弥漫性轴索损伤病人的护理

弥漫性轴索损伤 (DAI) ,在脑损伤中发生率高 ,病死率高 ,占脑外伤死亡病人总数的 3 5 %。全部DAI病人中植物生存率为 15 % ,重残 14 % [1] 。为了降低病死率 ,提高病人的生存质量 ,现将 1999年 1月— 2 0 0 2年 1月我院收治的 5 5例DAI昏迷病人的护理体会总结如下。1　临床资料　　本组 5 5例 ,男 3 8例 ,女 17例 ,年龄 6岁～ 68岁 ,平均 40 .9岁。格拉斯哥 (GLS)计分均 <8分 ,其中评分为 3分～ 5分的特重型病人 3 2例。致伤原因 :车祸 44例 ,高处坠落 8例 ,打击伤 3例。 5 5例病人中有 17例因合并颅内血肿而行开颅手术 ,其他病人为保…     

弥漫性轴索损伤50例临床分析

弥漫性轴索损伤(diffuse axonal injury,DAI)是在特殊外力作用下,脑内发生的以神经轴索断裂为特征的一系列病理生理变化。意识障碍是其典型临床表现,诊断治疗困难,预后极差[1]。我院2002年1月至2005年3月共收治DAI 50例,现分析临床资料如下。1临床资料1·1一般资料本组50例,其中男43例,女7例;年龄8~65岁,平均35岁。受伤原因:交通事故伤37例,坠落伤8例,打击伤5例。合并伤:颅骨、颌面部骨折29例,四肢骨折13例,血气胸、腹腔脏器损伤各3例。1·2临床表现50例入院时均有严重意识障碍,昏迷时间6小时~69天。格拉斯哥(GCS)评分:3~5分24例,6~8分2…     

奥美拉唑治疗消化性溃疡并上消化道出血78例临床分析

目的:总结奥美拉唑治疗消化性溃疡并上消化道出血的临床疗效和安全性。方法:回顾性分析201 1年1月至2012年12月收治的经胃镜确诊的消化性溃疡并上消化道出血患者78例的临床资料。结果:本组78例中,止血的总有效率为93.6%(73/78),无效率为6.4%(5/78)无1例死亡;未发现严重不良反应。结论:奥美拉唑治疗消化性溃疡并上消化道出血的临床疗效确切,副作用小。     

双重灌注治疗中晚期肺癌34例分析

目的:探讨双重灌注(DAI)治疗中晚期肺癌的临床应用价值。方法:对34例中晚期非小细胞肺癌患者同时经支气管动脉和肺动脉行化疗药物灌注治疗,并进行临床疗效观察。结果:本组病例中,完全缓解2例,部分缓解26例,无效6例,有效率为70%。随访1 a存活率为97%,3 a存活率为47%,5 a存活率11%。结论:DAI是一种治疗中晚期肺癌有效介入治疗方法。     

重型颅脑损伤356例临床分析

我科自 1996年 1月～ 2 0 0 3年 12月共收治急性重型颅脑损伤 3 5 6例 ,其中手术 170例 ,疗效满意。1　临床资料1 1　一般资料 :男 2 68例 ,女 88例 ,年龄 3～ 81岁 ,平均42岁。1 2　临床资料 :车祸 164例 ( 5 1 7% ) ,跌伤 10 0例( 2 8 1% ) ,重物击伤 40例 ( 11 2 % ) ,其他     

弥漫性轴索损伤44例分析

目的 探讨脑弥漫性轴索损伤(DAI)的诊断标准、治疗及其预后.方法 回顾性分析2004年至2007年诊治的44例DAI患者的临床资料.结果 本组DAI患者中86.4%(38/44)为交通事故致伤,13.6%(6/44)为坠落伤;按格拉斯哥顸后评分(GOS)标准:良好4例,中残和重残12例,植物生存10例,死亡16例.2例好转后放弃继续治疗.结论 除目前的CT诊断标准外,基底池、四叠体池和环池结构不清并蛛网膜下腔出血也应成为DAI的影像学诊断标准之一;在康复期,高压氧治疗是一种有效的方法;患者的预后与入院时GCS评分、瞳孔改变、年龄及脑出血灶部位等有关,高血糖也是影响预后的重要因素之一.     

弥漫性轴索损伤44例分析

目的 探讨脑弥漫性轴索损伤(DAI)的诊断标准、治疗及其预后.方法 回顾性分析2004年至2007年诊治的44例DAI患者的临床资料.结果 本组DAI患者中86.4%(38/44)为交通事故致伤,13.6%(6/44)为坠落伤;按格拉斯哥顸后评分(GOS)标准:良好4例,中残和重残12例,植物生存10例,死亡16例.2例好转后放弃继续治疗.结论 除目前的CT诊断标准外,基底池、四叠体池和环池结构不清并蛛网膜下腔出血也应成为DAI的影像学诊断标准之一;在康复期,高压氧治疗是一种有效的方法;患者的预后与入院时GCS评分、瞳孔改变、年龄及脑出血灶部位等有关,高血糖也是影响预后的重要因素之一.     

雄性激素对促红细胞生成素疗效的影响

贫血是慢性肾功能不全患者常见的临床症状 ,通常采用注射促红细胞生成素 (以下简称促红素 )来治疗。为提高其治疗效果 ,我们于 1998年 1月～ 2 0 0 0年 8月对 5 4例慢性肾功能不全患者进行了雄性激素与促红素同用治疗肾性贫血的研究 ,以期提高促红素的疗效。1　资料与方法1.1　一般资料　 5 4例患者随机分为观察组和对照组。其中观察组 2 6例 ,男 18例 ,女 8例 ;平均年龄 39.2岁。 Hb(5 9.7± 5 .9) g/ L,红细胞压积 (Ht)为 (2 0 .7± 3.2 ) % ,BUN(2 8.7± 9.9) mmol/ L ,Cr (4 72 .1± 96 .2 )μmol/ L。对照组 2 8例 ,男 2 0例 ,女 8…     

亚低温治疗弥漫性轴索损伤32例临床分析

目的探讨亚低温下综合治疗弥漫性轴索损伤 ( DAI)的疗效。方法亚低温下综合治疗 DAI患者 32例与常温下综合治疗的同类患者 32例比较。结果亚低温治疗组恢复良好者 6例 ( 18.75 % ) ,死亡 10例 ( 31.2 5 % ) ;常温组分别为 2例 ( 6 .2 5 % )及 18例 ( 5 6 .2 5 % ) ,两组比较有显著性差异 ( P<0 .0 5 )。两组并发症无显著性差异 ( P>0 .0 5 )。结论 DAI早期采用亚低温下综合治疗可降低病死率 ,提高恢复良好率     

大剂量纳洛酮在治疗弥漫性轴索损伤中的应用

目的 :探讨大剂量纳洛酮治疗弥漫性轴索损伤 (DAI)患者的疗效。方法 :纳洛酮治疗DAI患者 45例与同等条件下但未用纳洛酮治疗的同类患者 45例比较。结果 :纳洛酮治疗组恢复良好 12例 (占 2 6 7% ) ,死亡 10例 (占 2 2 2 % ) ,觉醒天数为 ( 18 18± 9 2 1)d(n =31) ;对照组分别为 6例 (占 13 3% )及 18例 (占 40 0 % ) ,觉醒天数为 ( 2 6 0 6± 9 93)d(n =2 3)。两组比较差异均有显著意义 (P <0 0 5 )。结论 :DAI早期应用大剂量纳洛酮治疗可降低病死率 ,提高恢复良好率 ,缩短昏迷时间 ,治疗过程中未见毒副作用     

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.     

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.     

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.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."