阿魏酸钠联合甲钴胺治疗糖尿病周围神经病变的 疗效观察

目的:观察阿魏酸钠联合甲钴胺治疗2型糖尿病周围神经病变(DPN)的临床疗效。方法:将78例DPN患者随机分为对照组和观察组,各39例。对照组给予甲钴胺(0.5 mg)肌注治疗,1次/日;观察组给予阿魏酸钠(300 mg)静脉滴注联合甲钴胺(0.5 mg)肌注治疗,1次/日;2组均治疗14 d。比较2组治疗前、后运动神经传导速度(MCV)和感觉神经传导速度(SCV)及有效率。结果:治疗后,2组正中神经和腓总神经的MCV和SCV均较同组治疗前提高(P0.05),且观察组正中神经和腓总神经的MCV和SCV快于对照组(P0.05)。对照组的总有效率为56.41%,低于观察组的87.18%(P0.05)。结论:阿魏酸钠与甲钴胺联合治疗能有效增强甲钴胺治疗DPN的临床疗效。     

鼠神经生长因子治疗腕管综合征电生理疗效观察

目的:探讨鼠神经生长因子(NGF)对腕管综合征(CTS)的治疗作用。方法:CTS患者69例随机分为2组,对照组(35例)给予甲钴胺治疗4周,治疗组(34例)给予甲钴胺联合鼠NGF治疗4周;于治疗前后行电生理检查,评价治疗效果。结果:治疗组总有效率为88.2%,高于对照组68.6%(P0.05)。治疗后,指1及指3感觉神经传导速度(SCV)均高于同组治疗前(均P0.05),且治疗组高于对照组(均P0.05);治疗后,治疗组运动神经复合肌动作电位(CMAP)潜伏期明显短于治疗前(P0.05),且短于对照组治疗后(P0.05);2组治疗后指1、指3感觉神经动作电位(SNAP)波幅及CMAP波幅也均有所增高,但差异无统计学意义(均P0.05)。结论:应用甲钴胺联合鼠NGF治疗腕管综合征有较好效果。     

丁咯地尔联合甲钴胺治疗糖尿病周围神经病变疗效观察

目的 观察丁咯地尔联合甲钴胺治疗糖尿病周围神经病变(DPN)的疗效.方法 62例DPN患者随机分为治疗组和对照组各31例,治疗组给予丁咯地尔联合甲钴胺治疗,对照组仅给予甲钴胺治疗.测定两组患者治疗前后正中神经和腓总神经的运动神经传导速度(MCV)和感觉神经传导速度(SCV).结果 治疗后治疗组和对照组的MCV和SCV分值均比治疗前改善(P＜0.05),治疗组比对照组改善更明显.结论 丁咯地尔联合甲钴胺治疗DPN优于单纯甲钴胺治疗.     

前列地尔、硫辛酸联合西洛他唑治疗糖尿病周围神经病变疗效观察

目的:观察前列地尔、硫辛酸和西洛他唑3药联合使用对糖尿病周围神经病变(DPN)的疗效。方法:DPN患者76例,随机分为对照组和治疗组各38例,在糖尿病基础治疗基础上,对照组给予前列地尔和硫辛酸治疗,治疗组给予前列地尔、硫辛酸和西洛他唑3药联用。于治疗前和治疗4周后,检测并分析2组运动神经传导速度(MCV)、感觉神经传导速度(SCV)、运动神经复合肌动作电位(CMAP)波幅、CMAP潜伏期和感觉神经动作电位(SNAP)波幅的变化和神经病变主觉症状问卷(TSS)评分。结果:治疗前,2组TSS评分、神经传导速度、CMAP波幅、CMAP潜伏期和SNAP波幅无统计学差异(P>0.05);治疗后,2组TSS评分和CMAP潜伏期均低于治疗前,且治疗组低于对照组(P<0.01);2组MCV、CMAP波幅、SNAP波幅和SCV均较治疗前提高(P<0.01),且治疗组优于对照组(P<0.05)。结论:前列地尔、硫辛酸和西洛他唑3药联用治疗DPN疗效好于前列地尔、硫辛酸2药联用。     

神经松动术联合甲钴胺治疗轻中度腕管综合征的临床疗效及电生理观察

目的观察神经松动术联合甲钴胺治疗轻、中度腕管综合征（CTS）的疗效。 方法采用随机数字表法将60例早期CTS患者分为对照组及神经松动组。对照组单纯给予甲钴胺口服治疗,神经松动组在甲钴胺治疗基础上辅以神经松动术治疗。于治疗前、治疗2周、治疗4周后分别采用视觉模拟评分（VAS）、整体症状评分（GSS）对2组患者疗效进行评定,同时于上述时间点对2组患者腕部正中神经进行电生理检查,检查指标包括正中神经远端潜伏期（DML）、拇指-腕及中指-腕感觉传导速度(SCV)、拇指-腕和中指-腕感觉神经动作电位波幅（SNAP）、正中神经复合动作电位波幅（CMAP）及正中神经运动传导速度(MCV)等。 结果治疗2周及治疗4周后,神经松动组患者疼痛VAS评分［分别（3.95±1.87）分、（3.29±1.51）分］、GSS评分［分别为（14.63±4.76）分、（11.62±4.21）分］、正中神经电生理检查结果均较治疗前明显改善（P<0.05）;治疗2周后神经松动组患者疼痛VAS评分较对照组明显改善（P<0.05）;治疗4周后神经松动组患者GSS评分及正中神经各项电生理指标均显著优于对照组水平（P<0.05）。 结论神经松动术联合甲钴胺治疗轻、中度CTS患者的疗效显著优于单纯甲钴胺口服治疗,电生理检查能客观评价神经松动术治疗轻、中度CTS患者的临床疗效。     

艾灸按摩联合甲钴胺治疗糖尿病周围神经病变的疗效观察——附24例报告

目的：观察艾灸按摩联合甲钴胺治疗糖尿病周围神经病变（DPN）的疗效。方法：48例DPN患者随机分为治疗组和对照组各24例,均使用基础治疗2周,然后在原有的基础治疗方案上,治疗组给予甲钴铵联合艾灸按摩治疗,对照组则仅予甲钴铵治疗,测定两组患者治疗前后正中神经和腓总神经的运动神经传导速度（MCV）和感觉神经传导速度（SCV）,使用多伦多临床评分系统（TcSS）对治疗前后的DPN临床症状进行评价,比较两组上述指标。结果：治疗后治疗组和对照组的MCV、SCV和TCSS分值均比治疗前改善（P均〈0．05）,其中治疗组比对照组改善更为明显。治疗过程中两组均未发现明显不良反应,治疗组患者皮肤均无损害。结论：艾灸联合甲钴胺治疗DPN优于单纯甲钴胺治疗,且安全性高。     

葛根素与甲钴胺联合治疗糖尿病周围神经病变疗效观察

目的:观察葛根素与甲钴胺联合治疗糖尿病周围神经病变(DPN)的疗效。方法:选择94例DPN患者,随机分成葛根素与甲钴胺联合治疗组48例和单用甲钴胺治疗对照组46例。治疗组用葛根素注射液300mg加入0.9%氯化钠250mL中静脉滴注,每日1次,同时予甲钴铵注射液500μg加入生理盐水250mL中静滴,共6周;对照组予甲钴铵注射液500μg加入生理盐水250mL中静滴,共6周。观察两组治疗后的临床效果及腓、尺神经运动神经传导速度(MCV)和感觉神经传导速度(SCV)变化。结果:治疗组总有效率为89.58%,明显高于对照组的67.39%(P<0.01);两组的神经传导速度均明显改善,且以治疗组改善更为明显(P<0.05)。结论:葛根素与甲钴胺联合治疗DPN较单用甲钴胺治疗效果更显著,更有利于患者的症状改善和神经传导速度提高。     

硫酸锌联合甲钴胺治疗糖尿病周围神经病变的临床观察

目的探讨硫酸锌和甲钴胺单独应用及二者联合应用治疗糖尿病周围神经病变(DPN)的临床效果。方法选取DPN患者105例,随机分为硫酸锌组、甲钴胺组合联合组,每组35例,3组患者均给予控制血糖、血压等糖尿病综合治疗。分别应用硫酸锌片、甲钴胺片及硫酸锌片联合甲钴胺片治疗DPN,观察患者临床症状及体征,测定患者治疗1月后正中神经和腓总神经的运动传导速度(MNCV)和感觉传导速度(SNCV)。结果治疗后,联合组正中神经和腓总神经的MNCV均显著高于硫酸锌组和甲钴胺组(P0.05);联合组正中神经SNCV显著高于硫酸锌组和甲钴胺组(p0.05),联合组腓总神经的SNCV与硫酸锌组和甲钴胺组比较差异无统计学意义(P=0.259)。联合组临床总有效率显著高于其他2组(P=0.002)。结论硫酸锌联合甲钴胺片治疗DPN对正中神经和腓总神经MNCV及正中神经的SNCV改善程度要优于单独应用硫酸锌和甲钴胺片。     

鼠神经生长因子联合甲钴胺治疗糖尿病周围神经病的疗效及安全性观察

目的:观察鼠神经生长因子(m NGF)联合甲钴胺治疗糖尿病周围神经病变(DPN)的疗效及安全性。方法:选择2型糖尿病DPN患者108例,随机分为观察组和对照组,每组54例。2组均接受控制饮食、血糖监测等糖尿病综合诊疗,在此基础上对照组给予甲钴胺治疗,观察组则给予甲钴胺加用m NGF治疗,均连续治疗4周。采用肌电图仪测量2组治疗前后正中神经、腓总神经、胫神经的运动传导速度(MNCV)和感觉传导速度(SNCV);应用多伦多临床评分系统(TCSS)进行神经病变严重程度评分;采用免疫比浊法测定2组治疗前后血浆超敏C反应蛋白(hs-CRP)水平;观察2组患者的疗效和治疗期间的不良反应。结果:观察组总有效率高于对照组(P0.05);与治疗前比较,2组治疗后正中神经、腓总神经、胫神经MNCV及SNCV均明显增加(P0.05),但观察组腓总神经MNCV、正中神经和胫神经SNCV提高幅度高于对照组(P0.05);与治疗前比较,2组治疗后TCSS评分及hs-CRP水平均明显下降(P0.05),但观察组降幅大于对照组(P0.05)。2组均未出现严重不良反应。结论:m NGF联合甲钴胺治疗DPN有明显疗效,安全性高。     

甲钴胺联合前列地尔治疗糖尿病周围神经病变的疗效及安全性

目的探讨甲钴胺联合前列地尔治疗糖尿病周围神经病变(DPN)的疗效及安全性。方法选取DPN患者138例,随机分为A、B、C 3组,每组46例。在常规治疗基础上,A组给予前列地尔注射液,B组给予甲钴胺注射液,C组给予前列地尔注射液联合甲钴胺注射液,疗程均为14 d。观察3组临床疗效和不良反应发生率,比较3组治疗前后神经传导速度和神经病变症状总评分(TSS)。结果 A、B、C 3组总有效率(ORR)分别为76.09%、73.91%、91.30%,C组ORR显著高于其他组(P0.05)。治疗后,3组TSS均显著低于治疗前(P0.01),运动神经传导速度(MCV)和感觉神经传导速度(SCV)均显著高于治疗前(P0.05或P0.01),且C组升高程度高于其他组(P0.01)。3组不良反应发生率比较无显著差异(P0.05)。结论在治疗DPN方面,甲钴胺联合前列地尔的临床疗效优于两药单用,且不良反应少,安全性高。     

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.     

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.     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

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.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.