改良肺部超声评分与肺纤维化兔血清涎液化糖链抗原-6和基质金属蛋白酶-7水平的相关性

目的 探讨改良肺部超声评分与肺纤维化兔血清涎液化糖链抗原-6(KL-6)和基质金属蛋白酶-7(MMP7)水平的相关性.方法 将33只新西兰雄兔随机分为实验组(18只)和对照组(15只),其中实验组经气管灌注盐酸博来霉素建立兔肺纤维化模型,对照组灌注等量生理盐水,造模后分别于第14、21天随机抽取实验组和对照组各5只兔进行肺部超声检查及测定血清KL-6和MMP7水平,然后处死行病理学检查.余兔(实验组8只和对照组5只)在第21天按照上述方法再次灌注后于第42天行上述检查.分析改良肺部超声评分与肺纤维化兔血清KL-6和MMP7水平的相关性.结果 与对照组比较,实验组第14、21及42天改良肺部超声评分明显增加,两两比较差异均有统计学意义(均P<0.05);与对照组比较,实验组血清KL-6、MMP7水平明显升高(均P<0.05),其中第21、42天血清KL-6、MMP7水平与第14天比较差异均有统计学意义(均P<0.05),第42天血清MMP7水平与第14、21天比较差异均有统计学意义(均P<0.05).改良肺部超声评分与肺纤维化兔血清KL-6、MMP7水平均呈正相关(r=0.844、0.751,均P<0.05).结论 改良肺部超声评分与肺纤维化兔血清KL-6、MMP7水平均呈正相关.     

肺部超声B线征与肺水肿病理的相关性研究

目的探讨肺部超声B线征与肺水肿病理严重程度的相关性。方法20只新西兰兔随机分为对照组5只和实验组15只,实验组经耳缘静脉注射油酸0.12ml/kg,制备肺水肿模型后打开胸腔根据肉眼观察将肺组织分为无病变区、轻度病变区、中度病变区和重度病变区,并于相应区域行直视下肺部超声检查,再分别留取相应的肺组织行病理组织学检查,分析肉眼观病变严重程度、B线数量与肺病理严重程度的相关性。结果随着肉眼观病变严重程度增加,直视下肺部超声B线评分增加(P<0.05),肺病理组织学评分增加(P<0.05);直视下肺部超声B线评分与肉眼观不同病变程度、病理组织学评分相关性高(r值分别为0.893、0.897,P<0.001),肉眼观不同病变程度与病理组织学评分相关性较高(r=0.735,P<0.001)。结论肺部超声B线征可反映肺水肿病理组织学严重程度,可用于半定量评估肺水肿。     

肺部超声评分联合血CRP、LDH水平对肺炎支原体肺炎患儿病变程度评估的临床意义

目的探讨肺部超声(LUS)评分联合血C反应蛋白(CRP)、乳酸脱氢酶(LDH)水平对肺炎支原体肺炎(MMP)病变程度的评估价值。方法选取82例MMP患儿作为研究对象,根据病变程度分为难治性(28例)与普通性(54例),入院3 d内行肺部超声检查并评分,统计对比两组LUS评分、CRP、LDH水平,分析难治性MMP病变程度影响因素,并绘制ROC曲线分析LUS评分、CRP、LDH水平对MMP病变程度的评估价值。结果 MMP患儿左右侧LUS评分相比,无明显差异(P0.05),后侧LUS评分高于前侧,下部LUS评分高于上部,差异有统计学意义(P0.05);Logistic回归方程进行分析,发现LUS评分、CRP、LDH水平均为难治性MMP患儿病变程度影响因素(P0.05);ROC曲线显示,三者联合评估AUC值最大,为0.907,最佳灵敏度、特异度分别为82.14%、90.74%。结论难治性MMP患儿LUS评分及CRP、LDH水平较高,临床可监测上述指标,评估MMP病变程度,为临床治疗方案制定提供依据。     

IPF患者血清MDA、PCⅢ、LN检测的临床意义

目的 探讨特发性肺间质纤维化(IPF)患者疾病过程中血清MDA、PCⅢ、LN变化的临床意义以及其与IPF疾病严重程度(CRP评分)的关系.方法 将106例IPF患者进行CRP评分,根据评分结果将患者分为高分组、中分组及低分组,采用硫巴比妥酸反应底物法(TBARs)测定IPF患者MDA含量,采用放射免疫分析法检测血清PCⅢ、LN含量；选择35例体检的健康人作为对照.结果 IPF患者患者血清MDA、PCⅢ、LN显著高于对照组(P＜0.01),且随着病情加重上述指标有升高趋势.结论 检测血清血清MDA、PCⅢ、LN对IPF患者肺纤维化的动态观察和早期诊断具有重要意义.     

肺超声在分析早产儿早期肺部疾病状态中的应用价值

目的 探讨肺超声(Lung ultrasound, LUS)在分析早产儿出生早期肺部疾病状态中的应用价值。方法 收集我院2018年5月-2019年4月行肺超声检查符合入组条件的低体重早产儿59 例。按照指南推荐,将肺部分为12区,于患儿出生72小时内,应用超声高频探头对早产儿肺部各区进行逐一扫查并进行超声肺部通气评分,以观察患儿肺部超声表现特点,评估患儿肺部疾病状态,并判断评估超声改变与出生胎龄、体重的相关关系。结果 1.不同区域超声肺部通气评分比较：左、右肺部和上、下肺部评分差异无统计学意义（p＞0.05）;后肺部超声肺部通气评分较前肺部增高,差异具有统计学意义（p＜0.05）。2.超声肺部通气评分与出生胎龄及体重关联性分析：超声肺部通气评分总分与出生胎龄具有显著相关关系（r=-0.62,p＜0.01）,与出生体重具有相关性（r=-0.33,p=0.011）。结论 肺超声可早期快速准确地评估低体重早产儿肺部疾病状态,指导临床早期干预治疗。出生胎龄及体重是预示早产儿肺部疾病严重程度的重要因素。     

特发性肺纤维化急性加重的护理研究现状

特发性肺纤维化（idiopathic pulmonary fibrosis,IPF）是一种病因不明、发病机制不清、缺乏治疗手段的以普通型间质性肺炎（UIP）为特征性病理改变的一种慢性间质性肺疾病[1].诊断后中位生存期＜3年[1].IPF多数缓慢进展[2],但相当比例的患者可在相对稳定期间突然出现不可预测的急性加重,导致患者的呼吸衰竭甚至死亡[3-4].IPF急性加重的发生难以预测,病死率高[4-6],住院期间的病死率高达86％[6].而且发生率逐步递增[7],已越来越受到国内外研究者的关注.为进一步提高对IPF急性加重的认识,提高IPF的抢救成功率,本文将IPF急性加重护理研究现状进行总结,现报道如下.     

新型冠状病毒肺炎经胸超声和CT评估相关性的研究

目的探讨经胸肺部超声及其优化方案评估新型冠状病毒肺炎(COVID-19)的可行性,并与CT评估相比较。方法采用改良的BLUE检查方案和BUDA肺间质性疾病的评估方案,对确诊的14例COVID-19患者(普通型5例,重症型5例,危重型4例)进行评估,分析其与CT Warrick评估方案测值在不同病情程度COVID-19的差异,并评价两种测量方法的相关性。结果 (1)COVID-19超声表现的主要特征:①胸膜线受累100%;②肺部表现为部分融合或完全融合B线(白肺)(100%),严重者出现肺部或胸膜下小实变(C线征)(5/14);③较少出现胸腔积液(2/14)和肺部气囊肿(1/14)。(2)随着COVID-19严重程度的增加,经胸肺部超声和HRCT的评分值明显增加。在经胸肺部超声方面,普通组与重症组或危重组均有明显差异(P均0.05),而重症组与危重组之间没有差异。(3)经胸肺部超声与HRCT评分值有中度正相关(r=0.55,P0.05)。结论 COVID-19肺部声像图有一定的特征,经胸肺部超声优化BLUE方案和Bude方案可用于COVID-19评估。超声鉴别普通组和重症组或危重组比HRCT更有优势,而HRCT鉴别重症组与危重组更好。     

核心蛋白聚糖在特发性肺纤维化患者血清中的表达及其意义

【目的】探讨核心蛋白聚糖(DCN)在特发性肺纤维化(IPF)患者血清中的表达及其意义。【方法】选取2016年3月至2018年3月在陕西省第四人民医院诊治的87例IPF患者(IPF组)、82例特发性间质性肺炎(idiopathic interstitial pneumonia,IIP)患者(非IPF组)和100例健康体检者(对照组)作为研究对象。采用ELISA法检测三组受试者血清DCN水平。分析IPF患者血清DCN水平与病情及预后的关系。【结果】IPF组血清DCN水平显著低于非IPF组和对照组(均P<0.05);IPF患者血清DCN水平与高分辨率CT(HRCT)评分呈负相关(r=-0.524,P<0.001)。IPF急性加重(AE-IPF)患者血清DCN水平低于IPF疾病稳定(SD-IPF)患者,其差异有统计学意义(t=7.806,P<0.001)。87例IPF患者,随访1~12个月,18例(20.68%)死亡。DCN高水平组(DCN≥7.51 mg/L)平均生存时间长于DCN低水平组(DCN<7.51 mg/L),其差异有统计学意义(χ²=11.423,P<0.001)。Cox单因素及多因素分析结果显示:HRCT评分、DCN水平与IPF患者预后密切相关。【结论】血清DCN水平能反映IPF患者疾病严重程度,且与IPF患者预后密切相关。     

重型颅脑损伤继发肺部感染患者血清胆碱酯酶和肿瘤坏死因子α水平的临床意义

目的探讨重型颅脑损伤继发肺部感染患者血清胆碱酯酶(ChE)、肿瘤坏死因子α(TNF-α)水平的临床意义。方法选取2012年3月至2019年4月武警北京市总队医院收治的重型颅脑损伤继发肺部感染患者80例作为疾病组,选取同期体检健康人80例作为健康组,检测两组血清ChE、TNF-α水平;根据临床肺部感染评分(CPIS)将疾病组分为两个亚组:轻度组(CPIS≤6分),重度组(CPIS>6分),比较两组患者血清ChE、TNF-α水平,分析两者与重型颅脑损伤继发肺部感染严重程度的相关性及诊断价值。结果疾病组血清ChE、TNF-α水平与健康组比较,差异有统计学意义(P<0.05)。重度组血清ChE水平低于轻度组,TNF-α水平和临床肺部感染评分(CPIS)高于轻度组。经Spearman相关分析,疾病组患者血清ChE水平与CPIS评分呈负相关(r=-0.438,P<0.001);TNF-α水平与CPIS评分呈正相关(r=0.216,P=0.028)。ROC曲线分析显示,血清ChE、TNF-α联合诊断重度颅脑损伤并发肺部感染严重程度的曲线下面积(AUC)为0.893高于单一指标。结论重型颅脑损伤继发肺部感染患者血清ChE、TNF-α水平异常变化;随着感染加重ChE水平有所降低,TNF-α水平升高,两者联合可帮助评估患者感染的严重程度。     

COVID-19患者肺超声与CT影像相关性研究

目的 探讨新型冠状病毒肺炎患者肺超声与CT影像相关性，肺超声对COVID-19患者肺部病变评估的作用。 方法 超声医师采用单侧六分区法对25例COVID-19患者进行床旁肺超声顺序盲扫，观察每个肺区胸膜线厚度、形态、完整性，胸膜滑动征，A线，B线的分布、数目、融合范围，肺实变位置、内部回声、范围，是否有胸腔积液等伴随征象。行半定量评分，与同期胸部CT影像对照，应用SPSS24. 0统计学软件分析右肺、左肺、全肺超声评分与CT病灶体积占比相关性。比较普通型、（危）重型患者全肺超声评分、CT病灶体积占比。 结果 全肺总评分最低为0分（1例），最高为22（1例）。患者右肺、左肺超声评分比较差异有统计学意义（P<0.05），R1-R6、L1-L6区评分比较差异有统计学意义（均P<0.05）。右肺、左肺、全肺超声评分与CT病灶体积占比相关系数分别为0.942、0.956、0.922（均P<0.01）。全肺超声评分普通型[5（4.25）]与（危）重型[14（9.5）]比较；全肺CT病灶体积占比普通型[4.3（6.85）%]与（危）重型[22.4（20.25）%]比较，差异均有统计学意义（均P<0.01）。COVID-19患者肺超声评分与CT病灶体积占比具有显著相关性。 结论 以CT为参照，床旁肺超声对COVID-19患者肺部病变的无创性评估具有重要意义。     

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.