高尿酸血症与2型糖尿病大血管病变及高敏C反应蛋白水平的关系

目的观察高尿酸血症（HUA）与2型糖尿病（T2DM）患者大血管病变及血清高敏C反应蛋白（hs-CRP）水平的关系。方法将249例T2DM患者分为T2DM合并HUA（n=98）及血尿酸正常（NUA）组（n=151）。全部对象记录病程、大血管病变史（大血管病变诊断标准：具有高血压、冠心病、脑动脉硬化3项任1项以上）,测身高、体重,计算体重指数（BMI）,收缩压（SBP）、舒张压（DBP）、腰围（WL）、取清晨空腹静脉血,测空腹血糖（FPG）、空腹C肽（FCP）、血尿酸、血脂谱：总胆固醇（TCH）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、糖化血红蛋白（HbA1 C）、血清hs-CRP水平;彩色超声仪测量颈动脉内膜中层厚度（IMT）及颈动脉斑块情况,血管多普勒检测肱踝指数（ABI）。结果①T2DM合并 HUA组患者BMI、WL、SBP、DBP、TCH、TG、LDL-C及hs-CRP均高于NUA组（P＜ 0.05）;②与NUA组比较,T2DM合并 HUA组患者IMT增厚,颈动脉斑块、大血管病变发生率增加（P均＜ 0.05）,而ABI明显降低（P＜ 0.05）。结论 T2DM合并 HUA组患者,颈动脉斑块发生率及大血管病变发生率增加;代谢紊乱及炎性反应参与了颈动脉斑块及大血管病变的形成。     

血尿酸对2型糖尿病心脑血管并发症的影响

目的 评价高尿酸血症对2型糖尿病（T2DM）心脑血管并发症的影响，探讨其可能的作用机制。方法 对288例T2DM患者，根据血尿酸水平分成高尿酸（HUA）组和尿酸正常（NUA）组，分析比较两组及心脑血管等并发症发病率的差别。结果 ①HUA组的血脂TC、TG、LDL—C及BMI、WC均高于NUA组（P〈0.05，P〈0．01），而HDL—C则低于NUA组（P〈0．01）；②HUA组的高血压、冠心病、脑血管病、视网膜病变、肾脏病变、周围神经病变的发病率均高于NUA组（P〈0．05，P〈0．01）。结论 ①高尿酸血症与肥胖、血脂异常明显相关；②高尿酸血症加重T2DM患者的代谢紊乱，并促进心脑血管并发症的发生和发展。     

大学生血尿酸与儿茶酚胺的相关性

目的研究大学生血尿酸(SUA)水平与儿茶酚胺及血压的相关性。方法用R语言分层随机抽样法自参与血压调查的5185名大学生中抽取285人,根据其血尿酸水平分为两组(非高尿酸血症组177例,高尿酸血症组108例),检测血儿茶酚胺、生化等指标并进行组间比较,分析SUA与血肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DA)、收缩压(SBP)、舒张压(DBP)、心率(HR)、体重指数(BMI)、空腹血糖(FBG)、血肌酐(SCr)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)的相关性。结果女生高尿酸血症组血E高于非高尿酸血症组(P<0.05)。大学生人群高尿酸血症组SBP、DBP、BMI、SCr、SUA、TC、TG、LDL-C均高于非高尿酸血症组,HDL-C低于非高尿酸血症组(均P<0.05)。在女生中,SUA与E呈正相关(P<0.05)。所有入组者SUA水平与SBP、DBP、BMI、SCr、TG、LDL-C呈正相关(均P<0.05),与HDL-C呈负相关(P<0.05)。结论大学生高血压、肥胖、血脂异常、SCr升高与高尿酸血症的发生密切相关;大学生血浆E水平升高与高尿酸血症的发生有关,女生中血E与SUA的相关性较强。     

血尿酸与其他代谢指标的相关性研究

目的探讨影响血尿酸(UA)的相关代谢指标。方法选取符合纳入标准的10 000名体检者作为研究对象。采集受试者收缩压(SBP)、舒张压(DBP),血清UA、血脂相关指标[包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)]、糖化血红蛋白(Hb A1c)、空腹血糖(FBG)。按照性别和UA分组,分析血UA与其他代谢指标的相关性。结果 (1)高尿酸血症(HUA)检出率为26.2%,男性检出率为25.1%,女性检出率为32.4%,性别比较,差异有统计学意义(P0.05);(2)男女之间年龄、Hb A1c、TC、TG和LDL-C等指标比较,差异无统计学意义(P0.05),女性BMI、FBG、SBP、HDL-C和DBP高于男性,男性血UA水平高于女性(P0.05);(3)女性HUA患者年龄、体质量指数(BMI)、SBP、DBP、FBG和TG高于尿酸正常组(NUA组),HDL-C低于HUA组;男性HUA年龄、BMI、SBP、DBP和TG高于NUA组,而HDL-C低于NUA组(P0.05)。女性UA水平与年龄、BMI、SBP、DBP、FBG、TC、TG水平呈正相关;男性UA与年龄、BMI、SBP、DBP、TC、TG水平呈正相关(P0.05);血尿酸水平与HDL-C呈负相关(P0.05)。结论性别、BMI、血压、血糖、TG及TC、LDL-C和HDL-C与HUA的发生有关。     

2型糖尿病微血管并发症与高尿酸血症等相关危险因素的分析

目的研究2型糖尿病(T2DM)患者血尿酸(UA)水平与微血管病变之间的相关性。方法 1477例T2DM患者根据UA水平分为高尿酸血症组(HUA)与非高尿酸血症组(NUA),比较两组的临床资料和微血管病变的合并率,比较微血管病变组和非微血管病变组的各项临床指标,并分析糖尿病视网膜病变(DR)和糖尿病肾病(DN)的相关危险因素。结果 (1)HUA组的高密度脂蛋白胆固醇、估算肾小球滤过率(e-GFR)低于NUA组,尿素氮、肌酐、尿微量白蛋白均高于NUA组,HUA组DR、DN的发病率均高于NUA组(P<0.01);(2)合并微血管病变组与无微血管病变组相比,年龄、血压、体质指数、UA、肌酐、尿素氮、e-GFR等因素有统计学差异(P<0.01);(3)Logistic回归分析显示,收缩压、UA、尿微量白蛋白与DR的发生呈正相关,糖化血红蛋白、收缩压、年龄、UA与DN的发生呈正相关。结论高尿酸血症是T2DM患者微血管病变的危险因素之一。     

黑龙江省佳木斯地区高尿酸血症与代谢性疾病的相关性分析

目的了解黑龙江省佳木斯地区高尿酸血症(HUA)的患病率并分析其与其他代谢性疾病的相关性。方法选取1249例佳木斯大学附属第一医院2017年8月-2018年6月健康体检者,分为高尿酸血症组(HUA组,n=316)与非高尿酸血症组(NUA组n=933),进行统计学分析。结果1.HUA患病率为25.3%,男性明显高于女性(35.10%VS 13.7%);2.HUA组中各代谢性疾病的患病率均显著高于NUA组(P0.05);HUA组内男性与女性比较,HHcy及超重/肥胖的患病率男性较高,高血糖患病率女性较高,PHUA0.05;3.BMI、TG、LDL-C与HUA呈正相关,GLU(OR=0.835,P0.01)、HDL-C(OR=0.190,P0.01)分别与男性、女性HUA呈负相关。结论HUA患病率较高,且伴发各个代谢性疾病罹患率亦较高,BMI、TG、LDL-C是HUA危险因素,GLU、HDL-C分别是男女HUA的保护性因素。     

中青年体检人群血尿酸水平及相关因素分析

目的 观察天津市中青年体检人群血尿酸(SUA)水平及高尿酸血症的患病率,探讨中青年高尿酸血症的相关危险因素.方法 选取2008年天津市在我院进行健康体检的中青年共9 086例,采用日立7170全自动生化分析仪测定SUA、空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)水平,并对研究对象分别记录其年龄、性别,用相同仪器测量其身高、腰围(WC)、体质量、血压.结果 ①天津市中青年体检人群高尿酸血症的患病率为13.23%,其中男性17.27%,女性5.89%.②SUA水平相关因素男性和女性均与体质量指数(BMI)、WC、舒张压(DBP)、TG及TC水平呈正相关(P＜0.05);女性SUA水平还与年龄、收缩压(SBP)及LDL-C呈正相关,与HDL-C呈负相关(P＜0.05).③高尿酸组在男性BMI 27.27±3.31 vs 25.70±3.14、WC(92.66±8.69)cm vs(88.19±8.94)cm、SBP(124.61±15.14)mmHg vs(120.84±14.95)mmHg、DBP(82.01±10.80)mmHg vs(79.04±10.67)mmHg、TC(5.31±0.94)mmol/L vs(5.08±0.88)mmol/L、TG(2.51±1.91)mmol/L vs(1.84±1.59)mmol/L、LDL-C(3.08±0.83)mmol/L vs(3.01±0.78)mmol/L;女性BMI 26.57±4.58 vs 23.74±3.28、WC(83.41±10.01)cm vs(76.85±8.79)cm、SBP(122.21±18.27)mmHg vs(113.95±16.01)mmHg、DBP(77.36±10.29)mmHg vs(73.21±9.90)mmHg、TC(5.57±0.99)mmol/L vs(5.11±0.95)mmol/L、TG(1.75±1.07)mmol/L vs(1.17±0.81)mmol/L、LDL-C(3.36±0.88)mmol/L vs(3.01±0.8)mmol/L水平均高于正常尿酸组(P＜0.05或＜0.01);而男性平均年龄、FBG低于正常尿酸组,女性则高于正常尿酸组,比较差异均有统计学意义(P＜0.05);男性HDL-C水平在两组间比较差异无统计学意义(P>0.05),女性HDL-C水平低于后者(P＜0.05).结论 天津市中青年体检人群高尿酸血症的患病率为13.23%,中青年SUA水平不但与体质量超重、脂代谢紊乱、高血压相关,且上述危险因素在高尿酸血症患者中有聚集倾向.     

血尿酸水平与2型糖尿病患者颈动脉粥样硬化的相关性

目的探讨2型糖尿病(T2DM)患者血尿酸(SUA)与颈动脉粥样硬化(CAS)之间的关系。方法选取2017年1―6月在承德医学院附属医院神经内科住院的T2DM患者86例,采集患者入院时的基本信息、生化检查指标及颈动脉内膜中层厚度(IMT)等数据。依据SUA结果分为正常尿酸组(33例)与高尿酸血症组(53例)。结果高尿酸血症组体质量指数、吸烟史、总胆固醇、低密度脂蛋胆固醇、IMT、同型半胱氨酸高于正常尿酸组,差异有统计学意义(P0.05)。多因素Logistic回归分析显示,体质量指数、SUA升高、低密度脂蛋白胆固醇是T2DM患者CAS的独立危险因素。结论 T2DM患者SUA水平与CAS呈明显的相关性。临床可通过早期检测SUA水平,并给予相关干预,预防或延缓CAS及相关性疾病的发生、发展。     

2型糖尿病患者血尿酸水平与胰岛β细胞功能的相关性

目的 探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者血尿酸水平与胰岛β细胞功能的相关性。方法选取2018年1月至2020年4月复旦大学附属中山医院厦门医院收治的T2DM患者304例，根据血尿酸水平将患者分为2组：正常尿酸组(NUA组，n=245)和高尿酸血症组(HUA组，n=59)。采用精氨酸刺激试验评估胰岛β细胞功能，比较2组患者的临床特征和β细胞功能，采用多元线性回归模型分析血尿酸水平与胰岛β细胞功能的关系。结果 HUA组患者体质量、体质量指数(BMI)、腰围、臀围、稳态模型评估的胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)均显著高于NUA组(P<0.05)；糖化血红蛋白(HbA_1c)、血肌酐(CREA)、估算的肾小球滤过率(eGFR)、高密度脂蛋白胆固醇(HDL-C)均显著低于NUA组(P<0.05)。HUA组0-min胰岛素(I0)、2-min胰岛素(I2)、4-min胰岛素(I4)、6-min胰岛素(I6)、0-min C肽(CP0)、2-min C肽(CP2)、4-min C肽(CP...     

基于倾向性评分匹配法分析高尿酸血症对老年2型糖尿病患者微血管并发症发生风险的影响

目的 探讨基于倾向性评分匹配法分析高尿酸血症对老年2型糖尿病(T2DM)患者微血管并发症发生风险的影响。方法 选取2019年1月-2022年1月本院收治的老年T2DM患者150例,其中合并高尿酸血症者29例,未合并高尿酸血症者121例。采用倾向性评分匹配法,按照1∶1配比,对高尿酸血症组和非高尿酸血症组进行匹配。匹配完成后,采用Logistic回归分析法分析高尿酸血症与老年T2DM患者微血管并发症发生风险的关系。结果 两组按照1:1配比进行倾向性匹配后,25例合并高尿酸血症的老年T2DM患者成功匹配到25例未合并高尿酸血症的老年T2DM患者,且除血尿酸(UA)外,两组的年龄、性别、病程、糖尿病家族史、吸烟史、饮酒史、体重指数(BMI)、血压、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、血尿素氮(BUN)、尿微量白蛋白(mAlb)、血肌酐(Scr)分布达到均衡(P>0.05);匹配后,高尿酸血症组的微血管并发症发病率为72.00%,非高尿酸血症组的微血管并发症发病率为28.00%,Logistic回归分析表明,高尿酸血症组微血管并发症的发病风险是非高尿酸血症组的2.472倍(P<0.05)。结论 高尿酸血症对老年T2DM患者微血管并发症的发生有影响,是老年T2DM患者微血管并发症的独立危险因素,控制UA水平可减少老年T2DM微血管并发症发生风险。     

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.     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.