冠心病、Ⅱ型糖尿病及肾透析患者OX-LDL和AOC分析

目的 :通过对冠心病、Ⅱ型糖尿病及肾透析后患者血清甘油三酯、胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、氧化型低密度脂蛋白胆固醇、载脂蛋白及血液抗氧化状态的分析 ,探讨它们在动脉粥样硬化发生过程中的作用 ,以及氧化型低密度脂蛋白与血液抗氧化状态的关系 ,寻找评价冠心病危险性有效的血液生化指标。方法 :收集经临床确诊的冠心病患者、Ⅱ型糖尿病及肾透析患者各 5 0例及 5 0例无心血管疾病、糖尿病及肾病人群的空腹血清。进行血脂及血液抗氧化状态分析。结果 :冠心病组TG (1 39± 0 34)mmol/L、Chol (4 5 8± 0 92 )mmol/L、HDL -C (1 2 6± 0 36 )mmol/L、LDL -C (2 6 4± 0 4 6 )mmol/L、ApoA1(1 5 9± 0 37)g/L、ApoB10 0 (0 87± 0 2 7)g/L、OX -LDL (0 133± 0 0 3)nmol/L、AOC (14 1± 1 32 )U/ml;Ⅱ型糖尿病组TG (1 4 8± 0 5 1)mmol/L、Chol (4 5 7± 1 10 )mmol/L、HDL -C (1 4 2± 0 4 4 )mmol/L、LDL -C (2 6 9± 0 83)mmol/L、ApoA1(1 6 5± 0 4 7)g/L、ApoB10 0 (0 84± 0 2 1)g/L、OX -LDL (0 12 9± 0 0 2 )nmol/L、AOC (12 8± 2 4 8)U/ml;肾透析后组TG (1 5 5± 0 5 8)mmol/L、Chol (4 6 2± 0 5 8)mmol/L、HDL -C (1 2 7± 0 5 0 )mmol/L     

缺血性脑血管病患者血浆卵磷脂-胆固醇酰基转移酶活性与其脂质代谢

背景脂质代谢异常是缺血性脑血管病的危险因素之一.很多研究提出其与体内卵磷脂-胆固醇酰基转移酶活性变化有关.目的观察缺血性脑血管病患者血浆卵磷脂-胆固醇酰基转移酶活性与红细胞膜脂质成分含量变化的关系.设计病例对照(实验组对照,标准对照).单位一所大学医学院附属医院的检验科、急诊室及神经内科.对象2002-03/2003-12青岛大学医学院附属医院急诊神经门诊就诊及住院的脑血管病患者105例,均符合第二届全国脑血管病会议的诊断标准,选择脑动脉硬化患者42例和脑梗死63例构成两个患者组,其中男67例,女38例.同期选择在本院健康查体者65例构成对照组,男36例,女29例.方法采集参与者空腹血8 mL,采用酶学方法检测血浆卵磷脂-胆固醇酰基转移酶活性和血清高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A1和载脂蛋白B水平,采用邻苯二甲醛-醋酸硫酸方法测定红细胞膜胆固醇含量,采用化学定量法测定红细胞膜磷脂含量.主要观察指标患者组与对照组卵磷脂-胆固醇酰基转移酶活性变化及红细胞膜脂质成分含量的变化.结果按意向分析处理,105例患者组和65例对照组全部进入结果分析.①卵磷脂-胆固醇酰基转移酶活性脑动脉硬化组和脑梗死组活性变化均明显低于对照组[(2.14±0.72)kat/L,(2.06±0.80)kat/L,(2.61±0.74)kat/L,P＜0.01].②高密度脂蛋白胆固醇与载脂蛋白A1水平脑动脉梗化组与脑梗死组明显低于对照组[(11.32±0.33)mmol/L,(1.37±0.33)g/L,(1.28±0.33)mmol/L,(1.27±0.31)g/L,(1.60±0.43)mmol/L,(1.60±0.43)g/L,(t=2.72～5.01,P＜0.01)].③低密度脂蛋白胆固醇及红细胞胆固醇含量脑动脉硬化组与脑梗死组明显高于对照组[(2.94±0.82)mmol/L,(0.63±0.05)mmol/g,(3.02±0.79)mmol/L,(0.60±0.07)mmol/g,(2.56±0.58)mmol/L,(0.57±0.05)mmol/g,(P＜0.01)].并且卵磷脂-胆固醇酰基转移酶活性分别与高密度脂蛋白胆固醇及载脂蛋白A1呈正相关(r=0.247,P＜0.05;r=0.303,P＜0.01),而与低密度脂蛋白胆固醇和红细胞膜胆固醇呈负相关(r=-0.212,P＜0.05;r=-0.346,P＜0.01).结论缺血性脑血管病患者血浆卵磷脂-胆固醇酰基转移酶活性下降,且并非继发于脑梗死发生后,其活性变化与高密度脂蛋白胆固醇及载脂蛋白A1呈正相关,与低密度脂蛋白胆固醇及红细胞膜胆固醇呈负相关性.     

失代偿期肝硬化患者血脂变化分析

目的 :探讨肝硬化对血脂代谢的影响。方法 :观察失代偿期肝硬化患者血脂水平 ,包括甘油三酯 (TG)、总胆固醇 (Tch)、低密度脂蛋白胆固醇 (LDL ch)和高密度脂蛋白胆固醇 (HDL ch) ,并以肝功能正常者作对照。结果 :肝硬化患者TG水平明显低于对照组 [(0 .76± 0 .3 6)mmol/L比 (1.3 1± 0 .41)mmol/L ,P <0 .0 0 1] ,Tch和LDL ch明显低于对照组 [Tch(2 .80± 0 .94)mmol/L比 (3 .95± 1.90 )mmol/L ;LDL ch(1.83± 0 .62 )mmol/L比 (2 .60± 1.2 5 )mmol/L ,P值分别 <0 .0 5 ] ,而HDL ch在两组间无明显差异 [(0 .64± 0 .3 9)mmol/L比 (0 .78± 0 .2 7)mmol/L ,P >0 .0 5 ]。结论 :血甘油三酯降低比胆固醇降低更能反映肝硬化患者肝功能受损的情况     

血脂代谢紊乱与中青年脑梗死危险因素的相关性分析

目的探讨血脂与中青年人脑梗死的关系. 方法检测了 111例中青年人脑梗死患者及 80例对照者的三酰甘油、总胆固醇、高密度脂蛋白胆固醇 (High density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇 (Low density lipoprotein cholesterol,LDL-C)、载脂蛋白 A-I(apolipoproteinA-I,ApoA-I)、载脂蛋白 B100(apolipoprotein B100, ApoB100)和脂蛋白 (a)血清含量. 结果脑梗死组三酰甘油 [(1.92± 1.33)mmol/L],总胆固醇 [(5.21± 1.08)mmol/L],LDL-C[(3.13± 0.96)]mmol/L,ApoB100[(1.10± 0.29)g/L]及脂蛋白 (a)[(0.23± 0.18)]g/L水平高于对照组 (t=2.523～ 3.796,P< 0.05),总胆固醇与年龄呈正相关 [青年 (4.96± 1.14)mmol/L,中年 (5.27± 1.06)mmol/L], HDL-C与年龄呈负相关 [青年 (1.39± 0.43)mmol/L,中年 (1.26± 0.35)mmol/L].亚组分析发现青年人脑梗死亚组的脂蛋白 (a)水平和中年人脑梗死亚组的三酰甘油、总胆固醇、 LDL-C、 ApoB100及脂蛋白 (a)水平均显著高于相应的对照组 (t=2.571～ 4.107,P< 0.05);皮层支动脉闭塞亚组脂蛋白 (a)水平显著高于穿通支动脉闭塞亚组 (t=5.414,P< 0.01);首发脑梗死亚组与复发脑梗死亚组之间的血脂水平无显著差异. 结论血脂代谢紊乱是中青年人脑梗死的危险因素.     

首发缺血性脑卒中患者血脂调查与分析

目的 了解首发缺血性脑卒中患者血脂各项情况,以便更好地实施健康教育.方法 对130例首发缺血性脑卒中患者总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)进行检测并分析.结果 130例患者总胆固醇平均值(4.69±1.12) mmol/L,甘油三酯平均值(1.91±1.07) mmol/L,高密度脂蛋白平均值(1.19±0.32)mmol/L,低密度脂蛋白平均值(2.89±0.85) mmol/L.总胆固醇、高密度脂蛋白、低密度脂蛋白均处于正常范围,甘油三酯高于正常水平.血脂异常者98例,占75.4％,血脂正常者32例,占24.6％.女性的总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)显著高于男性,而不同年龄阶段血脂各项情况没有差异.结论 缺血性脑卒中患者血脂情况不容乐观,临床护理人员应从饮食、运动等方面对患者进行系统化的健康指导.     

临产妇血清蛋白电泳谱分析

目的　了解临产妇血清蛋白电泳谱改变。方法　采用法国SEBIA琼脂糖电泳技术测定10 0例临产妇 (实验组 )、30名育龄非孕健康女性 (对照组 )的血清蛋白电泳、总蛋白白蛋白、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)、载脂蛋白AⅠ (apoAⅠ )、载脂蛋白B(apoB)。同时在array 36 0上采用散射比浊法测定了 2 0例实验组、10名对照组血清转铁蛋白 (TRF)、铜蓝蛋白(CER)、C3 、CRP、IgG、IgA、IgM。结果　实验组总蛋白、白蛋白较对照组显著降低 [分别为总蛋白(6 2 .5± 4 .5 )g/L对照组 (73.3± 3.4 )g/L白蛋白 (35 .4± 3.8)g/L对照组 (46 .1± 2 .1)g/L ,P <0 0 0 1],白蛋白百分比较对照组低 [(5 6 .6± 3.5 ) %对照组 (6 2 .9± 2 .4 ) % ,P <0 .0 0 1]。α1、α2 、β球蛋白百分比实验组较对照组显著增高 [分别是 (4.2± 0 .9) %对照组 (2 .9± 0 .6 ) % ,(11.1± 2 .6 ) %对照组(9.3± 1.0 ) % ,(13.4± 2 .8) %对照组 (10 .1± 1.0 ) % ,P <0 .0 0 1]γ球蛋白百分比与对照组差异无显著性 [(14 .6± 2 .7) %对照组 (14 .8± 1.8) % ,P >0 .0 5 ];实验组脂类各项较对照组增高 ;TRF、CER较对照组显著增高。IgM、C3 与对照组相比差异无显著性 (P >0 .0 5 )。结论　临产妇蛋白电泳谱的改变主要     

基于跨理论模型的动机性访谈对糖尿病前期患者自我管理和血糖的影响

目的观察基于跨理论模型的动机性访谈对糖尿病前期患者自我管理和血糖的影响。方法将100例患者按随机数字表分为对照组和观察组,每组50例。两组患者均接受为期6个月的护理干预,对照组接受常规的健康教育模式干预,观察组在对照组的基础上给予基于跨理论模型的动机性访谈干预。分别于干预前、干预6个月后检测空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、体质指数、腹围及自我管理水平等指标。结果干预后观察组空腹血糖(5.9±0.4)mmol/L、糖化血红蛋白(5.2±0.5)%、总胆固醇(4.7±0.5)mmol/L、甘油三酯(1.6±0.6)mmol/L、低密度脂蛋白胆固醇(2.9±0.5)mmol/L、体质指数(21.6±2.3)及腹围(75.7±6.5)cm,较对照组低,高密度脂蛋白胆固醇(1.4±0.5)mmol/L和糖尿病自我管理行为量表评分(40.7±3.4)分较对照组高,差异均有统计学意义(P均<0.05)。结论基于跨理论模型的动机性访谈能够提高糖尿病前期患者自我管理水平,改善血糖、血脂等实验室指标值。     

家族聚集性脑梗死发病与低密度脂蛋白胆固醇的相关性

目的:探讨血脂水平与脑梗死的关系。方法:检测和比较40例家系中无脑卒中史的普通脑梗死(CI)患者、26例家族中有明确脑梗死先证者的家族聚集性脑梗死(FMACI)患者和90例江苏地区无血缘关系的健康汉族人群的总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A-I(ApoA-I)、载脂蛋白B(ApoB)和脂蛋白(a)犤Lp(a)犦的血清含量。结果:FMACI组血清总胆固醇(5.80±0.81)mmol/L,LDL-C(3.47±0.82)mmol/L,ApoB(1.17±0.14)g/L,Lp(a)(0.36±0.11)g/L分别较CI组犤(5.53±0.74),(3.30±0.70)mmol/L,(1.09±0.16),(0.29±0.10)g/L犦有升高趋势,并且均明显高于对照组犤(4.79±0.72),(2.57±0.70)mmol/L,(0.87±0.17),(0.20±0.15)g/L犦(F=25.94,23.43,46.85,17.70,P<0.01);HDL-C在对照组、GI组、FMACI组分别为犤(1.46±0.38),(1.34±0.28),(1.07±0.30)mmol/L犦(F=12.91,P<0.01);FMACI组HDL-C水平明显低于对照组和CI组(分别为P<0.01和P<0.05),而后两组间差异无显著性意义。结论:脂质代谢异常与脑梗死密切相关,LDL-C促发脑梗死的发生,尤其与家族聚集性脑梗死的发病似有更大的相关性,HDL-C对脑梗死的发生有保护作用。     

二重滤过血浆置换治疗难治性高脂血症

目的　了解单次二重滤过血浆置换治疗非家族性、难治性高脂血症的短期疗效。方法　 2 0例非家族性高脂血症患者接受二重滤过血浆置换疗法 ,其中 14例患者治疗前血浆总胆固醇 (TC)大于6 .8mmol/L或甘油三脂 (TG)大于 2mmol/L ,低密度脂蛋白 (LDL)水平均高于 3.1mmol/L。取治疗前和治疗结束时的血样 ,分别测量血浆TC、TG、LDL、Apo(A)、Apo(B)、Lp(a)、HDL和纤维蛋白原水平。　结果11例患者具有完整的记录 ,其平均年龄 (4 5 .2 5± 8.33) (2 6～ 5 9)岁 ;平均病程为 6 .7年。单次治疗总置换量为 (4 183± 6 6 7) (30 0 0～ 5 0 0 0 )ml,治疗前后TC、TG、LDL、Apo(A)、Apo(B)、Lp(a)、HDL和纤维蛋白原水平分别为 (6 .86± 1.17)mmol/Lvs (3.4 2± 0 .6 3)mmol/L、(3.92± 2 .13)mmol/Lvs (3.5 7± 1.82 )mmol/L、(4 .0 3± 0 .86 )mmol/Lvs (1.13± 0 .6 6 )mmol/L、(1.34± 0 .37)g/Lvs (0 .85± 0 .30 )g/L、(1.34± 0 .5 7)g/Lvs (0 .70± 0 .34)g/L、(176 .14± 75 .5 3)mg/Lvs (98.4 3± 4 4 .0 8)mg/L、(1.0 3± 0 .2 8)mmol/Lvs (0 .6 8±0 .2 2 )mmol/L、(2 6 3.6± 86 .4 9)mg/dlvs (15 4 .88± 4 4 .12 )mg/dl。TC平均下降 5 1% ;LDL下降约 72 % ;Apo(a)和Apo(b)分别下降 32 %和 4 4 %左右。Lp(a     

湖北地区汉族人群动脉硬化性脑梗死与载脂蛋白(a)5''''调控区(TTTTA)n基因多态性的关系

背景载脂蛋白(a)具有促进动脉粥样硬化斑块形成的作用,在载脂蛋白(a)5'存在一个五核苷酸重复序列(pentanuclotide repeats,PNR),对研究遗传和预测动脉硬化性脑梗死(atherosclerosis cerebral infarction,ACI)的危险性具有一定的价值,但在不同人种中与ACI的关系尚处在探索阶段,载脂蛋白(a)PNR基因多态性在汉族人群ACI发病中的意义如何?目的研究载脂蛋白(a)PNR基因多态性与ACI的关系.设计以湖北地区汉族ACI患者和正常人群为研究对象的病例-对照研究.单位一所大学医院的检验科.对象选择1998-02/1999-03武汉大学中南医院和武汉大学亚太医院神经内科确诊的ACI患者82例(ACI组)及健康体检者153例(对照组),均为无血缘关系的湖北地区汉族人.方法对所有受试者分别检测血清脂蛋白(a)、总胆固醇、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(ligh density lipoprotein cholesterol,LDL-C)、三酰甘油、载脂蛋白AⅠ及载脂蛋白B水平.同时采用聚合酶链反应结合高压聚丙烯酰胺凝胶电泳检测载脂蛋白(a)5'调控区五核苷酸重复序列基因多态性,并加以对照分析.结果ACI患者脂蛋白(a)[(239.9±225 4)mg/L]、总胆固醇[(4.76±0.74)mmol/L]、三酰甘油[(1.74±0.60)mmol/LI、LDL-C[(2.84±0.63)mmol/L]水平明显高于对照组[(133.5±97.7)mg/L,(4.29±0.72)mmol/L,(1.05±0.52)mmol/L,(2.84±0.63)mmol/L],HDL-C水平[(0.88±0.17)mmol/L]明显低于对照组[(1.03±0.35)mmol/L],差异均有显著性意义(t=3.65～9.18,P均＜0.01),载脂蛋白A Ⅰ[(1.13±0.15)和(1.25±0.19)mmol/L]、载脂蛋白B[(0.93±0.12)和(0.89±0.15)mmol/L],与对照组比较差异无显著性意义;ACI组中重复序列数为5的等位基因频率(0.098)明显高于正常对照组(0.026),差异有显著性意义(x2=5.62,P＜0.05),重复序列数为9的等位基因频率(0.073)明显低于对照组(0.213),差异有显著性意义(x2=7.83,P＜0.01),且重复序列数为5的等位基因还与血浆TC下降和Lp(a)升高有关联.结论提示Apo(a)PNR基因多态性与人群易感ACI有关,可能在一定程度上参与ACI的发生和发展过程.     

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.     

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.     

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.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.