辛伐他汀治疗高脂血症的疗效观察

目的:观察并分析辛伐他汀治疗高脂血症的临床治疗效果。方法:对118例原发性高脂血症患者给予辛伐他汀20mg,晚餐后顿服,疗程6周,观察血脂变化。结果:治疗6周后总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)均较治疗前显著降低(P<0.01),高密度脂蛋白胆固醇(HDL-C)也明显升高(P<0.05)。仅2例病人出现转氨酶一过性升高。结论:辛伐他汀降血脂作用明显、快速,安全可靠。     

辛伐他汀对冠心病伴高血脂患者血脂的影响

对2010年6月~2012年6月间诊治的50例冠心病伴高血脂患者临床资料进行分析,运用辛伐他汀进行治疗对患者血脂的影响。结果运用辛伐他汀进行治疗的患者,治疗后TC(血浆总胆固醇)有效率达91.5%,TG(甘油三酯)为76.2%,HDL-C(高密度脂蛋白胆固醇)为72.2%,LDL-C(低密度脂蛋白固醇)为82.5%。经4、8w治疗,患者TC、LDL-C均降低(P<0.01),经8w治疗后,TG降低(P<0.05),HDL-C升高(P<0.05),临床意义显著。辛伐他汀在治疗冠心病高血脂方面安全、有效,为理想药物。     

仙人掌对小鼠实验性高脂血症的降脂作用

目的研究仙人掌对实验性高血脂小鼠血清脂质含量的影响。方法以3月龄的40只雄性小鼠为实验对象,随机分为4组空白对照组、以猪油造成的高脂模型对照组、仙人掌干粉实验组、仙人掌浸出液实验组。15天后小鼠断头取血测定血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C),并计算出动脉硬化指数(AI)。结果与高脂对照组比较,仙人掌干粉组和仙人掌浸出液组小鼠的血清TC、TG含量和AI均极显著的降低(P<0.01),并且HDL-C含量也极显著升高(P<0.01)。结论饲喂仙人掌能够显著降低实验小鼠血清TC、TG含量及AI水平,明显升高HDL-C含量。仙人掌有可能成为一种具有降血脂作用的天然保健品。     

不同剂量辛伐他汀治疗冠心病的疗效观察

目的探讨不同剂量辛伐他汀治疗冠心病的疗效。方法将86例冠心病患者随机分为观察组与对照组,每组各43例,前者口服辛伐他汀20 mg/d,后者口服辛伐他汀5 mg/d,治疗8周后观察所有患者的血脂变化。结果①治疗前,两组患者三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)比较差异无统计学意义(P>0.05)。治疗后,观察组患者TG、TC、LDL-C显著下降,HDL-C显著上升;对照组患者TC、LDL-C显著下降,治疗前后比较差异有统计学意义(P<0.05)。治疗前后,观察组患者TG、TC、HDL-C、LDL-C的降低幅度显著大于对照组,两组比较差异有统计学意义(P<0.05)。②观察组、对照组不良反应发生率分别为11.6%、9.3%,两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论根据患者的具体情况选择不同剂量的辛伐他汀给予治疗。     

Therapeutic Effects and Safety of Pitavastatin Calcium Tablets on Clinical Hypercholesterolemia

目的 观察匹伐他汀钙治疗高胆固醇血症的安全性和有效性.方法 采用随机、双盲、阳性药物平行对照方法,将入选的高胆固醇血症48例经4周停用降血脂药物处理后,随机接受A药(匹伐他汀钙每日1 mg,A组)、B药(匹伐他汀钙每日2 mg,B组)和C药(辛伐他汀胶囊每日20 mg,C组)治疗,疗程8周.分别于治疗前、治疗4周及8周末检测计算血清低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)改变百分数,并记录血常规、尿常规、心电图、血生化检测结果及不良反应发生情况,分析降脂效果和安全性,并对3组进行比较.结果 治疗前3组年龄、性别、身高、体重、收缩压、舒张压、心率以及LDL-C、TC、TG水平比较差异均无统计学意义(P ＞0.05)；HDL-C水平比较差异有统计学意义(P＜0.05),行Kruskal-Wallis检验,发现B组与C组比较差异有统计学意义(P＜0.05).与治疗前比较,治疗4周和8周末3组LDL-C、TG、TC水平均下降,差异有统计学意义(P＜0.05).3组血脂改变百分数比较差异均无统计学意义(P＞0.05).3组均未出现严重不良反应及紧急破盲事件,且无未预知的不良反应发生.结论 临床使用匹伐他汀钙每日1～2 mg治疗高胆固醇血症,能有效降低LDL-C、TC、TG水平,效果确切、安全.     

辛伐他汀联合参麦治疗高血脂症的疗效观察

目的:观察辛伐他汀联合参麦治疗高血脂症的临床疗效。方法:168例高血脂症患者随机分为治疗组和对照组,两组均采用常规辛伐他汀治疗,治疗组加用参麦注射液40mL静脉输注,每日1次;4周后测定血浆总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和高敏C反应蛋白(hs-CRP)。结果:在治疗后第4周,治疗组与对照组相比较,TC、LDL-C和CRP明显下降,HDL-C升高,差异显著,均具有统计学意义(P<0.05)。结论:辛伐他汀联合参麦治疗高血脂效果更明显,可更有效降低hs-CRP水平。     

丹皮酚对高脂血症大鼠降血脂及血管保护作用的实验研究

目的观察丹皮酚对高脂血症大鼠降血脂及血管保护作用。方法 48只SD大鼠随机分为对照组、模型组、丹皮酚低、中、高剂量组和辛伐他汀组,分别给予普通饲料、高脂饲料加丹皮酚,高脂饲料加辛伐他汀饲喂。干预40d后,12 h禁食,门静脉取血后处死动物,剥离出胸主动脉。检测各组血脂、一氧化氮(NO)含量及内皮型一氧化氮合酶(eNOS)活力。结果大鼠用高脂饲料喂养40 d后,与正常对照组比较,模型组甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)明显水平升高,高密度脂蛋白胆固醇(HDL-C)水平降低,NO含量、eNOS活力明显降低(P0.05)。治疗组给予丹皮酚后,与模型组比较,丹皮酚低、中、高剂量组及辛伐他汀组TC、TG、LDL-C及动脉粥样硬化指数明显降低,HDL-C明显提高,NO含量、eNOS活力明显升高(P0.05),且丹皮酚的上述作用呈剂量依赖性。结论丹皮酚对高脂血症大鼠具有明显的降血脂作用且呈现一定的剂量依赖性,并对血管有保护作用。     

瑞舒伐他汀治疗高血脂症合并颈动脉粥样硬化患者的临床效果

目的探讨瑞舒伐他汀对高血脂症合并颈动脉粥样硬化患者血脂水平、颈动脉内膜中层厚度(IMT)和粥样硬化斑块的影响。方法 75例高血脂症合并颈动脉粥样硬化患者随机分为研究组37例和对照组38例,分别给予瑞舒伐他汀10 mg/d和辛伐他汀20 mg/d治疗。对比2组治疗前、治疗后3和6个月时血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)变化,以及2组治疗前、治疗后6个月时颈动脉IMT和粥样硬化斑块情况。结果治疗后3和6个月,2组血清TC、TG和LDL-C较治疗前显著降低,HDL-C较治疗前显著升高(P0.05或P0.01),研究组TC和LDL-C显著低于对照组(P0.05或P0.01)。治疗后6个月,2组IMT、粥样硬化斑块积分较治疗前显著下降(P0.05或P0.01),研究组IMT下降幅度显著大于对照组(P0.05)。结论瑞舒伐他汀和辛伐他汀均能有效改善高血脂伴颈动脉粥样硬化患者血脂水平,瑞舒伐他汀逆转颈动脉IMT增厚效果更好。     

类风湿关节炎早期应用抗风湿药物在降低心血管事件发生率中的作用

目的探讨类风湿关节炎早期应用抗风湿药物在降低心血管事件发生率中的作用。方法随机选取2010年6月至2013年6月收治的80例类风湿关节炎患者作为研究组,另选取同期体检的80例健康人员作为对照组。对照组无任何治疗,研究组患者给予泼尼松+甲氨喋呤+柳氮磺胺吡啶+硫酸羟氯喹抗风湿药物联合治疗。对两组人员的红细胞沉降率(ESR)、疾病活动分数(DAS28)、血脂[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]和炎症因子C-反应蛋白(CRP)变化情况以及动脉粥样硬化、心血管事件进行统计分析。结果治疗前研究组患者TC、TG、LDL-C、TC/HDL-C、LDL-C/HDL-C水平均显著高于对照组(P0.05),HDL-C水平显著低于对照组(P0.05);治疗后研究组的HDL-C水平显著高于治疗前(P0.05),TC/HDL-C、LDL-C/HDL-C、DAS28、ESR、CRP水平均显著低于治疗前(P0.05)。研究组动脉粥样硬化及心血管事件的发生率6.3%(5/80)、3.8%(3/80)均显著低于对照组15.0%(12/80)、10.0%(8/80)(P0.05)。结论类风湿关节炎存在血脂异常升高,经抗风湿药物治疗后炎症因子、疾病活动分数得到有效降低,同时HDL-C水平升高,并能够有效降低动脉粥样硬化和心血管事件发生率。     

降血脂口服液治疗混合型高血脂症疗效观察

目的 探讨降血脂口服液治疗混合型高血脂症的临床疗效.方法 117例混合性高血脂症患者随机分为两组:辛伐他汀组(A组)59例,辛伐他汀片20 mg,每晚一次口服;降血脂口服液组(B组)58例,降血脂口服液10 ml,3次/d口服.两组疗程均为3个月.结果 两组治疗前后总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-c)均明显降低(P＜0.05),高密度脂蛋白(HDL-c)升高(P＜0.05).结论 降血脂口服液治疗混合性高血脂症的疗效与辛伐他汀相似.     

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.