银杏叶片联合阿托伐他汀干预动脉粥样斑块形成的临床效果观察

目的研究银杏叶片联合阿托伐他汀干预动脉粥样斑块形成的临床疗效。方法选择148例高脂血症伴动脉粥样硬化患者,应用随机数表法分为对照组和观察组各74例。对照组患者口服阿托伐他汀治疗,观察组患者口服银杏叶片+阿托伐他汀联合治疗。比较治疗前后2组血脂指标及颈动脉内膜-中膜厚度改善情况以及治疗期间药物不良反应发生比例。结果2组治疗后HDL-C水平均显著高于治疗前,LDL-C、TG、TC等水平均显著低于治疗前,观察组治疗后HDL-C水平均显著高于对照组,LDL-C、TG、TC等水平均显著低于对照组(P0.05);2组治疗后颈动脉内膜-中膜厚度均显著低于治疗前,观察组治疗后颈动脉内膜-中膜厚度显著低于对照组(P0.05);2组不良反应发生率比较,差异无统计学意义(P0.05)。结论银杏叶片与阿托伐他汀联合治疗可有效调节血脂水平,预防动脉粥样斑块形成,促进动脉粥样斑块消退,改善血管功能,且安全性高。     

高压氧联合阿托伐他汀对冠心病患者颈动脉斑块及血脂的影响

目的 观察高压氧(hyperbaric oxygen,HBO)联合阿托伐他汀对冠心病合并颈动脉粥样斑块、高脂血症患者的治疗效果,并与单独应用阿托伐他汀的疗效进行比较.方法 选择2011年2月-2012年2月我院收治的104例冠心病合并高脂血症、颈动脉硬化斑块,按随机数字表法分成两组.治疗组52例接受HBO联合阿托伐他汀治疗,对照组52例单独应用阿托伐他汀治疗,观察并对比两组治疗前后血脂指标及颈动脉斑块的变化情况.结果 治疗组应用HBO联合阿托伐他汀治疗1.5个月、3个月后,52例甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及颈动脉内膜中层厚度(IMT)、斑块长径、斑块厚度较单纯应用阿托伐他汀的对照组有明显改善,差异均有统计学意义(P＜0.05).治疗组治疗3个月后血脂治疗总有效率与对照组比较,差异亦有统计学意义(P＜0.05).结论 HBO联合阿托伐他汀治疗可明显降低冠心病患者的血脂,并有效减轻动脉硬化,稳定易损斑块.     

阿托伐他汀对脑梗死患者颈动脉粥样硬化斑块稳定性的影响

探讨阿托伐他汀对脑梗死患者颈动脉粥样硬化斑块稳定性的影响。选取我院脑梗死住院患者80例,按治疗方法分为对照组和观察组各40例。对照组采用阿司匹林治疗,观察组在对照组基础上口服阿托伐他汀治疗。治疗前及治疗后6个月分别检测患者血脂和颈动脉内膜中膜厚度(IMT)。对照组治疗前后血脂TC、TG、HDL、LDL和颈动脉IMT比较,无显著变化,差异无统计学意义(P0.05)。观察组治疗后血脂TC、TG、LDL和颈动脉IMT显著低于治疗前,HDL显著高于治疗前,差异有统计学意义(P0.01)。阿托伐他汀可显著降低脑梗死患者血脂水平和颈动脉内膜中膜厚度,稳定颈动脉粥样硬化斑块,改善机体机体功能。     

阿托伐他汀联合氯吡格雷治疗对脑梗死患者超敏C反应蛋白、血脂、颈动脉粥样硬化的影响

目的探讨阿托伐他汀联合氯吡格雷对脑梗死患者超敏C反应蛋白(hs-CRP)、血脂、颈动脉粥样硬化影响。方法将123例伴有颈动脉粥样硬化的脑梗死患者按随机数字表分为氯吡格雷组(61例)和阿托伐他汀联合氯吡格雷组(62例)。观察治疗8个月后2组血清hs-CRP、血脂水平及颈动脉内膜中层厚度(IMT)、颈动脉斑块面积的变化及脑血管病复发率。结果氯吡格雷组治疗前后血脂无明显变化,阿托伐他汀联合氯吡格雷组血脂水平下降明显(P均<0.05)。2组患者治疗后8个月血清hs-CRP、IMT均显著下降,颈动脉粥样硬化斑块面积缩小(P均<0.01);阿托伐他汀联合氯吡格雷组CRP下降幅度、IMT变薄及颈动脉粥样硬化斑块面积缩小较氯吡格雷组更明显(P均<0.05)。结论阿托伐他汀联用氯吡格雷应用于脑梗死患者能更有效地降低血hs-CRP浓度,使IMT变薄及颈动脉粥样硬化斑块面积缩小,更有利于抑制炎症、稳定斑块及降低卒中发病率。     

血脂康胶囊、氨氯地平联合阿托伐他汀钙片治疗高血压病合并冠心病的临床效果

目的:探讨血脂康胶囊、氨氯地平联合阿托伐他汀钙片治疗高血压病合并冠心病患者的效果。方法:选取2018年1月～2019年1月收治的高血压病合并冠心病患者84例,采用随机数字表法均分为观察组与对照组。对照组42例采用氨氯地平、阿托伐他汀钙片等常规药物治疗,观察组42例在对照组治疗基础上采用血脂康胶囊治疗。对比两组治疗效果,治疗后血压控制水平,血脂、血清炎症因子、左室射血分数及血管内皮功能指标水平。结果:观察组总有效率明显高于对照组(P0.05);观察组治疗后血压控制水平、血清炎症因子水平、左室射血分数及内皮功能指标水平均明显优于对照组(P0.05);观察组治疗后总胆固醇水平明显低于对照组(P0.05),三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平与对照组比较,差异无统计学意义(P0.05)。结论:采用血脂康胶囊、氨氯地平联合阿托伐他汀钙片治疗高血压病合并冠心病患者可有效改善患者血脂、血清炎症因子水平,控制患者血压,提高患者左室射血分数,改善患者血管内皮功能,效果显著。     

RIPC联合阿托伐他汀治疗CAS斑块的临床疗效

目的探讨远程缺血预适应(RIPC)联合阿托伐他汀对颈动脉粥样硬化(CAS)斑块的影响。方法选取2015年7月至2016年12月于沧州市人民医院治疗的120例CAS患者随机分为两组。对照组60例,单独应用阿托伐他汀进行治疗;观察组60例,在对照组基础上再进行RIPC训练。治疗6个月后,就两组患者的血脂水平[血浆总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白-胆固醇(LDL-C)、高密度脂蛋白-胆固醇(HDL-C)]、粥样硬化斑块情况[颈动脉内-中膜厚度(IMT)、斑块面积、斑块积分]、C反应蛋白(CRP)水平以及卒中量表评分(NIHSS)与治疗前情况进行比较分析。结果 2组患者血脂水平、粥样硬化斑块情况、CRP水平均在治疗后有明显改善,差异有统计学意义(P0.05),NIHSS水平差异无统计学意义(P0.05);治疗后观察组LDL-C、IMT、CRP较对照组差异有统计学意义(P0.05)。结论 RIPC联合阿托伐他汀可明显改善CAS患者的血脂水平、粥样硬化斑块情况,比单独使用阿托伐他汀降低卒中风险的作用更显著。     

阿托伐他汀治疗老年人颈动脉粥样斑块临床观察

目的观察阿托伐他汀对颈动脉粥样斑块的治疗作用。方法将经彩色多普勒超声检查发现颈动脉粥样硬化斑块老年患者130例随机分为治疗组(70例)和对照组(60例),治疗组给予阿托伐他汀20mg/d治疗4个月,治疗前后测定粥样斑块内膜-中层厚度(IMT)和血脂、C反应蛋白、纤维蛋白原、肝肾功能、肌酸磷酸激酶。对照组同时也测定IMT和血脂、C反应蛋白、纤维蛋白原。结果70例患者经阿托伐他汀治疗4个月后,粥样斑块的IMT由1.87±0.25mm降为1.31±0.22mm,下降幅度为29.95%,与对照组比较差异有统计学意义(P<0.01)。血清低密度脂蛋白-胆固醇(LDL-C)、C反应蛋白、纤维蛋白原降低,与对照组比较差异有统计学意义(P<0.01)。结论阿托伐他汀通过降低LDL-C、拮抗炎症反应等,可以稳定、逆转颈动脉粥样斑块。     

瑞舒伐他汀治疗高血脂症合并颈动脉粥样硬化患者的临床效果

目的探讨瑞舒伐他汀对高血脂症合并颈动脉粥样硬化患者血脂水平、颈动脉内膜中层厚度(IMT)和粥样硬化斑块的影响。方法 75例高血脂症合并颈动脉粥样硬化患者随机分为研究组37例和对照组38例,分别给予瑞舒伐他汀10 mg/d和辛伐他汀20 mg/d治疗。对比2组治疗前、治疗后3和6个月时血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)变化,以及2组治疗前、治疗后6个月时颈动脉IMT和粥样硬化斑块情况。结果治疗后3和6个月,2组血清TC、TG和LDL-C较治疗前显著降低,HDL-C较治疗前显著升高(P0.05或P0.01),研究组TC和LDL-C显著低于对照组(P0.05或P0.01)。治疗后6个月,2组IMT、粥样硬化斑块积分较治疗前显著下降(P0.05或P0.01),研究组IMT下降幅度显著大于对照组(P0.05)。结论瑞舒伐他汀和辛伐他汀均能有效改善高血脂伴颈动脉粥样硬化患者血脂水平,瑞舒伐他汀逆转颈动脉IMT增厚效果更好。     

探讨血脂康胶囊联合氨氯地平阿托伐他汀钙片治疗高血压合并冠心病的临床效果

目的：探讨血脂康胶囊联合氨氯地平阿托伐他汀钙片对冠心病合并高血压患者的治疗效果。方法：选取我院2018年7月-2019年7月我院收治的84例冠心病合并高血压患者。采取随机数字表法均分为两组。对照组42例患者采取氨氯地平阿托伐他汀钙片等常规治疗。观察组42例患者在对照组基础上采用血脂康胶囊治疗。对比两组的治疗效果及治疗后血压控制水平、血脂、血清炎症因子、LVEF及血管内皮功能指标改善情况。结果：观察组总有效率明显高于对照组,对比差异有统计学意义(P＜0.05)。观察组42例患者血压控制水平、血清炎症因子水平、LVEF水平及内皮功能指标均明显优于对照组,对比差异有统计学意义(P＜0.05)。观察组42例患者TC水平明显优于对照组(P＜0.05),其余血脂指标无明显差异(P＞0.05)。结论：血脂康胶囊联合氨氯地平阿托伐他汀钙片可有效改善冠心病合并高血患者血脂水平,且对控制血压、改善内皮功能具有显著效果。值得临床推广和广泛应用。     

阿托伐他汀治疗急性脑梗死合并颈动脉粥样硬化斑块的临床观察

目的探究阿托伐他汀对急性脑梗死合并颈动脉粥样硬化斑块的疗效及预后。方法选取我院就诊的122例急性脑梗死合并颈动脉粥样硬化斑块患者。采用随机数字表法分为观察组和对照组各61例。对照组采用常规方法治疗,观察组在对照组基础上应用阿托伐他汀治疗。治疗半年后,观察两组颈动脉IMT和血脂指标的变化、并发症及治疗后神经功能缺损改善情况。对照组治疗前后血脂指标及颈动脉IMT无明显差异(P0.05)。结果治疗后,观察组TC、TG、LDL及颈动脉IMT水平均明显下降,HDL明显升高,差异有统计学意义(P0.05)。观察组并发症率为4.92%,对照组为16.39%,差异有统计学意义(P0.05)。观察组神经功能改善有效率为90.16%,高于对照组的49.18%,差异有统计学意义(P0.05)。结论阿托伐他汀治疗急性脑梗死合并颈动脉粥样硬化斑块,疗效显著,能有效降低血脂水平,且并发症较少,值得推广应用。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.