C反应蛋白与传统心血管危险因子的相关性研究

目的 探讨C反应蛋白（CRP）与传统心血管危险因子的相关性。方法 按CRP水平分为高CRP组213例，低水平CRP对照组202例，分析两组各心血管危险因子；分别以危险因子：性别（女／男）、吸烟（吸烟／不吸烟）、糖尿病（糖尿病／非糖尿病）、体重指数（BMI）（超重／正常）、血脂（异常／正常）、血压（高血压／正常）为切入点分析与高CRP的相关性。结果高CRP组各危险因子参数均比低水平CRP对照组异常明显（P＜0．05），相关分析高CRP与肥胖、糖尿病、血脂异常、女性性别、高血压、吸烟相关联。结论 CRP与传统心血管危险因子相关联。     

C反应蛋白与传统心血管危险因子的相关性

目的探讨C反应蛋白(CRP)与传统心血管危险因子的相关性。方法按CRP水平分为高CRP组213例,低水平CRP对照组202例,分析两组各心血管危险因子;分别以危险因子:性别(女/男)、吸烟(吸烟/不吸烟)、糖尿病(糖尿病/非糖尿病)、体重指数(BMI)(超重/正常)、血脂(异常/正常)、血压(高血压/正常)为切入点分析与高CRP的相关性。结果高CRP组各危险因子参数均比低水平CRP对照组异常明显(P<0.05),相关分析高CRP与肥胖、糖尿病、血脂异常、女性性别、高血压、吸烟相关联。结论CRP与传统心血管危险因子相关联。     

血浆ⅡA分泌型磷脂酶A_2与冠心病相关性研究

目的：研究血浆A分泌型磷脂酶A2（A-sPLA2）与冠心病的相关性。方法：40例确诊冠心病患者（冠心病组）及46例非冠心病患者（对照组）,用酶免法测定血浆中的A-sPLA2浓度 用免疫比浊法测定血清中载脂蛋白A1、载脂蛋白B、脂蛋白a、C-反应蛋白含量 酶法测定血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白。结果：冠心病组体内A-sPLA2浓度显著高于对照组（P〈0.05）。A-sPLA2与CRP呈显著正相关（P〈0.05）,与传统的危险因子（年龄、吸烟、糖尿病、高血压、高胆固醇血症、低HDL-C）的数目及血管病变支数无相关性。多变量Logistic回归分析显示：高浓度A-sPLA2、吸烟、糖尿病是区分冠心病与非冠心病显著的变量。结论：血浆A-sPLA2是冠心病重要的危险因子,与冠心病相关。     

沈阳地区铁路职工内科住院患者冠状动脉性心脏病危险因素结构及强度变化趋势10年分析

目的：分析10年中沈阳地区铁路职工内科住院患者冠状动脉性心脏病（冠心病）危险因素结构及强度的变化趋势，为早期防治冠心病提供依据。 方法：①选择1993／2002沈阳铁路局中心医院心内科住院患者，包括冠心病、风湿性心脏病、高血压、心肌病、心律失常及其他患者。1993／1995组1500例，2000／2002组1500例，调查体质量指数、收缩压、舒张压、血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、吸烟等危险因素结构及强度的变化趋势及与冠心病构成比、住院期间病死率的相关关系。 ②在沈阳铁路局中心医院，调查2003年内科各科系及体检中心就诊的4900例患者的血脂异常，高血压、吸烟、糖尿病、体质量指数、焦虑状态、血半胱氨酸、脂蛋白（a）、C-反应蛋白、年龄及家族史情况。分析冠心病危险因素的强度、结构与冠心病构成比、住院期间病死率的联系。预测沈阳地区铁路职工心血管事件发病的绝对危险度。 结果：1993／1995组1500例，2000／2002组1500例患者全部进入结果分析。2003年来沈阳铁路局中心医院内科就诊的患者4900例全部进入结果分析。①1993／2002冠心病危险因素强度中体质量指数，舒张压、三酰甘油呈显著上升趋势。冠心病危险因素结构排序为：原发性高血压、体质量指数超过标准（肥胖）、高三酰甘油血症、高胆固醇血症、吸烟、糖尿病。②2003年调查资料分析显示：收缩压、舒张压、高三酰甘油血症、高胆固醇血症、吸烟、焦虑、年龄与冠心病构成比呈正相关（r=0．79～0．80，P〈0．01）。收缩压、舒张压、焦虑、年龄与冠心病住院期间病死率呈正相关（r=0.71～0.73，P〈0.05）。沈阳地区铁路职工心血管事件发病绝对危险度男性为13．2％，女性9．7％。 结论：原发性高血压、体质量指数超标、焦虑、高甘油三酯血症、高胆固醇血症、吸烟、糖尿病是沈阳地区铁路职工冠心病危险因素。强度呈上升趋势的危险因素是：高血压（舒张压）、高甘油三酯血症、焦虑。     

冠心病患者sPLA2与hs—CRP联合测定及其临床意义

目的探讨血清分泌型磷脂酶A2（sPLA2）联合高敏C反应蛋白（hs—CRP）测定对冠状动脉粥样硬化性心脏病（简称冠心痛）患者远期心血管事件的临床预测意义。方法经冠状动脉造影证实的172例冠心病患者,分别在入院时测定其sPLA2、hs—CRP,并按不同测定水平分组,通过2年随访,观察sPLA2、hs—CRP对远期心血管事件的预测意义。结果2年后共发生心血管事件49例．高sPLA2组（≥66．48u／m1）的心血管事件发生率为38-46％,调整了高血压、糖尿病、吸烟、冠脉3支病变等传统危险因素后。Cox风险回归提示高sPLA2是预测远期事件的独立危险因素之一,相对危险度（RR）2．76;2年后高hs—CRP组（≥0．03g／L）的心血管事件发生率为39．24％,其RR为2．55;而两者同时升高的患者（sPLA2≥66．48u／ml合并hs～CRP≥0．03g／L）远期心血管事件发生率为52．08％,RR为3.34;在低LDL—C冠心病患者中,高sPLA2、高hs—CRP及高sPLA2＋高hs—CRP组患者2年后发生心血管事件的RR分别为2．66、2．77、3．73。结论sPLA2是冠心病发生远期心血管事件的独立危险因素之一,联合hs—CRP测定能提高对冠心病,特别是LDL—C患者心血管事件的临床预测意义。     

ⅡA分泌型磷脂酶A2与冠心病的关系

目的 测定冠心病患者及非冠心病患者体内ⅡA分泌型磷脂酶A2（ⅡA-sPLA2）的浓度；分析它与高敏C-反应蛋白（hs-CRP）之间的相关性。方法 40例确诊冠心病患者及46例非冠心病患者对照，采用酶免法测定EDTA抗凝血浆中的ⅡA-sPLA2浓度；采用免疫比浊法测定血清中hs-CRP含量；同时，应用酶法测定血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白的浓度。结果 冠心病患者ⅡA-sPLA2浓度的中位数（242．5ng／d1）显著高于非冠心病组的浓度中位数（198．7ng／d1）（P〈0．05）；ⅡA-sPLA2与hs-CRP呈显著正相关（P〈0．05），与传统的危险因子（年龄、吸烟、糖尿病、高血压、高胆固醇血症、低HDL-C）无相关性。多变量Logistic回归分析显示：高浓度ⅡA-sPLA2（333．9ng／d1，非冠心病组90％分布）、吸烟、糖尿病是区分冠心病与非冠心病显著的变量。结论 体内高浓度的ⅡA-sPLA2是冠心病重要的危险因子，它可能与发生动脉粥样硬化时炎症的活化有关。     

原发性高血压患者血浆同型半胱氨酸水平的变化及相关性研究

目的了解原发性高血压患者血浆同型半胱氨酸（Hcy）水平,探讨其与传统心血管危险因素及亚临床靶器官损害之间的关系。方法收集106例原发性高血压患者的相关资料,依据《中国高血压防治指南》行超声心动图、颈动脉超声、估算的肾小球滤过率（iGFR）判断是否存在靶器官损伤（若患者同时存在2种或2种以上的靶器官损伤,则归人各组分别统计）,将106例患者分为单纯高血压组（44例）、高血压伴左心室肥厚组（18例）、高血压伴颈动脉硬化组（46例）及高血压伴iGFR下降组（27例）。同时检测血浆Hcy、血糖（FPG）、血脂、血肌酐（Cr）等,并采用Spearman相关性分析及多元logistic回归对各组数据进行分析。结果Hcy与各靶器官损害呈明显正相关（P〈0,05）,且与传统心血管危险因素[性别、年龄、吸烟、收缩压（SBP）、FPG、Cr]明显相关（P〈0．05）。单纯高血压组血浆Hcy水平[（12．184-3．30）p~mol／L]明显低于高血压伴iGFR下降组[（19．05±8．58）~mol／L]、高血压伴左心室肥厚组[（18．63±7．99）Ixmol／L]、高血压伴颈动脉硬化组[（16．80±6．34）~mol／L]（P均〈0．05）。高血压伴颈动脉硬化组年龄、Hcy、血糖、iGFR与单纯高血压组比较差异有统计学意义（P〈0．05）。以有无颈动脉粥样硬化为因变量,年龄、血糖、iGFR和Hcy为自变量,通过多元logistic回归分析,结果表明仅有年龄是高血压患者颈动脉粥样硬化的独立危险因素。按美国心脏病协会制定的Hcy异常临界值标准（〉15μmol／L）将Hcy区分为正常和升高,高血压伴Hcy升高者罹患颈动脉粥样硬化的风险比Hcy正常者高出2．74倍。结论年龄是高血压患者颈动脉粥样硬化的独立危险因素;Hcy升高与高血压患者亚临床靶器官损害密切相关,且罹患颈动脉粥样硬化的风险上升。     

原发性高血压患者C-反应蛋白与动脉粥样硬化的关系

目的 对不同程度的原发性高血压患者进行血浆高敏C-反应蛋白（C—reactive protein。CRP）检测，探讨超敏C-反应蛋白（hs—CRP）在动脉粥样硬化疾病中的临床意义。方法 对30例1～2级原发性高血压患者（第1组）和30例3级原发性高血压患者（第2组）进行hs—CRP、内皮素、同型半胱氨酸（HCY）和血脂检测、颈动脉超声检查，与除外原发性高血压、冠心病、糖尿病以及各种感染、肿瘤患者进行比较分析。结果 第2组hs—CRP、内皮素、HCY浓度明显高于第1组，差异有显著性（P〈0．05）。两组分别与对照组比较差异有非常显著性（P〈0．01）。第2组颈动脉硬化最严重。血脂除低密度脂蛋白胆固醇（LDL—C）两组间比较差异有显著性外（P〈0．05），均无明显差异。结论 原发性高血压患者血液中hs—CRP、内皮素、HCY浓度与原发性高血压和颈动脉粥样硬化程度呈正相关。对血脂正常的患者测定hs—CRP尤其重要，对血脂和hs—CRP两个危险因子联合测定，对心血管事件的发生会有更高的预报作用。     

颈动脉硬化患病情况及危险因素分析

目的 探讨颈动脉硬化（CAS）的患病情况及其危险因素。 方法 将该院603例住院患者根据颈动脉彩超检查结果分为非硬化组和硬化组,计算CAS的患病率,分析比较两组临床资料及生化指标,利用多因素Logistic回归分析各危险因素与CAS的相关性。 结果 入选患者CAS的发生率为57.5%。两组年龄、糖化血红蛋白、血尿酸、甘油三酯、低密度脂蛋白胆固醇、高血压、糖尿病、吸烟差异有统计学意义（P<0.05）。Logistic回归分析显示,年龄、吸烟、高血压、糖尿病、低密度脂蛋白胆固醇为CAS的独立危险因素。 结论 年龄、吸烟、高血压、糖尿病、低密度脂蛋白胆固醇与CAS的发生具有明显相关性,合并危险因素的中老年人应尽早行颈动脉彩超检查。血尿酸与CAS的相关性有待进一步研究证实。       

早发冠心病的高血压患者危险因素分析

目的探讨早发冠状动脉粥样硬化性心脏病(简称冠心病)的高血压患者传统冠心病危险因子的流行病学特点。方法对比冠状动脉造影证实的267例合并早发冠心病的高血压患者(病变组)与96例冠状动脉正常的高血压患者的临床资料和实验室检查结果,分析其中主要心血管危险因素。结果病变组比正常组的男性、早发冠心病家族史、糖尿病、吸烟、饮酒比例显著增高,且在体重指数、甘油三酯、极低密度脂蛋白胆固醇、尿素氮、尿酸、白细胞计数和C反应蛋白水平上显著增高,但高密度脂蛋白胆固醇水平较低(P<0.05)。多元Logistic回归分析表明,早发冠心病家族史、低高密度脂蛋白胆固醇血症、高甘油三酯血症、糖尿病年数、性别对早发冠心病有显著的预测价值,OR值分别为12.317、3.267、2.894、1.140、0.088。结论低高密度脂蛋白胆固醇血症和高甘油三酯血症是我国汉族人群年轻高血压患者出现早发冠心病的重要的可控危险因素。     

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.     

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.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.