绝经后骨质疏松症患者危险因素的相关性分析

目的探讨绝经后骨质疏松症患者L2-4骨密度值降低的危险因素的相关性及其程度。方法对已确诊为绝经后骨质疏松症的92例患者进行危险因素的回顾性问卷调查,以L2-4骨密度值为因变量,各危险因素为自变量,建立多元逐步回归模型,进行相关性分析。结果绝经后妇女年龄越大、绝经越早、绝经年限越长、体重指数越小,骨密度越低。结论绝经年限、牛奶摄人史、绝经年龄、初潮年龄、骨折史及弯背对绝经后妇女的L2-4骨密度值有较大的影响,尤其是绝经年限的影响作用最大。普及骨质疏松症危险因素的防治常识,具有重要意义。     

南昌市社区中老年人群生活方式与骨密度测定现状调查及分析

目的了解南昌市社区40岁以上人群生活方式与骨密度测定情况,为社区骨密度异常的预防和干预措施提供依据。方法应用超声骨密度检测仪测量南昌市社区10002名40岁以上人群的跟骨骨密度,骨密度分为骨量正常、骨量减少和骨质疏松。并对所有受试者进行问卷调查,问卷内容包括基本信息、一般情况、生活方式等,测量血压、身高、体质量、腰围、臀围。计算体重指数。分析吸烟、饮酒、牛奶、碳酸饮料、运动与骨密度间的关系。结果骨质疏松患病率男为6．8％,女为10．4％;骨量减少患病率男为43．8％,女为39．7％。各年龄组的男女受调查者间骨质情况分布比较差异均有统计学意义。牛奶和碳酸饮料摄人情况及运动情况对男性受调查者的骨质水平有影响。吸烟、碳酸饮料及牛奶的饮用情况和运动状况对女性受调查者的骨质水平有影响。结论女性、高龄、少运动、奶类摄入量低者的骨密度异常患病率高,吸烟、饮酒对骨密度异常的影响有待进一步研究。     

苏州市中老年女性骨质疏松症的患病状况及影响因素研究

目的 探究苏州市部分地区中老年女性骨质疏松病的患病状况及影响因素。方法 采用超声骨密度检测仪检测2016年6月至2018年5月在苏州市立医院北区体检中心行健康体检的且在苏州市常住的中老年（40~69岁）女性300人的骨密度,计算骨质疏松症（osteoporosis,OP）的患病率。同时采用自制调查问卷和国际骨质疏松基金会测试题目筛查OP的影响因素。结果 300名研究对象的OP总发病率为39.00%。年龄、饮酒、吸烟、BIM、每周运动时间、每周饮奶量、产次及绝经状态在非OP和OP患者比较中有统计学意义（P＜0.05）。多因素分析表明,高龄、饮酒、吸烟、肥胖、多产次及绝经是影响OP发生的高危因素。结论 苏州市中老年女性骨质疏松症的患病率较高。骨质疏松症受多种因素的影响,控制产次、减少饮酒和吸烟、合理控制体重及增加运动次数和牛奶的摄入均可降低骨质疏松症的发生。     

北京崇文区中老年原发性骨质疏松症的发生及其影响因素：分层多阶段整群抽样调查

目的:了解北京市崇文区中老年人原发性骨质疏松症患病情况及其影响因素。方法:①调查对象:选择1998-06/09居住在北京市崇文区具有正式户口的常住男女人群,按照分层多阶段整群抽样方法抽取年龄在40～85岁中老年人为调查对象。②实验方法和评估指标:骨密度测量采用双能X线骨密度测定仪测量308名中老年人腰椎(L2～L4)前后位及股骨上端的骨股颈、三角区(Ward's)和大粗隆的骨密度;问卷调查分为一般情况、月经和生育史、药物应用史、饮食习惯和体格检查情况。结果:308名中老年人接受调查,其中男140名,女168名。年龄40～85岁,平均(60.80±10.12)岁。①各年龄段不同性别中老年人腰椎和股骨上端骨密度测量结果:大粗隆、骨股颈和三角区骨密度无论男女均随着年龄的增长有下降趋势。②各年龄段不同性别中老年人原发性骨质疏松症患病率情况:腰椎、大粗隆和三角区部位的患病率女性高于男性,股骨颈部位的患病率男性高于女性。男性以股骨颈原发性骨质疏松症检出率最高,女性以三角区检出率最高。原发性骨质疏松症患病率随着年龄的增加有增高的趋势。③Ward's三角区骨密度单因素分析:年龄、绝经后年限、生育次数与Ward's三角区骨密度呈负相关(P<0.05);居住环境采光条件、每周蛋类摄入量、身高和体质量与Ward's三角区骨密度呈正相关(P<0.05)。男性和女性、服用钙剂组和未服用钙剂组、服用避孕药物组和未服用避孕药物组、受背痛困扰组和未受背痛困扰之间差异有显著性(P<0.05)。④Ward's三角区骨密度多因素分析:年龄、体质量、绝经年限(女性)是引起骨密度降低的3个重要因素。结论:对于男性人群腰椎骨密度正常,但有明显骨质增生者应参考股骨上端骨密度方能作出正确评价。绝经后高龄妇女、低体质量的人群是原发性骨质疏松的高危人群。     

长沙地区女性促卵泡刺激素水平与骨密度和骨质疏松患病率的关系

目的:调查中国女性年龄相关的血清促卵泡刺激素浓度及其与骨密度和骨质疏松症患病率之间的关系.方法:于2007-06/2008-06选择自长沙和附近地区20～82岁699名健康的中国女性,排除患有影响骨代谢疾病、服用影响骨代谢药物的个体.其中绝经前妇女464名和绝经后妇女235名,绝经年龄为41～59岁.受试者均知情同意并签定了书面协议书.抽空腹静脉血测定血清卵泡刺激素和黄体生成素浓度.用DXA仪测定腰椎、总髋部、前臂超远端骨密度,评价血清促卵泡刺激素与年龄、骨密度和患骨质疏松症风险的关系.结果:促卵泡刺激素约从40岁起随增龄而增加,到60岁又随增龄而下降.促卵泡刺激素与不同部位骨骼的骨密度呈显著负相关.在腰椎、总髋部、前臂超远端,促卵泡刺激素四分位数的骨质疏松症平均患病率分别为0.57%,0.43%,27.1%,30.9%.与一分位数和二分位数比较,四分位数的妇女骨质疏松症患病率和患病风险显著增加;与三分位数比较,处于四分位数的妇女骨质疏松症患病率和患病风险也显著增加,特别是在腰椎.结论:血清促卵泡刺激素水平与骨密度的变化呈负相关,和骨质疏松症的发生呈正相关.     

社区中老年人骨质疏松症的患病危险因素调查

目的:分析社区中老年人骨质疏松症的患病危险因素。方法:于2003-10/11随机抽取广州市海珠区南石头街福南居委会中老年居民141人进行骨密度检查,用自制的骨质疏松症行为问卷进行基本情况和运动及钙营养摄入等相关行为调查。包括:是否每日饮用牛奶、吃豆制品和补充钙剂,以及运动量的大小。钙营养摄取具备上述一种行为或没有的为摄钙量低,具备两种以上行为者为摄钙量高。具备经常骑自行车、每周体育活动3次以上、家务劳动承担>50%或具备其中两项为运动量大,凡未达上述标准者为运动量小。采用双能X射线骨吸收仪检查腰2～4(L2～4)和股骨颈的骨密度,低于峰值骨量2SD为骨质疏松症。结果:①摄钙量低组腰椎骨质疏松症发生率高于摄钙量高组(66%比46%,χ2=5.497,P=0.019),运动量小组腰椎骨质疏松症发生率高于运动量大组(85%比25%,χ2=52.161,P=0.000),年龄大于60岁组腰椎骨质疏松症发生率高于小于60岁组(69%比48%,χ2=6.800,P=0.009)。②体质量指数小于23岁组股骨颈骨质疏松症发生率高于大于23岁组(31%比10%,χ2=9.104,P=0.003),女性绝经年限>10年组股骨颈骨质疏松症发生率高于小于<10年组(25%比9%,χ2=4.245,P=0.039)。结论:钙摄入低、少运动、高龄、绝经年限长和体质量指数低是社区中老年人骨质疏松症患病危险因     

女性原发性骨质疏松症患者年龄、绝经年限与不同部位骨密度的关系

目的:探讨女性原发性骨质疏松症患者的年龄、绝经年限与不同部位骨密度的关系。方法:对100例女性原发性骨质疏松症患者腰椎及髋部进行骨密度测定,并对患者年龄、绝经年限、骨密度的关系进行统计分析。结果:随着患者年龄及绝经年限的增长,髋部骨密度逐渐降低,年龄及绝经年限与髋部骨密度呈显著负相关。腰椎骨密度进行组间比较及相关性分析中,没有统计学意义。结论:绝经年限可以作为骨质疏松症重要的危险因素,髋部(特别是Ward三角)DEXA是骨密度测量的首选部位。     

不同中医证型及维生素D受体基因BsmⅠ多态性与绝经后骨质疏松症患者骨密度的关系

目的:观察维生素D受体基因BsmⅠ多态性及中医证型与绝经后骨质疏松症患者骨密度的相关性,分析影响骨密度的自身因素。方法:①选择2003-01/2004-04福建省中医药研究院骨科门诊绝经后骨质疏松症患者180例,年龄45～70岁,绝经年龄40～58岁。均对检测项目知情同意。肾阴虚118例、肾阳虚42例、肾阴阳两虚20例。②用美国Hologic(4500W)型双能X线骨密度仪检测正位第2～4腰椎、左侧股骨颈、大转子和Ward’s区骨密度。③记录患者自身因素:年龄、绝经年龄、绝经年限、身高、体质量和体质量指数。④应用聚合酶链反应检测维生素D受体基因BsmⅠ多态性。⑤计量资料两组比较正态分布用t检验,非正态分布用Wilcoxon秩和检验,用Bivariate分析患者自身因素与骨密度的相关关系。结果:纳入绝经后骨质疏松症者180例,均进入结果分析。①不同维生素D受体基因型与不同中医证型骨质疏松症患者骨密度比较,3种维生素D受体基因型骨质疏松症患者骨密度差异不明显(P>0.05);3种中医证型骨质疏松症患者骨密度差异也不明显(P>0.05)。②在维生素D受体基因bb型中,肾阴阳两虚患者第2～4腰椎骨密度明显低于肾阴虚型(P<0.05),其他证型间差异不明显(P>0.05)。③在肾阴虚型骨质疏松症患者中,bb型与Bb型骨密度相近(P>0.05)。④在相关性因素中,年龄和绝经年限与4个部位的骨密度呈显著负相关(r=-0.206～-0.441,P<0.05～0.01);身高与腰椎、股骨颈、大转子的骨密度呈显著正相关(r=0.171～0.222,P<0.05～0.01);体质量与股骨颈呈显著正相关(r=0.188,P<0.05);绝经年龄、体质量指数与骨密度无明显相关性(r=0.032～0.158,P>0.05);年龄与腰椎、股骨颈骨密度均呈显著负相关(r=-0.345,-0.427,P<0.05),而绝经年龄、绝经年限、身高、体质量、体质量指数与骨密度无明显相关性(r=-0.018～-0.246,P>0.05)。结论:①维生素D受体基因BsmⅠ多态性及中医证型分类与绝经后骨质疏松症骨密度存在相关性。②年龄、绝经年限、身高、体质量是影响维生素D受体基因bb型患者骨密度的因素。年龄是影响维生素D受体基因Bb型患者骨密度的因素。     

社区中老年人骨质疏松症的患病危险因素调查

目的：分析社区中老年人骨质疏松症的患病危险因素。方法：于2003-10／11随机抽取广州市海珠区南石头街福南居委会中老年居民141人进行骨密度检查，用自制的骨质疏松症行为问卷进行基本情况和运动及钙营养摄入等相关行为调查。包括：是否每日饮用牛奶、吃豆制品和补充钙剂，以及运动量的大小。钙营养摄取具备上述一种行为或没有的为摄钙量低，具备两种以上行为者为摄钙量高。具备经常骑自行车、每周体育活动3次以上、家务劳动承担&;gt;50％或具备其中两项为运动量大，凡未达上述标准者为运动量小。采用双能X射线骨吸收仪检查腰2—4(L2-4)和股骨颈的骨密度，低于峰值骨量2SD为骨质疏松症。结果：①摄钙量低组腰椎骨质疏松症发生率高于摄钙量高组(66％比46％，X^2=5．497，P=0．019)，运动量小组腰椎骨质疏松症发生率高于运动量大组(85％比25％，X^2=52．161，P=0．000)，年龄大于60岁组腰椎骨质疏松症发生率高于小于60岁组(69％比48％，X^2=6．800，P=0．009)。②体质量指数小于23岁组股骨颈骨质疏松症发生率高于大于23岁组(31％比10%，X^2=9．104，P=0．003)，女性绝经年限&;gt;10年组股骨颈骨质疏松症发生率高于小于&;lt;10年组(25%比9％，X^2=4．245，P=0．039)。结论：钙摄入低、少运动、高龄、绝经年限长和体质量指数低是社区中老年人骨质疏松症患病危险因素，其中钙的摄入、运动和体质量指数为可控因素。     

绝经后骨质疏松症发病相关危险因素分析及预防措施探讨

目的:探讨绝经后女性骨质疏松的患病情况与其发病相关危险因素,以及防治骨质疏松的策略。方法:采用了与骨质疏松相关的危险因素问卷调查表,对155例年龄50—79岁离退休绝经后女性采用双能X线骨密度测定仪(DXA)测定其骨密度(BMD),并对其进行统计学分析及二分变量Logistic逐步回归分析。结果:①各年龄段绝经后,女性骨密度随着年龄的增长均有下降趋势;②155例绝经后女性中,骨质疏松患者为66例(42.58%),50—79岁各组骨质疏松患病率分别为31.58%,41.79%,64.52%;③体重指数(OR=0.467,P=0.000),规律运动(OR=0.124,P=0.000),青少年时爱好运动(OR=0.246,P=0.012),生育个数(OR=2.416,P=0.000),绝经年限(OR=1.174,P=0.001)为骨质疏松的相关因素;④体重指数、规律运动、青少年时爱好活动与骨质疏松的发病呈负相关(P<0.05),而生育个数、绝经年限与骨质疏松的发病呈正相关(P<0.05)。结论:绝经后女性是否规律运动、青少年时是否爱好运动、体重指数、绝经年限及生育个数均是影响绝经后女性骨质疏松的发病风险。绝经后女性进行规律运动,防治低体重指数可阻止骨质疏松的发展。     

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.     

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.