血管回声跟踪技术评价甲状腺功能减退症临床型及亚临床型患者颈动脉弹性

目的 应用血管回声跟踪(ET)技术定量评价甲状腺功能减退症临床型(甲减)及亚临床型(亚甲减)患者颈动脉弹性的变化。 方法 选择甲减患者25例,亚甲减患者25例及25名健康者(对照组),用二维超声测量双侧颈总动脉内-中膜厚度(IMT),应用ET技术检测双侧颈总动脉的僵硬度指数(β)、血管压力-应变弹性系数(Ep)、动脉顺应性(AC)、增大指数(AI)及脉搏波传导速度(PWVβ)。 结果 与对照组比较,甲减患者β、Ep、PWVβ增高,亚甲减患者β及Ep增高,AI降低(P<0.05),余差异无统计学意义;甲减与亚甲减患者的IMT及ET参数比较差异均无统计学意义(P均>0.05)。IMT与β、Ep及PWVβ呈正相关(P<0.01),与AC、AI无相关性(P>0.05);年龄与IMT、β、Ep及PWVβ呈正相关(P<0.01),与AC呈负相关(P<0.01),与AI无相关性(P>0.05)。 结论 颈动脉弹性的降低与甲状腺功能的减退及年龄增长有关,且其弹性下降先于颈动脉形态学改变。ET技术可以快速、无创地评价甲状腺功能减退症患者颈动脉弹性。     

血管回声跟踪技术评价颈动脉内中膜正常脑梗死患者的颈动脉弹性

目的 应用血管回声跟踪(ET)技术评价颈动脉内中膜厚度(IMT)正常的脑梗死患者颈动脉弹性功能的变化。方法 应用ET技术评价66例颈动脉IMT正常的脑梗死患者(A组)、111例伴有颈动脉斑块的脑梗死患者(B组)及83例正常人(C组)的颈动脉弹性参数,并进行对比分析。结果 与C组比较,A组颈动脉弹性参数β、Ep及PWVβ显著增高(P<0.01),B组β、Ep、AI、及PWVβ显著增高(P<0.01),AC减小(P<0.01);与B组比较,A组Ep和AI降低(P<0.05)。结论 ET技术可反映颈动脉IMT正常的脑梗死患者颈动脉弹性功能的降低。     

血管内-中膜自动跟踪及血管回声跟踪技术评价青年吸烟者颈动脉血管弹性

目的 探讨血管内-中膜(IMT)自动跟踪技术(IMT技术)和血管回声跟踪技术(ET技术)评价青年吸烟者颈动脉IMT应变和血管弹性功能的应用价值,并分析两者的相关性。方法 对30名主动吸烟者(吸烟组,年龄19~27岁)及27名非吸烟者(对照组,年龄21~24岁)应用ET技术检测两侧颈总动脉,测量血管收缩期最大内径(Ds)、舒张期最小内径(Dd)、僵硬度(β)、弹性系数(Eρ)、顺应性(AC)、膨大指数(AI)以及脉搏波传导速度(PWVβ)等指标。同时用IMT自动跟踪技术观察两组双侧颈总动脉收缩期及舒张期IMT,得出收缩期内-中膜厚度(IMT_收)、舒张期内-中膜厚度(IMT_舒),一个心动周期时间(t),并计算IMT应变率、时间应变、脉压差应变。结果 与对照组比较,吸烟组Dd－Ds、β、Eρ、AC、AI、PWVβ均无显著差异(P＞0.05);吸烟组IMT时间应变、脉压差应变低于对照组(P＜0.05),IMT应变率组间比较无统计学意义(P＞0.05);吸烟组IMT应变率、脉压差应变与AC成正相关。结论 采用IMT应变分析技术,通过观察时间应变、脉压差应变,能早期发现血管弹性功能改变。     

血管回声跟踪技术评价抗氧化剂干预吸烟对肱动脉弹性的影响

目的 应用血管回声跟踪(ET)技术探讨单剂口服维生素C(Vit C)拮抗吸烟对短期吸烟者肱动脉弹性的影响。方法 60名健康男性受试者,随机分为治疗组(吸烟+口服Vit C)和对照组(吸烟+口服安慰剂),每组各30名。应用ET技术检测治疗组和对照组吸烟前及吸烟后即刻、5 min、10 min、15 min血压、心率及肱动脉弹性指标,包括僵硬度(β)、压力应变弹性模量(Ep)及顺应性(AC)。结果 治疗组吸烟后即刻肱动脉β、Ep较吸烟前增高(P＜0.05),AC较吸烟前减低(P＜0.05),于吸烟后5 min时恢复至吸烟前水平(P＞0.05)。对照组吸烟后即刻、5 min、10 min肱动脉β、Ep较吸烟前增高(P＜0.05),AC较吸烟前减低(P＜0.05),于吸烟后15 min时恢复至吸烟前水平(P＞0.05)。治疗组吸烟后即刻、5 min、10 min肱动脉β、Ep较对照组减低(P＜0.05),于吸烟后即刻、5 min时AC较对照组升高(P＜0.05)。治疗组与对照组的收缩压、心率变化一致,两组间差异均无统计学意义(P均＞0.05)。结论 吸烟使健康男性受试者肱动脉产生短期血流动力学效应,表现为肱动脉弹性减低、血压增高、心率加快,吸烟前单剂口服Vit C能够在短时间内拮抗由吸烟引起的肱动脉弹性减低,但对血压及心率无明显干预作用。     

血管回声跟踪技术评价头颈部肿瘤患者放疗早期颈总动脉弹性

目的 探讨血管回声跟踪(ET)技术评价头颈部肿瘤患者放疗早期颈总动脉弹性功能的改变及意义。 方法 42例头颈部肿瘤放疗患者按照放疗进程分为3组:A组,放疗前1~3天;B组,放疗时间2.5~3.0周(照射剂量为26~30 Gy);C组,放疗时间5~6周(照射剂量为50~60 Gy)。比较3组颈总动脉超声测量数据:内-中膜厚度(IMT),阻力指数(RI),搏动指数(PI),收缩、舒张期比值(S/D),颈总动脉收缩末期内径(Ds)、舒张末期内径(Dd),僵硬度(β),弹性系数(Ep),脉搏波传导速度(PWVβ),顺应性(AC),增大指数(AI)。 结果 B组、C组与A组比较及C组与B组比较,β、Ep、PWVβ显著升高,AC显著降低,差异均有统计学意义(P均<0.05);AI、IMT、RI、PI、S/D、Ds和Dd测值在各组间差异均无统计学意义(P均>0.05)。 结论 头颈部肿瘤患者放射治疗早期即可发生动脉弹性功能改变,ET技术能够早期定量评价头颈部肿瘤放疗患者颈总动脉损伤。     

血管回声跟踪技术评估多囊卵巢综合征合并胰岛素抵抗患者早期颈动脉粥样硬化

目的 探讨血管回声跟踪（ET）技术评估多囊卵巢综合征合并胰岛素抵抗（PCOS-IR）患者早期颈动脉粥样硬化的应用价值。方法 收集90例PCOS-IR患者,根据颈动脉内中膜厚度（CIMT）分为PCOS-IR-A组（CIMT<0.10 cm,n=52）和PCOS-IR-B组（CIMT为0.10~0.15 cm,n=38）;另选取90名与其年龄相匹配的健康女性为对照组。采用ET技术测量颈总动脉僵硬度（β）、压力-应变弹性系数（Ep）、单点脉搏波传导速度（PWVβ）、增大指数（AI）和顺应性（AC）,比较3组间的差异。结果 PCOS-IR-A组、PCOS-IR-B组与对照组间β、Ep、PWVβ、AC总体差异均有统计学意义（P均<0.05）,AI差异无统计学意义（P=0.250）。PCOS-IR-B组β、Ep、PWVβ均高于、AC值低于对照组和PCOS-IR-A组,PCOS-IR-A组β、Ep、PWVβ均高于、AC值低于对照组,差异均有统计学意义（P均<0.05）。结论 ET技术能够定量评估颈动脉各弹性参数,及早发现PCOS-IR患者早期颈动脉粥样硬化等血管弹性功能异常,为临床及早干预提供重要依据。     

应用血管回声跟踪技术评价脑梗死患者颈动脉弹性

目的应用血管回声跟踪技术评价脑梗死患者颈动脉弹性的变化。方法应用血管回声跟踪技术检测135例脑梗死患者颈动脉弹性功能改变,并与70例正常人(对照Ⅰ组)及70例颈动脉有斑块形成的非脑梗死患者(对照Ⅱ组)相对照。结果脑梗死组β、Ep、AI及PWVβ较对照Ⅰ组升高,但AC较对照Ⅰ组降低,且差异有统计学意义;脑梗死组β、Ep、AI及PWVβ较对照Ⅱ组升高,AC较对照Ⅱ组稍降低,两组β、Ep及PWVβ差异有统计学意义,AC及AI差异无统计学意义。颈动脉弹性指标Ep、β、AI及PWVβ的RR值大于1,其中PWVβ的RR值最大。结论ET技术可较为敏感地反映出脑梗死患者颈动脉弹性的降低。     

孕妇颈动脉弹性变化的血管回声跟踪技术评价

目的应用血管回声跟踪技术(ET)评价孕妇颈动脉弹性的变化。方法将60例孕妇按年龄分成20~29岁组(即Ⅰ组)和30~39岁组(即Ⅱ组)。应用ET技术检测其双侧颈动脉的血管僵硬度(β)、弹性模量(Ep)、顺应性(AC)、膨大指数(AI)及脉搏波传导速度(PWVβ),并分别与国人正常值进行比较。结果和国人正常值比较,Ⅰ组的Ep、PWVβ、AI及Ⅱ组的AI、PWVβ差异有统计学意义(P<0.05);Ⅰ组的β、AC及Ⅱ组的β、Ep和AC差异无统计学意义。结论 (1)妊娠对颈动脉的AI、PWVβ有一定的影响,而对β、AC的影响不明显。(2)ET技术能敏感地评价孕妇颈动脉弹性的变化。     

血管回声跟踪技术对正常高值血压伴高脂血症患者颈动脉弹性的研究

目的：探讨血管回声跟踪（Echo tracking,ET）技术检测正常高值血压伴高脂血症患者颈总动脉弹性功能的变化及临床意义。方法：应用ET技术检测51例正常高值血压伴高脂血症患者（Ⅰ组）、62例正常高值血压患者（Ⅱ组）及50例正常人（Ⅲ组）双侧颈总动脉的弹性参数,即弹性系数（β）、僵硬度（Ep）、顺应性（AC）、增大指数（AI）、单点脉搏波传导速度（PWVβ）,并用常规血管超声测量颈动脉内中膜厚度（IMT）,进行对比分析。上述各组常规血管超声扫查未见明显异常。结果：各组左、右侧颈总动脉的各弹性指标比较均无统计学意义（P＞0.05）;Ⅰ组、Ⅱ组颈总动脉β较Ⅲ组明显增高,AC较Ⅲ组明显降低,Ⅰ组与Ⅱ组间的β、AC无明显差异;3组间颈总动脉的Ep、PWVβ比较均有统计学意义（P＜0.05）,AI、IMT比较均无统计学意义（P＞0.05）。结论：正常高值血压伴高脂血症患者颈总动脉弹性明显降低;应用ET技术优于常规超声,能更早的发现颈总动脉弹性改变,为临床及时预防心脑血管疾病的发生提供依据。     

血管回声跟踪技术评价慢性肾病1期患者颈总动脉弹性的初步研究

目的 应用血管回声跟踪技术评价慢性肾病(CKD)1期患者颈总动脉弹性.方法 收集47例CKD1期患者及66例正常对照人群,应用 血管回声跟踪(E Tracking)技术检测颈总动脉弹性参数,包括压力应变系数(Ep)、硬化参数(β)、顺应性(AC)、单点脉搏波传导速度(PWVβ)及增大指数(AI),并进行统计学分析.结果 CKD 1组β、Ep、AI及PWVβ值较正常对照组升高,AC值减低,差异有统计学意义(P＜0.05); IgA肾病β、Ep、AC及PWVβ值较膜性肾病升高,差异有统计学意义(P＜0.05),膜性肾病β、AC、PWVβ值较局灶性肾小球硬化升高,差异有统计学意义(P＜0.05).结论 CKD 1期患者颈总动脉弹性降低,E-Tracking技术能够定量测量颈总动脉弹性功能.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.