肝硬化难治性腹水结肠透析时间和插管深度的临床研究

[目的]研究结肠透析时间和插管深度对肝硬化难治性腹水治疗效果的影响。[方法]将100例肝硬化难治性腹水病人随机分成两组，每组50例。观察组结肠透析时间80min，插管深度55crn～60cm；对照组结肠透析时间40min，插管深度25cm～30cm。[结果]观察组结肠透析后中药灌肠保留时间、腹水消退、清除肌酐与尿素氮以及病人症状改善明显优于对照组（P〈0．01）。[结论]选择结肠透析时间80min、插管深度55cm～60cm对难治性腹水治疗效果好。     

结肠透析患者插管深度的临床对比研究

目的 研究结肠透析插管深度对慢性肾功能衰竭治疗效果的影响.方法 将80例慢性肾功能衰竭病人随机分为观察组和对照组,观察组灌肠管插入肛门深度为25～30 cm,对照组灌肠管插入肛门深度为10～15 cm.治疗2个疗程后观察病人的血肌酐(Scr)、尿素氮(BUN)、血色素水平变化情况.结果结肠透析2个疗程后观察组的各项指标较对照组有明显改善.结论 结肠透析插管深度对慢性肾功能衰竭治疗效果有明显影响,使血肌酐、尿素氮、血色素水平明显改善,明显延长了药液在结肠中的保留时间,而且使被动排便的次数比主动排便的次数增多.     

脐敷联合结肠透析治疗肝硬化难治性腹水的观察

目的：观察脐敷联合中药结肠透析两种不同给药护理方法对肝硬化难治性腹水疗效影响。方法：将50例患者随机分成两组，每组25例。实验组接受脐敷联合中药结肠透析改良护理方法，对照组接受常规护理方法。结果：实验组患者在腹水消退、症状改善和皮肤过敏、中约结肠透析后药物保留时间等方面均优于对照组，差异有显著性意义，P＜0.05。结论：通过改良脐敷联合结肠透析方法，确能提高肝硬化难治性腹水患者治疗效果。     

机器法结肠透析治疗慢性肾衰竭的护理研究

[目的]观察机器法结肠透析治疗慢性肾衰竭的护理研究。[方法]将80例慢性肾衰竭病人随机分为治疗组和对照组各40例,治疗组结肠透析前给予纯净水肠道润洗15min,对照组结肠透析前不行肠道润洗,两组均采用中药结肠透析液2号行机器法结肠透析治疗60min,每日1次,1个疗程2周,治疗2个疗程,观察治疗前后临床疗效。[结果]治疗组较治疗前及对照组治疗后血尿素氮(BUN)、血肌酐(Scr)变化差异有统计学意义(P<0.05);治疗组有效率92.5%,对照组为72.5%,两组比较差异有统计学意义(P<0.05)。[结论]机器法结肠透析前肠道润洗可显著提高慢性肾衰竭病人的临床疗效,延缓慢性肾衰竭的进展。     

机器法结肠透析治疗慢性肾衰竭的护理研究

[目的]观察机器法结肠透析治疗慢性肾衰竭的护理研究。[方法]将80例慢性肾衰竭病人随机分为治疗组和对照组各40例,治疗组结肠透析前给予纯净水肠道润洗15min,对照组结肠透析前不行肠道润洗,两组均采用中药结肠透析液2号行机器法结肠透析治疗60min,每日1次,1个疗程2周,治疗2个疗程,观察治疗前后临床疗效。[结果]治疗组较治疗前及对照组治疗后血尿素氮（BUN）、血肌酐（Scr）变化差异有统计学意义（P〈0.05）;治疗组有效率92.5%,对照组为72.5%,两组比较差异有统计学意义（P〈0.05）。[结论]机器法结肠透析前肠道润洗可显著提高慢性肾衰竭病人的临床疗效,延缓慢性肾衰竭的进展。     

结肠透析机治疗肝硬化难治性腹水的护理

肝硬化难治性腹水是指肝硬化晚期药物治疗后腹水消退不满意,或治疗性排放腹水后药物不能防止腹水的早期复发,腹水持续3个月以上者[1],约20%病人在1年内发生肝肾综合征(HRS)[2]。若不采取积极有效的治疗,病死率达100%。我科应用JS-308F型结肠透析加中药保留灌肠治疗肝硬化难治性腹水80例,取得了较好的效果,现报告如下。1资料与方法1.1一般资料所有病例均符合文献[3]的诊断标准:腹水量较大,持续3个月以上。对常规利尿治疗反应不佳,对钠耐受力差,血钠<130mmol/L,尿钠<10mmol/L,尿钠∶尿钾<1,肾小球滤过率低于正常。其中结肠透析治疗45例,男…     

难治性肝硬化腹水并发氮质血症患者结肠透析联合中药贴敷的疗效

目的探讨结肠透析联合改良中药贴敷对肝硬化腹水并发氮质血症患者治疗效果的影响。方法将50例肝硬化腹水并发氮质血症患者随机分成两组,每组25例。两组患者除基础治疗外,观察组给予结肠透析治疗机肠道灌洗和改良中药贴敷(以蜜糖和丁香油为基质调制);而对照组采用普通肠道灌洗及传统的中药贴敷(温开水调制)。结果观察组患者结肠灌洗后中药保留时间长于对照组,局部皮肤过敏反应的发生率低于对照组;治疗后腹水消退的效果及肌酐、尿素氮的清除率均优于对照组(P<0.05或0.01)。结论在肝硬化腹水并发氮质血症患者的治疗、护理中采用结肠透析联合改良的中药贴敷方法,具有良好的效果。     

依据病变部位进行药物灌肠治疗放射性直肠炎的效果观察

[目的]探讨分析对放射性直肠炎实施药物保留灌肠时,依据病变部位决定插管深度、灌肠及保留体位的效果观察。[方法]选取2015年5月—2016年12月收治的60例出血性放射性直肠炎的病人,按年龄、病程等指标分为观察组和对照组,观察组30例采取依据病变部位决定插管深度,灌肠体位采用截石位,保留体位采用俯卧位和半坐卧位交替的方法;对照组30例采用常规保留灌肠方法,并将导尿管插入15cm~20cm,两组病人灌肠之后药液均保留1h~8h。[结果]观察组治疗有效率为93.3%,治疗有效的28例病人症状消退时间为6.75d±1.92d,对照组治疗有效率为80.0%,治疗有效的24例病人症状消退的时间为8.96d±1.93d。两组治疗有效率、治疗有效消退时间的差异均有统计学意义(P0.05)。[结论]在放射性肠炎病人实施药物保留灌肠时,依据病变部位决定插管的深度、灌肠体位,采取俯卧位和半坐卧位交替保留药液,能使药液充分与创面接触,在创面停留时间更长,使药液更好地发挥作用。     

结肠透析与常规灌肠治疗肝性脑病的临床观察

[目的]探讨结肠透析与常规灌肠治疗肝性脑病的效果.[方法]60例肝性脑病病人随机分为两组,对照组28例,观察组32例,两组均给予基础的保肝、抗肝性脑病等综合治疗,对照组给予常规乳果糖灌肠液保留灌肠,观察组采用在结肠灌洗透析后予乳果糖灌肠液保留灌肠.观察并比较两组治疗后平均清醒时间、治疗效果、治疗前后血氨值及灌肠液在肠腔内保留时间.[结果]观察组平均清醒时间短于对照组;观察组总有效率为96.87%,对照组总有效率为85.71%,观察组明显优于对照组(P<0.05);两组治疗后血氨值明显降低;观察组灌肠液在肠腔内保留时间延长.[结论]在综合治疗的基础上,结肠灌洗透析后给予乳果糖联合氧氟沙星保留灌肠治疗肝性脑病效果满意.     

难治性肝硬化腹水并发氮质血症患者结肠透析联合中药贴敷的疗效

目的探讨结肠透析联合改良中药贴敷对肝硬化腹水并发氮质血症患者治疗效果的影响。方法将50例肝硬化腹水并发氮质血症患者随机分成两组，每组25例。两组患者除基础治疗外，观察组给予结肠透析治疗机肠道灌洗和改良中药贴敷（以蜜糖和丁香油为基质调制）；而对照组采用普通肠道灌洗及传统的中药贴敷（温开水调制）。结果观察组患者结肠灌洗后中药保留时间长于对照组，局部皮肤过敏反应的发生率低于对照组；治疗后腹水消退的效果及肌酐、尿素氮的清除率均优于对照组（P〈0．05或0．01）。结论在肝硬化腹水并发氮质血症患者的治疗、护理中采用结肠透析联合改良的中药贴敷方法，具有良好的效果。     

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.     

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.     

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."