彩色多普勒观察高危妊娠时硝酸甘油对胎儿—胎盘血流动力学的影响

本文介绍应用彩色多普勒超声技术观察３０例高危妊娠孕妇口含硝酸甘油前后的脐动脉、胎儿大脑中动脉、胎儿腹主动脉的备注动力学改变。结果：用药后脐动脉的搏动指数（ＰＩ）、阻力指数（ＲＩ）和Ｓ／Ｄ值均有显著改变（Ｐ＜０．００１），胎儿大脑中动脉和胎儿腹主动脉的ＰＩ、ＲＩ和Ｓ／Ｄ值无显著变化。而孕妇血压、心率和心率未见明显改变，呈现良好的耐受性。表明应用硝酸甘油可明显降低脐－胎盘血管阻力；是改善胎儿血氧供应的     

彩色多普勒观察高危妊娠时硝酸甘油对胎儿－胎盘血流动力学的影响

本文介绍应用彩色多普勒超声技术观察３０例高危妊娠孕妇口含硝酸甘油前后的脐动脉、胎儿大脑中动脉、胎儿腹主动脉的血流动力学改变。结果：用药后脐动脉的搏动指数（ＰＩ）、阻力指数（ＲＩ）和Ｓ／Ｄ值均有显著改变（Ｐ＜０．００１），胎儿大脑中动脉和胎儿腹主动脉的ＰＩ、ＲＩ和Ｓ／Ｄ值无显著变化。而孕妇血压、心率和胎心率未见明显改变，呈现良好的耐受性。表明应用硝酸甘油可明显降低脐－胎盘血管阻力，是改善胎儿血氧供应的简便、有效的方法。而彩色多普勒超声显像则为围产期好高征早期诊断及疗效观察提供了重要的依据。     

脉冲多普勒超声对胎儿不同妊周脐带及脑循环动态变化的研究

目的，探讨不同妊周胎儿脐血流及脑血流的变化规律。方法，对４２２例妊娠２１～４２周正常产妇，用脉冲多普勒超声测量其胎儿脐带动脉（ＵＡ）、大脑中动脉（ＭＣＡ）之ＲＩ（阻力指数）与ＰＩ（搏动指数）。结果与结论，ＲＩ与ＰＩ的变化高度一致（ｒ＝０．９７８）（ｐ＜０．００１）。ＵＡ两指数在妊娠２１周时最高，此后逐渐下降至足月（Ｐ＜０．００１）。ＭＣＡ两指数从２１周起先缓慢上升，２９周时达高峰，此后迅速下降至足月（ｐ＜０．００１）。ＵＡ的ＲＩ、ＰＩ与ＭＣＡ的ＲＩ、ＰＩ之比值，从妊娠２１周起迅速下降，２９～３４周间维持较低水平，以后缓慢上升，到妊娠足月时仍明显低于妊娠２１周时水平（Ｐ＜０．００１）。     

胎儿脐动脉、大脑中动脉及腹主动脉的血流频谱与脐动脉血气相关性的研究

本文对３２例足月单胎正常妊娠拟行择期剖宫产的初孕妇，于术前３０小时内，以彩色超声多普勒测定胎儿脐动脉（ＵＡ），大脑中动脉（ＭＣＡ）及腹主动脉（ＡｂＡｏ）的血流频谱．即血流阻力指数（ＲＩ），搏动指数（ＰＩ），收缩期峰值（Ｓ）与舒张末期值（Ｄ）的比值（Ｓ／Ｄ）。并于剖宫术胎儿娩出后取脐动、静脉血、测定ＰＨ、ＰＣＯ２及ＰＯ２，观察各种动脉血流频谱与脐血血气间相关性。结果表明：ＵＡ—ＲＩ与脐动脉血气ＰＨ、ＰＣＯ２呈显著的负相关（Ｐ＜０．０１及Ｐ＜０．０５），ＭＣＡ—ＲＩ与脐动脉ＰＨ值呈负相关（Ｐ＜０．０５），与ＰＣＯ２呈明显正相关，（Ｐ＜０．０１），ＡｂＡｏ－ＲＩ与脐动脉血气三项虽呈负相关，但不显著（Ｐ＞０．０５）。提示：产前监测ＵＡ及ＭＣＡ血流频谱，可间接了解胎儿的内环境血气及酸碱情况，能及早的诊断胎儿宫内安危状况。     

羊水过多胎儿血流变化的临床研究

目的探讨羊水过多胎儿血流的变化。方法对１３例足月妊娠羊水过多应用彩色多普勒显像技术（ＣＤＦＩ）检测胎儿肾动脉,大脑中动脉的搏动指数（ＰＩ）、阻力指数（ＲＩ）以及脐动脉Ｓ／Ｄ。结果羊水过多胎儿肾动脉ＰＩ、ＲＩ明显高于正常羊水量对照组（Ｐ＜０．０５）;大脑中动脉ＰＩ、ＲＩ,脐动脉Ｓ／Ｄ值两组比较无显差异（Ｐ＞０．０５）。结论羊水过多与胎儿肾动脉血流有明显相关性,其胎儿肾动脉血流阻力改变在羊水过多中的     

慢性肾脏病患者基于 ２４ ｈ 尿蛋白的尿蛋白肌酐比值 估算方程研究

摘要：目的 分析慢性肾脏病（ＣＫＤ）患者 ２４ ｈ 尿蛋白（２４ｈｕＰ）与尿蛋白肌酐比值（ｕＰＣＲ）的相关性，并基于不同拟合方法建 立简单有效的估算方程。方法 收集 ２０１８ 年 １ 月至 ２０２０ 年 １２ 月我院肾内科住院且病因诊断明确的 ＣＫＤ 患者 ６３６ 例，按性 别、年龄、ＣＫＤ 分期等条件分组，比较各分组条件下 ２４ｈｕＰ 与 ｕＰＣＲ 的相关性；利用简单线性回归、多元线性回归、变量自然对 数（ｌｎ）转换后线性回归，比较不同回归方式下相关性并建立估算方程。结果 相关性分析显示，ＣＫＤ１～ ４ 期，各分期 ２４ｈｕＰ 与 ｕＰＣＲ 相关性差异小（ｒ 为 ０．８５９～ ０．８７８，Ｐ 均＜０．０５），ＣＫＤ５ 期二者相关性（ｒ ＝ ０．７８２，Ｐ＜０．０５）明显较 ＣＫＤ１ ～ ４ 降低；尿肌酐 （ｕＣｒ）分组显示，随着 ｕＣｒ 水平升高，二者相关性升高；病因分组中，原发性肾病、多囊病 ｕＰＣＲ 与 ２４ｈｕＰ 相关性（ｒ ＝ ０．８４５、 ０．８５６，Ｐ＜０．０５）相似，但均低于继发性肾病（ｒ ＝ ０．９６１，Ｐ＜０．０５）。将 ２４ｈｕＰ 作为因变量，ｕＰＣＲ 作为自变量，进行简单线性回归， 相关系数为 ０．７３５（Ｆ＝ ７ ４４１，Ｐ＜０．００１）；将 ２４ｈｕＰ 作为因变量，性别、年龄、胆固醇等作为自变量进行多元线性回归，相关系数 为０．８５８（Ｆ＝ １３５．６５７，Ｐ＜０．００１）；将 ｕＰＣＲ 及 ２４ｈｕＰ 数据经 ｌｎ 转换后，以 ｌｎ（２４ｈｕＰ）为因变量（Ｙ），ｌｎ（ｕＰＣＲ）为自变量（Ｘ）进行 线性回归，Ｙ＝ １．７２９＋０．７８３Ｘ（ｒ ＝ ０．８６３，Ｆ＝ １ ８７１．１６８，Ｐ＜０．００１）。结论 ｕＰＣＲ 与 ２４ｈｕＰ 相关性较好，但应注意 ｕＣｒ 低值或高值 时，ｕＰＣＲ 可能会高估或低估 ２４ｈｕＰ；基于变量 ｌｎ 转换后线性回归，建立了简单有效的 ２４ｈｕＰ 与 ｕＰＣＲ 的估算方程。     

彩色多普勒超声检测妊高征孕妇肾内动脉血流指数的临床应用价值

目的　探讨彩超检测妊高征（ＰＩＨ）孕妇肾内动脉（ＩＲＡ）血流指数的临床应用价值。方法　应用彩超检测４６例ＰＩＨ孕妇ＩＲＡ 的搏动指数（ＰＩ）、阻力指数（ＲＩ）, 并与１８６例正常孕妇进行对照。　结果①ＰＩＨ 孕妇ＩＲＡ的ＰＩ、ＲＩ较正常孕妇明显升高（Ｐ＜ ０．００１）, 且中重度ＰＩＨ孕妇ＩＲＡ的ＰＩ较轻度ＰＩＨ进一步升高（Ｐ＜ ０．００１）; ②ＰＩＨ孕妇ＩＲＡ的ＰＩ、ＲＩ与ＰＩＨ分类（Ｐ＜ ０．００１）、尿蛋白量（Ｐ＜ ０．０１）、平均动脉压（Ｐ＜ ０．０５）成一定程度正相关, 且以ＰＩ的相关性最好。结论　彩超检测ＰＩＨ孕妇ＩＲＡ的Ｄｏｐｐｌｅｒ血流指数对临床观察、治疗ＰＩＨ具有一定的参考意义, 其中ＰＩ可能为更好的观察指标     

肝动脉多普勒血流灌注指数与门静脉逆流的相关性及二者与肝癌肝内转移的关系

目的：探讨肝动脉多普勒血流灌注指数（ＤＰＩ）与门散脉逆流发生率（ＰＶＣＦ）的相关性及二者与肝癌肝内转移伯关系。方法：应用彩色多普勒检测４组不同人群的ＤＰＩ与ＰＶＣＦ;结果：①ＤＰＩ以转移组最高,依次为肝癌组、对照组、肝硬化组（Ｐ〈０．０５￣Ｐ〈０．００１）;ＰＶＣＦ以转移组最高,依次为肝癌组、肝硬化组、对照组（Ｐ〈０．０５￣Ｐ〈０．００１）;②肝癌组与转移组ＤＰＩ与ＰＶＣＦ的相关系数分别为ｒ＝０．     

脓毒血症患者血清白介素2受体及肿瘤坏死因子α表达水平的研究

目的：研究脓毒血症患者血清中可溶性白介素 ２ 受体（ｓＩＬ ２Ｒ）和肿瘤坏死因子 α（ＴＮＦ α）的表达水平及其与该病预后的关系。方法：用单抗与多抗双抗体夹心酶联免疫分析法检测了２９ 例脓毒血症患者血清ｓＩＬ ２Ｒ和ＴＮＦ α表达水平的动态变化,并以３０ 例正常人作为对照。结果：①脓毒血症患者血清ｓＩＬ ２Ｒ及ＴＮＦ α表达水平较正常人明显升高（Ｐ均＜ ０．００１）;②脓毒血症患者中死亡者感染初期及晚期的ｓＩＬ ２Ｒ及ＴＮＦ α水平明显高于存活者（ｓＩＬ ２Ｒ：Ｐ＜ ０．０５;ＴＮＦ α：Ｐ＜ ０．０１）;③ｓＩＬ ２Ｒ与ＴＮＦ α两者表达水平在整个感染过程中呈明显正相关（ｒ１ ＝ ０．６２,Ｐ＜ ０．００１;ｒ２ ＝ ０．８６,Ｐ＜ ０．００１;ｒ３ ＝ ０．８２,Ｐ＜ ０．００２;ｒ４ ＝ ０．８８,Ｐ＜ ０．０５）。结论：脓毒血症患者血清ｓＩＬ ２Ｒ及ＴＮＦ α表达水平明显升高;两者表达水平与该病预后密切相关;该病患者的ｓＩＬ ２Ｒ与ＴＮＦ α分泌水平之间可能存在密切的关系;此两项指标的检测对判断脓毒血症患者的病情及预后有重要意义。     

彩色多普勒血流会聚法对室间隔缺损分流程度的评估研究

本文应用彩色多普勒血流会聚法对２３例单纯室间隔缺损患者的分流程度进行评估，结果表明血流会聚法所测分而率Ｆ与频谱多普勒法所测的每搏分流量Ｑｐ－Ｑｓ及肺体循环血流量之比Ｑｐ／Ｑｓ之间均有极好的相关性（ｒ分别为０．９９和０．８７，Ｐ＜０．００１）。血流会聚区的简化指标ＮＬ×Ｒ及ＮＬ×Ｓ与Ｑｐ－Ｑｓ（ｒ＝０，９０～０．７３，Ｐ＜０．００１）及Ｑｐ／Ｑｓ（ｒ＝０．９３～０．８８，Ｐ＜０．００１）之间的相关性均很好。彩色多普勒血流会聚法能够快速、准确、无创地评估室间隔缺损的分流程度，其简化指标可以简便地对室间隔缺损的分流程度进行评估。     

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.