声光电物理因子组合治疗痛风效果观察

目的：探讨远外线和超声波（2．2－5．5kHz）组合疗法对改善痛风症状的效果。方法：应用台湾国际研究所所提供的设备治疗关节疼痛肿胀 部位，按药物组、声光组和混合组观察治疗2周后的疗效。结果：药物组的声光组有效率分别为53．84％、64．70％，混合组有效率为90．90％（P＜0．01）。结论：在纠正关节炎症状上药物和声光电物理治疗效果相同，药物配合物理疗法有助于减少药物副作用，提高疗效，缩短疗程。     

温针灸治疗原发性痛经的临床观察

目的:观察温针灸对原发性痛经的治疗效果。方法:将患者随机分为温针灸和药物治疗组,采用相应的治疗,并观察症状评分及疗效。结果:治疗组总有效率95.0%,对照组总有效率82.5%,2组有效率比较差异有非常显著性(P<0.01);2组痛经症状评分治比较,治疗前后都有非常显著性差异(P<0.01),但治疗组优于对照组(P<0.01)。结论:温针灸对原发性痛经有良好的治疗效果。     

多种药物混合持续湿敷治疗化疗药物渗漏所致皮肤损害的效果分析

目的多种药物混合持续湿敷治疗化疗药物渗漏所致皮肤损害的效果分析。方法本文选取我院于2013年08月~2014年08月收治的50例化疗药物渗漏所致皮肤损害患者,将其随机分为治疗组和对照组,对照组采用芦荟实施治疗过程,治疗组采用多种药物混合持续湿敷治疗方式,对比两组患者的临床疗效、起效时间以及痊愈时间。结果:治疗组的治疗总有效率为96.00%,对照组的治疗总有效率为76.00%,两组结果对比存在显著性差异(P0.05),具有统计学意义。结论化疗药物渗漏所致皮肤损害患者采用多种药物混合持续湿敷治疗方式,效果更优,值得在临床中推广应用。     

多维干预模式对抑郁症患者疼痛症状的疗效及成本效果比

目的:评估多维干预模式治疗抑郁症患者疼痛症状的疗效及成本-效果分析。方法:60例抑郁症患者,疼痛持续3个月以上,随机分为多维干预组(MI组)和药物治疗组(DT组),治疗8周,采用汉密顿抑郁量表(Hamilton Depression Scale,HAMD17)评估抗抑郁疗效,采用视觉模拟评分法(Visual Analog Scale,VAS)评估镇痛疗效,应用大体评定量表(General Assessment Scale,GAS)计算有效率和成本效果比,了解每获得1%有效率所需成本。结果:60例伴有疼痛症状的抑郁症患者,男23例,女37例,经过8周治疗,多维干预组患者的HAMD17和VAS评分显著优于药物治疗组,成本效果分析显示,尽管认知行为治疗和生物反馈治疗导致成本增加,但是每获得1%有效率所需成本仍显著低于药物治疗组。结论:多维干预模式治疗抑郁症患者的疼痛症状疗效更佳,且具有更好的经济学价值。     

针刺配合磁圆梅针治疗膝关节骨性关节炎的临床研究

观察针刺配合磁圆梅针治疗膝关节骨性关节炎的临床疗效。选取2014年1月~2016年1月笔者所在医院门诊膝关节骨性关节炎患者80例,随机分为治疗组和对照组,各40例。治疗组行磁圆梅针配合针刺治疗,对照组单纯给以药物治疗,持续四周,比较两组间治疗效果差异。结果磁圆梅针配合针刺治疗组治疗有效率为97.5%,药物治疗组治疗有效率为87.5%。疗效评价提示两种疗法均对患者的疼痛程度及症状积分有明显作用,差异有统计学意义(P0.05);磁圆梅针配合针刺治疗组较药物治疗组在疼痛视觉模拟量表评分(VAS)及症状积分方面的改善作用更为显著,差异有统计学意义(P0.05)。针刺配合磁圆梅针治疗膝关节骨性关节炎具有显著疗效。     

药物联合认知行为治疗精神分裂症的效果

目的探讨药物联合认知行为治疗精神分裂症的临床效果。方法将120例精神分裂症患者按随机数字表法分为观察组和对照组,每组60例。2组均采用常规的药物治疗。在此基础上,对照组采用支持性心理治疗,观察组采用认知行为治疗。观察2组治疗前、治疗24周后阳性和阴性症状量表(PANSS)评分及临床疗效。结果观察组总有效率为95.0%,明显高于对照组的68.3%(P<0.05)。观察组治疗24周后PANSS评分为(35.0±3.2)分,明显低于对照组的(48.0±5.4)分(P<0.05)。结论药物联合认知行为治疗精神分裂症有较好的效果,能够改善患者的临床症状,促进患者的康复。     

胃肠安丸治疗功能性腹泻60例临床观察

目的:评价胃肠安丸治疗功能性腹泻的疗效和安全性。方法:将120例患者随机分为2组:治疗组60例给予胃肠安丸治疗,对照组60例舒丽启能(马来酸曲美布汀片)治疗,疗程为4周。比较治疗组不同观察时点各症状积分情况,并比较治疗组与对照组临床疗效,同时观察有无副作用。结果:治疗组有效率98.3%,对照组有效率61.67%,2组比较差异有统计学意义(P0.05);治疗14d有效率70.00%,治疗28d有效率98.3%,2组比较差异有统计学意义(P0.05);治疗组不同时点各症状积分与治疗前比较,差异有统计学意义(P0.05);用药期间未发现明显不良反应。结论:胃肠安丸治疗功能性腹泻效果显著,且随着疗程的延长有效率逐渐提高,疗程长,效果好,是安全、有效的药物。     

豁痰活血法治疗原发性癫痫临床研究

目的:观察以豁痰活血为治法的抗痫煎剂对具有痰瘀表现的原发性癫痫的临床疗效。方法:将符合诊断和治疗标准的80例原发性癫痫患者随机分为治疗组和对照组各40例。治疗组以抗痫煎剂联合常规抗癫痫药物治疗,对照组以常规抗癫痫药物治疗。结果:治疗组有效率95.0%,观察组有效率77.5%。2组临床有效率差异有统计学意义(P0.05)。综合治疗后,癫痫中医症状比较,差异有统计学意义(P0.05)。治疗后2组患者脑电图改善情况,差异有统计学意义(P0.05)。结论:治疗组治疗原发性癫痫的有效率优于对照组,治疗组在改善原发性癫痫患者中医临床症状、脑电图等方面也优于对照组,且治疗组不良反应较轻。     

超短波联合药物治疗小儿肺炎的临床效果

目的探讨超短波联合药物治疗小儿肺炎的效果与安全性。方法将2012年12月至2016年12月北京世纪坛医院82例肺炎患儿随机分成观察组与对照组,观察组采用超短波联合药物治疗,对照组采用单纯药物治疗。比较2组患儿的治疗疗效、症状缓解时间及不良反应。结果治疗7d后,观察组和对照组的临床总有效率分别为97.56%和82.93%,差异有统计学意义(P0.05);观察组患儿体温恢复正常时间、咳嗽消失时间、肺部啰音消失时间及住院时间明显短于对照组,差异有统计学意义(P0.05)。结论超短波联合药物治疗小儿肺炎显著缩短临床症状恢复时间和住院时间,提高临床疗效且安全性较高。     

氟哌噻吨美利曲辛辅助治疗心血管疾病合并心理障碍的临床观察

目的:探讨氟哌噻吨美利曲辛辅助常规药物治疗心血管疾病合并心理障碍的临床效果。方法:选取在我院住院治疗的心血管疾病合并心理障碍的患者112例,随机分为观察组和对照组。对照组采用常规治疗高血压和冠心病的药物治疗;观察组在对照组的基础上加用氟哌噻吨美利曲辛进行综合治疗。两组患者均给予相应的心理干预。结果:观察组治疗有效率(89.3%)、焦虑抑郁症状改善有效率(94.8%)明显高于对照组(P0.05)。结论:氟哌噻吨美利曲辛联合心血管药物治疗可有效改善心血管疾病合并心理障碍患者的症状,提高治疗效果。     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.