应用组织追踪法评价犬左室收缩功能的研究

目的应用超声心动图组织追踪法观察左室收缩功能改变对犬二尖瓣瓣环收缩期位移的影响.方法选用11只健康杂种犬,分别在基础状态时、静脉注射多巴酚丁胺后、静脉注射心得安后以及结扎冠状动脉左前降支,发生急性心肌缺血后,用组织追踪法在心尖四腔心切面、两腔心切面及心尖长轴切面测量二尖瓣瓣环6个不同位置的收缩期位移(DS);用M型超声心动图测量二尖瓣瓣环收缩期下移距离(DM);用超声心动图Simpson法测定左室射血分数(LVEF).结果在改变犬心肌整体收缩功能的过程中,用组织追踪法测量的二尖瓣瓣环6个不同位置的收缩期平均位移与用M型超声心动图测量的二尖瓣瓣环收缩期平均下移距离显著相关(r=0.94, P＜0.001);同时,二尖瓣瓣环收缩期平均DS与用超声心动图Simpson法测定的LVEF显著相关(r=0.92, P＜0.001);发生急性心肌缺血时,用组织追踪法测量的二尖瓣瓣环6个不同位置的收缩期平均位移与用超声心动图Simpson法测定的LVEF也呈显著相关(r=0.78, P＜0.001),但相关性相对较低.结论超声心动图组织追踪法测量二尖瓣瓣环收缩期位移可快速、直观、无创性地定量评价左室收缩功能.     

应用组织追踪法评价左室功能的研究

目的 用超声心动图组织追踪法评价左室功能。方法 对90人有不同左室收缩功能患者的心尖四腔心、心尖长轴和心尖二腔心切面,用组织追踪法和M型超声心动图法记录收缩期二尖瓣瓣环向心尖方向的运动位移。所有患者均用Simpson方法确定左室射血分数,其中27例患者又做了左室造影。结果 在50例患者中（包括25例正常左室功能患者和25例左室整体功能减退患者）,组织追踪法从二尖瓣环的6位置测得的收缩期平均二尖瓣环距离与M型测得的值非常接近（r＝0．99,P＜0．001）,与左室射血分数的相关性很匹配（r＝0．97,P＜0．001）。用组织追踪法测定的收缩期二尖瓣不下移距离4．8mm作为一个切断点的值匹配（r＝0．97,P＜0．001）。用组织追踪法测定的收缩期二尖瓣瓣环下移距离4．8mm作为一个切断的值（cut-of value）,预测左室射血分数≤30％的敏感性为98％,特异性为78％。但在陈旧性心肌梗死患者中,组织追踪法从二尖瓣瓣环的6个位置测得的收缩期平均二尖瓣瓣环下移的距离与左室射血分数的相关性是较低的（r＝0．87,P＜0．001）。结论 组织追踪法测收缩期二尖瓣瓣环下移距离可为临床提供一种简单快速和无创伤性评价左室功能的方法。     

组织追踪法快速而精确评价心梗患者左室功能

目的本研究旨在用一种新的超声心动图技术-组织追踪法评价心梗患者左室节段收缩功能.方法我们研究40例陈旧性心梗患者和25例左室收缩功能正常对照组,在心尖四腔心、三腔心和二腔心切面,用组织追踪法和M型超声心动图法记录收缩期二尖瓣瓣环向心尖方向的运动位移.所有患者均用Simpsons方法确定左室射血分数,其中27例患者又做了对比造影.结果在陈旧性心梗患者中,组织追踪法从二尖瓣瓣环的6个位置测得的收缩期平均二尖瓣瓣环下移的距离与M-mode测得的距离相关性很匹配(r＝0.98,P＜0.001),与左室射血分数的相关性很好(r＝0.87,P＜0.001).陈旧性心梗节段收缩减退患者与正常左室收缩功能患者的比较,收缩期二尖瓣瓣环下移距离在6个位置都是有意义地减少,而且收缩期二尖瓣瓣环下移距离在6个位置之间有较大的异质性.结论组织追踪法测收缩期二尖瓣瓣环下移距离为临床提供了一种简单的、快速的和无创伤性的方法评价心梗患者左室功能.     

应用二维斑点追踪技术测量二尖瓣瓣环位移评价左室整体收缩功能的临床价值

目的：应用二维斑点追踪技术（2D-STI）测定二尖瓣瓣环位移（MAD）,探讨MAD作为评价左室整体收缩功能的可行性和准确性。方法：对50例患者均采用Simpson’s法描记心内膜面来测定左室收缩功能以及应用2D-STI技术在心尖四腔心切面测定收缩期二尖瓣瓣环向心尖方向的位移,并进行相关性研究。结果：2D-STI测定收缩期二尖瓣瓣环中点位移（MADMidpt）与左室射血分数（LVEF）相关性良好（r=0.97, P<0.01）,用2D-STI测定收缩期二尖瓣瓣环中点位移距离5.3mm作为一个切断点值,预测LVEF≤30%的敏感性90%,特异性90%。结论：用2D-STI技术测定二尖瓣瓣环位移是一种快速可靠,简便的评价左室整体收缩功能的新方法。     

组织追踪法评价阿霉素致兔心脏毒性左心室收缩功能影响的研究

目的探讨组织追踪法(TT)评价阿霉素致兔心脏毒性左心室收缩功能的价值。方法42只兔分成4组A组(对照组)10只,注射2mg/kg生理盐水8周;B组10只,每周静脉注射阿霉素2mg/kg,注射2周;C组10只,同样方法给予阿霉素4周;D组12只同样方法给予阿霉素8周。12周后对4组兔心脏用组织追踪法测量二尖瓣瓣环的收缩期位移(Ds);用M型超声心动图测量二尖瓣瓣环收缩期下移距离(Dm);用超声心动图Simpson法测定左室射血分数(LVEF)。结果D组二尖瓣瓣环平均Ds、Dm和、EF明显减低(P<0.01)。C组二尖瓣瓣环平均Ds、Dm明显减低(P<0.01),而EF正常低值(P>0.05)。B组与A组间各参数均无显著性差异(P>0.05)。4组二尖瓣瓣环收缩期平均Ds与Dm显著相关(P<0.04);同时二尖瓣瓣环收缩期平均Ds与LVEF也呈显著相关(P<0.03)。病理结果从B组到D组的心肌损害程度逐渐加重。结论组织追踪法可无创有效地评价阿霉素心脏毒性左室心肌收缩功能的变化。     

彩色室壁运动技术测定二尖瓣瓣环位移评价左室收缩功能

目的 应用彩色室壁运动(CK)技术测定二尖瓣瓣环的位移,定量评价左心室收缩功能.方法 应用彩色室壁运动技术(CK)检测26例健康对照组(Con组)和25例扩张型心肌病组(DCM组)心尖四腔观及两腔观二尖瓣环各壁的位移,并用Simpson's法测定左室射血分数.结果 Con组CK图像由心底向心尖部依次显示橙→黄→绿→青→蓝相交替,均匀分布,DCM组则彩带明显变窄或彩带颜色显示不完整;CK测量的DCM组二尖瓣环各壁收缩期位移较Con组明显降低(P<0.01),且均与左室射血分数之间有高度相关(r=0.81～0.87,P<0.01).结论 CK技术测定二尖瓣瓣环位移可作为一种简单、快速和无创性评价左室收缩功能的新方法.     

定量组织速度成像和组织追踪法对扩张型心肌病左室功能的分析

目的 探讨定量组织速度成像（QTVI）和组织追踪法（TT）对扩张型心肌病（DCM）患左室收缩和舒张功能的价值。方法 获取标准心尖位左室长轴切面，两腔切面及四项切面，分别应用QTVI和TT技术分析30例正常人和20例DCM患左室长轴方向不同室壁节段即左室前壁、后壁、侧壁、下壁、前间隔和后间隔的心肌多普勒速度曲线和位移曲线；用M-型超声心动图测量收缩期二尖瓣环下移距离（Don）；用二维超声心动图测量左室射血分数（LVEF）：用多普勒超声心动图测量二尖瓣口血流快速充盈速度E峰、左房收缩充盈速度A峰，计算E/A值。结果 DCM患左室不同室壁节段Vs，Ve，Va和Ds以及LVEF均比正常人显减低。在DCM患中，用定量组织速度成像和组织追踪法测量的二尖瓣环水平Ds与用M-型超声心动图测量的Dm显相关（r=0.64，P=0.005），二尖瓣环水平的平均Vs(r=0.73，P=0.001）、平均Ds(r=0.64,P=0.005）与LVEF分别显相关。正常人与DCM患两组间E/A值无显统计学差异，而DCM患二尖瓣环平均Ve/Va较正常人显减低；正常人中二尖瓣环平均Ve/Va与E/A显相关（r=0.63,P=0.008)，而DCM患二尖瓣环平均Va与E/A无显相关。结论 定量组织速度成像和组织追踪法技术可快速、直观、元创性定量评价扩张型心肌病患左心室收缩舒张功能。     

组织运动二尖瓣环位移自动追踪技术在评价尿毒症患者左室收缩功能早期受损中的价值

目的应用组织运动二尖瓣环位移自动追踪技术测定二尖瓣环向心尖移动的距离,分析其在评价尿毒症患者左室收缩功能的应用价值。方法 45例尿毒症患者分为左室肥厚(LVH组)25例和左室未见肥厚(NLVH组)20例,另选取30例正常成人为对照组。应用组织二尖瓣环位移自动追踪技术测量各组心尖四腔切面、心尖左室长轴切面及心尖两腔切面的二尖瓣环位移,并用Simpsons法测定左室射血分数。结果 NLVH组二尖瓣环位移除左室前壁、后壁外其余室壁均较对照组明显减低(均P0.05),LVH组左室所有室壁的二尖瓣环位移均较对照组明显减低(均P0.05)。LVH组和NLVH组其收缩期二尖瓣环连线中点的最大位移、收缩期二尖瓣环连线中点的最大位移占左室长轴的百分比及其均值较对照组明显减低(P0.05)。尿毒症患者在左室射血分数正常的情况下,二尖瓣环位移的相关指标较对照组减低(P0.05)。结论组织运动二尖瓣环位移自动追踪技术提供了一种简便、精准地评价急性尿毒症患者左室整体收缩功能的方法,能早期评估左室整体收缩功能。     

应用组织追踪法观察犬急性心肌缺血对二尖瓣瓣环收缩期位移的影响

目的 :应用超声心动图组织追踪法观察心肌缺血对犬二尖瓣瓣环收缩期位移的影响。方法 :选用11只健康杂种犬 ,胸骨正中开胸 ,在第一对角支起点以下套扎冠脉左前降支主干 ,制备急性心肌缺血模型。在心肌缺血发生前后 ,用组织追踪法分别在心尖四腔心切面、两腔心切面及心尖长轴切面测量二尖瓣瓣环 6个不同位置的收缩期位移 ;用 Simpson法测定心肌缺血时犬的左室射血分数。心肌缺血的范围通过心肌染色切片确定。结果 :在基础状态时 ,二尖瓣瓣环 6个不同位置的收缩期位移之间无显著性差异 (P>0 .0 5 ) ;在心肌缺血状态下 ,组织追踪法所测定的二尖瓣瓣环 6个不同位置的收缩期位移及其平均值较基础状态时均明显减小 (P<0 .0 1) ;其平均值与左室射血分数之间有明显相关性 (r=0 .78,P<0 .0 1) ;缺血处室壁所对应的二尖瓣瓣环收缩期位移较相同状态下非缺血处室壁所对应的二尖瓣瓣环收缩期位移明显减小 (2 .3± 0 .3 vs 2 .7± 0 .4,P<0 .0 0 1) ;缺血处室壁所对应的二尖瓣瓣环收缩期位移较基础状态时的百分变化率比非缺血处室壁所对应的二尖瓣瓣环收缩期位移较基础状态时的百分变化率更高 (3 4%± 10 % vs 16%± 12 % ,P<0 .0 0 1)。结论 :在出现心肌缺血时 ,应用组织追踪法测量二尖瓣瓣环收缩期位移可以评价左室     

定量组织速度成像和组织追踪法对肥厚型心肌病左心室局部心肌收缩功能的分析

目的:探讨定量组织速度成像(QTVI)和组织追踪法(TT)评价肥厚型心肌病(HCM)患者左室局部心肌收缩功能的价值。方法:获标准心尖长轴切面、心尖二腔切面和心尖四腔切面,分别应用QTVI和TT技术分析17例HCM患者(HCM组)和18例健康对照者(对照组)左室长轴方向不同室壁节段的多普勒速度曲线和位移曲线,测量收缩期峰值速度(Vs)和收缩期峰值位移(Ds)。结果:HCM组患者不同室壁节段的Vs和Ds均降低,分别与对照组相比,绝大部分节段差异有显著意义(P<0.05或P<0.01);HCM组患者同一水平不同节段的平均峰值速度和平均位移大部分较对照组降低,其差异有显著意义(P<0.05或P<0.01)。结论:HCM患者左室长轴心肌各节段收缩功能较正常人减低。QTVI和TT能定量评价HCM患者左室局部心肌收缩功能。     

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.     

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.     

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.