两种直接法测定HDL—C试剂盒的可靠性评价

目的：基于选择性抑制和化学修饰原理的两种高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）直接测定法的精密度、准确度和特异性加以评价。方法：将这两种方法和磷钨酸－镁沉淀法（ＰＴＡ法）作了比较，并分析其准确度、线性范围及干扰因素。精密度评价按照ＮＣＣＬＳ的ＥＰ５－Ｔ文件进行。并以超速离心分离的纯ＬＤＬ和ＨＤＬ组分验证ＨＤＬ－Ｃ测定的特异性及准确性。结果：实验结果表明两种直接法测定ＨＤＬ－Ｃ均有良好的精密度。总ＣＶ值选     

血浆高密度脂蛋白的研究进展

血浆高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）与冠心病（ＣＨＤ）的发生风险呈负相关，因而ＨＤＬ－Ｃ是临床上对ＣＨＤ发生的风险预测、选择药物治疗及预后等方面十分有意义的指标。本文就近几年ＨＤＬ的功能、ＨＤＬ与ＣＨＤ的关系、ＨＤＬ－Ｃ测定等方面的研究进展作一综述。     

尿毒症脂质代谢紊乱发生机制的进一步研究

采用口服葡萄糖耐量试验方法（ＯＧＴＴ），检测５０例尿毒症患者胰岛素糖代谢调节作用活性，分析胰岛素拮抗与尿毒症脂质代谢紊乱的关系。结果显示：（１）本组尿毒症者存在明显的脂质代谢紊乱，表现为血浆甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）水平增高，高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）水平低下，ＬＤＬ－Ｃ／ＨＤＬ－Ｃ比值增高；（２）胰岛素拮抗组较非胰岛素拮抗组其ＬＤＬ－Ｃ水平和ＬＤＬ－Ｃ／ＨＤＬ－Ｃ比     

对国产高密度脂蛋白胆固醇直接法测定试剂的评价

评价国产慈城生化试剂厂生产的ＨＤＬ－Ｃ直接测定法试剂在临床应用的可行性。将慈城直接测定法试剂与葡聚糖（ＤＳ５０）－氯化镁沉淀法和磷钨酸（ＰＴＡ）－氯化镁沉淀法进行比较，并分析其特异性、线性范围、准确度和干扰因素。慈城试剂与ＤＳ５０沉淀法相关良好，ｒ＝０．９７１７、Ｙ＝１．０５９Ｘ－０．０５７，ｇｎ ＰＴＡｉｆ ｘｘｌｕ，ｒ＝０．９８５１、－１．０８８Ｘ－０．０９。在ＨＤＬ－Ｃ浓度为３．３４ｍｍｏｌ     

冠心病患者血浆氧化修饰低密度脂蛋白含量的观察

为观察冠心病（ＣＨＤ）患者血浆氧化修饰低密度脂蛋白（ＯＸ－ＬＤＬ）的含量在动脉粥样硬化（ＡＳ）的发生发展中所起的作用，采用酶联免疫吸附试验（ＥＬＩＳＡ）测定血浆ＯＸ－ＬＤＬ水平，结果显示，ＣＨＤ患者血浆ＯＸ－ＬＤＬ水平明显高于对照组，其中不稳定性心绞痛患者高于病情稳定者。提示ＯＸ－ＬＤＬ与ＡＳ的发生发展有密切联系，动态监测其变化对ＣＨＤ的辅助诊断具有一定的价值，同时也为ＣＨＤ的抗氧化治疗提供了依据。     

血清HDL—C测定对肝病诊断价值的临床观察

对４７例各型肝病患者血清ＨＤＬ－Ｃ，ＡＬＴ和Ａｌｎ进行测定，并对其测定结果的各项临床诊断评价指标：阳性预告值，阴性预告值，灵敏度，特异性和准确度进行比较分析。结果显示，４７例各型肝病患者血清ＨＤＬ－Ｃ值都降低，与健康对照组比较较差异有显著性，且其降低程度与肝脏功能损伤程度相一致。     

大运动量负荷对青少年运动员血清HDL－C水平的影响

大运动量负荷对青少年运动员血清ＨＤＬ－Ｃ水平的影响湖南医科大学王学铭，柳兴其，黄丽兰湖南省体育科学研究所王武韶，李协群血清高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）是预防动脉硬化的良性因素，其水平与冠心病（ＣＨＤ）患病率呈负相关，运动能提升血清ＨＤＬ－Ｃ水平，...     

高密度脂蛋白胆固醇直接测定法与硫酸葡聚糖50-镁法比较

目的评价高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）直接测定法在临床应用的可行性。方法将直接测定法与硫酸葡聚糖（ＤＳ５０）－氯化镁沉淀法进行比较，并分析其线性范围、准确度和干扰因素。结果直接法与ＤＳ５０沉淀法相关良好，Ｙ＝０．９２７Ｘ＋０．２１４，ｒ＝０．９６４，ＨＤＬ－Ｃ浓度为２．４５ｍｍｏｌ／Ｌ范围内线性良好，ｒ＝０．９９９，ＨＤＬ－Ｃ浓度两组低、中、高值血清标本（０．８４、１．３１、２．３１；０．９２、１．４２、２．５３ｍｍｏｌ／Ｌ）的批内和批间ＣＶ值分别为２．３８％、１．１５％、２．４７％和３．４８％、０．９９％、２．０６％。浓度为１０．５８ｍｍｏｌ／Ｌ甘油三酯并不影响ＨＤＬ－Ｃ直接测定法。结论ＨＤＬ－Ｃ直接测定法简易快速，结果准确，适于自动化分析。     

高密度脂蛋白胆固醇直接测定法与硫酸葡聚糖50—镁法比较

目的 评价高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）直接测定法在临床应用的可行性，方法 将直接测定法与硫酸葡聚糖（ＤＳ５０）－氯化镁沉淀法进行比较，并分析其线性范围，准确度和干扰因素。结果 直接法与ＤＳ５０沉淀法相关良好，Ｙ＝０．９２７Ｘ＋０．２１４，ｒ＝０．９６４，ＨＤｌ－Ｃ浓度为２．４５ｍｍｏｌ／Ｌ范围内线性良好，ｒ＝０．９９９，ＨＤＬ－Ｃ浓度两组低，中，高值血清标本（０．８４，１．３１，２．３１；０．     

高密度脂蛋白胆固醇PEG—修饰酶直接测定法与DS—镁法和PTA—Mg^＋＋的实 …

评价高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）ＰＥＧ－修饰酶直接测定法在临床应用的可行性。方法：将ＰＥＧ－修饰酶直接测定法与硫酸葡萄聚经镁沉淀法进行比较，分析线线性范围，准确度和干扰因素。结果：ＰＥＧ－修饰酶法与硫酸葡聚糖－氯化镁法相关性良好。Ｙ＝１．１２ｘ－０．０８，ｒ＝０．９７４，ＨＤＬ－Ｃ浓度为２．５５ｍｍｏｌ／Ｌ范围内线性良好，ｒ＝０．９９８；ＨＤＬ－Ｃ浓度在两组低，中、高血清标本０．８５、１．４５     

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.     

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.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.