硫辛酸对大鼠急性肺损伤/急性呼吸窘迫综合征模型的保护机制

目的:探讨代谢性抗氧化剂硫辛酸(LA)对内毒素(LPS)诱发大鼠急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)模型的保护机制,为ALI/ARDS药物治疗提供新的途径.方法:选择Wister雄性大鼠40只,随机分为正常对照组(NS组)、ALI/ARDS模型组(LPS组)、LA干预组(LA组)和谷胱甘肽(GSH)干预组(GSH组),每组各10只.除NS组外,余3组均给予LPS 6 mg/kg尾静脉注射诱发大鼠造成ALI/ABDS模型,LA组和GSH组分别于注射LPS后0.5 h注射LA和GSH各100 mg/kg.注射后1、2、4和6 h观察血清肿瘤坏死因子(TNF-α)水平,6 h后处死大鼠,测定动脉血氧分压(PaO2)、血清脂过氧化物水平(LPO)、肺湿干比(wet/dry weight ratio,W/D)、肺泡灌洗液(bronchoalveolar lavage fluid,BALF)中蛋白浓度和TNF-α水平.结果:LA组和GSH组PaO2水平较LPS组明显增高(P<0.01);血清LPO水平、W/D、BALF中蛋白浓度明显下降(P<0.01);LA组TNF-α水平呈进行性下降.在注射后各时点与LPS组比较均明显降低(P<0.01).结论:LA对LPS诱发的大鼠ALI/ARDS模型的损伤有一定保护作用.     

脑白质疏松症患者Claudin基因的多态性调查与认知功能的关系

目的:分析脑白质疏松症(1eukoaraiosis,LA)患者Claudin基因的多态性并研究Claudin基因多态性与认知功能的相关性。方法:选取我院2019年1月-2020年1月收治的100例LA患者为LA组,50名健康体检者为对照组,对两组受试者认知功能评分、Claudin-1单核苷酸多态性(SNP)基因型和等位基因频率进行测定和比较,相关性分析采用多元非条件Logistic回归分析模型检验,Claudin基因多态性与认知功能的关联程度采用比值比(OR)及其95%置信区间(CI)表示。结果:LA组认知功能评分(MMSE评分、MoCA评分)均小于对照组,差异有统计学意义(P0.05);Logistic回归分析结果提示,Claudin-1 SNP位点rs17501010、rs893051、rs9290927与LA认知功能障碍在加性模型、显性模型、隐性模型均存在关联性(P0.05)。结论:LA患者Claudin具有基因多态性特点且参与到了认知功能障碍的发生进程之中。     

缺血性脑白质疏松患者基于体素的脑结构特征研究

目的:用基于体素的形态学分析(VBM)方法,探讨缺血性脑白质疏松(LA)患者大脑灰质体积是否存在异常及其分布特征。方法:LA认知功能障碍患者34例和年龄、性别、受教育程度相匹配的正常老年人23名(对照组)纳入研究。所有被试均进行了认知功能测查和3.0T磁共振影像检查,根据认知量表评分结果将LA组分为LA轻度认知功能障碍(LA-MCI)组和LA血管性痴呆(LA-VD)组。采用VBM对所有被试大脑灰质密度和灰质体积进行基于体素检测和比较,分析LA认知功能障碍患者大脑灰质密度减少区域、分布特征及其临床意义。结果:与对照组相比,LA-VD组左前额叶及黑索回大脑灰质密度减低(P<0.05);LA-MCI组右中央前后回及左顶上回、左尾状核区灰质密度减低(P<0.05);与LA-MCI组比较,LA-MCI组左额中回和右额中回灰质密度减低(P<0.05)。LA认知功能障碍患者执行功能分数与左额中叶灰质体积显著相关(P<0.05)。结论:LA患者存在广泛的大脑灰质萎缩,执行功能下降与其密切相关。     

微型腹腔镜单孔阑尾切除术治疗急、慢性阑尾炎

目的:探讨微型腹腔镜单孔阑尾切除术(One-pore microlaparoscopic appendectomy,OMLA)治疗急、慢性阑尾炎的临床疗效。方法:118例急、慢性阑尾炎患者随机分为两组:OLMA组53例LA组65例。OMLA组采用微型腹腔镜单孔阑尾切除术;LA组采用腹腔镜阑尾切除术。并观察两组的手术时间、术中失血量、术后肠道功能恢复时间、术后体温恢复正常时间、住院时间和疼痛情况。结果:OMLA组手术时间(23.58±8.07)min,短于LA组(36.43±7.32)min(t=9.0579,P=0.0000);术中出血量:MOLA组(10.9±2.5)mL与LA组(11.3±3.2)mL之间差异无统计学意义(t=0.7434,P=0.4587);OMLA组术后肠道功能恢复时间(16.0±5.3)h,明显短于LA组(29.0±10.1)h(t=8.4639,P=0.0000);OMLA组术后体温恢复正常时间(29.0±8.3)h,明显短于LA组(41.0±16.2)h(t=4.8919,P=0.0000);住院时间:OMLA组(2.5±1.5)d与LA组(3.0±2.1)d之间差异无统计学意义(t=1.4562,P=0.1480);术后切口疼痛消失平均时间:OMLA组(39.0±12.9)h,明显短于LA组(56.0±21.2)h(t=5.1144,P=0.0000)。两组患者术后随访7 d~1.5年,平均8个月,OMLA组未发现手术并发症;LA组右下腹戳孔感染1例,未发现其它并发症。结论:OMLA具有损伤小,康复快,并发症少和住院时间短的优点,治疗急、慢性阑尾炎较理想的微创手术方法。     

老年脑白质疏松与腔隙梗塞预后的关系

目的 :探讨脑白质疏松(LA)与腔隙梗塞(LI)预后的关系。方法 :将100例腔隙梗塞患者分为LI合并LA组(LI )及LI不合并LA组(LI-)。对两组患者卒中危险因素、卒中复发率、痴呆发生率、Barthel指数、病死率及死亡原因进行对比分析。结果 :随访结束时LI 组神经功能缺损评分、Barthel指数、卒中复发率、痴呆发生率及病死率与LI-组均有明显差异 ,P<0.01。结论 :LI合并LA者预后较差。     

RT-3DE对阻塞性睡眠呼吸暂停综合征不同左室构型患者左房结构和功能的评价

目的应用实时三维超声心动图(RT-3DE)技术评价阻塞性睡眠呼吸暂停综合征(OSAS)不同左室构型患者的左房结构和功能,探讨左房结构和功能参数与左室构型的关系。方法选取我院确诊的OSAS患者121例和同期健康成人42例(N组),均行血压、血糖、血脂及超声心动图检查,依据左室质量指数和相对室壁厚度,将OSAS患者分为四组:正常构型组(NG组)62例、向心性重构组(CR组)17例、向心性肥厚组(CH组)31例、离心性肥厚组(EH组)11例。分析各组全容积图像并获取左房容积-时间曲线,得到左房最大容积(LAVmax)、左房最小容积(LAVmin)和左房收缩前容积(LAVpre-a),计算左房总排空容积(LA TotEV)、总排空分数(LA TotEF)、被动排空容积(LA PassEV)、被动排空分数(LA PassEF)、主动排空容积(LA ActEV)和主动排空分数(LA ActEF),比较各组上述左房结构和功能参数的差异。结果①结构参数:NG组标化LAVmax较N组增加,CR组LAVmax、LAVmin、LAVpre-a、标化LAVpre-a较N组和NG组均增加,EH组和CH组LAVmax、标化LAVmax、LAVmin、标化LAVmin、LAVpre-a、标化LAVpre-a较N组、NG组和CR组均增加,差异均有统计学意义(均P0.05)。②储存功能参数:CR组、EH组和CH组LA TotEV较N组和NG组均增加,EH组和CH组LATotEV较CR组均增加,差异均有统计学意义(均P0.05)。③管道功能参数:EH组和CH组LAPassEF较N组、NG组和CR组均降低,差异均有统计学意义(均P0.05)。④助力泵功能参数:CR组、EH组和CH组LA ActEV较N组均增加,NG组、CR组、EH组和CH组LA ActEF较N组均增加;CH组、EH组LA ActEF较NG组均增加,CR组、EH组和CH组LA ActEV较NG组均增加;CH组LA ActEV和LA ActEF较CR组均增加,差异均有统计学意义(均P0.05)。结论不同左室构型OSAS患者其左房结构和功能不同,左房结构和功能参数随左室构型的变化而变化,提示临床应早期重视左房的改变,有一定的应用价值。     

血清AFP、ChE水平变化与肝硬化合并肝癌患者Child-Pugh分级的关联性分析

目的:探讨血清甲胎蛋白(AFP)、胆碱酯酶(ChE)水平变化与肝硬化(LC)合并肝癌(LA)患者Child-Pugh分级的关联性。方法:选取2017年3月~2020年5月我院LC合并LA患者63例作为观察组,选取同期LC患者71例作为对照Ⅰ组、LA患者66例作为对照Ⅱ组。对比三组及观察组不同Child-Pugh分级患者血清AFP、ChE水平,分析血清AFP、ChE水平与Child-Pugh分级关联性。结果:观察组血清AFP高于对照Ⅰ组、对照Ⅱ组,ChE水平低于对照Ⅰ组、对照Ⅱ组,差异有统计学意义(P<0.05);随Child-Pugh分级升高,血清AFP水平呈升高趋势,ChE水平呈降低趋势,差异有统计学意义(P<0.05);经Spearman秩相关系数模型分析,血清AFP水平与Child-Pugh分级呈正相关,ChE水平与Child-Pugh分级呈负相关(P<0.05)。结论:LC合并LA患者血清AFP、ChE水平异常,且与Child-Pugh分级关系密切,可作为临床评价此类患者肝功能的辅助指标。     

脑白质疏松与血脂水平的关系

目的探讨血脂水平与脑白质疏松的关系。方法 322例患者根据头颅MRI分为脑白质疏松组(LA组)181例和非脑白质疏松组(非LA组)141例。LA组根据Fazekas分级标准分为轻度组(FazekasⅠ)57例,中度组(FazekasⅡ)52例,重度组(FazekasⅢ)72例。比较各组间血脂水平。结果随着LA程度加重,总胆固醇水平逐渐升高(P<0.05),中、重度组间及低密度脂蛋白胆固醇有显著性差异(P<0.05);甘油三酯在各LA组间无显著性差异(P>0.05),但各LA组与非LA组间均有显著性差异(P<0.05);各组间高密度脂蛋白胆固醇水平无显著性差异(P>0.05)。结论总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平与LA发病有关,高密度脂蛋白胆固醇与LA发病无关;总胆固醇与低密度脂蛋白胆固醇与LA程度有关,甘油三酯与LA程度无关。     

中度颈动脉狭窄与脑白质疏松对认知功能的影响

目的:研究中度颈动脉狭窄(CAS)与轻度脑白质疏松(LA)对认知功能的影响。方法:选取中度CAS患者25例(CAS组)、中度CAS合并轻度LA患者21例(CAS+LA组)、同期无CAS和LA的患者30例(对照组),均进行简易精神状态评价量表(MMSE)、阿尔茨海默病评价量表-认知分表(ADAS-Cog)第1套、韦氏数字符号转换测验、数字广度顺背、倒背测验、语言流畅性测验、临床痴呆评定量表(CDR)、日常生活能力评定量表(ADL)测试。结果:CAS组及CAS+LA组患者MMSE、韦氏数字符号转换、数字广度顺背、倒背测验、语言流畅性测试等评分均低于对照组,ADSA-Cog评分高于对照组,差异有统计学意义(P<0.05);CAS+LA组与CAS组比较,MMSE、数字广度顺背评分减低,ADAS-cog评分增高,差异有统计学意义(P<0.05)。结论:中度CAS患者出现认知功能障碍;中度CAS与轻度LA合并时,认知功能障碍进一步加重。     

脑白质疏松与认知功能的关系研究

目的:评估脑白质疏松(LA)与认知功能的关系。方法:253例患者依据有无LA表现分为LA组127例和对照组126例,LA组根据年龄相关白质变化分级量表(ARWMCRs)评分又分为轻度亚组36例、中度亚组48例、重度亚组43例。应用简明精神状态量表(MMSE)和蒙特利尔认知评估量表北京版(MoCA)评估患者认知功能。结果:LA组与对照组相比,患有高血压、糖尿病的比例升高,差异有统计学意义(P<0.05)。中、重度亚组与对照组相比,MMSE和MoCA评分显著降低,差异有统计学意义(P<0.05)。LA组与对照组相比,在视空间与执行、命名能力、注意力、语言能力、抽象能力、延迟记忆能力、定向力7个认知域的评分差异均有统计学意义(P<0.05)。ARWMCRs评分与MMSE、MoCA评分呈负相关(P<0.01)。结论:LA与老年患者认知功能密切相关。     

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.     

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.     

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.