超声心动图Tei指数对自发性高血压大鼠左心室功能的研究

目的探讨超声心动图Tei指数对自发性高血压大鼠左室心功能的应用价值。方法经胸超声检测高血压大鼠与正常大鼠（各20只）左室容积、内径及室壁厚度,了解其心功能指标左室射血分数（LVEF）、左室缩短分数（LVFS）变化以及二尖瓣口E峰、A峰流速、E/A比值,测量射血时间（ET）、等容收缩时间（ICT）、等容舒张时间（IRT）,计算Tei指数。结果高血压大鼠左室心肌较正常对照组明显肥厚,以左室后壁为主,左室腔缩小,Tei指数（0.59±0.19）较正常对照组（0.35±0.10）增大,P〈0.05,而二尖瓣口E峰、A峰流速,LVEF、LVFS与正常组无明显差别。结论超声心动图Tei指数评价高血压大鼠左心室功能较常规指标更有效。     

Tei指数在新生儿窒息后心肌损害的诊断及治疗中的价值

目的探讨Tei指数在新生儿窒息后心肌损害的诊断及治疗中的临床意义。方法选择正常足月新生儿60例（正常对照组）、重度窒息和轻度窒息后心肌损害足月新生儿（重度窒息组、轻度窒息组,各40例）,对3组新生儿在生后24～48h内、窒息心肌损害新生儿治疗1周后行常规超声心动图检查并同步描记心电图,分别测量左室射血分数（EF）及左、右心室舒张早期最大血流速度（E峰）、舒张晚期最大血流速度（A峰）及E/A比值、等容舒张时间（IRT）、等容收缩时间（ICT）、射血时间（ET）、Tei指数。比较3组新生儿上述各项心功能指标。对窒息后心肌损害新生儿同时作血清CK-MB测定并与Tei指数做相关性分析。对窒息后心肌损害患儿经规范治疗1周后重测以上部分指标,并对其治疗前后进行比较。结果 3组间左室EF及左、右心室E峰、A峰及E/A比较差异均无统计学意义（均P〉0.05）。重度窒息组与正常对照组相比,Tei指数、IRT、ICT明显增高（P〈0.01）,ET明显降低（P〈0.05）;重度窒息组与轻度窒息组相比,Tei指数、IRT、ICT明显增高（P〈0.01）,ET的差异无统计学意义（P〉0.05）;轻度窒息组与正常对照组相比,Tei指数、IRT、ICT明显增高（P〈0.01）,ET明显降低（P〈0.05）。窒息并心肌损害新生儿生后24～48h血清CK-MB与左、右心室Tei指数呈正相关（r=0.787、r=0.773,均P〈0.01）。窒息并心肌损害患儿经规范治疗1周后与治疗前比较,Tei指数、ICT、IRT及CK-MB均明显下降（均P〈0.01）,ET明显上升（P〈0.01）。结论 Tei指数能快速、准确地评价新生儿窒息后心肌损害的心脏功能。     

超声心动图Tei指数评价心衰大鼠干细胞移植前后心功能

目的 探讨超声心动图Tei指数评价心力衰竭大鼠左室心功能的应用价值,研究骨髓间充质干细胞移植对心衰大鼠心功能的影响.方法 经胸超声检测移植干细胞前后心衰大鼠移植组、未移植组及对照组大鼠左室内径,了解其心功能指标左室射血分数(LVEF)、左室缩短分数(LVFS)变化,测量射血时间(ET)、等容收缩时间(ICT)、等容舒张时间(IRT),计算Tei指数.结果 心衰大鼠干细胞移植前左室腔明显扩大,Tei指数较对照组增大(P＜0.05),而LVEF、LVFS较对照组明显减小.干细胞移植术后1周,移植组LVEF值较术前增大,但差异无统计学意义;而Tei指数较未移植组降低,差异有统计学意义(P＜0.05).干细胞移植术后2周、8周,移植组LVEF值升高,Tei指数更降低,与未移植组比较P＜0.05.移植术后8周,移植组LVEF、Tei指数与对照组比较差异无统计学意义.结论 超声心动图Tei指数可评价心力衰竭大鼠左心室功能,较常规指标更敏感、全面;干细胞移植可显著改善心衰大鼠心功能.     

Tei指数监测蒽环类药物对肿瘤患者左心功能的影响

目的探讨心肌做功指数（myocardial performance index，MPI又称Tel index）在评价蒽环类药物（anthracycline，ATC）对肿瘤患者左心功能早期损害方面的临床应用价值。方法测定并比较50例肿瘤患者ATC化疗前和化疗后6个月常规超声心动图参数及Tei指数的变化。结果与化疗前相比，左心室等容舒张时间（IRT）延长（P〈0．05），左心室Tei指数明显升高（P〈0．01）。而左心内径及收缩功能指标（EF、FS）化疗前后无显著性差异，仅14例（28％）患者化疗后出现一项或多项常规左室舒张功能指标异常（E峰减低，A峰升高，E／A〈1）。结论Tei指数能更早、更敏感地评价ATC对肿瘤患者左心功能的损害。     

Tei指数在儿童传染性单核细胞增多症合并心肌损害心功能评价中的价值

目的 探讨T ei 指数在传染性单核细胞增多症（IM ）合并心肌损害儿童左心功能评价的意义。方法 检测并比较 IM 合并心肌损害患儿96例（观察组）和正常对照组40例（对照组）左心室射血分数（EF）、二尖瓣舒张早期血流速度峰值（E峰）及舒张晚期血流速度峰值（A峰）、（E／A ）比值、左心室等容收缩时间（ICT）、等容舒张时间（IRT）、射血时间（ET）,计算Tei指数。结果 观察组EF、E／A比值与对照组比较差异无统计学意义（P ＞0．05）,左室Tei指数较对照组明显增大（0．48±0．09vs0．39±0．08,P ＜0．05）,且Tei指数与EF、E／A无显著相关（ P ＞0．05）。结论 IM合并心肌损害患儿存在心脏整体功能异常,Tei指数能简便、敏感检测其功能变化。     

Tei指数评价卡维地洛治疗慢性心衰效果研究

目的：用Tei指数及其他心功能指标评价卡维地洛治疗慢性心衰的效果。方法：63例慢性心衰患者（NYHAⅡ～Ⅲ级）随机分为2组,一组为常规治疗组,用常规抗心衰的方法治疗;另一组为卡维地洛治疗组,在常规治疗方法的基础上加用卡维地洛。所有的病人至少随访6个月,用超声心动图分别检查左室射血分数（LVEF）、Tei指数、左室舒张末期内径（LVIDd）、室间隔舒张末期厚度（IVSd）、左室后壁舒张末期厚度（LVPWd）以及左室的等容收缩期（ICT）、等容舒张期（IRT）、射血时间（ET）。结果：治疗后常规治疗组和卡维地洛治疗组的LVIDd、ICT、IRT和Tei指数均较治疗前显著减低,IVSd、LVPWd、LVEF和ET均显著增加。治疗6个月后,卡维地洛治疗组的LVEF和ET显著高于常规治疗组（P〈0.05,P〈0.01）,卡维地洛治疗组的Tei指数和ICT显著低于常规治疗组（P〈0.01,P〈0.05）。结论：在常规治疗方法的基础上加用卡维地洛治疗慢性心衰效果好于仅用常规的方法治疗。Tei指数较LVEF和NYHA分级法评价心功能更为敏感。     

Tei指数评价川崎病患者心功能的研究

目的 应用Tei指数评价急性期川崎病患者左心功能变化。 方法 急性期川崎病患者83例，正常对照组40例，以M-型超声获得左室射血分数（LVEF），在心尖五腔观，应用脉冲多普勒（PW）同时获得二尖瓣口和主动脉瓣口血流频谱，在同一心动周期内测量所需数据并计算出Tei指数、E／A比值。比较两组间参数。 结果 川崎病组与正常组LVEF差别无显著性意义（P〉0．05）；川崎病组E／A比值低于正常对照组（P〈0．05），而Tei指数明显高于正常对照组（P〈0．01），差别具有显著性意义。 结论 Tei指数可以很好地评价川崎病患者急性期左心整体功能的损害，较之射血分数（EF）值更为敏感、准确。     

蒽环类药物对肿瘤患者心脏Tei指数影响的临床研究

目的探讨利用心肌做功指数（MPI,Tei指数）早期检测和评估蒽环类药物（ATC）对肿瘤患者心脏毒性的临床价值。方法用多普勒法测定46例恶性肿瘤患者ATC化疗前和化疗后3～6个月左心Tei指数,常规超声心动图EF、FS和E／A指标。结果与化疗前比较,Tei指数相关参数中ATC化疗后左心室等容舒张时间（IRT）延长,等容舒张指数（IRT／ET）增大,E／A指标降低（P〈0．05）。左心室等容收缩时间（ICT）,等容收缩指数（ICT／ET）,EF和FS指标较化疗前无显著性差异。结论在早期评价ATC对肿瘤患者心脏功能损害方面,Tei指数、等容舒张指数是敏感的指标,E／A指标虽然在应用上有局限性,但也有一定参考意义。     

多普勒超声心动图评价充盈限制型左室舒张功能不全

目的 探讨应用多普勒超声检测二尖瓣及肺静脉血流频谱对评估充盈限制型左室舒张功能不全的价值。方法 应用多普勒超声技术,对10例充盈限制型左室舒张功能不全的冠心病患者和46例正常对照者的二尖瓣及肺静脉血流频谱进行检测,并与常规超声心动图检查结果作对照分析。结果 充盈限制（RF）组与对照组比较,表现为二尖瓣E峰、A峰速度比（EV／AV）＞2,肺静脉收缩期、舒张期程度比（VS／VD）＜1,肺静脉收缩分数（SF）＜0．50（P＜0．05）,左房、左室及左室重量指数（LVMI）增大（P＜0．01）,左室射血分数（LVEF）下降（P＜0．01）,左房压力增高（P＜0．01）。结论 结合常规超声心动图结果和临床症状,多普勒超声检查对充盈限制型左室舒张功能不全的诊断具有一定价值。     

超重和肥胖者多普勒超声心动图左室功能分析

目的：研究超重和肥胖人群左室收缩、舒张功能的改变。方法：用多普勒超声心动图测定左室收缩功能参数、舒张功能参数，分析超重和肥胖人对左室收缩和舒张功能的影响。结果：左室收缩功能参数，肥胖组主动脉瓣最大血流速度、流速积分、平均血流加速度、每搏量及心排血量均较正常组显著增高（P＜0．01）。超重组每搏理、心排血量、主动脉瓣最大血流速度较正常组增高（P＜0．01）。左室舒张功能参数，肥胖组等容舒张时间，舒张早期快速充盈峰速度（E峰）、舒张晚期充盈峰速度（A峰）、A／E、舒张早期减速度均显著改变（P＜0．01）。超重组等容舒张时间、A峰、A／E显著改变（P＜0．01）。超重和肥胖组左室收缩功能增强和舒张功能受损与体重指数有显著相关性（P＜0．01）。结论：起重和肥胖可导致左室收缩增强和舒张功能下降，左室增大和左室充盈障碍。     

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.