罗格列酮对急性冠脉综合征患者冠脉介入术预后的影响

目的探讨罗格列酮对急性冠脉综合征(ACS)患者冠脉介入术(PCI)预后的影响。方法将60例行PCI治疗的ACS患者分为2组,罗格列酮治疗组及对照组各30例,治疗组在常规治疗的基础上应用罗格列酮4 mg/d治疗半年,观察PCI术后2组患者心绞痛发作情况及EF值的变化,并检测治疗前后血浆内皮素(ET)、一氧化氮(NO)、C反应蛋白(CRP)水平,做治疗后组间对比。结果治疗组心绞痛发生率明显下降,P<0.01,心机梗死发生率下降,P<0.05,EF值治疗组较对照组明显改善P<0.01,治疗组治疗后NO明显升高,而ET、CRP明显下降,与对照组比较P<0.01,两组差异有统计学意义。结论罗格列酮可减少ACS患者PCI术后不良心血管事件的发生率。     

VerifyNow和Multiplate两种血小板功能检测方法对急性冠脉综合征患者的预测价值

目的探讨两种快速床旁检测血小板功能的方法Multiplate和VerifyNow技术对急性冠脉综合征(ACS)患者不良心血管事件的预测价值。方法分别应用VerifyNow和Multiplate技术检测ACS患者的血小板反应性,探讨血小板反应性与主要不良心血管事件(MACE,由全因死亡、非致死性心肌梗死、非致死性卒中、支架内血栓形成和血运重建组成的复合终点)之间的关系。结果对120例ACS患者随访1年后,MACE 18例(15%)。两种方法检测的血小板反应性均与MACE相关。Logistic回归分析发现,只有VerifyNow可以预测MACE的发生(P=0.01)。VerifyNow检测显示为血小板高反应(HPR)的患者MACE发生率为16%,没有HPR的患者MACE发生率为7%(OR=2.6,95%CI=1.5~4.4,P=0.001)。Multiplate检测显示为HPR的患者MACE发生率为13%,没有HPR的MACE发生率为9%(OR=1.5,95%CI=0.9~2.5,P=0.11)。结论 VerifyNow技术检测血小板功能比Multiplate技术可以更好地预测ACS患者的不良预后。     

心肌损伤标志物与重症急性胰腺炎预后的临床研究

目的探讨肌钙蛋白I等心肌损伤血清标志物对重症胰腺炎患者预后的影响。方法48例本院收治的重症急性胰腺炎患者,检测其入院48h内的肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶(CKMB)、乳酸脱氢酶同工酶(LDH1)等心肌损伤标志物,用彩色多普勒测定左室射血分数(EF),同时对所有患者进行APACHEⅡ评分,计算入选患者病死率。按患者血清肌钙蛋白I定性结果分组,用单因素方差分析比较cTnI阳性组和阴性组CKMB、LDH1、EF、APACHEⅡ评分的差别。用卡方检验比较两组心衰发生率和病死率,并计算OR值。结果cTnI阳性组的CKMB、LDH1较阴性组高,但差异没有显著性;APACHEⅡ评分、心衰发生率和死亡率明显高于阴性组,cTnI对SAP患者心衰和死亡的OR分别为4.350和5.850,EF值低于阴性组,P<0.05。结论cTnI作为心肌损伤的敏感且特异的指标,能较好地反映急性重症胰腺炎患者心血管功能的走向,对患者的疾病进展程度和临床预后方面有较佳的预测能力。     

急性心肌梗死介入治疗和溶栓治疗的临床疗效比较

[目的]比较直接经皮冠状动脉介入（PCI）治疗和静脉溶栓治疗急性心肌梗死患者（AMI）的临床疗效.[方法]132例AMI患者按不同治疗方法分为两组,其中75例患者直接行冠脉造影术和梗死相关动脉介入治疗（急诊PCI组） 57例行静脉溶栓（对照组）.比较两组患者梗死后冠脉再通率、心绞痛发生率、左室收缩功能（左室射血分数）、平均住院天数、主要不良心血管事件发生率的差别.[结果]急诊PCI组冠脉再通率高于对照组 平均住院天数、梗死后心绞痛、心源性休克发生率、总病死率和室性心律失常发生率明显低于对照组（P〈0.01）.[结论]AMI患者采取急诊冠脉介入治疗能及时有效的开通梗死相关血管,实现心肌再灌注,改善心功能,降低病死率,明显缩短住院时间,其效果优于静脉溶栓治疗.     

急性冠脉综合征的临床诊断进展

随着静息性缺血性胸痛患者的心脏死亡事件和非致死性缺血性事件危险性的增加，急性冠脉综合征（acute coronary syndrome，ACS）初步评估与早期诊断变得非常重要。通常，用于诊断和危险度分层的指标包括病史、体格检查、12导联心电图及冠脉造影的检查，近年来一些新的心肌标志物的应用．结合上述指标为ACS患者诊断及治疗提供了更有价值的依据。本文旨在评价各项心肌损伤标志物的利弊，为临床诊断不同类型ACS提供个性化诊断思路。     

心肌肌钙蛋白I测定及其在急性冠状动脉综合征中的应用

心肌肌钙蛋白I(cTnI)是一种心肌细胞损伤敏感而特异的生化标志物,对心血管事件的预测具有重要临床价值。现就cTnI的生化特性、检测方法及其在急性冠状动脉综合征(ACS)中的应用作一简要概述。     

超滤法缺血修饰白蛋白检测在急性冠脉综合征早期诊断中的作用

急性冠脉综合征(acute coronary syndrome,ACS)是急诊胸痛患者中最常见的致命性疾患.如何早期诊断ACS是急诊医师面临的一项挑战[1].传统心肌损伤标记物在心肌坏死后才升高,而对ACS迅速诊断并尽早干预,对患者预后极其重要.     

床旁快速血液分析仪在急诊抢救中的应用体会

总结床旁快速血液分析仪在急诊抢救中的应用体会。对50例急诊患者抢救处置时应用床旁快速血液分析仪进行血液分析检测,缩短了急诊检验出报告的时间和患者在急诊科的滞留时间,提高了患者的早期确诊率,提高了患者的满意度。     

人cTnI抗原性及测定标准化的研究进展

上个世纪90年代起。心肌肌钙蛋白(cTn)用于临床诊断心肌损伤．由于心肌肌钙蛋白Ⅰ(cTnI)可检出微小心肌损害，现已成为心肌细胞损伤敏感度和特异度最强的标志物之一，是快速诊断急性心肌梗死(AMI)和急性冠脉综合征(acute coronary syndromes．ACS)、协助ACS危险分级和反映其预后的主要生化标志。大量临床研究表明cTnI在诊断心肌损伤时有高度的特异度及灵敏度。是诊断心肌损伤的“金标准”。     

心肌肌钙蛋白Ⅰ测定及其在急性冠状动脉综合征中的应用

心肌肌钙蛋白Ⅰ(cTnⅠ)是一种心肌细胞损伤敏感而特异的生化标志物，对心血管事件的预测具有重要临床价值。现就cTnⅠ的生化特性、检测方法及其在急性冠状动脉综合征(ACS)中的应用作一简要概述。     

Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing

Physical therapists require an accurate, reliable method for measuring muscle strength. They often use manual muscle testing or hand-held dynametric muscle testing (DMT), but few studies document the reliability of MMT or compare the reliability of the two types of testing. We designed this study to determine the intrarater reliability of MMT and DMT. A physical therapist performed manual and dynametric strength tests of the same five muscle groups on 11 patients and then repeated the tests two days later. The correlation coefficients were high and significantly different from zero for four muscle groups tested dynametrically and for two muscle groups tested manually. The test-retest reliability coefficients for two muscle groups tested manually could not be calculated because the values between subjects were identical. We concluded that both MMT and DMT are reliable testing methods, given the conditions described in this study. Both testing methods have specific applications and limitations, which we discuss.     

A narrative review of manual muscle testing and implications for muscle testing research

Objective

Manual muscle testing (MMT) is used for a variety of purposes in health care by medical, osteopathic, chiropractic, physical therapy, rehabilitation, and athletic training professionals. The purpose of this study is to provide a narrative review of variations in techniques, durations, and forces used in MMT putting applied kinesiology (AK) muscle testing in context and highlighting aspects of muscle testing important to report in MMT research.

Method

PubMed, the Collected Papers of the International College of Applied Kinesiology–USA, and related texts were searched on the subjects of MMT, maximum voluntary isometric contraction testing, and make/break testing. Force parameters (magnitude, duration, timing of application), testing variations of MMT, and normative data were collected and evaluated.

Results

“Break” tests aim to evaluate the muscle's ability to resist a gradually increasing pressure and may test different aspects of neuromuscular control than tests against fixed resistances. Applied kinesiologists use submaximal manual break tests and a binary grading scale to test short-term changes in muscle function in response to challenges. Many of the studies reviewed were not consistent in reporting parameters for testing.

Conclusions

To increase the chances for replication, studies using MMT should specify parameters of the tests used, such as exact procedures and instrumentation, duration of test, peak force, and timing of application of force.     

动态测验的发展及应用

目的:动态测验是评估人类能力的一种新的测量方法。综合分析动态测验的理论和发展,并对动态测验的实证研究进行重点介绍,以期对国内动态测验的实证研究有所帮助。方法:通过Proquest数据库检索2000-01/2006-05、关键词为"动态测验"及"动态评估"的外文文献。同时,通过中国期刊网全文数据库检索1996-01/2006-05同样关键词的相关中文文献。根据检索的文献论述动态测验的相关知识,讨论动态测验的发展,并按领域对动态测验的实证研究进行综述。结果:动态测验逐渐被应用于神经心理学、精神病理学、教育等方面,并被证实为较好的测量方法。但在国内,动态测验的实证研究少之又少。结论:动态测验是对传统测验的一个必要的有益的补充,随着动态测验理论和实证研究的不断深入,动态测验必将会发展成为很有潜力的测量工具。     

Comparison of different antimicrobial susceptibility testing methods for Stenotrophomonas maltophilia and results of synergy testing

Accurate determination of resistance is important to ensure appropriate antimicrobial therapy in Stenotrophomonas maltophilia infections. This study was undertaken to evaluate the susceptibility results obtained by disc diffusion, E-test, Phoenix system, and reference agar dilution method and also to evaluate the in vitro activity of various antimicrobial combinations against multidrug-resistant S. maltophilia. Susceptibilities to several antimicrobial agents were determined by agar dilution, disc diffusion, and E-test according to the US Clinical Laboratory and Standards Institute (CLSI) guidelines. Results were also evaluated in the in Phoenix system for available agents. Twelve different antibiotic combinations were tested for synergy by the E-test method. Most synergic combinations were confirmed by microdilution checkerboard assay. Tigecycline, trimethoprim/sulfamethoxazole (TMP–SMX) and doxycycline were the most effective drugs against S. maltophilia. Poorest agreement was determined by disc diffusion and E-test against ticarcillin/clavulanate and ciprofloxacin (κ < 0.4), by disc diffusion against colistin (κ < 0.4), and by the Phoenix system against piperacillin/tazobactam (κ < 0.4). Based on these data, disc diffusion seems to be unreliable for ticarcillin/clavulanate, ciprofloxacin, and colistin; E-test for ticarcillin/clavulanate and ciprofloxacin; and the Phoenix system for piperacillin/tazobactam for S. maltophilia susceptibility testing. Synergistic activity was detected predominantly with TMP–SMX + ticarcillin/clavulanate and TMP–SMX + ceftazidime. TMP–SMX + ceftazidime synergy was also supported by the checkerboard method. However, TMP–SMX + ticarcillin/clavulanate combination revealed indifferent effect by the checkerboard assay. As ticarcillin/clavulanate and ciprofloxacin E-test results were beyond the acceptable correlation limits, synergy testing performed with these agents was considered as unreliable. Further studies are required to standardize susceptibility testing, especially for colistin, ticarcillin/clavulanate, and ciprofloxacin for S. maltophilia. TMP–SMX-containing drug combinations seemed to be more synergistic on multidrug-resistant S. maltophilia; however, these results merit further evaluation.