低场磁共振检查的护理配合

磁共振(MRI)是继CT后出现的一种特殊的影像技术,发展极为迅速,临床诊断中的作用越来越突出,它对人体无创、无辐射、无痛苦,无不良反应,能对人体剖面进行直接成像,组织分辨力高,对人体各个系统的诊断提供了一种可靠安全的方法,并且在二级医院应用越来越多受到临床医生的青睐;但MRI检查也有一些缺点,检查时间长,噪声大,空间狭小等,患者容易产生恐惧、烦躁不安,或因射频噪声和因疼痛不适,而不能完成检查,为充分使用好医疗设备的检查,护士配合医生的工作也很重要,结合MRI检查的特点,护理工作体会报告如下.     

1例糖尿病足骨髓炎患者的药学监护

摘要：临床药师参与1例糖尿病足骨髓炎患者的临床治疗实践,和临床医师共同探讨药物治疗方案,监护患者药物治疗效果及药物不良反应,并为患者提供个体化用药教育。患者治疗过程顺利,病情好转出院。临床药师在团队治疗中充分发挥专业优势,使临床用药更加有效、安全、经济。     

血友病性关节病磁共振新技术进展

血友病性关节病(Hemophilic Arthropathy,HA)的早期发现及预防治疗对关节功能的预后至关重要,磁共振成像(MRI)是诊断血友病性关节病的最敏感方法,近年来MRI新技术发展迅速,对血友病性关节病深入研究提供了契机.本文就MRI新技术在HA的临床研究进展进行综述.     

磁共振扩散加权成像在宫颈癌诊断中的应用

目的 探讨高场强磁共振扩散加权成像技术在宫颈癌诊断中的应用价值.方法 对15例无明显宫颈病变的健康志愿者及25例宫颈癌患者分别进行常规核磁共振成像（MRI）及磁共振扩散加权成像（DWI）检查,分析正常宫颈及病变的影像特点,测量病灶表观扩散系数（ADC）值.结果 （1）15例健康女性宫颈ADC平均值为：内带（1.38±0.32）×10-3 mm2/s、中间带（1.41±0.26）×10-3 mm2/s、外带（1.41±0.08）×10-3 mm2/s;正常宫颈内带 ADC值低于中间结合带及外带肌层ADC值（P〈0.05）,而中间结合带与外带肌层ADC平均值比较差异无统计学意义（P=0.16〉0.05）.（2）25例宫颈癌患者ADC平均值为（0.869±0.108）×10-3 mm2/s,明显小于正常宫颈ADC平均值（P〈0.05）.结论 DWI图可明显观察宫颈癌病灶的位置、范围,作为常规MRI检查的有益补充,采用ADC值可有效地定量区分宫颈癌与正常宫颈,有助于宫颈癌的诊断.     

正常青年人脑组织不同回波时间磁共振波谱分析

目的探讨不同回波时间(TE)对正常青年人脑组织代谢物含量的影响。方法选择23名健康青年志愿者,进行二维1H-磁共振波谱(MRS)检查,TE分别为135 ms和270 ms,对比分析N-乙酰门冬氨酸(NAA)/肌酐(Cr)、胆碱(Cho)/Cr及NAA/Cho比值。结果在正常青年人右侧基底节区,TE=135 ms,NAA/Cr、Cho/Cr和NAA/Cho比值分别为2.1±0.6、1.2±0.3和1.7±0.4;TE=270 ms,NAA/Cr、Cho/Cr和NAA/Cho比值分别为2.8±0.8、1.4±0.4和2.0±0.5。TE=135 ms组与TE=270 ms组比较,NAA/Cr、Cho/Cr及NAA/Cho比值差异均有统计学意义(P<0.05)。男性组与女性组比较,NAA/Cr、Cho/Cr及NAA/Cho比值差异均无统计学意义(P>0.05)。结论TE=270 ms所测量的NAA/Cr、Cho/Cr及NAA/Cho比值均高于TE=135 ms所测量的比值,性别不是影响正常青年人脑组织代谢物含量的因素。     

磁共振波谱与弥散张量成像在颞叶癫痫诊断中的应用

癫痫是一种常见的神经系统综合征,在药物难治性癫痫中,约有70%~80%是颞叶癫痫（temporal lobe epilepsy,TLE）,临床上因其发病率高、手术治疗效果好已成为近年来医学研究的重点,其中致痫灶的影像学定侧与定位更是研究的热点之一。海马在TLE的发生、发展和传导中起重要作用。     

磁共振对乳腺疾病的诊断

在当前众多诊断乳腺疾病的方法中,影像学是最常用和有效的诊断方法.X线、B超及MRI检查是诊断乳腺疾病的黄金组合,各有优势及限度,3者结合可最大限度地弥补各自不足,提高诊断的正确率.     

磁共振对乳腺疾病的诊断

近年来,部队大学生士兵的比例呈逐年上升趋势,由于思想观念、价值取向、思维方式以及承受能力等方面存在着一定的差异,部分新入伍大学生士兵产生了这样或是那样的心理问题。解决好他们的心理问题,对部队的长远建设有着极其重要的意义。1心理问题的主要表现     

磁共振检查对脾脏淋巴瘤的诊断价值

目的探讨磁共振检查对脾脏原发性淋巴瘤（PSL）的诊断价值。方法经手术病理证实的脾脏PSL患者3例,均采用磁共振检查,分析其影像学表现及诊断情况。结果3例手术后病理诊断均为B细胞型非霍奇金淋巴瘤,磁共振检查表现为多发肿块型2例,巨块型1例;磁共振平扫表现为脾脏不规则增大,呈等／稍长T1稍短T2信号巨大肿块影像,脾周围见线样长T1、长T2信号,脾门血管被包绕;增强扫描后,脾脏病变不均匀强化,呈等、低混杂信号,腹膜后病变呈中等均匀强化。免疫组化提示弥漫大B细胞型2例,肿瘤细胞CD20及CD19α弥漫（＋）、CD3、CD5散在（＋）、CD43（＋）、CD45RO（＋）、CD10（＋／-）、Mum（＋）、MAC387散在（＋）,B系淋巴浆细胞型1例,CD79eL（＋）、CD23（＋）、CD38（＋）、λ（＋）。结论PSL的磁共振表现具有特征性,有助于明确诊断,确诊依靠手术病理和免疫组化检查。     

磁共振对乳腺疾病的诊断

在当前众多诊断乳腺疾病的方法中,影像学是最常用和有效的诊断方法.X线、B超及MRI检查是诊断乳腺疾病的黄金组合,各有优势及限度,3者结合可最大限度地弥补各自不足,提高诊断的正确率.     

Pharmacotherapy of diabetic foot osteomyelitis

Diabetic foot osteomyelitis (DFO) complicates about 20% of diabetic foot infections (DFIs) and increases the risk of lower extremity amputation. This contentious infection is important to discuss, given the frequency with which diabetes mellitus and its complications occur and the devastating consequences of amputation. The diagnosis and management of DFO is complicated by the diverse presentations, delayed recognition, poorly defined diagnostic criteria, and lack of validated treatment regimens. Major issues of concern include when to undertake bone resection surgery and which antimicrobial agents to use, by what route, and for how long. Patients in whom DFO is suspected are best cared for by a multidisciplinary team, including infectious disease physicians or clinical microbiologists, orthopaedic, plastic and vascular surgeons, diabetologists, primary care physicians, podiatrists and specialist (especially tissue viability) nurses. Such multidisciplinary teams have repeatedly been shown to improve disease outcomes. We herein analyse the limited, and recently published, literature on the pharmacotherapy of DFO and put it into the broader context of management of DFI and osteomyelitis.     

糖尿病足感染的相关因素分析

目的探讨糖尿病足溃疡发生感染的相关因素。方法选取本院就诊的2型糖尿病患者120例,分为感染组与非感染组,对其临床资料进行分析。结果感染组与非感染组患者的年龄、糖尿病病程、体质量指数（BMI）、收缩压（SBP）、舒张压（DBP）、空腹血糖（FPG）、低密度脂蛋白胆固醇（LDL-C）比较,差异无统计学意义（P〉0.05）;感染组患者的糖负荷后2 h血糖（2 h PG）、糖化血红蛋白（Hb A1c）、三酰甘油（TG）、踝肱指数（ABI）、白细胞（WBC）计数、C反应蛋白（CRP）显著高于非感染组,差异有统计学意义（P〈0.05）。结论 HbA1c、2h PG、TG、ABI、WBC、CRP可能与足溃疡感染的发生有关,可认为是感染的相关因素。     

湿润烧伤膏治疗糖尿病足54例临床分析

目的探讨湿润烧伤膏（moist exposed burn ointment,MEBO）治疗糖尿病足的临床疗效。方法在局部清创、感染控制情况下,使用MEBO外敷。结果治疗糖尿病足54例,治愈47例,好转7例,有效率100%。结论 MEBO治疗糖尿病足疗效显著,安全易行,易于推广。     

Presence or absence of a gallate moiety on catechins affects their cellular transport

The accumulation of (-)-epicatechin (EC), a non-gallate catechin, was significantly lower than that of (-)-epicatechin gallate (ECG), a gallate catechin, in Caco-2 cells. Using Caco-2 cell monolayers cultured in transwells, the transport of catechins in the basolateral-to-apical direction was much higher than that in the apical-to-basolateral direction, suggesting the involvement of an efflux transporter. Moreover, the results suggest that involvement of a transporter in EC efflux is greater than that for ECG. Treatment with transporter inhibitors MK571, quinidine or mitoxantrone, which inhibit MRP2, P-glycoprotein (P-gp) and BCRP, respectively, led to an increase in the accumulation of EC into Caco-2 cells and a decrease in the Papp ratio (Papp B-->A/Papp A-->B) for EC. These transporters seemed to be involved in EC efflux. BCRP was not an efflux transporter for ECG, and the influences of MRP2 and P-gp on ECG efflux were lower than for EC. Thus, efflux transporters appear to be responsible for the difference in cellular accumulation of EC versus ECG, suggesting that the presence or absence of a gallate moiety in the catechin structure influences the transporters.     

Morphine or its withdrawal affects plasma malondialdehyde,vitamin E levels and absence or presence of abstinence signs in rats

Objectives Various experimental observations show that morphine treatment generates reactive oxygen species, and that its discontinuation leads to signs of withdrawal. We therefore investigated plasma malondialdehyde and vitamin E levels under both conditions to verify the occurrence of any alterations in oxidative metabolism, and whether these are associated with behavioural changes. Methods We investigated the effects of morphine or morphine plus naloxone on plasma malondialdehyde, vitamin E levels and withdrawal signs such as jumping, wet dog shakes and faecal excretion in rats. Furthermore, isopropylnoradrenaline was injected in rabbits to verify its effects on plasma malondialdehyde levels. Key findings Morphine treatment increased free malondialdehyde and decreased vitamin E levels. The elevation in malondialdehyde levels were exacerbated by the abrupt removal of morphine by naloxone, which also led to the appearance of withdrawal signs. The increased malondialdehyde values can be attributed to the interactions of reactive oxygen species with unsaturated fatty acids, and the lowered levels of vitamin E to its interactions with reactive oxygen species. Conclusions A connection seems to exist between altered peroxide status and withdrawal signs in abstinent animals.     

胰岛素混合液治疗糖尿病足溃疡的临床分析

目的分析胰岛素混合液治疗糖尿病足溃疡的临床疗效。方法将45例糖尿病足患者随机分为观察组（22例）和对照组（23例）,两组均实施血糖控制及抗感染等基础治疗,对照组在此基础上采用胰岛素、盐酸山莨菪碱注射液、庆大霉素混合液进行外用治疗;观察组在常规治疗的基础上采用胰岛素、头孢哌酮钠粉针剂混合液外用治疗。结果观察组的创面愈合时间平均为（13．3±3．2）d,显著短于对照组的（27．5±2．8）d,两组差异有统计学意义（P〈0．05）;观察组的痊愈率及总有效率为68。18％、94．45％,显著高于对照组的43．48％、73．91％,两组差异有统计学意义（P〈0．05）;两组均未出现严重并发症。结论胰岛素、头孢哌酮钠粉针剂混合液治疗糖尿病足溃疡,可有效提高治愈率,并可促进溃疡面的愈合,从而减少患者的痛苦,是一种安全有效的治疗方法,值得推广。     

社区糖尿病患者糖尿病足相关知识调查与分析

目的：调查社区糖尿病患者糖尿病足相关知识的掌握现况,并探讨其影响因素。方法：采用描述性研究设计,对上海市某社区210例糖尿病患者进行问卷调查。结果：社区糖尿病患者糖尿病足相关知识掌握情况不理想;多元线性回归分析显示,糖尿病病程、文化程度、家庭人均月收入是影响知识的主要因素（P〈O．05）.结论：要加强社区糖尿病患者糖尿病足相关知识的健康教育,关注家庭经济条件较差的患者,并根据患者的病程长短、文化程度的不同有针对性地进行教育,进而提高健康教育质量。     

Meta‐analysis of Chinese herbs for diabetic foot ulcers

Chen M, Zheng H, Yin LP, Xie CG. Is oral administration of Chinese herbal medicine effective and safe as an adjunctive therapy for managing diabetic foot ulcers? A systematic review and meta‐analysis. J Altern Complement Med 2010; 16: 889–98.     

Microcirculation of the diabetic foot

Studies over the last decade have revealed impairment of the microcirculation in the diabetic foot. Endothelial dysfunction along with derangements in numerous biochemical pathways has been implicated as causes of microcirculation impairment. Additionally, reduction or absence of the nerve-axon reflex renders the diabetic foot unable to mount a vasodilatory response under conditions of stress, such as injury or infection and makes it functionally ischemic even in the presence of satisfactory blood flow under normal conditions. Furthermore, these changes appear to be directly related to the presence of diabetic neuropathy. These alterations in the diabetic microcirculation may explain the poor wound healing commonly observed in diabetes.