血管回声跟踪技术检测酒精性肝病患者颈动脉弹性及其与血管内皮舒张功能相关性的研究

目的：应用血管回声跟踪技术检测酒精性肝病（ALD）患者颈动脉弹性,并分析各项参数与血管内皮舒张功能的相关性。方法：ALD患者及正常对照组各50例,常规颈动脉超声获取IMT、D、RI、PI、S/D几项指标;采用E-Tracking技术获取Eρ、β、AC、AI、PWVβ几项指标;超声测量右侧肱动脉反应性充血后内径百分变化率（EDD%）。比较两组常规超声指标及E-Tracking指标,分析ALD组各项E-Tracking指标与EDD%的相关性。结果：两组间常规检测指标无明显差异,ALD组的Eρ、β、PWVβ明显高于对照组,AC则明显低于对照组,ALD组中EDD%与AC呈正相关,与Eρ、β呈负相关。其中,相关性最强的指标为Eρ和AC。结论：ALD患者早中期即出现血管弹性、硬度指数增高,顺应性减低,扩张性增高,血管内皮功能受损,E-Tracking技术能准确定量评价颈动脉弹性,为临床早期评价动脉功能变化提供了一种新的方法。     

血管回声跟踪技术评价妊娠期高血压疾病患者血管内皮功能

目的 探讨血管回声跟踪(E-Tracking,ET)技术评价妊娠期高血压疾病患者动脉血管内皮功能的应用价值.方法 对妊娠期高血压疾病患者45例(妊娠期高血压患者25例,子痫前期患者20例)及正常妊娠女性60例,应用ET技术测量双侧颈总动脉及肱动脉的硬化度(β)、弹性系数(Eρ)、动脉顺应性(AC)、膨大系数(AI)及单点脉搏波传导速度(PWVβ).结果 妊娠期高血压组和子痫前期组β、Eρ、AI、PWVβ与对照组比较明显升高,AC降低,差异有显著性(P<0.05).子痫前期组与妊娠期高血压组比较:β、Eρ、AI、PWVβ明显升高,AC明显降低,差异有显著性(P<0.05).结论 血管回声跟踪技术能够早期,简便、准确地反映妊娠期高血压疾病患者血管内皮功能的变化.     

E-tracking技术对妊娠期高血压疾病患者颈动脉弹性功能的研究

目的:探讨血管回声跟踪(E-Tracking,ET)技术评价妊娠期高血压疾病患者颈动脉弹性功能的改变。材料与方法:对妊娠期高血压疾病患者(孕28周后)49例和66例正常妊娠期孕妇(孕28周后)进行双侧颈总动脉血管弹性指标的测量:弹性模量(Eρ)、僵硬度(β)、顺应性(AC)、膨大指数(AI)和脉搏波传导速度(PWVβ),并进行统计学分析。结果:妊娠期高血压疾病组双侧颈总动脉Eρ、β、AC及AI较对照组升高,AC较对照组减低,具有显著性差异(P<0.05,P<0.01)。结论:血管回声跟踪技术能较早、明确的反映妊娠期高血压疾病患者颈动脉弹性功能的改变,具有一定价值。     

血管回声跟踪技术对正常高值血压者颈总动脉弹性的研究

目的 探讨血管回声跟踪（ET）技术检测正常高值血压者颈总动脉弹性功能的变化情况及其临床意义.方法 应用ET技术检测63例正常高值血压者（HNBP组）与50例健康成人（正常对照组）双侧颈总动脉的弹性参数,包括弹性系数（β）、僵硬度（Eρ）、顺应性（AC）、增大指数（AI）及单点脉搏波传导速度（PWVβ）,并使用常规血管超声测量颈动脉内-中膜厚度（IMT）,结果进行对比分析.结果 组内双侧颈总动脉的IMT及其各弹性参数比较差异均无统计学意义;两组间上述各指标比较,HNBP组的β、Eρ和PWVβ增高,AC降低,差异均有统计学意义（P 〈 0.01）,AI和IMT无明显变化,差异无统计学意义.结论 正常高值血压者颈总动脉Eρ增加,ET技术能较早发现颈总动脉弹性的改变,对临床早期预防心脑血管疾病的发生具有重要意义.     

应用血管回声跟踪技术对中心性肥胖患者早期颈动脉硬化的评价

目的:应用血管回声跟踪技术(E-Tracking)技术评价中心性肥胖患者颈动脉弹性的变化及临床意义。材料与方法:选择85例中心性肥胖者和80例正常体重指数健康者,采用Aloka公司生产的SSD-α10型彩色多普勒超声诊断仪测量颈动脉内膜一中层厚度(IMT)、压力-应变弹性系数(Ep)、硬化指数(β)、顺应性(AC)、单点脉搏波传导速度(PWVβ)等参数作比较。结果:与正常组比较,中心性肥胖组IMT值和Eρ、β、PWVβ均明显增高(P0.01),AC低于正常组(P0.01),直线相关分析表现IMT与β、Ep、PWVβ呈正相关(P0.05),与AC呈负相关(P0.05)。结论:中心性肥胖患者的颈动脉弹性在出现粥样硬化斑块前,血管弹性已经发生改变,E-Tracking技术能够预示动脉硬化的进展,作为判断颈动脉粥样硬化的早期指标,是评价中心性肥胖患者血管壁弹性的一种新方法。     

应用新版eTRACKING技术对高血压患者颈动脉斑块的研究

目的应用新版血管回声跟踪eTRACKING技术对高血压患者颈动脉无斑块组与斑块组的特征进行研究。方法高血压颈动脉无斑块组43例,高血压颈动脉软斑组56例,高血压颈动脉硬斑组24例,正常对照组39例。应用新版血管回声跟踪技术评估颈动脉硬化参数,包括压力应变弹性系数(Ep)、硬化参数(β)、顺应性(AC)、脉搏波传导速度(PWVβ)和增大指数(AI),并对高血压组上述参数进行相关分析。结果高血压颈动脉无斑块组与斑块组Ep、β、PWVβ、AI较正常对照组明显增高,AC明显减小(P<0.01);高血压颈动脉硬斑组Ep、β、PWVβ较软斑组明显增高(P<0.01);高血压组的PWVβ与Ep、β呈正相关,与AC呈负相关;高血压组的AI与Ep、β、AC无相关性。结论新版血管回声跟踪技术对高血压颈动脉无斑块组与斑块形成组均有评估价值。     

血管回声跟踪技术及超声弹性成像评价2型糖尿病患者足背动脉弹性功能

目的 运用血管回声跟踪技术及超声弹性成像技术探讨不同病程的2型糖尿病患者足背动脉弹性功能的变化.方法 测量83例2型糖尿病患者(43例病程＜10年者,为DM-Ⅰ组;40例病程≥10年,为DM-Ⅱ组)及35名健康志愿者(对照组)的踝部动脉和肱动脉的血压,并计算踝臂指数(ABI);应用超声弹性成像技术计算足背动脉的管壁弹性应变率比值(B/A),应用血管回声跟踪技术计算足背动脉的僵硬度(β)、弹性模量(Eρ)、顺应性(AC)、膨大系数(AI)及脉搏波传导速度(PWVβ)的变化.结果 与对照组及DM Ⅰ组比较,DM-Ⅱ组足背动脉β、Eρ、PWVβ及B/A升高,内-中膜厚度(IMT)增加,AC及ABI降低(P均＜0.05),但AI差异无统计学意义;与对照组比较,DM-Ⅰ组足背动脉β、Eρ、PWVβ及B/A升高,AC降低(P均＜0.05),IMT、ABI及AI差异无统计学意义.结论 β、Eρ、AC、PWVβ及B/A可早期反映动脉弹性功能变化;血管弹性功能的改变早于血管形态学的改变;2型糖尿病病程长短对足背动脉弹性功能有影响,病程≥10年者足背动脉血管弹性功能显著降低.     

回声跟踪技术评价冠状动脉粥样硬化患者颈动脉弹性

目的应用回声跟踪技术评价冠状动脉粥样硬化患者颈动脉弹性特征。方法选取健康体检者50例(对照组),经冠状动脉造影证实的冠状动脉粥样硬化患者50例(病例组)。应用回声跟踪技术评价两组颈动脉弹性参数,包括压力应变弹性系数(Eρ)、硬化参数(β)、顺应性(AC)、脉搏波传导速度(PWVβ)及增大指数(AI),并对所有受试者上述参数进行相关分析。结果病例组Eρ、β、PWVβ较对照组明显增高(P<0.01),AC较对照组明显减少(P<0.01);AI两组比较差异无统计学意义;受试者的Eρ与β、PWVβ呈正相关(r=0.947、0.867,均P<0.01),Eρ、β、PWVβ与AC呈负相关(r=-0.541、-0.541、-0.518,均P<0.01),β与PWVβ呈正相关(P<0.01),AI与Eρ、β、PWVβ、AC无相关性。结论回声跟踪技术能尽早反映冠状动脉粥样硬化患者血管的改变,为临床定量评价血管功能提供了一种新的手段。     

血管回声跟踪技术评价糖尿病患者颈动脉功能的临床研究

目的 应用血管回声跟踪技术检测糖尿病患者的颈动脉弹性特征。方法 糖尿病组57例，正常对照组39例。应用血管回声跟踪技术评估颈动脉硬化参数，包括压力应变弹性系数（Ep）、硬化参数（β）、顺应性（AC）、脉搏波传导速度（PWVβ）和增大指数（AI），并对上述参数进行统计学分析。结果糖尿病组颈动脉Ep，β、PWV8较正常对照组明显增高（P〈0．01），AC较正常对照组明显降低（P〈0．01），AI较正常对照组增高（P〈0．05）。结论 应用血管回声跟踪技术有助于评估糖尿病患者颈动脉弹性的功能改变。     

应用血管回声跟踪技术评价冠心病患者颈动脉硬化程度

目的 应用血管回声跟踪（ET）技术评价不同程度冠心病患者颈动脉弹性功能参数的改变.方法 应用ET技术检测经冠状动脉造影确诊的50例冠心病患者（冠心病组）和50例非冠心病者（非冠心病组）颈动脉,检测僵硬度参数（β）、压力-应变弹性系数（Ep）、顺应性（AC）、增大指数（AI）及单点脉搏波传导速度（PWVβ）血管弹性功能指标,以及血管壁内-中膜厚度（IMT）.冠心病组根据冠状动脉造影的结果又分为单支、二支和三支病变组.分析上述检测参数与冠心病患者血管病变的关系.结果 冠心病组β、Ep、AI、PWVβ及IMT明显高于非冠心病组（P〈0.05）,AC则明显低于非冠心病组（P〈0.05）,并且冠心病病变程度越重,差异越明显.结论 冠心病患者颈动脉弹性明显减低,应用ET技术检测颈动脉弹性功能有助于评估冠心病患者血管的改变,可作为监测冠状动脉疾病发生和发展的一项有临床意义的指标.     

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.     

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.     

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.     

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.     

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.