急性有机磷农药口服中毒与自由基变化关系的初步探讨

目的：探讨急性有机磷农药口服中毒患者体内的一系列自由基异常反应及其对患者机体损伤程度的关系。方法：采用独立样本对照设计，用分光光度比色分析法检测了58例急性有机磷农药中毒患者（AOPP）和58例健康成人志愿者（HAV）的血浆过氧化脂质（LPO）、一氧化氮（NO）、维生素C（VC）、维生素E（VE）、β－胡萝卜素（β－CAR）含量和谷胱甘肽－S－转移酶（GST）活性及红细胞超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GSH－Px）活性。结果：与HAV组各生化参数（BP）平均值（AV）比较，AOPP组血浆LPO、NO和GST的AV均升高，差异具有显著性意义（P＜0．001），血浆VC、VE、β－CAR和红细胞SOD、CAT、GSH－Px的AV均降低，差异具有显著性意义（P＜0．001）。对58例AOPP患者红细胞乙酰胆碱酯酶（AChE）活性与上述各BP的直线回归和相关分析表明，随着AChE值的降低，LPO、NO和GST值逐渐升高，均呈直线负相关（P＜0．005），而VC、VE、β－CAR、SOD、CAT和GSH－Px值逐渐降低，均呈直线正相关（P＜0．001）。对58例AOPP和58例HAV用上述BP进行判别分析的结果提示，判别正确率均为100％。结论：急性有机磷农药口服中毒患者体内的一系列自由基反应病理性加剧，采用上述参数可提高判别分析的正确率。     

急性肾功能衰竭与氧化损伤

目的测定急性肾功能衰竭患者体内自由基异常反应诱导的氧化损伤。方法采用随机对照研究设计,选择50例急性肾功能衰竭患者(ARF)和50例健康成人志愿者(HAV)。用分光光度测量法分别检测血浆一氧化氮(NO),维生素C(V_C),维生素E(V_E),β-胡萝卜素(β-CAR),血浆和红细胞过氧化脂质(LPO)以及红细胞超氧化物歧化酶(SOD)、过氧化氢酶(CAT)和谷胱甘肽过氧化物酶(GPX)的活性。结果与HAV比较,ARF的血浆NO浓度、血浆和红细胞LPO浓度明显增高(P＜0．01),而血浆V_C、V_E、β-CAR浓度和红细胞SOD、CAT、GPX活性明显下降(P＜0．01)。直线相关分析显示,ARF随着血浆NO水平、血浆和红细胞LPO水平增高,以及血浆V_C、V_E、β-CAR水平和红细胞SOD、CAT和GPX活性下降,血清尿素氮和肌酐水平逐渐增高(P＜0．01)。判别分析显示,ARF的判别正确率为75．3%～93%,HAV为70%～91．3%,逐步判别分析显示,ARF的判别正确率提高到99．2%,HAV提高到100%。可靠性分析显示,ARF的可靠系数(α)为0．816,标准系数α为0．972,P＜0．01。结论在ARF体内,一系列自由基连锁反应呈现严重病理变化,其结果导致氧化损伤,加速肾功能恶化。因此,在ARF的治疗上,加用抗氧化剂非常必要。     

氧化、脂质过氧化在食管癌患者中的变化

目的：探讨氧化、脂质过氧化在食管癌患中的变化。方法：检测45例食管癌患（患组）和50例健康人（对照组）血浆维生素C（P－VC）、维生素E（P－VE）、β－胡萝卜素（P－β－CAR）和过氧化脂质（P－LPO）含量及红细胞超氧化物歧化酶（E－SOD）、过氧化氢酶（E－CAT）、谷胱甘肽过氧化物酶（E－GSH－PX）活性和过氧化脂质（E－LPO）含量。结果：与对照组比较，P－VC、P－VE、P－β－CAR、E－SOD、E－CAT、E－GSH－PX值显降低（p＜0．001）P－LPO、E－LPO值显增高（p＜0．001）。结论：食管癌患氧化、脂质过氧化损伤加剧。     

部分性脾栓塞对肝硬化患者氧化和抗氧化失衡的影响

目的　探讨部分性脾动脉栓塞术 (PSE)对肝硬化患者氧化和抗氧化系统的影响及其临床意义。方法　测定 30例肝硬化PSE后 2个月患者、30例肝硬化非PSE患者和 6 0例正常人血浆维生素C(P VitC ) ,维生素E(P VitE) ,β 胡萝卜素 (P β CAR)和一氧化氮 (P NO)含量 ,红细胞超氧化物歧化酶 (E SOD)、过氧化氢酶 (E CAT)和谷胱甘肽过氧化物酶 (E GSH Px)活力 ,血浆及红细胞过氧化脂质 (P LPO ,E LPO)水平的变化。结果　肝硬化非PSE组、PSE后 2个月组 (PSE组 )和对照组的P VitC、P VitE、P β CAR、E SOD、E CAT和E GSH Px水平依次升高 (均 P <0 .0 0 1) ;3组的P NO、P LPO和E LPO含量依次降低 (均P <0 .0 0 1) ;除了PSE组和对照组E SOD的差异无统计学意义外 ,3组之间其他检测值的两两比较差异均具有统计学意义。结论　PSE有利于纠正肝硬化患者体内一氧化氮代谢异常、氧化和抗氧化的失衡     

急性结石性胆囊炎与一氧化氮、氧化和脂质过氧化关系的研究

目的：从自由基医学的角度探讨一氧化氮、氧化和脂质过氧化与急性结石性胆囊炎之间的关系。方法：用分光光度法检测了97例急性结石性胆囊炎患者（ALC）和100例健康志愿者（HVT）血浆中的一氧化氮（）P－NO）、维生素C（P－VC）、维生素E（PVE）、β－胡萝卜素（P- β-CAR）和过氧化脂质（P－LPO）含量及红细胞超化物歧化酶（E－SOD）、过氧化氢酶（E－CAT）、谷胱甘肽过氧化物酶（E－CSH－Px)活性和过氧化脂质（E－LPO）含量,分析比较了ALC组与HVT组各平均检测（AV）之间的差异及患者组手术前后各AV之间的差异。结果与HCT组上述各AV比较,ALC组P－NO、P－LPO和E－LPO的AV均显著增高（P＝0．001）,P－VC、P－VE、P-β-CAR、E-SOD、E-CAT和E－GSH－Px的AV均显著降低（P＝0．0001）;与ALC组手术前上述各AV比较,ALC组手后P＝NO、P－LPO和E－LPO的AV均显著降低（P＜0．001）,P－VC、E－SOD、E－CAT和E－CSH－Px的AV均显著增高（P＜0．001）,但PVE和P－β-CAR的AV在手术前后无显著性差异（P＞0．05）。结论：ALC患者体内的一氧化氮代谢严重紊乱,一系列自由基连锁反应病理性加剧,氧化抗氧化平衡严重失调。     

SOD、LPO测定在急诊患者中的应用

本文以邻苯三酚自氧化抑制法和硫代巴比妥酸反应产物比色分析法检测34例多发伤、41例脑外伤、45例脑出血、57例脑梗死、42例肺心病患者及100例健康成人血浆超氧化物歧化酶（P－SOD）活性和红细胞超氧化物歧化酶（E－SOD）活性及血浆过氧化脂质（P－LPO）含量和红细胞过氧化脂质（E－LPO）含量的结果表明，与各相应的对照组值相比较，各患者组的P－SOD、E－SOD平均活性均显著降低（P＜0.001），P－LPO、E－LPO平均含量均显著升高（P＜0．001），提示多发伤、脑外伤、脑出血及肺心病患者体内的病理性氧自由基反应和脂质过氧化反应明显加剧，导致细胞组织的进一步损伤。     

银杏叶制剂的抗氧自由基作用

本文以邻苯三酚自氧化抑制法和硫代巴比妥酸反应产物比色分析法检测经服用。天保宁”（银杏叶制剂）前后58例心绞痛患者的红细胞超氧化歧化酶（E－SOD）活性，血浆过氧化服质（P－LPO）和红细胞过氧化脂质（E－LPO）含量。结果表明，与治疗前相比，治疗后的E－SOD平均活性显著升高（Pwto．0of），P－LPO和E－LPO平均含量均显著降低（P＜0．001），提示心绞痛患者体内的毒性氧自由基反应和脂质过氧化反应在治疗后明显减缓，银杏叶制剂具有较强的抗氧自由基损伤和抗脂质过氧化损伤作用。     

美蓝对静滴普鲁卡因致红细胞过氧化损伤影响的临床观察

目的：探讨美蓝对静滴普鲁卡因（PPOC）致人体红细胞过氧化损伤的影响。方法：40例择期行上腹部手术患者根据麻醉方法不同随机分为静脉普鲁在复合麻醉（IPA）组（观察组,n=20)和芬太尼组（对照组，n=20)。分别观察麻醉诱导前，IPA120min,IPA 180min，静脉注射美蓝（1－2mg/kg)后30min患者血内一氧化氮（NO），氧自由基（OFR），超氧化物歧化酶（SOD），过氧化氢酶（CAT），高铁血红蛋白（MHb)含量变化，IPA60，120，180min血浆对氨基苯甲酸（PABA）浓度与MHb增量的关系。结果：IPA组120，180min与麻醉诱导前相比NO，OFR，MHb有显著性升高（P＜0．05，P＜0．05，P＜0．01）；SOD，CAT较麻醉前显著性降低（P＜0．05，P＜0．01）。而对照组诸指标无显著变化，IPA期间血浆PABA分别与MHb增量间自始至终呈显著正相关关系（r=0.892,0.7146,0.8517, 均P＜0．001），IPA组经美蓝治疗后诸指标均恢复至正常水平，结论：PROC在体内的代谢产物具有强氧化剂特性，可致机体NO，OFR水平升高，红细胞SOD，CAT活性受抑制及与PROC剂量相关的高铁血红蛋白血症，美蓝具有OFR清除剂特性，对PROC所致红细胞过氧化损伤可提供保护作用。     

血小板GMP-140、vWF、SOD、LPO与高血压病关系的研究

为了解高血压病（EH）发病机理，采用ELISA法和比色法检测EH患者血小板a-颗粒膜蛋白140（GMP－140）、血浆VonWillebrand因子（vWF）、超氧化物歧化酶（SOD）、过氧化脂质（LPO）的含量。结果显示EH患者血小板GMP－140、vWF和LPO水平均高于正常对照组（P＜0．01～0．001），SOD水平低于正常对照组（P＜0．01）。相关分析：GMP－140与vWF、LPO是正相关（r=0．78、0．82，P＜0．05）。表明：EH患者血小板活化与血管内皮细胞受损及自由基损伤关系密切。     

脑出血与一氧化氮、氧化、脂质过氧化的关系

目的：探讨脑出血与一氧化氮、氧化、脂质过氧化的关系及临床意义。方法：检测98例脑出血患者以及100例健康人血浆一氧化氮（P-NO）、维生素C（P-VC）、维生素E（P-VE）、过氧化脂质（P－LPO）含量、血浆和红细胞超氧化物歧化酶（P-SOD、E-SOD）活性及红细胞过氧化脂质（E－LPO）含量，采用直线回归和相关、逐步回归分析患者病情（临床神经功能缺损程度积分，NDS）和颅内血肿量与上述指标的关系。结果：与对照组比较，患者组的P-NO、P－LPO、E-LPO平均值均显著升高（P＜0．001），P-VC、P-VE、P-SOD、E-SOD平均值均显著降低（P＜0．001）；逐步回归分析发现患者NDS与P-NO、P-VC、E-LPO值相关最为密切，颅内血肿量与P-NO、P-VE、E-LPO值相关最为密切。结论：脑出血患者体内自由基反应病理性加剧，氧化抗氧化平衡严重失调。     

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.     

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.     

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.     

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.