毒鼠强浓度在人体内变化规律研究

目的 探讨3种方法治疗急性毒鼠强中毒后不同时期患者体内毒鼠强浓度的改变及出院后正常生活条件下毒鼠强浓度变化.方法 用气相色谱-质谱分析患者血液中毒鼠强浓度,根据101例患者血液中毒鼠强浓度高低和临床症状分为常规综合治疗组、加行血液灌流组、加行输血治疗组,监测其治疗前后体内毒鼠强浓度变化,对出院患者进行为期1年的跟踪随访,检测其体内毒鼠强浓度变化.结果 常规综合治疗组治疗后毒鼠强浓度由治疗前33.0(1.7～115.0)μg/L下降为18.0(0.3～47.6)μg/L,平均下降45.5%;加行血液灌流组由治疗前108.0(54.0～290.0)μg/L经多次血液灌流后下降为26.0μg/L,末次血液灌流后较血液灌流前下降75.9%,每次血液灌流后下降20.0%～45.0%,血液灌流24 h后毒鼠强浓度略有回升现象;加行输血治疗患者2例,治疗后毒鼠强浓度分别下降33.5%及60.0%.25例出院患者在中毒6个月时有2例体内仍含有毒鼠强,且仍以化学原形存在,随访1年时均未再检出毒鼠强.结论 常规综合治疗、血液灌流、输血治疗毒鼠强中毒是积极有效的方法,毒鼠强在人体内代谢缓慢.     

兔急性草乌中毒血液灌流治疗实验方法的建立

目的 探讨建立血液灌流(HP)治疗兔急性草乌中毒的实验方法.方法 将24只实验兔随机分成中毒模型组、HP组和假HP组,每组8只.中毒模型组及HP组用草乌酒灌胃制作急性中毒模型;假HP组及HP组经颈内动脉、颈外静脉插管,建立HP装置后进行HP 2 h,假HP组吸附柱内无吸附剂.用液相-质谱联用仪检测中毒模型组与HP组灌流前后相同时间点血中乌头碱的浓度;检测假HP组灌流前后血液有形成分及电解质、血浆蛋白浓度的变化.结果 HP组灌流2 h后血中乌头碱浓度为(2.02±1.46)μg/L,明显低于中毒模型组(36.97±8.30)μg/L(P<0.05);假HP组灌流前、后血细胞计数和血红蛋白、血浆蛋白质及电解质数值变化差异无统计学意义(P均>0.05).结论 HP可明显降低血中乌头碱浓度,HP实验装置对兔血液系统无不良影响,是一项安全有效的实验方法与治疗技术.     

包膜活性炭吸附血液灌流清除人血浆中毒鼠强的实验

目的:观察包膜活性炭对血浆中毒鼠强的清除率及吸附规律。方法:实验于2004-05/2006-04在军事医学科学院毒物药物研究所国家重点实验室完成。采用包膜活性炭灌流器对毒鼠强血浆样进行血液灌流吸附,在灌流的1,2,3h分别取样,经乙酸乙酯萃取后,用气相色谱氮磷检测器法(GC/NPD)测定其含量并计算清除率。结果:活性炭对毒鼠强的吸附作用在血液灌流1h最高,灌流2h后毒鼠强质量浓度无明显变化。400,200μg/L毒鼠强血液灌流1h清除率分别为(57.83±1.85)%,(48.18±1.81)%。结论:用包膜活性炭吸附剂进行血浆的灌流吸附,能清除大部分毒物,迅速降低血浆中毒鼠强的质量浓度。     

树脂吸附血液灌流器治疗肝性高胆红素血症的临床观察

目的　观察用丽珠HA型树脂吸附血液灌流器行血液灌流 (HP)治疗肝性高胆红素 (TBil≥ 171μmol/L)血症的疗效和安全性。 方法　选择肝性高胆红素血症患者 4 8例 ,观察血液灌流治疗前后的胆红素变化情况 ,评价灌流术的安全性。结果　血液灌流术后TBil较术前明显下降 ,经统计学处理有显著差异 (P <0 .0 1) ;血液灌流术不良反应发生率为 35 .4 % (主要是血压下降 2 0 .83% ,恶心 /呕吐 16 .6 7% )。结论　树脂吸附血液灌流器治疗肝性重度高胆红素血症有较满意疗效和较好安全性 ,可明显改善症状及缩短平均住院时间。     

血液灌流对急性中、重度毒鼠强中毒的疗效评价

目的：通过64例中、重度毒鼠强中毒病例的治疗，评价血液灌流在治疗毒鼠强中毒的应用价值。方法：对64例中、重度中毒病人于血液灌流前后及清醒、抽摔停止时的血毒浓度进行测定，血液灌流的间隔时间为24h。并对入院时、第3天、第7天的生化酶学指标进行测定，分析其之间的相关性。结果：①血毒浓度与临床症状：血毒浓度越高，其临床症状越明显；②血液灌流疗效：血液灌流能有效地降低血毒浓度，迅速改善临床症状，对于毒鼠强中毒的疗效显著，一般经2-4次灌流后即可达到治疗目的。③酶学指标变化：酶学水平与血毒浓度密切相关，随着血毒浓度下降，酶学指标则迅速下降，接近正常。结论：血液灌流是清除血中毒鼠强的好方法。     

树脂型血液灌流器抢救急性毒鼠强中毒的临床观察与护理

目的探讨树脂型血液灌流器抢救急性毒鼠强中毒的临床效果.方法在临床综合治疗的基础上应用mikkiso单泵机和珠海丽珠医用生物材料有限公司生产的HA330型血液灌流器对21例急性毒鼠强中毒患者进行血液灌流.结果在临床综合治疗的基础上加用血液灌流使21例急性毒鼠强中毒患者治愈率达100%.结论血液灌流治疗是抢救急性毒鼠强中毒的有效措施,尽早应用可提高治愈率.     

不同治疗方式对毒鼠强中毒患儿心肝肾功能的影响

目的　探讨血液灌流及非血液灌流治疗对毒鼠强中毒患儿心肝肾功能的影响。方法　 4 5例毒鼠强中毒患儿按不同治疗方式分为两组 ,血液灌流组和非血液灌流组 ,比较两组之间以及治疗前后的心肝肾功能。结果　两组患儿治疗前血液中毒鼠强浓度测定无显著性差异 (P >0 .0 5 ) ,治疗后血液灌流组毒鼠强浓度明显低于非血液灌流组 (P <0 .0 1)。治疗前两组患儿均有不同程度的心肝肾功能损害 ,但两组间无显著性差异。治疗后血液灌流组患儿心肝肾功能较非血液灌流组患儿恢复好 ,两组有显著性差异。LDH(IU/L) :14 0 .2± 5 6 .1vs 2 0 5 .7± 6 4 .9,t =3.6 2 ,P <0 .0 1;CK -MB(IU/L) :10 6 .7± 33.2vs 2 5 6 .3± 6 8.2 ,t =9.74 ,P <0 .0 1;AST(IU/L) :73.9± 33.2vs 16 7.9± 76 .3,t =5 .6 2 ,P <0 .0 1;Cr(μmol/L) :10 6± 4 3.2vs178 3± 5 9.3,t =4 .73,P <0 .0 1。结论　血液灌流组患儿心肝肾功能较非血液灌流组患儿恢复快 ,后遗症较少。早期血液灌流对毒鼠强患儿心肝肾功能具有保护作用。     

血液灌流对维持性血液透析患者血清β2-微球蛋白的清除效果

目的 研究血液灌流对维持性血液透析患者血清β2-微球蛋白(β2-MG)的清除效果.方法 将42例维持性血液透析患者随机分为2组A组血液灌流+血液透析(HD+HP)、B组血液透析(HD),A组接受树脂吸附联合血液透析治疗,B组接受常规血液透析治疗,均在单次治疗前后用放射免疫法测定血清β2-MG水平.结果 A组治疗后患者血β2-MG从(22.61±5.17)mg/L降至(11.98±3.92)mg/L,治疗前后比较,差异有显著性(P＜0.01);B组治疗后血β2-MG从(23.37±5.13)mg/L降至(23.34±5.08)mg/L,治疗前后比较,差异无显著性(P＞0.05).结论 血液灌流联合血液透析能有效地清除β2-MG.     

树脂型血液灌流器抢救急性毒鼠强中毒的临床观察与护理

目的探讨树脂型血液灌流器抢救急性毒鼠强中毒的临床效果.方法在临床综合治疗的基础上应用mikkiso单泵机和珠海丽珠医用生物材料有限公司生产的HA330型血液灌流器对21例急性毒鼠强中毒患者进行血液灌流.结果在临床综合治疗的基础上加用血液灌流使21例急性毒鼠强中毒患者治愈率达100%.结论血液灌流治疗是抢救急性毒鼠强中毒的有效措施,尽早应用可提高治愈率.     

血液灌流联合血液透析治疗各种中毒疗效观察

目的探讨应用血液灌流（HP）联合血液透析（HD）治疗各种中毒的疗效。方法入院后按中毒常规处理后，迅速采用HP／HD联合疗法，灌流器在前端与透析器串联相接，动脉管路接灌流器上端，静脉管路接透析器静脉端，建立体外循环治疗。观察患者治疗前后肾功能、肝功能、电解质变化。结果患者通过HP／HD联合治疗，中毒症状明显改善，肾功能、肝功能、电解质恢复正常，抢救成功率高。结论应用HP／HD联合治疗各种中毒简单、效果可靠、抢救成功率高。     

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.     

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.     

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.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.