高分辨率超声技术对冠心病血管内皮功能的评价

目的采用高分辨率超声技术评估冠心病患者肱动脉内皮功能受损情况.方法通过选择性冠状动脉造影确定冠心病组患者28例,非冠心病组26例,在冠状动脉造影前后24h内进行肱动脉超声检查,比较反应性充血和含服硝酸甘油后肱动脉内径和血流变化,并对冠心病易患因素做比较.结果冠心病组较非冠心病组肱动脉血流介导的血管扩张反应(FMD)显著减低(4.17%±2.98%)vs(10.26%±8.41%),P=0.03,但两组含服硝酸甘油后血管内径无明显差异.两组的冠心病易患因子数(P=0.01)和吸烟(P=0.004)有显著性差异.结论应用高分辨率超声技术可非侵入性评价周围血管内皮功能,冠心病患者通常存在肱动脉FMD受损.此技术可作为一种无创性冠状动脉内皮功能检测方法.     

益心康泰对稳定型心绞痛冠心病患者血管内皮功能的影响

目的探讨益心康泰胶囊对稳定型心绞痛冠心病患者血管内皮功能的影响。方法稳定型心绞痛冠心病患者40例，正常健康组18例，采用随机、对照、单盲法将稳定型心绞痛冠心病患者分为益心康泰治疗组和常规治疗组各20例。益心康泰治疗组除心绞病常规治疗外，加用益心康泰胶囊1．0g，3次／d口服；常规治疗组仅给予常规治疗。疗程均为30d。治疗前后分别进行肱动脉血流介导性舒张功能（FMD）超声检测。结果治疗前益心康泰治疗组和常规治疗组的肱动脉反应性充血时内径舒张百分比均显著低于正常组（均P〈0．05）；益心康秦治疗组与常规治疗组比较，反应性充血时内径舒张百分比差异无统计学意义（P〉0．05）；疗程结束时益心康泰治疗组肱动脉反应性充血时内径舒张百分比显著高于常规治疗组（P〈0．05）。结论心绞痛冠心病患者血流介导性舒张功能减退；益心康泰胶囊治疗后随着血流介导性舒张功能得到明显改善，心肌缺血显著减轻，说明内皮功能异常在心绞痛冠心病的发病中起重要作用。     

冠状动脉内皮功能与肱动脉内皮功能的相关性研究

目的利用经胸超声心动图冠状动脉血流显像技术检测冠状动脉（冠脉）内皮功能，利用高分辨力超声检测肱动脉内皮功能，同时对冠脉内皮功能与肱动脉内皮功能进行相关性分析。方法应用彩色多普勒超声仪对43例冠心病患者及37例健康人进行冷加压试验检测冠脉内皮功能，肱动脉袖带加压检测肱动脉内皮功能。结果所有受试者冠脉冷加压前、肱动脉加压前血流速度以及冠脉冷加压后、肱动脉加压后血流速度比较差异均有统计学意义（P〈0．0001）；但冠脉反应性充血后血流速度变化率与肱动脉反应性充血后血流速度变化率差异性很小（P〉0．05），两者呈线性正相关，相关系数均接近1。结论冠脉内皮功能与肱动脉内皮功能呈高度相关。     

原发性高血压患者肱动脉内皮功能与致动脉粥样硬化危险因素的相关性

目的：观察原发性高血压患者血液内皮素、同型半胱氨酸、低密度脂蛋白胆固醇的水平，探讨这些危险因素之间相关性及相关程度，同时关注这些危险因素与超声心动图检测的反应性充血肱动脉内径变化率之间的关系。 方法：①选择2003-10／2004-04在徐州医学院附属医院心内科住院的患者56例，男40例，女16例。所有病例依据血压水平分为2组：高血压组38例，男28例，女10例；血压正常组18例，男12例，女6例。其中高血压组据冠状动脉造影结果分为2组：单纯高血压组20例和高血压合并冠心病组18例。纳入对象均了解实验目的，并愿意配合。②测定患者血压，超声心动图测量肱动脉内皮功能。计算反应性充血肱动脉内径变化率[(血流介导的肱动脉内径-安静时肱动脉内径)／安静时肱动脉内径×100％]，以反应性充血肱动脉内径变化率数值大小判断肱动脉内皮功能。采用免疫法测定患者血浆同型半胱氨酸水平，采用放射免疫学法测定患者血浆内皮素1水平，采用全自动生化仪测定患者血清低密度脂蛋白胆固醇水平。③计量资料差异比较采用t检验，数据间相关性分析采用直线相关分析，多因素相关分析采用Logistic回归分析。 结果：高血压患者38例，血压正常患者18例均进入结果分析。①高血压组、高血压合并冠心病组、单纯高血压组患者血浆内皮素和同型半胱氨酸水平及血清低密度脂蛋白胆固醇明显高于血压正常组(P<0．05～0．01)，而反应性充血肱动脉内径变化率明显低于血压正常组(P<0．05～0．01)。单纯高血压组患者血浆内皮素和同型半胱氨酸水平明显低于高血压合并冠心病组(P<0．01)，反应性充血肱动脉内径变化率明显高于高血压合并冠心病组(P<0．01)。②高血压组患者血浆内皮素与同型半胱氨酸呈正相关(r=0．676，P<0．01)；内皮素与反应性充血肱动脉内径变化率呈显著负相关(r=-0．636，P<0．01)；同型半胱氨酸与低密度脂蛋白胆固醇、反应性充血肱动脉内径变化率呈显著负相关(r=-0．378，-0．591，P<0．05，0．01)。内皮素与低密度脂蛋白胆固醇和反应性充血肱动脉内径变化率之间无相关性。③内皮素、同型半胱氨酸、低密度脂蛋白胆固醇是高血压致动脉粥样硬化的危险因素(OR=12．341，12．489，P=0．018，0．013)，高血压致动脉粥样硬化危险因素中以内皮素作用最强，其次是低密度脂蛋白胆固醇。 结论：①高血压患者血浆中内皮素和同型半胱氨酸水平及血清低密度脂蛋白胆固醇水平明显异常，内皮功能障碍，而高血压合并冠心病者上述损害更为明显。②内皮素与同型半胱氨酸最终通过共同途径损伤血管内皮细胞，内皮功能失调，反应性充血肱动脉内径变化率下降。内皮素与低密度脂蛋白胆固醇是动脉粥样硬化的两个独立的危险因素。     

高分辨力超声评价川崎病后肱动脉内皮功能

目的 :应用高分辨力超声分析川崎病后肱动脉内皮依赖性血管舒张 ;明确川崎病急性期丙种球蛋白的应用是否对晚期内皮功能异常有作用。方法 :评价 3 9例有川崎病病史患者及 17例健康对照者的肱动脉内皮依赖性及非内皮依赖性血管舒张。结果 :反应性充血所致的肱动脉内径百分变化率在川崎病组明显低于对照组(P<0 .0 0 0 1)。舌下含服硝酸甘油所诱导的肱动脉内径百分变化率 2组间无显著性差异 (P=0 .49)。反应性充血诱导的肱动脉内径百分变化率在接受和未行丙种球蛋白治疗者无显著性差异 (P=0 .3 3 )。结论 :反应性充血诱导的肱动脉内径百分变化率在有川崎病病史者较健康儿童减低 ,提示川崎病后存在周围血管内皮功能的异常。川崎病急性期大剂量丙种球蛋白的早期治疗不能干预周围血管内皮功能     

阿托伐他汀对混合型高脂血症患者血管内皮依赖性舒张功能的影响

目的　观察阿托伐他汀对混合型高脂血症患者血管内皮依赖性舒张功能的影响。方法　 60例混合型高脂血症患者进行 8周阿托伐他汀片 10mg/d ,口服治疗 ,60例健康人群为对照组 ,治疗前后测定血脂以及用超声多普勒测定肱动脉血管内径、血流量以及反应性充血和含服硝酸甘油片后肱动脉内径和血流量变化。 2 8例经阿托伐他汀治疗 8周后血脂正常的患者停药 4周、8周 ,再次测定血脂以及肱动脉血管内径和血流量。结果　混合型高脂血症患者血管内皮依赖性舒张功能明显受损 (P <0 .0 0 1) ,而对硝酸甘油反应两组无差异 (P >0 .0 5 ) ,阿托伐他汀治疗 8周后血清TG、TC、LDL C、ApoB显著下降 ,对肱动脉内皮依赖性舒张功能较治疗前明显改善 (P <0 .0 0 1) ,停药后 4周、8周肱动脉血管内皮依赖性舒张功能明显下降 (P <0 .0 0 1) ,而治疗前后肱动脉内径以及对硝酸甘油的反应无变化。结论　阿托伐他汀治疗混合型高脂血症疗效明显 ,并显著改善肱动脉内皮依赖性舒张功能 ,这一作用源于其对内皮细胞的直接作用 ,可能独立于降脂作用之外     

多普勒超声评价维生素C和维生素E对高血压血管内皮舒张功能的影响

目的应用超声技术观察维生素C,维生素E对高血压患者肱动脉内皮依赖性舒张功能的影响。方法研究对象包括20例高血压患者和20例正常人分别服用维生素C、维生素E12个月前后,应用高分辩力超声测定静息状态下,反应性充血后,舌下含服硝酸甘油后的肱动脉内径,并计算反应性充血和硝酸甘油诱发的内径百分变化率。结果反应性充血前后肱动脉内径百分变化率,高血压组明显低于正常组(P<0.001),硝酸甘油诱发的肱动脉内径百分变化率高血压组和正常组无显著差异。服用维生素C、维生素E12个月后,高血压患者反应性充血前后肱动脉内径百分变化率明显高于治疗前(P<0.001)。但硝酸甘油诱发的肱动脉内径百分变化率无明显变化。结论服用维生素C、维生素E可改善高血压患者受损的内皮依赖性血管舒张功能。     

血管内皮功能障碍与冠状动脉硬化的关系

目的评定血管内皮功能障碍与冠状动脉粥样硬化的关系。方法306例怀疑冠心病的患者冠状动脉造影后行超声扫描肱动脉血管内皮功能检测,其中男195例,女111例,平均年龄(57±12)岁。根据冠状动脉造影结果分成3组,A组172例,有明显的血管狭窄,即血管内径狭窄≥50%;B组81例,血管内径狭窄<50%;C组53例,无血管狭窄。所有患者均于冠状动脉造影后3d内行肱动脉内皮功能检测。结果3组间基础血管内径、血流速度差异无显著性意义(t=1.02;P>0.05)。反应性充血内径变化值A组与B组(t=4.78;P<0.05)、C组(t=16.92;P<0.001)以及B、C两组间(t=6.89;P<0.01)差异具有显著性意义;反应性充血血流速度变化值A组与B组(t=5.57;P<0.05)、C组(t=12.08;P<0.001),以及B、C两组间(t=8.56;P<0.01)差异均有显著性意义。结论肱动脉内皮功能不良可间接反应冠状动脉内皮依赖性舒张功能受损,与冠状动脉狭窄密切相关,是冠状动脉病变良好的预测指标。     

血管内皮功能障碍与冠状动脉硬化的关系

目的评定血管内皮功能障碍与冠状动脉粥样硬化的关系。方法306例怀疑冠心病的患者冠状动脉造影后行超声扫描肱动脉血管内皮功能检测，其中男195例，女111例，平均年龄(57&;#177;12)岁。根据冠状动脉造影结果分成3组，A组172例，有明显的血管狭窄，即血管内径狭窄≥50％；B组8l例，血管内径狭窄&;lt;50％；C组53例，无血管狭窄。所有患者均于冠状动脉造影后3d内行肱动脉内皮功能检测。结果3组间基础血管内径、血流速度差异无显著性意义(t=1．02；P&;gt;0．05)。反应性充血内径变化值A组与B组(t=4．78；P&;lt;0．05)、C组(t=16．92；P&;lt;0．001)以及B、C两组间(t=6．89；P&;lt;0．01)差异具有显著性意义；反应性充血血流速度变化值A组与B组(t=5．57：P&;lt;0．05)、C组(t=12.08;P&;lt;0．001)，以及B、C两组间(t=8．56；P&;lt;0．01)差异均有显著性意义。结论 肱动脉内皮功能不良可间接反应冠状动脉内皮依赖性舒张功能受损，与冠状动脉狭窄密切相关，是冠状动脉病变良好的预测指标。     

乙醛脱氢酶2基因多态性与血管内皮功能及动脉粥样硬化关系的研究

目的应用高分辨力超声技术对肱动脉舒张功能及血流动力学进行评价,并结合定量冠状动脉(冠脉)造影结果,探讨乙醛脱氢酶2(ALDH2)基因多态性与血管内皮功能及动脉粥样硬化之间关系。方法150例经冠脉造影证实的冠心病患者,根据基因测序结果分为A组(野生型)93例(62%)和B组(突变型)57例(38%),观察两组患者冠心病易患因素及冠状动脉病变程度,同时应用高分辨力超声技术评价肱动脉舒张功能及相应状态下血流最大剪切率。结果两组患者基本临床特征比较差异无统计学意义(P>0.05)。B组患者多支病变率显著低于A组(57.9%对76.4%,P=0.017),Gensini评分亦低于A组(46.3±35.7对61.8±49.3,P=0.04)。高分辨力超声检查:肱动脉基础内径两组间差异无统计学意义(P>0.05)。内皮依赖性血管舒张功能检查:反应性充血后肱动脉内径变化两组间差异无统计学意义(P>0.05);非内皮依赖性血管舒张功能检查:含化硝酸甘油后B组血管内径的增幅较A组显著减少(P<0.05),表明B组患者对硝酸酯类药物反应能力较低。脉冲多普勒检查血流动力学,基础状态及反应性充血后肱动脉最大剪切率A组显著低于B组(P<0.01),提示野生型患者易发生动脉粥样硬化。结论ALDH2基因多态性与血管内皮功能及动脉粥样硬化之间关系密切。ALDH2基因突变虽可导致非内皮依赖性血管舒张功能障碍,但内皮依赖性血管舒张功能不受影响。ALDH2基因突变可能具有抗动脉粥样硬化的作用。     

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.     

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.     

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.     

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.     

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.