同型半胱氨酸与鼻咽癌相关性及其机制研究

目的探讨同型半胱氨酸(Hcy)和血清超敏C-反应蛋白(hs-CRP)水平的关系,明确Hcy和hs-CRP水平与鼻咽癌发生的关系,以明确Hcy是否为鼻咽癌的危险因素。方法收集2012年1月至2014年7月中山市中医院肿瘤科收治并确诊为鼻咽癌的患者72例,另选取同期体检的50例志愿者作为健康对照组,鼻咽癌患者分为鼻咽癌缓解组和鼻咽癌未缓解组。收集入选研究对象清晨空腹静脉血测定血浆Hcy和hs-CRP水平。结果与健康对照组比较,鼻咽癌缓解组、未缓解组治疗前血浆Hcy和hs-CRP水平显著升高,差异均有统计学意义(t=9.08,P=0.023;t=6.84,P=0.035);与鼻咽癌缓解组治疗前比较,鼻咽癌未缓解组治疗前血浆Hcy和hs-CRP水平显著升高,差异均有统计学意义(t=10.94,P=0.018;t=8.67,P=0.026);与鼻咽癌缓解组治疗前比较,鼻咽癌缓解组治疗后血浆Hcy和hs-CRP水平显著降低,差异有统计学意义(t=7.15,P=0.030;t=5.34,P=0.047);与鼻咽癌未缓解组治疗前比较,鼻咽癌未缓解组治疗后血浆Hcy和hs-CRP水平降低,但差异无统计学意义(t=1.05,P=0.072;t=1.84,P=0.064)。鼻咽癌患者血浆Hcy与hs-CRP水平之间有直线相关关系,呈正相关,相关系数为0.522。结论血浆Hcy和hs-CRP水平变化与鼻咽癌严重程度和治疗效果均有正相关性,为临床早期诊断和提高治疗效果提供了参考依据。     

冠心病患者血清同型半胱氨酸和脂蛋白a联合检测的临床意义

目的探讨冠心病(CHD)患者血清同型半胱氨酸(Hcy)和脂蛋白a[LP(a)]联合检测的临床意义。方法 66例CHD患者来自无锡市人民医院心内科的住院患者,根据国际标准分为稳定型心绞痛(SAP)22例,不稳定型心绞痛(UAP)22例和心肌梗死(AMI)22例,另外对照组22例来自该院体检中心健康体检人员。采用循环酶法和免疫透射比浊法,分别检测患者血清Hcy和LP(a)水平,并与对照组进行比较。结果 CHD患者血清Hcy和LP(a)水平呈正相关(P<0.05)。CHD患者Hcy、LP(a)水平均高于对照组,比较差异有统计学意义(P<0.05)。AMI组血清Hcy和LP(a)水平均明显高于UAP组、SAP组和对照组,UAP组血清Hcy和LP(a)水平均明显高于SAP组和对照组,SAP组血清Hcy和LP(a)明显高于对照组,比较差异有统计学意义(P<0.05)。结论 Hcy和LP(a)是CHD的两个危险因子,联合检测血清中Hcy和LP(a)的水平,对于预防性提示冠心病的病情严重程度,以及发病后的诊断、判断治疗预后更有意义。     

脂蛋白(a)、同型半胱氨酸、超敏C反应蛋白和颈动脉内膜中层厚度与高血压合并冠心病相关性研究

目的研究脂蛋白(a)[LP(a)]、同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)和颈动脉内膜中层厚度(IMT)与高血压合并冠心病患者的相关性。方法收集符合入选标准的原发性高血压病患者145例,根据是否合并冠心病分为原发性高血压病组(对照组)70例和原发性高血压合并冠心病组(观察组)75例。分析LP(a)、Hcy、hs-CRP和IMT与冠心病患者的相关性。结果观察组的LP(a)、Hcy、hs-CRP、IMT及斑块形成的比例高于对照组,差异均有统计学意义(P<0.05)。多因素分析显示:在调整年龄、性别后,LP(a)(OR=1.02,P<0.001)、Hcy(OR=1.30,P<0.001)、hs-CRP(OR=4.73,P<0.001)与冠心病呈正相关,且纳入IMT变量后,正相关关系仍有统计学意义。在调整年龄、性别后,IMT中左主干(OR=154.97,P<0.001)、左分叉(OR=52.74,P<0.001)、右主干(OR=183.64,P<0.001)、右分叉(OR=77.31,P<0.001)均与冠心病呈正相关。结论LP(a),Hcy,hs-CRP均可能为高血压合并冠心病的独立危险因素。     

急性冠脉综合征血清脂蛋白(a)与肌钙蛋白I的检测意义

目的探讨急性冠脉综合征(ACS)患者血清脂蛋白(a)[LP(a)]及肌钙蛋白I(cTnI)检测的临床意义。方法收集110例ACS患者,包括急性心肌梗死(AMI组)60例,不稳定型心绞痛(UA组)50例,测量治疗前血清LP(a)、cTnI浓度。另取50例稳定型心绞痛患者为对照组,对检测结果进行统计学分析。结果 ACS组LP(a)、cTnI水平均显著高于对照组(P0.05),AMI组血清cTnI显著高于UA组(P0.05)。结论血清LP(a)、cTnI联合检测对急性冠脉综合征的诊断和危险度分层具有重要临床意义。     

急性脑梗死患者血浆Hcy hs-CRP vWF检测的临床意义

目的探讨急性脑梗死患者血浆同型半胱氨酸(Hcy)与超敏C反应蛋白(hs-CRP)、血管性假血友病因子(vWF)水平的相关性及临床意义。方法选取急性脑梗死患者150例,按照其血浆Hcy增高程度不同分为3组。另外,选取同期健康体检者50例作为对照组,分别测定急性脑梗死患者和对照组健康者血浆hs-CRP、vWF及Hcy水平并进行组间比较,并对hs-CRP与Hcy、vWF与Hcy的检测结果进行相关性分析。结果急性脑梗死患者血浆hs-CRP、vWF及Hcy水平显著高于对照组(P<0.05);急性脑梗死患者血浆hs-CRP、vWF升高水平与Hcy升高水平呈正相关。急性脑梗死患者各组Hcy、hs-CRP、vWF水平均显著高于对照组(P<0.05)。结论血浆hs-CRP、vWF、Hcy可作为血管内皮损伤的标志物,这三项指标的联合检测可以为急性脑梗死早期诊断和治疗提供依据。     

急性脑梗死患者血清3项指标水平分析

目的检测分析急性脑梗死患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)、超敏C反应蛋白(hs-CRP)及脂蛋白(a)[LP(a)]水平变化及临床意义。方法急性脑梗死患者100例(急性脑梗死组)与同期体检健康者40例(健康对照组),平行检测两组血清Lp-PLA2、hs-CRP及LP(a)水平。急性梗死组按美国国立卫生研究院卒中量表(NIHSS)评分,比较不同NIHSS评分患者的血清Lp-PLA2、hs-CRP及LP(a)水平。结果急性脑梗死组血清Lp-PLA2、hs-CRP及LP(a)水平明显高于健康对照组(P<0.01),且各指标水平变化呈显著正相关(r分别为0.339,0.545,0.297,P<0.01)。急性脑梗死组NIHSS评分小于5分、5～15分和大于15分3个亚组之间血清Lp-PLA2、hs-CRP及LP(a)水平差异有统计学意义(P<0.05)。NIHSS评分越高的亚组,其血清Lp-PLA2、hs-CRP及LP(a)水平越高。血清Lp-PLA2、hs-CRP及LP(a)水平与急性脑梗死患者病情严重程度均呈高度正相关(r分别为0.745、0.636、0.701,P<0.01)。结论检测急性脑梗死患者Lp-PLA2、hs-CRP及LP(a)血清水平,对临床诊断有一定参考价值。     

肺栓塞患者血清同型半胱氨酸和超敏C反应蛋白检测的临床意义

目的探讨肺栓塞(PE)患者血清中同型半胱氨酸(Hcy)和超敏C反应蛋白(hs-CRP)的变化与临床意义。方法测定43例急性肺栓塞患者和42例健康体检者血清的Hcy、hs-CRP浓度并进行统计分析。结果与健康对照组相比,PE组中Hcy和hs-CRP水平明显升高(P<0.01);且血清Hcy水平与hs-CRP水平呈正相关(r=0.621,P<0.01)。结论急性肺栓塞患者血清Hcy和hs-CRP水平的升高呈正相关,联合检测可作为预测急性肺栓塞发生、发展的敏感指标。     

男性冠心病患者血清性激素（E2/T）、hs-CRP、cTnI和LP（a）水平分析

目的：探讨男性冠心病患者血清性激素（E2/T）、高敏C反应蛋白（hs-CRP）、肌钙蛋白I（cTnI）和脂蛋白（a）[LP（a）]水平与临床的关系。方法采用化学发光免疫法测定127例男性冠心病（CHD）患者（37例AMI,43例UA和47例SA）血清性激素（E2/T）和cTnI,免疫比浊法测定血清hs-CRP、LP（a）,并与60名健康对照组进行比较。结果与对照组比较,CHD患者E2明显增高、T明显降低（P＜0.05）,CHD患者E2/T比值为41.38＆#177;7.34,较之对照组的21.03＆#177;6.58明显增高（P＜0.01）。CHD患者hs-CRP、cTnI和LP（a）明显增高（P＜0.05）,随CHD的严重程度（SA、UA和AMI）逐级升高。结论男性CHD患者性激素代谢紊乱,E2明显增高,T明显降低,随CHD严重程度hs-CRP、cTnI和LP（a）水平逐渐增高。     

老年心梗患者血清LP(a)和miR-210水平变化与心梗后心力衰竭的相关性分析

目的 检测脂蛋白a [LP (a)]和miR-210在老年急性心肌梗死(AMI)患者血清中的改变,并探讨其与心肌梗死后并发心力衰竭的相关性。方法 选取2017年1月至2019年12月湖州市第一人民医院130例AMI患者,其中60例为AMI并发心力衰竭(AMI-HF)组,70例为未并发心力衰竭(AMI)组,另选取50例无AMI体检者设为对照组。三组均采取空腹血检测LP (a)水平,收集血清样本并通过实时荧光定量PCR法分析血清miR-210的相对表达量,并分析血清LP (a)和miR-210水平与心肌梗死后心力衰竭的相关性。结果 血清LP (a)和miR-210水平在AMI组和AMI-HF组患者中显著高于对照组(P<0.05和P<0.01),并且AMI-HF组患者的血清LP (a)和miR-210水平明显高于AMI组(P<0.05和P<0.01)。而且,miR-210与左室射血分数(LVEF)呈负相关(r=-0.653,P<0.05),与B型脑钠肽(BNP)呈正相关(r=0.745,P<0.05),与LP (a)呈正相关(0.672,P<0.05...     

动脉硬化性脑梗死相关生化指标分析

目的探讨同型半胱氨酸(Hcy)及血脂代谢指标与动脉硬化性脑梗死(atherosclerotic cerebral infarction,ACI)的关系。方法选择我院明确诊断的ACI 150例(ACI组)及同期健康体检的140例(对照组)同时行血清Hcy、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、甘油三酯(TG)、脂蛋白(a)〔Lp(a)〕、载脂蛋白(Apo)A1、ApoB、超敏C反应蛋白(hs-CRP)检测,并进行对比分析。结果 ACI组血清Hcy、Lp(a)及TC、hs-CRP、LDL、TG、ApoB水平均高于对照组,血清中HDL水平低于对照组,组间比较差异均有统计学意义(P<0.05,P<0.01);ACI组Hcy、Lp(a)、TC、LDL、TG、hs-CRP阳性检出率明显高于对照组,差异有统计学意义(P<0.05,P<0.01)。结论血浆Hcy、hs-CRP和血脂相关指标变化与ACI密切相关,及早检测对ACI的预防及治疗有重要意义。     

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.