小儿血液净化中快速建立临时血管通路的方法

目的 探讨快速建立临时血管通路的方法，方法 对16例急诊血液净化小儿，46次应用股静脉套管针或颈内静脉双腔导管置管进行血液净化。结果 14例用套管针经皮股静脉和周围静脉直接穿刺置管建立血管通路，其中股静脉置管35次，股动脉置管1次，外周静脉置管8次，血流速度150－200ml/min。结论 股一胸脉套管针置管，既简单，快捷又经济，适合小儿急诊血液净化应用。     

小儿血液净化中快速建立临时血管通路的方法

目的探讨快速建立临时血管通路的方法.方法对16例急诊血液净化小儿,46次应用股静脉套管针或颈内静脉双腔导管置管进行血液净化.结果14例用套管针经皮股静脉和周围静脉直接穿刺置管建立血管通路,其中股静脉置管35次,股动脉置管1次,外周静脉置管8次.血流速度150～200ml/min.结论股静脉套管针置管,既简单、快捷又经济,适合小儿急诊血液净化应用.     

经皮股静脉置血管通路的护理

对于需要血液透析的患者，建立良好的血管通路是进行有效透析的保证。血管通路有临时性和永久性两类。常用的临时性血管通路有直接的动静脉穿刺、留置中心静脉插管、外瘘。经皮中心静脉插管是临床上常用的临时性血管通路，其中经皮颈内静脉插管是目前紧急透析中最常用、最安全的血液通路，而经皮股静脉置血管通路因为其存在的缺点而采用较少。从2001年1月至2004年6月，本科有9例患者经皮股静脉置血管通路行血液透析，对于通路的护理积累了一定的经验，现介绍如下：     

锁骨下静脉上位置管与颈内静脉置管在血液透析中比较

目的比较锁骨下静脉上位置管与颈内静脉置管建立临时性血液透析通路的优缺点.方法采用回顾性对照研究,98例急需血液透析患者先后采用锁骨下静脉上位置管68例,颈内静脉置管30例.观察两种插管途经的穿刺成功率、完成插管时间、导管留置时间、导管相关并发症、血流量及Kt/V值等.结果锁骨下静脉上位穿刺成功率94.1%,显著高于颈内静脉80.0%(P＜0.01),完成插管时间亦优于颈内静脉(P＜0.05);锁骨下静脉上位插管的留置时间明显长于颈内静脉插管(P＜0.05),锁骨下静脉上位置管的血流量不足、感染及导管堵塞发生率均低于颈内静脉置管(P＜0.05),两部位插管的Kt/V值无显著性差异(P＞0.05).结论相对而言,锁骨下静脉上位插管是一种更理想的临时性血液通路.     

深静脉置管行血液净化治疗临床病例分析

目的总结血液净化治疗患者留置临时性中心静脉导管的经验,探讨中心静脉留置导管在血液净化治疗中的应用以及中心静脉留置导管并发症的防治.方法2004年2月～2005年6月,中山大学附属第一医院肾内科行临时性单针双腔静脉导管留置术血液净化治疗病例223例,其中颈内静脉置管193例(右181例,左12例),右锁骨下静脉置管21例,股静脉置管9例(右8例,左1例).分析不同置管方法临床并发症的发生率及处理方法.结果置管术中的常见并发症有:误穿动脉8例(3.6%),皮下血肿10例(4.5%),穿刺部位渗血3例(1.3%).置管术常见远期并发症有:导管相关感染28例(12.6%),导管栓塞9例(4.0%),导管意外脱落5例(2.2%),血流量不足(血流＜180ml/min)21例(9.0%).带管时间3～155天.结论临时性中心静脉留置导管是建立血液净化治疗血管通路的一种方便快捷方法,操作技术简便,并发症低,并能提供稳定血流量,是建立血液净化治疗临时性血液通路的理想选择.     

股静脉与颈内静脉留置双腔导管在血液透析中的应用

目的 比较股静脉与颈内静脉插管建立临时性血液透析通路的优缺点。方法 采用回顾性对照研究,106例尿毒症患者先后共留置股静脉导管72根,颈内静脉导管59根。观察两种插管途径的导管留置时间、导管相关并发症、血流量及 Kt/V值等。结果 颈内静脉插管的导管留量时间为 38±15天,明显长于股静脉插管21±11天(P<0.01);血流量分别为260±35ml/分、215±61ml/分(P<0.05);颈内静脉插管的血流量不足、感染及导管堵塞发生率低于股静脉插管;而且前者Kt/V值高于后者(1.1±0.4,0.8±0.5,P<0.05)。结论 相对而言,颈内静脉插管是一种更理想的临时性血液通路。     

中心静脉置管在血液净化中的应用及护理

目的探讨中心静脉穿刺置管在血液净化中的应用效果及护理。方法收集我院2006—02—2007一09的173例血液净化患者，其中包括急性中毒后致肾功能衰竭、尿毒症、肿瘤晚期致肾功能衰竭及其他类原因致肾功能衰竭患者（分别为95、18、37、23例），分别采用不同途径中心静脉穿刺插管，其中股静脉115例，颈内静脉20例，锁骨下静脉7例次，半永久性颈内静脉2例。结果绝大多数病例血流量满意；留置导管时间平均（23．5±61）d，穿刺处感染率38％，导管堵塞率3．8％，导管周围渗血例数占50％；导管留置过渡到动、静脉内瘘成熟看32例。结论中心静脉置管作为短时间血管通路用以血液净化，是一种简便、安全、有效的手段，并且留置导管是永久性血管通路使用前的理想方法。     

血液净化血管通路选择及护理

目的 通过观察血液净化患者不同血管通路的效果，总结血管通路的护理体会。方法 对486例血液净化患者分别采取直接动静脉穿刺术、中心静脉置管术及内瘘穿刺术，观察患者的疼痛程度、并发症及一次穿刺成功率情况。结果 中心静脉置管术与直接动静脉穿刺比较，前者疼痛轻、并发症出现几率低，一次穿刺成功率高（P〈0．01）；临时性血管通路（包括直接动静脉穿刺和中心静脉置管）和永久性内瘘穿刺术比较，后者疼痛轻、并发症少、穿刺成功率高（P〈0．01）。结论 临时血液净化患者采取中心静脉置管术一次成功率高，并发症少，疼痛轻，而长期血液净化患者首选内瘘穿刺术。     

中心静脉留置导管血流不足的原因分析及护理对策

目的：总结血液净化治疗患者留置临时性中心静脉导管的经验。探讨中心静脉留置导管在血液净化治疗中血流量不足的防治与护理。方法：分析2004年2月至2005年6月，中山大学附属第一医院血遗中心行临时性单针双腔静脉导管留置术血液净化治疗病例223例（颈内静脉193例，右锁骨下静脉21例，股静脉9例）。总结选择不同穿刺点的优缺点．统计分析出现血流量不足的原因及处理方法。结果：16倒导管贴壁，9例血栓形成导致血流不足（血流〈150mL／min）；其中颈静脉置管者血流不足有19例。锁骨下静脉置管的有3侧。股静脉置管的有3例。三者结果比较差异有显著性（p〈0．05）。结论：导管贴壁及血栓形成是血流不足的主要原因；颈静脉置管较其他置管方法更能提供稳定的血流量．是建立临时性血液通路的理想选择。     

改良颈外静脉置管术在血液透析中的应用

近年来中心静脉留置导管建立临时性血液透析血管通路被广泛应用，插管的部位主要有：股静脉、颈内静脉、锁骨下静脉，其中尤以颈内静脉置管具有血流量佳、保留时间长的优点，而被多家大的血液透析中心推荐为首选。但颈内静脉置管对操作技术要求较高，并有可能发生血气胸、纵隔血肿等严重并发症而一定程度限制了使用范围。中南大学湘雅二院肾内科血液净化中心近两年来开展改良的颈外静脉置管术用于临床取得了较好效果，本研究主要是对颈外静脉置管术与颈内静脉置管术作一比较研究，为临床选择合适的血管通路提供参考。[第一段]     

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.     

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."     

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.