系统性红斑狼疮患者血栓前状态指标的改变

目的研究系统性红斑狼疮患者血栓前状态。方法采用CA-7000凝血仪测定抗凝血酶-Ⅲ活性(AT-Ⅲ:C)、蛋白C活性(PC:A)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT);采用酶联免疫吸附测定(ELISA)法测定D-二聚体(D-dimer):采用SLT SPECTRA酶标仪以ELISA法测定纤维蛋白肽A(FPA)、凝血酶原片段1+2(F1+2)、抗凝血酶-Ⅲ抗原(AT-Ⅲ:Ag)、蛋白C抗原(PC:Ag)、组织纤溶酶原激活物活性(t-PA:A)、纤溶酶原活性(PLG:A)、纤溶酶原激活抑制物活性(PAI:A)。结果与对照组比较,系统性红斑狼疮患者凝血功能显著增强(P<0.01),抗凝血、纤溶系统功能由于消耗显著减低(P<0.01)。结论系统性红斑狼疮患者由于血管内皮细胞破坏导致其处于血栓前状态。     

慢血、晚血、慢性乙型肝炎和肝硬化病人凝血、抗凝血及纤溶功能的研究

目的探讨慢血、晚血、慢性乙型肝炎和肝硬化患者的凝血、抗凝血及纤溶功能。方法收集血防站诊治的慢性、晚期血吸虫病和南昌大学第一附属医院住院的慢性乙型肝炎和肝硬化患者各50例及同期健康体检者50例作为对照组,测定和分析血浆凝血功能(PT、APTT、TT、Fg)、抗凝血功能(AT-Ⅲ、PC、PS)及纤溶功能[纤溶酶原(PLG)、D-二聚体(D-D)]。结果1、与健康对照组相比:⑴慢血组凝血功能(PT、APTT、TT、Fg)差异无显著性,抗凝血功能(AT-Ⅲ、PC、PS)差异有显著性,纤溶产物D-D水平差异有显著性而PLG无统计学差异;⑵晚血组PT、TT、Fg差异有显著性而APTT差异无显著性,抗凝血功能(AT-Ⅲ、PC、PS)和纤溶功能(PLG、D-D)差异有显著性;⑶慢性乙型肝炎和肝硬化组凝血功能、抗凝血和纤溶功能差异均有显著性;2、慢血组与晚血组比较:PT、TT差异有显著性而APTT、Fg差异无显著性,AT-Ⅲ、PC差异有显著性而PS差异无显著性,D-D、PLG差异有显著性;3、慢血组和慢性乙型肝炎组比较:凝血功能和抗凝血功能差异非常显著,纤溶功能PLG差异非常显著而D-D差异无显著性;4、晚血组和肝硬化组比较:凝血功能除TT差异无显著性外PT、APTT、Fg差异有显著性,抗凝血功能和纤溶功能差异有显著性;5、慢性乙型肝炎和肝硬化比较:TT、Fg差异无显著性而PT、APTT差异有显著性,抗凝血功能和D-D差异有显著性,PLG差异无显著性。结论慢血、晚血、慢性乙型肝炎及肝硬化患者均存在一定程度的凝血、抗凝血和纤溶功能紊乱,且凝血、抗凝血及纤溶指标的检测有助于监测慢血、晚血、慢性乙型肝炎及肝硬化患者病情的出凝血功能。     

系统性红斑狼疮患者血栓前状态指标的改变

目的研究系统性红斑狼疮患者血栓前状态。方法采用CA-7000凝血仪测定抗凝血酶-Ⅲ活性（AT-Ⅲ：C）、蛋白C活性（PC：A）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）；采用酶联免疫吸附测定（ELISA）法测定D-二聚体（D-dimer）：采用SLT SPECTRA酶标仪以ELISA法测定纤维蛋白肽A（FPA）、凝血酶原片段1＋2（F1＋2）、抗凝血酶-Ⅲ抗原（AT-Ⅲ：Ag）、蛋白C抗原（PC：Ag）、组织纤溶酶原激活物活性（t—PA：A）、纤溶酶原活性（PLG：A）、纤溶酶原激活抑制物活性（PAI：A）。结果与对照组比较，系统性红斑狼疮患者凝血功能显著增强（P〈0．01），抗凝血、纤溶系统功能由于消耗显著减低（P〈0．01）。结论系统性红斑狼疮患者由于血管内皮细胞破坏导致其处于血栓前状态。     

肝硬化患者凝血抗凝及纤溶指标的变化及临床意义

目的探讨肝硬化患者凝血功能、抗凝及纤溶指标的改变及其对治疗和预后的指导作用。方法对正常人和肝硬化患者检测凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、纤维蛋白原（FIB）、凝血酶时间（TT）、抗凝血酶Ⅲ（ATⅢ）、蛋白C（PC）、纤溶酶原活性（PLG）、组织型纤溶酶原活化物（t—PA）、纤溶酶原激活物抑制剂（PAI）,用SPSS软件进行统计分析。结果肝硬化患者PT（P〈0．01）、APTT（P〈0．05）、TT（P〈0．01）、t-PA（P〈0．01）明显高于健康对照组,FIB（P〈0．05）、ATⅢ（P〈0．01）、PLG活性（P〈0．01）、PC（P〈0．01）、PAI（P〈0．01）明显低于健康对照组。结论肝硬化患者存在抗凝活性下降及易发纤溶,各指标可用于评价肝脏损伤程度,防止出血及判断预后。     

活化蛋白C抵抗对老年人慢性梗阻性肺病患者凝血、抗凝血、纤溶系统功能的影响

目的测定活化蛋白C抵抗(APCR)对老年慢性梗阻性肺病(COPD)患者凝血、抗凝血、纤溶系统功能的影响.方法采用ELISA法测定凝血酶原片段1+2(F1+2)、纤维蛋白肽A(FPA)、可溶性纤维蛋白单体复合物(SFMC)、抗凝血酶-Ⅲ抗原(AT-Ⅲ:Ag)、蛋白C抗原(PC:Ag);以发色底物法测定纤溶酶原激活抑制物活性(PAI)、组织纤溶酶原激活物(t-PA);采用CA-7000血液凝固仪测定活化蛋白C抵抗性、抗凝血酶-Ⅲ活性(AT-Ⅲ:A)、蛋白C活性(PC:A).结果与对照组比较,慢性梗阻性肺病患者组F1+2、FPA、SFMC水平均显著增高(P＜0.01),AT-Ⅲ及PC的活性和抗原水平显著降低(P＜0.01).t-PA水平显著降低(P＜0.01),,PAI水平显著增加(P＜0.01),提示凝血系统显著活化,抗凝血、纤溶系统功能明显减低.COPD患者组中,与APCR正常的患者比较,APCR阳性的患者F1+2、FPA、SFMC、PAI水平明显增高(P＜0.01),AT-Ⅲ及PC的活性和抗原水平显著降低(P＜0.01),t-PA水平明显减低(P＜0.01),提示APCR阳性的COPD患者的血栓前状态较APCR正常的COPD患者更为显著.结论活化蛋白C抵抗可造成慢性梗阻性肺病患者凝血系统功能显著增强,抗凝血、纤溶系统功能显著减弱,导致患者已经存在的血栓前状态进一步加重.     

凝血、纤溶与抗凝指标在慢性肝衰竭患者中的变化及相关性

目的探讨凝血、纤溶与抗凝指标在慢性肝衰竭患者中变化及相关性。方法选取该院2016年1月至2018年6月收治的慢性肝衰竭患者120例纳入观察组,并给予治疗。同期选择健康体检者120例纳入对照组。于观察组患者治疗前后,健康体检者体检时清晨空腹抽取静脉血3mL,分别检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)、蛋白C活性(PC∶A)、凝血酶原活动度(PTA)、凝血因子Ⅴ(FⅤ)、人凝血因子Ⅶ(FⅦ)、人凝血因子Ⅷ(FⅧ)、抗凝血酶Ⅲ(AT-Ⅲ)、血浆中纤溶酶原(PLG)水平,分析以上指标的相关性。结果治疗前观察组患者PT、APTT、FⅧ水平高于对照组(P0.05),PTA、FⅤ、FⅦ水平低于对照组(P0.05)。治疗后观察组患者PT、APTT、FⅧ水平低于治疗前(P0.05),PTA、FⅤ、FⅦ水平高于治疗前(P0.05)。治疗前观察组PC∶A水平低于对照组(P0.05),AT-Ⅲ水平高于对照组(P0.05)。治疗后观察组PC∶A水平较治疗前升高(P0.05),AT-Ⅲ水平较治疗前降低(P0.05)。治疗前观察组D-D水平高于对照组(P0.05),PLG水平低于对照组(P0.05)。治疗后观察组D-D水平低于治疗前,但高于对照组(P0.05);PLG水平高于治疗前,但低于对照组(P0.05)。FⅤ分别与PT、PTA、APTT、PLG、PC∶A具有显著相关性(P0.05),FⅦ分别与PTA、PT、APTT,PLG分别与AT-Ⅲ、FⅤ、FⅧ、PTA、PT、APTT具有显著相关性(P0.05)。结论慢性肝衰竭患者的凝血、纤溶与抗凝指标关系复杂,治疗前后检测这些指标能有效指导诊断,改善预后。     

急性心肌梗死患者溶栓治疗前后凝血与纤溶系统的变化

目的　探讨急性心肌梗死 (AMI)患者溶栓治疗前后不同时间段凝血与纤溶系统的变化情况。方法　对 4 1例经溶栓治疗的AMI患者分别于治疗前及治疗后 4、8、12、4 8h和 3、7d共 7次抽取静脉血 ,分别检测凝血酶原时间 (PT)、活化部分凝血活酶时间 (APTT)、纤维蛋白原 (Fg)、D 二聚体 (DD)、纤溶酶原 (PLG)、α2 纤溶酶抑制物 (α2 PI)、组织型纤溶酶原激活物 (t PA)和纤溶酶原激活物抑制剂 1(PAI 1)等指标的活性或含量。结果　所有患者经溶栓治疗后 ,均导致PT、APTT的明显延长 ,t PA活性、DD含量的明显增高 ,PLG、α2 PI、PAI 1活性和Fg含量的明显降低 (与溶栓前比较 ,P均 <0 .0 1)。但这种变化为时较短 ,至溶栓后 12h ,各项指标已出现不同程度的恢复 ,t PA与PAI 1已回复至溶栓前水平。结论　凝血与纤溶活性的变化与溶栓疗效关系密切 ,应用时监测PLG、α2 PI、t PA、PAI 1、Fg和DD等指标 ,对判断溶栓疗效有重要价值。     

妊娠高血压综合征患者凝血、抗凝及纤溶系统的变化及其临床意义

目的探讨妊娠高血压综合征(妊高征)患者凝血、抗凝、纤溶功能指标的改变及其临床意义。方法分别应用凝固法、发色底物法和免疫法检测85例妊高征患者、50例晚期妊娠者及50名正常非孕妇女血浆凝血酶原时间(PT)、活化的部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)、抗凝血酶Ⅲ(AT-Ⅲ)、纤溶酶原(PLG)、α2-抗纤溶酶(α2-AP)、D-二聚体(D-dimer)。所有测定均在SysmexCA-7000全自动血凝仪上完成。结果与对照组比较,晚孕组及妊高征各组PT、APTT、Fbg、AT-Ⅲ、PLG、α2-PI、D-dimer差异有统计学意义(P<0.05或P<0.01);与晚孕组比较,妊高征及各组PT、APTT、Fbg、AT-Ⅲ、PLG、α2-PI、D-dimer差异亦有统计学意义(P<0.05或P<0.01);且随病情加重差异有增高趋势。结论正常晚孕妇女处于高凝状态,而妊高征患者存在明显的高凝状态,且有血栓形成倾向。产前进行凝血与纤溶功能的检查对妊高征的监测和治疗有一定临床意义。     

同型半胱氨酸水平与脑梗死患者高凝状态的相关性研究

【目的】研究同型半胱氨酸（Hcy）血症与脑梗死患者高凝状态的关系。【方法】测定114例脑梗死患者Hcy、凝血酶原片段1＋2（F1＋2）、纤维蛋白肽A（FPA）;可溶性纤维蛋白单体复合物（SFMC）。抗凝血酶-Ⅲ抗原及活性（AT-Ⅲ：Ag,AT-Ⅲ：A）、蛋白C抗原及活性（PC：Ag,PC：A）、组织纤溶酶原激活物（t-PA：A）、纤溶酶原活性（PLG：A）、纤溶酶原激活抑制物活性（PAI：A）并与对照组比较分析。【结果】与对照组比较,脑梗死患者各项指标存在显著性改变（P〈0．01）,其水平均与Hcy水平显著相关。【结论】高水平Hcy与脑梗死患者凝血、抗凝血、纤溶系统的异常显著相关,对促进血栓形成具有重要影响。     

肿瘤患者凝血及纤溶状态的改变

目的 探讨恶性肿瘤患者凝血、抗凝及纤溶指标的变化及其临床意义。方法 用Culter ACL-200全自动血凝仪对35例正常对照,25例子宫肌瘤,98例恶性肿瘤(胃癌20例,结直肠癌21例,食道癌18例,肺癌19例,宫颈癌20例)的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)、凝血酶凝固时间(TT)、抗凝血酶Ⅲ(AT-Ⅲ)、纤溶酶原(PLG)及α2-纤溶抑制物(α2-PI)进行检测。结果 恶性肿瘤组PT、APTT、TT水平较正常对照组增高,但无显著性差异;Fbg含量增高,AT-Ⅲ活性降低,PLC及2-PI活性增高,有显著性差异(p<0.05或p<0.01);恶性肿瘤有转移组与无转移组比较Fbg舍量增加、TT缩短、AT-Ⅲ、PLG及α2-PI活性均有显著性改变(p<0.05或p<0.01)。子宫肌瘤的上述指标与正常对照组之间无统计学差异。结论 恶性肿瘤凝血功能增强,抗凝及纤溶活性降低,机体处于高凝状态,有血栓形成倾向;恶性肿瘤有转移组纤溶活性增高则有助于恶性肿瘤转移。     

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.