脂联素及其基因多态性与某地冠心病的相关性研究

目的探讨某地瑶族冠心病(CHD)患者血清脂联素(APN)水平及其基因位点+45T/G和-11377C/G的多态性与该地区瑶族健康者、汉族CHD患者、汉族健康者的差异。方法采用酶联免疫吸附(ELISA)方法检测瑶族CHD患者、瑶族健康者、汉族CHD患者和汉族健康者(各100例)血清APN水平;使用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测APN基因位点+45T/G和-11377C/G的多态性。结果 (1)2组CHD患者血清APN水平明显低于2组健康对照者,差异有统计学意义(均P0.05)。2组CHD患者血清APN水平差异无统计学意义(P=0.076)。(2)在H-W平衡检验中,4组研究对象APN基因位点+45T/G和-11377C/G均有群体代表性(均P0.05)。(3)瑶族CHD患者ANP+45TG、GG基因型频率均高于瑶族健康者,但差异无统计学意义(P0.05);汉族CHD患者ANP+45基因型等位基因频率略高于瑶族CHD患者,但差异无统计学意义(P0.05)。(4)CHD患者ANP-11377基因型和等位基因频率与同民族健康者比较,差异有统计学意义(P0.05);瑶族CHD患者APN-11377基因杂合程度略低于汉族CHD患者,但差异无统计学意义(P0.05)。结论血清低APN水平和APN-11377位点是瑶族CHD患者的危险因素,与汉族CHD患者相同。     

脂联素及其基因多态性与广西瑶族冠心病的关系

目的 探讨广西地区瑶族冠心病患者血清中脂联素(APN)水平及其基因位点+276 G/T和-11377 C/G的多态性。方法 瑶族、汉族冠心病患者、瑶族和汉族正常人各100例纳入研究。采用酶联免疫吸附法(ELISA)检测研究对象血清中APN水平,聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测APN基因位点+276G/T和-11377C/G的多态性。结果 ①两组冠心病组血清中APN水平明显低于两组正常组,差异有统计学意义(t=10.311,8.642; 均P=0.000)。瑶族冠心病组和汉族冠心病组血清中APN的差异无统计学意义(t=1.792,P=0.076); ②在H-W平衡检验中,四组中APN基因位点+276G/T和-11377C/G均具有群体代表性(均P＞0.05); ③四组APN+276G/T位点的主要型别是野生型。4组间APN+276G/T位点的等位基因频率均无显著差异(均P＞0.05); ④冠心病组ANP-11377C/G基因型和等位基因频率与同民族正常组的差异有统计学意义(χ²=8.908,P=0.012; χ²=17.275,P=0.000); 瑶族冠心病组APN-11377C/G基因杂合程度略低于汉族冠心病组,但差异无统计学意义(χ²=0.363,P=0.834)。结论 同汉族冠心病一样, 血清低APN水平和APN-11377C/G位点是瑶族冠心病患者的危险因素。     

半胱氨酸蛋白酶抑制剂C及其基因多态性与广西壮族、汉族代谢综合征的相关性

目的探讨半胱氨酸蛋白酶抑制剂C(Cys C)水平及其基因位点+148和+73的多态性与广西壮族及汉族代谢综合征(MS)的相关性。方法用免疫比浊法检测壮族、汉族MS患者和壮族、汉族健康人(各100例)血清中Cys C水平,用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测Cys C+148和+73基因位点的多态性,分析血清Cys C水平及Cys C的基因多态性与壮族及汉族MS的相关性。结果壮族及汉族MS患者血清中Cys C水平分别与健康人对照组间差异有统计学意义(P均0.05)。壮族、汉族MS患者组及壮族、汉族健康人对照组Cys C+73、Cys C+148位点不同基因型分布频率差异均无统计学意义(χ~2=3.139,P=0.791;χ~2=4.841,P=0.564)。壮族、汉族MS组Cys C+73位点为GG基因型的患者Cys C水平低于AG和AA型,差异均有统计意义(P均0.05)。MS组外周血Cys C水平与肌酐水平相关(P0.01),与Cys C+73基因位点多态性亦有相关性(P0.01)。结论广西地区壮族、汉族MS患者Cys C+73位点不同基因型Cys C水平存在差异,且与肌酐有关。     

广西地区胱抑素C及其单核苷酸多态性与冠心病的关系

目的探讨广西地区胱抑素C(Cys C)水平及其基因位点+73A/G和-82G/C多态性与冠心病(CHD)的相关性。方法选择壮族CHD患者、壮族体检健康者(壮族正常对照组)、汉族CHD患者和汉族体检健康者(汉族正常对照组)各100例,采用免疫比浊法检测血清Cys C水平,聚合酶链反应(PCR)-限制性片段长度多态性(RFLP)检测Cys C+73A/G和-82G/C位点的基因多态性,同时收集一般临床资料。结果CHD组与同民族正常对照组之间血清Cys C水平及一般临床资料差异均有统计学意义(P0.05);CHD组Cys C+73A/G位点基因型频率与同民族正常对照组比较,差异均有统计学意义(P0.05),且GG基因型的CHD患者Cys C水平明显低于AG和AA型(P0.05),而AG与AA基因型之间差异无统计学意义(P0.05)。CHD组血清Cys C水平与肌酐(Cr)水平、Cys C+73A/G基因位点呈正相关(r=0.60,P0.01;r=0.42,P0.01)。结论 CHD患者肾功能下降引起的Cys C水平升高掩盖了Cys C+73A/G基因多态性所致的低Cys C水平。Cys C+73A/G基因多态性所致的低Cys C水平可能是广西地区人群CHD的易感因素。     

胱抑素C及其基因多态性与广西壮族人群代谢综合征的研究

目的探讨胱抑素C(Cys C)水平及其基因位点+148G/A、+73A/G和-82G/C的多态性与广西壮族人群代谢综合征(MS)的相关性。方法采用免疫比浊法检测壮族、汉族MS患者和壮族、汉族健康人(各100例)血清中Cys C水平,聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测Cys C基因位点+148、+73和-82的多态性。结果 (1)4组间Cys C水平和临床指标差异有统计学意义(P0.05),两个民族MS组临床指标和血清中Cys C水平较两组健康组差异有统计学意义(P0.05);(2)4组中外周血Cys C水平与肌酐(Cr)水平呈正相关(r=0.551,P=0.000);(3)4组间Cys C+73、Cys C+148、Cys C-82位点的等位基因分布频率差异均无统计学意义(χ~2=3.139,P=0.791;χ~2=4.841,P=0.564;χ~2=3.207,P=0.782);(4)Cys C+73位点GG基因型MS患者Cys C水平显著低于AG和AA型,差异有统计意义(P0.05),而AG型与AA型之间Cys C水平差异无有统计学意义(P0.05)。结论肾功能受损引起的高水平Cys C可能是广西地区壮族、汉族MS患者的一个危险因素;Cys C+73位点基因多态性与广西壮族人群MS患者的关系需进一步研究。     

脂联素基因rs2241766 多态性与代谢综合征的相关性研究

目的 探讨脂联素(adiponectin,APN)rs2241766基因多态性与代谢综合征(metabolic syndrome,MS)患者发生的关系。方法 410例MS患者和203例健康人群纳入研究。使用酶联免疫吸附试验(ELISA)检测研究对象的血清APN水平,采用限制性片段长度多态性聚合酶链反应(PCR-RFLP)技术检测APN基因rs2241766 位点T/G基因的多态性,分析各基因型与MS发生的关系。结果 MS患者血清APN水平明显低于对照组(15.3 ± 4.4 mg/ml vs 27.2 ± 6.5 mg/ml),差异有统计学意义(χ²=41.7,P< 0.001); rs2241766位点三种基因型在MS组与对照组间的分布,差异有统计学意义(χ²=39.222,P< 0.001),MS组G等位基因频率高于健康人群,差异有统计学意义(χ²=36.657,P< 0.001); logistic回归分析显示研究组G等位基因发生MS的风险高于T等位基因(OR=2.19, 95% CI:1.17～3.01 vs OR=1.00ref),差异有统计学意义(P=0.034,<0.05)。TG和GG基因型发生MS的风险较TT基因型增高(OR=1.55, 95% CI:0.79～2.83; OR=2.48, 95% CI:1.67～7.35 vs OR=1.00ref),将TG和GG基因型合并后发生MS风险同样增高(OR=2.23,95% CI:1.21～6.09),差异均有统计学意义(P=0.019,0.006,0.029),且TG(15.7± 4.1 mg/ml)及GG(14.3 ± 4.5 mg/ml)基因型研究对象的APN水平低于TT基因型(18.7± 4.9 mg/ml),差异有统计学意义(F=7.621,P< 0.001)。结论 MS的发生可能与rs2241766位点的基因变异相关,尤其是T向G变异的个体发生MS的风险更高,使APN水平降低。     

脂联素启动子基因多态性与2型糖尿病及并发症的相关性研究

目的 观察脂联素(APN)启动子基因单核苷酸多态性(SNP)频率与2型糖尿病(T2DM)及其合并症间的相关性,探讨脂联素基因(aPM1)突变是否是T2DM遗传的危险因素.并确立一种高效、准确、经济的检测APN基因实用筛查方法,供临床检测应用.方法 对单纯T2DM49例(男28例,女21例)、T2DM合并高血压(T2DM-HP)90例(男51例,女39例)、T2DM合并冠心病(T2DM-CHD)33例(男15例,女18例)、T2DM合并肾病(T2DM-NE)41例(男18例,女23例)患者和健康对照组58名(男30名,女28名),测定空腹血清生化指标.采用变性高效液相色谱(DHPLC)技术,筛选APN基因多态性位点.结果 在APN基因(aPM1)启动子区扩增的片段与基因库中登陆的APN GeneID:9370序列相比,存在点突变(-11377G/C).GG、GC、CC基因频率在T2DM组和对照组分别为:5.16%、42.25%、52.58%和3.40%、32.75%、63.85%.T2DM患者aPM1 的SNP-11377位点G等位基因频率明显高于健康对照组(x2=6.818,OR=0.55,P=0.033).从T2DM基因型分组临床资料比较可见,-11377G/C基因型与T2DM患者的收缩压(P=0.035)、体重指数(BMI)(P=0.010)、腹围(P=0.013)和腰臀比(P=0.015)显著相关.通过对试验条件优化,在采用DHPLC技术检测APN基因多态性位点发现,本试验检测柱温以60℃最佳.结论 aPM1启动子区SNP-11377C/G多态性与T2DM及并发症的发生和T2DM患者体型肥胖形成机制有相关性,提示SNP.11377C/G多态性可能增加T2DM的遗传风险.     

广西地区壮族和汉族冠心病患者胱抑素C水平及其基因多态性的比较研究

目的探讨广西地区壮族冠心病患者血清中胱抑素C(Cys C)水平及其基因位点+148 G/A和-82 G/C的多态性与同地区汉族冠心病(CHD)患者及两个民族正常人的不同。方法采用免疫比浊法检测壮族、汉族CHD患者和壮族、汉族正常个体(各100例)血清中Cys C水平,聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测Cys C基因位点+148和-82的多态性,并分析上述数据和临床资料。结果①两组CHD组血清中Cys C水平和临床资料与两组正常组间的差异有统计学意义(P值均0.05);②四组中Cys C基因位点+148和-82等位基因分布频率符合H-W群体遗传平衡法则(P值均0.05),具有群体代表性。CHD组Cys C基因+148和-82位点不同基因型分布频率较同民族正常组虽有差异,但差异均无统计学意义(X~2=0.760~2.090,P0.05);③CHD病组血清中Csy C水平与Cr呈正相关(r=0.597,P0.001)。结论 Cys C基因位点+148和-82的多态性与广西地区的壮族、汉族CHD相关性需作进一步研究,但肾损伤引起的高Cys C血清水平可能是广西地区壮族、汉族CHD患者的一个危险因素。     

中国人群脂联素基因+276G/T位点多态性与T2DM易感性的Meta分析

目的 探讨中国人群脂联素基因+276G/T位点多态性与2型糖尿病(T2DM)的相关性.方法 检索2011年8月前中国知网、维普中文科技期刊全文数据库、中国万方数据库、中国学位论文全文数据库和中国重要会议论文全文数据库及Medline、Cochrane Library、Embase、Springer、Ovid等数据库,收集有关中国人群脂联素基因+276G/T位点多态性与T2DM相关性研究的文献;评价纳入研究质量,提取有效数据,采用Review Manager 5.0软件进行Meta分析.结果 共纳入11项研究中国人群脂联素基因+276G/T位点多态性与T2DM相关性的病例对照研究;T2DM患者1 697例,健康对照者1 341例.Meta分析结果显示,脂联素基因+276G/T位点G/T多态性与T2DM的相关性中T等位基因与G等位基因(OR=0.83,95% CI为0.65～1.05,P=0.12)、基因型(GT+TT)与GG(OR=0.82,95% CI为0.60～1.12,P=0.20)、基因型GT与GG(OR=0.93,95%CI为0.63～1.38,P=0.72)、基因型TT与GG(OR=0.81,95%CI为0.46～1.42,P=0.46)比较,差异均无统计学意义.结论 中国人群脂联素基因+276G/T位点多态性可能与T2DM易感性无关.     

宁夏地区汉族代谢综合征患者脂联素基因多态性与冠心病的相关性研究

目的 探讨宁夏地区汉族代谢综合征(MS)患者脂联素(APN)水平及其单核苷酸基因多态性(SNP)+45T/G和+276G/T两个位点与冠心病(CHD)的关系.方法 302例研究对象分为正常对照组、代谢综合征(MS)组、代谢综合征合并冠心病(M+C)组,采用实验-对照研究方法,应用酶联免疫吸附法(ELISA)及聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术,对血浆APN水平及APN两个位点基因多态性进行检测.结果 与对照组相比,MS组及M+C组血浆APN水平降低(P<0.05);与对照组及MS组相比,M+C组SNP+45TG+GG基因型及G等位基因的分布频率明显降低(P<0.05).多因素逐步Logistic回归分析显示,SNP+276基因多态性为MS危险因素,SNP+45G等位基因为CHD的保护因素.结论 MS患者APN水平降低,携带SNP+276T等位基因者患MS的风险增加,携带SNP+45G等位基因的MS患者发生CHD的危险性减小.     

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.     

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.     

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.     

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.