一氧化氮动态变化与急性脑血管病关系

目的 通过对204例急性脑血管病患者一氧化氮水平的动态观察,探讨其与急性脑血管病情变化及预后之间的关系.方法 采用生物化学方法检测急性脑血管病患者血清第1、第2、第3、第4 NO含量水平.并与正常对照组比较.结果 急性脑血管病中NO水平明显高于正常对照组(P＜0.01),发病后第1周显著升高,随着病情好转,第2～4周逐渐下降.出血性脑血管病中NO水平明显高于缺血性脑卒中组(P＜0.05).结论 对急性脑血管病患者NO水平动态观察,可判定病情和评价预后.     

急性缺血性脑卒中并发全身炎症反应综合征或多脏器功能障碍综合征的临床研究

目的:探讨急性缺血性脑卒中患者全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)或MODS的发生率,以及C-反应蛋白(C-reactive protein,CRP)在急性缺血性脑卒中并发SIRS和MODS中的诊断意义.方法:严密监测82例急性缺血性脑卒中患者的病情,按其有否并发SIRS或MODS而将其分为急性单纯性缺血性脑卒中组(45例)及急性非单纯性缺血性脑卒中组(37例),采用构成比描述SIRS及MODS的发生率,另将30名体检正常健康者作对照组,采用免疫透射比浊法测定各组的CRP水平,比较3组的差别.结果:急性缺血性脑卒中并发SIRS的发生率为45%、并发MODS发生率为39%;并发SIRS的患者86%发生MODS.急性单纯性缺血性脑卒中组的CRP水平为(17.3±2.8)mg/L,急性非单纯性缺血性脑卒中组的CRP水平为(55±4)mg/L,对照组的CRP水平为(4.0±1.7)mg/L.急性单纯性缺血性脑卒中组、急性非单纯性缺血性脑卒中组的CRP水平与对照组比较差异有统计学意义,均为P＜0.01.急性单纯性缺血性脑卒中组的CRP水平与急性非单纯性缺血性脑卒中组比较差异有统计学意义,P＜0.0l.结论:急性缺血性脑卒中可并发SIRS或MODS,各组CRP水平的不同提示CRP可作为估计患者是否并发SIRS或MODS的一项指标.     

急性脑卒中患者血清一氧化氮、一氧化氮合酶、丙二醛、超氧化期歧化酶及过氧化脂质水平动态变化与病情预后分析

目的通过对216例急性脑卒中患者血清一氧化氮（NO）、一氧化氮合酶（NOS）、丙二醛（MDA）、超氧化物歧化酶（SOD）、过氧化脂质（LPO）水平变化的动态观察,探讨这5项指标与急性脑卒中病情变化及预后之间的关系。方法采用生物化学方法检测急性脑卒中患者血清第1～4周NO、NOS、MDA、SOD、LPO含量水平,并与正常对照组比较。结果①急性脑卒中组NO、NOS、MDA、LPO水平均明显高于正常对照组（P均（0.01）,发病后第1周显著升高,随着病情的好转,第2～4周逐渐下降;SOD水平明显低于正常对照组（P（0.01）,发病后第1周显著降低,第2～4周逐渐升高。②出血性脑卒中NO、NOS、MDA、LPO水平明显高于缺血性脑卒中组（P（0.01）,而SOD水平则明显降低（P（0.05）。结论急性脑卒中患者存在NO、NOS、MDA、SOD、LPO含量失衡的变化,并随病情的严重与演变而变化。观察这5项指标的水平动态变化,可作为判定病情和评价预后的参考指标。     

急性脑梗死程度及预后与C反应蛋白水平的关系

目的 探讨急性脑梗死患者血清C反应蛋白(CRP)水平与神经功能缺损程度及病情预后的关系.方法 对80例急性脑梗死患者(脑梗死组)和60例健康体检者(对照组)24 h内抽取空腹静脉血2 mL,采用免疫散射比浊法测定CRP含量.对2组CRP水平的变化进行比较.结果 脑梗死组的CRP含量平均为(23.7±1.5)mg·L-1,对照组CRP含量平均为(4.5±1.2)mg·L-1,2组比较差异有统计学意义(P＜0.01).脑梗死组重型组、中型组CRP水平高于轻型组(P＜0.05或P＜0.01),重型组CRP水平高于中型组(P＜0.05).脑梗死好转组CRP水平低于无好转组(P＜0.01).结论 CRP参与了脑梗死的病程,能反应病情严重程度;急性脑梗死患者CRP水平越高,提示病情越重,预后越差.     

老年急性缺血性脑卒中患者血浆N端-脑钠肽前体水平的变化及与预后的关系

目的 通过分析老年急性脑卒中患者N端-脑钠肽前体（NT-pro-BNP）水平的变化,探讨NT-pro-BNP与老年急性脑卒中预后的关系.方法 将80例老年急性缺血性脑卒中患者按TOAST分型标准分为心源性卒中组和非心源性卒中组,每组40例;另选择同期健康体检的老年人（对照组）30例.分别于入院48 h,治疗第14、90天进行美国国立卫生研究卒中量表（NIHSS）评分;观察各组入院48 h和第14天的血浆NT-pro-BNP水平的变化及患者入院时血浆NT-pro-BNP水平与缺血性卒中患者预后的关系.结果 缺血性脑卒中患者入院48 h及入院第14天血浆NT-pro-BNP水平均较对照组明显增高（P＜0.05）;心源性卒中组血浆NT-pro-BNP水平较非心源性卒中组明显增高（P＜0.05）;心源性卒中组及非心源性卒中组入院第14天血浆NT-pro-BNP水平较48 h的NT-pro-BNP明显降低（均P＜0.05）.心源性卒中组及非心源性卒中组入院第14、90天的NIHSS评分均较入院48 h明显下降,尤以入院第90天降低更明显（P＜0.05或P＜0.01）.NIHSS评分≤6分组入院时血浆NT-pro-BNP浓度明显低于NIHSS＞6分组（P＜0.0l）.好转组入院时血浆NT-pro-BNP浓度明显低于死亡组（P＜0.05）.结论 BNP水平越高患者病情越严重,预后越差.老年急性缺血性脑卒中患者血浆NT-pro-BNP升高可作为预测急性缺血性脑卒中预后的一个危险因子.     

CT和MRI对急性缺血性脑卒中的诊断价值比较

[目的]比较头颅计算机断层扫描(CT)平扫和核磁共振成像(MRI)检查对诊断急性缺血性脑卒中的临床诊断价值差异.[方法]选择2013年6月至2014年11月本院收治的152例急性缺血性脑卒中的患者作为观察对象,根据其发病后行CT及核磁共振弥散加权成像(DWI)检查的时间不同将其分成三组:发病后6h内行CT以及DWI检查组(A组,n=66),发病后6～24 h行CT以及DWI检查组(B组,n=57),发病后24～72 h行CT及DWI检查组(C组,n=29).所有患者均通过NIHSS量表评估病情严重程度,分析不同时间段CT、DWI对急性缺血性脑卒中的检出率.根据患者病情以及就诊时间采用适当的治疗方法,观察患者的临床预后.[结果]A组、B组DWI检查对急性缺血性脑卒中的检出率明显高于头颅CT平扫检查,差异均具有统计学意义(均P ＜0.05);而C组两种检查方法差异无统计学意义(P＞0.05).急性缺血性脑卒中的早期(发病24 h内)诊断的患者病死率为5.89％(7/119)明显低于后期(发病24～72 h)诊断的患者的病死率22.23％(6/27),差异有统计学意义(x2=4.67,P=0.03＜0.05),早期及时诊断能显著降低患者的病死率.[结论]DWI检查在急性缺血性脑卒中的早期检出率方面明显优于CT平扫,可有显著降低患者的病死率,对患者预后有重要的临床意义.     

血清病毒水平预测急性乙型肝炎患者慢性化的效果

目的:研究急性乙型肝炎患者发病后血清病毒水平与病情慢性化之间的关系.方法:对238例急性乙肝患者于发病初诊时、4周、12周进行HBV-DNA定量测定,按HBV-DNA水平进行分组,观察各组患者慢性化发生率.结果:急性乙型肝炎患者发病初期血清HBV-DNA水平与慢性化发生率之间无明显关系.发病4周时,HBV-DNA＞105拷贝/mL组慢性化发生率高达46.43％,显著高于HBV-DNA 103～ 105拷贝/mL组(13.46％)和HBV-DNA＜103拷贝/mL组(3.94％) (P＜ 0.01);HBV-DNA 103 ～ 105拷贝/mL组慢性化率显著高于HBV-DNA＜ 103拷贝/mL组(P＜0.01).12周时血清HBV-DNA＞ 105拷贝/mL组慢性化发生率高达81.81％,显著高于HBV-DNA 103～ 105拷贝/mL组(29.41％)和HBV-DNA＜103拷贝/mL组(7.89％)(P＜0.01);HBV-DNA 103～105拷贝/mL组慢性化率显著高于HBV-DNA＜ 103拷贝/mL组(P＜ 0.01).结论:急性乙型肝炎发病初期HBV-DNA水平与慢性化发生率之间无明显相关性;发病4周和12周HBV-DNA水平越高,慢性化发生率越高.     

热休克因子1在缺血性脑卒中患者外周血检测的临床意义

目的:探讨急性缺血性脑卒中患者发病48 h内热休克因子1(Hsf-1)水平及其与不同病因学亚型的关系。方法:对62例缺血性脑卒中患者进行TOAST病因学分型、用美国国立卫生研究院神经功能缺损评分(NIHSS)评估神经功能缺损,发病3个月时改良Rankin量表(mRS)评分评估预后。并与正常对照组(31例)用逆转录PCR法检测外周血单核细胞中Hsf-1mRNA的表达水平。结果:神经功能缺损轻型与重型之间差异无统计学意义(P=0.138),大动脉粥样硬化性卒中(LAA)组的Hsf-1表达高于小动脉闭塞性卒中(SAA)组,且差异具有统计学意义(P<0.01),按NIHSS进一步分层后统计学差异仍存在,预后良好组Hsf-1表达高于预后不良组且差异具有统计学意义(P=0.007)。结论:Hsf-1表达测定对缺血性卒中病因学分型有一定的参考价值,并可能成为缺血性卒中患者病情评估的参考指标之一。     

急性脑梗死患者血浆神经元特异性烯醇酶和碱性髓鞘蛋白的动态变化及意义

目的 探讨急性脑梗死患者血浆神经元特异性烯醇酶(NSE)和碱性髓鞘蛋白(MBP)的动态变化及其对预后的影响.方法 选择急性脑梗死患者75例,分别于发病24 h、第4天、第7天、第14天采集血标本,应用酶联免疫吸附法测血浆NSE、MBP水平,并与正常对照组40例进行比较.结果 脑梗死患者发病24 h、第4天血浆NSE、MBP明显高于对照组,以24 h为主,预后不良组血浆NSE水平在发病24 h、第4天、第7天各时间点均明显高于预后良好组,而预后不良组血浆MBP水平发病在24 h、第4天各时问点亦高于预后良好组.73例脑梗死患者发病第4天的梗死体积与发病24 h、第4天血浆NSE、MBP水平呈正相关.相关系数分别为0.92、0.78(均P＜0.001)及0.82、0.69(均P＜0.001).72例脑梗死患者第14天神经功能缺损评分减少值与发病24 h、第4天的血浆NSE、MBP水平呈负相关,相关系数分别为-0.51、-0.45(均P＜0.001)及-0.47、-0.36(P＜0.001和0.01).结论 急性脑梗死患者早期血策NSE、MBP水平升高明显,血浆NSE、MBP的动:态变化可反映脑梗死的严重程度及预后.     

急性缺血性脑卒中患者血清CRP、TNF-α、IL-6水平变化的临床观察

目的探讨急性缺血性脑卒中患者血清C反应蛋白(CPR)、肿瘤坏死因子(TNF-a)、白细胞介素-6(IL-6)变化及其与病情严重程度的关系。方法对30例急性缺血性脑卒中患者和30名健康体检者进行对照,缺血性脑卒中患者发病后第1、2、3d测定血清CRP、TNF-a、IL-6水平。分析其与缺血性脑卒中病灶大小及与临床神经功能缺损程度评分(CNFDS)的相关性。结果急性缺血性脑卒中组血清CRP、TNF-a、IL-6含量高于正常对照组(P<0.01);不同临床分型组间患者血清CPR、TNF-a、IL-6水平比较,重型患者CRP、TNF-a、IL-6水平明显高于轻、中型患者(P<0.01);CRP、TNF-a、IL-6的变化且与临床神经功能缺损程度评分呈正相关(分别r=0.65、0.59、0.70,P<0.01)。结论血清CRP、TNF-a、IL-6水平增高与急性缺血性脑卒中的发生和严重程度有密切关系,CRP、TNF-a、IL-6在血清中的水平可作为判断急性缺血性脑卒中患者病变严重程度的指标。     

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."