血管回声跟踪技术评价糖尿病患者颈动脉功能的临床研究

目的 应用血管回声跟踪技术检测糖尿病患者的颈动脉弹性特征。方法 糖尿病组57例，正常对照组39例。应用血管回声跟踪技术评估颈动脉硬化参数，包括压力应变弹性系数（Ep）、硬化参数（β）、顺应性（AC）、脉搏波传导速度（PWVβ）和增大指数（AI），并对上述参数进行统计学分析。结果糖尿病组颈动脉Ep，β、PWV8较正常对照组明显增高（P〈0．01），AC较正常对照组明显降低（P〈0．01），AI较正常对照组增高（P〈0．05）。结论 应用血管回声跟踪技术有助于评估糖尿病患者颈动脉弹性的功能改变。     

干预治疗对肥胖儿童颈动脉弹性指标的影响

【目的】探讨对肥胖儿童实施干预治疗后颈动脉弹性功能的变化。【方法】利用血管回声跟踪（Echo～Tracking，ET）技术检测肥胖儿童干预治疗前、后双侧颈动脉弹性系数（Eρ）、硬化度（β）、顺应性（AC）及内中膜厚度（IMT），比较干预治疗前及治疗6个月、1年后各指标的变化。【结果】与干预治疗前比较：治疗后6个月Eρ、β降低，有统计学差异（P〈0．05），AC增高，但差异无统计学意义（P〉0．05）；治疗后1年Eρ、β降低，AC增高，均有统计学差异（P〈0．05）。治疗1年与治疗6个月的组间比较：Eρ、β降低，AC增高，均有统计学差异（P〈0．05）。治疗前后IMT变化均无统计学意义（P〉0．05）。【结论】ET技术可早期、敏感、无创的评价肥胖儿童干预治疗效果，并可动态随访。     

应用新版E-Tracking技术对高血压患者颈动脉血管病变的研究

目的：应用新版血管壁回声跟踪技术（E-Tracking）评价高血压颈动脉血管病变。方法：分别对高血压患者56例（平均年龄55.5岁）和正常健康者52例（平均年龄54.7岁）采用高频线阵探头测量颈总动脉内中膜厚度（IMT），应用新版血管壁回声跟踪技术检测弹性系数（Eρ）、硬化参数（β）、顺应性（AC）、脉搏波传导速度（PWVβ）和增大指数（AI），并对高血压患者组上述参数进行相关性分析。结果：高血压组较正常对照组Eρ，β，PWVβ及IMT增高，AC降低，且均有显著性差异。高血压组的PWVβ与β，Eρ和IMT呈正相关，与AC呈负相关；高血压组的AI与Eρ，β，AC和IMT无明显相关。结论：新版E-Tracking技术客观准确的反映了高血压患者血管弹性改变，是评价血管壁弹性简便实用的新方法。     

血管回声跟踪技术早期评价2型糖尿病患者下肢血管弹性功能

目的探讨血管回声跟踪技术对2型糖尿病患者下肢血管弹性的早期诊断价值。方法68例2型糖尿病患者和30例健康者（对照组）,按照病程将糖尿病患者分为A组（刚出现症状的首诊糖尿病患者）27例和B组（病程有一段时间的非首诊糖尿病患者）42例;采集受检者股动脉和腘动脉的二维声像图,应用血管回声跟踪技术检测其动脉弹性指标：僵硬度指数（B）、血管压力-应变弹性系数（Eρ）、顺应性（AC）、增大指数（Al）及脉搏波传导速度（PWVβ）,比较各组下肢血管弹性改变。结果糖尿病A组及B组股动脉、胴动脉的β、Eρ、PWVβ均较对照组增高（P〈0．05）,AC值降低（P〈0．05）;糖尿病A组与B组股动脉弹性指标间比较差异无统计学意义（P〉0．05）,B组腘动脉AC值较A组降低（P〈0．05）。结论糖尿病患者存在弹性大动脉硬化,腘动脉作为肌性动脉也存在动脉硬化,且在临床诊断糖尿病之前,这些血管动脉弹性已经发生异常。     

血管回声跟踪技术对冠心七味片干预兔动脉早期粥样硬化疗效的评价

目的利用血管回声跟踪（ET）技术评价蒙药冠心七味片在兔动脉粥样硬化（AS）早期干预后血管弹性的变化。方法60只雄性新西兰白兔随机分为实验组和对照组。实验组于第8周末再随机均分为高脂对照组、蒙药低剂量组、蒙药高剂量组、辛伐他汀组,各组分别于12、16周末利用ET技术测量兔腹主动脉弹性指标：弹性系数（Ep）、硬度指数（β）、顺应性（AC）、脉搏波速度（PWVβ）。结果与高脂对照组比较,高脂喂养第12周末及16周末蒙药高剂量组、蒙药低剂量组、辛伐他汀组的总胆固醇、甘油三酯、低密度脂蛋白值均减低（P〈0．05）,Ep、β、PWVβ均减低（P〈0．05）;与高脂对照组比较,蒙药低剂量组、蒙药高剂量组、辛伐他汀组的血管内皮生长因子（VEGF）表达强度增高,灰度值下降,测量及分析分别在高、低倍镜下进行,各组间比较差异有统计学意义（P〈0．05）,第12、16周末各组VEGF表达的灰度值均与β呈负相关。结论ET技术可作为早期抗AS药效评价方法,冠小七味片通过抑制VEGF的表达来延缓AS的进展。     

血管回声跟踪技术评价颈动脉弹性与冠心病的相关性

目的探讨应用血管回声跟踪技术（E—Tracking）评价颈动脉弹性与冠心病的相关性：方法对103例疑似冠心病患者同时行冠状动脉造影检查（CAG）和E-Trackingk检查,根据造影结果分为非冠心病组（A组：对照组）和冠心病组,冠心病组又根据冠状动脉病变的范围和血管阻塞程度由轻至重依次分为B、C、D、E四组。分析比较各组间应用E—Tracking检查获得的颈动脉弹性参数（包括压力应变弹性系数Ep、硬化参数β、动脉顺应性AC、单点脉搏波速度PWVβ、增大指数AI）。结果冠心病组的参数Ep、β和PWVβ较对照组明显增高,差异有统计学意义（p〈0．05）,且随着各组间冠状动脉病变程度的不断加重,参数Ep、β和PWVβ逐渐增高,差异有统计学意义（p〈0．05）,两者之间存在相关性。参数AC和AI在各组间无明显差异（p〉0．05）。结论应用血管回声跟踪技术测量的颈动脉弹性参数大小与冠状动脉的病变程度有相关性.     

高血压病患者左心室舒张功能与颈总动脉弹性关系的超声研究

目的探讨高血压病患者左心室舒张功能与颈总动脉弹性间的关系。方法对临床确诊的高血压病患者41例和正常对照组31例，采用频谱多普勒和组织多普勒检测心脏舒张功能，即左心房收缩末期最大径（LA）、二尖瓣前叶射血分数斜率（EFS）、二尖瓣口舒张早期充盈速度（Ve）、舒张晚期充盈速度（Va）、Ve／Va、二尖瓣环舒张早期最大运动速度（Em）、二尖瓣环舒张晚期最大运动速度（Am）和Em／Am。采用血管回声跟踪技术（ET）测量颈总动脉弹性指标，主要有血管僵硬系数（B）、压力应变弹性系数（Ep）、动脉顺应性（AC）、增大指数（AI）和脉搏波传播速度（PWVβ）。结果（1）高血压病组LA、EFS和Ve与对照组相比差异无统计学意义（P〉0.05），高血压病组Va和Am高于对照组（P〈0．05，P〈0．01），而Em、Ve／Va和Em／Am低于对照组（P〈0．05）；（2）高血压病组双侧颈总动脉内膜．中层厚度（IMT）均高于对照组（P〈0．05，P〈0．01）；（3）高血压病组颈总动脉Ep、PWVβ高于对照组（P〈0．05，P〈0．01）；（4）Va与Ep和PWVβ、Ve／Va与AC、Am与Ep和PWVβ呈显著正相关，Ve／Va与PWVβ、Era／Am与岱和PWVβ呈显著负相关，Em与各弹性指标均无相关性。结论高血压病患者左心室舒张功能及血管弹性较正常对照组降低，大动脉弹性降低与左心室舒张功能降低呈正相关。     

血管壁超声回声跟踪技术评价2型糖尿病患者早期颈动脉硬化的初步研究

目的 应用血管壁回声跟踪技术（E-Tracking技术）评价2型糖尿病（T2DM）患者颈动脉早期硬化。方法在E-Tracking模式下，采集30例T2DM患者和40例正常人双侧颈总动脉的二维超声图像，测量双侧颈总动脉内中膜厚度平均值（IMTm）、阻力指数（RI）、搏动指数（PI）及收缩期、舒张期比值（S／D）。应用E-Tracking技术实时跟踪描记颈总动脉管壁的运动轨迹，系统自动得出颈总动脉收缩末期内径（Ds）、舒张末期内径（Dd）、硬度指数（β）、压力应变弹性系数（Eρ）、顺应性（AC）、增大指数（AI）和脉搏波传导速度（PWVβ）结果T2DM组颈总动脉IM Tm、Ds、Dd、RI、PI及S／D测值与正常组相比差异均无统计学意义（P〉0．05），而β、Eρ、和PWVβ测值与正常组相比显著增高（P〈0．01或0．05），AC测值显著降低（P〈0．05），AI测值与正常组相比差异无统计学意义（P〉0．05）。结论E-Tracking成像技术为T2DM患者颈动脉的早期硬化趋势提供了一种快速、无创、定量的评价方法。     

血管回声跟踪技术评价甲状腺功能减退症颈动脉弹性的临床研究

目的 探讨血管回声跟踪技术(echo-tracking,ET)对甲状腺功能减退症(甲减)患者颈动脉壁弹性的诊断价值.方法 应用ET技术对32例甲减患者和30例正常人右侧颈总动脉进行超声检测,评估颈动脉弹性参数指标,包括硬化参数(β)、血管压力应变弹性系数(Eρ)、血管顺应性(AC)、脉搏波增大指数(AI)及脉搏波传导速度(PWVβ),将两组参数进行比较.结果 与对照组相比,甲减组β、Eρ和PWVβ明显升高,AC显著减低(P＜0.05),AI无显著性差异(P＞0.05).β、Eρ、PWVβ值的升高可能继发于甲状腺激素水平的降低.结论甲减患者颈动脉弹性明显低于正常对照组,ET技术为甲减患者颈动脉的弹性检测提供了一种快捷、无创的早期评价方法 .     

血管回声跟踪技术评价冠心病患者颈动脉弹性与肱动脉内皮功能的相关性

目的探讨颈动脉弹性参数与肱动脉内皮功能的相关性。方法冠心病组、冠状动脉粥样硬化组、健康对照组各30例,回声跟踪技术检测颈动脉弹性参数：压力应变弹性系数（Ep）、硬化参数（β）、顺应性（AC）、脉搏波传导速度（PWVβ）和增大指数（AI）;肱动脉袖带加压检测血流介导的内皮依赖性血管舒张功能（FMD）。结果冠心病、冠状动脉粥样硬化患者Ep、β、PWVβ均较对照组增高,AC、FMD减低（P〈0．01）;所有受试者、冠心病组、冠状动脉粥样硬化组、对照组的FMD分别与Ep、β、PWVβ呈负相关,与AC呈正相关,与AI无相关性。结论颈动脉弹性各参数与肱动脉内皮功能呈高度相关,提示回声跟踪技术能早期、定量反映冠心病患者血管的改变,是评价血管内皮功能简便实用的方法。     

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.