一种腹部脏器体积较精确的超声测量方法

本文提出了一种较精确的主要用于腹部脏器容积的测量和计算方法。它在计算机帮助下使用普通超声诊断仪实现其功能。通过两次手动操作游标钩画二维图像的解剖轮廓，即可迅速得到体积测值。     

Combined measurements of N-terminal pro-brain natriuretic peptide and cardiac troponins in potential organ donors

Objective Brain death may induce cardiac dysfunction. In potential organ donors measurements of N-terminal pro-brain natriuretic peptide (NT-proBNP) and circulating cardiac troponins T and I (cTnT and cTnI), alone or in combination, are performed to investigate the accuracy of these biomarkers for early diagnosis of left ventricular systolic dysfunction. Design and setting Prospective study in a multidisciplinary intensive care unit of an university hospital. Patients 63 brain-dead patients scheduled for multiple organ harvesting. Measurements and results We measured NT-proBNP, cTnT, and cTnI and determined fractional area change (FAC) using transesophageal echocardiography. Forty-five patients had normal FAC, 9 a moderate decrease in FAC (30–50), and 9 a severe decrease in FAC (≤ 30%). NT-proBNP and cTnT concentrations were significantly higher in patients with a severe decrease in FAC than in those with a moderate decrease. Combining measurements of these two biomarkers, the sensitivity of the test to predict severe decrease in FAC increased significantly to reach 1.00 compared with the sensitivities of individual measurements. The ROC curve area of combined measurements of NT-proBNP and cTnT was significantly higher than single measurements: 0.87 vs. 0.82 for NT-proBNP, 0.78 for cTnT, and 0.72 for cTnI. Conclusions In potential organ donors the combined measurement of NT-proBNP and cTnT concentrations is more accurate than individual measurement of NT-proBNP, cTnT, and cTnI in the early diagnosis of severe left ventricular systolic dysfunction. These findings may lead to improve the quality of cardiac care of the potential organ donors.     

Urine measurement indicates the plasma brain natriuretic peptide concentration during optimization of heart failure treatment

Aim: To assess the correlation between the amino-terminal pro-hormone brain natriuretic peptide (NT-proBNP) concentration in blood and urine during a period when actively adjusting the treatment of heart failure (HF). Methods: Plasma and urine analyses of NT-proBNP were compared in 51 patients on admission to and discharge from a nurse-led outpatient clinic where HF treatment was optimized. The median time between the two measurements was 42 days. Correlations were analyzed using linear regression, where R² is the degree of variability in the plasma NT-proBNP concentration that can be accounted for by the urinary NT-proBNP. Results: There was a statistically significant linear relationship between the urine and plasma concentrations of NT-proBNP on both occasions, but R² varied greatly depending on how the data were presented. The correlation between the raw data showed an R² of only 30%, and it almost doubled upon logarithm transformation, which shows that the variability (error) was concentration-dependent. Correction of the urinary NT-proBNP for urinary creatinine further increased R² for the logarithm-transformed correlation to 68% on admission and 76% on discharge. The highest R² (77%) was obtained when the relative changes in urinary NT-proBNP/creatinine between admission and discharge were compared with the corresponding relative changes in the plasma concentration. The sensitivity and specificity of the urine in indicating plasma concentration changes?>?10% were 82% and 86%, respectively. Conclusion: Relative changes in plasma NT-proBNP could be reliably estimated from urine samples during a period of optimization of HF treatment.     

肺感染致多器官功能障碍综合征血清瘦素浓度的变化

目的检测肺部严重感染所致多器官功能障碍综合征(MODS)、急性心肌梗死(AMI)和心律失常(AR)等危重症患者血清中瘦素(Leptin)及相关因子水平的变化,探讨Leptin在MODS发病及诊断中的可能意义。方法采用放射免疫分析法测定Leptin、脂肪酸结合蛋白(FABP)、转铁蛋白(Ferr)以及白细胞介素1β(IL1β)水平,采用酶联免疫吸附法(ELISA)测定C反应蛋白(CRP)水平。结果与正常对照组相比,Leptin水平在MODS、AMI和AR组均明显增高(P均<0.01);CRP和IL1β水平在MODS、AMI和AR组均显著增高(P<0.05或P<0.01),以MODS组患者增高更明显(P均<0.05);FABP和Ferr在3组患者中也均有明显上升趋势,特别是在MODS组中上升更多,但统计学上差异无显著性。结论肺感染所致MODS患者血清中Leptin水平明显上升,伴有CRP和IL1β同时升高,Leptin可能在MODS的发生和转归中发挥一定作用。     

Impaired chemoreflex sensitivity in adult patients with multiple organ dysfunction syndrome—the potential role of disease severity

Objective The cardiac chemoreflex sensitivity is a powerful predictor of autonomic dysfunction in chronic heart failure and after myocardial infarction. The objective of the present study was to characterize cardiac chemoreflex sensitivity in patients with multiple organ dysfunction syndrome (MODS). We also aimed to elucidate the effect of the severity of MODS on the assessment of cardiac chemoreflex sensitivity.Design Prospective cohort study.Setting Twelve-bed medical intensive care unit in a university center.Patients Forty consecutively admitted patients with MODS during a 7-month period. Patients with MODS were identified by an APACHE II score of 20 or more. Sepsis was defined as a Sepsis Score, according to Elebute and Stoner, of 12 or more.Interventions The cardiac chemoreflex sensitivity was assessed using the regression of heart interval (ms) versus arterial oxygen pressure (mmHg).Measurements and results First, we established a new method to assess cardiac chemoreflex sensitivity and applied it to healthy controls and patients. Second, we found that cardiac chemoreflex sensitivity correlated with the severity of MODS as calculated by the APACHE II score (r²=0.34, p=0.001). This relation was best fitted by a model including minimum heart rate and standard bicarbonate in 24 h (r²=0.5, p<0.001) and Glasgow Coma Scale (r²=0.5, p=0.005). Age, however, did not significantly contribute (r²=0.001, p=0.8).Conclusions The calculation of cardiac chemoreflex sensitivity enabled us to quantify an important component of the cardiorespiratory interactions in patients with MODS. Severity of illness was a more pronounced determinant of impaired cardiac chemoreflex sensitivity than age. The quantification of the cardiorespiratory interactions by measuring the cardiac chemoreflex sensitivity has potential to identify a subgroup of patients with worse prognosis.     

Fear of fear and the anxiety disorders

The responses of 271 outpatients with diagnoses of agoraphobia with panic attacks, panic disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, or depression (major depressive disorder or dysthymic disorder) to the Agoraphobic Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ) were examined. Agoraphobics scored significantly higher than all other groups on fear of body sensations associated with anxiety. In addition, agoraphobics, together with clients with panic disorder, had significantly higher scores on thoughts that physical illness would be caused by their anxiety. All clinical groups scored significantly higher than normal controls on thoughts that their anxiety would lead to social embarrassment or loss of control; there were no significant differences among clinical subjects on this measure, although agoraphobics' scores were higher than those of all other groups. In addition, analyses of data from 364 agoraphobics showed that the ACQ and BSQ predicted an important feature of agoraphobia—namely, self-reported avoidance behavior, even once the common variance of fear of fear with trait anxiety was partialed out. In summary, it appears that fear of fear is an important distinguishing characteristic among clients with anxiety disorders, and one that cannot be reduced to global psychological distress or trait anxiety.The authors wish to thank Aaron T. Beck, Gary Brown, and Gail Steketee, whose cooperation in data collection made this study possible; Nazareth Pantaloni, for his assistance in data analysis; and Carol Glass, for her helpful comments on an earlier draft of this paper.     

Planning locally relevant Internet programs for secondary prevention of cardiovascular disease

Background

Although the Internet has been shown to be an effective tool for supporting behavioural change in other chronic diseases, less in known about the efficacy of, or need for, Internet-based interventions in the prevention of coronary heart disease (CHD).

Aims

We investigated computer literacy, consumer need and perceived usefulness of the Internet as a secondary prevention tool in people with CHD.

Methods

A two-step mixed-method process was used that included a survey and two focus groups. The 12-item survey explored participants' access and confidence using the Internet. For the focus groups, we used standard methodology.

Results

We recruited 66 (88% response rate) consecutive cardiac patients; age 36–73 years (mean 64 ± 13), mostly male (85%), whose primary language was predominantly English (67%). Seventy percent had a home computer with Internet access but only 20% reported researching their heart-health online. There was polarity between those with and without Internet access. Further, we found less women than men could complete online forms (p = 0.03) and that participants aged over 65 years were less likely to access the Internet (p < 0.01) and had lower confidence (p < 0.01) than younger counterparts. Focus groups revealed challenges of an online secondary prevention service, but participants valued relevant, practical advice and placed strong emphasis on simple web design.

Conclusion

Using a mixed-methods process we collected locally sensitive information about Internet usage and recommendations for future online health-management strategies. Some patients have more confidence using the Internet, therefore a range of multi-technological secondary prevention interventions should be considered based on individual need.     

可溶性P-选择素及血栓调节蛋白在多器官功能障碍综合征早期诊断中的意义

目的 :观察多器官功能障碍综合征 (MODS)患者的内皮细胞功能改变 ,寻求早期诊断方法。方法 :采用免疫荧光技术连续监测 30例 ICU中严重感染、创伤患者外周血可溶性 P选择素 (s P选择素 )和血栓调节蛋白 (TM)浓度的动态变化 ,并计算其诊断 MODS的灵敏度、特异性和正确诊断指数。结果 :发生 MODS患者的 s P选择素、TM水平比未发生 MODS患者明显升高 (P均 <0 .0 5 )。 s P选择素对 MODS的诊断灵敏度高 ,但特异度不理想 ,诊断能力不高 ;提高诊断的截断值其特异度和正确诊断能力提高。TM对 MODS诊断的灵敏度高而特异度不足 ;诊断能力低 ;提升截断值后灵敏度下降 ,特异度提高 ,诊断能力提高 ,但 TM仍不足以作为独立的 MODS诊断指标。两个指标联合诊断意义更大。结论 :s P 选择素联合 TM有助于 MODS早期诊断     

Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror

Sayer NA, Chiros CE, Sigford B, Scott S, Clothier B, Pickett T, Lew HL. Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror.

Objective

To describe characteristics and rehabilitation outcomes among patients who received inpatient rehabilitation for blast and other injuries sustained in Iraq and Afghanistan during the Global War on Terror.

Design

Observational study based on chart review and Department of Veterans Affairs (VA) administrative data.

Setting

The 4 VA polytrauma rehabilitation centers (PRCs).

Participants

Service members (N=188) admitted to a PRC during the first 4 years of the Global War on Terror for injuries sustained during Operation Iraqi Freedom or Operation Enduring Freedom.

Intervention

Multidisciplinary comprehensive rehabilitation program.

Main Outcomes Measures

Cognitive and motor FIM instrument gain scores and length of stay (LOS).

Results

Most war-injured patients had traumatic brain injury, injuries to several other body systems and organs, and associated pain. Fifty-six percent had blast-related injuries, and the pattern of injuries was unique among those with injuries secondary to blasts. Soft tissue, eye, oral and maxillofacial, otologic, penetrating brain injuries, symptoms of post-traumatic stress disorder, and auditory impairments were more common in blast-injured patients than in those with war injuries of other etiologies. The mechanism of the injury did not predict functional outcomes. LOS was variable, particularly for those with blast injuries. Patients with low levels of independence at admissions made the most progress but remained more dependent at discharge compared with other PRC patients. The rate of gain was slower in this low-functioning group.

Conclusions

Blasts produce a unique constellation of injuries but do not make a unique contribution to functional gain scores. Findings underscore the need for assessment and treatment of pain and mental health problems among patients with polytrauma and blast-related injuries. Patients with polytrauma have lifelong needs, and future research should examine needs over time after community re-entry.