血清同型半胱氨酸水平对首发急性脑梗死患者短期预后的影响

目的探讨同型半胱氨酸(Hcy)水平对首发急性脑梗死(ACI)患者短期预后的影响。方法 90例首发ACI患者与90例健康志愿者分成ACI组和对照组,检测其Hcy、内皮型一氧化氮合酶(e NOS)、一氧化氮(NO)、颈动脉内膜中层厚度(IMT)和血管内径变化率(FMD)等指标,另将90例ACI患者分为干预Ⅰ组(45例)和干预Ⅱ组(45例),干预Ⅰ组常规治疗,干预Ⅰ组给予维生素B12和B9辅助Hcy代谢。治疗后观察Hcy、IMT、FMD、e NOS、NO,并对数据进行统计学分析。结果与对照组治疗后比较,ACI组的Hcy、IMT和FMD明显升高,e NOS、NO明显降低,两组之间差异具有显著性(P0.05)。治疗前,干预Ⅰ组和干预Ⅱ组患者间血清Hcy、NIHSS评分和BI评分无显著差异,治疗后2周至6周,干预Ⅰ组患者的血清Hcy显著改善,神经功能逐步恢复,明显优于干预Ⅱ组,差异具有显著性(P0.05)。结论血清Hcy水平与ACI患者的发病和预后有密切联系,可在常规治疗的基础上给予维生素B辅助Hcy代谢。     

叶酸与维生素B_(12)在改善急性脑梗死患者血管内皮功能中的应用

选取2011年10月²012年10月在我院进行治疗的64例急性脑梗死患者,将其平均分为对照组和观察组各32例,两组均给予常规治疗,观察组在此基础上给予叶酸和维生素B12口服治疗,1个月后对两组患者治疗前后的血浆HCY水平、一氧化氮(NO)水平以及内皮素(ET)进行测定,分析叶酸与维生素B12在改善急性脑梗死患者血管内皮功能中的作用。结果经过1个月的治疗后,观察组患者的血浆HCY水平、NO水平明显下降,ET水平明显升高,与对照组相比差异显著(P<0.05)。叶酸和维生素B12应用于急性脑梗死患者血管内皮细胞功能损害的改善中具有一定作用,可作为干预治疗在临床中推广使用。     

丁苯酞注射液对急性脑梗死患者血管内皮功能的影响

目的：探讨丁苯酞氯化钠注射液对急性脑梗死患者血管内皮功能的影响。方法将106例急性脑梗死患者随机分为观察组57例,对照组49例。两组患者均给予常规治疗,观察组在此治疗基础上加用丁苯酞氯化钠注射液100ml静脉滴注,2次/d。分别检测两组患者治疗前及治疗2周后根据美国国立卫生院神经功能缺损评分（NIHSS）,血管内皮生长因子（VEGF）、内皮素-1（ET-1）、一氧化氮（NO）水平。结果治疗前,两组患者NIHSS评分及血清VEGF、ET-1、NO水平比较,差异无统计学意义（P〉0.05）。治疗2周后与对照组比较,观察组患者NIHSS评分及ET-1水平明显降低（P〈0.05）,血清VEGF、NO水平明显升高（P〈0.05）;总有效率比较,观察组疗效明显优于对照组（P〈0.05）。结论丁苯酞氯化钠注射液能明显降低急性脑梗死患者NIHSS评分,提高血管内皮功能,促进神经功能的恢复。     

同型半胱氨酸及血管内皮功能检测在脑梗死中的应用

目的观察脑梗死患者血清同型半胱氨酸(Hcy)、血管内皮功能指标[内皮素(ET-1)、一氧化氮(NO)、血管内皮生长因子(VEGF)]的变化,探讨其与脑梗死的关系及临床应用价值。方法分别检测90例脑梗死患者(脑梗死组)及80名体检健康者(正常对照组)血清Hcy、NO、ET-1及VEGF水平,计算异常检出率并进行分析比较。结果与正常对照组比较,脑梗死组血清Hcy、ET-1、VEGF水平明显升高(P0.05),NO水平明显降低(P0.05)。脑梗死组血清Hcy、NO、ET-1及VEGF的异常检出率明显高于正常对照组(P0.05)。结论Hcy及血管内皮功能指标与脑梗死有一定的关系。     

浅析急性脑梗死与血浆同型半胱氨酸的关系

目的探讨急性脑梗死与血浆同型半胱氨酸(Hcy)关系。方法选取急性脑梗死住院患者112例为急性脑梗死组,另选同期健康体检者100例作为对照组,监测两组血浆Hcy、叶酸和维生素B12并进行比较。结果急性脑梗死组血浆Hcy水平明显高于对照组(P<0.05),而急性脑梗死组叶酸及维生素B12水平则明显低于对照组,差异均有统计学意义(P均<0.05)。结论对有脑梗死高危因素的人群进行血浆Hcy、叶酸和维生素B12水平检测,早期采取干预措施,可以降低急性脑梗死的发生率。     

叶酸、维生素 B6、甲钴胺联合干预脑梗死伴高同型半胱氨酸血症的随机对照研究

目的：探讨叶酸、维生素B6、甲钴胺联合治疗对急性脑梗死伴高同型半胱氨酸（ homocysteine ,Hcy）血症患者的血Hcy水平及颈动脉斑块积分的影响。方法将入组的52例急性脑梗死伴高Hcy血症患者采用区组随机法将其随机分为2组,干预组予叶酸2.5 mg qd,维生素B610 mg tid,甲钴胺500μg bid,持续3月;对照组除上述B族维生素治疗以外均与干预组相同。两组均于基线及3月时行血脂、血Hcy、颈动脉彩超检查,并行统计分析。结果两组干预后的总胆固醇（干预组内P＝0.022,对照组内P＜0.001）、LDL-C（干预组内P ＝0.016,对照组内P＜0.001）水平均较基线水平显著下降,甘油三酯及HDL-C水平无明显变化（ P＞0.05）;3个月时,干预组血Hcy水平（ P＜0.001）及斑块积分较基线时明显下降（ P ＝0.027）,并且显著低于对照组（ t值分别为-5.164,-3.530;P值分别为＜0.001和0.001）,而总胆固醇、甘油三酯、LDL-C及HDL-C水平与对照组比较差异无统计学意义（ P＞0.05）。结论叶酸、维生素B6、甲钴胺联合治疗高Hcy血症安全有效,且可明显减轻急性脑梗死患者动脉粥样硬化程度,是高Hcy人群缺血性卒中治疗的有益补充。     

脑梗死患者血浆中同型半胱氨酸、维生素B_(12)与叶酸表达水平研究

目的:探讨脑梗死患者血浆中同型半胱氨酸、维生素B_(12)与叶酸表达水平与血管性痴呆的关系。方法:采用高效液相色谱法检测受试者(脑梗死患者血管性痴呆组、脑梗死患者非痴呆组、健康对照组)血浆Hcy、维生素B_(12)及叶酸水平,并观察MTHFR基因型在不同组间分布情况。结果:血管性痴呆组的血浆Hcy水平明显高于非痴呆组、健康对照组(P0.05),而维生素B_(12)及叶酸水平明显低于非痴呆组和健康对照组(P0.05)。不同病情严重程度脑梗死血管性痴呆患者间Hcy、维生素B_(12)及叶酸水平无统计学差异(P0.05)。MTHFR基因型在各组间分布情况差异也无统计学意义(P0.05)。结论:血浆中Hcy、维生素B_(12)及叶酸水平可能与血管性痴呆有关。     

呼和浩特地区1094例急性脑梗死患者血清维生素B_12、叶酸及同型半胱氨酸的测定分析

目的探讨呼和浩特地区急性脑梗死（ACI）与血清维生素B12、叶酸及同型半胱氨酸（Hcy）的关系。方法将1 094例ACI患者作为ACI组,100例健康体检者作为对照组。采用化学发光法测定其血清维生素B12、叶酸及Hcy浓度。结果 ACI组患者血清叶酸、维生素B12浓度显著低于对照组（P〈0.05）。ACI组患者服用叶酸、维生素B12前、后的血清Hcy浓度均显著高于对照组（P〈0.05）。结论血清维生素B12、叶酸及Hcy检测对ACI的治疗、预后判断具有重要意义。     

东菱迪芙联合依达拉奉对老年脑梗死患者血清血管内皮生长因子、同型半胱氨酸和肿瘤坏死因子α的影响

目的探讨东菱迪芙联合依达拉奉对老年脑梗死患者血清血管内皮生长因子(VEGF)、同型半胱氨酸(Hcy)和肿瘤坏死因子-α(TNF-α)的影响。方法选取140老年急性脑梗死患者,分为对照组和观察组各70例。对照组患者给予依达拉奉治疗,观察组在对照组基础上联合东菱迪芙治疗。比较2组临床疗效、NIHSS评分、血清VEGF、Hcy、TNF-α水平。结果观察组总有效率显著高于对照组(P0.05)。治疗后,2组NIHSS评分、血清VEGF、Hcy、TNF-α水平比较,差异有统计学意义(P0.05)。结论东菱迪芙联合依达拉奉治疗老年急性脑梗死患者效果良好。     

有关叶酸与维生素B_6、B_(12)对冠心病心绞痛患者血清Hcy水平及预后的影响

目的探讨叶酸与维生素B_6、B_(12)对冠心病心绞痛患者血清Hcy水平及预后的影响。方法选取本院2017年5月～2018年5月我院收治的冠心病心绞痛患者102例。随机分为观察组和对照组各51例。对照组给予常规治疗,观察组在此基础上给予叶酸、维生素B_6、维生素B_(12)治疗。对比两组治疗效果及治疗前后血清Hcy水平变化情况、预后情况。结果观察组治疗总有效率显著高于对照组,治疗后,观察组血清Hcy水平显著低于对照组,且治疗后心绞痛发作频率、心绞痛持续时间显著低于对照组,差异有统计学意义(P0.05)。结论对冠心病心绞痛患者进行常规治疗的同时加以叶酸、维生素B_6、维生素B_(12)治疗,可有效降低患者血清Hcy水平,提高临床治疗效果,显著改善患者预后。     

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.