坦索罗辛联合宁泌泰对输尿管结石术后残石排出的疗效分析

目的:探讨坦索罗辛联合宁泌泰对输尿管结石术后残石排出的疗效。方法:选取2015年7月～2019年2月收治的输尿管结石患者121例,所有患者采用体外冲击波碎石,根据术后治疗方案不同分为观察组56例和对照组65例。对照组口服盐酸坦索罗辛缓释胶囊治疗,观察组口服盐酸坦索罗辛缓释胶囊联合宁泌泰胶囊治疗。比较两组治疗效果。结果:观察组术后14 d、28 d时的结石排净率均明显高于对照组,差异有统计学意义(P0.05);两组术后3 d、7 d时的结石排净率比较,差异无统计学意义(P0.05);观察组术后排石时间明显短于对照组,视觉模拟评分法评分明显低于对照组,差异有统计学意义(P0.05)。结论:输尿管术后联合使用坦索罗辛和宁泌泰治疗,排石率高,排石时间短,能够明显减轻患者术后疼痛。     

坦索罗辛配合体外冲击波碎石术治疗输尿管结石的疗效

目的观察坦索罗辛对输尿管结石患者体外冲击波碎石术后排石的疗效。方法将86例男、女输尿管结石患者在接受ESWL治疗后随机分为两组:肾石通组(43例),口服肾石通颗粒制剂4 g/次,3次/d;坦索罗辛组(43例),口服坦索罗辛0.4mg/次,1次/d,共2周,观察两组临床疗效。结果坦索罗辛和肾石通对输尿管结石患者ESWL术后治疗比较:排石率、平均排石时间、肾绞痛发生率,坦索罗辛组好于肾石通组;药物副作用的发生率:肾石通组明显低于坦索罗辛组。结论坦索罗辛和ESWL联合治疗输尿管结石可提高结石排出率。     

盐酸坦索罗辛联合宁泌泰胶囊治疗慢性非细菌性前列腺炎的临床观察

目的评价盐酸坦索罗辛联合宁泌泰胶囊治疗慢性非细菌性前列腺炎的疗效。方法对78例慢性非细菌性前列腺炎进行4周的治疗。口服盐酸坦索罗辛胶囊每晚1次,每次1粒;宁泌泰胶囊每天3次,每次3粒。结果治疗4周后患者慢性前列腺炎症状评分（NIH-CPSI）、尿流率和前列腺液中白细胞计数均较治疗前明显改善,治疗总有效率92.3%。全组病例观察过程中未见明显药物不良反应。结论盐酸坦索罗辛联合宁泌泰胶囊治疗慢性非细菌性前列腺炎的疗效确切,耐受性良好。     

复方玄驹胶囊联合坦索罗辛治疗早泄60例疗效观察

目的探讨复方玄驹胶囊联合坦索罗辛在早泄治疗中的疗效。方法对符合诊断标准的120例肾阳虚型早泄患者随机分为联合治疗组、坦索罗辛组和复方玄驹胶囊组,其中联合治疗组60例,其他两组每组各30例,给予相应治疗,观察疗效。结果治疗前后,从阴道内射精潜伏期变化来看,联合治疗组组内比较、联合治疗组与坦索罗辛组和复方玄驹胶囊组分别组间比较均有极显著性差异(P<0.01);坦索罗辛组和复方玄驹胶囊组各自组内比较也有显著性差异(P<0.05);而坦索罗辛组和复方玄驹胶囊组组间比较无显著性差异(P>0.05)。从夫妻双方对性生活满意率来看,联合治疗组组内比较、联合治疗组与坦索罗辛组和复方玄驹胶囊组组间比较同样均有极显著性差异(P<0.01);坦索罗辛组组内比较也有显著性差异(P<0.05);复方玄驹胶囊组组内比较、坦索罗辛组和复方玄驹胶囊组组间比较均无显著性差异(P>0.05)。结论复方玄驹胶囊联合坦索罗辛治疗早泄可明显增加阴道内射精潜伏期,且疗效优于单一的药物治疗;阴道内射精潜伏期的延长则可明显提高夫妻双方对性生活满意率,从而提高生活质量。     

坦索罗辛联合氟哌噻吨-美利曲辛治疗尿道炎后综合征

目的观察坦索罗辛联合氟哌噻吨-美利曲辛治疗尿道炎后综合征（MPUS）患者的疗效。方法采用Zung焦虑自评量表（SAS）调查MPUS患者焦虑精神症状,将伴有焦虑患者分为两组：治疗组予坦索罗辛与氟哌噻吨-美利曲辛联合,对照组予坦索罗辛,连用4周后,评价两组疗效及治疗前后Zung积分。结果70例MPUS患者49例伴有焦虑,治疗后Zung积分下降,MPUS患者治疗组有效率显著高于对照组。结论MPUS患者焦虑症发生率较高,坦索罗辛与氟哌噻吨-美利曲辛联合治疗伴焦虑症MPUS患者效果良好。     

α受体及M受体阻滞剂联合应用治疗留置双J管致下尿路症状的效果分析

目的 分析留置双J管所致下尿路症状（LUTS）患者联合α受体阻滞剂与M受体阻滞剂的治疗效果.方法 选择2013年1月至2016年12月接受泌尿外科手术术后留置双J管120例患者,以随机数字表法均分成对照组（未给予任何药物干预,30例）、治疗A组（口服坦索罗辛0.2 mg,30例）、治疗B组（口服索利那新5.0 mg,30例）、联合组（联合坦索罗辛0.2 mg＋索利那新5.0 mg,30例）,后3组服药均为1次/d.记录术前、术后1、4周各组患者的国际前列腺症状评分（IPSS）、生命质量评分（QOL）和可视疼痛量表评分（VAPS）并进行统计学比较.结果 联合组术后4周IPSS总评分[（8.21±2.36）分]、对照组[（13.68±3.65）分]、治疗A组[（12.59±3.76）分]、治疗B组[（12.39±4.58）分]比较差异有统计学意义（F组间=7.905,P〈0.05）,且术后4周联合组 IPSS 总评分均较其他3组显著降低（P 均〈0.05）;联合组术后4周 QOL 评分[（1.52 ± 0.99）分]、对照组[（2.86 ± 1.14）分]、治疗 A 组[（2.69 ±1.21）分]、治疗B组[（2.74±1.40）分],比较差异有统计学意义（F组间=13.725,P〈0.05）,且术后4周联合组QOL评分均较其他3组显著降低（P均〈0.05）.各组间VAPS评分比较差异均无统计学意义（P均〉0.05）.结论 泌尿系手术后留置双J管所致LUTS患者联合给予α受体阻滞剂与M受体阻滞剂可明显改善相关症状.     

老年输尿管结石URSL术后给予坦索罗辛治疗效果观察

目的：探讨老年输尿管结石患者输尿管镜钬激光碎石术后给予坦索罗辛治疗的临床效果。方法：回顾性分析2018年1月~2020年1月收治的86例老年输尿管结石患者临床资料,均行输尿管镜钬激光碎石术治疗。根据术后治疗方式不同分为对照组和观察组,各43例。对照组给予常规治疗,观察组给予常规治疗联合坦索罗辛。对比两组治疗前后结石清除率、疼痛程度及不良反应发生情况。结果：观察组治疗3周结束时结石清除率较对照组高,差异有统计学意义（P＜0.05）;治疗3周结束时,两组疼痛评分均低于治疗前,且观察组低于对照组,差异有统计学意义（P＜0.05）;两组不良反应发生率比较,差异无统计学意义（P＞0.05）。结论：老年输尿管结石患者输尿管镜钬激光碎石术后给予坦索罗辛治疗可提升老年输尿管结石患者结石清除率,减轻患者疼痛症状,且安全性较高。     

坦索罗辛对肾结石体外震波碎石术后辅助排石作用的研究

目的 评估高选择性α1受体阻滞剂坦索罗辛对肾结石体外震波碎石（ESWL）术后辅助排石作用的有效性及安全性.方法 140例单发的非下盏部位的肾结石患者,结石大小6～20 mm,ESWL碎石成功后随机分为两组,每组70例.对照组给予标准治疗包括中成药尿石通丸及司帕沙星,试验组接受标准治疗基础上加用坦索罗辛,随访2个月.结果 试验组（坦索罗辛组）单次ESWL后结石排出率、结石排出时间、石街形成率、肾绞痛发生次数及哌替啶的使用次数等指标均优于对照组（P值分别为0.009,0.000,0.028,0.012,0.002）,但两组之间的结石排净率差异无统计学意义（P =0.125）.按结石大小进行分组分析,结石≥10 mm患者中,坦索罗辛组的结石排净率高于对照组,差异有统计学意义（P=0.044）,且其余各项指标均优于对照组（P＜0.05）.结石＜ 10 mm者,坦索罗辛组仅结石排出时间与肾绞痛发生次数两项指标优于对照组（P=0.001,0.026）.坦索罗辛组药物副作用发生率与对照组相比差别无统计学意义（P =0.085）,且症状轻微,无一例患者因副作用停止治疗.结论 坦索罗辛能够促进并加快肾结石单次ESWL术后碎石排出,减少石街形成并降低肾绞痛发生频率及止痛针使用,对于≥10 mm肾结石患者还能够提高结石排净率,用于辅助排石安全有效.     

坦索罗辛与索利那新联合治疗TUPR手术后膀胱痉挛的疗效及安全性观察

目的：探讨坦索罗辛与索利那新联合治疗前列腺电切除术（TUPR）术后膀胱痉挛的疗效及安全性观察。方法：选取2018年7月~2020年1月接受TUPR术后膀胱痉挛的168例患者,根据随机数字法分为观察组和对照组,各84例。对照组采用单纯索利那新治疗,观察组采用坦索罗辛与索利那新联合治疗。对比两组相关临床指标,治疗前后膀胱活动症状（OABSS）评分及国际前列腺症状（IPSS）评分,术后不良反应发生情况。结果：治疗后观察组痉挛次数、膀胱痉挛时间、排尿次数均低于对照组,最大尿流量高于对照组（P＜0.05）;治疗后观察组OABSS评分及IPSS评分均低于对照组（P＜0.05）。观察组视物模糊、食欲不振、头晕、恶心呕吐发生率略低于对照组,差异无统计学意义（P＞0.05）。结论：坦索罗辛与索利那新联合治疗TUPR术后膀胱痉挛患者可减少术后膀胱痉挛次数,有效改善临床症状,且不良反应发生率较低,安全性较好。     

前列倍喜胶囊联合坦索罗辛治疗慢性前列腺炎临床观察

目的:研究分析前列倍喜胶囊联合坦索罗辛治疗慢性前列腺炎的临床效果。方法:随机选取2013年7月²014年7月经我院诊断并治疗的慢性前列腺炎患者68例作为研究对象,分为联合用药组和常规用药组各34例。常规用药组给予口服坦索罗辛缓释胶囊,联合用药组给予口服前列倍喜胶囊联合坦索罗辛缓释胶囊。治疗1个月后,采用美国国立卫生研究院制定的慢性前列腺炎症状评分表对两组患者治疗前后分别进行评定和比较。结果:治疗后联合用药组评分情况明显优于常规用药组。结论:前列倍喜胶囊联合坦索罗辛治疗慢性前列腺炎具有明显的临床效果,值得深入研究及临床推广。     

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.