State of the art contemporary treatment of patients with ST elevationmyocardial infarction： pre- and in-hospital organization,devices anddrugs

Objective To review the presentation, diagnosis and recent developments in the pharmacological and invasive treatmentof ST elevation myocardial infarction （STEMI） with a special focus on health-care organization in order to increaseaccessibility of primary percutaneous coronary intervention （PCI）.     

Exploration of Stratified Evidence Scoring Method of Acupuncture Clinical Practice Guidelines

Due to its own internal laws of development,Chinese medicine(CM)seems more inclined to empirical medicine in a relatively long historical period.It is considered to be lacking objective and unified clinical practice guidelines(CPGs),and the difficulties in diagnosis and therapeutic effect evaluation comes with it,have restricted its further inheritance,development and international communication.Over the years,our research group has been committed to improving the standardization theory and methodology of CM,also perfecting relative techniques for further application,which are all based on the stratified evidence scoring method.We have already applied this method to 45 issued guidelines,including 5 national guidelines,3 industrial guidelines,and 37 formulation/revision social organization guidelines.The stratified evidence scoring method has been recognized and used widely.It helps scholars and applicators to study,formulate,publish and popularize the acupuncture therapy clinical practice guidelines better,thus further promotes the development of acupuncture therapy.     

John Murtagh全科病案研究(五)——7岁男孩24小时内疲乏嗜睡发热呕吐皮疹

1病例简介患儿,男,7岁,突发高热,精神萎靡,嗜睡。发病12h后厌食,呕吐3次后就诊。患儿自诉头痛,在胸部和背部发现细小皮疹。体检结果提示,患儿明显地表现为麻木状态,面色潮红,病态显著。躯干上发现一些细小的斑点状皮疹。四肢末端温度较低,而且毛细血管回流低于正常。生命体征为     

感冒的病因与诊治

由上海强生制药有限公司与<中国社区医师>杂志社联合开展的"强生泰诺杯--社区爱心天使大奖赛"已启动,请根据相关文章将第3期、7期、11期、15期的参赛答题卡连续4次正确填写并按要求回寄给我们,您可获国家一类学分4分并有资格参加"强生泰诺怀-社区爱心天使大奖赛".     

震后皮肤病预防与治疗

传染性软疣 由传染性软疣病毒引起,一般可通过直接接触传染,也可自体接种,儿童常见.皮损为有圆形或半圆形丘疹,呈肉色或粉红色,有蜡样光泽,中心呈脐凹状,含有干酪样物,数目较多,多发于前胸后背,可挤压出.治疗可用小镊子夹住疣体,将之挤出或挑出干酪样物,外涂2%碘酒.     

《安徽医学》版权声明

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劳务女工孕期血铅水平与血压相关性研究

目的 探讨劳务女工孕期血铅水平与其血压的关系,为改善围生期工作,促进孕妇健康提供参考.方法 对2008年3月至2009年11月在深圳市宝安区妇幼保健院产前门诊建卡的劳务女工孕妇进行问卷调查、血压及血微量元素浓度测定.随机选取其中897例资料完整并在深圳居住满2年者作为研究对象,采用简相关和回归方法评价血铅与血压的关系.结果 孕妇血铅均值为(45±23)μg/L;家族史、体质量指数(BMI)、血铅浓度对血压升高有预测作用;在血铅56 μg/L分界点时,两组舒张压比较差异有统计学意义(P＜0.05);高铅组(血铅浓度≥100 μg/L)收缩压、舒张压均显著高于低铅组(P＜0.05).结论 低铅暴露是致孕妇血压升高的危险因素之一,铅对血压的影响以舒张压更为敏感. Abstract： Objective To observe the degree of blood lead in pregant women and the influence of different levels of blood lead on blood pressure under environmental lead exposure, in order to previde basic evidences for taking the further measures. Methods A quesionnaire survey was administed, blood pressure and the serum of microelements were tested for the pregnant women who took the prenatal examinationin the Maternal and Child Care Service Centre of Baoan between March 2008 and November 2009, gathered 897 pregnant women whose materials were complete and stayed in Shenzhen more than one year as the study objects. Compare the differences between groups distributed by quartileand carried out the pair matching study. Correlation, stepwise regression analysis and T test were usedto statistic. Results The average of blood lead was (45±23)μg/L;The Bivriate correlations showed the association between blood lead and blood pressure was positive. Stepwise regression analysis indicated family history, BMI,blood lead were predictors of increasing blood pressure. After excluding the confounding factors, on the 56 μg/L the diastolic pressure(DBP) with statistical significance (P＜0.05);Blood pressure of case group was higher than that of control group with significant difference (P＜0.05). Blood calcium of case group was lower than that of control group without statistical significance (P＞0.05). Conclusions The results indicate the degree of blood lead of pregnant women in Shenzhen is low. Environmental lead exposure is one of the dangerous factors of increasing blood pressure .DBP is more sensitive to lead.     

儿童可否练瑜伽

虽然,瑜伽有悠久历史,但正式从国外传入中国却只有40年左右的时间。瑜伽是一种健康时尚的纤体塑身运动,形式比较多,目前在全国各地流行的有高温瑜伽、力量瑜伽、芭蕾瑜伽、印度瑜伽、恋爱瑜伽、     

国殇与国威

2008年5月12日,国际护士节。母亲节的后一天。这一天,天津多云,东南风4～5级。14时28分,四川汶川发生了8.0级的特大地震,连2000公里外的天津、北京都有明显的震感。一时,汶川、北川、平武、茂县一个个我们本     

认识老年痴呆症

老年痴呆症,又称阿尔茨海默病,其患病率呈逐年上升的趋势。据中国阿尔茨海默病协会公布,我国该病患者已超过500万,占世界总病例的1/4以上。一项对北京、上海、西安、成都、重庆、沈阳六城市部分区县的调查显示,被调查的43000名老人中,老年性痴呆患病率为2.9%,65岁以上患病率为5.22%,且每年新增病例30万人以上,已成为威胁老年人健康继心脑血管病、肿瘤之后的第三位疾病。     

高原地区急性胰腺炎526例诊治体会

目的 :探讨高原地区急性胰腺炎的临床诊疗特点。方法 :对青海省人民医院收治的 5 2 6例急性胰腺炎的诊断、治疗情况进行了回顾性分析。结果 :5 2 6例患者中 ,男 3 1 0例 (5 8.9% ) ,女 2 1 6例 (4 1 .1 % ) ;平均年龄46.93岁。其中急性重症胰腺炎 44例 (8.4% )。共施行手术 40例 ,其中死亡 5例。死亡的 5例患者的待手术时间都在 2周之内。结论 :高原地区急性胰腺炎发病率男性高于女性 ;对于诊断明确的胆源性胰腺炎应该积极开展手术治疗 ,对于其他类型的急性胰腺炎应该在积极地支持治疗的基础上根据个体化原则选择手术时机和手术方式 ,尽量避免在发病的早期手术 ,同时尽量避免采用胰腺切除的手术方式。     

平均血小板体积在急性胆源性和非胆源性胰腺炎中的临床应用

目的 分析平均血小板体积(MPV)在胆源性与非胆源性急性胰腺炎之间的关系,探讨MPV能否作鉴别急性胰腺炎病因的参考指标.方法 检测55例胆源性胰腺炎与57例非胆源性胰腺炎患者的血清生化指标和全血的MPV值,比较两种类型胰腺炎各指标间的相关性.结果 谷氨酸丙酮酸转氨酶、天门冬氨酸氨基转移酶、碱性磷酸酶、谷氨酰转肽酶、淀粉酶、脂肪酶等酶类以及总胆红素和直接胆红素在胆源性与非胆源性急性胰腺炎之间差异有统计学意义(P＜0.05),且浓度水平在胆源性胰腺炎组中较非胆源性胰腺炎组中高.胆源性胰腺炎组和非胆源性胰腺炎组在血小板和MPV之间的差异有统计学意义(P＜0.05).MPV在胆源性胰腺炎组中较非胆源性胰腺炎组中高.受试者工作特征曲线显示,在鉴别胆源性胰腺炎组和非胆源性胰腺炎组的MPV曲线下面积为0.746;当MPV的cut-off值为8.33时,判断胆源性胰腺炎组的敏感性和特异性分别为78.6％和62.3％.结论 部分酶类指标的差异显示胆源性胰腺炎比非胆源性胰腺炎对相关器官组织的损伤较重,病情更加复杂;胆源性胰腺炎组的MPV值较非胆源性胰腺炎组高,提示MPV可以作为鉴别急性胰腺炎病因的一种简便实用的参考指标.     

急性胰腺炎MRI诊断

目的 探讨MRI在急性胰腺炎中的诊断价值。方法 选择经临床确诊的急性胰腺炎20例。男14例，女6例，平均年龄41.4岁。20例中轻度型15例，重度型5例，使用1.5T超导MRI扫描仪，SE序列常规T1WI和T2WI横断和冠状面成像；MRCP使用2D、HASTE加脂肪抑。结果 MRI主要显示胰腺信号不均匀或假囊肿形成；MRCP主要显示胰胆管扩张、狭窄或宽窄不一，严重的胰胆近呈囊肿扩张。结论 MRI尤其T2WI能清楚显示胰腺胆管的狭窄、扩张及腔内缺损等表现，一般能作出急性胰腺炎、轻重程度及病因的诊断。     

高脂血症性胰腺炎与急性胆源性胰腺炎的特征比较

目的：：比较高脂血症性胰腺炎( HLAP)和急性胆源性胰腺炎( ABP)的临床特点,提高对HLAP的诊疗水平。方法：依据病因将88例胰腺炎患者分为HLAP组(28例)和ABP组(60例),比较2组患者一般临床资料、主要生化指标、影像学资料、伴随疾病、病死率、复发率等方面资料。结果：HLAP合并脂肪肝、糖尿病和APACHEⅡ评分、重症胰腺炎均高于ABP( P<0.05~P<0.01),而病死率、HLAP患者总胆固醇、TG、血糖、C反应蛋白均高于ABP组,而淀粉酶、丙氨酸氨基转移酶和胆红素均低于ABP组(P<0.01)。2组患者入院后48 h病死率、Ranson评分、胰腺假性囊肿形成如胸腔积液和复发率差异均无统计学意义(P>0.05)。而APACHEⅡ评分和重症胰腺炎发生率均高于ABP组(P<0.05)。结论：HLAP临床特点独特,其临床表现不典型,合并基础疾病多,易复发,除常规治疗外,尽快降低血脂水平是治疗关键。     

胰腺腺泡细胞钙超负荷在诱发大鼠由水肿性向坏死性胰腺炎转变中 …

OBJECTIVE: To investigate the potential of pancreatic acinar cell calcium overload in the conversion of acute edematous pancreatitis (AEP) to necrotizing pancreatitis (ANP). METHODS: Ninety-six Sprague-Dawley rats were randomized in three experimental groups. Sham-operated control (Group I) AEP (Group II) was induced by pancreatic duct ligation and intravenous injection of bombesin (100 micrograms/kg) and secretin (10 micrograms/kg). ANP (Group III) was induced same as group II but with a large dose of dextran 110,000(500 mg/kg) intravenously. Pancreatic acinar cell Ca2+ overload was studied using fluorescent probe Fura2. Cytosolic free Ca2+ concentration ([Ca2+]i) in isolated pancreatic acinar cells and Ca(2+)-ATPase activity in pancreatic cell plasma membranes were determined 1, 3, 6, 9 h respectively after treatment. RESULTS: The results showed that pancreatic acinar cell [Ca2+]i was elevated at 1 h[(213 +/- 19) nmol/L, P < 0.05] and increased to (464 +/- 29) nmol/L at 6 h(P < 0.05) in rats with ANP, pancreatic cell plasma membrane Ca(2+)-ATPase activity decreased significantly from (29.8 +/- 0.4) nmol.min-1.mgp-1 at 1 h to (18.6 +/- 0.5) nmol.min-1.mgp-1 at 9 h in rats with ANP (P < 0.05). CONCLUSIONS: In ischemia-induced conversion of AEP to ANP, there exists Ca2+ overload in the pancreatic acinar cells. The decreased pancreatic cell plasma membrane Ca(2+)-ATPase activity may be an important reason for acinar cell Ca2+ overload in the development of acute pancreatitis.     

Accuracy in diagnosis of acute pancreatitis

During an eight-year period, 113 cases of acute pancreatitis were studied to determine the accuracy and modes of diagnosis in the first attack. In 65% of cases, a confident diagnosis was made on a combination of the clinical picture and a marked elevation of the serum amylase level. Diagnosis on laparotomy was made in 30% of cases, and autopsy diagnosis in the remaining 5%. Cullen's and Grey Turner's signs, radiology test results, and the presence of hyperglycaemia were of little or no diagnostic value. Recently developed laboratory tests may increase the diagnostic yield in the future. The precise indications for laparotomy diagnosis in the first attack are discussed. Laparotomy for diagnosis did not increase the mortality rate in this series.     

乌司他丁综合治疗急性胰腺炎的临床观察

目的：观察乌司他丁治疗急性胰腺炎的临床效果．方法：急性胰腺炎患者60例随机分为实验组和常规组，治疗前和治疗后7d分别查患者血清IL-6，TNF-α，C反应蛋白CRP，脂肪酶LIS和AMS．结果：实验组和常规组总有效率依次为94．4％，79．2％，实验组全身炎症反应情况改善时间缩短，与常规组相比，差异具有统计学意义（P〈0．05）．经治疗7d后，实验组和常规组两组IL-6，TNF-α，CRP，AMY，LIP水平均下降，与治疗前相比差异均具统计学意义（P〈0．05），与常规组治疗后相比，实验组下降更快，差异亦具有统计学意义（P〈0．05）．结论：乌司他丁治疗急性胰腺炎疗效肯定，可改善患者全身炎症反应．     

Gallstone pancreatitis

Gallstone pancreatitis is a disease of high mortality (11%) and significant morbidity (42%). An analysis of 66 patients with this disease revealed the importance of an early aetiological diagnosis; 66% of our patients had evidence of previous biliary disease. Most patients were elderly and the severity of their disease could be predicted using Ranson's predictive indices. Surgery was immediate (within 48 hours) in 11 (17%) patients, early (two-14 days) in 16 (24%) and delayed in 27 (41%) patients. Some patients refused surgery. Our study suggests that very ill patients require immediate surgery--often cholecystostomy alone--and that although in the majority symptoms should settle on conservative treatment, definitive surgery should be carried out at the time of the initial admission. Further delay increases morbidity, mortality and expense.