血乳酸联合神经元特异性烯醇化酶预测创伤性脑损伤患者预后的价值

目的:探讨血乳酸联合神经元特异性烯醇化酶(NSE)水平预测创伤性脑损伤(TBI)患者预后的价值。方法:选取我院收治的TBI患者148例,根据28 d预后情况分成存活组(n=117)和死亡组(n=31)。根据格拉斯哥昏迷评分(GCS)分为轻度组(n=96,9分≤GCS≤15分)和重度组(n=52,3分≤GCS≤8分)。比较各组第1、3、5天血乳酸及NSE水平变化。应用受试者工作特征(ROC)曲线分析血乳酸及NSE水平预测TBI患者死亡的价值。采用Pearson相关分析TBI患者血乳酸及NSE水平与GCS评分的相关性。结果:死亡组第1、3、5天血乳酸及NSE水平均明显高于存活组(P0.05),且死亡组血乳酸及NSE水平呈升高趋势(P0.05)。重度组第1、3、5天血乳酸及NSE水平均明显高于轻度组(P0.05),且重度组血乳酸及NSE水平呈升高趋势(P0.05)。ROC曲线显示,第3天血乳酸及NSE水平两项联合预测TBI患者死亡的曲线下面积最大(0.922,95%CI:0.858～0.970),其敏感度和特异度分别为92.6%和87.0%。相关分析显示,死亡组血乳酸及NSE水平与GCS评分均呈负相关(r=-0.763、-0.820,P0.01),血乳酸与NSE水平呈正相关(r=0.804,P0.01)。结论:血乳酸与NSE水平升高与TBI患者的病情严重程度相关,血乳酸联合NSE水平预测TBI患者预后的价值较高。     

血乳酸及血肌酐水平测定对重症急性胰腺炎患者的预后评估价值

目的 探讨血乳酸及血肌酐水平的测定在重症急性胰腺炎(severe acute pancreatitis,SAP)患者预后评估的临床价值.方法 分析61例SAP患者入住ICU 24h及住院期间总体血乳酸及肌酐水平,根据预后分为生存组(n=39)及死亡组(n=22),分析比较两组患者全血乳酸及肌酐水平与SAP病死率的关系.结果 两组患者在ICU住院期间总体血乳酸水平,生存组(4.32±0.59) mmol/L低于死亡组(10.62±1.33) mmol/L,两组差异有统计学意义(P＜0.05);两组患者在在ICU住院期间总体血肌酐水平,生存组(121.17±12.03) μmol/L低于死亡组(297.54±13.15)μmol/L,两组差异有统计学意义(P＜0.01).血乳酸、血肌酐水平与APACHEⅡ评分明显相关(P＜0.05).结论 血乳酸和肌酐水平对SAP患者预后评估具有一定的临床价值.     

创伤性颅脑损伤患者血清NGF、NF-L水平与脑损伤程度和预后的关系

目的 通过前瞻性研究分析血清神经生长因子(NGF)和神经丝蛋白轻链(NF-L)水平与患者创伤性颅脑损伤(TBI)严重程度和预后之间的关系及其预测价值。方法 收集132例TBI患者和132例普通外伤患者分别作为观察组和对照组;观察组患者根据格拉斯哥昏迷(GCS)评分分为轻症、中症和重症3个亚组;观察组患者在随访6个月时按格拉斯哥预后评分(GOS)评分分为良好组和不良组;采用酶联免疫吸附试验(ELISA)检测所有患者入院后血清NGF、NF-L水平;通过对比观察组和对照组,明确颅脑损伤和血清NGF和NF-L水平之间的关系;通过对比观察组不同亚组之间的差异,明确血清NGF、NF-L水平与颅脑损伤程度和预后之间的关系;通过相关关系、受试者工作特征(ROC)曲线和多因素Logistic回归分析,明确血清NGF、NF-L水平对TBI的预测价值。结果 相比于对照组,观察组血清NGF、NF-L水平显著升高,GCS评分显著降低(P<0.01);此外,观察组中,轻症、中症和重症亚组血清NGF、NF-L水平逐渐升高(P<0.01);血清NGF、NF-L水平预测轻症颅脑损伤的曲线下面积(AUC)分别...     

创伤性脑损伤患者血清miR-422a水平变化的初步探讨

目的检测创伤性脑损伤(traumatic brain injury,TBI)患者血清miR-422a的表达水平,探讨其作为TBI诊断及预后判断指标的临床应用价值。方法采用TaqMan实时荧光定量聚合酶链反应(qRT-PCR)检测75例轻度创伤性脑损伤(mTBI)、75例重度创伤性脑损伤(sTBI)及75例健康人对照者血清miR-422a的表达水平,比较CT阳性和阴性患者血清miR-422a表达水平的差异;采用ROC曲线评估miR-422a对mTBI和sTBI的诊断效能,Spearman相关性分析评估miR-422a与TBI患者病情和预后的关系。结果与健康人对照组[(31.1×10~(-5)(18×10~(-5),51.5×10~(-5))]相比,mTBI[81.6×10~(-5)(51.2×10~(-5), 131.1×10~(-5))]和sTBI[132.5×10~(-5)(51.5×10~(-5),240.5×10~(-5))]患者血清miR-422a水平均明显升高(Z=-6.647,P0.001;Z=-7.345,P0.001),且sTBI患者血清miR-422a水平明显高于mTBI患者(Z=-2.573,P=0.01)。ROC曲线分析显示,miR-422a用于鉴别健康人对照组与TBI患者的曲线下面积(AUC~(ROC))为0.831(95%CI:0.776～0.886,P0.001);用于鉴别健康人对照组与mTBI患者的AUC~(ROC)为0.814(95%CI:0.744～0.885,P0.001);用于鉴别健康人对照组与sTBI患者的AUC~(ROC)为0.847(95%CI:0.785～0.910,P0.001)。TBI患者CT阳性组血清miR-422a水平明显高于CT阴性组(P=0.025)。此外,TBI患者预后较差组的miR-422a表达水平明显高于预后较好组(P=0.031)。相关性分析显示,TBI患者血清miR-422a的表达水平与GCS评分(r=-0.231,P=0.004)、GOS评分(r=-0.208,P=0.011)均呈负相关。结论 TBI患者血清miR-422a表达水平明显升高,且与病情和预后相关,是潜在的TBI辅助诊断指标。     

颅脑损伤合并低钠血症患者血钠水平与颅脑损伤类型、程度及预后的相关性研究

目的探讨颅脑损伤合并低钠血症患者血钠水平与颅脑损伤类型、程度及预后的相关性。方法选取2014年1月—2016年12月我院收治的300例颅脑损伤合并低钠血症患者,根据血钠降低程度分为A组(轻度低钠组,血钠浓度130～135 mmol/L)187例,B组(中度低钠组,血钠浓度120～130 mmol/L)74例和C组(重度低钠组,血钠浓度120 mmol/L)39例。比较3组损伤类型;通过格拉斯哥昏迷评分(glasgow coma score, GCS)评价3组入院时颅脑损伤程度;比较3组治疗后1个月和6个月时格拉斯哥预后量表(glasgow outcome scale, GOS)评分和Barthel指数(barthel index, BI),评估患者预后情况。结果 3组患者在损伤类型上比较差异无统计学意义(P0.05)。由A组到C组,随着血钠值的降低,患者GCS评分呈逐步降低趋势(P0.05)。治疗后1个月、6个月时,3组患者GOS评分随着血钠值的降低而降低,整体及各组间比较差异均有统计学意义(P0.05或P0.01);且与治疗后1个月时比较,治疗6个月时A、B组GOS评分均升高,差异均有统计学意义(P0.05)。治疗后3组BI均显著升高,且同一时间点C组B组A组,差异均有统计学意义(P0.05)。结论颅脑损伤合并低钠血症患者血钠水平与颅脑损伤类型无关,与颅脑损伤程度存在密切联系,血钠值越低其颅脑损伤程度越重,且治疗后临床预后也更差。     

额叶脑挫裂伤合并颅内血肿单侧开颅手术临床疗效评价

【目的】探讨单侧开颅手术治疗额叶脑挫裂伤合并颅内血肿的临床疗效。【方法】选取2015年6月至2017年6月本院手术治疗的额叶脑挫裂伤合并颅内血肿患者110例,根据手术入路分为单侧开颅手术(观察组,n=60)、双侧开颅手术(对照组,n=50),对比两组患者的手术时间、输血量、住院时间、术后不同时间的格拉斯哥昏迷(GCS)评分、格拉斯哥预后评分,手术前后患者血清神经元烯醇化酶(NSE)、S100β蛋白、乳酸水平变化。【结果】观察组患者的手术时间、输血量、住院时间均显著地低于对照组患者,差异均具有统计学意义(P<0.05)。术后1周,观察组患者的GCS评分显著地高于对照组患者,差异均具有统计学意义(P<0.05)。术后3个月进行患者预后评估,观察组患者的预后良好率66.67%显著高于对照组患者的46.00%,差异具有统计学意义(P<0.05)。术后1d,两组患者的血清NSE、S100β蛋白、血乳酸浓度差异不具有统计学意义(P>0.05);术后1周,观察组患者的血清NSE、S100β蛋白、血乳酸浓度均显著低于对照组患者,差异具有统计学意义(P<0.05)。【结论】额叶脑挫裂伤合并颅内血肿患者采用单侧开颅手术相对于双侧开颅手术其创伤更小、术后恢复效果更好。     

特重度烧伤患者预后影响因素的COX回归分析

目的分析影响特重度烧伤患者预后的危险因素。方法回顾性纳入苏州市六所医院ICU收治的2014年8月2日江苏省昆山市铝粉尘爆炸事故中的46例特重度烧伤患者,根据预后将患者分成生存组和死亡组。收集两组患者年龄、性别、入ICU时烧伤程度、白细胞、乳酸、48 h乳酸、肌酐、白蛋白、尿量、血钙、入ICU当日急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和SOFA评分及90 d预后。采用多因素COX回归分析两组患者各指标对预后(死亡情况)的影响。结果生存组与死亡组患者在入院时,白细胞、肌酐、白蛋白、尿量、SOFA评分和入ICU当日APACHEⅡ评分比较差异无统计学意义(P>0.05);而两组间烧伤程度、乳酸、48 h乳酸以及血钙水平差异有统计学意义(P<0.05)。多因素回归分析结果表明年龄、白蛋白与48 h乳酸水平是特重度烧伤患者死亡的独立预测指标(P<0.05)。结论年龄、白蛋白水平、48 h乳酸水平是影响特重度烧伤患者预后的独立危险因素,能够初步评估特重度烧伤患者的预后。     

危重症专职护理小组在颅脑损伤伴昏迷患者中的应用

目的:探讨危重症专职护理小组在颅脑损伤(TBI)伴昏迷患者中的应用方法及效果。方法:将114例TBI伴昏迷患者根据护理方法分为观察组54例和对照组60例,对照组给予常规治疗护理,观察组给予危重症专职护理小组护理,比较两组护理效果。结果:两组干预2周格拉斯哥昏迷评分(GCS)、美国国立卫生研究院卒中量表(NHISS)评分优于干预前(P0.05),观察组干预2周GCS、NHISS评分优于对照组(P0.05);两组并发症发生率及预后情况比较差异均有统计学意义(P0.05)。结论:危重症专职护理小组可改善TBI伴昏迷患者恢复情况和预后状况,降低并发症发生率。     

重型颅脑损伤术后血糖及乳酸水平与预后的关系

目的：探讨重型颅脑损伤（Traumatic brain injury,TBI）术后血糖及乳酸水平与预后的关系。方法：将84例TBI手术治疗后收入我科的患者,入组条件为入院时格拉斯哥昏迷指数评分（GCS）低于8分,既往无糖尿病史,术中未输注含糖液体,无其他部位严重损伤,无重要脏器疾患,住院时间大于一周的患者,于手术后0h、24h、48h分别抽取静脉血进行血糖测定,抽取动脉血进行乳酸测定,根据预后（出院时的预后情况）分为存活组和死亡组,然后分别比较不同时段及两组间血糖和乳酸水平与预后的关系。结果：84例TBI患者术后血糖和乳酸的平均水平均高于正常参考值（P〈0.05）。术后0h、24h及48h的血糖水平与预后呈负相关（相关系数r值分别为-0.581、-0.443、-0.177,均P〈0.05）,乳酸水平与预后亦呈负相关（相关系数r值分别为-0.300、-0.364、-0.117,均P〈0.05）。死亡组0h,24h的血糖及乳酸水平显著高于存活组（P〈0.05）。结论：TBI术后特别是早期,血糖及血乳酸水平均有不同程度升高,两者与预后均具有一定的相关性。我们可以将其作为早期评估预后的指标之一。     

血乳酸及肌酐总体水平对早期急性重症胰腺炎患者的预后评估价值

目的:探讨血乳酸及血肌酐总体水平的测定在早期急性重症胰腺炎(SAP)患者预后评估的临床价值。方法:检测61例SAP患者入住ICU24h及ICU住院期间总体血乳酸及肌酐水平,根据预后分为生存组(n=39)及死亡组(n=22),比较两组患者全血乳酸及肌酐水平与SAP病死率的关系。结果:生存组在ICU住院期间总体血乳酸和肌酐水平(5.68±1.23)mmol/L和(135.19±13.02)umol/L均明显低于死亡组的[(10.66±1.34)mmol/L,P0.05)]和[(309.53±18.26)umol/L,P0.01]。血乳酸、血肌酐总体水平与APACHEⅡ评分明显相关(P0.05)。结论:血乳酸和肌酐总体水平可预测SAP患者的预后。     

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.     

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.     

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."