氦氖激光照射治疗皮肤感染的临床观察

目的观察氦氖激光照射治疗皮肤感染的疗效.方法179例皮肤感染患者分为2组,对照组69例采用口服多西环素和外涂药物治疗;激光组110例采用药物治疗的同时配合氦氖激光皮损处局部照射.治疗15 d后对2组疗效进行评定.结果激光组治愈率显著高于对照组(χ2=18.0216,P<0.01),有效率亦显著高于对照组(χ2=17.8416,P<0.01);痊愈平均时间明显短于对照组(t=1.9835,P<0.01).结论氦氖激光局部照射治疗皮肤感染疗效显著,疗程短、无痛苦及副作用.     

氦氖激光治疗皮肤溃疡的临床疗效

目的 :验证氦氖激光治疗皮肤溃疡的疗效。方法 :36例皮肤溃疡患者分为治疗组 2 5例 (37个溃疡面 )和对照组 11例 (2 1个溃疡面 )。治疗组采用局部清创和外敷药物的同时应用氦氖激光照射治疗 ,对照组仅采用局部清创和外敷药物 ,2 0d后 ,2组进行疗效比较。结果 :治疗组的痊愈率和有效率明显高于对照组 (P <0 0 1,P <0 0 5 )。痊愈平均时间明显短于对照组 (P <0 0 1)。结论 :氦氖激光照射治疗皮肤溃疡可提高疗效 ,缩短疗程 ,减少副作用等。     

氦氖激光及旋磁治疗痔疾疗效观察

目的　探索治疗痔疾的较好方法。方法　采用氦氖激光局部和穴位照射及旋磁局部治疗 88例与药物治疗 84例 ,随机分组对比观察。结果　氦氖激光及旋磁组疗效优于药物组 (P <0 .0 1 )。结论　氦氖激光及旋磁治疗痔疾疗效显著 ,安全无痛苦。     

氦氖激光照射治疗结节囊肿性痤疮的临床疗效

目的 :验证氦氖激光治疗结节囊肿性痤疮的疗效。方法 :134例结节囊肿性痤疮患者分为 2组。对照组 30例采用口服和外敷药物治疗。观察组 10 4例采用口服和外敷的同时应用氦氖激光照射治疗。 4个疗程后 ,2组进行疗效比较。结果 :观察组和对照组治愈率分别为 6 2 5 0 % (6 5 /10 4 )、2 6 6 6 % (8/30 ) ,治愈天数分别为 12 3d、17.4d ,2组比较差异均有显著性 (P <0 .0 1)。结论 :氦氖激光照射治疗结节囊肿性痤疮可缩短疗程提高疗效 ,且无副作用。     

氦氖激光联合药物治疗带状疱疹的疗效观察

目的 观察氦氖激光联合药物治疗带状疱疹的疗效.方法 将2009年1月至2010年7月72例带状疱疹患者,随机分为治疗组和对照组.治疗组30例,采用药物治疗的同时加用氦氖激光局部照射;对照组42例,采用单纯的药物治疗.对2组疗效进行观察比较.结果 治疗组的疗效明显优于对照组.结论 氦氖激光在带状疱疹的治疗中能促进皮疹...     

氦氖激光治疗斑秃的疗效观察

目的观察氦氖激光治疗斑秃的疗效。方法将67例斑秃患者按随机数字表法分为2组,对照组31例,口服谷维素片、养血生发胶囊、六味地黄丸,局部采用曲安奈德注射液加2%利多卡因行斑块基底部注射,1次.周-1,2个月1个疗程。治疗组36例在对照组治疗的基础上用氦氖激光局部照射,1次.d-1,每次1个部位照射15 min,10次1个疗程,连用2个月。结果治疗组总有效率为94.4%,对照组总有效率64.5%,2组比较差异有统计学意义（P〈0.01）。结论氦氖激光局部照射配合其他药物治疗斑秃起效快,疗效确切,且经济有效,无不良反应,是治疗斑秃的一种较好的方法。     

氦氖激光局部照射治疗褥疮应用

目的探讨氦氖激光局部照射治疗褥疮的疗效。方法55例褥疮病人随机分为激光治疗组和对照组，在常规治疗基础上，治疗组加用氦氖激光局部照射，20天后观察疗效。结果治疗组的治愈率为60％，总有效率100％。较对照组治愈率和总有效率明显提高（P〈0．01）。结论氦氖激光局部照射治疗褥疮疗效肯定，值得临床推广。     

氦氖激光与超短波治疗颞颌关节综合征疗效观察

目的　探讨治疗颞颌关节综合征的较好的物理疗法。方法　采用氦氖激光穴位照射与超短波局部辐射治疗 66例 ,药物治疗 64例 ,随机分组 ,对比观察。结果　氦氖激光与超短波组治愈率优于药物组 (P <0 .0 1 )。结论　氦氖激光与超短波能较快治愈颞颌关节综合征。其特点 :痊愈快 ,无副作用 ,安全无痛苦。     

氦氖激光血管内照射对肿瘤浸润淋巴细胞生物活性的影响

目的　研究氦氖激光血管内照射 (ILIB)对肿瘤浸润淋巴细胞 (TIL)生物活性的影响。方法　ILIB组 6 0例恶性肿瘤患者用ILIB加生物治疗 ,对照组 6 0例恶性肿瘤患者用模拟照射加生物治疗 ,分别测定照射前后TIL细胞增殖活性、细胞亚群 (APAAP法 )、细胞毒性 (MTT法 )与端粒酶活性 (TRAP -PCR法 )。结果　ILIB组治疗 2 0d后TIL增殖活性与对照组及治疗前相比 ,差异无显著性 (P >0 .0 5 ) ;CD3、CD4、CD4/CD8明显高于治疗前及对照组 (P <0 .0 5 ) ,而CD8差异无显著性 (P >0 .0 5 ) ,TIL细胞毒性治疗后 (4 1.0± 6 .2 ) %明显高于治疗前 (2 1.1± 4.0 ) %及对照组 (2 5 .1± 3 .1) %(P <0 .0 1) ;TIL端粒酶活性治疗后 0 .0 6 1± 0 .0 0 1明显高于治疗前 0 .0 2 8± 0 .0 0 9及对照组 0 .0 2 5±0 .0 0 7(P <0 .0 5 )。ILIB组缓解率 5 3 %、有效率 79% ,明显高于对照组缓解率 2 8% (χ2 =7.84,P <0 .0 1)、有效率 48% (χ2 =12 .17,P <0 .0 0 1)。结论　ILIB引起TILCD3、CD4、CD4/CD8、细胞毒性与端粒酶活性增加 ,增加肿瘤患者的免疫功能 ,增强TIL抗肿瘤效应 ,ILIB辅助生物治疗有希望进一步提高恶性肿瘤患者生存率。     

氦氖激光并微波照射治疗糖尿病足溃疡

目的检验氦氖激光合并微波照射治疗糖尿病足部溃疡的治疗效果。方法对18例糖尿病足部溃疡患者分治疗组11例,对照组7例。所有患者均接受传统的常规治疗,治疗组另采用氦氖激光并微波照射治疗。结果治疗组与对照组治愈率为57%(12/21)和27%(13/11),P<0.01,χ2=2.59,差异有非常显著性意义。总有效率分别86%(18/21)和73%(8/11),P<0.01,χ2=0.80差异有非常显著性意义。治疗组和对照组平均痊愈时间分别是(3.83±1.87)周和(6.17±1.16)周(P<0.05,t=2.5706)有显著差异。结论氦氖激光并微波照射治疗对糖尿病足部溃疡有显著疗效。     

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.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.