上下台阶方法的生物力学研究

目的：从运动学角度对不同上下台阶方法的差异进行比较分析，取得科学数值。方法：以3名健康青年男性为研究对象，利用三维动作分析系统(VICON612)及肌电图仪检测膝关节力矩和股四头肌收缩强度的变化值。结果：不同方法上下台阶时的膝关节力矩有差异，而膝关节屈曲角度未见明显不同；上台阶时的肌肉活动强度要比下台阶时大。结论：膝关节屈伸力矩、内外翻力矩以及股四头肌收缩强度均按正面一脚一阶、正面两脚一阶、横面两脚一阶、斜面两脚一阶的顺序逐渐减小。     

急诊病人的氧治疗

氧是维持生命的必需物质．是机体进行物质代谢、产生热量、保证生长活动的重要物质。然而—个正常机体体内氧贮量约为1000ml左右氧耗250ml／min，仅能供3-5min消耗，而大脑无氧代谢只能维持8min左右，进入急诊科救治的病人许多会有不同程度的缺氧。因此，纠正缺氧的首先方法应是在改善通气功能的同时进行氧的体外供给，通过提高暇人气体中氧浓度，使其分压上升．提高动脉氧分压．改善通气、换气功能。也就是维持正常的外呼吸和内呼吸。     

无创正压通气辅助治疗急性重症支气管哮喘12例体会

目的：总结无创正压通气辅助治疗急性重症支气管哮喘的临床效果。方法：对我科2003年2月～2005年10月住院的12倒急性重症支气管哮喘监测血气指标，氧饱和度心率和呼吸频率；在常规治疗基础上给无创正压通气治疗。结果：12例经无创正压通气治疗前后血气指标明显改善，心率和呼吸频率降低。结论：急性重症支气管哮喘早期使用无创正压通气对改善和阻止病情恶化有积极作用。     

无创正压通气治疗在急性心源性肺水肿中的应用

目的 探讨双水平气道正压通气（BiPAP）治疗急性心源性肺水肿的疗效。方法 将40例急性心源性肺水肿患者分为两组：对照组20例，采用常规吸氧及药物治疗；BiPAP组20例，常规药物治疗的基础上，给予双水平正压通气。观察治疗前后血压、心率、呼吸频率以及血气分析。结果 两组治疗后心率、血压、呼吸频率、氧合指数、动脉血pH均有明显改善；BiPAP组通气治疗后0．5小时呼吸频率、治疗后1小时心率、氧合指数、动脉血pH较对照组改善更加明显（P〈0．05）。结论 对急性心源性肺水肿应用双水平气道正压通气是安全有效的，值得推广。     

冷环境对运动员身体功能的影响

目的以生理生化理论从体温调节、代谢、损伤及冷适应等方面分析冷环境对运动员身体功能的影响。方法检索冷环境对运动员身体功能影响的文献，并进行相关信息的分析。结果人体处于冷环境中，会加大能量的消耗，从而出现体温下降、代谢、呼吸和循环功能障碍。可引起肢端末梢血管和皮肤血管的收缩，心率加快，氧耗量增加。冷环境中运动容易造戍运动损伤，同时暴露的身体还容易造成冻伤。充分的准备活动、合适的服装及呼吸的方法可防止冷环境中的运动损伤。结论在冷环境中进行运动训练或比赛会使运动员机体代谢、运动能力等方面受到影响。进行适当预防措施，可减少冷环境对运动员身体功能的不良影响。     

自制15°斜坡垫肩背部斜仰卧位联合下半身截石位在复杂性肾结石患者术中体位护理中的应用

目的：分析自制15°斜坡垫肩背部斜仰卧位联合下半身截石位在复杂性肾结石患者术中体位护理中的应用效果。方法：选取2018年5月~2020年2月收治的复杂性肾结石患者109例，均行经皮肾镜联合输尿管镜取石术，其中55例采用自制15°斜坡垫肩背部斜仰卧位联合下半身截石位为试验组，另54例采用常规体位为对照组。比较体位摆放时间、手术时间、术中出血量、术后出血量、生命体征（舒张压、收缩压、心率、呼吸频率、血氧饱和度）、舒适度、术后残石率。结果：试验组体位摆放时间较对照组短、术中出血量较对照组少（P＜0.05）；两组舒张压、收缩压、心率、呼吸频率、血氧饱和度比较，差异无统计学意义（P＞0.05）；试验组舒适度评分高于对照组（P＜0.05）；试验组术后残石率5.45%（3/55）低于对照组18.52%（10/54）（P＜0.05）。结论：自制15°斜坡垫肩背部斜仰卧位联合下半身截石位应用于复杂性肾结石临床手术，可缩短体位摆放时间，减少术中出血量，降低术后残石率，提高舒适度。     

索他洛尔与胺碘酮对运动心电和运动生理的作用比较

目的 比较索他洛尔与胺碘酮对运动心电图和血流动力学的影响。方法 采用单盲、自身前后对照研究索他洛尔与胺碘酮对3l例无器质性心脏病患者运动心电图、运动血压及心率一收缩压乘积的影响。结果 与胺碘酮比较，索他洛尔显著降低运动心率、收缩压及心率一收缩压乘积，不影响心率储备、运动时间和运动当量；与用药前比较，索他洛尔与胺碘酮均显著延长静态和运动各级爪间期，但是在运动过程中，与用药前及胺碘酮比较，索他洛尔致爪间期加速缩短并与心率呈正相关。结论 索他洛尔可显著降低运动氧耗量，有抗心肌缺血作用；和胺碘酮比较，索他洛尔延长运动JTc的作用表现为加速缩短(逆频率依赖现象)，提示其在运动中抗心律失常作用减弱。     

山羊烧伤后高代谢状态及与肿瘤坏死因子的关系

研究烧伤后高代谢状态及其与肿瘤坏死因子（ＴＮＰ）的关系。在短时间将山羊全身麻醉后用９５℃水烫两侧臀部和大腿３０ｓ造成面积为２０％～２５％的３度烧伤，６ｈ后按Ｐａｒｋｌａｎｄ公式输入生理盐水，伤后每日测定有关指标直至死亡。结果：氧耗量从烧伤后２４ｈ起逐日升高，第３天达高峰，为基础值的１５０％，死前下降；心率、体温、血白细胞计数及心指数从第１天起均升高，第３天达峰值，ｐ值均＜０．０１，此后下降，但仍高于基础值；外周血管阻力从烧伤后２４ｈ起下降，第３天最低，Ｐ＜０．０１；烧伤后２４ｈ起血浆ＴＮＦ升高，第３天达高峰，Ｐ＜０．０１，此后虽有下降仍显著高于基础值；烧伤后１～４天氧耗量和血浆ＴＮＦ均呈显著正相关；烧伤后第１天起血浆皮质醇和生长激素未见升高。研究表明：山羊２０％～２５％３度烧伤延迟复苏后约２／３出现高代谢状态和高动力循环。ＴＮＦ释放可能是本研究中出现高代谢的重要因素。     

冷环境对运动员身体功能的影响

目的以生理生化理论从体温调节、代谢、损伤及冷适应等方面分析冷环境对运动员身体功能的影响。方法检索冷环境对运动员身体功能影响的文献,并进行相关信息的分析。结果人体处于冷环境中,会加大能量的消耗,从而出现体温下降、代谢、呼吸和循环功能障碍。可引起肢端末梢血管和皮肤血管的收缩,心率加快,氧耗量增加。冷环境中运动容易造成运动损伤,同时暴露的身体还容易造成冻伤。充分的准备活动、合适的服装及呼吸的方法可防止冷环境中的运动损伤。结论在冷环境中进行运动训练或比赛会使运动员机体代谢、运动能力等方面受到影响。进行适当预防措施,可减少冷环境对运动员身体功能的不良影响。     

肺部围手术期综合呼吸功能训练对术后并发症的影响

目的探讨肺部围手术期不同呼吸功能训练方式对术后肺功能及术后并发症的影响。方法选择本科肺部手术病人100例，按住院序号分为观察组和对照组，各50例。对照组给予常规护理＋腹式呼吸和缩唇呼吸训练；观察组在对照组基础上加用呼吸功能训练器进行综合呼吸功能训练，观察呼吸频率、最大通气量、时间通气量、指脉氧饱和度。结果两组患者术前训练后呼吸频率显著降低（P〈0．01），最大通气量、时间通气量、指脉氧饱和度均有不同提高，两组比较，观察组优于对照组（P〈0．01）。术后训练第4天两组指脉氧饱和度及术后并发症发生率比较有显著性差异（P〈0．01）。结论不同呼吸训练方法均能改善病人肺功能，增加手术耐受性，减少术后并发症，但使用呼吸功能训练器优于其他呼吸功能训练方法；其训练方法直观、病人易于掌握、效果显著，具有较好的临床应用价值。     

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."