应变率显像对缺血心肌收缩和舒张功能评价的研究

目的通过应变率显像评价冠心病患者缺血心肌的局部收缩和舒张功能。方法30例冠心病患者，测定缺血心肌的应变率数值（SR），包括收缩期峰值（SRs）、舒张早期峰值（SRe）和舒张晚期峰值（SRa），并测量左室射血分数（EF）；正常组选取30人作为对照。结果冠心病组节段心肌SRs和SRe均低于正常组相应节段的测值（P〈0．05），而两组间的EF差异无统计学意义。结论心肌应变率显像是一项实用的诊断心肌缺血的新方法。     

应变率显像评价不同构型高血压患者左室舒张功能及收缩后缩短

目的探讨心脏应变率显像（SRI）技术评价不同构型高血压患者左室舒张功能价值及收缩后缩短（PSS）现象。方法原发性高血压非左室心肌肥厚（NLVH）组30例,左室心肌肥厚（LVH）组30例,对照组30例,分别获得左室6个壁基底部、中间部和心尖部舒张早期应变率（SReb、SRem、SRea）,统计3组左室壁出现的PSS的节段数,并记录PSS值。结果NLVH组SReb、SRem、SRea均低于对照组（P〈0.01）。LVH组的SReb、SRem、SRea均低于NLVH组（P〈0.05）。LVH组的PSS出现比率及PSS绝对值均高于NLVH组（P〈0.05）。结论SRI技术为定量、准确评价不同构型高血压左室局部心肌舒张功能提供了新的方法,LVH组病理性PSS的出现提示局部心肌节段存在相对心肌缺血。     

应变率成像评价高血压和冠心病患者左室心肌功能

目的应用应变率成像（SRI）技术评价高血压和冠心病患者的左心室功能,探讨SRI评价左心室功能的临床价值。方法A组30例健康人群,B组23例原发性高血压病患者,C组19例冠心病合并原发性高血压患者,取心尖四腔、心尖两腔、心尖左室长轴切面的心肌应变率曲线,测定左室各室壁的收缩期、舒张早期、舒张晚期的峰值应变率（SRS、SRE、SRA）和收缩期峰值应变（εS）,计算其平均峰值应变率（mSRS、mSRE、mRSA）和平均峰值应变（mεS）;统计各组左室各壁出现的收缩后缩短（PSS）的节段数;观察左心室曲线M型应变率成像（CMM-SRI）图像特点,定量检测各节段收缩-舒张转换时间（TCEC）,冠状动脉造影确定缺血节段,比较各组左心室壁各节段TCEC的差异。结果与正常组（A组）相比,高血压病组（B组）患者和冠心病合并高血压组（C组）患者的mSRS、mSRE、mRSA和mε均有明显降低（P〈0.05）;与A组及B组相比,C组各节段PSS的检出率明显增多（P〈0.05）,而A、B两组各节段的PSS检出率的差异无显著性（P〉0.05）;与非缺血节段比较,缺血节段TCEC延长（P〈0.05）。结论应变率成像（SRI）技术为定量、准确评价高血压和冠心病左室心肌功能提供了新的方法。     

实时三平面应变率成像评价原发性高血压左心室心肌肥厚对长轴舒张功能的影响

目的：应用实时三平面应变率成像技术定量评价原发性高血压患者左心室肥厚的长轴舒张功能。方法：选择原发性高血压患者62例和正常对照组35例。原发性高血压患者分成两组,30例伴有心肌肥厚,32例没有心肌肥厚。应用实时三平面应变率成像技术测定各受检者左心室各壁基底段及中间段舒张早期峰值应变率（SRe）、舒张晚期峰值应变率（SRa）。结果：左室壁基底段、中间段SRe在原发性高血压组均明显小于正常对照组（P〈0.01）,且原发性高血压左室肥厚（LVH）组均明显小于非左室肥厚（NLVH）组（P〈0.05或P〈0.01）。SRa在左室侧壁和后壁LVH组小于正常对照组（P〈0.05）。结论：实时三平面应变率成像能够准确定量分析原发性高血压患者左心室肥厚长轴舒张功能的变化。     

应变率成像评价不同左心室构型原发性高血压患者右心室局部功能

目的 探讨应变率成像技术检测不同左室构型原发性高血压(HBP)患者右室收缩、舒张功能的应用价值.方法 HBP患者38例,根据左室质量指数(LVMI)和相对室壁厚度(RWT)值分为左室正常构型(LVN)组和左室重构(LVR)组,对照组23例.获取各受试者心尖四腔观清晰组织速度成像(TVI)图存盘供脱机分析.测量三尖瓣环处心肌收缩期峰值运动速度(Vs)、舒张早期峰值运动速度(Ve)、舒张晚期峰值运动速度(Va),计算Ve/Va;右室游离壁中部心内膜下心肌收缩期峰值应变(Ss)、收缩期峰值应变率(SRs)、舒张早期峰值应变率(SRe)、舒张晚期峰值应变率(SRa),计算SRe/SRa.结果 与对照组比较,高血压LVN组患者三尖瓣环Vs和Ve差异无统计学意义,Ve/Va减低;与对照组及高血压LVN组比较,高血压LVR组患者Vs差异无统计学意义,Ve、Ve/Va均显著减低;与对照组比较,高血压LVN组、LVR组患者右室游离壁中部心内膜下心肌SRs差异无统计学意义,Ss、SRe、SRe/SRa均显著减低;与高血压LVN组比较,高血压LVR组患者SRs差异无统计学意义,Ss、SRe、SRe/SRa均显著减低.结论 HBP患者无论左室构型有无变化,其右室局部收缩、舒张功能已受损,应变率成像技术能准确评价其右室局部功能.     

超声评价原发性高血压患者右室舒缩功能

目的观察组织速度成像（QTVI）与应变率成像（SRI）技术在监测原发性高血压患者右室功能中的价值。方法原发性高血压患者98例,分为正常构型组（Ⅰ组）、向心性重构组（Ⅱ组）、向心性肥厚组（Ⅲ组）、离心性肥厚组（Ⅳ组）;对照组33例。测量各组三尖瓣环收缩期峰值运动速度（Vs）、舒张早期峰值运动速度（Ve）、舒张晚期峰值运动速度（Va）及Ve／Va;测量右室游离壁中部收缩期峰值应变率（SRs）、舒张早期峰值应变率（SRe）、舒张晚期峰值应变率（SRa）及SRe／SRa。结果与对照组比较,高血压Ⅰ组患者Ve／Va显著减低;与对照组及高血压Ⅰ组比较,高血压Ⅱ组、Ⅲ组和Ⅳ组Ve、Ve／Va均显著减低;与Ⅱ组、Ⅲ组比较,Ⅳ组患者Ve、Ve／Va均显著减低。与对照组比较,高血压各组SRe、SRe／SRa均显著减低;与高血压Ⅰ组比较,高血压Ⅱ组、Ⅲ组和Ⅳ组患者SRe、SRe／SRa均显著减低;与Ⅱ组、Ⅲ组比较,Ⅳ组患者SRe、SRe／SRa均显著减低。结论高血压患者右室收缩功能受损不明显,无论有无左室构型变化其右室舒张功能已受损,尤以高血压第Ⅳ组舒张功能受损最为严重。     

心肌应变率成像评价肥厚型心肌病左心室局部舒张功能的应用研究

目的应用应变率成像（SRI）技术评价肥厚型心肌病（HCM）左心室局部舒张功能。方法分别获得30例HCM患者和30例正常对照者心尖四腔及长轴观图像，在应变率模式下测量各室壁基底段、中间段及心尖段舒张早期应变率（SRe）、舒张晚期应变率（SRA）和SRE/SRA等参数。结果与正常对照组相比，HCM组舒张早期负向应变率（SRE-）的节段数明显增多，差异有统计学意义（P〈0．01），并且室间隔各节段s艮绝对值显著增大；HCM组SRE降低，SRA增高或无明显变化，SRE/SRA明显减小，部分节段SRE/SRA〈1。结论SRI可以无创、准确地描述局部心肌组织的形变特性，检测局部舒张功能的异常，为临床评定HCM局部心肌舒张功能提供准确、敏感的量化指标。     

应用实时三平面应变率成像评价原发性高血压无左室重构患者右心室舒张功能

目的：研究实时三平面应变率成像评价原发性高血压（PH）无左室重构患者右心室舒张功能的临床应用价值。方法：无左室重构PH患者28例、健康志愿者44例,应用实时三平面定量组织速度成像（QTVI）及应变率成像测量右心室游离壁各节段心肌舒张早期和舒张晚期峰值速度（Ve,Va）及应变率（SRe,SRa）。结果：PH组与正常对照组比较右室心肌舒张早期峰值应变率差异有统计学意义（P<0.05）。结论：实时三平面应变率成像可以对PH无左室重构患者右心室舒张功能进行准确的估测。     

应变率成像评价肥厚型心肌病患者左心室局部功能和室壁运动同步性

目的 评价应变率成像技术在定量检测肥厚型心肌病(HCM)患者左心室局部心肌功能及室壁运动同步性中的价值.方法 HCM患者21例,根据室间隔及左室壁厚度分为3组:①非肥厚组(NH),室壁厚度≤11 mm,101节段;②轻度肥厚组(MH),11mm＜室壁厚度≤15 mm,86节段;③重度肥厚组,室壁厚度＞15mm,65节段.对照组18例,216节段.获取各受试者心尖四腔观、左室长轴及两腔观组织速度图像存盘供脱机分析.测量收缩期峰值应变率(SRs)、舒张早期峰值应变率(SRe)、舒张晚期峰值应变率(SRa),计算SRe/SRa;测量收缩期应变率达峰时间(TssR),并计算收缩期应变率达峰时间变异(CVTSSR);测量舒张早期应变率达峰时间(TESR),并计算舒张早期应变率达峰时间变异(CVTESR).结果 与对照组室壁节段比较,HCM组NH、MH、SH亚组SRs、SRe、SRe/SRa均显著降低,且三个亚组间SRe依次降低,即NH＞MH＞SH,NH与MH组间SRe/SRa差异无统计学意义,与NH、MH组比较,SH组SRe/SRa显著减低;与对照组比较,MH、SH组SRa显著降低,而NH组较对照组差异无统计学意义,且NH＞MH＞SH;与对照组比较,HCM组CVTSSR及CVTESR显著增大.结论 HCM患者无论有无室壁肥厚,其左室局部收缩舒张功能均受损;HCM患者左室心肌运动存在不同步现象,应变率成像技术能准确、定量评价其左室局部心肌功能及其左室心肌运动不同步.     

二维应变技术对不同分期慢性肾脏病患者右室功能的评价

目的：探讨二维应变技术对评价慢性肾脏病患者右室功能的价值。方法：52例慢性肾脏病患者分为两组,A组（n=22）和B组（n=30）,同时选取32名健康志愿者为正常对照组,分别取二维及TVI条件下心尖四腔观3个连续心动周期图像。应用2DS获取右室游离壁各节段心肌应变（S）及应变率（SR）,舒张早期峰值应变率（SRe）及晚期峰值应变率（SRa）;QTVI获取右室游离壁三尖瓣环收缩期峰值速度（Sm）、等容收缩时间（IVCT）、等容舒张时间（IVRT）、收缩时间（ET）、舒张早期峰值速度（Em）、舒张晚期峰值速度（Am）,并计算Tei指数。结果：B组患者右室游离壁长轴各节段心肌的s及SRs,SRe均明显低于正常组。A组患者右室游离壁心尖段S、中间段SR及中间段SRe均明显小于正常组。结论：二维应变技术可以早期评价慢性肾脏病患者右室功能。     

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.