莫西沙星序贯治疗社区获得性肺炎住院患者疗效观察

目的 评价莫西沙星序贯治疗社区获得性肺炎(CAP)住院患者的疗效和安全性.方法 北京大学深圳医院2009年1月-2010年12月收治的186例CAP住院患者随机分为2组,莫西沙星序贯组(序贯组)和莫西沙星静脉滴注组(对照组),序贯组(86例)在治疗当天开始给予莫西沙星注射液400 mg/d静脉滴注,每日1次,3～5d后改为口服莫西沙星片剂400 mg/d,总疗程7～14 d;对照组(88例)给予莫西沙星注射液400 mg/d静脉滴注,每日1次,总疗程7～14 d.结果 经剔除部分患者后,两组均无严重不良反应,两组安全性比较差异无统计意义,临床疗效:序贯组有效率87.2%,对照组有效率89.8%.细菌学疗效比较:治疗后序贯组细菌清除率为92.1%,对照组细菌清除率为95.7%,两组差异无统计学意义(P>0.05).结论 莫西沙星对住院CAP患者疗效可靠,安全性好.序贯治疗组与全程静脉滴注相仿,对于可以口服的患者可以替代全程静脉滴注作为住院CAP患者的治疗方案.     

莫西沙星序贯治疗老年下呼吸道感染临床观察

目的:评价莫西沙星序贯治疗老年下呼吸道感染的疗效。方法:58例患者随机分为治疗组30例,静脉滴注莫西沙星注射液0.4 g,1次/d;对照组28例,静脉滴注头孢呋辛1.5 g,2次/d,两组症状明显改善后改同类药继续口服,疗程7~10 d。结果:治疗组和对照组的临床有效率分别为93.3%和71.4%,细菌清除率分别为94.4%和76.5%,两组临床有效率及细菌清除率比较差异均有统计学意义(P<0.05);两组不良反应发生率分别为6.7%和7.1%,差异无统计学意义(P>0.05)。结论:莫西沙星序贯治疗老年下呼吸道感染安全有效,有较高的临床价值。     

莫西沙星序贯治疗频发加重表型慢性阻塞性肺疾病急性加重期的临床观察

目的:观察莫西沙星序贯治疗频发加重表型慢性阻塞性肺疾病急性加重期(AECOPD)的临床效果。方法:将106例频发加重表型AECOPD患者随机分成观察组和对照组各53例,观察组予莫西沙星针剂,400mg静脉滴注,1次/d,5 d后,改为口服莫西沙星片剂,400 mg,1次/d;对照组予莫西沙星针剂,400 mg静脉滴注,1次/d,两组疗程均为8-10 d。结果:观察组和对照组的临床有效率(87.5%vs 80.1%)、细菌清除率(81.8%vs 83.3%)均无显著性差异(P0.05);观察组与药物相关的副作用显著小于对照组(20.8%vs 45.3%,P0.05);观察组人均医疗成本费用明显低于对照组(2958.5±18.3元vs 4710.3±24.5元,P0.05)。结论:莫西沙星序贯治疗频发加重表型AECOPD疗效确切、副作用少、并可节省医疗费用。     

莫西沙星序贯疗法治疗老年人下呼吸道感染的临床研究

目的评价莫西沙星序贯疗法的疗效。方法64例老年人下呼吸道感染者随机分入序贯治疗组和静脉给药对照组进行治疗。结果序贯组和对照组治疗老年人下呼吸道感染有效率分别为87.5%(28/32)和90.6%(29/32),细菌清除率分别为89.5%和90.9%,统计学分析两组间均无显著性差异。结论莫西沙星序贯疗法是一安全、有效、经济、方便的治疗方法。     

莫西沙星序贯疗法治疗社区获得性呼吸道感染临床观察

目的探讨莫西沙星序贯疗法治疗社区获得性呼吸道感染的临床效果。方法社区获得性呼吸道感染患者180例,随机分为顺(序)贯组和常规组各90例。常规组采用莫西沙星0.4 g,每日一次,每250 ml滴注时间不少于90 min,持续静脉滴注;顺贯组上述剂量莫西沙星,静脉给药3~5 d,体温正常,外周血白细胞正常,病情稳定者改为口服莫西沙星0.4 g每日一次。结果两组临床治疗效果比较无显著差异(P>0.05);顺贯组莫西沙星静脉滴注时间短于常规组,顺贯组药物不良反应少于常规组(P<0.05)。结论莫西沙星序贯疗法治疗社区获得性呼吸道感染是较经济、有效的治疗方法。     

治疗急性肺炎中莫西沙星的序贯应用

目的观察莫西沙星序贯治疗急性肺炎患者的临床治疗效果。方法采用莫西沙星注射液400 mg,每日1次静脉滴注,症状明显改善后改为片剂口服继续治疗,疗程为7～10 d。完成病例52例,观察治疗前后症状、细菌学、药敏情况与并发症。结果治疗有效率、细菌清除率、不良反应发生率分别为90.91%、93.94%、9.09%。结论莫西沙星序贯治疗急性肺炎安全、有效,有较高的临床价值。     

莫西沙星治疗老年性下呼吸道感染的临床疗效

目的观察莫西沙星与左氧氟沙星治疗老年性下呼吸道感染的临床疗效和安全性。方法选择老年性下呼吸道感染患者74例,随机分为治疗组（38例）和对照组（36例）。治疗组使用莫西沙星400 mg,对照组使用左氧氟沙星500 mg,均为静脉滴注给药,每日1次,疗程7~10 d,观察疗效与不良反应。结果治疗组和对照组的临床有效率分别为92.11%和80.56%,细菌清除率分别为93.33%和82.76%,两组间比较差异均有统计学意义（P〈0.05）,两组间不良反应相似。结论莫西沙星注射液治疗老年性下呼吸道感染疗效佳且安全,优于左氧氟沙星注射液。     

莫西沙星序贯疗法治疗下呼吸道感染的疗效观察

目的评价莫西沙星序贯疗法治疗下呼吸道感染的临床疗效。方法将106例下呼吸道感染患者随机分为观察组和对照组各53例,观察组给予莫西沙星序贯治疗,对照组应用左氧氟沙星序贯治疗,观察并比较两组的临床疗效、细菌清除率及不良反应。结果观察组总有效率为96.2%,对照组总有效率为92.5%,两组总有效率比较无统计学差异(P>0.05)。观察组细菌阳性率为90.6%(48/53),细菌清除率为95.8%(46/48),对照组细菌阳性率为88.7%(47/53),细菌清除率为83.0%(39/47),观察组细菌清除率显著高于对照组,差异具有统计学意义(P<0.05)。药物敏感试验,莫西沙星敏感率为95.4%(83/87),左氧氟沙星敏感率为86.2%(75/87),两组比较差异有统计学意义(P<0.05)。主要不良反应有恶心、食欲减退、腹泻等。观察组不良反应发生率为3.8%,对照组为5.7%,差异无统计学意义(P>0.05)。结论莫西沙星序贯疗法的临床疗效确切,不良反应小,是治疗下呼吸道感染较为理想的方法     

莫西沙星序贯方案对高龄社区获得性肺炎患者疗效、病程及免疫功能的影响

目的研究莫西沙星序贯治疗方案对高龄社区获得性肺炎患者疗效、病程及免疫功能的影响。方法选择2015年1~12月在北京市通州区妇幼保健院接受治疗的74例高龄社区获得性肺炎患者,随机分为对照组和序贯组,每组各37例。对照组给予莫西沙星静脉滴注,序贯组给予莫西沙星静脉滴注联合口服序贯治疗。结果序贯组患者的总有效率高达94.59%,对照组患者的总有效率为72.97%;序贯组患者的啰音消失时间为(3.85±1.27)d、咳嗽咳痰消失时间为(5.93±1.84)d、发热消失时间为(6.05±2.12)d,临床症状消失时间短于对照组(P<0.05);序贯组患者T细胞亚群CD3~+、CD4~+和CD4~+/CD8~+水平分别为(68.94±8.12)%、(35.64±4.25)%和1.36±0.17,高于对照组,CD8~+水平为(28.26±3.31)%,低于对照组,以上差异均具有统计学意义(P<0.05)。结论莫西沙星序贯治疗方案可以提高高龄社区获得性肺炎患者的临床疗效和免疫功能,利于患者康复。     

莫西沙星序贯治疗慢性阻塞性肺疾病感染发作期的临床分析一附68例报告

目的评价莫西沙星序贯治疗慢性阻塞性肺疾病（chronicobstructivepulmonarydisease,COPD）感染发作期的临床疗效和安全性。方法68例COPD感染发作期患者随机分为两组：莫西沙星序贯组（序贯组）,莫西沙星静脉滴注组（对照组）,两组疗程均为2周。比较两组患者的临床疗效、细菌清除率和不良反应。结果序贯组总有效率88．2％,细菌清除率为92．6％,不良反应发生率为11．8％;对照组总有效率88．2％,细菌清除率为92．3％,不良反应发生率为11．8％;两组比较差异均无统计学意义。结论莫西沙星序贯治疗COPD感染发作期疗程显著,不良反应少,对于可以口服的患者可以替代全程静脉滴注作为住院COPD感染发作期患者的治疗方案。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

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.