脂质水胶体敷料治疗浅Ⅱ度烫伤患儿的疗效观察

目的 观察采用脂质水胶体敷料换药对患儿浅Ⅱ度烫伤治疗的效果。方法 将63例浅Ⅱ度烫伤患儿随机分为实验组36例和对照组27例。实验组采用脂质水胶体敷料治疗创面,对照组采用磺胺嘧啶银霜治疗创面,比较两组患儿创面干燥天数、愈合时间及换药次数。结果 实验组在创面干燥天数、愈合时间及换药次数均少于对照组,两组比较差异具有非常显著性(P<0.01)。结论 脂质水胶体敷料治疗患儿浅Ⅱ度烫伤创面,能够促进创面愈合和减少换药次数,提高治疗效果。     

用患者中位数连续实时监测分析过程中的误差

目的 模拟患者数据并建立以中位数的改变实时监测分析过程中误差的方法。方法 利用计算机模拟足量符合偏态分布的患者数据,选取中位数达到稳定所对应的n个数据作为中位数质控的一个分析批,计算每批的中位数,并计算所有中位数的均数`M和标准差δ,作为分析方法中位数质控图的靶值与标准差,`M±2S作为警告线,`M±3S作为控制线。再模拟需要实时监测的患者数据,连续计算数据A₁到A_n的中位数M₁,A₂到A_n+1的中位数M₂,依次类推,得到中位数M₁ 、M₂、M₃……,绘制在中位数质控图中。再分别模拟分析过程第350-550个数据出现3倍正偏倚和第100-300个数据出现3倍负偏倚,可通过中位数质控图直观地判断分析方法出现正负偏倚的时间和持续的时长。结果 本次模拟数据达到稳定所需的患者数据个数n=60,依据质控设计方法处理模拟数据,绘制中位数质控图,模拟3倍正偏倚时,中位数质控图中第335个数据点(第394个模拟数据)开始警告存在系统误差,第345个数据点(第404个模拟数据)开始出现失控;模拟3倍负偏倚时,中位数质控图中第87个数据点(第146个模拟数据)开始警告存在偏倚,第98个数据点(第157个模拟数据)反映出失控。结论 应用患者数据中位数能连续实时监测分析过程中的误差,通过中位数质控图中数据的改变能可视化地警告实验室人员存在系统误差,并在较短时间内反映出失控状态,有助于分析过程中的误差控制。     

脂质水胶体敷料联合表皮生长因子治疗浅Ⅱ度烫伤的疗效观察

目的观察脂质水胶体敷料联合表皮生长因子治疗浅Ⅱ度烫伤的疗效,探求一种操作简单、安全有效容易被患者接受的烫伤换药新方法。方法将864例轻、中度烫伤的患者按单双号分为观察组和对照组。观察组采用脂质水胶体敷料联合表皮生长因子,对照组采用磺胺嘧啶银传统无菌包扎法。比较两组创面患者更换敷料时有无创面粘连发生、有无疼痛、出血及伤口换药次数、愈合时间。结果观察组患者更换敷料时无创面粘连发生,平均治愈时间明显少于对照组且患者疼痛较轻(P0.05)。结论脂质水胶体敷料联合表皮生长因子治疗患者浅Ⅱ度烫伤,具有不粘连创面、换药无疼痛及出血、加速创面愈合等优点,值得在浅Ⅱ度烫伤患者中推广。     

莫匹罗星联合磺胺嘧啶银治疗糖尿病合并压疮的疗效观察

目的 探讨莫匹罗星（百多邦）软膏联合磺胺嘧啶银治疗Ⅲ期、Ⅳ期压疮的临床疗效.方法 将收入院的85例糖尿病合并压疮患者随机分为实验组（43例）和对照组（42例）,治疗组采用莫匹罗星软膏联合磺胺嘧啶银局部外用,对照组采用胰岛素外用联合红外线照射,观察两组疗效.结果 实验组治疗Ⅲ期、Ⅳ期压疮的治愈率为81.4%,对照组治愈率为42.9%,2组疗效差异有统计学意义（P＜0.01）结论百多邦软膏联合磺胺嘧啶银治疗Ⅲ期、Ⅳ期压疮安全、有效.     

穴位自血疗法联合痤疮散外敷对痤疮疗效及肿瘤坏死因子-a 、白细胞介素8的影响

目的：探讨采用穴位自血疗法联合痤疮散外敷治疗痤疮的作用机理及对肿瘤坏死因子-α（TNF-α）及患者血清中白细胞介素8（IL-8）的影响。方法将本院2012年11月～2013年10月皮肤科收治的180例面部痤疮患者随机分为观察组、对照1组、对照2组,每组60例;另选择健康体检者50例为对照3组。观察组患者采用穴位自血疗法及痤疮散面部外敷治疗痤疮;对照1组采用穴位自血疗法;对照2组给予罗红霉素胶囊口服及阿达帕林凝胶外用;对照3组未做任何治疗。观察痤疮治疗效果及治疗前、治疗后第4周、第8周、第12周三组患者皮损状态、皮损计数;TNF-α与IL-8指标。结果观察组痊愈率、总有效率明显优于对照组,差异有显著意义（P＜0．05）;观察组治疗前、治疗后第4周、第8周、第12周,平均皮损数量减少与对照组比较差异有显著意义（ P＜0．05）;观察组TNF-α与IL-8治疗前、治疗后第4周、第8周、第12周与对照组比较,差异有显著意义（P＜0．05）。结论采用穴位自血疗法结合痤疮散外敷治疗面部痤疮并实施专业护理,能有效促进痤疮恢复,且总有效率高。TNF-α和IL-8均参与了痤疮的发病过程,与痤疮的严重程度成正比,在痤疮皮损的形成中起着重要作用。随着用药时间的增长,TNF-α和IL-8明显降低,说明该联合治疗法对痤疮有明显疗效。     

磺胺嘧啶银乳膏联合金因肽治疗糖尿病足溃疡的疗效观察

目的探讨磺胺嘧啶银乳膏联合金因肽对糖尿病足溃疡的治疗效果。方法将糖尿病足30例随机分为对照组和治疗组。对照组创面应用碘伏换药,治疗组创面以磺胺嘧啶银乳膏联合金因肽治疗,每日换药1次,两组其他治疗相同。治疗6周后,观察两组肉芽生长情况和创面愈合率。结果治疗组肉芽生长和创面愈合率明显高于对照组(P<0.05)。结论磺胺嘧啶银乳膏联合金因肽能有效抑制糖尿病足创面细菌生长,促进创面愈合。     

1例藤黄微球菌致腹膜透析相关隧道炎的护理

介绍了1例藤黄微球菌致腹膜透析相关隧道炎的护理经验,强调护理过程中应注意排脓、隧道冲洗、应用磺胺嘧啶银脂质水胶体敷料填塞引流,经积极治疗及护理20d后病人痊愈出院。     

1例藤黄微球菌致腹膜透析相关隧道炎的护理

介绍了1例藤黄微球菌致腹膜透析相关隧道炎的护理经验,强调护理过程中应注意排脓、隧道冲洗、应用磺胺嘧啶银脂质水胶体敷料填塞引流,经积极治疗及护理20 d后病人痊愈出院.     

α-促黑色素细胞激素和KPV合成肽对烫伤大鼠血浆白介素-10水平的调节作用

目的观察烫伤大鼠血浆白介素-10(IL-10)水平的变化及α-促黑色素细胞激素(α -MSH)、合成肽KPV(Ac-Lys-L-ProD-Val)对其产生的调节作用.方法采用酶联免疫吸附法(ELISA)检测正常对照组、轻度烫伤组和重度烫伤组大鼠血浆IL-1 0的水平.采用体内注射肿瘤坏死因子-α(TNF-α)和IL1β中和抗体及α-MSH和合成肽KPV等措施调节其改变.收集大鼠腹腔巨噬细胞,体外观察α-MSH及KPV对其产生IL-10的影响.结果烫伤后12小时的血浆IL-10水平,轻度烫伤组[(83.97±16.08)ng/L]显著高于正常对照组[(6.70±3.93)ng/L,P<0.01] ,重度烫伤组大鼠血浆[(177.50±15.79)ng/L]又明显高于轻度烫伤组(P<0.01 );而抗TNF-α治疗组[(107.84±11.05)ng/L]、抗IL-1β治疗组[(105.22±23.01)ng/L]和α-MSH治疗组[(118.43±18.75) ng/L]及KPV治疗组[(124.69±24.27)ng/L]则均明显低于重度烫伤组(P均<0 .01).α-MSH和KPV可以刺激腹腔巨噬细胞分泌IL-10,分别为 (50.48±15.42)ng/L和(48.94±15.47)ng/L.结论不同程度的烫伤可使大鼠血浆IL-10水平升高,尤以重度烫伤升高更加明显.体内注射TNF-α和IL-1β中和抗体及αMSH和KPV均使重度烫伤大鼠血浆IL-10水平下降.α-MSH 和KPV可刺激大鼠腹腔巨噬细胞分泌IL-10.     

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."