西布曲明减重效应及其影响因素分析

进行探讨。方法：2000—07／2001—09收集207例单纯性肥胖患者，均来自重庆市各社区医疗服务点。纳入标准：经过两周的平衡期(包括行为、运动、平衡饮食控制)后BMI≥27kg／m^2；年龄(18—65)岁；女性应未怀孕，非哺乳期；6个月内未使用过影响体质量、食欲、5-羟色胺及去甲肾上腺素代谢的药物。排除标准：继发性肥胖患者；肝、肾功能超过正常值；合并高血压、糖尿病、心血管疾病、胃肠疾病及精神系统疾病。207例患者中138例随机分配入盐酸西布曲明治疗组，69例入安慰剂组试验为期24周，治疗前及治疗后4，8，12，18及24周测定人体测量学指标。结果：西布曲明组138例中123例，安慰剂组69例中59例完成试验。治疗24周后，西布曲明组体质量平均下降了(4．5&;#177;4．7)kg[下降百分率为(6．0&;#177;6．0)％]，安慰剂组则增高了(0．6&;#177;3．0)kg[增加(0．7&;#177;3．7)％]，两组比较，差异有显著性意义(t=3．145—9．166，P&;lt;0．01)。多元逐步回归分析提示西布曲明组治疗24周的体质量下降百分率与性别、年龄、4周体质量下降值相关女性患者体质量下降了(5．2&;#177;4．6)kg，[(7．0&;#177;5．9)％]，显著高于男性患者[(2．3&;#177;4．4)kg,(2．7&;#177;5．1)％，P&;lt;0．01]。患者越年轻，体质量下降的幅度也越大。4周体质量下降≥1％者，24周时体质量下降更明显。结论：西布曲明能有效降低体质量，年轻、女性患者减肥效果更明显。治疗4周时的体质量下降能预测长期疗效。     

针刺治疗单纯性肥胖患者的临床对比研究

目的：观察针刺治疗肥胖症的临床疗效及对血清瘦素、抵抗素和脂联素等的影响。方法：将门诊单纯性肥胖患者80例随机分组。设治疗组（针刺组）50例，对照组（口服盐酸西布曲明）30例，30d为1疗程，连续治疗3个疗程。治疗前后观察总疗效（体重指数）、瘦素、抵抗素和脂联素、三酰甘油、胆固醇、腰臀比的变化。结果：治疗组总有效率94．0％，优于对照组（P〈0．011，与治疗前比对血清瘦素、抵抗素和脂联素、三酰甘油、胆固醇、腰臀比的作用具有显著性意义（P〈0．01）。对三酰甘油、血清瘦素、脂联素的作用明显优于对照组（P〈0．01）。结论：针刺可以明显改善单纯性肥胖患者的生理生化指标．是治疗单纯性肥胖的优选方法。     

苦参素注射液联合NP方案治疗晚期非小细胞肺癌近期疗效观察

目的：观察苦参索联合NP方案治疗Ⅲ、Ⅳ期非小细胞肺癌的近期疗效。方法：将65例晚期非小细胞肺癌患者随机分为单纯化疗组32例,联合化疗组33例。单纯化疗组采用跃春瑞滨加顺锄方案,联合化疗组方案在单纯化疗基础上加用苦参素注射液,治疗3个疗程后观察瘤体大小、卡氏评分、体重和不良反应发生情况。结果：两组瘤体大小变化有效率分别为18．75％、30．31％,临床获益率分别为68．75％、72．73％。两组有效率比较,差异有统计学意义（P〈0．05）,但临床获益率差异无统计学意义（P〉0．05）;单纯化疗组卡氏评分值有所下降,但治疗前后比较差异无统计学意义（P〉0．05）;联合化疗组卡氏评分值上升,治疗前后比较,差异有统计学意义（P〈0．05）;治疗后组间比较差异有统计学意义（P〈0．01）：两组治疗前后体重无明显变化（P〉0．05）。联合化疗组比单纯化疗组较少出现Ⅲ、Ⅳ度不良反应。Ⅲ度以上白细胞、血小板、血红蛋白下降和恶心呕吐两组差异均有统计学意义（P〈0．05）,其余不良反应发生率两组间差异均无统计学意义（P〉0．05）。结论：苦参素注射液联合化疗治疗中晚期非小细胞肺癌近期疗效优于单纯化疗,可以减低化疗不良反应。     

西布曲明减重效应及其影响因素分析

目的:观察西布曲明治疗单纯性肥胖的疗效,并对影响疗效的相关因素进行探讨。方法:2000-07/2001-09收集207例单纯性肥胖患者,均来自重庆市各社区医疗服务点。纳入标准:经过两周的平衡期(包括行为、运动、平衡饮食控制)后BMI≥27kg/m2;年龄(18～65)岁;女性应未怀孕,非哺乳期;6个月内未使用过影响体质量、食欲、5-羟色胺及去甲肾上腺素代谢的药物。排除标准:继发性肥胖患者;肝、肾功能超过正常值;合并高血压、糖尿病、心血管疾病、胃肠疾病及精神系统疾病。207例患者中138例随机分配入盐酸西布曲明治疗组,69例入安慰剂组。试验为期24周,治疗前及治疗后4,8,12,18及24周测定人体测量学指标。结果:西布曲明组138例中123例,安慰剂组69例中59例完成试验。治疗24周后,西布曲明组体质量平均下降了(4.5±4.7)kg犤下降百分率为(6.0±6.0)%犦,安慰剂组则增高了(0.6±3.0)kg犤增加(0.7±3.7)%犦,两组比较,差异有显著性意义(t=3.145～9.166,P<0.01)。多元逐步回归分析提示西布曲明组治疗24周的体质量下降百分率与性别、年龄、4周体质量下降值相关。女性患者体质量下降了(5.2±4.6)kg,犤(7.0±5.9)%犦,显著高于男性患者犤(2.3±4.4)kg,(2.7±5.1)%,P<0.01犦。患者越年轻,体质量下降的幅度也越大。4周体质量下降≥1%者,24     

药敏试验对临床幽门螺杆菌菌株根治的指导意义

目的：探讨幽门螺杆菌(Helicobacter pylori，HP)对常用抗生素耐药特点，为临床选用抗生素治疗HP提供依据。方法：采用改良Kiby-bauer法对53例HP分离菌株进行阿莫西林、甲硝唑、克拉霉素、庆大霉素、氟嗪酸、痢特灵药敏试验。分析其特点，并将体外药敏试验结果与体内治疗效果相比较。结果：①阿莫西林与克拉霉素、甲硝唑与庆大霉素组问差别无统计学意义(P＞0．05)，其余各组问差别均有统计学意义(P＜0．05，P＜0．01)；②阿莫西林耐药菌株对庆大霉素和痢特灵显著敏感(P＜0．005)、克拉霉素敏感(P＜0．025)；甲硝唑耐药菌株对阿莫西林、庆大霉素、痢特灵显著敏感(P＜0．005)、克拉霉素敏感(P＜0．025)；庆大霉素耐药菌株对阿莫西林、甲硝唑、痢特灵显著敏感(P＜0．005)、克拉霉素敏感(P＜0．025)；③高敏根除率为100％(5／5)，中、低敏根除率为75％(6／8)，耐药根除率为25％(1／4)。结论：药敏试验对临床幽门螺杆菌菌株的根治有指导作用。     

较低剂量氟哌噻吨美利曲辛治疗功能性消化不良的疗效观察

目的：研究功能性消化不良患者采用较低剂量氟哌噻吨美利曲辛治疗的临床疗效。方法据患者自愿原则,将本院2011年3月至2013年3月接诊的功能性消化不良患者120例分为研究组与对照组,每组各60例。对照组患者采取个体化治疗原则,包括促动力药物和（或）质子泵抑制剂治疗,而研究组患者在对照组治疗方式上加用较低剂量氟哌噻吨美利曲辛治疗。两组患者皆治疗8周后行疗效评定,对比两组患者治疗前后症状积分改变情况,抑郁自评量表（SDS）、焦虑自评量表（SAS）得分,有效指数,不良反应情况。结果（1）两组患者治疗后症状积分明显低于治疗前,比较差异有统计学意义（P＜0．05）;治疗后研究组与对照组症状积分比较,比较差异具有统计学意义（P＜0．05）。（2）治疗前研究组各亚组SDS与SAS评分与对照组相应亚组比较,比较差异无统计学意义（P＞0．05）;两组患者各亚组治疗后SDS与SAS评分均明显低于治疗前,比较差异有统计学意义（P＜0．05）。（3）研究组有效率93．33％（56／60）,对照组则为78．33％（48／60）,组间对比,比较差异有统计学意义（ P＜0．01）。（4）研究组不良反应发生率为3．33％（2／60）,对照组为13．33％（8／60）,组间对比,比较差异有统计学意义（ P＜0．05）。结论较低剂量氟哌噻吨美利曲辛治疗功能性消化不良患者效果明显,症状积分与抑郁症状改善明显,并且不良反应较少,值得临床借鉴。     

辨证针刺取穴与埋线治疗青年单纯性肥胖的临床疗效观察

目的观察辨证针刺取穴法与埋线法对青年单纯性肥胖的治疗方法和临床疗效。方法将2008年4月至2012年4月109例单纯性肥胖患者随机分为三组：针刺组36例根据患者肥胖辨证分型,选择穴位针刺配合电针治疗,每隔2d治疗1次,共治疗3个月。埋线组36例采用取穴埋线治疗,15d治疗1次,共治疗6次。联合组37例采用辨证针刺取穴配合电针治疗及取穴埋线联合治疗。治疗结束后对比三组患者体重、体质指数、脂肪含量及疗效。结果三组患者治疗后,体重、体质指数均较治疗前有所改善（P〈0．05）,联合组及针刺组治疗后脂肪含量较治疗前有所下降（P〈0．05）;联合组治疗后,体重、体质指数及脂肪含量改善优于其他两组（P〈0．01）;联合组总有效率为97．30％,针刺组总有效率为66．67％,埋线组总有效率为55．55％,总有效率组间比较差异具有统计学意义（P〈0．05）,联合组总有效率优于针刺组与埋线组（P均〈0．01）,针刺组与埋线组比较差异无统计学意义（P〉0．05）。结论辨证针刺取穴及取穴埋线对于青年单纯性肥胖均具有一定改善作用,但两种方法效果区别不大。而联合辨证针刺取穴与埋线法可提高对青年单纯性肥胖治疗效果。     

西咪替丁辅助治疗儿童过敏性紫癜72例

目的：观察西咪替丁对过敏性紫癜的治疗效果。方法：将132例过敏性紫癜患者随机分为两组，对照组（60例）常规治疗，观察组（72例），在此基础上加用西咪替丁10－20mg/(kg.d)，观察两组疗效。观察：观察组治愈率为71％，有效率为90％，对照组治愈率为52％，有效率为74％，两组比较差异有统计学意义（P＜0．01），观察组皮肤，消化道紫癜消失率高于对照组（P＜0．01，P＜0．05），结论：西咪替丁对过敏性紫癜有确切疗效，可缓解各种症状和缩短病程。     

盐酸吗啡缓释片联合复方苦参注射液治疗中重度癌痛的临床观察

目的 观察盐酸吗啡缓释片联合复方苦参注射液治疗癌痛患者的近期疗效和不良反应。方法 将120例癌痛患者随机分为治疗组和对照组各60例,治疗组给予盐酸吗啡缓释片联合复方苦参注射液治疗,对照组给予盐酸吗啡缓释片治疗。结果 治疗后7、14d的镇痛总有效率治疗组分别为83．3％和93．3％,对照组为65．0％和76．7％,差异有统计学意义（P〈0．05）。治疗后7、14d治疗组数字评分法（KPS）改善率分别51．7％和65．0％,对照组为33．3％和45．0％,差异也有统计学意义（P〈0．05）。治疗组便秘、恶心、呕吐、头晕、头痛、嗜睡、排尿困难等不良反应发生率明显低于对照组。结论 盐酸吗啡缓释片联合复方苦参注射液治疗中重度癌痛患者效果良好,具有临床意义。     

探讨复方沙棘籽油栓联合奥硝唑治疗滴虫性阴道炎的临床疗效

目的探讨复方沙棘籽油栓联合奥硝唑治疗滴虫性阴道炎的临床效果。方法将四川省革命伤残军人医院妇科2012年3月至2013年2月就诊的167例滴虫性阴道炎患者按就诊时间分为治疗组和对照组，治疗组87例采用阴道给复方沙棘籽油栓和口服奥硝唑片治疗，对照组80例口服奥硝唑片治疗。将两组临床症状改善和疗效以及患者不良反应进行比较。结果两组临床症状改善比较，差异有统计学意义（P＜0．05）；治疗组总有效率为96．55％，对照组总有效率为86．25％，两组比较，差异有统计学意义（ P＜0．05）；对照组的不良反应率（48．75％）显著高于治疗组的不良反应率（12．64％），两组比较，差异有统计学意义（ P＜0．01）。结论复方沙棘籽油栓与奥硝唑联合治疗滴虫性阴道炎疗效显著提高，且安全可靠，值得推广应用。     

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.     

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.     

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.     

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.