支气管舒张试验在慢性变异性咳嗽病人中的应用研究

目的探讨支气管舒张试验在慢性变异性咳嗽病人中临床应用的效果。方法选取2015年1月~2015年12月在本院呼吸科初步诊断为变异性咳嗽的病人,行肺通气功能检测后,对肺通气功能正常、小气道功能异常的125例病人做支气管舒张试验,并对通气功能指标(FVC、FEV1、FEF25、FEF50、FEF75)进行试验前后对比。结果做完支气管舒张试验后,病人小气道功能指标明显改变,FEF50、FEF75的改善程度大于FVC、FEV1、FEF25。提示反映小气道功能的指标较大气道的指标在应用支气管舒张剂前后有差异,且差异具有统计学意义(P0.05)。结论支气管舒张试验有利于变异性咳嗽病人的早期明确诊断和规范治疗。     

小气道功能异常对急性支气管炎患者的临床意义

目的探讨小气道功能测定异常对急性气道炎症的临床意义。方法使用Vmax8500肺功能仪测定102例急性支气管炎患者的肺活量（VC）、用力肺活最（FVC）、第一秒用力呼气容积（FEV1）、一秒率（FEV1／FVC）、最大通气量（MVV）、峰值呼气流速（PEF）、用力呼气25％～75％肺活量时的平均流速（FEF25%～75%）、用力呼气50％肺活量的瞬间流速（FEF50%）等。分为小气道功能正常组（52例）与小气道功能异常组（50例）,判定标准：FEV1／FVC≥70％的肺通气功能正常者,FEF25％-75%和FEF50％均小于正常预计值的80％为小气道功能异常。结果2组VC、FVC、FEV-、FEV1／FVC、MVV、PEF等常规肺功能指标均正常（P〉0．05）。但反映小气道功能的FEF25%-75%和FEF50%小气道功能异常组均降低,与正常组差异均有统计学意义（P〈0．05）。结论急性气道炎症患者存在小气道功能异常,小气道功能检测可为诊治提供循证。     

支气管哮喘患者肺功能的变化及临床意义

目的检测哮喘患者的肺功能变化,探讨其在临床诊断及评估分级方面的意义。方法对急性发作期、慢性持续期、临床缓解期共计48例哮喘患者及10例健康人进行肺功能检测。结果哮喘患者FEV1%pred、PEF%pred、FEF25%pred、FEF50%pred、FEF75%pred较健康人均有显著下降,不同分期哮喘患者与健康人比较,FEV1%pred、FVC%pred、FEV1/FVC%、PEF%pred、FEF25%pred、FEF50%pred、FEF75%pred的差异均有统计学意义。结论哮喘患者肺功能变化对其诊断和治疗有重要意义。     

咳嗽变异型哮喘患者T细胞亚群水平变化与小气道功能的关系

目的：探讨咳嗽变异型哮喘（CVA）患者外周血T细胞亚群数量与小气道功能变化的相关性及其临床意义。方法：用流式细胞仪测定分析32例CVA患者（CVA组）及24例健康人（正常组）外周血T细胞亚群（CD2^＋T、CD4^＋T、CD4^＋T、CD4／CD8的比值）水平的变化。并测定反映大气道和小气道（FVC、FEV1和FEF25％-75％、FEF75％-85％）功能的指标。结果：①CVA组患者外周血CD4^＋T及CD4／CD8比值显著高于正常组（P〈0．05，P〈0．01）；CD8^＋T显著性低于正常组（P〈0．01）；CD3^＋T与正常组差异无显著性意义。②CVA组FEF25％-75％及FEF75%-85％值明显低于正常组（P〈0．05）。③FEF25%-75%、FEF75%-85％与CD^4＋T水平皆呈负相关（前者r=-0．462，P=0．021；后者r=-0．461，P=0．019），与CD4／CD8比值也呈负相关（前者r=-0，529，P=0．009，后者r=-0．501，P=0．013）；FVC、FEV1与外周血CD3^＋T、CD4^＋T、CD8^＋T及CD4／CD8比值无相关性。结论：FEF25％-75%、FEF75％-85%对CVA患者的早期诊断有重要意义；CVA患者FEF25%-75%、FEF75％-85％与CD4^＋T、CD4／CD8的比值有负相关性，说明患者体内细胞免疫功能异常，在哮喘变应性气道炎症中起重要作用。可能是导致CVA患者小气道功能进一步减退的原因。早期诊断、治疗CVA，可防止典型哮喘发作，降低入院率及死亡率。     

支气管舒张试验的临床应用探讨

目的探讨科学合理的支气管舒张试验方法。方法对于临床怀疑有气道阻塞，基础肺功能FEV。小于70％预计值的病人，吸入福莫特罗（奥克斯都保）9．0ug，吸入后分别于15min、30min、60min、120min、240min测定FEV1,PEF、FEF25、FEF50、FEF75、FEF25／75、FEV1／FVC，观察各个时间点不同指标的支气管舒张效果。以卡方检验的方式比较各个时间点的阳性率。结果①如果以15min为一个时间点作为判定标准，FEV1作为判定指标，该组病人支气管舒张试验的阳性率为22％。如果继续观察到120min时，其阳性率达到32％（P〈0．05），当观察到240min时阳性率为33％（P〈0．01），有显著差异。②如以PEF作为判定指标，15min时阳性率为19％，30min阳性率达30．5％（P〈0．05），120min达39％（P〈0．01），具有显著差异。③如果以FEF25／75为判定标准，15min其阳性率为29％，60min阳性率为49％（P〈0．01），120min阳性率为53．5％（P〈0．01）。结论用福莫特罗吸入，采用多点连续检测的方法，进行支气管舒张试验，较既往单点检测的支气管舒张试验，更加科学，准确地反映支气管阻塞的可逆性，值得临床推广。     

FEF_(25%～75%)/FVC与气道反应性的相关性分析

目的:探讨反映气道容积相时大小的指标FEF25%-75%/FVC(用力呼出气量为25%-75%肺活量时的平均流量与用力肺活量的比值)与气道对组织胺反应性的相关性.方法:2006年10月至2007年3月,因怀疑患有支气管哮喘在广东省人民医院肺功能室行组织胺支气管激发试验的连续性患者205例,其中激发试验阴性患者108例(激发试验191性组),阳性患者97例(激发试验阳性组).组胺支气管激发试验用反映气道敏感性的指标PD20FEV1 (FEV1 下降20%所需的组胺最低累积剂量)和反映气道收缩性的指标剂量反应曲线的斜率(DRS,FEV1下降的百分比/组胺的累积剂量)来评价.结果:(1)激发试验阳性组FEF25%-75%/FVC值显著低于激发试验阴性组(0.77±0.28 vs 1.02±0.26,P<0.001).(2)通过建立多元线性回归方程,校正了年龄、身高、FEV1占预计值百分比对气道收缩性的影响后,FEF25%-75%/FVC可以解释气道对组织胺收缩性变异14.4%.FEF25%-75%/FVC随着PD20FEV1的降低呈下降趋势.结论:FEF25%-75%/FVC值与气道对组织胺的反应性之间存在负相关性,即相对于肺容积,气道容积越小,气道对组织胺的敏感性和收缩性越强.     

216例支气管激发试验结果及不良反应分析

目的分析接受支气管激发试验患者的试验结果及不良反应。方法采用磷酸组胺直接激发试验,吸入方法选用Chai氏测定法,分0.3%、0.6%、2.5%、5.0%4个浓度进行检测。仪器选用德国耶格组合型肺功能仪。结果进行激发试验的216例患者,以咳喘为主要症状的患者激发试验阳性率(47.62%)明显高于单纯咳嗽患者阳性率(29.55%),差异有统计学意义(χ~2=7.229,P0.05)。支气管激发试验阳性与阴性患者,用力肺活量(FVC)、1s用力呼气容积(FEV1)、呼气峰流量(PEF)差异均无统计学意义(P0.05)。FEV1/FVC、50%肺活量最大呼气流量(FEF50%)、75%肺活量最大呼气流量(FEF75%)和最大呼气中期流量(MMEF)比较,阳性患者低于阴性患者,差异有统计学意义(P0.05)。激发试验阳性患者基础通气功能已经出现下降,小气道阻塞较为明显。大多数患者均有不同程度的不良反应,仅有2例患者出现较为严重的不良反应。结论以咳喘为主要症状、病程较长的患者支气管激发试验阳性率较高;且激发试验阳性患者小气道功能较差;随着气道反应程度的升高,激发后肺通气功能下降幅度增加;支气管激发试验不良反应大多较轻微、持续时间短,临床应用较安全。     

伴和不伴肺功能降低的类风湿关节炎患者Treg变化及新风胶囊对其影响

目的:观察类风湿关节炎(RA)伴肺功能降低和肺功能正常患者外周血调节性T细胞(Treg)的表达,探讨健脾化湿通络中药复方新风胶囊改善RA肺功能的机理。方法:66例RA患者通过肺功能仪检测,根据肺功能的变化分为2组:肺功能降低组为A组,肺功能正常为B组,观察A、B组患者外周血Treg的表达及XFC干预后Treg的变化。结果:RA患者中肺功能降低45例(68.2%),肺功能降低主要以FEV1/FVC、FEF75、FEF50、MVV、FEF25为主;A、B组患者外周血CD4+ CD25+ Treg、CD4+ CD25+ CD127- Treg表达水平均明显低于健康对照组(P<0.05);XFC干预后,A组肺功能参数FEV1、FEV1/FVC、MVV、FEF50均明显升高(P<0.05或P<0.01);RA患者肺功能参数中VC、FEV1、FEF50与CD4+ CD25+ CD127- Treg呈正相关(P<0.05),FEF75与CD4+ CD25+ Treg、CD4+ CD25+ CD127- Treg呈正相关(P<0.01或P<0.05)。结论:RA肺功能改变主要以限制性通气功能障碍并伴有小气道阻塞,同时与Treg表达密切相关;XFC能明显改善RA患者的肺功能,其机理是通过上调CD4+ CD25+ Treg、CD4+ CD25+ CD127- Treg的表达,调节自身免疫功能,增强肺部气体交换,改善肺功能。     

哮喘儿童呼出气一氧化氮与肺功能的相关性分析

目的分析儿童哮喘的呼出气一氧化氮(Fe NO)水平和肺大小气道功能的相关性,以明确Fe NO对于哮喘气道阻塞的诊断价值。方法收集2014年6月至2015年10月在我院哮喘专科门诊确诊为支气管哮喘的4~18岁患儿560例,均进行Fe NO和肺功能检测。肺功能指标包括:大气道功能,包括1秒用力呼气量(FEV1)、用力肺活量(FVC)、峰值呼气流速(PEF);和小气道功能,包括用力呼出25%肺活量时呼气流速(FEF25)、用力呼出50%肺活量时呼气流速(FEF50)、用力呼出75%肺活量时呼气流速(FEF75)、最大呼气中段流量(MMEF)。分析Fe NO值和肺功能各项指标的相关性。结果 560例哮喘儿童Fe NO值为(25.60±21.00)ppb,与肺功能各项指标FEV1、FVC、PEF、FEF25、FEF50、FEF75、MMEF皆存在线性负相关(均P0.05)。结论儿童哮喘的Fe NO水平与肺功能及小气道功能受损相关,可反映儿童哮喘的气道阻塞程度。     

老年支气管哮喘患者气道反应性测定及意义

目的：探讨老年支气管哮喘(哮喘)患者气道反应性特点：方法：对33例老年哮喘患者先运用乙酰甲胆碱进行气道激发试验，后再进行气道扩张试验，观察用力肺活量、第1s用力呼气量、最高呼气流量、用力呼气流速和MMEF变化，并与28例中青年哮喘患者进行比较。结果：老年哮喘气道激发试验阳性所需乙酰甲胆碱浓度高于中青年人(P=0．01)，而气道扩张试验的FEV1、PEF、FEF和MMEF的改善率低于后者(P均≤0．01)，老年组气道扩张试验后FEF和MMEF的改善率均高于FEV。(P均≤0．02)。结论：老年气道反应程度普遍低于中青年人，气道扩张试验后FEF和MMEF的变化较FEV1敏感。     

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.     

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.     

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.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.