血清神经元特异性烯醇化酶对于老年急性脑出血患者的临床意义

目的探讨老年急性脑出血患者血清神经元特异性烯醇化酶(NSE)与出血部位、出血量、神经功能缺损及预后之间的关系。方法选择发病在24 h内老年急性脑出血患者105例,选93例同期健康体检者作为对照组,采用酶联免疫分析法测定两组NSE浓度,按SSS标准评定神经功能缺损及预后,出血量以入院时CT显示计。结果急性脑出血组血清NSE水平与出血部位无明显关系(P>0.05)。急性脑出血组血清NSE水平[少量出血(13.81±3.95)μg/L、中量出血(18.74±4.32)μg/L、大量出血(25.19±3.07)μg/L]显著高于对照组[(8.62±2.64)μg/L],P<0.05。急性脑出血组血清NSE水平与出血量成正比(P<0.05)。急性脑出血组血清NSE水平与神经功能缺损程度呈正相关(r=0.926,P<0.05)。结论血清NSE能够反映神经组织的损害程度,可作为老年急性脑出血病情判断及预后评估的参考指标。     

依达拉奉治疗急性脑出血的疗效分析

目的探讨依达拉奉对急性脑出血患者血清肿瘤坏死因子α(TNF-α)和白细胞介素-1(IL-1)水平的影响,并观察其治疗效果。方法将首次发病的急性脑出血患者90例,按病例对照研究方法随机分为对照组45例、治疗组45例,对照组是采用常规治疗,治疗组是在常规治疗基础上加用依达拉奉注射液30 mg+0.9%氯化钠注射液100 m L静脉滴注,2次/d,共14 d。比较两组患者于治疗前、后神经功能缺损程度(NIHSS)及日常生活活动量(ADL)评分,并进行疗效评定,检测患者血清TNF-α、IL-1水平的变化。结果治疗组在治疗后14 d NIHSS评分[(11.57±1.82)分]及ADL评分[(54.84±4.18)分]与对照组[(16.82±2.27)分、(45.13±3.93)分]相比,差异有统计学意义(均P0.05);治疗组临床疗效明显优于对照组(P0.05),其神经功能缺损程度明显改善,日常生活能力明显提高。治疗后,治疗组TNF-α[(13.06±2.90)ng/L]、IL-1[(4.31±2.23)ng/L]水平较对照组[(18.96±3.04)ng/L、(9.76±2.67)ng/L]比较,差异有统计学意义(均P0.05)。结论依达拉奉能减轻脑出血后炎性反应、清除自由基、改善神经功能缺损。     

糖尿病患者超敏C反应蛋白和白细胞介素6的应用研究

目的 探讨血清超敏C反应蛋白(hs-CRP)和血清白细胞介素6(IL-6)在糖尿病并发动脉粥样硬化的临床价值。方法 用岛津7200生化分析仪胶乳增强免疫比浊法检测血清hs-CRP,一步法检测低密度脂蛋白胆固醇(LDL-C);采用ELISA双抗体夹心法测定血清IL-6。结果 糖尿病患者LDL-C升高组,血清hs-CRP浓度为(6.81±3.32)mg/L,IL-6为(17.2±5.6)ng/L,两者呈显著正相关,r=0.61;P<0.01。糖尿病患者LDL-C正常组hs-CRP为(3.81±1.86)mg/L,IL-6为(9.2±3.9)ng/L,呈明显正相关,r=0.46,P<0.01。健康组血清hs-CRP为(0.76±0.65)mg/L,血清IL-6为(5.8±2.1)ng/L,r=0.136,两者无明显相关性(P>0.05)。结论 糖尿病患者血清IL-6参与诱导肝急性时相蛋白(CRP)的合成,并共同参与糖尿病动脉粥样硬化的病理过程。     

急性脑出血患者血清IL-6和TGF-β_1含量变化及临床分析

目的使用双抗体夹心法检测36例急性脑出血患者(试验组)血清内IL-6和TGF-β1在第1、3、7、14d时的含量变化情况,与正常人(对照组)血清IL-6和TGF-β1浓度水平对比分析二者的动态及临床意义。方法试验组分别于发病的第1、3、7、14d的早晨采集空腹状态下的静脉血,健康体检者于体检当天早上空腹采血。结果 (1)试验组在病程的第1、3、7d,血清TGF-β1的含量水平明显低于对照组(P<0.05),而血清IL-6的含量水平则表现出明显高于对照组(P<0.05),第14d二者在血清中含量趋于正常水平(P<0.05),并且血清IL-6的浓度在病程第1d达到峰值(P<0.05),血清TGF-β1的浓度在病程第3d低至谷值(P<0.05);(2)急性脑出血患者的血清IL-6水平与出血量的多少和神经功能缺损程度均表现出正相关(P<0.05),不同出血量和不同程度的神经功能缺损患者之间的血清TGF-β1水平无显著区别(P>0.05);(3)急性脑出血患者中血清IL-6和TGF-β1含量水平无明显相关性(P>0.05)。结论血清IL-6和TGF-β1的浓度变化与急性脑出血的发生有密切关系,血清IL-6的浓度检测对判断急性脑出血患者的严重程度及治疗的预后观测具有一定的临床意义。     

急性脑梗死患者血清白细胞介素-6和转化生长因子β1含量变化与神经功能缺损

目的:探讨白细胞介素-6(IL-6)和转化生长因子β1(TGF-β1)在脑梗死的发病过程中所起的作用、临床意义及二者的相关性。方法:采用双抗体夹心ELISA法对30例急性脑梗死患者在起病后第1,3,7,14天连续检测IL-6,TGF-β1浓度。结果:脑梗死组在病程1,3,7d3个时间点上血清IL-6水平犤(55.91±23.74),(10.33±1.61),(9.29±1.68)ng/L犦升高,与正常对照组(2.86±0.86)ng/L相比,差异有显著性意义(F=73,P<0.05)。TGF-β1水平减低,与正常对照组相比,差异有显著性意义(F=106,P<0.05)。至14d,血清IL-6(4.39±1.49)ng/L,TGF-β1(40.83±8.90)μg/L则均接近正常水平。脑梗死患者血清IL-6水平与梗死面积大小呈正相关(P<0.05),而血清TGF-β1水平与梗死面积大小无关(P>0.05)。神经功能受损程度与血清IL-6水平呈正相关(P<0.05)。而与TGF-β1水平无关(P>0.05)。IL-6水平与TGF-β1水平无明显相关性(r=0.289,P>0.05)。结论:IL-6,TGF-β1与脑梗死的病理生理过程密切相关。IL-6浓度测定对判断脑梗死的病情严重程度具有一定意义。     

血清超敏C反应蛋白和白介素-6在脑梗死患者中的应用

目的探讨脑梗死(CI)患者血清超敏C反应蛋白(hsCRP)和白介素-6(IL-6)水平的变化,及其与脑梗死严重程度的关系。方法检测86例脑梗死患者血清hsCRP和IL-6水平,并分析其与脑梗死患者神经功能损伤程度的相关性。选取60例健康体检者作为对照。采用免疫比浊法检测hsCRP,用ELISA双抗体夹心法测IL-6。结果脑梗死患者血清hsCRP浓度为15.48±2.87mg/l,IL-6水平为20.23±4.86ng/l,明显高于对照组(P<0.01)。健康对照组hsCRP为2.48±0.52mg/l,IL-6水平为8.56±2.38ng/l。血清hsCRP和IL-6水平与脑梗死患者神经功能损伤程度呈正相关(P<0.01),重型患者明显高于轻、中型患者,差异均有显著意义。结论脑梗死患者血清hsCRP和IL-6明显升高,而且与患者神经功能损伤程度呈正相关。hsCRP和IL-6水平升高为脑梗死患者发病的两个危险因素。     

血清同型半胱氨酸及白细胞介素-6和超敏C-反应蛋白在急性脑卒中病程中的变化及其意义

目的 观察血清同型半胱氨酸(Hcy)及白细胞介素-6(IL-6)、超敏C-反应蛋白(hs-CRP)在不同病情程度急性脑卒中(AS)患者中的差异.方法 选择AS患者126例.按临床神经功能缺损程度评分标准进行病情程度及预后分组.分别测定发病后第3、14、28天血清Hcy、IL-6、hs-CRP浓度.选择同期健康体检者108名作为对照组.结果 ①AS组血清Hcy、IL-6和hs-CRP水平明显高于健康对照组[(58.24±9.86)、(17.12±4.23)μmol/L,(59.64±13.82)、(18.46±4.62)ng/L,(19.78±6.12)、(2.28±0.82)mg/L,t值分别为2.623、2.761、3.746,P均＜0.01];②发病第3天重、中、轻型AS组血清Hcy、IL-6、hs-CRP水平均高于健康对照组(P均＜0.01),且重型组、中型组高于轻型组(P均＜0.01);发病第14天重型组与中型组高于轻型组及健康对照组(P均＜0.01);发病第28天重型组高于中、轻型组及健康对照组(P均＜0.01).③发病第28天基本治愈组与显著进步组较无变化组的血清Hcy、IL-6、hs-CRP水平明显降低[(16.12±4.74)、(18.42±5.02)、(48.69±7.89)μmol/L,(19.52±5.67)、(20.74±6.13)、(51.26±11.66)ng/L,(3.21±1.36)、(3.24±2.51)、(8.86±1.32)mg/L,P均＜0.01].结论 血清Hcy、IL-6、hs-CRP是临床评价AS严重程度和预后的重要生物学指标.     

急性加重期COPD患者血清TNF-α、IL-6和CRP变化及意义

【目的】探讨慢性阻塞性肺病(COPD)急性加重期患者血清TNF-α、IL-6和CRP的含量变化及临床意义。【方法】分别检测38例COPD急性加重期患者治疗前后血清TNF-α、IL-6、CRP的含量变化,并以26例健康体检者作对照。【结果】COPD急性加重期患者治疗前血清TNF-α、IL-6、CRP水平分别为(38.29±13.53)ng/L、(49.71±15.39)ng/L、(61.18±28.75)mg/L,明显高于治疗后[(15.58±8.78)ng/L、(18.26±10.33)ng/L、(8.21±1.98)mg/L](均P<0.01);且治疗前血清TNF-α、IL-6、CRP水平较正常对照组显著增高(P<0.01);治疗后血清TNF-α、IL-6水平仍高于正常对照组(P<0.05)。【结论】动态监测血清TNF-α、IL-6、CRP变化对于评价COPD急性加重期患者病情具有一定的临床意义。     

测定急性脑血管病患者血清白介素-8的临床意义

目的　了解急性脑血管病患者血清白介素-8(IL-8)改变的意义。方法　采用ELISA方法测定了74例急性脑血管病患者(40例脑出血,34例脑梗死)和30例健康对照者的血清IL-8含量。结果　急性脑血管病患者血清IL-8水平(10728±3816ng/L),明显高于正常对照组(5135±1329ng/L)。急性脑出血和急性脑梗死组患者血清IL-8水平(11332±3955ng/L和9773±4388ng/L)均明显高于正常对照组,而它们之间则无明显差别。结论　急性脑血管病患者急性期血清IL-8水平明显升高,提示IL-8可能参与了急性脑血管病的发病过程。     

血清超敏C反应蛋白和白介素-6在脑梗死患者中的应用

目的 探讨脑梗死(CI)患者血清超敏C反应蛋白(hsCRP)和白介素-6(IL-6)水平的变化,及其与脑梗死严重程度的关系.方法 检测86例脑梗死患者血清hsCRP和IL-6水平,并分析其与脑梗死患者神经功能损伤程度的相关性.选取60例健康体检者作为对照.采用免疫比浊法检测hsCRP,用ELISA双抗体夹心法测IL-6.结果 脑梗死患者血清hsCRP浓度为15.48±2.87 mg/l,IL-6水平为20.23±4.86 ng/l,明显高于对照组(P＜0.01).健康对照组hsCRP为2.48±0.52 mg/l,IL-6水平为8.56±2.38 ng/l.血清hsCRP和IL-6水平与脑梗死患者神经功能损伤程度呈正相关(P＜0.01),重型患者明显高于轻、中型患者,差异均有显著意义.结论 脑梗死患者血清hsCRP和IL-6明显升高,而且与患者神经功能损伤程度呈正相关.hsCRP和IL-6水平升高为脑梗死患者发病的两个危险因素.     

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.     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.