腹腔复温对大鼠腹腔低温海水浸泡伤的救治效果

目的　观察腹腔复温对腹腔低温海水浸泡伤大鼠存活的影响。方法　SD大鼠 2 4只 ,随机均分为对照组 (A组 )、腹腔低温海水浸泡组 (B组 )及腹腔低温海水浸泡后复温组 (C组 ) ,观察每一组平均动脉压 (MAP)、心率 (HR)、乳酸 (LA)及乳酸脱氢酶 (LDH)的变化。另取大鼠 4 0只 ,随机均分为腹腔海水浸泡组 (D组 )、腹腔海水浸泡后复温组 (E组 ) ,用以观察腹腔复温后 2 4h死亡率。结果　①术后 2 4hE组大鼠死亡率 (6 / 2 0 )显著低于D组 (15 / 2 0 ) (P <0 0 1)。②低温腹腔海水浸泡后B、C两组大鼠均出现MAP及HR急剧下降 (与浸泡前比较P <0 0 1) ,腹腔灌洗后C组改善快于B组 (P <0 0 5 )。③腹腔灌洗后C组LA及LDH水平显著低于B组 (P <0 0 5 )。结论　腹腔复温有助于纠正低温腹腔海水浸泡伤大鼠血液动力学率乱 ,改善机体代谢 ,提高实验大鼠存活率     

两种低张胶体液腹腔海水浸泡伤战地初步救治的实验效果

目的观察野战环境战地初步救治对腹腔海水浸泡伤实验犬生存的影响.方法杂种犬24只,随机均分为对照组(A组)、右旋糖酐40救治组(B组)及右旋糖酐70救治组(C组),观察每一组腹腔海水浸泡后的存活情况、血浆内毒素水平及组织病理学变化.结果①B、C两救治组长期存活率均为62.5%,显著高于对照组(P＜0.05);②腹腔海水浸泡后12 h始B、C两救治组内毒素水平显著低于对照组;③对照组腹腔海水浸泡后24 h腹腔器官病理改变以化脓性炎症反应为主,而两救治组则以充血水肿性炎症反应为主.结论腹腔海水浸泡伤战地早期补入低张胶体液及完成初步清创能有效减轻机体腹腔感染,提高创伤动物生存率.     

早期应用头孢菌素类抗生素对腹腔海水浸泡伤大鼠的救治研究

目的　观察早期应用头孢菌素类抗生素对腹腔海水浸泡伤大鼠的救治效果。方法　选取SD大鼠 6 0只 ,随机均分为腹腔海水浸泡组 (A组 ,n =30 )及腹腔海水浸泡后治疗组 (B组 ,n =30 ) ,观察每组术后血浆内毒素 (endotoxin ,ET)、肿瘤坏死因子 (tumornecrosisfactor,TNF)、细菌培养水平变化。另外再选取SD大鼠 4 0只 ,随机均分为C组 (n =2 0 )及D组 (n =2 0 ) ,C组处理同A组 ,D组处理同B组 ,观察C、D两组在两种不同处理情况下实验动物的存活情况。结果　①腹腔海水浸泡后两组血浆ET、TNF水平均显著升高 (P <0 0 1) ,而术后 12h始B组水平开始显著低于A组 (P <0 0 5 ) ;②腹腔海水浸泡后 2 4hB组细菌培养总阳性率 (2 /12 )显著低于A组 (8/12 ) (P <0 0 5 ) ;③D组存活率 (9/2 0 )显著高于C组 (2 /2 0 ) (P <0 0 5 )。结论　腹腔海水浸泡后早期应用头孢菌素类抗生素减轻了机体感染和继发损伤的程度 ,有利于提高创伤后动物存活率。     

聚维酮碘腹腔灌洗对腹腔海水浸泡伤大鼠术后败血症的防治作用

目的　观察聚维酮碘腹腔灌洗对防治腹腔海水浸泡伤后败血症的作用。方法　建立大鼠腹腔开放伤动物模型。选取 SD大鼠 84只 ,随机均分为腹腔海水浸泡组 (A组 ,4 2只 )及聚维酮碘灌洗组 (B组 ,4 2只 ) ,观察每个时间点 6只动物处理前后血浆内毒素 (ET)和肿瘤坏死因子 (TNF)的变化及每组 18只大鼠腹腔灌洗后 2 4 h血细菌培养阳性率。结果　 1腹腔海水浸泡后 A、B组 ET及 TNF水平均显著升高 (与浸泡前比较 ,P均 <0 .0 5 ) ;自术后 12 h开始 ,B组血浆 ET及 TNF水平均显著低于 A组 (P<0 .0 5或 P<0 .0 1)。2术后 2 4 h,B组细菌培养总阳性率为 16 .7% (3/ 18) ,显著低于 A组 77.8% (14 / 18,P<0 .0 1)。结论　聚维酮碘灌洗腹腔可显著降低血浆 ET及 TNF水平 ,降低血细菌培养阳性率 ,减少机体败血症发生的可能性。     

地塞米松对腹腔海水浸泡伤的保护作用

目的 :观察早期应用地塞米松 (DXM)对腹腔海水浸泡伤大鼠的救治效果。方法 :将 88只腹腔海水浸泡伤 SD大鼠随机均分为模型组和地塞米松治疗组 ,观察术后不同时间 (n=6 )丙氨酸转氨酶 (AL T)、血清淀粉酶 (AMS)、尿素氮 (BUN)、肌酸激酶 (CK)、丙二醛 (MDA )、超氧化物歧化酶 (SOD)及乳酸 (L A )水平变化 ;同时计算两种不同处理情况下实验动物的存活情况。结果 :地塞米松治疗组术后 12、2 4和 36小时存活率分别为6 0 %、35 %和 2 0 % ,而模型组分别为 35 %、2 5 %和 10 %。治疗组 SOD水平显著高于模型组 (P均 <0 .0 5 ) ,而AL T、AMS、BU N、CK、MDA及 L A水平均显著低于对照组 (P<0 .0 5或 P<0 .0 1)。结论 :腹腔海水浸泡后早期应用 DXM能保护机体多器官功能 ,有利于提高存活率     

早期补入低张胶体液对失血并腹腔海水浸泡伤实验犬血自由基水平的影响

目的　观察早期补入低张胶体液对失血并腹腔海水浸泡伤实验犬血自由基水平的影响。方法　建立失血并腹腔海水浸泡伤动物模型。 35只犬随机均分为对照组 (A组 )、5 %葡萄糖治疗组 (B组 )、0 4 5 %氯化钠 (含 2 5 %葡萄糖液 )治疗组 (C组 )、0 9%氯化钠治疗组 (D组 )及低张胶体液治疗组 (E组 ) ,观察每一组腹腔海水浸泡后丙二醛 (malondialdehyde ,MDA)、超氧化物歧化酶 (superoxidedismutase ,SOD)及乳酸 (lacticacid ,LA)水平的变化。结果　补液后B、C、D、E组MDA及LA水平均显著下降 ,SOD水平显著上升 (与A组比较 ,P <0 0 5 ) ,补液后 2 4hE组MDA及LA水平均显著低于而SOD水平显著高于B、C、D组 (P <0 0 5 )。结论　失血并腹腔海水浸泡伤后早期补入低张胶体液可显著降低血自由基水平 ,改善机体代谢。     

低张胶体液对失血并腹腔海水浸泡伤实验犬的救治作用

目的：观察低张胶体液对失血并腹腔海水浸泡伤的救治效果。方法：建立腹腔海水浸泡伤动物模型。35只犬随机均分为对照组(A组)、质量分数为5％的葡萄糖治疗组(B组)、0．45％氯化钠治疗组(C组)、0．9％氯化钠治疗组(D组)及低张胶体液治疗组(E组)，观察每组动物腹腔海水浸泡后平均动脉压(MAP)、心排血量(CO)、尿量、血浆渗透压及脑、肺组织的病理学变化。结果：低张胶体液可显著改善MAP及CO，增加尿量，降低血浆渗透压，预防脑、肺水肿的发生。结论：低张胶体液对失血并腹腔海水浸泡伤具有较好的救治效果。     

血浆乳酸测定及其在儿科急腹症中的应用

目的　探讨急腹症患儿血浆和腹腔液乳酸测定对小儿急腹症鉴别诊断的意义。方法　用乳酸快速测定仪检测 6 1例急腹症患儿 ,其中腹膜炎组 33例 ,包括绞窄性肠梗阻 3例、肠穿孔腹膜炎 7例、阑尾炎穿孔脓肿2 3例 ;非腹膜炎组 2 8例 ,包括单纯性肠梗阻 8例、肠系膜淋巴结炎 7例 ,单纯性或早期化脓性阑尾炎 1 3例。结果　腹膜炎组血浆乳酸值 [(5 .37± 2 .4 0 )mmol/L]明显高于非腹膜炎组 [(3.71± 1 .0 0 )mmol/L ,P <0 .0 0 1 ];腹膜炎组腹腔液乳酸值 [(1 1 .93± 4 .1 7)mmol/L]明显高于非腹膜炎组 [(4 .2 5± 0 .97)mmol/L ,P <0 .0 0 1 ];腹膜炎组腹腔液 -血浆乳酸的差值均≥ 2 .75mmol/L ,非腹膜炎组 <1 .6 5mmol/L ;腹膜炎组的腹腔液乳酸值水平明显高于血浆乳酸值 (P <0 .0 0 1 )。结论　血浆和腹腔液乳酸的快速测定对小儿急腹症的鉴别诊断有重要意义。     

两种置换液配方在连续性血液净化中的效果比较

目的　置换液的配方关系到连续性血液净化 (CBP)中电解质及酸碱平衡的调控 ,目前较多采用的Port方尚不十分理想 ,需频繁检测患者血生化值 (1～ 2h1次 )进行调整 ,此研究拟探索及评估一种更理想的置换液配方。方法　将我们在临床实践中摸索的自配方与Port方进行比较 ,分动物实验和临床观察 2部分 ,比较 2种配方在CBP中对电解质、渗透压及酸碱平衡维持的差异。结果　自配方的葡萄糖浓度、总分子浓度分别为 16 .2mmol/L、339mmol/L ,比Port方的 6 5mmol/L、36 5mmol/L更接近生理状况 ;动物实验显示自配方组3小时血糖、血钙浓度分别为 (7.2± 0 .7)mmol/L、(2 .3± 0 .2 )mmol/L ,明显好于Port方组的 (14 .2± 1.0 )mmol/L、(1.9± 0 .2 )mmol/L(P <0 .0 1) ;治疗中Port方组渗透压显著上升 (由 (2 98± 8)mOsm/L至 (317± 8)mOsm/L ,(P <0 .0 5 ) ,自配方组变化无显著 ;临床资料也显示了相似的变化趋势。结论　自配方在血糖、血钙及渗透压调控方面较优于Port方 ,似有进一步应用和验证的价值。     

急性心肌梗死患者前驱心绞痛的心肌保护作用

目的 :探讨前驱心绞痛对急性心肌梗死 (AMI)患者的心肌保护作用及其机制。方法 :经冠状动脉造影证实无侧支循环的 2 6 1例首次急性心肌梗死患者 ,分组比较前驱心绞痛对肌酸激酶峰值浓度和左室功能的影响。结果 :2 6 1例患者中 ,有前驱心绞痛组 (A组 ) 92例 ,占 35 2 % ;无前驱心绞痛组 (B组 ) 16 9例 ,占 6 4 8%。肌酸激酶峰值浓度 :A组为 ( 14 2 5± 10 86 )U/L ,显著低于B组的 ( 1747± 115 8)U/L (P <0 0 5 ) ;肌酸激酶同功酶MB (CK MB)的峰值浓度A组 ( 12 8± 10 2 )U/L ,也显著低于B组的 ( 16 3± 10 7)U/L (P <0 0 1)。左室射血分数 :A组 ( 5 1±11) % ,显著高于B组 ( 4 6± 12 ) % (P <0 0 1)。室壁运动Cortina计分 :A组明显低于B组 ( 6 9± 2 4vs 7 6± 2 7,P<0 0 1)。结论 :前驱心绞痛可通过缺血预适应机制对急性心肌梗死后的心脏功能起保护作用     

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.