奥扎格雷钠治疗急性脑梗死60例分析

目的观察奥扎格雷钠注射液治疗急性脑梗死的临床疗效。方法选择我科收治的急性脑梗死患者114例,随机分为治疗组60例和对照组54例。治疗组给予奥扎格雷钠注射液治疗,对照组给予银杏达莫注射液治疗,连用15d,观察两组患者治疗前后神经功能缺损评分和临床疗效。结果两组患者治疗后7d神经功能缺损评分间差异无统计学意义(P0.05),治疗15d神经功能缺损评分间差异有统计学意义(P0.05)。两组显效率及有效率差异有统计学意义(P﹤0.05)。结论奥扎格雷钠注射液治疗急性脑梗死,有助于神经功能的改善,提高疗效,早期应用可促进神经功能恢复,改善预后。     

丹红注射液联合奥扎格雷钠治疗急性脑梗死临床观察

目的:观察丹红注射液联合奥扎格雷钠治疗急性脑梗死的临床疗效。材料与方法:将80例急性脑梗死确诊病人,随机分为治疗组40例(丹红注射液联合奥扎格雷钠治疗),对照组40例(川芎嗪注射液治疗),14天后观察并比较两组患者神经功能缺损评分、临床疗效及用药期间的不良反应。结果:治疗组总有效率明显高于对照组,为97.5%。结论:丹红注射液联合奥扎格雷钠治疗急性脑梗死有效、安全,且疗效优于川芎嗪注射液。     

丹红注射液联合奥扎格雷钠治疗急性脑梗死疗效观察

目的 评价丹红注射液联合奥扎格雷钠治疗急性脑梗死的疗效.方法 98例脑梗死随机分为治疗组50例及对照组48例.对照组奥扎格雷钠注射液80 mg,1次/d;治疗组在对照组基础上加用丹红注射液20 ml加入氯化钠溶液250 ml静脉滴注.测定两组实验室指标及神经功能缺损评分.结果 在临床疗效、神经功能缺损评分以及降低纤维蛋自原方面比较,治疗组明显优于对照组.结论 丹红注射液联合奥扎格雷钠是治疗急性脑梗死的较好方法.     

依达拉奉联合奥扎格雷钠治疗急性脑梗死120例临床观察

目的观察依达拉奉联合奥扎格雷钠治疗急性脑梗死的临床疗效及其安全性。方法将240例急性脑梗死患者随机分为治疗组和对照组,各120例。治疗组应用依达拉奉联合奥扎格雷钠治疗,对照组单用奥扎格雷钠,于治疗前及治疗后14 d对患者进行神经功能缺损评分并进行疗效比较。结果治疗后14 d治疗组神经功能缺损与对照组比较差异有统计学意义(P<0.05);治疗14 d,治疗组总有效率为93.3%,对照组总有效率为66.7%,2组比较差异有统计学意义(P<0.05)。2组均无不良反应发生。结论 依达拉奉联合奥扎格雷钠治疗急性脑梗死安全有效。     

马来酸桂哌齐特联合奥扎格雷钠治疗急性脑梗死疗效观察

目的:观察马来酸桂哌齐特联合奥扎格雷钠治疗急性脑梗死的疗效及安全性。方法:将82例急性脑梗死患者随机分为两组,联用组予马来酸桂哌齐特与奥扎格雷钠联用;对照组用血栓通针与奥扎格雷钠,治疗前后进行临床神经功能缺损程度评分及临床疗效评定。结果:治疗后两组临床神经功能缺损程度及总有效率比较差异有统计学意义(P<0.05)。结论:马来酸桂哌齐特联合奥扎格雷钠治疗急性脑梗死疗效肯定,用药安全。     

奥扎格雷钠治疗急性脑梗死的临床疗效

目的观察奥扎格雷钠治疗急性脑梗死的临床疗效和安全性。方法采用随机对照方法将110例急性脑梗死患者分为治疗组(奥扎格雷钠组)和对照组,两组分别在治疗前和治疗后14 d进行神经功能缺损评分、临床疗效评定并测定。结果与对照组比较,治疗组患者神经功能缺损评分的降低和临床疗效的改善差异均有统计学意义(P0.05);治疗组治疗后14 d部分凝血功能有显著改善。结论奥扎格雷钠能够降低纤维蛋白原,改善急性脑梗死患者的神经功能缺损,临床疗效显著。     

依达拉奉联合奥扎格雷钠治疗急性脑梗死的疗效分析

目的:探讨依达拉奉联合奥扎格雷钠治疗急性脑梗死的临床疗效。方法:选取2014年1月~2016年1月我院收治的急性脑梗死患者88例,按照随机数字表法分为对照组与观察组各44例。对照组给予奥扎格雷钠治疗,观察组给予奥扎格雷钠联合依达拉奉治疗。比较两组治疗前后神经功能缺损程度、临床疗效及不良反应发生情况。结果:治疗后,在神经功能缺损评分及临床疗效上,观察组均优于对照组(P0.05);两组治疗期间不良反应发生情况无显著性差异(P0.05)。结论:依达拉奉联合奥扎格雷钠治疗急性脑梗死效果显著,可有效改善患者神经功能,且安全性高。     

小牛血清去蛋白注射液联合奥扎格雷钠治疗急性脑梗死疗效观察

目的 观察小牛血清去蛋白注射液联合奥扎格雷钠治疗急性脑梗死的临床疗效.方法 应用小牛血清去蛋白注射液联合奥扎格雷钠治疗急性脑梗死61例,并设对照组61例应用奥扎格雷钠治疗,两组基础治疗相同,连续治疗14 d为1个疗程.结果 小牛血清去蛋白注射液联合奥扎格雷钠治疗急性脑梗死用药前后神经功能缺损评分与对照组比较明显降低(P<0.05 ),总有效率为91.8%,明显高于对照组的77.1% (P< 0.05).结论 小牛血清去蛋白注射液联合奥扎格雷钠治疗急性脑梗死具有较好的临床疗效.     

奥扎格雷钠与银杏达莫联合治疗急性脑梗死45例疗效观察

目的观察奥扎格雷钠与银杏达莫联合用药治疗急性脑梗死的疗效。方法将90例急性脑梗死患者随机分为治疗组45例和对照组45例,治疗组采用奥扎格雷钠与银杏达莫联合进行静脉滴注,对照组单独采用银杏达莫注射液进行静脉滴注,比较两组神经功能评分情况及疗效的比较。结果治疗组神经功能缺损的分值平均水平低于对照组神经功能缺损的水平;治疗组总有效率91.1%明显优于对照组总有效率66.7%(P<0.05)。结论奥扎格雷钠联合银杏达莫对于急性脑梗死患者的治疗疗效较好,适合在临床上推广应用。     

血塞通注射液联合奥扎格雷钠对急性脑梗死患者NIHSS评分及不良反应发生率的影响

目的探讨血塞通注射液联合奥扎格雷钠对急性脑梗死患者神经功能缺损(NIHSS)评分及不良反应发生率的影响。方法选取我院2015年3月~2017年2月收治的急性脑梗死患者84例,按随机数表法分为观察组和对照组各42例。对照组予以血塞通注射液治疗,观察组予以血塞通注射液+奥扎格雷钠治疗。对比两组疗效、NIHSS评分及不良反应发生率。结果观察组总有效率为95.24%显著高于对照组的76.19%,治疗后观察组NIHSS评分显著低于对照组,观察组不良反应发生率为14.29%低于对照组的33.33%,差异有统计学意义(P0.05)。结论血塞通注射液联合奥扎格雷钠联合应用于急性脑梗死患者效果显著,可显著降低其NIHSS评分及不良反应发生率。     

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.