风湿性心脏病并发左心房血栓的危险因素探讨

目的　探讨风湿性心脏病并发左心房血栓的发生率及危险因素。方法　采用非条件Logistic回归模型分析二尖瓣狭窄患者并发左心房血栓的危险因素。结果　风湿性心脏病并发左心房血栓的发生率为 10 .77% ;二尖瓣狭窄、二尖瓣关闭不全、主动脉瓣病变和联合瓣膜病的发生率分别为 15 .6 3%、1.2 5 %、0和 2 .11%。二尖瓣狭窄并发左心房血栓的预测因子是左房自发性超声对比现象 (leftatrialspontaneousechocontrast ,LASEC) (相对危险比3.0 9,P<0 .0 0 0 0 )和房颤 (相对危险比 1.74 ,P =0 .0 0 2 3)。结论　风湿性心脏病二尖瓣狭窄患者最易发生左心房血栓 ;LASEC和房颤是决定二尖瓣狭窄发生左心房血栓的危险因素。二尖瓣狭窄伴房颤、LASEC的患者应积极抗凝治疗     

老年人房颤145例临床分析

目的 :分析老年人心房颤动病因、临床特点、左房内径和抗凝治疗的状况。方法 :对我院 1998-2 0 0 2年共 14 5例老年人心房颤动住院患者的临床资料进行分析。结果 :心房颤动患者中阵发性、持续性和持久性房颤分别占 8 94%、14 62 %、76 3 4% ,高血压病是最常见的病因 ( 5 0 86% ) ,其次是冠心病 ( 2 5 3 4% )、老年性瓣膜病( 10 5 2 % ) ,持久性房颤患者中 65 42 %心功能Ⅲ～Ⅳ级 ,与阵发性房颤相比有较大的左房内径 [( 5 0 94± 12 46)mm ;( 3 3 96± 7 64 )mm ,P <0 0 1]和较低的左室射血分数 [( 69 3± 12 88) % ;( 73 93± 11 0 8) % ,P <0 0 1] ,房颤患者血栓栓塞事件发生率为 3 0 46% ,华法令应用率 2 5 64 % ,而 3 6 84%的患者出院时未接受任何抗凝治疗。结论 :老年人房颤常见原因是高血压病 ,血栓栓塞是房颤的重要并发症 ,抗凝治疗应得到临床医生充分认识和重视。     

左心房血栓与血栓栓塞并发症

目的探讨二尖瓣狭窄合并左心房血栓患者的血栓栓塞发生率及其危险因素。方法观察 5 16例二尖瓣狭窄患者的一般资料、经食管超声心动图检查结果及血栓栓塞发生率 ,并予溶栓治疗和随访。结果二尖瓣狭窄患者在近期 ( 6个月内 )的血栓栓塞发生率为7.3 6% ,左房血栓患者、无左房血栓患者的近期血栓栓塞发生率分别为 2 8.40 %、3 .45 % ( P<0 .0 1)。窦性心律和二尖瓣口面积较大的左房血栓患者血栓栓塞发生率高。华法林治疗后 92 .11%的患者左房血栓溶解 ,随访 6～ 9个月血栓栓塞发生率为 1.3 2 %。结论二尖瓣狭窄合并左心房血栓患者的血栓栓塞发生率高 ;窦性心律和二尖瓣口面积较大的左房血栓患者易发生血栓栓塞。华法林治疗能溶解血栓和降低血栓栓塞发生率。     

青年冠心病患者危险因素分析

目的　探讨 5 0岁以下冠心病患者危险因素 ,对高危青年人的冠心病一级预防提供参考。方法　根据 15 6例冠状动脉造影结果将 5 0岁以下行冠脉造影者分为冠心病组 (89例 )和非冠心病组 (6 7例 ) ,收集临床心血管危险因素资料进行Logistic多因素回归分析。结果　 15 6例冠状动脉造影者中 89例诊断为冠心病 (5 7.1% ) ,6 7例无冠心病(42 .9% )。Logistic多因素回归分析显示冠心病家族史、血浆总胆固醇水平及吸烟为冠心病的独立危险因素 ,其相关系数分别为 0 .6 3、0 .5 0、0 .97,优势比 (OR)分别为 1.0 6、1.6 5、2 .6 4 (P <0 .0 5 )。结论　冠心病家族史、高血浆总胆固醇水平及吸烟是青年人冠心病的发生的高危因素 ,对这类人群应尽早干预。     

血液透析患者与静息性脑梗死的关系

目的　观察血液透析患者静息性脑梗死 (SCI)的发病率及分析其相关危险因素。方法　 70例无症状脑血管疾病的血液透析患者 (HD组 )及 4 0例健康对照者 (对照组 )行头颅核磁共振 (MRI)检查 ,观察SCI的发生率、应用多元logistic回归分析SCI与相关危险因素 ,如慢性肾功能衰竭、高血压、吸烟及年龄等。结果　血液透析患者比健康对照组SCI的发病率明显升高 [2 7例 (38.6 % )对 4例 (10 % ) ,χ2 =10 .6 ,P <0 .0 0 1];所有观察对象经多元logistic回归分析显示 ,SCI的独立危险因素是慢性肾功能衰竭、高血压、吸烟和年龄 (R2 =0 .4 0 7,P <0 .0 0 1) ,而在血液透析患者组 ,年龄及吸烟是SCI的独立危险因素 (R2 =0 .342 ,P <0 .0 0 1) ,血液透析的年限及高血压不是SCI的独立危险因素。结论　维持性血液透析患者慢性肾功能衰竭增加了SCI的发生率 ,而且对于血液透析的患者 ,吸烟和年龄与SCI的发生率密切相关     

不同抗凝强度华法令对非瓣膜性房颤患者的抗栓治疗

目的 探讨不同抗凝强度华法令对非瓣膜性房颤（Af）患者进行抗栓治疗。观察其血栓栓塞事件及其不良反应。方法 117例非瓣膜病Af患者随机分为两组：抗凝强度国际标准化比率（INR）1．6—2．4组（低等强度，67例）和INR2．5～3．0组（中等强度，50例）。观察两组血栓栓塞并发症及出血等不良反应的发生率。结果 INR1．6—2．4组血栓栓塞年发生率为0．75％，INR2．5—3．0组为0，两组比较差异无显著性（P〉0．05）。低强度抗凝组出血不良反应年发生率为0．49％，明显低于中等强度抗凝组的3．74％（P〈0．05），但两组中均无一例为严重出血及其他不良反应。结论 华法令抗凝强度INR1．6—2．4时有一定的血栓栓塞危险。INR2．5—3．0时自发出血危险性增加。     

老年人房颤与NT-ProBNP、左房大小的关系及抗凝现状分析

目的观察老年人房颤与N-末端脑钠肽前体(NT-proBNP)及左房大小的关系,并分析其抗凝现状。方法对120例老年房颤患者的临床资料进行回顾性分析,包括初发、阵发、持续性、持久性、长期持续性房颤患者的NT-proBNP水平、左房内径和抗凝方法。结果 120例老年房颤患者中,初诊房颤占15.0%,阵发性房颤占30.0%,持续性房颤、持久性房颤、长期持续性房颤占55.0%。使用华法林抗凝治疗占41%,房颤发生脑栓塞占9.1%。持续性房颤、持久性房颤、长期持续性老年房颤的患者NT-proBNP明显高于阵发性、初诊房颤患者,其左房内径明显大于阵发性、初诊房颤患者的左房内径。抗凝治疗中华法林组栓塞事件发生率(2.08%)低于阿司匹林组(13.89%),而两组出血事件发生率无显著差异。结论持续性房颤、永久性房颤、长期持续性房颤在老年患者中占主导地位。房颤时间越长,左房内径越大,NT-proBNP也越高。华法林抗凝效果优于阿司匹林,且获益超过出血风险。     

综合超声技术检测非瓣膜性房颤缺血性脑卒中栓子来源的研究

目的研究非瓣膜性心房颤动(房颤)患者缺血性脑卒中可能的栓子来源。方法非瓣膜性房颤患者140例,应用经食管超声心动图(TEE)和外周血管超声技术检测缺血性脑卒中的左房危险因素(左房和/或左心耳内有重度自发声学显影和血栓)、主动脉危险因素(升主动脉和主动脉弓粥样斑块)、颈动脉危险因素(颈动脉复合型粥样斑块)和卵圆孔未闭。结果140例患者中21例(15%)发生缺血性脑卒中。具有左房、主动脉和颈动脉危险因素者分别为61.4%(86/140)、8.6%(12/140)和20.0%(28/140),脑卒中发生率分别为20.9%(18/86)、16.7%(2/12)和39.3%(11/28),同时存在左房和颈动脉危险因素者占14.3%(20/140),脑卒中发生率为50.0%(10/20);无危险因素者占28.6(40/140),脑卒中发生率为2.5%(1/40)。存在危险因素患者脑卒中的发生率明显高于无危险因素者(P<0.05～0.001)。结论左房、主动脉、颈动脉危险因素是房颤患者缺血性脑卒中的主要栓子来源,同时存在多种危险因素,特别是同时存在左房和颈动脉危险因素的房颤患者为脑卒中的高危人群;TEE和外周血管超声为房颤患者栓塞的进一步危险分层提供了精确方法。     

心房颤动患者血栓栓塞危险分层及抗血栓治疗临床分析

目的 分析心房颤动(Af)患者血栓栓塞危险分层及抗血栓治疗的现状.方法 调查航天中心医院2001 ～2010 年Af 患者467 例.(1)应用ACC/AHA/ESC 心房颤动指南血栓栓塞危险分层标准对患者进行血栓栓塞危险评估.(2)对抗栓治疗与未抗栓治疗的患者的脑梗死发病率进行分析.结果 (1)对467 例Af 患者进行血栓栓塞危险评估,符合抗血栓指征的患者467 例,其中仅214 例(45.82%)抗栓治疗.未抗栓组发生脑梗死的比率为35.97%,抗栓组发生脑梗死的比率为4.21%,两组比较差异有统计学意义(P ＜0.01).(2)由低危至极高危组梗死率依次增高.结论 Af患者抗栓治疗率低,治疗不规范,依从性差,抗栓治疗的教育和管理有待加强;Af 患者血栓栓塞危险性越高,脑梗死发病率越高,抗栓治疗越有意义.     

慢性乙型肝炎肝硬化患者门静脉血栓形成危险因素及抗凝治疗效果分析

目的分析慢性乙型肝炎肝硬化患者门静脉血栓(PVT)形成危险因素及抗凝治疗效果。方法选取2015年1月至2017年12月该院收治的86例慢性乙型肝炎肝硬化患者作为研究对象,回顾性分析所有患者的临床及随访资料,根据其资料结果记录所有患者性别、年龄及疾病情况,以及抗凝治疗方法、治疗效果及其PVT形成情况,比较发生和未发生PVT的患者上述资料的差异,分析影响慢性乙型肝炎肝硬化患者PVT形成的相关危险因素。结果 (1)86例慢性乙型肝炎肝硬化患者中16例并发PVT,发生率为18.60%,16例PVT患者分为抗凝治疗组(6例)和未抗凝治疗组(10例),随访1年期间抗凝治疗组出现食管胃底静脉曲张破裂出血3例(50.00%),未抗凝治疗组3例(30.00%),抗凝治疗组和未抗凝治疗组出现食管胃底静脉曲张破裂出血比较,差异无统计学意义(χ~2=0.640,P=0.424)。(2)经非条件单因素Logistic回归分析显示,高血小板、低清蛋白、存在糖尿病病史、有脾脏切除史及门静脉主干宽度增加均为导致慢性乙型肝炎肝硬化患者发生PVT的可能危险因素(P0.05)。(3)经进一步非条件多因素Logistic回归分析显示,血小板计数增加及门静脉主干宽度增厚均为慢性乙型肝炎肝硬化患者并发PVT的独立危险因素(P0.05)。结论血小板计数增加及门静脉主干增厚均为导致慢性乙型肝炎肝硬化患者并发PVT的独立危险因素,而相关抗凝治疗不会加大其出血概率,可适当予以治疗。     

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.     

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.     

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.     

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."