Tei指数评价系统性红斑狼疮右室功能的变化

目的探讨超声心动图测定右室Tei指数评价系统性红斑狼疮(SLE)患者右室功能的价值。方法对30例正常对照者及56例SLE患者进行超声心动图右室功能检测。结果与对照组相比,SLE患者组的右室等容收缩时间与等容舒张时间之和(ICT IRT)延长,右室射血时间(ET)及肺动脉血流加速时间(AT)缩短,右室Tei指数显著增高(P<0.01)。结论SLE患者在右心构型尚无明显改变时,右室功能及肺动脉血流已出现异常。多普勒超声心动图检测右室Tei指数有可能为SLE患者的早期病情判断与诊治提供重要信息。     

右室Tei指数评价肺栓塞患者右心室功能

目的 探讨应用组织多普勒成像技术(tissue Doppler imaging,TDID测算右室Tei指数评价肺栓塞患者右心室功能的临床应用价值.方法 人选研究对象为正常对照组和肺栓塞组,并根据预期的肺栓塞相关早期病死率进行危险分层为高危、中危、低危3个组,测量其右心常规超声指标,运用TDI获取三尖瓣环组织运动频谱,测量相关时间间期,并计算出右心室Tei指数.结果 与对照组相比,肺栓塞患者高危组具有较明显的右心扩大及肺动脉高压征象,其右室射血时间(ET)明显缩短(P＜0.05),等容收缩期(ICT)+等容舒张期(IRT)明显延长(P＜0.05),Tei指数明显增高(P＜0.05);中危组尽管没有明显右心增大,但其右室ET、ICT+ IRT、Tei指数均已出现异常(P＜0.05);低危组的ET、ICT+ IRT、Tei指数与对照组相比,差异无统计学意义(P＞0.05).结论 运用TDI测量右室Tei指数可以较敏感反映肺栓塞患者右室功能变化,是评价其右室综合功能的较好指标.     

Tei指数评价肥厚型心肌病右心功能

目的探讨Tei指数评价非对称性肥厚型心肌病(包括梗阻性和非梗阻性)患者右心功能的临床价值。方法应用脉冲多普勒技术分别对28例肥厚型梗阻性心肌病(HOCM)患者、34例肥厚型非梗阻性心肌病(HNCM)患者和30例正常对照者的标准心尖四腔观及主动脉短轴观三尖瓣血流和肺动脉瓣血流进行分析,并计算出Tei指数。结果①HOCM患者与HNCM患者的右室加速时间与右室射血时间比值(ACT/RVET)、等容收缩时间(ICT)、等容舒张时间(IRT)、右室射血时间(RVET)以及二组的Tei指数之间的差异无显著性意义。②与正常对照组相比,HOCM患者的Tei指数显著增大(P<0.001),ICT延长(P=0.001),IRT延长(P<0.001),RVET明显缩短(P<0.001);ACT/RVET显著增大(P=0.006)。③与正常对照组相比,HNCM患者的Tei指数显著增大(P<0.001),ICT延长(P=0.03),IRT延长(P<0.001),RVET明显缩短(P=0.005);二组的ACT/RVET之间也存在显著性差异(P=0.02)。④Tei指数与IRT、ICT、(IRT+ICT)、ICT/RVET间有显著性正相关关系(r分别为0.865,0.516,0.956,0.697,P<0.001),Tei指数与RVET间有显著性负相关关系(r=-0.759,P<0.001)。结论Tei指数能简便、敏感、综合评价肥厚型心肌病右心室的整体收缩与舒张功能;肥厚型心肌病(包括梗阻性和非梗阻性)患者右心室舒张功能降低,收缩功能     

Tei指数及其相关参数定量评估子痫前期孕妇胎儿右室功能

目的 探讨Tei指数及等容收缩指数(ICT/ET)、等容舒张指数(IRT/ET)等相关参数在评价正常胎儿和子痫前期孕妇胎儿心室功能中的临床价值.方法 应用组织多普勒(tissue Doppler imaging,TDI)测量64例孕妇胎儿右室等容收缩时间(ICT),射血时间(ET)及等容舒张时间(IRT),获得右室Tei指数及其相关参数,其中正常孕妇30例(A组)、子痫前期轻度孕妇21例(B组)及子痫前期重度孕妇13例(C组).并比较A、B和C三组间Tei指数及其相关参数.结果 C组胎儿右室Tei指数及IRT/ET明显高于A组,差异有统计学意义(分别为P<0.01与P<0.05);A、B两组间胎儿右室Tei指数及IRT/ET差异不明显,无统计学意义(P>0.05);A、B及C三组间的ICT、IRT、ET及ICT/ET差异均无统计学意义(P>0.05);结论子痫前期重度不仅损害母体脏器,而且累及胎儿心室舒张功能;Tei指数及其相关参数是一种定量评价心室功能的多普勒指数,能简便、敏感、准确地评估胎儿心室功能.     

组织多普勒右室Tei指数评价肺动脉高压患者右心室功能

目的 运用组织多普勒成像技术(tissue Doppler imaging,TDI)测算肺动脉高压患者右心室Tei指数,探讨其在评价不同程度肺动脉高压患者右室功能的临床应用价值以及获取右室Tei指数的合理观测点.方法 入选研究对象为正常对照组和肺动脉高压组,并依肺动脉压力升高的程度将肺动脉高压组分为轻、中、重度3个亚组.组织多普勒分别在心尖四腔切面三尖瓣前瓣附着处、隔瓣附着处及胸骨旁右心两腔切面后瓣附着处记录三尖瓣环运动频谱并测算右室Tei指数.结果 (1)肺动脉高压患者右室Tei指数较正常对照组增高(P<0.05);(2)三尖瓣前瓣附着处取样点所测右室Tei指数在轻、中、重度肺动脉高压组间均有明显差异,且Tei指数与肺动脉压力呈正相关(r=0.75,P<0.05);(3)隔瓣及后瓣附着处取样点所测Tei指数轻、中度组间无显著性差异,重度组较轻、中度组增高(P<0.05).结论 肺动脉高压患者右心室Tei指数升高,提示右心室整体功能降低,且与肺动脉收缩压呈正相关.TDI测量右室Tei指数可较准确反映右室整体功能,为临床评估肺动脉高压患者右心功能提供了一种无创的、新的检测方法.心尖四腔切面右室侧壁三尖瓣前叶瓣环处测定右室Tei指数是较为理想的测定点.     

脉冲组织多普勒评价尿毒症患者右室功能及负荷状态

目的 应用脉冲组织多普勒技术评价尿毒症患者右室整体功能及负荷状态.方法 随机选取行透析治疗的尿毒症患者20例(尿毒症组)及30例健康体检者(对照组).采用脉冲组织多普勒成像获取心尖四腔切面右室侧壁三尖瓣环运动频谱,测量等容收缩时间(ICT)、射血时间(ET)、等容舒张时间(IRT)、收缩期峰值运动速度(St)、舒张早期峰值运动速度(Et)、舒张晚期峰值运动速度(At),计算Et/At及Tei指数.结果 与对照组比较,尿毒症组右室ET缩短,IRT延长,Et减低,At增加,Et/At降低,Tei指数增大,差异均有统计学意义(P <0.05).结论 尿毒症患者右室整体功能异常,主要为舒张功能受损,参数的变化情况正确地反映了右室压力和容量超负荷状态.     

超声测量右室心肌功能指数评价急性肺栓塞治疗前后右室功能

目的应用超声心动图技术观察急性肺栓塞(APE)患者治疗前后右室舒缩功能的改变,探讨右室心肌功能指数(MPI)对APE患者右室功能的评估价值.方法利用超声对28例正常对照者及33例急性肺栓塞患者(其中大面积急性肺栓塞19例,非大面积急性肺栓塞14例)治疗前后的右室功能进行测定.结果急性肺栓塞患者三尖瓣E峰峰值速度(E)较对照组减低,右室等容收缩与等容舒张时间之和(ICT IRT)延长,右室心肌功能指数增高,大面积急性肺栓塞患者E峰减速时间(VEDT)延长,右室射血时间(ET)缩短;急性肺栓塞患者治疗后右室射血分数(EF)增高,(ICT IRT)缩短,右室心肌功能指数降低;大面积急性肺栓塞患者治疗后右心内径减小,肺动脉收缩压降低,VEDT缩短;非大面积急性肺栓塞患者治疗后右心内径、肺动脉收缩压及VEDT改变不明显.心肌功能指数与(ICT IRT)、EF、ET、VEDT、E间有相关关系(r分别为0.880、-0.513、-0.464、0.485、-0.462,P＜0.01).结论右室心肌功能指数是反映急性肺栓塞时右室功能变化的敏感指标.     

ET-1与肺动脉高压右室功能相关关系的研究

目的:探讨内皮素-1(ET-1)在肺动脉高压(PH)右室功能损害、右室重塑病理生理过程中的作用和相关关系.方法:PH组58例,非PH组23例,对照组20例.超声心动图分别测量三尖瓣前向血流及反流频谱、肺动脉前向血流频谱;ET-1的测定采用非平衡法.结果:PH组与非PH组及正常对照组相比,E、E/A显著降低,A增加,PV显著降低,IRT、ICT显著延长,Tei指数显著增加(P<0.001);血浆ET-1浓度显著增高,与肺动脉收缩压正相关.ET-1与E/A、PV负相关,与A、IRT、ICT正相关.结论:ET-1参与了肺动脉高压及右室功能减退的病理生理过程.     

脉冲多普勒Tei指数在评价肺动脉高压患者右心室功能中的价值

目的:探讨Tei指数在评价肺动脉高压(PH)患者右心室功能中的价值及其影响因素。方法:测量45例PH患者[25例肺源性PH患者,20例为继发于房间隔缺损(ASD)的PH患者]和26例正常对照组的右心常规超声指标,分别测量相关时间间期并计算右室Tei指数。结果:(1)病例组Tei指数明显增高,与对照组相比差异有统计学意义(P<0.01);(2)对照组右室Tei指数与年龄呈正相关(r=0.4,P<0.01),各病例组右室Tei指数与年龄间无相关性;(3)对照组及各病例组右室Tei指数均与心率、右室舒张末期前后径无相关性;(4)肺源性PH组右室Tei指数与肺动脉收缩压(SPAP)无相关性,ASD性PH患者Tei指数与SPAP存在相关关系(r=0.48,P<0.05)。结论:(1)Tei指数是评价PH患者右室功能简便而准确的敏感指标;(2)右心室功能受损状态受压力负荷增加影响大,受容量负荷增加影响小,但就非高动力性PH患者而言,其右室功能受损程度并不与SPAP升高程度呈相关关系。     

组织多普勒成像Tei指数测量对扩张型心肌病患者左室功能的评价

目的探讨组织多普勒成像(TDI)测量Tei指数评价扩张型心肌病(DCM)患者左室功能的价值。方法应用TDI获取25例DCM患者二尖瓣环间隔侧及左侧壁两点的运动频谱,测量等容舒张期(IRT)、等容收缩期(ICT)、射血时间(ET),并计算TDI-Tei指数,并与健康对照组及传统脉冲多普勒显像所测值进行比较。结果TDI所测DCM患者IRT、ICT显著延长,ET显著缩短,而TDI-Tei指数显著增大,TDI与传统脉冲多普勒显像两种方法所测IRT、ICT、ET及Tei指数分别呈直线相关,而两种方法所测二尖瓣环室间隔侧与左侧壁的Tei指数平均值相关性最高。结论TDI技术可用于测量DCM患者左室Tei指数,并与传统脉冲多普勒显像所测值相关性好。     

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.