Propofol versus Midazolam/Fentanyl for Reduction of Anterior Shoulder Dislocation

OBJECTIVE: The authors aimed to compare propofol and midazolam/fentanyl for reduction of anterior shoulder dislocations using the modified Kocher's maneuver. METHODS: This was a multicenter, randomized, clinical trial of patients with anterior shoulder dislocation. Patients were randomized to either propofol or midazolam/fentanyl. The randomized drug was titrated to a clinical sedation end point (spontaneous eye closure). One physician sedated the patient. Another, blinded to the drug administered, reduced the shoulder and recorded details of muscle tone and ease of reduction. RESULTS: Eighty-six patients were randomized to treatment with propofol (n = 48) or midazolam/fentanyl (n = 38). Patients in the propofol group had shorter mean times to first wakening (difference in means, 4.6 minutes; 95% confidence interval [CI] = 0.7 to 8.6; p = 0.097) and full consciousness (difference in means, 21.7 minutes; 95% CI = 14.7 to 28.7; p <0.001), had easier shoulder reduction (difference in mean rating, 0.5; 95% CI = 0.0 to 0.9; p = 0.047), and needed fewer reduction attempts (difference in means, 0.5; 95% CI = 0.1 to 1.0; p = 0.02). Patients in the propofol group also had less mean muscle tone at the first reduction attempt (p = 0.08) and needed fewer reduction maneuvers (p = 0.40) but had more respiratory depression (11 vs. six patients; difference in proportions, 7.1%; 95% CI = -11.8 to 26.1; p = 0.58) and had one patient who vomited. CONCLUSIONS: Propofol appears to be as effective as midazolam/fentanyl for reduction of anterior shoulder dislocation using the modified Kocher's maneuver. However, the advantage of shorter wakening times associated with propofol should be weighed against the possibility of adverse events, particularly respiratory depression and vomiting.     

壳聚糖/肝素和壳聚糖/重组水蛭素共价包被镍钛合金片的体外生物相容性

目的:体外评价生物活性分子共价包被镍钛金属片后的生物相容性。方法:实验于2005-11/2006-10在南京医科大学心血管药理实验室完成。实验材料:镍钛合金片(镍含量55.3%～55.6%,钛含量43.5%～44.2%,厚度0.05cm,激光切割为0.5cm×0.5cm);壳聚糖(脱乙酰度90%,Mr200000);肝素、重组水蛭素。实验分组:①实验分4组:未包被组、壳聚糖组、壳聚糖/肝素组、壳聚糖/重组水蛭素组。将壳聚糖、肝素(1g/L)和重组水蛭素(20mg/L)用共价化学交联法包被于镍钛金属片单面。②溶血实验:将各组样品加0.2mL稀释血液和10mL生理盐水。阳性对照和阴性对照分别用10mL蒸馏水和10mL生理盐水各加0.2mL稀释血,与样品同样操作。③人全血动态接触实验:各组镍钛合金片分别放入10mL新鲜的人全血后行扫描电镜检查,并检测血常规(红细胞计数、白细胞计数、血小板计数)及凝血3项(部分凝血活酶活化时间、凝血酶原时间、凝血酶时间)。④内皮细胞种植、培养:人脐静脉内皮细胞培养、传代后,植入每孔已放入1片镍钛金属片的24孔板中,倒置显微镜下观察人脐静脉内皮细胞生长情况及细胞形态。⑤免疫荧光标记:Fn免疫荧光染色(红色激发波长510nm)观察细胞生长和黏附情况,Ki67免疫荧光标记(绿色激发波长510nm)观察细胞增殖情况。实验评估:①各组血液样本溶血率。②各组人全血接触实验后血液样本血细胞计数和凝血活性。③扫描电镜下各组人全血接触实验后镍钛金属片表面形态。④倒置显微镜下人脐静脉内皮细胞形态。⑤荧光显微镜下镍钛金属片表面人脐静脉内皮细胞生长、黏附情况。⑥荧光显微镜下镍钛金属片表面人脐静脉内皮细胞增殖情况。结果:①溶血率:各组镍钛金属片溶血率均小于1.7%。②血细胞计数和凝血活性:各组接触血液后红细胞、白细胞和血小板计数与未接触血液无差别;壳聚糖/重组水蛭素组与壳聚糖/肝素组部分凝血活酶活化时间、凝血酶原时间和凝血酶时间值较未包被组和壳聚糖组明显延长,差异有显著性意义(P<0.001);壳聚糖/重组水蛭素组部分凝血活酶活化时间和凝血酶时间值较壳聚糖/肝素组延长,差异有显著性意义(P<0.005)。③扫描电镜下各组人全血接触实验后镍钛金属片表面形态:镍钛合金片表面有纤维蛋白黏附、血小板黏附和聚集,顺序依次为壳聚糖组>未包被组>壳聚糖/肝素组>壳聚糖/重组水蛭素组。④倒置显微镜下人脐静脉内皮细胞形态:与人脐静脉内皮细胞72h孵育,见各组镍钛金属片边缘细胞生长、移行良好,无细胞变形。⑤荧光显微镜下镍钛金属片表面人脐静脉内皮细胞生长、黏附情况:利用Fn免疫荧光标记人脐静脉内皮细胞,镍钛金属片表面的人脐静脉内皮细胞黏附和生长顺序如下:壳聚糖组>未包被组>壳聚糖/重组水蛭素组>壳聚糖/肝素组。⑥荧光显微镜下镍钛金属片表面人脐静脉内皮细胞增殖情况:利用Ki67免疫荧光标记人脐静脉内皮细胞,镍钛金属片表面的人脐静脉内皮细胞增殖顺序如下:壳聚糖组=未包被组>壳聚糖/重组水蛭素组>壳聚糖/肝素组。结论:壳聚糖/肝素与壳聚糖/重组水蛭素包被镍钛金属后具有良好抗凝血活性,但壳聚糖/重组水蛭素与壳聚糖/肝素相比更有利于人脐静脉内皮细胞的生长。     

大鼠海马神经细胞体外缺糖缺氧模型制备方法的改进

目的:改进培养大鼠海马神经细胞体外缺糖缺氧模型制备方法,并通过兴奋性氨基酸N-甲基-D-天冬氨酸受体拮抗剂进行验证。方法:实验于2004-09/2005-06在南方医科大学基础医学院神经生物学教研室进行。实验材料:出生1d内清洁级SD大鼠,由南方医科大学实验动物中心提供(合格证号为粤证监字2004B023号)。N-甲基-D-天冬氨酸受体拮抗剂5-甲基二氢丙环庚烯亚胺马来酸(MK-801)和D-2-氨基-5-磷酰基戊酸(d-APV)购自Sigma公司。实验方法:取新生1dSD大鼠海马组织作神经细胞分散细胞原代培养,培养到13d时进行氧/葡萄糖剥夺模型的制备:将neurobasal培养基更换为不含葡萄糖的BSSo培养基,连续充以50mL/LCO2 950mL/LN2(体积比)混合气体。缺氧30,45,60,90min后取出细胞,更换为正常neurobasal培养基,恢复正常条件继续培养。将神经细胞随机分为正常对照组、单纯缺氧组、无糖缺氧组、MK-801组和d-APV组。将10μmol/LMK-801和500μmol/Ld-APV在通50mL/LCO2 950mL/LN2混合气前加入到BSSo培养基,缺氧结束后随BSSo培养基一起去掉。复氧24h后采用MTT比色法测神经细胞成活率及Hoechst荧光染料法测神经细胞凋亡率。结果:①随着氧/葡萄糖剥夺时间延长,神经细胞存活率下降。氧/葡萄糖剥夺30,45,60,90min再复氧24h,神经细胞存活率分别为(81.48±3.84)%、(63.14±3.14)%、(41.73±2.97)%和(16.78±2.12)%。②N-甲基-D-天冬氨酸受体拮抗剂MK-801(10μmol/L)和d-APV(500μmol/L)均能明显增加神经细胞存活率(P<0.05),并且两组细胞存活率与正常对照组比较,差异无统计学意义(P>0.05)。结论:实验制备的海马神经细胞短时间氧/葡萄糖剥夺模型可对神经细胞造成迟发性死亡,兴奋性氨基酸N-甲基-D-天冬氨酸受体拮抗剂可保护氧/葡萄糖剥夺诱导的神经细胞损伤,说明本实验建立的缺氧模型有效并简便可靠,并且缩短了缺氧时间。     

The Accuracy of Oral Predictive and Infrared Emission Detection Tympanic Thermometers in an Emergency Department Setting

OBJECTIVE: To assess the accuracy of an oral predictive thermometer and an infrared emission detection (IRED) tympanic thermometer in detecting fever in an adult emergency department (ED) population, using an oral glass mercury thermometer as the criterion standard. METHODS: This was a single-center, nonrandomized trial performed in the ED of a metropolitan tertiary referral hospital with a convenience sample of 500 subjects. The temperature of each subject was taken by an oral predictive thermometer, an IRED tympanic thermometer set to "oral" equivalent, and an oral glass mercury thermometer (used as the criterion standard). A fever was defined as a temperature of 37.8 degrees C or higher. The subject's age, sex, triage category, and diagnostic group were also recorded. Sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, and corresponding 95% confidence intervals were calculated. Logistic regression was used to identify predictors of fever. RESULTS: The sensitivities and specificities for detection of fever of the predictive and the IRED tympanic thermometers were similar (sensitivity 85.7%/88.1% and specificity 98.7%/95.8%, respectively). The predictive thermometer had a better positive predictive value (85.7%) compared with the IRED tympanic thermometer (66.1%). The positive and negative likelihood ratios for the predictive oral thermometer were 65 and 0.14, respectively, and for the IRED tympanic thermometer 21 and 0.12, respectively, indicating that the predictive thermometer will "miss" 1 in about 7 fevers and the IRED tympanic thermometer will "miss" 1 in about 8 fevers. CONCLUSIONS: Although quick and convenient, oral predictive and IRED tympanic thermometers give readings that cannot always be relied on in the detection of fever. If we are to continue using electronic thermometers in the ED setting, we need to recognize their limitations and maintain the importance of our clinical judgment.     

成都地区50岁以上骨质疏松患者QCT骨密度在不同性别及体质量间的差异

目的:分析成都地区50岁以上骨质疏松患者羟磷灰石定量计算机断层扫描骨密度的变化及部分影响因素。方法:①对象:选择2004-05/2006-02在成都市温江区人民医院内分泌科住院的原发性骨质疏松患者189例。男80例,年龄(69.21±8.87)岁,女109例,年龄(67.14±8.85)岁。②分组:按年龄分为50～59岁,60～69岁,70～79岁,≥80岁4个组,按体质量指数分为<18.5,18.5～23.9,24.0～27.9,≥28.0kg/m2,即消瘦、正常、超重和肥胖4个组。③评估:用国产HK-2000QCT骨矿密度测定校验体模系统测定腰椎L1～3骨密度,分别探讨年龄和体质量指数与QCT骨密度的关系。结果:①男女两组50岁以上骨质疏松患者QCT测定的L1～3骨密度和T值均随年龄增加而逐渐降低,二者与年龄呈直线负相关关系(P<0.01)。②女性患者在60～79岁之间骨密度下降速率与相同年龄男性比较更快。③按体质量指数分组,消瘦组骨密度和T值显著低于正常体质量(P<0.05)和超重组(P<0.01),与肥胖组比较差异无统计学意义(P>0.05)。结论:50岁以上骨质疏松患者骨密度降低随年龄增加而逐渐加重,消瘦患者比正常体质量和超重患者骨密度降低更严重。     

ONSET OF ACTION OF EFORMOTEROL BY DRY POWDER INHALER: OBJECTIVE AND SUBJECTIVE MEASURES

SUMMARY This double-blind, randomised, placebo-controlled crossover trial in 18 adults with asthma evaluated the onset of efficacy of doses of 12 and 24μg eformoterol delivered as a dry powder, and compared patients' subjective assessments of efficacy with objective measures. Bronchodilatory efficacy was measured in terms of specific conductance (sGaw) and forced expiratory volume in one minute (FEV₁). With both doses of eformoterol, a bronchodilatory effect was observed one minute after inhalation. The difference in bronchodilator effect (sGaw and FEV₁) between both eformoterol doses and placebo was statistically significant (p<0.01) from one minute onwards. No significant difference in onset of action or peak effect was seen between the two doses of eformoterol. Patients' subjective reports were closely related to the observed onset of efficacy and indicated no difference between the two eformoterol doses.     

Disruption of the Purine Nucleotide Cycle: A POTENTIAL EXPLANATION FOR MUSCLE DYSFUNCTION IN MYOADENYLATE DEAMINASE DEFICIENCY

A patient with symptoms of easy fatigability, postexercise myalgias, and delayed recovery of muscle strength after activity is described. Skeletal muscle from this patient had <1.0% normal myoadenylate deaminase activity and NH₃ was not released from muscle after ischemic exercise. In association with this enzyme deficiency, exercise led to a >90% reduction in muscle content of adenine nucleotides. No inosine monophosphate accumulated after exercise and total purine content of the muscle fell to 21% of control. Repletion of the adenine nucleotide pool in this patient was delayed compared to controls, and ATP content had only returned to 68% of control at 165 min after exercise. These studies demonstrate that disruption of the purine nucleotide cycle as a consequence of myoadenylate deaminase deficiency results in marked alterations in ATP content of muscle, and potentially, these changes in ATP content could account for muscle dysfunction in this patient.     

手术及经皮自体骨髓移植治疗骨延迟愈合和骨不连

观察手术及经皮自体骨髓移植治疗四肢骨折骨不连、骨延迟愈合的临床效果。选择1997-11/2004-02山东省聊城市第二人民医院应用经皮自体骨髓移植法治疗骨不连、骨延迟愈合的患者23例,患者均了解相关治疗目的、方法并同意治疗方案。①17例骨不连患者采用手术治疗。15例存在骨质缺损者在骨折端间隙及周围自体髂骨植骨10例,收集术中骨屑及骨髓原位植骨4例,异体植骨1例;2例单纯外固定架重新固定未植骨并行自体骨髓移植。术后2周抽取自体骨髓注入骨折部位,注射10～20mL/次,每2周1次,需注射2～4次。②6例骨延迟愈合患者仅行自体骨髓移植,未改变固定方式。术后定期随访,观察患者骨折愈合情况。骨折愈合标准:X射线片显示连续骨痂通过折线,骨折处无疼痛及压痛,能够全部负重。23例骨不连、骨延迟愈合患者全部进入结果分析,无脱落。23例患者术后平均随访12.5个月,其中随访7～9个月11例,10～12个月6例,13～15个月5例,16个月1例。23例患者均达到骨性愈合,愈合率100%,平均愈合时间为5.6个月。坚强固定加必要的植骨修复骨缺损是治疗骨折术后骨不连的基础和关键,自体骨髓具有成骨作用,可进一步促进骨折愈合。