连续性血液净化对严重脓毒症患者的疗效

目的研究对严重脓毒症患者应用连续性血液净化(CBP)治疗的效果。方法选取2018年1月至2020年1月在濮阳市人民医院治疗的70例严重脓毒症患者的临床资料,采取随机数字表法将其分为两组,每组35例。对照组采取常规对症治疗,观察组在此基础上采取CBP治疗。比较两组患者的血流动力学、炎症因子、免疫功能指标。结果治疗后,观察组平均动脉压、全身血管阻力指数明显高于对照组,心率明显低于对照组(P 0.05);观察组超敏C-反应蛋白、白细胞介素-6水平明显低于对照组(P 0.05);观察组CD3+、CD4+明显高于对照组(P 0.05)。结论 CBP治疗可改善严重脓毒症患者血流动力学指标及免疫功能,减轻炎症因子水平。     

CBP联合胸腺肽α1在脓毒症患者中的疗效及对免疫功能的影响

目的:探析连续性血液净化(CBP)联合胸腺肽α1在脓毒症患者中的临床疗效及对免疫功能的影响作用。方法:分析2014-03—2017-03期间在我院ICU接受治疗的72例脓毒症患者的临床资料。根据治疗方式不同,将入选者分成观察组(CBP联合胸腺肽α1治疗,37例)和对照组(CBP治疗,35例)两组。比较两组患者的一般资料、临床疗效、治疗前后的炎性因子及免疫功能情况。结果:两组患者的年龄、性别及BMI值等一般资料差异无统计学意义(P0.05)。治疗后观察组患者的临床疗效明显优于对照组(P0.05)。治疗前两组患者的炎性因子及免疫功能差异无统计学意义(P0.05)。治疗后观察组患者的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及CD8+比例均明显低于对照组,而CD3+、CD4+、HLA-DR比例及白细胞介素-10(IL-10)明显高于对照组(P0.05)。治疗后两组患者的炎症状态及免疫功能均较治疗前有明显改善(P0.05)。结论:CBP联合胸腺肽α1在脓毒症患者中具有突出的临床疗效,不但可以改善患者的炎症状态,而且有效纠正了患者的免疫紊乱现象。     

连续性血液净化在重症急性胰腺炎治疗中的应用效果

目的 探讨连续性血液净化在重症急性胰腺炎(SAP)治疗中的应用效果。方法 将2017年11月至2020年5月商丘市第一人民医院收治的90例SAP患者纳入研究,按照随机双盲的原则分为对照组和观察组,每组45例。对照组患者接受临床常规综合治疗,观察组患者在此基础上接受连续性血液净化治疗。检测并记录两组患者治疗前后的白细胞介素及肿瘤坏死因子等指标的水平及其变化情况,比较两组患者使用机械通气时间及住院时间。结果 在接受治疗前,两组患者的白细胞介素-1、白细胞介素-6、白细胞介素-8和肿瘤坏死因子-α等指标组间比较差异未见统计学意义(P 0. 05),治疗后,两组患者各炎症因子水平均明显降低,且观察组各指标明显低于对照组,组间比较差异有统计学意义(P 0. 05),同时观察组患者使用机械通气时间和住院时间方面均显著低于对照组(P 0. 05)。结论 在重症胰腺炎的治疗中采用连续血液净化结合常规综合治疗具有较好的临床应用效果,可显著改善患者体内炎症因子水平及其预后。     

小剂量肝素钠与低分子肝素钙对脓毒症治疗作用的对比研究

目的观察小剂量肝素钠与低分子肝素钙对脓毒症的治疗效果差异。方法将90例脓毒症患者随机分为A、B、C三组,A组给予常规治疗包括早期广谱抗生素,液体复苏等,B组常规治疗基础上持续给予小剂量肝素5~10U/(kg·h)静脉泵入,C组在常规治疗基础上加低分子肝素钙0.6 ml皮下注射。对比三组患者治疗前及治疗后第1、3、5、7 d急性生理学慢性健康状况Ⅱ(APACHEⅡ)评分,治疗前和治疗后的凝血指标、炎症因子指标、播散性血管内凝血(DIC)发生率、28 d病死率和不良反应发生率。结果 B、C两组患者治疗后各时点APACHEⅡ显著低于A组(P0.05),C组患者治疗5 d后APACHEⅡ分值显著低于B组(P0.05)。B、C两组患者治疗后血小板(PLT)、纤维蛋白原(Fib)、凝血活酶时间(APTT),凝血酶原时间(PT)水平显著优于A组(P0.01),C组患者各指标显著优于B组(P0.05)。B、C两组患者治疗后血清肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)水平显著低于A组(P0.05),C组患者TNF-α水平显著低于B组(P0.05)。B、C两组患者DIC发生率、28 d病死率显著低于A组(P0.01,P0.05),C组患者DIC发生率显著低于B组(P0.05)。结论低分子肝素钙对脓毒症的治疗更为有效,可以有效改善患者的凝血功能及炎症水平,具有临床应用价值。     

重症急性胰腺炎应用连续性血液净化治疗的疗效分析

目的探讨连续性血液净化治疗重症急性胰腺炎的临床效果。方法选取2013年6月~2017年6月我院收治的重症急性胰腺炎患者102例作为本次研究对象,随机分为观察组和对照组各51例,对照组给予常规治疗手段。在此基础上,观察组采用连续性血液净化治疗,观察两组临床症状缓解情况、住院时间、炎症因子水平情况、APACHEⅡ评分(急性生理与慢性健康评分)及患者存活情况。结果观察组临床症状缓解情况优于对照组,住院时间低于对照组(P0.05);炎症因子水平中,观察组白细胞介素-1、白细胞介素-6、白细胞介素-8、肿瘤坏死因子四项指标明显优于对照组(P0.05);治疗前,两组APACHEⅡ评分比较,无显著性差异(P0.05);治疗后,观察组APACHEⅡ评分低于对照组(P0.05);观察组存活率为98.04%,明显高于对照组的84.31%(P0.05)。结论对于重症急性胰腺炎患者采用连续性血液净化,可有效缓解患者的临床症状,减少死亡病例,值得在临床上推广。     

肝素与柠檬酸盐局部抗凝法在危重烧伤脓毒症患者连续性血液净化中的效果比较

目的比较局部肝素抗凝法与局部柠檬酸盐抗凝法在危重烧伤脓毒症患者连续性血液净化(CBP)中的效果。方法将90例危重烧伤脓毒症行CBP治疗的患者分为2组各45例。对照组采用局部肝素抗凝法,研究组采用局部柠檬酸盐抗凝法。比较2组患者治疗前后凝血功能指标、炎症因子指标及不良反应发生率。结果治疗后,研究组凝血酶原时间、活化部分凝血活酶时间显著短于对照组(P 0. 05),血清降钙素原、C反应蛋白水平均显著低于对照组(P 0. 05)。研究组不良反应发生率显著低于对照组(P 0. 05)。结论对于危重烧伤脓毒症行CBP患者,局部柠檬酸盐抗凝法的效果更佳,安全性较高,可减少对患者全身系统凝血状态的影响。     

连续性静脉血液滤过对脓毒症患者内皮功能的作用

目的观察连续性血液净化(CBP)对严重脓毒症患者的治疗作用,探讨CBP对严重脓毒症患者内皮细胞功能的影响。方法将严重脓毒症患者分为常规对照组22例,联合治疗CBP组20例。2组患者均行常规治疗,联合治疗组同时行连续性静脉血液滤过(CVVH),分别于治疗前及治疗1 d3、d行动脉血气分析,测定血管性血友病因子(vWF)含量,并观察患者重症监护病房(ICU)住院时间、机械通气时间及28 d生存率。结果联合治疗组患者ICU住院时间(d)及机械通气时间(d)均明显短于常规对照组,病死率明显低于常规对照组。治疗3 d后,2组急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(分)均明显下降,且联合治疗组下降程度优于常规对照组。常规对照组治疗前后vWF均无明显变化。结论 CBP治疗能改善严重脓毒症患者受损的内皮细胞功能,减轻病情的严重程度,改善预后。     

血必净治疗严重脓毒症45例临床观察及其对炎症反应的影响

目的明确血必净治疗严重脓毒症临床疗效及其对炎症反应的影响。方法 2013年6~11月入住我院急诊科ICU的严重脓毒症患者随机分为治疗疗组45例,对照组46例,两组患者均接受常规治疗,治疗组在常规治疗基础上加用血必净注射液(天津红日药业股份有限公司)100ml加入生理盐水100ml静脉滴注,2次/d。对照组静脉滴注100ml加入生理盐水,2次/d。两组患者均连续接受治疗7d。比较治疗前和治疗7d后患者的降钙素原(PCT)、C反应蛋白(CRP)、白细胞(WBC)、白细胞介素-6(IL-6)及白细胞介素-10(IL-10)、肿瘤坏死因子(TNF-α)水平变化以及急性生理学号慢性健康状况评分系统Ⅱ(APACHEl I)评分,以及住ICU时间、总住院时间和28d病死率。结果两组患者较治疗前各项指标均得到显著改善(P0.05),但治疗组改善情况优于对照组。与对照组相比,治疗组PCT、CRP、IL-6及TNF-a水平降低更明显(6.92±0.77vs4.64±0.54,67.06±16.73vs39.79±11.97,8.92±1.85vs6.78±1.61,87.98±9.07vs74.58±4.51,P0.05),IL-10水平更高(110.83±35.19vs76.27±31.44,P0.05);且APACH EⅡ评分下降趋势也更显著(15.26±2.74vs20.01±4.18,P0.05);血必净治疗组患者的住ICU时间、总住院时间显著低于对照组(15.29±2.73vs25.52±11.24,11.78±4.25vs18.77±12.10,P0.05),但两组28d病死率相当。结论血必净注射液急诊治疗严重脓毒症显著改善炎症反应,降低APACHEⅡ评分,有效缓解病情,缩短住院时间,临床疗效确切,安全性良好。     

参附注射液对严重脓毒症患者D-乳酸和炎性因子的影响

目的:观察参附注射液对严重脓毒症肠黏膜屏障功能损伤患者血D-乳酸和炎性因子的影响,探讨其临床意义。方法:选择2014-01-2017-08期间我院收治的严重脓毒症肠黏膜屏障功能损伤患者102例,按随机数字表法分成对照组(51例)和治疗组(51例),对照组给予常规治疗,治疗组在常规治疗基础上加用参附注射液,连续治疗2周。两组患者均在治疗前及治疗7d、14d,检测血D-乳酸和二胺氧化酶(DAO)水平的变化,观察患者治疗前后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)和序贯器官功能衰竭评分(SOFA)情况,并统计分析患者ICU住院时间和28d生存情况。结果:治疗前两组患者D-乳酸、DAO、TNF-α、IL-6、IL-10水平及序贯器官功能衰竭(SOFA)评分比较,差异无统计学意义。治疗7d,治疗组患者D-乳酸和DAO较对照组降低(P0.05),两组D-乳酸和DAO低于治疗前(P0.05)。治疗14d,两组患者D-乳酸和DAO均低于治疗7d(P0.05);治疗组D-乳酸和DAO水平低于对照组(P0.05)。治疗14d,治疗组TNF-α、IL-6、IL-10水平及SOFA评分明显低于对照组(P0.05);治疗组ICU住院时间和28d病死率低于对照组,差异有统计学意义(P0.05)。脓毒症肠黏膜损伤患者血D-乳酸和DAO水平与SOFA评分呈正相关(r=0.239、0.382,P=0.015、0.000)。结论:参附注射液联合常规治疗对严重脓毒症肠黏膜损伤患者的疗效优于常规治疗,能降低D-乳酸、DAO、TNF-α、IL-6和IL-10水平,降低SOFA评分,降低ICU住院时间和28d病死率,在一定程度上可以改善患者预后,疗效显著,为指导临床治疗提供重要依据。     

腹腔镜胃癌根治术近期疗效及其对围术期炎性因子的影响

目的 探讨腹腔镜胃癌根治术治疗胃癌患者的近期疗效以及对围术期炎性因子水平的影响.方法 将96例胃癌患者按随机数字表法分为腹腔镜组和对照组,每组48例,腹腔镜组于腹腔镜辅助下行胃癌根治术治疗,对照组行常规开腹根治术治疗.比较两组患者手术时间、切口大小、术中失血量、术后排气时间、住院时间,检测手术前后白细胞介素-2、白细胞介素-6、白细胞介素-10及肿瘤坏死因子水平的变化.结果 腹腔镜组手术时间显著短于对照组、手术切口显著小于对照组、术中失血量显著少于对照组、术后排气时间显著早于对照组(P＜0.01),住院时间与对照组比较差异无显著性(P＞0.05).两组手术前及手术后第5d炎性因子白细胞介素-2、白细胞介素-6、白细胞介素-10及肿瘤坏死因子水平比较差异均无显著性(P＞0.05),但手术后第2d腹腔镜组白细胞介素-2水平显著高于对照组(P＜0.01),白细胞介素-6、白细胞介素-10及肿瘤坏死因子水平显著低于对照组(P＜0.01).结论 腹腔镜胃癌根治术治疗胃癌患者近期疗效确切,围手术期炎性因子变化程度较小,创伤程度更低,有利于患者后期康复.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."