中老年高尿酸血症与肥胖、冠心病和脂肪肝的相关性调查

目的了解高校中老年高尿酸血症（Hum）的发病及其与伴发肥胖（超重）、冠心病和脂肪肝的相关性。方法对1080例年龄在45岁以上的中老年知识分子进行常规体检。结果Hum组伴发的肥胖（超重）、冠心病和脂肪肝患病率与非Hum组的患病率相比较差异有统计学意义。Hum的患病与肥胖（超重）、冠心病、脂肪肝均有相关性；Hum的患病与性别有关，男性发病率高于女性（P〈O．05）。结论控制高校中老年Hum的发病，提出预防模式，减低与相关疾病的危害程度有重要意义。     

某社区高血压患病情况及相关危险因素的回顾性分析

目的探讨东营市社区人群高血压患病情况及相关危险因素的回顾性分析。方法采用横断面调查对来院体检的24～78岁部分人群进行回顾性统计分析。结果受检1038例,高血压总患病率达48．3％,其中男性患病率为54．1％,女性患病率为39．9％,男性患病率高于女性,差异有统计学意义（ P＜0．01）。各个年龄段的男性高血压患病率均高于女性患病率,其中,以40～49岁和50～59岁年龄段差异最为明显,差异均有统计学意义（ P＜0．01及 P＜0．05）。调查中高血压知晓率约为61．9％,控制率为17．7％。多因素Logistic回归分析显示,年龄、性别、肥胖、吸烟、饮酒、食盐摄入量及高血脂为高血压的危险因素。结论本地区高血压患病率较高,且控制率较低,年龄、性别、肥胖、吸烟、饮酒、食盐摄入量及高血脂等7项指标为高血压的危险因素,提示应对高血压给予重视并早期及时的做好高血压的防护措施。     

北京市民警高尿酸血症患病情况的调查

目的调查jE京市某区民警高尿酸血症的患病率并分析患病特点。方法对2013年1476名体检的男性在职民警进行横断面调查,通过体检报告单对数据进行统计学分析。结果该人群中高尿酸血症的患病人数378人,患病率达25．61％;年龄分组,〈40岁人群患病率为27．63％,≥40岁人群患病率为23．10％,两组比较差异有统计学意义（x2=3．925,P=0．048）;高尿酸血症患者和非高尿酸血症者在年龄、空腹血糖、HDL—C、腰围、体质指数、收缩压、舒张压、总胆固醇、甘油三酯、LDL—C、血尿酸等方面比较差异均有统计学意义（t分别为-2．27,-2．48,-3．23,9．63,5．28,5．20,5．13,4．97,7．65,3．32,46．67;P〈0．05）。结论北京某区在职民警高尿酸血症患病率较高,低年龄组尿酸血症患病率高于高年龄组,高尿酸血症的发生也伴随着代谢性疾病的发生,应注重对此部分人群的健康教育。     

青岛某海军院校干部高尿酸血症与血脂水平相关性分析

目的：了解人群中高尿酸血症与总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）和三酰甘油（TG）水平相关性及临床意义。方法采用酶比色法对机关及文职干部151例（男142例,女9例）进行了血尿酸（UA）、TC、HDL-C 和 TG 检测,分析高尿酸血症与血脂水平相关性。结果男性尿酸、TC、TG 水平明显高于女性;HDL-C 水平显著低于女性水平,差异有统计学意义（均 P ＜0．01）;高尿酸组的 TC、TG 水平明显高于正常尿酸组;HDL-C 水平显著低于正常尿酸组,差异具有统计学意义（TC 比较 P ＜0．05,其余均 P ＜0．01）;36～46岁年龄组的尿酸、TC、TG 水平明显高于22～35岁年龄组;HDL-C 水平显著低于22～35岁年龄组（均 P ＜0．01）。结论血尿酸水平存在明显性别差异;高尿酸血症人群存在明显的血脂代谢紊乱,应引起临床对此类患者的足够重视。     

中老年知识分子高尿酸血症与高血压、高血脂、高血糖的相关性调查

目的了解高校中老年知识分子高尿酸血症（Hum）及其与伴发三高症（糖尿病、高血压病、高脂血症）的相关性，认识其危害性。方法对本校1080例年龄在45岁以上的中老年知识分子进行常规健康体检。结果经统计学分析，发现Hum组伴发“三高症”的患病率与非Hum组的患病率相比较，差异有统计学意义（P〈0．01）。Hum的患病与性别有关，男性发病率高于女性。经统计学分析男女性别间差异有统计学意义（P〈0．05）。Hum的患病随年龄的增长而增高，且75岁以上呈下降趋势。结论提出高校社区服务模式，减低与相关疾病的危害程度。     

徐州市居民高血压患病率及危险因素的调查

目的了解高血压流行情况及危险因素。方法采用多阶段分层随机抽样方法,选择徐州地区20～75岁常住人口17500人,采用统一调查表进行一般情况、高血压患病情况及相关危险因素调查。结果徐州市人群高血压患病率为20．87％,标化患病率为16．97％;患病率与年龄呈正相关（P〈0．01）。城市、农村患病率分别为28．77％和17．22％,城市高于农村（P〈0．01）。男女性别患病率差异无统计学意义（P〉0．05）。城乡、年龄、经济收入、家族史、饮酒、BMI、腹型肥胖、婚姻与高血压发病有关,其中年龄、家族史、饮酒、超重、肥胖、腹型肥胖是高血压的危险因素,良好的婚姻状况是高血压保护性因素。结论徐州2008年高血压患病率高于2000年徐州同年龄人群。需积极调动社区高血压防治工作,将重心前移,对有高血压家族史、超重肥胖、分居、丧偶、饮酒人群进行干预。     

血脂异常与高尿酸血症的相关探讨

目的了解血脂异常患者血尿酸含量变化和临床意义。方法选取血脂异常患者335例，其中男162例，女173例，年龄35～55岁，以体检无血脂异常健康人群376名为对照组。结果血脂异常组有64例（19．1％）和对照组有8例（2．13％）血尿酸（UA）≥420μmol／L，两组患病率差异有统计学显著性意义（P〈0．001），其中血脂异常高尿酸患病率男性比例高于女性（0．05〈P〈0．1），血脂两项以上指标升高者，高尿酸血症明显高于血脂单项指标升高者（P〈0．01），LDL升高与血脂异常患者发生高尿酸有相关性，高尿酸组尿素氮、血糖高于正常对照组（P〈0．01）。结论血脂异常患者高尿酸血症患病率较正常人群高，应引起临床对此类患者血尿酸、尿素氮及血糖水平变化的重视。     

珠海地区干部高尿酸血症相关性分析及健康教育

目的:了解珠海地区机关干部高尿酸血症人群分布情况,分析体质指数、饮酒、进食高嘌呤食物等不良饮食习惯与其发病率的相关性。方法:以2008年7~12月珠海市干部体检人群为研究对象,测定其体质指数、血尿酸水平,并向其发放调查问卷,了解其饮食习惯。结果:珠海市干部人群高尿酸血症总患病率为35.42%,以中年组(40~49岁)发病率最高,达57.28%;其中男性发病率(30.90%)显著高于女性(4.52%);高尿酸血症人群超重或肥胖(BMI≥24)发生率显著高于非高尿酸血症人群(P0.05);高尿酸血症人群中饮酒和食用高嘌呤食物的人数高于非高尿酸血症人群(P0.05)。结论:珠海市干部体检人群高尿酸血症发病率高并与性别、超重或肥胖、不良饮食习惯呈显著正相关系,要建立和加强高尿酸血症的护理干预和健康教育体系。     

钦州地区痛风和高尿酸血症影响因素流行病学研究

目的了解钦州地区痛风和高尿酸血症的患病率及相关影响因素。方法采用问卷调查、体格检查及实验室检查等方式对钦州地区常住人口进行调查,统计痛风和高尿酸血症患病率,根据血尿酸水平分为高尿酸血症组和正常血尿酸组,比较两组生活习惯、合并疾病情况,分析不同年龄段不同性别高尿酸血症患病情况,采用多因素Logistic回归模型分析高尿酸血症的危险因素。结果 3 783例被调查者中痛风患病率1.67%(63/3 783),其中男性患病率2.81%(51/1 818),高于女性的0.61%(12/1 965),差异有统计学意义(P0.05);男性血尿酸水平(377.49±72.52)μmol/L高于女性[(291.38±39.14)μmol/L],差异有统计学意义(P0.05);高尿酸血症患病率21.04%(796/3 783),其中男性患病率26.90%(489/1 818)高于女性[15.62%(307/1 965)],差异有统计学意义(P0.05);高尿酸血症组吸烟、饮酒、超重或肥胖、糖尿病、高血压、高胆固醇血症、高三酰甘油血症发生率依次为31.03%、41.96%、58.92%、11.18%、24.87%、10.93%、40.95%,与血尿酸正常组的17.01%、23.97%、37.93%、8.37%、12.76%、5.42%、15.97%比较,差异有统计学意义(P0.05);男性、年龄≥50岁、超重或肥胖、饮酒、高胆固醇血症、高三酰甘油血症是高尿酸血症的危险因素(P0.05)。结论钦州地区居民高尿酸血症及痛风患病率较高,应针对其危险因素采取早期预防措施,患者应积极治疗。     

健康体检人群高尿酸血症患病率及危险因素分析

目的 了解高尿酸血症的危险因素,以便为针对性的健康教育提供依据.方法 对在绍兴华宇医院体检的1657人进行身高、体重、血压、实验室检测、B超及心电图检查.结果 患高尿酸血症者197人(11.89%).患病年龄分布在17～64岁,男性患病率高于女性,男女患病率比较,差异有统计学意义(P＜0.01);高尿酸血症与血尿酸正常者不良生活习惯比较,差异有统计学意义(P＜0.01).结论 高尿酸血症的发生与年龄、性别有关,随着年龄的增长而增高,发病原因与某些危险因素如肥胖、高脂血症、糖尿病、饮食习惯不良、饮酒、活动少有关.     

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.     

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.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.