高血压病患者脉压与左室肥厚关系的探讨

目的:探讨高血压患者脉压增大与左室肥厚的关系。方法:174例60岁以上的高血压患者测定其收缩压(SBP)、舒张压(DBP)、彩色多普勒超声检查仪测定舒张末期室间隔厚度(VSTd)、舒张末期左室内径(LVIDd)、舒张末期左室后壁厚度(PWTd),分析左室肥厚与脉压的关系。结果:随着脉压的增加,左室重量指数逐渐增加,左室肥厚程度的增加差异亦有显著性,P<0.01。当脉压相同,平均血压(MBP)<113mmHg与≥113mmHg两组进行比较,左室重量指数差异均无显著性。MBP≥113mmHg组的SBP、DBP均高于MBP<113mmHg组,两者差异有显著性。结论:左室肥厚不仅与SBP、DBP有关,而且与脉压有关,脉压是心血管事件的独立预测因子。     

中老年冠心病患者脉压与左心室重塑的相关性研究

目的：探讨脉压在中老年冠心病患者左心室重塑中的作用。方法：选取中老年冠心病患者100例,测定每位患者24h的动态血压,根据24h平均脉压分为2组,A组：脉压〈50mmHg（1mmHg=0．133kPa）,B组：脉压≥55mmHg,比较两组的左心室质量指数（LVMI）、室间隔厚度（IVST）、左心室后壁厚度（PWT）、左心室舒张末期内径（LVDd）及LVEF。结果：B组患者LVMI、IVST、PWT、LVDd明显高于A组,LVEF低于A组（P〈0．05或0．01）。结论：脉压高的中老年冠心病患者较脉压低的患者左心室重塑更加明显,心功能下降明显,监测脉压有助于冠心病患者心力衰竭的预测。     

左旋氨氯地平联合缬沙坦治疗老年高血压并左心室肥厚

目的探讨苯磺酸左旋氨氯地平联合缬沙坦治疗老年高血压患者左心室肥厚的临床效果。方法将58例老年高血压伴左心室肥厚患者随机分为两组,治疗组30例,对照组28例。两组均给予苯磺酸左旋氨氯地平治疗,治疗组联合缬沙坦治疗,疗程6mo。治疗前及治疗6mo末采用超声心动图超声仪检测左室舒张末期内径,室间隔与左心室后壁舒张末期厚度等各项指标并进行对比分析。结果治疗6mo末两组左室后壁舒张末期厚度、室间隔厚度、左室舒张末期内径、左室收缩末期内经、左室心肌重量指数及等容舒张时间均较治疗前明显下降,左室射血分数及E/A均较治疗前显著提高(P<0.05或0.01);两组间比较,治疗组左室后壁舒张末期厚度、心室间隔舒张末期厚度、左室舒张末期内径、左室收缩末期内经、左室心肌重量指数、左室射血分数及E/A均较对照组改善显著,差异均有显著或极显著性(P<0.05或0.01)。结论缬沙坦和苯磺酸左旋氨氯地平均能改善左室舒张功能,逆转扩大的左心室;苯磺酸左旋氨氯地平联合缬沙坦治疗的临床效果显著优于单用左旋氨氯地平治疗,可作为治疗高血压伴左心室肥厚患者的一线用药。     

脉压与冠心病患者左室肥厚的关系探讨

目的 探讨冠心病患者左室肥厚与脉压的关系.方法 将本院收治的96例冠心病患者根据脉压大小分为3组:A组30例,脉压≤45 mmHg;B组35例,55 mmHg≥脉压＞45 mmHg;C组31例,脉压＞55 mmHg.采用彩色超声心脏诊断仪测定舒张期室间隔厚度(IVST)、左室后壁厚度(PWT)、左室舒张末期内径(LVD...     

依那普利对高血压左室肥厚的逆转

我们用依那普利治疗左室肥厚的高血压病人３０例，治疗前后以超声心图观察对左心室肥厚逆转的影响。结果发现，患者左室舒张末期内径，室间隔厚度（ＩＶＳＴ）、左室后壁厚度（ＬＶＰＷＴ），左室重量指数（ＬＶＭＩ）均明显减少，ＬＶＨ逆率为７６％。提示依那普利是治疗高血压左心室肥厚的理想药物。     

老年人收缩期高血压左室肥厚与心律失常关系的探讨

目的：探讨老年人收缩期高血压发生左室肥厚与心律失常的关系，为临床治疗提供诊断依据。方法：选择收缩压≥140mmHg、舒张压≤90mmHg的老年患者146例（分为合并左室肥厚和无左室肥厚两组），应用超声心动图与动态心电图进行检查。按国际心脏病学会和WHO推荐方法，取胸骨左缘心脏的胸骨旁长轴切面，用M型超声心动图测量舒张末期左心室内径、左心室后壁厚度、舒张末期心室间隔厚度，连续取3个心动周期，求各项指标平均值。结果：合并左室肥厚组LⅢ级以上复杂性室性心律失常的发生率高达67.4％，显著高于无左室肥厚组的38.3％。结论：表明老年人收缩期高血压患者左室肥厚与复杂性室性心律失常密切相关，发生率高于文献报道的其他类型的高血压。     

麝香保心丸联合苯磺酸氨氯地平片、贝那普利对高血压伴心肌肥厚患者心功能的影响

目的：分析麝香保心丸联合苯磺酸氨氯地平片、贝那普利对高血压伴心肌肥厚患者心功能及心肌纤维化指标改善的影响。方法：选取2017年4月~2019年5月收治的89例高血压伴心肌肥厚患者,将接受苯磺酸氨氯地平片、贝那普利治疗的44例作为对照组,将接受麝香保心丸联合苯磺酸氨氯地平片、贝那普利治疗的45例作为观察组,比较两组治疗前后心功能（左室舒张末期内径、左心室后壁厚度、舒张末期室间隔厚度、左室射血分数）、心肌纤维化指标情况（血清Ⅰ型前胶原、透明质酸、层粘蛋白）。结果：治疗后,观察组左室舒张末期内径、左心室后壁厚度、舒张末期室间隔厚度较对照组低,左室射血分数较对照组高（P＜0.05）;治疗后,观察组血清Ⅰ型前胶原、透明质酸、层粘蛋白较对照组低（P＜0.05）。结论：高血压伴心肌肥厚患者接受麝香保心丸联合苯磺酸氨氯地平片、贝那普利治疗,能有效改善其心功能、降低心肌纤维化指标水平。     

左心室肥厚与心率变异性及室性心律失常的相关性

【目的】探讨原发性高血压患者左心室肥厚与心率变异性及室性心律失常的相关性。【方法】将98例原发性高血压患者分为无左心室肥厚组（A组,48例）和左心室肥厚组（B组,50例）,通过心脏B超观察患者心脏的结构与功能,通过动态心电图观察24h室性早搏情况及心率变异性各时域指标。【结果】B组患者的24h室性早搏发生率及室性早搏级别明显高于A组（P〈0．01）;两组患者心率变异性各指标无显著性差异（P〉0．05）;与室性期前收缩级别相关的独立危险因素依次为室间隔厚度、左心室舒张末期内径和患者的年龄（P〈0．05）。【结论】原发性高血压合并左心室肥厚患者严重室性心律失常的发生率明显增高,而左心室肥厚与心率变异性无相关性。室间隔厚度、左心室舒张末期内径与年龄是原发性高血压患者发生室性心律失常的独立危险因素。     

老年人收缩期高血压左室肥厚与心律失常关系的探讨

目的 :探讨老年人收缩期高血压发生左室肥厚与心律失常的关系 ,为临床治疗提供诊断依据。方法 :选择收缩压≥ 14 0mmHg、舒张压≤ 90mmHg的老年患者 14 6例 (分为合并左室肥厚和无左室肥厚两组 ) ,应用超声心动图与动态心电图进行检查。按国际心脏病学会和WHO推荐方法 ,取胸骨左缘心脏的胸骨旁长轴切面 ,用M型超声心动图测量舒张末期左心室内径、左心室后壁厚度、舒张末期心室间隔厚度 ,连续取 3个心动周期 ,求各项指标平均值。结果 :合并左室肥厚组LⅢ级以上复杂性室性心律失常的发生率高达 67 4% ,显著高于无左室肥厚组的 3 8 3 %。结论 :表明老年人收缩期高血压患者左室肥厚与复杂性室性心律失常密切相关 ,发生率高于文献报道的其他类型的高血压     

老年原发性高血压患者脉压指数与心血管病变的相关性分析

目的分析老年原发性高血压（EH）患者脉压指数（PPI）与心血管病变的临床相关性.方法 EH患者40例,按测得的PPI分为PPI≤0.4组、0.4-0.5组和〉0.5组,分析PPI与颈动脉粥样硬化斑块数量、面积和斑块积分及其与左心室舒张末期内径（LVDd）、舒张末期室间隔厚度（IVST）、舒张末期后壁厚度（LVPWT）和重量指数（LVMI）的相关性.结果 PPI与LVDd、IVST、LVPWT、LVMI及颈动脉斑块面积、数量积分呈正相关（P〈0.05）;PPI〉0.5组与PPI≤0.4组和0.4-0.5组比较差异均有统计学意义（P〈0.01,P〈0.05）.结论 PPI与老年EH患者左心室肥厚与颈动脉病变密切相关,可作为监测心血管病变的一个有效指标.     

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.     

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.     

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.     

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.