盐酸昂丹司琼联合地塞米松预防化疗所致呕吐的临床观察及护理

目的观察盐酸昂丹司琼联合地塞米松预防呕吐的效果。方法80例癌症患者随机分为2组，观察组和对照组。观察组于化疗前15min静脉注射盐酸昂丹司琼（8mg）和地塞米松（10mg）；对照组于化疗前单用盐酸昂丹司琼（8mg）静脉注射。结果对照组呕吐完全控制率71％，观察组为83％，2者比较有显著性差异（P〈0．05）。结论盐酸昂丹司琼联合地塞米松比单用盐酸昂丹司琼止吐效果好。     

昂丹司琼对全麻腹腔镜胆囊切除术患者术后恶心呕吐的影响及护理

目的研究术中静脉注射昂丹司琼对腹腔镜胆囊切除术患者术后恶心呕吐（PONV）的影响及护理。方法择期行全麻腹腔镜胆囊切除术患者90例，将患者随机分为3组各30例：小剂量昂丹司琼组（O1组），切皮前静脉注射4mg昂丹司琼；大剂量昂丹司琼组（O2组），切皮前静脉注射8mg昂丹司琼；对照组（C组），切皮前静脉注射生理盐水。所有注射液体均稀释为4ml。观察术后24h发生恶心呕吐的例数及程度。结果与C组比较，O1组与O2组发生PONV的例数减少且程度减轻，P〈0．05；O1组与O2组之间比较差异无统计学意义，P〉0．05。结论术中静脉注射昂丹司琼可以减少腹腔镜胆囊切除术后患者的恶心呕吐。     

不同剂量布托啡诺治疗硬膜外麻醉后寒战临床观察

目的 观察不同剂量布托啡诺治疗硬膜外麻醉后寒战的临床效果。方法 将45例出现硬膜外麻醉后寒战病人随机分为Ⅰ、Ⅱ、Ⅲ共3组，每组15例，分别静脉注射布托啡诺0．01、0．02、0．03mg／kg，观察用药后寒战治疗效果、镇静程度、不良反应。结果 Ⅰ、Ⅱ、Ⅲ组有效率分别为60．0％、93．3％和93．3％，11组、Ⅲ组疗效显著好于Ⅰ组（uc=2．623、2．888，P〈0．01）；Ⅰ组、Ⅱ组用药后5min OAA／S评分显著高于Ⅲ组，差异均有显著意义（t=3．695、2．550，P〈0．05）；Ⅲ组不良反应发生率显著高于Ⅰ、Ⅱ组（P=0．0003）。结论 0．02mg／kg布托啡诺静脉注射适用于治疗硬膜外麻醉后寒战。     

加温系统对麻醉剖宫产产妇术后寒战的效果

[目的]观察充气式病人加温系统对腰硬联合麻醉剖宫产产妇术后寒战的作用。[方法]将腰硬联合麻醉下行剖宫产且在术后恢复室发生寒战的产妇48例随机分为加温组和曲马多组，分别给予充气式加温系统保暖和曲马多（1．5mg／kg）静脉注射。观察两组产妇干预前及干预后5min、15min、30min体温、寒战发生率、寒战强度及恶心、呕吐发生率。[结果]干预后30min加温组产妇体温高于曲马多组（P〈0．05）；两组产妇干预后15min、30min寒战发生率和强度与干预前比较均下降（P〈0．05）；加温组在干预后5min的寒战发生率和强度较曲马多组高（P〈0．05）；加温组产妇干预后恶心、呕吐发生率低于曲马多组（P〈0．05）。[结论]充气式病人加温系统可以有效缓解产妇腰硬联合麻醉后寒战的发生，且无明显副反应。     

国产阿扎司琼防治化疗所致恶心呕吐的疗效观察

目的 观察国产盐酸阿扎司琼防治化疗所致恶心、呕吐的疗效和安全性。方法 对85例化疗患者采用随机对照方法，分别用国产盐酸阿扎司琼和昂丹司琼防治化疗所致的恶心、呕吐。结果 国产盐酸阿扎司琼和昂丹司琼防治恶心、呕吐的总有效率（CR＋PR）分别为93．0％和85．7％，两组差异无显著性（P〉0．05）；止呕完全缓解率（CR）分别为81．4％和61．9％，两组差异有显著性（P〈0．05）。不良反应均轻微。结论 国产盐酸阿扎司琼是防治化疗所致恶心、呕吐的高效、安全药物，值得推广。     

盐酸戊乙奎醚预防剖宫产术中寒战的临床观察

【目的】观察戊乙奎醚注射液预防剖宫产术中寒战的临床效果。【方法】80例ASAⅠ～Ⅱ级择期剖宫产产妇,均应用腰硬联合麻醉,随机分成两组,每组40例。入手术室后,工组肌肉注射盐酸戊乙奎醚注射液1mg;Ⅱ组静脉注射生理盐水2mL。观察术中寒战反应情况和新生儿1min、5min Apgar评分。【结果】术中Ⅰ组无寒战反应;Ⅱ组17例出现寒战反应,其中1级10例,2级6例,3级1例,与Ⅰ组比较差异有统计学意义（P〈0．05）。两组新生儿1min、5min Apgar评分差异均无统计学意义（P〉0．05）。【结论】戊乙奎醚注射液能有效预防剖宫产术中寒战反应,且对新生儿无不良影响。     

罗哌卡因复合小剂量舒芬太尼蛛网膜下腔注射应用于择期剖宫产术的临床研究

目的观察罗哌卡因复合小剂量舒芬太尼蛛网膜下腔注射应用于择期剖宫产术的麻醉效果，探索两药联合应用的合理配伍剂量。方法将择期120例腰硬联合麻醉下剖宫产孕妇随机分成四组，Ⅰ组：1．5ml 0．75％罗哌卡因＋1 ml 10％葡萄糖＋0．5ml舒芬太尼5μg；Ⅱ组：1．5ml 0．75％罗哌卡因＋1ml 10％葡萄糖＋0．5ml舒芬太尼7．5μg；Ⅲ组：1．5ml 0．75％罗哌卡因＋1ml 10％葡萄糖＋0．5ml舒芬太尼10．0μg；Ⅳ组：2．0ml 0．75％罗哌卡因＋1ml 10％葡萄糖，每组30例。比较各组产妇椎管内阻滞的效果、术中牵拉反应的抑制程度、围术期并发症的发生率及新生儿脐带血气、Apgar评分的统计学差异。结果Ⅱ、Ⅲ、Ⅳ组较Ⅰ组术中硬膜外追加局麻药量减少（X^2=10．23，P均〈0．05）；Ⅳ组的寒战和低血压的发生率低（X^2分别=12．38、14．20，P均〈0．05）；Ⅰ、Ⅱ组与Ⅲ组比较．围术期瘙痒的发生率降低（X^2=13．45，P均〈0．05）。Ⅰ、Ⅱ组与Ⅲ、Ⅳ纽相比恶心、呕吐的发生率偏低（X^2分别=9．87、10．05，P均〈O．05）。新生儿娩出后的Apgar评分（胎儿娩出即刻、娩出后10min）、从切皮至娩出时间及新生儿脐带血气分析结果（pH、PCO2、PO2、SBE）的比较均无明显统计学差异（X^2分别=2．05、2．19、3．32、2．49、1．96、2．97、1．78，P均〉0．05）。各组感觉麻醉平面、产妇呼吸抑制、术后头痛发生率及Bromage评分〉3的发生率也同样无统计学差异（X^2分别=2．59、3．42、2．45、1．87，P均〈0．05）。结论罗哌卡因复合舒芬太尼蛛网膜下腔注射麻醉效果确切。可安全应用于剖宫产术。舒芬太尼7．5μg（H组）复合11．25mg罗哌卡因蛛网膜下腔注射行择期剖宫产术的围术期并发症相对较少，该配伍相对更合理。     

小剂量地塞米松联合昂丹司琼预防妇科腹腔镜术后恶心呕吐

目的:观察小剂量地塞米松联合昂丹司琼预防妇科腹腔镜术后恶心、呕吐的效果.方法:择期行妇科腹腔镜手术患者100例随机分为Ⅰ,Ⅱ,Ⅲ,Ⅳ4组,每组25例.Ⅰ组于麻醉诱导前、手术结束时静脉注射生理盐水2 mL;Ⅱ组静脉注射生理盐水2 mL+昂丹司琼8 mg;Ⅲ组静脉注射地塞米松5 mg+昂丹司琼8 mg;Ⅳ组静脉注射地塞米松10 mg+昂丹司琼8 mg.观察4组患者术后24 h恶心、呕吐发生情况,并进行比较.结果:Ⅱ,Ⅲ,Ⅳ组恶心、呕吐发生率低于Ⅰ组(P<0.05),Ⅲ,Ⅳ组恶心、呕吐发生率低于Ⅱ组(P<0.05),Ⅲ、Ⅳ组恶心,呕吐发生率比较差异无统计学意义(P>0.05).结论:5 mg地塞米松或10 mg地塞米松联合昂丹司琼用于预防妇科腹腔镜术后恶心、呕吐均可取得满意效果.     

曲马多复合地塞米松治疗硬膜外麻醉寒战反应效果观察

目的：观察曲马多复合地塞米松治疗硬膜外麻醉寒战反应的临床效果。方法：60例硬膜外麻醉寒战患者，随机分为Ⅰ组：曲马多2mg／kg，地塞米松0．2mg／kg；Ⅱ组：奈福泮0．3mg／kg；Ⅲ组：哌替啶1mg／kg，非那根0．5mg／kg。观察寒战反应出现时间及不良反应。结果：术后6h寒战复发率Ⅰ组明显低于Ⅱ、Ⅲ组（P〈0．05），Ⅲ组嗜睡、头晕、恶心发生率比I组高（P〈0．05）。结论：曲马多复合地塞米松有效防治寒战反应。     

不同止呕药预防全麻术后芬太尼静脉镇痛恶心呕吐的疗效

【目的】探讨不同止呕药预防全麻术后芬太尼静脉自控镇痛（PCIA）后恶心呕吐的效果。【方法】选择ASAⅠ～Ⅱ级在全麻下手术病人120例,随机均分为A、B、C、D组。A组为对照组,不给止呕药;B组格拉司琼3mg术中静注,3mg加入PCIA;C组昂丹司琼8mg术中静注,8mg加入PCIA;D组托烷司琼5mg术中静注,5mg加入PCIA,观察术后48h各组恶心呕吐发生情况。【结果】各治疗组恶心呕吐发生率在术后明显低于对照组（P〈0．01,P〈0．05）;D组止恶心呕吐作用优于B、C组（P〈0．05）。【结论】托烷司琼与昂丹司琼、格拉司琼比较能更有效地防治术后芬太尼（PICA）引起的恶心呕吐。     

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."