伊伐布雷定治疗老年射血分数降低性心衰的疗效分析

目的：探讨伊伐布雷定治疗老年射血分数降低性心衰的疗效及对血浆氨基末端脑钠肽前体的影响。方法：选取2018年5月~2020年5月收治的90例老年射血分数降低性心衰患者作为研究对象,采用抽签法分为对照组和观察组,各45例。对照组行常规治疗,观察组在对照组基础上加服伊伐布雷定治疗,均治疗3个月。比较两组患者疗效、心功能指标、血浆氨基末端脑钠肽前体、6 min最大步行距离。结果：观察组治疗总有效率高于对照组（P＜0.05）;治疗后观察组左心室收缩末期内径、左心室舒张末期内径水平均低于对照组,左心室射血分数水平高于对照组（P＜0.05）;治疗后观察组血浆氨基末端脑钠肽前体低于对照组,6 min最大步行距离高于对照组（P＜0.05）。结论：在常规治疗基础上增加伊伐布雷定治疗老年射血分数降低性心衰,能提升治疗疗效,改善心功能,促进血浆氨基末端脑钠肽前体降低、6 min最大步行距离提升。     

运动疗法对慢性心力衰竭患者预后的影响

目的探讨运动疗法对行标准化治疗的慢性心力衰竭患者预后的影响。方法慢性心力衰竭患者54例随机分为运动组和对照组各27例,运动组在标准化治疗基础上进行运动训练治疗,对照组仅进行标准化治疗,随访12个月比较2组治疗效果。结果治疗前2组临床特征、NYHA心功能分级、左室射血分数、6min步行距离、血浆N末端脑钠肽、生存质量评分及药物使用率比较差异均无统计学意义（P〉0．05）;运动训练12个月后,2组左室射血分数、6min步行距离、生存质量评分、NYHA心功能分级、血浆N末端脑钠肽水平比较差异有统计学意义（P〈0．05）;运动疗法与血浆N末端脑钠肽水平较低是再住院和死亡的保护因素;室性心律失常、肾功能不全、伴有慢性肺疾病是再住院和死亡事件发生的促进因素。结论运动疗法可提高心力衰竭患者运动耐量和生活质量,改善患者心功能并明显降低死亡及再住院终点事件发生率。     

康复治疗对重症冠心病患者冠状动脉搭桥术后生活质量的影响

目的观察康复治疗对重症冠心病患者冠状动脉搭桥术后患者生活质量(QOL)的影响。 方法58例拟行冠状动脉搭桥的重症冠心病住院患者随机分为康复组（n=31）和对照组(n=27)。康复组于手术前、后均给予逐渐递增的运动和适当的心理干预治疗,对照组采取常规治疗。2组均于手术前、后采用SF-36量表、6 min步行距离(6MWD)和术后平均住院时间来观察患者生活质量的改善情况。 结果与对照组比较,康复组SF-36量表中躯体功能、一般健康状况、精力、情感职能和心理健康差异有统计学意义（P＜0.01）,康复组6MWD明显高于对照组（P＜0.01）,康复组患者术后平均住院时间较对照组明显缩短（P＜0.01）。 结论康复可以提高重症冠心病患者冠状动脉搭桥术后的生活质量。     

慢性心力衰竭患者血浆脑钠肽水平研究

目的：研究慢性心力衰竭患者血浆脑钠肽水平与左室功能的关系，探讨血浆脑钠肽在慢性心力衰竭的诊断、病情评估中的临床应用价值。方法：对134例慢性心力衰竭患者（CHF组，NYHA心功能Ⅱ～Ⅳ级）及102例健康体检者（正常对照组），采用ELISA法测定血浆脑钠肽水平，应用心脏彩色多普勒超声诊断仪测定左室射血分数、心脏指数，并将CHF组的血浆脑钠肽水平与左室射血分数、心脏指数作相关性分析。结果：CHF组血浆脑钠肽水平显著高于正常对照组（P〈0．01）。CHF组血浆脑钠肽水平随NYHA心功能分级程度的升高而显著增加（P〈0．01），其与左室射血分数、心脏指数呈负相关（P〈0．05）。CHF组患者经正规治疗后，随着心功能改善，血浆脑钠肽水平明显降低（P〈0．05）；NYHA心功能无改善的患者出院时血浆脑钠肽水平明显高于心功能至少改善一级的患者（P〈0．01）。结论：血浆脑钠肽水平能较好地反映慢性心力衰竭患者左室功能状态，其对于慢性心力衰竭的诊断、病情评估具有临床应用价值。     

步行运动训练对慢性充血性心衰患者左室结构和血浆B型脑利钠肽水平的影响

目的 观察步行运动训练对慢性充血性心衰(CHF)患者左心室结构和血浆B型脑利钠肽(BNP)水平的影响,探寻运动训练的意义.方法 将223例心功能分级Ⅱ～Ⅲ级的CHF患者分为处方康复组、非处方康复组和对照组,均给予基础药物治疗,处方康复组和非处方康复组按不同的要求进行康复训练.入选时及6个月随访时对各组进行血压测量、6 min步行距离测量和血浆BNP水平测定,并进行心脏超声检查观察左室射血分数(LVEF)和左室舒张末期内径(LVEDd)的变化.结果 入选时,各组血压、6 min步行距离、左室功能及血浆BNP水平比较,差异均无统计学意义.6个月随访时,处方康复组再次住院例次和其中因心功能恶化再次住院比率明显低于非处方康复组和对照组(P<0.05);与运动训练前及其他2组比较,血浆BNP水平明显下降,6 min步行距离和LVEF明显提高(P<0.01),LVEDd则无明显变化.结论 步行运动训练可改善CHF患者的运动耐力,降低血浆BNP水平,且安全性好,但短期内对左室的重构尚无积极影响.     

步行运动训练对慢性充血性心衰患者左室结构和血浆B型脑利钠肽水平的影响

目的 观察步行运动训练对慢性充血性心衰(CHF)患者左心室结构和血浆B型脑利钠肽(BNP)水平的影响,探寻运动训练的意义.方法 将223例心功能分级Ⅱ～Ⅲ级的CHF患者分为处方康复组、非处方康复组和对照组,均给予基础药物治疗,处方康复组和非处方康复组按不同的要求进行康复训练.入选时及6个月随访时对各组进行血压测量、6 min步行距离测量和血浆BNP水平测定,并进行心脏超声检查观察左室射血分数(LVEF)和左室舒张末期内径(LVEDd)的变化.结果 入选时,各组血压、6 min步行距离、左室功能及血浆BNP水平比较,差异均无统计学意义.6个月随访时,处方康复组再次住院例次和其中因心功能恶化再次住院比率明显低于非处方康复组和对照组(P<0.05);与运动训练前及其他2组比较,血浆BNP水平明显下降,6 min步行距离和LVEF明显提高(P<0.01),LVEDd则无明显变化.结论 步行运动训练可改善CHF患者的运动耐力,降低血浆BNP水平,且安全性好,但短期内对左室的重构尚无积极影响.     

依那普利对老年风湿性心脏病慢性心力衰竭患者LVEF、血浆BNP水平的影响

目的：探讨依那普利对老年风湿性心脏病慢性心力衰竭患者左心室射血分数、血浆脑钠肽水平的影响。方法：选取2016年8月~2019年9月收治的老年风湿性心脏病慢性心力衰竭患者96例,按随机数字表法分成对照组和观察组,各48例。对照组采用卡维地洛治疗,观察组在对照组基础上加用依那普利治疗。对比两组治疗后左心室射血分数、左心室舒张末期容积、左心室收缩末期容积、左室舒张末期内径、血浆B型脑钠肽水平及不良反应发生情况。结果：治疗后,观察组左心室射血分数高于对照组,左心室舒张末期容积、左心室收缩末期容积、左室舒张末期内径、血浆B型脑钠肽水平均低于对照组,差异有统计学意义（P＜0.05）;治疗期间,两组不良反应发生率比较,差异无统计学意义（P＞0.05）。结论：依那普利治疗老年风湿性心脏病慢性心力衰竭患者的疗效显著,可有效改善心功能与血浆脑钠肽水平,且不良反应发生率低。     

芪参益气滴丸联合左西孟旦对射血分数保留性心力衰竭心脏舒张功能的影响

目的：探究芪参益气滴丸联合左西孟旦对射血分数保留性心力衰竭患者心脏舒张功能及心力衰竭生活质量评分的影响。方法：选取2018年11月~2019年12月收治的102例射血分数保留性心力衰竭患者,按照随机数字表法分为研究组和对照组,各51例。对照组采用左西孟旦治疗,研究组采用芪参益气滴丸联合左西孟旦治疗。比较两组临床疗效、治疗前后二尖瓣舒张早期血流速度峰值与舒张晚期血流速度峰值的比值、血浆氨基末端脑钠肽前体水平、心力衰竭生活质量评分、6 min步行距离。结果：研究组总有效率高于对照组（P＜0.05）;治疗后,两组二尖瓣舒张早期血流速度峰值与舒张晚期血流速度峰值的比值、血浆氨基末端脑钠肽前体水平均较治疗前改善,且研究组优于对照组（P＜0.05）;两组心力衰竭生活质量评分、6 min步行距离均较治疗前改善,且研究组优于对照组（P＜0.05）。结论：芪参益气滴丸联合左西孟旦治疗射血分数保留性心力衰竭患者效果显著,可有效改善心脏舒张功能,提高生活质量及运动耐量。     

血浆N一末端脑钠肽前体对射血分数正常心力衰竭患者诊断价值

目的探讨射血分数正常的心力衰竭患者血浆N-末端脑钠肽前体的水平。方法30例射血分数正常的心力衰竭患者（观察组）与30例体检健康者（对照组）均行超声心动图检查,检测并比较2组血浆N-末端脑钠肽前体水平。结果观察组血浆N-末端脑钠肽前体水平明显高于对照组（P〈O．01）;血浆N-末端脑钠肽前体水平与心脏彩超指标舒张早期二尖瓣环运动速度（r=-0．395,P〈0．01）、舒张早期二尖瓣环运动速度／舒张晚期二尖瓣环运动速度（r=-0．292,P〈0．05）、舒张早期二尖瓣血流速度／舒张早期二尖瓣环运动速度（r=-0．529,P〈O．01）呈负相关,与左心房内径（r=0．300,P〈0．05）及左心室后壁厚度（r=0．262,P〈0．05）呈正相关;血浆N-末端脑钠肽前体水平与舒张功能分级、NYHA分级明显相关（P〈O．01）;N-末端脑钠肽前体诊断射血分数正常心力衰竭的AUC为0．702,最佳诊断界值127．58pg／mL,此时灵敏度为63．3％,特异度为83．3％。结论血浆N-末端脑钠肽前体对诊断左室射血分数正常的心力衰竭及评价心力衰竭严重程度有重要价值。     

济生肾气丸合真武汤治疗慢性心力衰竭疗效评价

目的：探究济生肾气丸合真武汤治疗慢性心力衰竭患者的效果。 方法：选取 2017 年 9 月 ~2020 年 1 月收治的慢性心力 衰竭患者 94 例,根据治疗方案不同分为对照组和观察组,各 47 例。 对照组给予西医常规治疗,观察组在对照组基础上加用济生肾 气丸合真武汤。 对比两组疗效,治疗前后心功能指标、 6%min 步行试验距离及血清基质金属蛋白酶 -9 、 N- 末端脑钠肽前体水平。 结 果：观察组总有效率高于对照组（ P ＜0.05 ）;治疗后观察组左室射血分数、每分输出量高于对照组（ P ＜0.05 ）;治疗后观察组 6%min 步行试验距离大于对照组（ P ＜0.05 ）;治疗后观察组血清基质金属蛋白酶 -9 、 N- 末端脑钠肽前体水平低于对照组（ P ＜0.05 ）。 结论： 济生肾气丸合真武汤辅助西医常规治疗慢性心力衰竭患者,可降低血清基质金属蛋白酶 -9 、 N- 末端脑钠肽前体水平,改善心功能 及运动耐力,效果显著。     

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.