超极速脉搏波传导速度技术定量评估临界性高血压成年人颈动脉变化

目的 观察超极速脉搏波传导速度（ufPWV）技术定量评估临界性高血压成年人颈动脉形态及弹性变化的价值。方法 纳入330名接受颈动脉超声检查的成年人,根据血压分为正常组（n=159）、临界组（n=43）及高血压组（n=128）。正常组收缩压（SBP）<130 mmHg且舒张压（DBP）<80 mmHg;临界组130 mmHg ≤ SBP<140 mmHg和/或80 mmHg ≤ DBP<90 mmHg;高血压组SBP ≥ 140 mmHg或DBP ≥ 90 mmHg或正在服用降压药者。测量并比较组间颈动脉内-中膜厚度（cIMT）、收缩起始脉搏波传导速度（PWV-BS）及收缩末期脉搏波传导速度（PWV-ES）,并以cIMT=0.05 cm为临界值进行亚组分析。采用Pearson相关性分析评价各参数与年龄的相关性。结果 3组间cIMT、cIMT ≥ 0.05 cm者占比、PWV-BS及PWV-ES差异均有统计学意义（P均<0.05）;随血压水平升高,cIMT、cIMT ≥ 0.05 cm比例及PWV-ES均升高（P均<0.05）,但仅正常组与临界组间PWV-BS差异有统计学意义（P<0.05）。cIMT ≥ 0.05 cm时,各亚组间PWV-BS差异无统计学意义（P>0.05）,高血压亚组PWV-ES高于正常亚组（P<0.05）;cIMT<0.05 cm时,临界亚组PWV-BS及PWV-ES均高于正常亚组（P均<0.05）,高血压亚组PWV-BS低于临界亚组（P<0.05）而PWV-ES高于正常亚组（P<0.05）。cIMT、PWV-BS及PWV-ES均与年龄成正相关（r=0.64、0.33、0.69,P均<0.01）。结论 临界性高血压成年人颈动脉形态及弹性已发生改变,且弹性变化可能早于形态变化。     

极速成像技术评价慢性阻塞性肺疾病患者颈动脉僵硬度

目的 探讨极速成像技术评价慢性阻塞性肺疾病（COPD）患者颈动脉僵硬度的价值。方法 48例COPD患者（COPD组）和45名志愿者（对照组）接受常规颈动脉超声检查后,应用超声极速成像技术测量颈总动脉脉搏波传导速度（ufPWV）,包括收缩期起始时PWV值（PWV-BS）及收缩期结束时PWV值（PWV-ES）,并进行统计学分析。结果 与对照组比较,COPD组PWV-BS值和PWV-ES值均升高（P<0.05）;COPD患者ufPWV值与第1秒用力呼气容积呈负相关（PWV-BS：r=-0.40,P<0.01;PWV-ES：r=-0.41,P<0.01）。结论 极速成像技术可早期评价慢性阻塞性肺疾病患者颈动脉硬化,为临床治疗方案的选择及预后评价提供重要依据。     

声辐射力脉冲成像诊断儿童慢性肾病

目的 观察声辐射力脉冲（ARFI）成像评估儿童慢性肾脏疾病（CKD）的价值。方法 纳入40例CKD患儿（CKD组）及40名健康儿童（对照组）,采用ARFI成像测量肾皮质剪切波速度（SWV）。计算估算肾小球滤过率（eGFR）,并将CKD组分为eGFR<60 ml/（min·1.73 m²）亚组和eGFR≥60 ml/（min·1.73 m²）亚组;比较组及各亚组间肾SWV及肾功能指标,观察肾SWV与肾功能指标的相关性。绘制受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,评估SWV诊断CKD的效能。结果 CKD组肾SWV、血肌酐、尿素氮及尿酸均高于对照组（P均<0.05）,而eGFR低于对照组（P<0.05）。CKD组平均肾SWV与血肌酐均与尿素氮呈正相关（r=0.46、0.54,P均<0.01）,与eGFR呈负相关（r=－0.44,P<0.01）,而与尿酸无明显相关（r=0.22,P=0.09）;其内eGFR<60 ml/（min·1.73 m²）亚组和eGFR≥60 ml/（min·1.73 m²）亚组血肌酐、尿素氮、尿酸、eGFR和平均肾SWV差异均有统计学意义（P均<0.05）。eGFR<60 ml/（min·1.73 m²）亚组平均肾SWV与血肌酐和尿素氮均呈正相关（r=0.48、0.47,P均<0.05）,与eGFR呈负相关（r=－0.76,P<0.01）,而与尿酸无明显相关（r=0.07,P>0.05）。以SWV=2.60 m/s为截断值,其诊断CKD的敏感度和特异度分别为67.50%和87.50%,AUC为0.80（P<0.01）。以SWV=2.66 m/s为截断值,其评估CKD患儿eGFR<60 ml/（min·1.73 m²）或≥60 ml/（min·1.73 m²）的敏感度和特异度分别为83.30%和59.10%,AUC为0.69（P=0.03）。结论 以ARFI成像测量肾皮质SWV有助于诊断儿童CKD,尤其是eGFR<60 ml/（min·1.73 m²）的CKD。     

极速脉搏波技术评价维生素D缺乏对2型糖尿病患者早期颈动脉弹性功能的影响

摘要 ]目的 应用极速脉搏波速度（UFPWV）技术观察维生素D缺乏对2型糖尿病（T2DM）患者早期颈动脉弹性功能的影响。方法 根据25-羟维生素D₃[25（OH）D₃]水平将92例T2DM患者（T2DM组）分为维生素D缺乏亚组和维生素D非缺乏亚组，以1 544名健康成人为对照组，记录2组临床资料及实验室指标，应用UFPWV技术测量颈动脉弹性参数，包括收缩期起始及结束时脉搏波速度（PWV-BS、PWV-ES），对上述数据进行统计学分析。结果 ① T2DM组中，维生素D缺乏亚组体质量指数（BMI）、空腹血糖（FPG）、收缩压、舒张压、总胆固醇（TC）、甘油三酯、PWV-BS、PWV-ES水平均高于非缺乏亚组（P均<0.05），高密度脂蛋白胆固醇（HDL-C）水平低于维生素D非缺乏组（P<0.05）。②Pearson相关分析发现，PWV-BS、PWV-ES与年龄、BMI、FPG、收缩压、舒张压及TC呈正相关（P均<0.05），与25（OH）D₃、HDL-C呈负相关（P均<0.05）。③多元线性逐步回归分析显示，FPG、收缩压、年龄及TC是PWV-BS、PWV-ES的危险因素（P均<0.05），25（OH）D₃是PWV-ES的保护因素（P<0.05）。结论 维生素D缺乏T2DM患者PWV-BS、PWV-ES明显升高；维生素D可能是T2DM患者颈动脉硬化的保护因素，监测T2DM患者维生素水平并及时补充维生素D或可延缓其并发症发生发展。     

彩色多普勒超声评价糖尿病肾病患者肾内动脉阻力指数与腹主动脉内-中膜厚度的相关性

目的 应用彩色多普勒超声技术评价糖尿病肾病（DN）患者肾内动脉阻力指数（RI）与腹主动脉内-中膜厚度（AA-IMT）的相关性。方法 以35名健康自愿者为对照组（A组），根据肾小球滤过率（GFR）将93例2型DN患者分为3组，其中B组33例GFR≥90 ml/（min·1.73 m²），C组（31例）60 ml/（min·1.73 m²）≤GFR<90 ml/（min·1.73 m²），D组29例GFR<60 ml/（min·1.73 m²），应用彩色多普勒超声技术获得肾内动脉RI和腹主动脉AA-IMT。结果 B、C、D组RI及AA-IMT均高于A组（P均<0.05），C、D组均高于B组（P均<0.05），D组高于C组（P<0.05）。RI与AA-IMT（r=0.90，P<0.01）、糖化血红蛋白（r=0.58，P<0.01）、空腹血糖（r=0.66，P<0.01）、总胆固醇（r=0.42，P<0.01）、低密度脂蛋白（r=0.03，P<0.01）、肌酐（r=0.64，P<0.01）及尿酸（r=0.54，P<0.01）均呈正相关，与估算肾小球滤过率（eGFR）（r=-0.84，P<0.01）呈负相关。受试者工作特征（ROC）曲线显示，以RI=0.70为判定DN患者肾功能轻度受损的[GFR<90 ml/（min·1.73 m²）]截断参考值，其敏感度为84.1%，特异度为92.9%；RI高于0.70者AA-IMT明显较低于者增厚（P<0.05）。AA-IMT及e GFR是肾动脉RI值的独立影响因素（P均<0.05）。结论 应用彩色超声多普勒技术可无创获得DN患者肾内动脉RI值和腹主动脉AA-IMT，客观、便捷地评价其微血管和大血管受损。     

血氧水平依赖成像参数评估慢性肾脏病肾功能:Meta分析

目的 采用Meta分析评估血氧水平依赖（BOLD）成像参数R2^*值对慢性肾脏病（CKD）分期的价值。方法 检索PubMed、Cochrane Library及中国知网、万方医学网和维普数据库中1999年1月—2019年9月发表的关于BOLD成像评估CKD的文献，自CKD组和健康对照组中提取R2^*值；采用Stata 12.0软件进行Meta分析。结果 最终纳入6篇文献，CKD组（包括轻度亚组及中重度亚组）190例，对照组88名健康人。汇总后CKD组肾皮质R2^*值（CR2^*值）明显高于对照组，加权均数差（WMD）为1.69[95% CI（0.34，3.03），P=0.01]。CKD组肾髓质R2^*值（MR2^*值）与对照组比较差异无统计学意义，WMD为－1.09[95% CI（－5.37，3.20），P=0.62]。CKD组中，轻度亚组CR2^*值明显高于对照组，WMD为1.36[95% CI（0.35，2.37），P=0.01]，其MR2^*值与对照组比较差异无统计学意义，WMD为－0.06[95% CI（－3.44，3.32），P=0.97]；中重度亚组CR2^*值与轻度亚组比较差异无统计学意义，WMD为0.72[95% CI（－0.35，1.78），P=0.19]；轻度亚组MR2^*值明显高于中重度亚组，WMD为-2.31[95% CI（－4.40，-0.21），P=0.03]。结论 BOLD成像可用于早期诊断CKD及其分期，R2^*值有望成为临床随访CKD的指标之一。     

MRI定量参数评估肠道克罗恩病病变活动性

目的 探讨MRI定量参数ADC与容积转运常数（K^trans）评估肠道克罗恩病（CD）病变活动性的应用价值。方法 收集50例回盲部单发病灶的CD患者,依次行常规MR、DWI和动态增强MRI（DCE-MRI）扫描,测量ADC和K^trans值,同时评估患者Harvey-Bradshow指数（HBI）和血清C反应蛋白（CRP）浓度。根据HBI将50例患者分为重度活动组、轻中度活动组及静止组,比较3组间K^trans、ADC值的差异;对K^trans、ADC值与对应的HBI、CRP行相关性分析。结果 50例CD患者中,静止组16例、轻中度活动组21例、重度活动组13例。3组K^trans、ADC值的差异均有统计学意义（P均<0.05）,组间两两比较差异均有统计学意义（P均<0.05）。病变肠壁K^trans值与HBI呈正相关（r=0.635,P<0.001）,与CRP呈正相关（r=0.764,P<0.001）;ADC值与HBI呈负相关（r=-0.614,P<0.001）,与CRP呈负相关（r=-0.490,P<0.001）。病变肠壁HBI与CRP呈正相关（r=0.755,P<0.001）,K^trans与ADC值呈负相关（r=-0.348,P=0.013）。结论 MRI定量参数K^trans和ADC可反映CD活动状态,且K^trans的稳定性和敏感性优于ADC。     

不同年龄阿尔茨海默病患者脑核团ADC值与年龄的相关性

目的 探讨不同年龄阿尔茨海默病（AD）患者ADC值与年龄的相关性。方法 选取30例AD患者（AD组）和年龄与之相匹配的30名志愿者（对照组），按年龄段各分为6个亚组[55~59岁（n=3）、60~64岁（n=4）、65~70岁（n=9）、71~74岁（n=5）、75~80岁（n=6）、>80岁（n=3）]，测量双侧海马、红核、尾状核、杏仁体、壳核ADC值，并进行配对t检验、独立样本t检验、单因素方差分析及Pearson相关分析。结果 AD组红核左、右侧ADC值有统计学差异（P=0.022）。AD组不同年龄亚组右侧海马、双侧尾状核、右侧壳核ADC值差异有统计学意义（P均<0.05）；2组不同年龄亚组双侧海马、壳核、尾状核ADC值差异有统计学意义（P均<0.05）。AD组右侧海马（r=0.615，P<0.001）、右侧壳核（r=0.653，P=0.001）及双侧尾状核（左侧：r=0.397，P=0.030；右侧：r=0.429，P=0.020）ADC值与年龄呈正相关。结论 AD患者右侧海马和壳核、双侧尾状核ADC值随年龄增加而增大。ADC值可为临床预测和早期诊断AD脑内右侧海马和壳核、双侧尾状核神经退行性病变提供参考。     

超声造影与18F-FDG PET/CT判断多发性大动脉炎活动性的相关性

目的 探讨超声造影（CEUS）和¹⁸F-FDG PET/CT在多发性大动脉炎（TA）活动性判断中的相关性。方法 收集TA患者36例，均接受CEUS及¹⁸F-FDG PET/CT检查，比较相关实验室指标及影像学参数，分析CEUS与¹⁸F-FDG PET/CT评价TA活动性结果之间的相关性。结果 CEUS明显增强组在病程、印度大动脉炎临床活动性评分（ITAS 2010）、颈动脉闭塞比、CEUS峰值强度、PET/CT视觉评分及最大标准摄取值（SUV_max）与对照组间差异存在统计学意义（P均<0.05）；CEUS分级标准与PET/CT视觉评分呈中度相关（r=0.697，P<0.001），与临床活动性NIH标准及SUV_max均呈低度相关性（r=0.385，P=0.018；r=0.477，P=0.014）；以¹⁸F-FDG PET/CT视觉评分作为判断TA活动性的标准，临床活动性NIH标准的敏感度和特异度分别为0.783及0.769，CEUS的敏感度和特异度分别为1.000及0.846，AUC分别为0.776和0.923。结论 CEUS判断TA活动性与¹⁸F-FDG PET/CT存在明显正相关；以¹⁸F-FDG PET/CT视觉评分作为TA活动性的判断标准，CEUS较临床活动性标准具有更高的敏感度和特异度，可作为判断TA活动性的有效指标。     

1H-MRS检测帕金森病伴轻度认知障碍患者后扣带回代谢物

目的 探讨¹H-MRS波谱技术联合线性拟合模型（LCmodel）软件在帕金森病（PD）伴认知障碍中的诊断价值。方法 选取PD患者35例（PD组）和健康体检者22名（对照组）,并根据是否伴有认知功能障碍,将PD组分为PDN亚组和PDMCI亚组。采用¹H-MRS波谱技术联合LCmodel软件获取PD组与对照组后扣带回（PCG）区域的波谱及代谢物的绝对浓度。比较2组各代谢物绝对浓度,并分析各代谢物绝对浓度与认知功能评分的相关性。结果 PDN亚组各代谢物绝对浓度与对照组差异均无统计学意义（P均>0.05）,PDMCI亚组总肌酸（tCr）、N-乙酰天门冬氨酸（NAA）、肌醇（mI）和胆碱复合物（tCho）的绝对浓度均较对照组降低（P均<0.05）;PDMCI亚组tCr绝对浓度较PDN亚组降低（P<0.05）。tCr（r=0.444,P=0.01）、谷胱甘肽（GSH;r=0.393,P=0.024）绝对浓度与MMSE评分存在相关性;tCr（r=0.367,P=0.035）、GSH（r=0.376,P=0.031）及tCho（r=0.375,P=0.031）绝对浓度与MoCA评分存在相关性。结论 ¹H-MRS技术联合LCmodel软件可定量分析PCG区域代谢物变化,有助于评估PD伴认知障碍。     

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.     

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.     

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.     

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.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."