Addressing Emergency Department Issues Using Advanced Practice in Saudi Arabia

Emergency departments (EDs) struggle to manage safe, effective care in the face of increasing patient volume. The role of the nurse practitioner has been shown to improve key factors such as waiting times and the patients’ experience in the ED. This quality improvement project evaluates the effectiveness of a nurse practitioner based in the ED. One nurse practitioner managed patients presenting with minor trauma over 3 months. A pre-post intervention approach was implemented and evaluated. Over 3 months, waiting times and the number of patients who left without being seen were reduced.     

本经取穴调控无先兆偏头痛患者基因表达谱的研究

【目的】研究针刺少阳经穴与针刺非经非穴治疗无先兆偏头痛患者前后的基因表达谱。【方法】采用基因芯片技术,分析比较采用经穴（经穴组）和非经非穴（非经非穴组）治疗无先兆偏头痛患者（各10例）后基因表达谱的差异;选取部分基因进行Real-time聚合酶链反应（RT－PCR）,验证基因芯片结果的准确性。【结果】经穴组治疗前后筛选出72个差异基因;非经非穴组治疗前后筛选出110个差异基因。经穴组差异基因涉及的功能包括脑内啡肽酶、 ATP合酶等,与治疗该病的关联性大。但非经非穴组涉及的基因功能广泛且分散,与治疗该病关联性较小,如细胞凋亡、 DNA修复等。 RT－PCR检测了经穴组的ATPAF2、 PTGS2、 TOR3A基因,非经非穴组的ACP2、 AURKA、 ARHGEF11、 CASP8基因,验证了基因芯片数据的可靠性。【结论】本经取穴治疗无先兆偏头痛的经穴效应在分子水平是多基因作用的综合结果,而非经非穴产生的安慰效应并未找到与之对应的与治疗无先兆偏头痛相关的靶基因,进一步证明了经穴效应的存在。     

饥不欲食证治探析

饥不欲食以胃为主,与心、肝胆、肾有关,病机关键可分为虚实两端.实为胃失和降,胃气上逆;虚为胃阳不足,气不消谷.证治分类为阳明热郁证,厥阴肝热证,湿阻中焦证(痰湿中阻证、湿热中阻证),肝胃不和证,胃阳虚证,胆火犯胃证,心肾不交证;分别选用栀子豉汤,白虎加人参汤,麻子仁丸,乌梅丸,瓜蒂散,陈平汤,外台茯苓饮,四逆散和温胆汤等方药加减及针灸治疗.     

Valve Strain Quantitation in Normal Mitral Valves and Mitral Prolapse With Variable Degrees of Regurgitation

ObjectivesThe aim of this study was to quantitate patient-specific mitral valve (MV) strain in normal valves and in patients with mitral valve prolapse with and without significant mitral regurgitation (MR) and assess the determinants of MV strain.BackgroundFew data exist on MV deformation during systole in humans. Three-dimensional echocardiography allows for dynamic MV imaging, enabling digital modeling of MV function in health and disease.MethodsThree-dimensional transesophageal echocardiography was performed in 82 patients, 32 with normal MV and 50 with mitral valve prolapse (MVP): 12 with mild mitral regurgitation or less (MVP ? MR) and 38 with moderate MR or greater (MVP + MR). Three-dimensional MV models were generated, and the peak systolic strain of MV leaflets was computed on proprietary software.ResultsLeft ventricular ejection fraction was normal in all groups. MV annular dimensions were largest in MVP + MR (annular area: 13.8 ± 0.7 cm²) and comparable in MVP ? MR (10.6 ± 1 cm²) and normal valves (10.5 ± 0.3 cm²; analysis of variance: p < 0.001). Similarly, MV leaflet areas were largest in MVP + MR, particularly the posterior leaflet (8.7 ± 0.5 cm²); intermediate in MVP ? MR (6.5 ± 0.7 cm²); and smallest in normal valves (5.5 ± 0.2 cm²; p < 0.0001). Strain was overall highest in MVP + MR and lowest in normal valves. Patients with MVP ? MR had intermediate strain values that were higher than normal valves in the posterior leaflet (p = 0.001). On multivariable analysis, after adjustment for clinical and MV geometric parameters, leaflet thickness was the only parameter that was retained as being significantly correlated with mean MV strain (r = 0.34; p = 0.008).ConclusionsMVs that exhibit prolapse have higher strain compared to normal valves, particularly in the posterior leaflet. Although higher strain is observed with worsening MR and larger valves and annuli, mitral valve leaflet thickness—and, thus, underlying MV pathology—is the most significant independent determinant of valve deformation. Future studies are needed to assess the impact of MV strain determination on clinical outcome.     

Prevalence and vascular associations with migraine in older Australians

Background: Migraine is a common disorder with recently described vascular associations, yet there are few Australian population-based data describing migraine prevalence.
Aims: To assess the prevalence and vascular associations with lifetime past history of typical migraine headache in a representative sample of older Australians.
Methods: The Blue Mountains Eye Study examined 3654 permanent residents aged 49 or older living in two postcode areas, west of Sydney (82.4% participation) during 1992–4. A structured interview was administered, including questions about past or present history of typical migraine. The diagnosis was consistent with International Headache Society criteria.
Results: A lifetime past history of typical migraine was given by 17% of participants, including 22% of women and 10% of men, a female:male ratio of 2.3:1. A marked trend for declining lifetime migraine frequency with increasing age was found for both sexes. Modest statistically significant associations were found with vascular disease history, after multivariate adjustment, which included vascular risk factors. These associations were stronger in men than in women. Among men, typical migraine was significantly associated with history of angina, odds ratio (OR) 2.0, acute myocardial infarction (OR 1.9) and stroke (OR 2.2). Among women, statistically significant associations were present only with history of myocardial infarct (OR 1.8).
Conclusions: These data indicate similar prevalence rates for lifetime typical migraine history in a representative sample of older Australians, compared to recent US and Canadian populations. Modest, statistically significant associations between typical migraine and past history of vascular disease were found, with the strongest associations found in men.     

参脉注射液治疗老年非ST段抬高心肌梗死急性期的疗效观察

目的探讨参脉注射液对老年非趼段抬高心肌梗死（NSTEMI）急性期的疗效及作用机制。方法68例老年急性非ST段抬高心肌梗死病人随机分为两组，除常规心肌梗死治疗外，参脉组每天静脉注射30mL参脉，刺五加组每矢静脉注射刺五加400mg．疗程4周，于用药前后监测心肌酶、心电图与血液流变学等指标。结果参脉组总有效率91．2％，显著高于刺五加组（80．0％），在降低心肌酶、改善心电图及血液流变学方面的作用均优于刺五加组（P〈0．01）。结论参脉注射液对老年非ST段抬高心肌梗死急性期的治疗效果好，副反应少，临床疗效显著。     

神经调节蛋白/表皮生长因子受体通路在偏头痛大鼠模型中的作用

目的 探讨神经调节蛋白(neuregulin,NRG)/表皮生长因子受体(epidermal growth factor receptor,ErbB)通路在偏头痛大鼠模型中的作用。方法 将Wistar大鼠随机分为对照组、模型组、空载(空慢病毒载体)组、NRG沉默(含NRG基因干扰片段的慢病毒载体)组、NRG1(0.01 mg/kg)组,每组各12只; 除对照组外,其余各组制备偏头痛大鼠模型,观察大鼠行为学表现,记录一段时间内大鼠挠头次数、爬笼次数; 测定各组大鼠机械性刺激及温度痛阈; 用酶联免疫吸附实验(Enzyme linked immunosorbent assay,ELISA)检测各组大鼠血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α),白介素-6(Interleukin-6,IL-6)水平; 免疫印迹实验检测各组大鼠脑组织NRG/ErbB通路相关蛋白表达水平。结果 与对照组比较,模型组、空载组大鼠挠头次数、爬笼次数、血清TNF-α及IL-6水平明显增高,机械性刺激痛阈值、热刺激潜伏期、脑组织NRG/ErbB通路相关蛋白NRG表达水平及ErbB/磷酸化表皮生长因子受体(phospho-epidermal growth factor receptor,p-ErbB)明显降低(P<0.05)。与模型组比较,空载组大鼠各指标水平无明显变化(P>0.05); NRG沉默组大鼠挠头次数、爬笼次数、血清TNF-α及IL-6水平增高,机械性刺激痛阈值、热刺激潜伏期、脑组织NRG/ErbB通路相关蛋白NRG表达水平及ErbB/p-ErbB降低(P<0.05); NRG1组大鼠挠头次数、爬笼次数、血清TNF-α及IL-6水平降低,机械性刺激痛阈值、热刺激潜伏期、脑组织NRG/ErbB通路相关蛋白ErbB/p-ErbB增高(P<0.05),NRG表达水平无明显变化(P>0.05)。结论 NRG/ErbB通路可调控大鼠偏头痛,上调该通路可减轻其头痛。