中药联合1％联苯苄唑乳膏治疗手足癣临床观察

目的比较中药联合1％联苯苄唑乳膏及单用1％联苯苄唑乳膏治疗手足癣的疗效。方法将182例门诊确诊为手足癣的病人随机分成治疗组（92例）和对照组（90例）,治疗组用中药联合1％联苯苄唑乳膏,对照组单用1％联苯苄唑乳膏治疗。结果治疗组痊愈率91．30％,显效率97．83％;对照组痊愈率52．22％,显效率75．56％。结论两种方法均有效,治疗组疗效明显高于对照组（Х^2=35．566,P〈0．01）。     

地红霉素联用必伏治疗中重度痤疮疗效观察

我们自2005-1～2006-05采用地红霉素口服联用必伏（1％联苯苄唑凝胶）治疗中重度痤疮取得很好疗效，总结如下。     

1％联苯苄唑溶液治疗花斑癣、体股癣临床观察

目的：观察1％联苯苄唑溶液治疗花斑癣、体股癣的疗效和安全性。方法：临床试验观察50例病人（男33例，女17例，平均年龄39．7岁。花斑癣22例。体癣10例、股癣18例）。外用涂搽于皮损处每晚一次，7天为一个疗程，连续用药3个疗程。结果：总有效率为97。6％，痊愈率分别为花斑癣78％，体癣77％和股癣77％＇o结论：1％联苯苄唑溶液治疗花斑癣、体股癣的临床疗效确切，安全性好。     

复方联苯苄唑凝胶对豚鼠感染真菌病的疗效观察

我们采用自身对照随机化方法,观察复方联苯苄唑凝胶治疗豚鼠皮肤真菌病的疗效。总结如下。1对象和方法1.1对象复方联苯苄唑凝胶(含1%联苯苄唑、5%水杨酸、5%苯甲酸),吉林市卓怡康纳制药厂提供。对照药为达克宁乳膏(含2%硝酸咪康唑,批号061107094,西安杨森制药有限公司)和克霉唑乳膏(含1%克霉唑,批号41023894,新乡同心药业有限公司)。豚鼠(Dunk in-H artlry品系)30例,北华大学动物室提供。须癣菌(4935国际标准株),中国预防医学院菌种保存中心提供。1.2方法实验室温度27~32℃,相关湿度65%~75%,选择豚鼠30只,雌雄各半,体重(450±5)g,分三组在…     

联苯卞唑凝胶治疗小儿花斑癣52例分析

目的：观察联苯卞唑凝胶治疗小儿花斑癣疗效。方法：使用前清洗患处，由患儿家属取适量药物涂于患处，轻轻按摩，1次／d，连用4周，同时消毒患儿衣服毛巾。结果：52例治疗4周后痊愈43例，痊愈率82．6%,40；有效5例，有效率9.6%,40；好转4例；无效0例；总有效率（痊愈率＋有效率）92．2％。结论：联苯卞唑凝胶是治疗小儿花斑癣一种安全有效的药物。     

抗真菌联合治疗糠秕马拉色菌毛囊炎38例分析

目的：评价抗真菌药物联合治疗糠秕马拉色菌毛囊炎的临床效果。方法：伊曲康唑200mg／d，连服1周；2％酮康唑洗剂每日或隔日洗浴，1％联苯苄唑霜每日2次涂于患处。结果：临床总有效率为86．8％，1个月后总有效率94．7％。结论：联合应用抗真菌药物治疗糠秕马拉色菌毛囊炎可取得较好的临床效果。     

癣药2号与联苯苄唑乳膏配合治疗手足癣200例临床观察

目的 观察癣药2号对手足癣的疗效.方法 将200例手足癣患者随机分为两组.治疗组给予癣药2号与1%联苯苄唑乳膏配合治疗,对照组单用1%联苯苄唑乳膏治疗,两组用药2个疗程后,分别观察疗效.结果 癣药2号与1%联苯苄唑乳膏配合治疗手足癣治愈率90.0%,单用1%联苯苄唑乳膏治愈率67.0%(P＜0.05),两组间差异具有显著性.结论 癣药2号与1%联苯苄唑乳膏配合治疗手足癣,疗效确切,治愈率高.     

苄索氯胺法——一种新的脑脊液蛋白质检测方法

目的对苄索氯胺脑脊液蛋白质检测方法进行评价。方法用罗氏公司的苄索氯胺试剂，以比浊法进行脑脊液蛋白质测定，并观察了本法的精密度、灵敏度、检测范围等。结果苄索氯胺法的批内精密度为1．5％、2．3％，日间精密度为0．62％、0．72％；灵敏度为0．08g／L；检测范围可达1．9g／L。传统磺基水杨酸蛋白质测定法与之比较，回归方程为Y=0．854X＋0．097，r=0．985。结论本法简便、快速、准确且样本用量少，适合临床实验室推广应用。     

伊曲康唑胶囊联合联苯苄唑乳膏治疗足癣

目的 观察口服伊曲康唑胶囊联合外用联苯苄唑乳膏治疗足癣的疗效.方法 将180例足癣患者随机分为三组,治疗组60例,口服伊曲康唑胶囊1周,联合外用联苯苄唑乳膏2周;对照Ⅰ组62例,仅口服伊曲康唑胶囊1周;对照Ⅱ组58例,仅予联苯苄唑乳膏外用连用4周.结果 用药后8周治疗组有效率为88.33%,真菌清除率为85%;对照Ⅰ组有效率为75.81%,真菌清除率为77.42%;对照Ⅱ组有效率为68.96%,真菌清除率为53.45%,两对照组有效率与治疗组相比差异有统计学意义.结论 口服伊曲康唑联合外用联苯苄唑乳膏治疗足癣,在缩短疗程、减少费用、提高依从性和疗效、降低复发率等方面有明显优势.     

联苯苄唑治疗皮肤浅部真菌病152例疗效观察

联苯苄唑治疗皮肤浅部真菌病１５２例疗效观察江苏淮安市人民医院皮肤科陈可联苯苄唑（ｂｉｆｏｎａｚｏｌｅ）是一种新型高效、广谱抗真菌外用制剂，对皮肤真菌感染均有显著的抗菌作用。作者自１９９４年以来采用该药对１５２例皮肤浅部真菌病进行临床治疗观察，并取得了...     

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.