骨质疏松性椎体压缩骨折不愈合诊断的临床研究

伴随着人口老龄化的进程,骨质疏松症患者越来越多,骨折疏松两大常见的并发症包括骨折及疼痛,脊柱是人体的支撑骨,是最易发生骨质疏松骨折的部位[1],骨质疏松性椎体压缩骨折(osteoporoticvertebral compression fractures,OVCFs)是临床上较为常见的骨折,由于此类骨折患者多存在愈合能力较差,患者治疗后多易发生骨折不愈合,发生骨折     

Wnt信号通路相关促骨形成抗骨质疏松作用靶点的研究进展

骨质疏松症主要发生于绝经后妇女及老年男性,表现为骨量减少、骨微结构破坏、骨强度减小、易发生骨折等,对患者的生活质量有严重影响,其引起的骨折及相关并发症更是增加了患者的致残率和致死率。我国目前已进入人口结构老龄化阶段,故治疗和预防骨质疏松症显得尤为重要。     

骨质疏松症患者的饮食干预与护理措施

骨质疏松（OP）是以骨量减少、骨的微观结构退化为特征,致使骨的脆性增加,引起骨痛、畸形及易发生骨折的一种全身性骨骼疾病。临床分为原发性和继发性骨质疏松症2种,常见有绝经后骨质疏松症、老年性骨质疏松症和继发性骨质疏松症。主要症状是骨痛、易骨折、生长停止或身高下降。在我国60岁以上骨质疏松患者约为1．3亿人,男性在55岁以上,女性在绝经后易发生老年性骨质疏松,女性发病率是男性发病率的4倍。骨质疏松的治疗方法主要包括饮食调节、运动治疗、药物治疗等措施。本文回顾分析25例OP患者的临床资料、饮食干预与护理措施。     

骨质疏松症患者的饮食干预与护理措施

骨质疏松(OP)是以骨量减少、骨的微观结构退化为特征,致使骨的脆性增加,引起骨痛、畸形及易发生骨折的一种全身性骨骼疾病.临床分为原发性和继发性骨质疏松症2种,常见有绝经后骨质疏松症、老年性骨质疏松症和继发性骨质疏松症.主要症状是骨痛、易骨折、生长停止或身高下降.在我国60岁以上骨质疏松患者约为1.3亿人,男性在55岁以上,女性在绝经后易发生老年性骨质疏松,女性发病率是男性发病率的4倍.骨质疏松的治疗方法主要包括饮食调节、运动治疗、药物治疗等措施.本文回顾分析25例OP患者的临床资料、饮食干预与护理措施.     

骨质疏松症的诊断和防治

骨质疏松症是以骨量减少,骨的微细结构退化为特征而易于发生骨折的一种全身性骨代谢性疾病,其发病率和并发症死亡率均高,是老年医学中最常见的骨骼疾病。据估计,半数以上的妇女和大约三分之一的男性在其生存期内会发生骨质疏松性骨折。骨质疏松症患者易发生脆性骨折而导致严重后果,目前尚无行之有效的治疗手段,本文就骨质疏松症的病因、诊断标准、诊断技术、治疗及预防原则的进展进行综述。 1 骨质疏松症的致病基因 1992年澳大利亚学者 Morrison等首先发现高加索人种维生素 D受体基因多态性与骨钙素水平相关,揭开了骨质疏松症遗传…     

骨质疏松症的诊断和鉴别诊断

骨质疏松症是由遗传和环境因素参与的复杂疾病,其定义是以骨量低下、骨组织微结构破坏为特征,导致骨脆性增加易致骨折的全身性骨病。骨质疏松症导致髋部或脊柱骨折的致残率和致死率非常高,已成为全球的公共健康问题。为预防骨质疏松性骨折的发生,早期诊断骨质疏松症尤其重要,及早进行有效干预,可降低患者发生骨折的风险     

骨质疏松防治的基本措施

骨质疏松是一种以骨强度减低为特征，易发生骨折的疾病。骨折是骨质疏松症的严重后果，最常见的部位有椎体、髋部和腕部等处。一旦发生骨质疏松性骨折，患者生活质量下降，出现各种并发症，可致残或致死。骨质疏松的预防比治疗更为现实和重要。     

阿仑膦酸钠联合辛伐他汀治疗糖尿病合并骨质疏松的疗效分析

正随着人们生活水平的提升,糖尿病发病人数逐年增加,患者易出现骨质疏松、高血压、肾脏疾病等并发症。2型糖尿病并骨质疏松症属全身性骨代谢障碍疾病,临床表现为全身骨量降低、骨脆性增大、骨微结构损坏、骨强度下降,且患者易发生骨折,易造成患者周身疼痛及活动障碍,情况严重时易造成致残,严重影响患者生活质量[1-2]。因此,寻找一种有效的2型糖尿病并骨质疏松症的治疗方法,对于提升患者生活质量非常重要。我院对2型糖尿病并     

骨质疏松症的中西医治疗

骨质疏松症是目前危害老年人健康的一大疾病。俗话说:“人老骨头脆”,就概括地道出了老年人易发生骨质疏松症和骨折的病理现象,它不仅大大降低了老年人的生活质量,也耗费了大量的医疗费用。随着社会进入老龄化社会,骨质疏松症及其伴发的骨折也会逐年增加,骨质疏松症的治疗不仅是一个医疗问题,也是一种严重的社会问题。骨质疏松症治疗的目的在于缓解疼痛,防止骨钙进一步丢失,提高骨密度,预防骨折。对于继发性骨质疏松症的治疗要标本兼治。因为有原发病的存在,应重在治疗原发病,如控制好糖尿病、肾病、治疗慢性消化道疾病等。但同时要兼顾对骨…     

老年骨质疏松症患者发生骨折的影响因素

目的：探讨老年骨质疏松症患者发生骨折的影响因素。方法选取在我院住院治疗的老年骨质疏松症患者239例,根据有无并发骨折分为老年骨质疏松性骨折组和老年骨质疏松症无骨折组。根据骨质疏松症相关文献制作调查问卷,采用二分类Logistic回归分析对老年骨质疏松性骨折发生的影响因素进行分析。结果老年骨质疏松症患者并发骨折的保护因素是骨密度,而老年骨质疏松症患者的年龄、低钙饮食、跌倒及脆性骨折史是并发骨折的危险因素。结论在对老年骨质疏松症性骨折进行临床护理的过程中,对可干预因素进行干预,适度增加饮食中钙的含量,增加体育锻炼,加强老年骨质疏松症患者的安全意识谨防摔倒。     

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.