血清丙二醛、超氧化物歧化酶、一氧化氮检测对新生儿缺氧缺血性脑病的应用价值

目的探讨新生儿缺氧缺血性脑病（HIE）患儿治疗前后，特别是促红细胞生成素（EPO）治疗后血清中丙二醛（MDA）、超氧化物歧化酶（SOD）和一氧化氮（NO）的含量变化。方法将62例HIE患儿随机分为常规治疗组和EPO治疗组，前者采用常规治疗，后者在常规治疗基础上于出生后24h内加用EPO每日200U／kg静脉滴注，疗程7d，2组患儿均于生后第1天、第8天采集血液样本，检测并比较2组患儿血清中MDA、SOD和NO的水平，同时与对照组（足月健康新生儿）比较。结果HIE患儿血清中MDA、NO水平明显高于对照组（P〈0．05），SOD水平明显低于对照组（P〈0．05）；中、重度HIE患儿用EPO治疗后血清中MDA、NO水平明显低于治疗前（P〈0．05），而SOD水平明显高于治疗前（P〈0．05）。结论血清中MDA、SOD、NO含量与HIE病情、疗效密切相关，是EPO治疗HIE效果的敏感指标。     

GSH联合早期护理干预对新生儿黄疸的疗效分析

目的探讨还原型谷胱甘肽(GSH)联合早期护理干预对新生儿黄疸的治疗效果及对脂质过氧化指标血清丙二醛(MDA)、超氧化物歧化酶(SOD)和氧化型谷胱甘肽(GSH-PX)水平的影响。方法选取新生儿黄疸患儿68例,随机分为观察组(34例)和常规组(34)例。另选取同时期出生的健康足月新生儿20例为健康对照组。观察组在常规组基础上加用GSH治疗及早期护理干预。检测治疗前后血清总胆红素(TBIL)、直接胆红素(DBIL)、MDA、SOD、GSH-Px水平。结果观察组的治疗总有效率为91.2%,明显高于常规组(73.5%)(P0.05);治疗后,两组患儿血清TBIL、DBIL水平均较治疗前明显下降(均P0.01),且观察组治疗后TBIL、DBIL水平明显低于常规组(均P0.01)。治疗前,两组患儿血清MDA水平明显高于健康对照组(均P0.01),两组SOD、GSH-Px水平明显低于健康对照组(均P0.01);治疗后,两组患儿血清MDA水平明显下降(P0.01或0.05),而血清SOD、GSH-Px则明显升高(P0.01或0.05);与常规组比较,观察组血清MDA水平下降更明显(P0.05),GSH-Px水平明显增高(P0.05)。结论 GSH联合早期护理干预对新生儿黄疸具有较好的临床疗效,且能有效降低患儿血清TBIL、DBIL、MDA水平,提高SOD、GSH-Px水平,具有积极的临床意义。     

重组组织型纤溶酶原激活剂对缺血性脑卒中患者LDH、NO、MDA、SOD的影响

目的研究重组组织型纤溶酶原激活剂对缺血性脑卒中患者血清乳酸脱氢酶(LDH)、一氧化氮(NO)、丙二醛(MDA)、超氧化物歧化酶(SOD)的影响。方法选取2012年3月至2018年8月来该院治疗的86例缺血性脑卒中患者为研究对象,将其分为对照组和治疗组,每组43例,治疗组采用重组组织型纤溶酶原激活剂结合阿司匹林治疗,对照组采用阿司匹林治疗。比较治疗后2组患者的临床疗效,检测血清LDH、NO、MDA、SOD水平。结果治疗组总有效率(90.70%)高于对照组(62.80%),LDH、NO、MDA水平低于对照组,SOD水平高于对照组,差异有统计学意义(P<0.05)。治疗后,治疗组基本痊愈、显效及有效患者的血清LDH、NO及MDA水平低于对照组,SOD水平高于对照组,差异有统计学意义(P<0.05)。随着临床疗效的逐渐增强,患者血清中LDH、NO、MDA水平降低,SOD水平升高,且差异有统计学意义(P<0.05)。结论重组组织型纤溶酶原激活剂对缺血性脑卒中患者有显著的临床治疗效果。     

促红细胞生成素监测对缺氧缺血性脑损伤患者的临床应用分析

目的分析促红细胞生成素(EPO)监测对缺氧缺血性脑损伤患者的临床应用。方法选取2012年6月至2016年6月于该院接受治疗的缺氧缺血性脑损伤(HIBD)新生患儿148例作为研究对象,按照随机数字表法分为常规治疗组(n=74)和EPO治疗组(n=74),常规治疗组进行常规治疗,EPO治疗组在常规治疗组的基础上加用EPO进行治疗,利用新生儿行为测定(NBNA)和智能发育评估(CDCC)评价EPO治疗效果;另选取同期出生的健康新生儿148例作为对照组,于出生后的第1、3、5天测定比较HIBD组与对照组血清中EPO水平。结果 HIBD轻、中、重度组血清中EPO水平与对照组相比均有不同程度增高,HIBD中度组增高最为明显;EPO治疗组NBNA评分在第14天与第28天时均明显高于常规治疗组,差异有统计学意义(P0.05);EPO治疗组在第180天时的智力发育指数(MDI)和心理运动发育指数(PDI)均明显高于常规治疗组,差异有统计学意义(P0.05)。结论血清中EPO水平可以作为评价HIBD的指标之一,EPO对于HIBD患儿的神经系统发育有着积极的影响,其对于HIBD患儿的治疗效果良好。     

辛伐他汀对脑梗死患者血清MDA及SOD的影响

目的探讨辛伐他汀对脑梗死患者血清丙二醛(MDA)和超氧化物歧化酶(SOD)的影响。方法筛选68例脑梗死患者,随机分成对照组34例和治疗组34例,对照组给予脑梗死常规治疗,治疗组在常规治疗的基础上加用辛伐他汀(20 mg/d),同时筛选健康体检者34例为健康组,随访30 d。测定血清MDA、SOD含量,同时对神经功能进行评分以判断疗效。结果脑梗死患者血清MDA水平高于健康组,血清SOD含量低于健康组(P0.05);治疗30 d,对照组及治疗组血清MDA水平均下降,SOD含量均升高(P0.05);治疗组较对照组MDA下降更明显,SOD升高更明显,差异有统计学意义(P0.05)。结论辛伐他汀可以下调脑梗死患者血清MDA水平,提高血清SOD水平,抵抗脑梗死后自由基损伤,改善神经功能缺损程度。     

长春西汀联合常规治疗增强急性脑梗死患者的疗效

目的:研究长春西汀联合常规治疗对急性脑梗死(ACI)患者氧化应激和血管内皮功能的影响。方法:ACI患者100例,随机分为对照组和联合组各50例,2组均给予常规治疗,联合组还予长春西汀治疗。对比2组治疗前后神经功能缺损评分(NIHSS)、临床疗效、血清氧化性低密度脂蛋白(ox-LDL)、丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平和血清内皮素-1(ET-1)、一氧化氮(NO)及血管性假血友病因子(v WF)水平及不良反应。结果:治疗后联合组的NIHSS评分低于对照组(P<0.05),总有效率高于对照组(P<0.05);联合组的血清ox-LDL、MDA、ET-1、vWF水平均低于对照组(P<0.05),血清SOD、GSH-Px、NO水平高于对照组(P<0.05);联合组不良反应总发生率高于对照组(P<0.05)。结论:长春西汀联合常规治疗ACI能显著改善神经功能,提高疗效,还可以减轻氧化应激损伤,改善血管内皮功能,但不良反应发生风险增加。     

新生儿缺氧缺血性脑病患儿血清一氧化氮和白细胞介素-18的变化及意义

目的 通过监测新生儿缺氧缺血性脑病(HIE)患儿血清NO、IL-18的变化,探讨NO、IL-18与HIE的相互关系及临床意义.方法 以2007年1月至2007年11月我院收治的HIE新生儿为观察组,正常新生儿为对照组.分别于生后第1、3、7、14天测定HIE组及对照组血清NO和IL-18,分析NO、IL-18的变化及意义.结果 生后第1天,正常对照组血清NO及IL-18含量分别为(6.40±4.24)μmol/L和(2.84±2.53)ng/L;轻度HIE组为(21.55±7.23)μmol/L和(6.79±1.96)ng/L;中度HIE组为(33.38±2.81)μmol/L和(14.07±2.91)ng/L;重度HIE组为(66.39±18.03)μmol/L和(26.85±9.82)ng/L.HIE组血清NO及IL-18含量较对照组均有升高(P均<0.01);且中、重度HIE患儿血清NO及IL-18含量明显高于轻度HIE患儿(P均<0.01).第14天轻、中度HIE组的NO、IL-18含量与对照组对比差异无统计学意义(P均>0.05),而重度HIE组与对照组对比差异有统计学意义[对照组NO及IL-18含量分别为(5.38±4.79)μmol/L和(2.39±1.41)ng/L,重度HIE组分别为(24.86±9.43)μmol/L和(13.43±3.23)ng/L,P均<0.01].方法 NO和IL-18参与HIE的整个发病过程,血清NO及IL-18含量与病情的严重程度有关,可以作为HIE病情变化的监测指标.     

护理干预对新生儿缺血缺氧性脑病(HIE)临床效果的影响

目的 探讨护理干预对新生儿缺血缺氧性脑病临床效果的影响.方法 选取2014年6月至2015年6月本院收治的缺血缺氧性脑病新生儿80例为研究对象,按照随机分组法分为对照组和观察组各40例.两组患儿分别接受临床常规的治疗,对照组患儿采用常规护理模式进行干预.观察组患儿在对照组的基础上采用综合护理模式进行干预,对比两组患儿护理前后的血清超氧物歧化酶(SOD)活性和血清丙二醛(MDA)水平,通过神经行为评定量表(NBNA)对两组患儿在出生7 d、16 d、30 d时的评分进行比较,比较两组患儿的并发症发生率.结果 护理前后两组患儿的SOD活性、MDA水平比较,差异均无统计学意义(均P>0.05),护理后观察组患儿的SOD活性、MDA水平明显优于对照组(P<0.05);两组患儿在第7天时的NBNA评分比较,差异无统计学意义(P>0.05),在第16天、第30天时,观察组患者的NBNA评分明显高于对照组(P<0.05),同时观察在第7天、第16天、第30天时的NBNA评分,差异有统计学意义(P<0.05);观察组患儿的颅内高压、低血糖、惊厥、呕吐等并发症发生率显著低于对照组(P<0.05).结论 对缺血缺氧性脑病新生儿采用综合护理模式进行干预能有效改善患儿的SOD活性和MDA水平,同时对神经功能的恢复也有很好的帮助,有利于患儿的预后,是一种高效的护理方法,值得临床推广应用.     

新生儿缺氧缺血性脑病血清神经元特异性烯醇化酶、髓鞘碱性蛋白的变化及临床意义

目的探讨血清神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)的水平变化在新生儿缺氧缺血性脑病(HIE)中的意义。方法 HIE组足月HIE患儿40例,轻度10例,中度16例,重度14例,对照组为正常足月新生儿10例。分别在1、3 d(急性期),7～10 d(恢复期)采血,用放射免疫法测定NSE,用ELISA法测定MBP,10例健康新生儿作为正常对照组。结果①HIE组在第1天和治疗后第3天,血清NSE水平均高于对照组(P0.05);在治疗7～10 d后,轻度HIE患儿NSE水平基本恢复正常,而中、重度HIE患儿仍保持较高水平。②重度组HIE患儿急性期MBP水平明显增高(P0.01)。对照组与轻、中度HIE组血清中MBP水平比较差异无统计学意义(P0.05),与重度组比较差异有统计学意义(P0.01)。结论血清NSE水平可作为早期诊断新生儿缺氧缺血性脑病的客观指标,血清MBP检测可作为判断HIE脑损伤程度的参考指标。     

新生儿缺氧缺血性脑病NO、GSH—PX和TNF的含量测定及其临床意义

目的探讨新生儿缺氧缺血性脑病(HIE)血浆和脑脊液(CSF)中的一氧化氮(NO)和谷胱甘肽过氧化物酶(GSH-PX)和肿瘤坏死因子(TNF)含量变化及其与HIE不同时期和不同程度间的相关关系.方法对HIE患儿第3天的CSF和出生初入院(HIE2h内)、第1天、第2天、恢复期的血浆中NO、SOD进行检测,并与正常对照组比较;分析NO、GSH-PX、TNF的变化原因和意义.结果HIE患儿血浆中第1天的NO含量最高,而GSH-PX相反;初入院、第1天、第3天的血浆中NO、GSH-PX含量与正常对照组对比均有显著性差异(P＜0.01),而恢复期中NO、GSH-PX含量与正常对照组对比无显著性差异(P＞0.05),血浆和HIE第3天的CSF中NO和GSH-PX水平均呈负相关;病情越重NO浓度越高,GSH-PX越低.急性期血浆TNF显著高于对照组(P＜0.01),恢复期两组无显著性差异(P＞0.05).结论NO、GSH-PX和TNF参与HIE的发病过程,在HIE的发病过程中起着重要作用;检测血浆和CSF中NO、GSH-PX、TNF含量有助于判断HIE患儿病变程度和病情进展.     

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.