低分子肝素钙对重度子痫前期患者血清PAPP-A、SPI、PLGF水平的影响

目的 分析低分子肝素钙对重度子痫前期患者血清妊娠相关蛋白A(PAPP-A)、妊娠特异性β1糖蛋白(SPI)、胎盘生长因子(PLGF)水平的影响。方法 选取收治的重度子痫前期患者86例,采用随机数字表法分为对照组和观察组各43例。对照组给予硫酸镁治疗,观察组在对照组基础上应用低分子肝素钙治疗,比较两组血清PAPP-A、SPI、PLGF水平及凝血功能。结果 两组治疗后血清PLGF水平比较,差异无统计学意义(P0.05);观察组治疗后血清PAPP-A水平相较对照组下降,SPI水平高相较对照组升高,差异有统计学意义(P0.05);治疗后,观察组纤维蛋白原(FIB)低于对照组,活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)相较于对照组增高,差异有统计学意义(P0.05)。结论 重度子痫前期患者采用低分子肝素钙治疗的效果较好,可有效调节PAPP-A、SPI、PLGF水平,改善凝血功能。     

小剂量低分子肝素联合硫酸镁治疗重度子痫前期的效果探讨

目的探讨小剂量低分子肝素联合硫酸镁治疗重度子痫前期的效果。方法将我院收治的70例重度子痫前期患者按照住院先后顺序分为两组,对照组35例予以硫酸镁治疗,观察组35例采用小剂量低分子肝素联合硫酸镁治疗,对比两组患者的临床效果。结果观察组治疗后血压、血脂、尿量、凝血功能优于对照组,围生儿不良结局、母体并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论重度子痫前期应用小剂量低分子肝素联合硫酸镁治疗重度子痫前期,可改善患者的症状指标、母婴结局,应用效果显著。     

低分子肝素联合硫酸镁、拉贝洛尔治疗早发型重度子痫前期患者对妊娠结局的影响分析

目的分析对早发型重度子娴前期患者应用低分子肝素联合硫酸镁、拉贝洛尔治疗对妊娠结局的影响。方法选取2016年1年～2017年1月医院收治的早发型重度子娴前期患者90例,按随机数表分为对照组和观察组各45例。对照组予以硫酸镁、拉贝洛尔治疗,观察组应用低分子肝素联合硫酸镁、拉贝洛尔治疗,比较两组患者治疗前后血管内皮因子水平、血压水平,观察并比较两组患者的妊娠结局。结果治疗后,两组的血清血管细胞粘附因子1(VCAM-1)、E选择素水平较治疗前明显降低(P0.05),且观察组比对照组更低(P0.05);治疗后,两组患者的收缩压、舒张压较治疗前均明显下降(P0.05),且观察组下降幅度大于对照组(P0.05),观察组剖宫产、早产、胎儿窘迫、胎盘早剥、新生儿窒息的发生率明细低于对照组(P0.05),但两组患者产后出血发生率比较差异不显著(P0.05)。结论在早发型重度子娴前期患者的治疗中应用低分子肝素联合硫酸镁、拉贝洛尔,可改善患者血管内皮因子和血压水平,降低不良妊娠结局发生率,且发生产后出血的风险小。     

常规治疗加用低分子肝素对重度子痫前期的临床效果

目的探讨常规治疗加用低分子肝素对重度子痫前期的临床治疗效果。方法选取2013年1月至2013年12月封丘县人民医院收治的36例重度子痫前期患者,并根据治疗方法的差异将其分为观察组与对照组。对照组患者18例,以常规治疗法进行治疗;观察组患者18例,在常规治疗基础上联合低分子肝素对患者进行治疗。比较两组患者的临床治疗效果。结果观察组患者的治疗效果明显优于对照组患者,两组患者在治疗后的平均动脉压、24 h尿量、全血比黏度等方面比较差异有统计学意义(P0.05)。结论在常规治疗基础上联合低分子肝素对重度子痫具有较好的临床治疗效果,且该种治疗方法不会对胎儿产生不良影响,安全性较高。     

低分子肝素联合叶酸治疗子痫前期合并胎儿生长受限对妊娠结局的影响

分析低分子肝素联合叶酸治疗子痫前期合并胎儿生长受限对妊娠结局的影响。收集子痫前期合并胎儿生长受限患者80例,按随机数表法分为对照组和观察组各40例。两组均给予常规治疗,对照组加用低分子肝素治疗,观察组在对照组基础上加用叶酸治疗。观察两组妊娠结局情况。治疗后观察组早产率(30.00%)、剖宫产率(47.50%)、产后出血率(2.50%)均低于对照组,差异具有统计学意义(P0.05);治疗后观察组新生儿窒息、新生儿贫血、新生儿黄疸发生率均低于对照组,差异具有统计学意义(P0.05)。低分子肝素联合叶酸治疗子痫前期合并胎儿生长受限能显著改善妊娠结局。     

低分子肝素对重度子痫前期患者的临床疗效分析

目的分析低分子肝素对重度子痫前期患者的治疗效果。方法选取2014年3月~2017年3月我院收治的70例重度子痫前期患者,随机分为两组,各35例,对照组行常规治疗,观察组在常规治疗基础上加低分子肝素,比较两组治疗前后相关指标改善情况。结果治疗后观察组平均动脉压、24h尿蛋白水平、炎症因子IL-4、IL-6水平及红细胞比容均明显低于对照组(P0.05),血小板计数(139.63±29.57)×109/L明显高于对照组的(121.44±28.30)×109/L,新生儿窒息率2.86%、明显低于对照组的20.00%(P0.05),两组产后出血发生率组间差异不显著(P0.05)。结论低分子肝素对重度子痫前期患者有显著治疗效果,可明显改善患者凝血功能、肾脏功能与血压水平,减轻炎症反应,且可降低新生儿窒息发生风险,值得推广。     

丹参注射液联合低分子肝素钙治疗早发型重度子痫前期的疗效

目的探究丹参注射液联合低分子肝素钙治疗早发型重度子痫前期的疗效。方法选取2016年3月～2018年4月在我院接受治疗的早发型重度子痫前期患者90例,按照随机数字表法分为观察组和对照组各45例。对照组采用低分子肝素钙治疗,观察组采用丹参注射液联合低分子肝素钙治疗,将两组患者治疗前后的血浆黏度、D-二聚体水平与治疗期间的并发症发生状况进行比较。结果治疗2w后,两组患者的血浆黏度、D-二聚体水平均比治疗前低,且观察组低于对照组,差异有统计学意义(P<0.05);治疗期间,观察组的并发症发生率(6.67%)显著低于对照组的(24.44%),差异有统计学意义(P<0.05)。结论丹参注射液联合低分子肝素钙治疗早发型重度子痫前期的临床效果显著,能有效降低患者的血浆黏度与D-二聚体水平以及并发症发生率。     

低分子肝素钙辅助治疗早发型重度子痫前期临床疗效观察

目的:观察低分子肝素钙辅助治疗早发型重度子痫前期的临床疗效。方法:采用随机双盲法将2017年7月～2019年6月就诊的早发型重度子痫前期患者102例分为对照组和观察组,各51例。对照组接受镇静、解痉、降压等常规治疗,观察组在常规治疗基础上接受低分子肝素钙辅助治疗。对比两组治疗前后肾功能、凝血功能及不良妊娠结局发生率。结果:观察组治疗后尿素氮、24 h尿蛋白定量水平均低于对照组(P0.05);观察组治疗后纤维蛋白原水平低于对照组,凝血酶时间、活化部分凝血活酶时间、凝血酶原时间均短于对照组(P0.05);观察组不良妊娠结局发生率9.80%低于对照组的31.37%(P0.05)。结论:低分子肝素钙辅助治疗早发型重度子痫前期患者可有效改善患者凝血功能和肾功能,降低不良妊娠结局发生风险。     

溶栓前肝素治疗对急性心肌梗死冠状动脉再通和梗死范围的影响

目的探讨尿激酶溶栓前使用肝素对急性心肌梗死冠状动脉再通和梗死范围的影响。方法随机将 86例急性心肌梗死患者分为早期肝素组和对照组 ,早期肝素组尿激酶溶栓之前静脉注射肝素 ,对照组常规尿激酶溶栓治疗。比较两组治疗前后的心肌梗死面积。结果早期肝素组和对照组的血管再通率分别为 83.33%和 6 0 .5 2 % ( P<0 .0 5 ) ,两组治疗前预计梗死面积无统计学差异 ( P>0 .0 5 )。对照组治疗前后的梗死面积无显著性差异 ( P>0 .0 5 ) ,早期肝素组治疗前后的梗死面积有显著的统计学差异 ( P<0 .0 1)。最终梗死面积和梗死面积变化百分率在两组之间均有显著性差异 ( P<0 .0 5和 P<0 .0 1)。结论早期应用肝素辅助尿激酶溶栓治疗 ,可提高急性心肌梗死早期冠状动脉再通率 ,减少再闭塞 ,缩小梗死面积     

丹参注射液联合低分子肝素钙治疗早发型重度子痫前期

目的:观察丹参注射液联合低分子肝素钙治疗早发型重度子痫前期的疗效。方法:选取2018年1月～2019年1月收治的早发型重度子痫前期患者106例为研究对象,遵循随机对照组原则分为对照组和观察组,各53例。对照组给予低分子肝素钙治疗,观察组在对照组治疗基础上联合丹参注射液治疗。对比两组治疗前后凝血功能、妊娠结局及并发症发生情况。结果:治疗后,观察组D-二聚体、纤维蛋白原水平低于对照组,凝血酶原时间长于对照组,差异均有统计学意义(P0.05);观察组胎龄延长时间大于对照组,新生儿体质量高于对照组,产后24 h出血量少于对照组,差异有统计学意义(P0.05);观察组并发症发生率24.53%低于对照组的9.43%,差异有统计学意义(P0.05)。结论:丹参注射液联合低分子肝素钙治疗早发型重度子痫前期患者可有效改善患者凝血功能,降低并发症发生率,改善母婴结局。     

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.