单纯性高甘油三酯血症辨证分型与自由基代谢及凝血-纤溶活性关系的研究

目的 :研究单纯性高甘油三酯血症辨证分型与自由基代谢及凝血纤溶活性的关系。方法 :选择血清甘油三酯 >1.8mm ol/ L患者 ,按中医辨证分为气虚证组 (2 5例 )、阴虚证组 (2 6例 )、阳虚证组 (2 0例 )、痰湿证组 (2 4例 )和血瘀证组 (2 5例 ) ,并设立对照组 (2 5例 ) ,比较各组血浆丙二醛 (MDA)、超氧化物歧化酶 (SOD)、谷胱甘肽过氧化物酶 (GSH Px)、内皮素 (ET)、一氧化氮 (NO)、血小板α颗粒膜蛋白 (GMP 14 0 )、组织型纤溶酶原激活剂 (t PA)及其抑制剂 (PAI)等指标的差异。结果 :高甘油三酯血症各证型 ET、MDA、PAI、GMP 14 0均高于对照组 ,而 NO、SOD、GSH Px、t PA均较之为低 (P均 <0 .0 1) ;痰湿证组、血瘀证组 ET、MDA、PAI、GMP 14 0、SOD、GSH Px均高于气虚证组、阴虚证组与阳虚证组 ,而 NO、t PA则较低 (P均 <0 .0 1) ;阳虚证组 SOD、GSH Px则较气虚证组与阴虚证组显著降低 (P均 <0 .0 1)。结论 :各证型均存在不同程度的自由基代谢紊乱及凝血纤溶系统的改变 ,痰湿证及血瘀证存在较明显脂质过氧化反应增强、血管内皮细胞功能障碍、血小板活化、纤溶活性降低等改变 ,阳虚证组抗氧化酶活性降低。     

2型糖尿病患者交感神经皮肤反应检测及中医证候研究

目的研究交感神经皮肤反应（SSR）在2型糖尿病（T2DM）周围神经病变中的诊断价值，分析其与中医证候之间的关系。方法检测192例T2DM患者的SSR；按气虚、阴虚、阳虚、血瘀、痰湿进行中医证候归类，用5级记分法进行量化评分。结果SSR总体异常率为73．4％（141／192）；在无周围神经损害症状和自主神经功能损害症状的患者中，SSR异常率分别为71．5％（27／38）和68．8％（11／16）；性别、年龄、病程及有无自主神经功能损害症状对SSR异常率无影响（P均〉0．05）。SSR上肢波幅（Amp）与脂蛋白B（ApoB）、低密度脂蛋白胆固醇（LDL-C）和胆固醇（CHO）呈正相关；下肢潜伏期（Lat）与餐后2h血糖（2hPBG）、舒张压（DBP）均呈正相关；下肢Amp与ApoA1、ApoB、LDL-C和CHO呈正相关（P〈0．05或P〈0．01）。阴虚证、血瘀证出现频率〉50％；〉60岁组阳虚证比例及积分均显著高于≤60岁组（P〈0．05和P〈0．01）；病程长者血瘀证、阳虚证积分均显著增高（P均〈0．01）；有自主神经功能损害症状患者的气虚证和阴虚证积分均显著高于无自主神经功能损害症状者（P均〈0．01）；SSR异常组的阴虚证积分显著低于正常组（P〈0．05）。相关分析显示：SSR的四肢Lat与气虚证积分呈负相关（-0．316〈r值〈-0．157，P〈0．05或P〈0．01）；右上肢Amp与阳虚证、血瘀证积分均呈负相关（阳虚证r=-0．207，P=0．006；血瘀证r=-0．162，P=0．032）。结论SSR有助于发现糖尿病的亚临床神经病变，可作为评价T2DM患者早期自主神经及小纤维神经病变的敏感指标；血糖、血脂和血压可影响SSR参数。DPN患者阳虚、血瘀程度随病程延长和年龄增长渐进加重，气虚、阳虚和血瘀3种证候的病情程度对SSR参数的异常有一定影响。     

54例高血压患者动态脂餐饮食耐量试验结果分析

目的 设计动态脂餐饮食耐量试验，观察高血压患者有关血脂、血糖、胰岛素（INS）、INS敏感指数（ISI）等变化规律。方法 测定67名健康人、54例高血压患者的总胆固醇（TC）、三酰甘油（TG）、载脂蛋白（Apo）A1、ApoB、高密度脂蛋白胆固醇（HDL-C）、血糖、INS及ISI。生化指标测定均采用常规方法，血清INS测定采用微粒子捕捉酶免疫分析（MEIA）方法。结果 67名健康人脂餐饮食后6h生化指标和服糖后2h血糖、INS检测结果与空腹比较差异无显著性。54例高血压患者空腹TG升高，与对照组比较差异有显著性（P〈0．01）；空腹HDL-C降低，空腹血糖升高，与对照组比较差异有显著性（P〈0．05）。高血压组脂餐饮食后6hTG升高，服糖后2h血糖明显增高，ISI明显降低，与空腹时比较差异有显著性（P〈0．01），其他指标与空腹时差异无显著性。结论 高血压组处于高血脂状态时间明显比正常对照组延长，并且伴有高INS血症、INS抵抗及ISI降低现象。     

172例糖尿病周围神经病变患者中医证候特点与神经传导速度的关系

目的探讨糖尿病周围神经病变（DPN）患者中医证候特点与神经传导速度的关系。方法对172例DPN患者按气虚、阴虚、阳虚、血瘀、痰湿进行中医证候归类，5级记分法量化评分，并进行常规神经传导速度（NCV）检测。结果中医证候出现频率阴虚、血瘀〉50％；高龄组阳虚证候比重及积分高于低龄组（P〈0．05）；血瘀、阳虚证候积分随着病程的延长明显增高（P〈0．01）。神经系统症状、体征评分与阴虚、阳虚、血瘀积分呈正相关；空腹血糖（FBG）与气虚积分、脂蛋白a与阴虚积分、同型半胱氨酸（Hcy）与阳虚积分呈正相关；NCV异常组中的阴虚、血瘀证候比例高于各自正常组，而气虚、痰湿证候反之，但无统计学意义（P〉0．05）；阳虚、血瘀积分越高，NCV异常越明显。病程、FBG、收缩压（SBP）、同时并发糖尿病肾病（DN）和糖尿病视网膜病变（DR）、神经系统体征评分是NCV异常的独立危险因素。结论DPN临床证候以阴虚、血瘀为主，阳虚、血瘀越明显，神经传导速度越慢；病程延长、FBG和SBP升高、合并DN和DR及神经系统体征评分增加是NCV异常的独立危险因素。     

胰岛素抵抗与脑梗死关系的研究

目的：对胰岛素抵抗与脑梗死之间的关系进行探讨,方法：分别对26例单纯脑梗死,38例高血压脑梗死,19例冠心病脑梗死患者及30例对照患者进行空腹血胰岛素（INS）,C肽（CP）,葡萄糖（BG）,胆固醇（TC）和甘油三酯（TG）水平及体重指数（BMI）等测定。结果：三组脑梗死患者分别与对照组比较,其INS水平明显升高,胰岛素敏感指数显著降低（P＜0．05）,结论：胰岛素抵抗与脑梗死有密切关系,可能是脑梗死的一个重要危险因素。     

38例2型糖尿病并胆石症患者的胰岛素、血脂水平及其相关关系

目的：探讨2型糖尿病并胆石症患者的胰岛素、血脂水平及其相关关系。方法：测定38例2型糖尿病并胆石症患者的空腹胰岛素、血清脂质及载脂蛋白水平，计算胰岛素敏感指数（ISI），分析其相互关系，并与38例不伴胆石症的2例糖尿病患者相比较。结果：2型糖尿病并胆石症组与不伴胆石症组相比较，前者的ISI明显降低（P＜0．01），空腹胰岛素，甘油三酯，总胆固醇和载脂蛋白A1（ApoA1)，明显升高（P＜0．01，P＜0．05），高密度脂蛋白－胆固醇（HDL－C），载脂蛋白AⅡ（ApoAⅡ)则无显著变化（P＞0．05），ISI与甘油三酯，总胆固醇呈负相关，与HDL－C呈正相关，多元回归分析显示胆石症与ISI呈负相关。结论：胰岛素抵抗可能是2型糖尿病患者胆石形成的危险因素。     

血液平衡对高甘油三酯伴胰岛素抵抗的影响

目的　探讨高甘油三酯对胰岛素水平的影响以及血液平衡疗法对甘油三酯、胆固醇和胰岛素水平的影响。方法　测定30例高TG血症患者(治疗组)经血液平衡治疗前后及32例正常对照者的血脂(TC、TG)、血糖(GLU)及胰岛素(Ins)浓度,并计算胰岛素敏感性指数(ISI)。结果　(1)高TG血症组经血液平衡治疗后,血脂较治疗前明显降低(P <0 .0 5 )。(2 )高TG血症组与正常对照组比较,空腹血糖差异无显著性(P >0 .0 5 ) ;胰岛素(Ins)及胰岛素敏感性指数(ISI)差异均有显著性(P <0 0 5 )。(3)高TG血症组经血液平衡治疗后Ins明显降低(P <0 .0 5 ) ;ISI较治疗前明显增高(P <0 .0 5 )。结论　高TG血症患者血浆胰岛素浓度高于正常,血脂水平的升高对胰岛素的分泌具有促进作用;通过血液平衡疗法的治疗在降脂的同时,具有改善胰岛素抵抗的作用。     

运动对胰岛素抵抗大鼠脂肪组织中糖原合成酶激酶3β表达的影响

目的 探讨运动对高脂饮食诱导的胰岛素抵抗大鼠脂肪组织中糖原合成酶激酶3B（GSK-3β）表达的影响。方法 将30只SPF级雄性Wistar大鼠随机分为2组，其中正常对照组10只，给予常规饲料喂养，模型组20只，给予高脂饲料喂养。模型组大鼠经喂养4周后制成胰岛素抵抗模型，将其随机分为2个亚组（即胰岛素抵抗组和运动干预组），2个亚组继续给予高脂饲料喂养，同时运动干预组大鼠每周进行5d游泳运动，持续6周。采用Western—blot方法检测各组大鼠附睾脂肪组织中GSK-3β的表达；定期检测大鼠体重（BW）、空腹血糖（FPG）、血浆胰岛素（FINS）、血甘油三酯（TG）及胆固醇（TC）水平，并计算胰岛素敏感指数（ISI）。结果 各组大鼠经高脂饲料喂养4周后，与正常对照组比较，模型组大鼠BW、FPG、FINS、TC、TG均显著升高（P〈0．05或0．01），ISI则明显降低（P〈0．01），提示胰岛素抵抗模型诱导成功。经6周运动干预后，与胰岛素抵抗组比较，运动干预组大鼠脂肪组织GSK-3β表达显著下降（P〈0．05），与正常对照组比较，差异无统计学意义（P〉0．05）。结论 运动可下调胰岛素抵抗大鼠脂肪组织GSK-3β的表达，促进葡萄糖的摄取及糖原合成，具有改善胰岛素抵抗功能。     

冠状动脉搭桥术前与术后胰岛素抵抗改变的观察

目的：观察冠状动脉搭桥术患者术前与术后胰岛素抵抗（IR）状态的改变，并探讨以（IR）评估术后患者糖、脂代谢情况，预测术后患者病情变化，为治疗提供依据。方法：对28例施冠状动脉搭桥术的冠心病患者为观察对象，（CAD组）；以6例风湿性心脏病直视心脏手术病人为对照组（HRD组）。术前检测两组病人空腹胆固醇（CHO）、甘油三脂（TG）、代密度脂蛋白胆固醇（LDL）、高密度脂蛋白胆固醇（HDL）的含量；并检测CAD组术前、术后24h及HRD组术前空腹血糖（FPG）、空腹血清胰岛素（FINS）、空腹血清C肽（CP）的含量，并计算出FPG／FINS比值、胰岛素敏感性指数（IAI）、胰岛素抵抗指数（IR），作为评价机体对胰岛素敏感性的指标。分别对两组病人血脂、胰岛素敏感性以及冠状动脉搭桥术前、术后24h机体对胰岛素敏感性改变作比较。结果：与HRD比较CAD组胆固醇、甘油三脂、低密度脂蛋白明显增高（P＜0．01－0．001）；高密度脂蛋白明显低于HRD组。CAD组患者的胰岛素敏感性明显低于HRD组的患者，CP、FINS水平明显高于HRD组（P＜0．01－0．001）。冠状动脉搭桥术后24h患者与术前比较胰岛素敏感性明显降低，FPG、CP、FINS含量明显高于术前（P＜0．01－0．001）。结论：冠心病患者存在脂代谢异常、明显的胰岛素抵抗（IR）及高胰岛素血症。冠状动脉搭桥术后24h胰岛素抵抗（IR）程度比术前明显加重，胰岛素水平进一步增高。产生这一现象的可能原因：由于手术应激、麻醉、低温和非波动性灌注等诸多因素的影响，使机体内环境改变所致。施冠状动脉搭桥的病人术前及术后有必要检测和评估胰岛素抵抗。     

糖尿病致瘀因素的临床评估

对120例Ⅱ型糖尿病（NIDDM）患者的血瘀证致瘀因素（NIDDM合并症、常见虚证证候）进行分析，分伴发血瘀证及非血瘀证组，2组其年龄、病程、体重指数相仿。表明高血压、冠状动脉粥样硬化性心脏病、周围神经病变等发生率在血瘀证中显著增高（P＜0．05）NIDDM患者中气虚、肝虚、肾虚证候在血瘀证组的发生率高于非血瘀证组（P＜0．05），气虚证尤为明显，也阐明了气虚与血瘀相关。     

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.