3项指标联合检测对心脑血管疾病的临床意义

目的探讨血清同型半胱氨酸(Hcy)、脂蛋白a[Lp(a)]和胱抑素C(Cys-C)对心脑血管疾病的临床意义。方法选择2013年12月至2014年12月重庆市人民医院心脑血管疾病患者147例为研究对象,其中冠心病患者65例为冠心病组,脑梗死患者47例为脑梗死组,心肌梗死患者35例为心肌梗死组。选取2014年12月至2015年12月健康体检者20例为健康对照组。分别检测各组标本血清中Hcy、Lp(a)、和Cys-C的水平,并比较各组间的阳性率。结果冠心病组、脑梗死组和心肌梗死组血清Hcy、Lp(a)、Cys-C水平均比健康对照组高,差异有统计学意义(P0.05)。单独检测时,冠心病组、脑梗死组和心肌梗死组血清Hcy、Lp(a)阳性率均高于健康对照组,差异有统计学意义(P0.05);冠心病组和心肌梗死组中Cys-C阳性率均高于健康对照组,差异有统计学意义(P0.05);在3个疾病组中,Hcy、Lp(a)、Cys-C联合检测的阳性率皆比单项检测时高,差异有统计学意义(P0.05);通过绘制受试者特征曲线(ROC曲线)进行分析,Hcy、Lp(a)、Cys-C联合检测的曲线下面积(AUC)比单项检测时高,差异有统计学意义(P0.05),说明Hcy、Lp(a)、Cys-C联合检测可提高3组疾病诊断的准确性。结论血清Hcy、Lp(a)和CysC皆可作为预测心脑血管疾病的风险指标,临床上可将此3项指标联合检测作为筛查心血管疾病的方法。     

脑梗死患者血清同型半胱氨酸和高敏C反应蛋白水平分析

目的：观察脑梗死患者血清同型半胱氨酸（Hcy）和高敏C反应蛋白（hs-CRP）水平的变化，探讨两者与脑梗死严重程度的关系。方法：测定74例脑梗死患者和70例健康对照者的血清Hcy、hs-CRP含量，并分析其与脑梗死患者临床神经功能缺损程度评分的相关性。结果：脑梗死患者血清Hcy、hs-CRP水平明显高于健康对照组（P〈0．01）。脑梗死不同临床分型组间血清Hcy、hs-CRP水平两两比较，Hcy差异无统计学意义（P〉0．05），hs-CRP差异有统计学意义（P〈0．01）。脑梗死患者血清hs-CRP含量与临床神经功能缺损程度评分呈显著正相关（r=0．631，P〈0．05）。结论血清Hcy、hs-CRP水平增高与脑梗死的发生有密切关系，hs-CRP能反映脑梗死的病变程度。     

Hcy、hs-CRP联合检测在冠心病、急性脑梗死患者中的临床应用价值

目的探讨血清同型半胱氨酸（Hcy）、超敏C反应蛋白（hs-CRP）联合检测在冠心病和急性脑梗死患者中的临床应用价值。方法冠心病患者150例,其中急性心肌梗死（AMI）组42例,不稳定型心绞痛（UAP）组51例,稳定型心绞痛（SAP）组57例;急性脑梗死组67例;健康对照组50例。hs-CRP采用乳胶增强免疫比浊定量法,Hcy采用循环酶法检测。结果冠心病组和急性脑梗死组Hcy、hs-CRP检测水平明显高于对照组（P〈0.05）;冠心病组各亚组间,SAP组与UAP组hs-CRP检测水平比较,差异无统计学意义（P〉0.05）,SAP组与UAP组Hcy检测水平比较,差异有统计学意义（P〈0.05）,AMI组与SAP组、UAP组Hcy、hs-CRP检测水平比较,差异有统计学意义（P〈0.05）。各组Hcy、hs-CRP的阳性率及两项联合检测的阳性率比较,二项联合检测的阳性率明显高于单项检测（P〈0.05）。结论 Hcy、hs-CRP水平与冠心病、急性脑梗死病情密切相关,二者联合检测有助于判断冠心病、急性脑梗死病变程度。     

2型糖尿病并发心血管病变患者C反应蛋白、脂蛋白a及B-型尿钠肽的检测分析

目的：分析血清超敏 C 反应蛋白（hs-CRP）、脂蛋白 a[Lp（a）]及血浆 B-型尿钠肽（BNP）水平在2型糖尿病（T2DM）患者并发心血管病变的指标变化及临床意义。方法收集84例2型糖尿病患者，分为单纯2型糖尿病组48例，2型糖尿病合并心血管病组36例；同时选择140例健康体检者作为对照组。透射比浊法检测 hs-CRP，胶乳比浊法检测 Lp（a）及化学免疫发光法定量检测 BNP。结果2型糖尿病合并心血管病组 BNP 、Lp（a）及 hs-CRP 的检测结果与健康对照组和单纯2型糖尿病组相比较，均有明显升高，差异均有统计学意义（P ＜0．05）；单纯糖尿病组 BNP 和 hs-CRP 的检测结果与健康对照组相比较明显升高，差异均有统计学意义（P ＜0．05），而 Lp（a）在两组间差异无统计学意义（P ＞0．05）。2型糖尿病合并心血管病组血浆 BNP 与 Lp（a）、hs-CRP 进行相关性分析，结果表明 BNP 与血清 hs-CRP 呈显著正相关（P ＜0．05），而与 Lp（a）无明显相关性；hs-CRP 与 Lp（a）亦无明显相关性。结论血清 Lp（a）、HS-CRP 、及血浆 BNP 可作为2型糖尿病并发心血管病变临床检测的良好指标。     

106例心脑血管患者血清同型半胱氨酸测定结果分析

目的探讨心脑血管患者血清同型半胱氨酸（Hcy ）水平与血脂含量变化间的关系。方法采集所有参与本试验对象的晨起空腹静脉血3 mL ,1 h内离心分离血清,采用酶法测定血清 Hcy、总胆固醇（TC）、三酰甘油（TG）。结果冠心病、脑梗死患者的血清Hcy水平明显高于健康对照组,心脑血管患者高Hcy血症的血清Hcy水平明显高于健康对照组,差异均有统计学意义（P＜0．05）。结论高 Hcy血症是心脑血管疾病患者的独立致病危险因素。     

超敏 CRP、同型半胱氨酸的联合检测对2型糖尿病肾病早期诊断的意义

目的：探讨超敏 C-反应蛋白（hs-CRP）、同型半胱氨酸（Hcy）和血脂水平在2型糖尿病（T2DM）、糖尿病肾病（DN）中的诊断意义。方法根据尿微量清蛋白排泄率（UAER）将61例 T2DM 患者分为单纯糖尿病组（SDM 组）、糖尿病肾病组（DN组）,30例健康者作为对照组,分别测定各组血清 Hcy 和血脂的水平并与对照组比较。结果 DN 组血清 hs-CRP、Hcy、血脂水平与 SDM 组均显著高于对照组,差异有统计学意义（P ＜0．05）。Hcy、Lp（a）和 hs-CRP 分别与 UAER 呈正相关（r 分别为0．551、0．432、0．594,P ＜0．01）。结论 hs-CRP 和 Hcy 随着 UAER 的增加而明显升高,可体现病情的加重,可作为糖尿病（DM）及 DN患者病情监测指标。     

高同型半胱氨酸血症和青年冠心病患者机关性分析

目的：探讨高同型半胱氨酸（Hcy）在青年冠心病患者中的意义。方法按照世界卫生组织对青年人的定义,选取16～44岁人群作为研究对象。根据选择性冠状动脉造影结果,冠心病组56例为试验组,同期门诊体检的健康人群组58例,为正常对照组,比较相关危险因素。结果在冠心病组与正常对照组之间,男性,吸烟史及甘油三酯（ TG）水平均有显著性差异;冠心病组的Hcy水平明显高于正常组（ P＜0．05）;冠心病组的血清高敏C－反应蛋白（ hs－CRP）与对照组比较差异有统计学意义（P＜0．05）;高血压组的脂蛋白Lp（a）明显高于正常对照组（P＜0．05）。结论高同型半胱氨酸血症（ HHCY）是青年冠心病患者的危险因素。     

Hcy、hs-CRP联合检测在冠心病和急性脑梗死患者中的预测价值

目的探讨同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)联合检测在冠心病和急性脑梗死患者中的预测价值。方法选取冠心病患者150例,其中稳定型心绞痛组52例,不稳定型心绞痛组46例,急性心肌梗死组52例,同时选取急性脑梗死组70例,健康对照组70例。采用循环酶法测定血清Hcy含量,采用免疫比浊法测定血清hs-CRP含量。结果冠心病组和急性脑梗死组Hcy、hs-CRP检测水平均明显高于对照组,差异有统计学意义(P0.05);冠心病组各亚组间比较,Hcy、hs-CRP含量均为AMI组UAP组SAP组,Hcy、hs-CRP含量UAP组与SAP组比较差异均有统计学意义(P0.05);Hcy、hs-CRP含量AMI组与UAP组比较差异均有统计学意义(P0.05)。各组Hcy、hs-CRP阳性率与两项联合检测阳性率比较,两项联合检测阳性率均明显高于单独检测,差异有统计学意义(P0.05)。结论 Hcy、hs-CRP水平与冠心病、急性脑梗死有密切关系,二者联合检测有助于提高冠心病HE急性脑梗死诊断的准确性,可为疾病的预后评估提供更有力的判断依据。     

超敏 C-反应蛋白与不同类型冠心病的相关性研究

目的：探讨超敏 C-反应蛋白（hs-CRP）与不同类型冠心病的相关性。方法选取2009年2月至2012年2月收治的134例冠心病患者,根据患者的冠心病分类,将其分成3个组,其中稳定型心绞痛组患者46例,不稳定型心绞痛组患者52例,急性心肌梗死组患者36例。同时选取100例健康人作为对照组,分别测定并比较三组冠心病患者以及对照组健康人群血清的 hs-CRP 水平。结果稳定型心绞痛组患者 hs-CRP 水平为（5．4±3．1）mg/L;不稳定型心绞痛组患者 hs-CRP 水平为（8．6±4．2）mg/L;急性心肌梗死组患者 hs-CRP 水平为（21．8±10．3）mg/L。三种类型冠心病患者的血清 hs-CRP 水平均高于对照组,差异均有统计学意义（P ＜0．05）;急性心肌梗死组患者的血清 hs-CRP 水平高于不稳定型心绞痛组患者,且两者明显高于稳定型心绞痛组患者,差异均有统计学意义（P ＜0．05）。结论血清 hs-CRP 与冠心病的发生、发展关系密切,对患者血清 hs-CRP 的检测有助于冠心病的早期诊断和预后判断,为临床医生提供依据。     

脑梗死患者的血细胞和相关生化指标检测结果研究

目的：分析脑梗死患者血液中血细胞、超敏C-反应蛋白（hs-CRP）、血浆氨基末端B型钠尿肽原（NT-proBNP）参数变化。方法选取95例脑梗死患者作为试验组，又将其分为慢性脑梗死组（A组），急性脑梗死组（B组），120例健康体检者作为健康对照组，采用相关仪器进行检测并对比分析。结果试验组白细胞计数（WBC ）、中性粒细胞百分率（Neu％）、平均血小板体积（MPV）、hs-CRP、NT-proBNP高于健康对照组，差异有统计学意义（P＜0．05）；两组血小板计数（PLT ）差异无统计学意义（t＝0．167，P＞0．05）。A组WBC、Neu％与健康对照组比较差异无统计学意义（P＞0．05），B组高于A组和健康对照组；B组MPV、hs-CRP、NT-proBNP高于A组和健康对照组， A组又高于健康对照组，差异均有统计学意义（ P＜0．05或0．01），A组PL T高于B组和健康对照组，差异有统计学意义（P＜0．01）；B组WBC、Neu％、MPV、hs-CRP、NT-proBNP指标异常率高于A组，差异有统计学意义（P＜0．05或0．01）。结论脑梗死患者血液中血细胞、hs-CRP、NT-proBNP均有不同程度升高，疾病诊断时可作为参考指标。     

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.     

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.     

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.