纳络酮与尿激酶联合治疗急性心肌梗死临床观察

目的 探讨纳络酮与尿激酶联合治疗急性心肌梗死(AMI)的临床疗效.方法 将112例ST段抬高的AMI患者随机分成络酮组(58例)和对照组(54例).对照组应用尿激酶(UK)150万u溶于生理盐水100ml中静滴,30 min滴完.纳络酮组在溶栓前给以纳络酮2 mg静脉推注,然后以0.01 mg/(kg·min)速度持续静脉泵注,溶栓方法 同对照组.各组在溶栓前常规记录18导联心电图,查血常规、血小板、出凝血时间、心肌酶,观察胸痛缓解时间,血清CPK峰值提前时间,比较两组再通情况和不良反应出现情况.结果 纳络酮组再通成功率明显高于对照组(P＜0.001),纳络酮组副作用发生率明显低于对照组(P＜0.05).对照组死亡3例,纳络酮组无死亡者.结论 纳络酮可提高ST段抬高的AMI患者溶栓再通成功率,减少溶栓后并发症的发生.纳络酮在ST段抬高的AMI患者的溶栓治疗中起着比较重要的作用.     

延髓腹外侧区在电针内关穴抗急性心肌缺血中的作用

目的探讨延髓腹外侧区(VLM)在电针内关穴改善家兔急性缺血心肌细胞动作电位影响中的作用。方法在电针内关穴对家兔急性心肌缺血(AMI)保护作用的基础上，进一步观察VLM贴敷纳络酮阻断后电针内关穴对缺血心肌细胞动作电位的影响。结果VLM阻断组分别与假手术组、急性心肌缺血组及VLM假阻断组比较，在各个时段的ST段电位均有明显升高，MAPA、MAPD50、MAPD90均有明显降低，差异有统计学意义(P＜O．05)。结论VLM贴敷纳络酮阻断后，电针内关穴治疗家兔AMI时，心电图sT段电位及心肌细胞动作电位MAPA、MAPD50、MAPD90恢复的时程延长，电针内关穴对缺血心肌的保护作用减弱。     

通心络胶囊对心肌梗死冠状动脉介入治疗患者术后再狭窄的疗效评价

目的 探讨通心络胶囊对经皮冠状动脉(冠脉)介入治疗(PCI)后患者的影响.方法 将80例PCI患者按随机原则分为两组.对照组(38例)术后使用β受体阻滞剂、他汀类、硝酸酯类药物;试验组(42例)在对照组用药基础上加服通心络胶囊0.52 g,每日3次.两组均连用6个月.随访6个月,观察6个月内急性心肌梗死(AMI)、心绞痛、心源性休克、冠脉再狭窄等并发症的发生率及血常规、血脂及肝肾功能的变化.结果 对照组发生AMI 2例(5.3%),心绞痛8例(21.1%),冠脉再狭窄3例(7.9%),无心源性休克;试验组4个并发症发生例数均为0,两组差异显著(P<0.05或P<0.01).试验组治疗后1、3和6个月总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平均较治疗前及对照组显著降低(均P<0.01);治疗3个月、6个月三酰甘油(TG)较治疗前及对照组明显降低(均P<0.05).两组治疗后高密度脂蛋白胆固醇(HDL-C)有逐渐升高趋势,血小板计数(PLT)有轻度降低,但差异均无统计学意义(均P>0.05).两组治疗前后肝肾功能无明显改变(均P>0.05).结论 使用通心络胶囊对PCI患者疗效显著,副作用小.     

通心络胶囊对急性心肌梗死后CRP及心室重构的影响

目的:观察通心络胶囊对急性心肌梗死(AMI)病人CBP及心室重构的影响.方法:将76例急性心肌梗死患者分为治疗组39例,对照组37例.2组均予以常规基础治疗,治疗组加服通心络胶囊.在治疗前、治疗14d检测血清CRP含量,并检查2组治疗前及治疗4周结束时后左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD)和左室射血分数(LVEF).结果:2组治疗后血清CRP含量、EDVI、ESVI、EF和WMSI较治疗前均有显著改善(均P＜0.01).2组治疗后各项指标比较,差异具有临床统计学意义(P＜0.01).结论:通心络胶囊联合常规治疗能明显降低急性心肌梗死患者的血清CRP水平,并可抗心肌梗死后心室重构.     

通心络胶囊在急性心肌梗死PCI术后患者中的应用价值

目的：研究基于脉络学说“孙络-微血管”理论应用通心络胶囊对急性心肌梗死（AMI）行经皮冠状动脉介入治疗（PCI）术后患者心肌微循环、心功能及炎症水平的影响。方法：选取2021年4月至2023年1月106例AMI行PCI术后患者随机分为对照组和观察组各53例,对照组给予基础治疗,观察组在对照组的基础上增加通心络胶囊治疗。4周后,对比两组临床疗效、心肌微循环、心功能、炎症水平和不良反应发生情况。结果：治疗后,观察组心肌梗死溶栓试验（TIMI）分级、心肌再灌注分级（MBG）均优于对照组,校正的TIMI帧数（CTFC）低于对照组（P<0.05）;观察组每搏心输出量（SV）、左心室射血分数（LVEF）、左心室收缩末期容积（LVEDV）水平均高于对照组（P<0.05）;观察组肿瘤坏死因子-α(TNF-α)、C反应蛋白（CRP）和白细胞介素-6(IL-6)水平均低于对照组（P<0.05）;观察组治疗总有效率高于对照组（P<0.05）;两组均未发生明显不良反应。结论：基于脉络学说“孙络-微血管”理论应用通心络胶囊能够有效改善AMI行PCI术后患者心肌微循环,保护心功能,减轻炎症...     

急性心肌梗塞合并完全性心脏传导阻滞的预后

急性心肌梗塞(AMI)伴完全性心脏传导阻滞(CHB)的住院期存活率下降。前壁AMI伴CHB的预后比下壁AMI伴CHB更差。作者分析4762例AMI,急性期CHB发生率5.8%其中下/后壁AMI发生率比前壁AMI多1     

老年心肌梗死伴消化道出血患者临床特点的研究

目的分析老年急性心肌梗死(AMI)伴消化道出血患者的临床特点。方法将280例老年AMI患者根据有无发生消化道出血及消化道出血与AMI的先后顺序分为3组,即AMI后消化道出血组(28例)、消化道出血后AMI组(12例)及未发生消化道出血的AMI患者(240例,对照组)。观察比较3组患者临床基本特征及治疗方法。所有患者均随访1年,观察3组患者终点事件(再发心绞痛、心力衰竭、脑卒中而住院及再次发生AMI、心源性休克、心力衰竭恶化和猝死而死亡)的发生情况。结果 3组患者性别、年龄、BMI、高血压、糖尿病及消化道病史等比较差异均无统计学意义(均P>0.05)。AMI后消化道出血组肾小球滤过率(EGFR)为(62.0±8.0)mL·min-1·1.73m-2,消化道出血后AMI组为(58.2±4.8)mL·min-1·1.73m-2,对照组为(77.2±12.0)mL·min-1·1.73m-2,前2组的EGFR均明显低于对照组(均P<0.05)。AMI后消化道出血组、消化道出血后AMI组氯吡格雷使用率明显高于阿司匹林(均P<0.05);PPI使用率明显高于对照组(71.43%、75.00%比0.00%,均P<0.05)。消化道出血后AMI组输血率明显高于AMI后消化道出血组及对照组(83.33%比28.57%及0.00%,均P<0.05)。AMI后消化道出血组、消化道出血后AMI组及对照组患者终点事件的发生率分别为28.57%、16.67%及7.50%,AMI后消化道出血组终点事件发生率较对照组显著升高(P<0.05);消化道出血后AMI组终点事件发生率与对照组比较差异无统计学意义、AMI后消化道出血组的终点事件发生率与消化道出血后AMI组比较差异无统计学意义(均P>0.05)。结论 AMI伴消化道出血使AMI的常规治疗变得较为困难,预后相对较差;肾功能不全是AMI伴消化道出血的危险因素。     

不同运动方式对心肌梗死大鼠心肌线粒体稳态的影响

目的 探讨中等强度持续运动(MCT)和高强度间歇运动(HIT)对急性心肌梗死(AMI)后心室重构及线粒体稳态的干预差异.方法 雄性SD大鼠制备AMI模型,随机(随机数字法)分为假手术组(Sham,n=10)、AMI对照组(AMI,n=9)、AMI+ MCT运动组(AMI+M,n=9)和AMI+ HIT运动组(AMI+H,n=10).AMI+M组和AMI+H组分别进行4周MCT或HIT运动训练.左心室导管法检测心功能,荧光探针法检测线粒体膜电位、ROS生成速率及ATP合成活力,Western blot法检测PINK1、Beclin1、Mfn2、Drp1、Tfam、COXⅣ和PGC-1α蛋白表达量.结果 与AMI组比较,AMI+M和AMI+H组Beclin1、PINK1、Mfn2和PGC-1α表达显著升高(P＜0.05或P＜0.01),ROS生成速率和Drp1表达显著降低(P＜0.05或P＜0.01);AMI+H组±dp/dt max绝对值、膜电位、ATP合成活力、Tfam和COXⅣ表达显著升高(P＜0.05).与AMI+M组比较,AMI+H组±dp/dt max绝对值、Tfam、COXⅣ和PGC-1α表达显著升高(P＜0.05).结论 HIT在干预AMI后心室重塑及线粒体稳态方面较MCT更具时效性.     

心肌梗死后患者消化道出血临床分析

目的分析急性心肌梗死(AMI)后消化道出血患者的临床特点及预后。方法将419例确诊为AMI的患者分为AMI对照组(404例)和AMI后消化道出血组(15例),分析AMI后消化道出血患者的临床特点及1年心血管病死亡和因再发心绞痛、非致死性AMI、心力衰竭和中风而住院的复合终点结果。结果①AMI后消化道出血组患者有消化道疾病史者的比例高于AMI对照组(13.3%vs.5.2%),但差异无统计学意义(P>0.05)。②AMI后消化道出血组的估测肾小球滤过率(eGFR)显著低于对照组[(57.1±23.5)m l.m in-1.1.73 m-2vs.(74.6±26.4)m l.m in-1.1.73 m-2,P<0.05],Logostic回归分析显示,eGFR降低对AMI患者发生消化道出血的相对危险为0.975(95%C I为0.957～0.995,P<0.05)。③AMI后消化道出血组阿司匹林使用率低于AMI对照组(66.7%vs.97.5%,P<0.05)。AMI后消化道出血组介入或溶栓治疗的比例低于AMI对照组,但差异无统计学意义(53.3%vs.76.0%,P>0.05)。④AMI后消化道出血组的1年心血管病死亡和因再发心绞痛、非致死性AMI、心力衰竭和中风而住院的复合终点明显高于AMI对照组(40.0%vs.15.3%,P<0.05)。结论 eGFR降低是AMI患者发生消化道出血的重要预测因素。AMI患者发生消化道出血后常使抗血小板和冠脉再通治疗困难,多预后不良。     

缺血修饰蛋白、胱抑素C联合检测在急性心肌梗死早期诊断中的价值

目的探究缺血修饰蛋白(IMA)和胱抑素C(CysC)在急性心肌梗死(AMI)早期诊断中的临床价值。方法选取103例AMI患者(AMI组),检测其IMA、CysC水平,并与同期健康体检人群(健康对照组)比较。结果 AMI患者的IMA和CysC水平相对于健康对照组明显升高(P0.05),二者联合检测对AMI的阳性率达到83.5%。结论联合检测IMA、CysC对早期AMI的发现具有临床意义。     

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.     

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.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.