一种新的稳定多囊卵巢综合征大鼠模型的建立

目的：建立适合运动疗法研究的多囊卵巢综合征（PCOS）大鼠模型．观察模型建立过程中激素水平及卵巢形态的变化规律。方法：实验组（n=25）以丙酸睾酮皮下注射2113龄Wistar雌性大鼠，对照组（n=25）同期皮下注射相同容积茶油，分别在注射第7天、14天、21天、28天观察大鼠肥胖指数、卵巢器官指数、空腹血糖、空腹胰岛素、性激素水平以及卵巢的形态学变化。结果：实验组大鼠在完成28天注射后表现出肥胖、雌激素升高、孕酮下降、空腹胰岛素水平显著升高、空腹血糖，空腹胰岛素显著降低等典型PCOS的激素变化特征。卵巢形态呈现显著的颗粒层细胞减少,膜层增多,窦前卵泡大量聚集．闭锁卵泡增多等多囊卵巢特点。各时间点观察可见雌二醇水平第7天即发生显著改变，血糖水平在各时间点均未有显著改变．而胰岛素水平在各时间点没有显著变化直至第28天实验组显著升高。卵巢形态的变化早期表现膜层增厚和颗粒层减少，第21天闭锁卵泡显著增多，第28天出现窦前卵泡大量聚集。结论：连续28天丙酸睾酮注射诱导的PCOS大鼠模型具有高胰岛素血症、性激素异常的内分泌特征和卵巢多囊改变的形态学特点．并且激素和形态变化符合生理规律具有相当的稳定性，适合运动干预的研究。     

二甲双胍联合罗格列酮治疗多囊卵巢综合征40例疗效观察

【目的】探讨二甲双胍联合罗格列酮治疗多囊卵巢综合征（PCOS）临床疗效。【方法】选择PCOS患者80例，随机分为二甲双呱联合罗格列酮治疗（治疗组）和单用二甲双呱治疗（对照组）两组，每组40例。疗程均6个月。检测并比较两组患者血清性激素水平、空腹血糖及胰岛素水平，观察卵巢的变化。【结果】治疗组治疗后促黄体生成素（LH）、睾酮（T）、空腹血糖、胰岛素、稳态模型胰岛素抵抗指数（HomaIR）、卵巢体积和卵泡数与治疗前及对照组治疗后比较均有显著性差异（P〈0．05）；治疗后两组促卵泡素（FSH）水平均有升高，但与治疗前比较无显著性差异（P〉0．05）；治疗组治疗前后HomaIR及卵巢改善显著高于对照组（P〈0．05）。【结论】两种药物联合使用治疗PCOS疗效可靠，值得临床推广。     

类胰岛素样生长因子-1和抑制素与多囊卵巢综合征相关性分析

目的 为探讨类胰岛素生长因子（IGF-1）和抑制素（INH）在多囊卵巢综合征（PCOS）发病中的作用。方法 检测30例PCOS患者血清类胰岛素生长因子-1（IGF-1）、空腹胰岛素（IN）。抑制素（INH），瘦素（Leptin），黄体生成素（Ln）、卵泡刺激素（FSH）、人体催乳素（PRL）、雌二醇（E2）和睾酮（T）。并取20例排卵正常、无怀孕妇女进行对照。结果 PCOS组IGF-1、IN、INH、LEP、T、LH均高于正常对照组，并有显著性意义（P〈0．05）。且IGF-1与INH呈正相关（r=0．7194，P〈0．01），INH与T也呈正相关（r=0．4343,P〈0．05）。FSH、PRL、E2随均低于正常对照组。结论 IGF-1和INH在多囊卵巢综合征（PCOS）中异常升高。     

多囊卵巢综合征患者内分泌及代谢特征临床分析

目的探讨多囊卵巢综合征（PCOS）患者内分泌及代谢特征的改变。方法对肥胖型PCOS（A组）32例、非肥胖型PCOS（B组）28例、正常对照（C组）26例行口服葡萄糖耐馈试验和胰岛素释放试验，并测定其血压、体重指数（BMI）、性激索、血脂，计算胰岛素敏感指数（ISI）。结果①与B、C组相比，A组收缩压、BMI、甘油三酯、低密度脂蛋白-胆固醇升高，高密度脂蛋白-胆固醇降低（P〈0．05或P〈0．01）；②与C组相比，A、B组行睾酮（T）升高；与B组相比，A组T升高更明照；与A、C组相比，B组LH、LH／FSH升高（P〈0．05或P〈0．01）；③与C组相比，A、B组空腹胰岛索升高、ISI降低；与B、C组相比，A组服糖后2h及3h胰岛素升高（P〈0．05或P〈0．01）。结论PCOS患者存在明显的内分泌及代谢紊乱。尤以肥胖型PCOS患者更严重，其远期并发症的防治应受到高度重视。     

炔雌醇环丙孕酮联合二甲双胍治疗多囊卵巢综合征并不孕疗效观察

目的观察炔雌醇环丙孕酮片联合二甲双胍治疗多囊卵巢综合征（polycystic ovary syndrome,PCOS）伴胰岛素抵抗不孕的治疗效果。方法102例PCOS伴胰岛素抵抗不孕患者随机分为2组,A组50例给予炔雌醇环丙孕酮片口服,B组52例给予炔雌醇环丙孕酮片和二甲双胍口服,治疗3个周期后2组均应用来曲唑促排卵,比较2组治疗前、后体质量指数、性激素水平、空腹血糖、空腹胰岛素、胰岛素抵抗指数及促排卵和妊娠结果。结果2组治疗前、后卵泡刺激素、泌乳素、雌二醇水平比较差异无统计学意义（P〉0．05）,促黄体素及睾酮较治疗前降低（P〈0．05）;B组治疗后体质量指数、空腹胰岛素及胰岛素抵抗指数低于治疗前及A组治疗后（P〈0．05）,B组周期排卵率、妊娠率均高于A组（P〈0．05）。结论PCOS伴胰岛素抵抗不孕患者应用炔雌醇环丙孕酮联合二甲双胍治疗可改善其内分泌,纠正糖代谢紊乱,提高妊娠率。     

肥胖型多囊卵巢综合征患者不同治疗方式对内分泌改善的比较

目的：探讨肥胖型多囊卵巢综合征（PCOS）患者不同治疗方式对内分泌的影响。方法：将78例肥胖型PCOS患者分为两组。第一组45例口服达应-35治疗6个月．第二组33例减轻体重治疗6个月：治疗前后测定体重指数（BMI）、血清生殖激素、口服糖耐量及胰岛素释放试验。结果：第一组治疗前后黄体生成素（LH）、雌二醇（E2）、睾酮（T）明显改善，差异有显著性（P〈0．01）；第二组治疗前后卵泡刺激素、LH、T、E2、BMI及糖耐量和胰岛素释放均有明显改善，差异有显著性（P〈0．05）。结论：对肥胖型PCOS患者，降低体重可明显改善其生殖内分泌状态．糖耐量及胰岛素释放也有明显改善，疗效较达应-35治疗明显     

抗苗勒管激素与多囊卵巢综合征的相关性研究

目的：探讨抗苗勒管激素与多囊卵巢综合征的相关性。方法：选取2011年3月至2011年9月聊城市东昌府区妇幼保健院生殖健康科门诊就诊的PCOS患者47例为PCOS组,健康女性40例作为对照组,分别行AMH、卵泡刺激素（FSH）、黄体生成素（LH）、总睾酮（T）测定。结果：PCOS组年龄与对照组无明显差异,体重、BMI均高于对照组（P〈0．05）,差异有统计学意义,T、LH、AMH明显升高（P〈0．05）,差异有统计学意义。结论：AMH通过对雄激素的调节作用及／或通过其它作用在PCOS的发病中起一定作用。     

胰岛素抵抗和非胰岛素抵抗多囊卵巢综合征患者的临床特征

目的 探讨多囊卵巢综合征（PCOS）胰岛素抵抗患者的临床特征。方法 选择临床诊断为PCOS，同时葡萄糖负荷60、120min血胰岛素≥160mU／L的患者33例为胰岛素抵抗组，选择胰岛素及糖负荷后60、120min血胰岛素正常的PCOS患者130例作为对照组。对比两组患者早卵泡期或闭经状态下各项性激素、体重指数、各个时点的血糖水平以及葡萄糖曲线下面积。结果 ①胰岛素抵抗组的睾酮和体重指数水平比对照组高（P〈0．05），而黄体生成素水平比对照组低（P〈0.05）；②糖负荷后各时点的血糖以及葡萄糖曲线下面积，胰岛素抵抗组均高于对照组（P〈0.05）。结论 两组PCOS患者性激素有不同改变，胰岛素抵抗者以睾酮升高为主，而非胰岛素抵抗患者则以黄体生成素升高为主要变化，肥胖可能是胰岛素抵抗的一个原因，胰岛素抵抗更容易出现糖耐量的异常。     

育龄期多囊卵巢综合征患者的糖代谢异常和胰岛素抵抗

目的探讨育龄期多囊卵巢综合征（PCOS）患者的糖代谢异常和胰岛素抵抗。方法选择育龄期PCOS患者168例,分为肥胖PCOS组78例和非肥胖PCOS组90例,正常对照组100例,对比临床表现及检测内分泌激素、空腹血糖、空腹胰岛素、服糖后2h血糖及2h胰岛素。结果育龄期PCOS患者的月经周期、多毛、痤疮、B超提示卵巢增大、卵巢多囊性改变、有不孕史与对照组比较,差异均有显著性（P〈0．05）,育龄期PCOS组的血清LH、T与对照组比较,差异有显著性（P〈0．05）。育龄期肥胖P-COS组的空腹血糖、服糖后2h血糖、空腹胰岛素、服糖后2h胰岛素与对照组比较,差异均有显著性（P〈0．05）。结论早期出现月经稀发、BMI升高的患者是否存在PCOS,值得重视。育龄期PCOS患者尤其肥胖型要高度重视糖代谢异常及胰岛素抵抗,以决定是否采取干预措施,避免出现远期并发症而对PCOS患者造成健康威胁。     

SCF在PCOS患者卵巢组织中的表达

目的：探讨干细胞生长因子（stemcellfactor,SCF）在多囊卵巢综合征（polycysticovarysyndrome,PCOS）发病中的可能作用。方法：本资料通过免疫组化染色检测SCF在正常卵巢和PCOS患者卵巢组织中的表达。结果：PCOS组SCF在窦前卵泡颗粒细胞的表达明显强于正常卵巢（P〈0．05）,在囊状卵泡颗粒细胞的表达明显弱于正常卵巢（P〈0．05）。结论：SCF与PCOS的卵巢多囊样变、持续无排卵密切相关。     

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.     

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.     

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.     

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.