应用多普勒组织成像评价肥厚型心肌病心功能

目的：应用多普勒组织成像脉冲技术测量二尖瓣环舒缩速度，以评价肥厚型心肌病心功能改变。方法：按左心室流出道是否梗阻分为梗阻性与非梗阻性肥厚型心肌病，分别测量正常人、梗阻性及非梗阻性肥厚型心肌病3组二尖瓣环各点收缩期峰值速度（Sa)、舒张早期峰值速度（Ea)、舒张晚期峰值速度（Aa)。结果：梗阻性与非梗阻性肥厚型心肌病患者与正常组Ea、Sa比较差异均有显著性意义（P＜0．001），Aa差异则无显著性意义（P＞0．05）。梗阻性与非梗阻性肥厚型心肌病间Ea差异有显著性意义（P＜0．05），Sa、Aa差异无显著性意义（P＞0．05）。结论：肥厚型心肌病左心室长轴收缩功能及主动松弛功能较正常人减低。梗阻性较非梗阻性肥厚型心肌病左心室主动松弛功能减低。     

组织多普勒显像检测二尖瓣环速度评价冠心病左室舒张功能

目的：探讨应用组织多普勒显像（TDI）检测二尖瓣环运动速度评价冠心病左室舒张功能的应用价值。方法：冠心病患者45例,正常对照组30例,应用脉冲多普勒（PWT）检测二尖瓣口舒张早、晚期血流峰值流速（E、A）、计算E／A;应用TDI速度模式,在心脏四腔心切面检测二尖瓣内、外环运动速度（Ea、Aa）,计算Ea／Aa。结果：冠心病组左室舒张功能假性正常组（E／A〉1）与正常对照组比较,二尖瓣血流频谱E、A、E／A及二尖瓣环Aa差异无统计学意义（P〉0．05）,TDI检测二尖瓣环Ea及Ea／Aa较正常组明显减低,差异有统计学意义（P〈0．01）。冠心病组左室舒张功能减低组（E／A〈1）与正常对照组比较,二尖瓣环Aa差异无统计学意义（P〉0．05）,二尖瓣血流频谱A较正常对照组增高,E、E／A及二尖瓣环Ea、Ea／Aa较正常组明显减低,差异有统计学意义（P〈0．01）。结论：TDI检测二尖瓣内、外环运动速度Ea、Aa,计算Ea／Aa,可评价冠心病左室舒张功能,与二尖瓣血流检测左室舒张功能（E／A〈1）减低者有很好相关性,并可鉴别左室舒张功能假性正常化,估测舒张功能受损的程度。     

多普勒组织成像评价高血压合并二尖瓣返流左室舒张功能的价值

目的：研究多普勒组织成像技术（DTI）评价高血压病合并二尖瓣返流左室舒张功能的价值。方法：研究对象为20例高血压患者，其中二尖瓣返流轻度12例，二尖瓣返流中度8例，应用DTI探测二尖瓣环运动，测量舒张早期速度（Ea)及舒张晚期速度（Aa）、计算Ea／Aa；并与常规脉冲多普勒法（PWD）测量E／A测量E／A相比较，结果：二尖瓣返流轻度组：Ea／Aa与E／A差异无显著性（P＞0．05）。二尖瓣返流中度组；Ea／Aa与E／A有显著性差异（P＜0．05）。E／A出现假正常化,而Ea/Aa＜1。结论：DTI评价高血压病合并二尖瓣返流左舒张功能有一定的临床应用价值。     

赖诺普利联合螺内酯治疗舒张性心力衰竭的疗效观察

目的：观察赖诺普利联合螺内酯治疗舒张性心力衰竭（DHF）的临床疗效。方法：将88例DHF患者,依据治疗方案分为治疗组（45例）和对照组（43例）,对照组给予基础治疗（包括硝酸酯类、钙拮抗药、排钾利尿药、β受体阻断药）,治疗组在此基础上口服赖诺普利（5—10mg／d）和螺内酯（20mg／d）,比较治疗前后两组脑钠肽、舒张早期二尖瓣血流速度峰值（E）、二尖瓣舒张环早期运动速度（Ea）和舒张晚期运动速度（Aa）、Ea／Aa、E／Ea、肺静脉舒张晚期逆行血流峰值（PVF-A）、左心房内径（IAD）及6min步行试验（6MWT）等,随访1年。结果：与治疗前比较,治疗后两组患者6MWT增加,E峰、PVF-A、E／Ea、脑钠肽降低,Ea及Ea／Aa升高（P〈0．01或0．05）,治疗组治疗后IAD缩小（P〈0．05）。两组治疗后比较,除LAD、Ea无明显差异外,其余指标治疗组改善均优于对照组（P〈0．01）。治疗组心功能改善总有效率达93％,明显高于对照组（P〈0．01）。结论：基础治疗联合赖诺普利、螺内酯能更明显改善DHF患者的舒张功能,提高患者运动耐量,改善临床症状。     

原发性高血压患者血管内皮功能与左室舒张功能间关系研究

目的研究原发性高血压患者血管内皮功能与左室舒张功能之间的关系。方法超声测量50例原发性高血压患者和21例健康对照者的肱动脉充血后反应性扩张血管内径变化（DTRH）和含服硝酸甘油后血管内径变化（DTNG）,多普勒组织显像技术检测其二尖瓣环的舒张早期峰值速度（Ea）、舒张晚期峰值速度（Aa）及两者之间的比值（Ea／Aa）。据二尖瓣环舒张期峰值速度将高血压病患者分为左室舒张功能正常（高血压Ea／Aa〉1组）23例,左室舒张功能异常（高血压Ea／Aa〈1组）27例。结果两组高血压病患者嘲均低于对照组（P〈0．01）,且Ea／Aa〈1组患者DTRH低于Ea／Aa〉1组（P〈0．01）。DTNG在三组间无统计学差异（P〉0．05）。相关分析表明：患者DTRH与Ea／Aa和Ea呈正相关（r=0．70,P〈0．01和r=0．38,P=0．01）,与Aa呈负相关（r=-0．30,P=0．04）。多元回归分析提示患者DTRH与Ea／Aa、年龄、收缩压有关联（r′=0．63,P〈0．01;r′=-0．21,P=0．04;r′=-0．21,P=0．04）。结论原发性高血压患者血管内皮功能改变与左室舒张功能的改变之间有一定的相关性,内皮功能障碍可能是左室舒张功能发生发展中的重要基础环节之一。     

多普勒组织成像技术对高血压患者左室舒张功能的评价

目的：探讨多普勒组织成像(DTI)技术评价高血压病(EH)患者左室舒张功能的价值，以寻求一种可靠、客观的评价高血压左室舒张功能的新方法。方法：采用放免法测定19例正常人和41例EH患者(伴心肌肥厚者19例和不伴心肌肥厚者22例)的血清I型前胶原(PC I)和Ⅱ型前胶原(PC Ⅱ)的浓度。用DTI法检测正常人及EH患者二尖瓣环舒张早期运动速度(Ea)、舒张晚期运动速度(Aa)及Ea／Aa，并用二尖瓣血流多普勒法检测舒张期血流速度E、A及E／A，比较两种方法测值与血清I、Ⅱ型前胶原的相关性。结果：1．EH患者非左室肥厚(non—LVH)组及左室肥厚(LVH)组二尖瓣口血流参数、二尖瓣环DTI参数均明显低于正常对照组(P＜0．01)；2．EH患者non—LVH组与LVH组间E、E／A无明显差别(P＞0．05)，但LVH组Ea、Ea／Aa明显低于non—LVH组(P＜0．05)；3．EH患者non—LVH组血清PC I、PC Ⅱ与E／A及Ea／Aa均呈负相关(r＝—0．58P＜0．01、r＝—0．61P＜0．01及r＝—0．62P＜0．01、r＝—0．49P＜0．05)；而LVH组血清PC I、PCⅡ与Ea／Aa亦呈负相关(r＝—0．50P＜0．05、r＝—0．55P＜0．05)，与E／A无明显相关(r＝—0．41P＞0．05、r＝0．02P＞0．05)。结论：DTI能更准确定量高血压患者二尖瓣环舒张期运动速度的改变，DTI法检测二尖瓣环运动速度之比与反应心肌纤维化程度的血清PC I、PC Ⅱ浓度相关良好，有利于舒张功能受损程度的判断，优于传统的二尖瓣口血流法。     

多普勒组织成像鉴别陈旧性心肌梗死患者舒张功能假性正常

目的 探讨应用多普勒组织成像（DTI）检测二尖瓣环舒张期运动速度可否鉴别陈旧性心肌梗死（OMI）患者舒张功能假性正常。 方法 OMI舒张功能假性正常患者68例，正常对照组50例，应用脉冲多普勒（PWD）分别测量二尖瓣口舒张早期峰值流速（E）、舒张晚期峰值流速（A）、E／A、E峰减速时间（DT）、左室等容舒张时间（IRT）、肺静脉收缩波（S）、舒张波（D）、S／D及心房收缩波（Ar）；转换DTI速度模式，测量左室侧壁缘二尖瓣环舒张早期运动峰值速度（Ea）、舒张晚期运动峰值速度（Aa）并计算Ea／Aa。 结果 OMI舒张功能假性正常患者与正常人的年龄和血流频谱E、A、E／A、IRT、D、S／D及二尖瓣环Aa测值比较无显著性差异（P〉0.05），DT缩短和S波降低具有显著性差异（P〈0．05），肺静脉血流Ar较正常人升高，而二尖瓣环Ea及Ea／Aa较比正常人明显减低，具有显著性差异（P〈0．01）。 结论 DTI检测二尖瓣环Ea及Ea／Aa比值可鉴别OMI患者舒张功能假性正常。     

应变率成像及实时三维超声心动图定量评价早期2型糖尿病兔左室心肌运动及功能

目的探讨超声应变率成像（SRI）及实时三维超声心动图（RT3DE）评价早期2型糖尿病兔左室心肌运动及功能的价值。方法通过静脉注射致病剂量链脲左菌素（STZ），诱发兔高血糖，制备2型糖尿病兔模型；应用SRI技术，分别观测正常兔（NC组，8只）、糖尿病兔（DM组，13只）左室心肌不同节段的收缩期平均峰值速度（PSV）、平均峰值应变率（PSSR）和平均峰值应变（PSS）、舒张早期峰值应变率（SRe）；应用RT3DE检测左心射血分数（EF）。应用脉冲多普勒测量二尖瓣血流速度（Ea、Aa）并计算Ea／Aa值。结果DM组各节段收缩期V、SR、S、SRe与NC组相应节段相比明显减低（P〈0．05）；同时，DM组左心收缩、舒张功能较NC组减低（P〈0．05）；DM组SRe值与Ea／Aa值之间密切相关（r=0．93，P〈0．01）。结论2型糖尿病兔早期即出现心肌运动及功能异常；应变率及实时三维成像能直观、无创地定量评价兔局部心肌功能及整体心功能。     

β1受体阻滞剂对脓毒症大鼠心肌损伤的影响

目的：探讨β1受体阻滞剂对脓毒症大鼠心肌损伤的影响和机制。方法将健康雄性大鼠72只随机分为对照组、脓毒症组、治疗组,每组24只。脓毒症组采用盲肠结扎穿孔法（ CLP）建立脓毒症模型,对照组仅剖腹而不进行CLP。脓毒症组和对照组在关腹后皮下注射生理盐水3 mL／100 g;治疗组除皮下补液外,经尾静脉注射艾司洛尔15 mg／（ kg? h）持续静脉泵入,分别于3、6、12、24 h采集标本,在每个时间点每组大鼠均为6只,观察三组血清肿瘤坏死因子－α（TNF－α）、心肌组织核转录因子－κB p65（NF－κB p65）、心肌肌钙蛋白I（cTnI）的变化。结果与对照组比较,脓毒症组在各时间点血清TNF－α浓度、cTnI浓度及心肌组织NF－κB p65表达均显著升高（P＜0.05）;与脓毒症组比较,治疗组在各时间点血清TNF－α浓度、cTnI浓度及心肌组织NF－κB p65表达均降低（ P＜0.05）。结论β1受体阻滞剂艾司洛尔可减轻脓毒症大鼠心肌损伤,其机制可能与抑制心肌NF－κB p65的表达,降低血清促炎介质的产生有关。β1受体阻滞剂能改善脓毒症失控的炎症反应以及保护心肌功能。     

维拉帕米对重症急性胰腺炎大鼠肺损伤的保护作用

目的：探讨钙通道阻滞剂维拉帕米对重症急性胰腺炎（SAP）大鼠肺损伤的影响。方法：wistar大鼠45只，随机分为假手术组、SAP组和维拉帕米治疗组，观察动物血清中白细胞介素－1（IL－1）、白细胞介素－6（IL－6）和肿瘤坏死因子－α（TNF－α）的含量，肺组织病理学变化。结果：SAP时，大鼠血清中IL－1、IL－6和TNF－α的含量均显著升高（P＜0．01），肺损伤严重，维拉帕米治疗组炎性细胞因子水平显著下降（P＜0．05），肺病理损害程度显著减轻（P＜0．05）。结论：维拉帕米可抑制SAP大鼠炎性细胞因子IL－1、IL－6、TNF－α的产生释放，减轻肺损伤的程度。     

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.