6及12 h采血、处死大鼠,检测各组大鼠脑组织S100B蛋白、RAGE含量以及血清丙二醛(MDA)和总超氧化物歧化酶(T-SOD)含量.结果 在观察期1h,S100B蛋白及RAGE在LR组、TR组高于C组(P＜0.01),到了观察期6、12h,S100B蛋白含量比较为TR组＞LR组＞C组,且差异有统计学意义(P＜0.01).而在观察期各个时间点,各组MDA在脑组织中含量比较均为LR组＞TR组＞C组,且各组之间比较差异有统计学意义(P＜0.01).而同样在观察期各个时间点,各组T-SOD在脑组织中含量比较均为C组＞LR组＞TR组,且各组之间比较差异有统计学意义(P＜0.01).结论 限制性液体复苏同常规液体复苏模式相比可使失血性休克大鼠脑组织S100B蛋白的表达减缓,S100B蛋白及RAGE表达可能跟机体氧化应激水平或缺血-再灌注损伤相关.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。