老年糖尿病患者脑血管病变的经颅多普勒超声分析

目的探讨经颅多普勒超声(TCD)在诊断和预测老年糖尿病患者脑血管病变中的临床应用价值.方法对32例糖尿病无脑梗死患者,31例糖尿病并脑梗死患者及31例健康者的995条脑血管,进行TCD检测,就收缩期峰血流速度(Vs)、舒张末期血流速度(Vd)、平均血流速度(Vm)、脉动指数(PI)、阻力指数(RI)值等检测;各参数的结果作比较分析.结果 3组颅内血流参数比较,两疾病组血流速度异常以Vs增快为多见,尤以颈内动脉终末端(ICA)、基底动脉(BA)异常为突出特点;两疾病组血管涡流检出率和血管条数均高于对照组;糖尿病组TCD异常率52.3%,而糖尿病合并脑梗死组57.8%,均明显高于对照组.结论 TCD检测对预测和预防糖尿病患者脑血管病发生,判断预后,指导早期治疗,预防脑梗死发生具有重要价值.     

新生儿缺氧缺血性脑病的脑超声血流动力学特征及与临床预后的关系

目的探讨新生儿缺氧缺血性脑病(HIE)的经颅彩色多普勒超声(TCD)脑血流动力学变化特征及与临床预后的关系。方法选取HIE新生儿136例作为HIE组,同期健康新生儿100例作为对照组(NC组)。采用TCD测定大脑中动脉(MCA)的舒张期流速(Vd)、收缩期峰值血流速度(Vs)、平均血流速度(Vm)和阻力指数(RI);出生后28 d复查TCD,并进行中国20项新生儿行为神经测定(NBNA)评分。结果 HIE组新生儿在出生24、48 h时,脑血流速度显著减慢,阻力指数显著升高,MCA的Vs、Vd、Vm均显著低于NC组,RI均显著高于NC组(P0.05);出生后72 h,轻度HIE组血流动力学参数与NC组差异无统计学意义(P0.05),中、重度HIE组的Vs、Vd、Vm均显著低于NC组,RI均显著高于NC组; HIE患儿随着病情程度增加,Vs、Vd、Vm相对越低,RI相对越高,差异均有统计学意义(P0.05);HIE组在出生后28 d随访复查TCD和NBNA,轻、中、重度三组患儿的NBNA评分差异有统计学意义(P0.05),预后良好组患儿的Vs、Vd、Vm显著高于预后不良组(P0.05),RI显著低于预后不良组(P0.05);Pearson相关分析显示, MCA血流动力学Vs、Vd、Vm与NBNA评分呈正相关(P0.05),RI与NBNA呈负相关(P0.05)。结论 HIE患儿普遍具有脑动脉阻力升高及低脑血流灌注,TCD动态观察HIE患儿的脑血流动力学变化过程对早期诊断及预后评价具有重要价值。     

福辛普利对糖尿病患者视网膜中央动脉血流动力学的影响

目的 观察糖尿病患者用福辛普利治疗前后视网膜中央动脉（CRA）血流动力学变化。方法 19例（38眼）糖尿病患者给予福辛普利10mg/d,于治疗前和治疗后1周用彩色多普勒超声检测CRA收缩期峰值血流速度（Vs）、舒张末期血流速度（Vd）、平均血流速度（Vm）、搏动指数（PI）和阻力指数（RI）,并与正常组对照。结果 糖尿病患者CRA的Vs、Vd、Vm低,而PI、RI高于对照组,治疗后患者的Vs、Vd和Vm增加,PI、RI降低（P＜0.05或0.01）。结论 福辛普利能改善糖尿病患者CRA血流动力学,彩色多普勒超声可用于评价糖尿病患者CRA血流动力学变化。     

老年高血压患者脑血管病变经颅多普勒超声观察

目的　了解老年高血压患者脑血管病变情况 ,探讨经颅多普勒超声 (TCD)在老年高血压患者脑血管病变辅助检查中的作用。方法　对经治疗将血压控制正常的 30例老年高血压患者 (高血压组 )作TCD检查 ,观察主要大中型脑动脉的平均血流速度 (Vm)、搏动指数 (PI)、阻力指数 (RI)和狭窄情况 ,并与 2 6例血压正常的老年人 (对照组 )对比分析。结果　高血压组患者各脑动脉的PI和RI均较对照组明显增加 (P <0 0 1) ,Vm 均较对照组明显减低 (P <0 0 5 ) ,脑动脉狭窄发生率明显高于对照组 (P <0 0 1)。高血压组 11例脑动脉狭窄中 ,病程 3～ 9年者 2例 ,10～ 35年者 9例 (P <0 0 5 ) ;中度高血压患者 2例 ,重度高血压患者 9例(P <0 0 5 )。结论　老年高血压患者尽管经治疗将血压控制正常 ,但仍常伴有脑血管病变 ,并随着高血压的病程延长 ,病情加重 ,脑动脉狭窄的发生率增加 ,TCD是一种简便且有价值的检查方法。     

糖尿病患者滑车上动脉彩色多普勒超声检测结果分析

目的通过对眼眶内上缘的眼动脉终末支-滑车上动脉(STCA)的彩色多普勒超声(CDFI)检测,分析糖尿病患者的脑血流动力学改变.方法对50例正常对照组,46例初发糖尿病和50例5年以上糖尿病患者的STCA行CDFI及脉冲多普勒超声检测.结果三组STCA彩色血流信号检出率为100%.对照组频谱特征为正向三峰型:SP1峰、SP2峰、DP峰,SP1＞SP2;其收缩期最高血流速度(Vs)为 56.01 cm/s, 均与眼动脉相似.糖尿病史平均5.6年以上患者,其Vs和舒张末期血流速度略低于对照组,两者比较无显著性差异,SP2、PI、RI均高于对照组,两组比较有显著性差异(P＜0.001).初期糖尿病患者的上述各值虽有改变,但与对照组比较无显著性差异.结论糖尿病患者STCA的血流动力学特点符合经颅多普勒(TCD)脑动脉硬化诊断标准,提示STCA的CDFI检测可为诊断脑动脉硬化提供相应的信息;长期高血糖会导致或加速脑动脉硬化,应加强对糖尿病的防治,以减少脑血管病的发生.     

高血压性脑出血经颅多普勒初步研究

目的 :观察高血压性脑出血患者经颅多普勒超声 (TCD)的脑血流的变化。方法 :对 6 0例高血压性脑出血患者和 6 0例健康对照组使用TCD测定颅内动脉平均血流速度 (Vm)及脉动指数 (PI) ,观察其参数有无差异性。结果 :在血肿量 <2 5ml出血患者组中 ,病灶区Vm与正常对照组比较各血管P <0 0 5或 <0 0 1,而患者组中出血半球与未出血侧比较P <0 0 5。大量出血组的出血侧Vm低于中量以及小量出血组Vm ;PI值大量出血组高于中量以及小量出血组 ,P <0 0 5。结论 :应用TCD检测高血压性脑出血患者脑血流变化 ,某些参数与出血量有高度相关性 ,TCD所测得脑血流参数值可间接推断出血量以及预后。     

经颅多普勒超声检查在评估颅脑创伤患者颅内压中的临床价值及参数分析

目的:探讨经颅多普勒超声(transcranial Doppler,TCD)检查在评估颅脑创伤患者颅内压中的临床价值及参数变化。方法:选取2021年1月—2023年1月成武县人民医院收治的50例颅脑创伤患者作为研究对象,均开展有创性颅内压监测,依据是否出现颅内压增高分为颅内压增高组及颅内压正常组;并开展TCD检测,比较两组大脑中动脉舒张末期血流速度(end diastolic velocity,Vd)、收缩期峰值血流速度(peak systolic velocity,Vs)、平均最大血流速度(mean velocity,Vm)、搏动指数(pulsatility index,PI)及阻力指数(resistance index,RI)变化,并测定视神经鞘直径(optic nerve sheath diameter,ONSD)变化;绘制受试者操作特征(receiver operating characteristic,ROC)曲线,分析Vd、Vs、Vm、PI、RI、ONSD及联合检测诊断颅内压增高的临床价值。结果:颅内压增高组Vd、Vm低于颅内压正常组,Vs、PI、RI、ONSD高于颅内压正...     

飞行人员紧张性头痛经颅多普勒分析

目的探讨飞行人员紧张性头痛(tension type headache,TTH)经颅多普勒(transcranial doppler,TCD)检查的血流动力学特点。方法对89例飞行人员TTH患者做TCD检测,观察分析大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)收缩峰血流速度(Vs)和舒张峰血流速度(Vd),同时选择90例正常人作为对照组。结果飞行人员TTH患者有先兆偏头痛(MWA)头痛侧和非头痛侧ACA、MCA、PCA的收缩峰血流速度(Vs)和舒张峰血流速度(Vd)与对照组相比,基本上呈现非同步性同向增高或降低,无先兆偏头痛(MWO)亦是如此。发作期痛侧ACA、MCA、PCA与对照组比较差异有统计学意义(P0.01或P0.05)。MWA与MWO比较,MWA患者ACA、PCA的Vs和Vd差异有统计学意义(P0.01或P0.05)。发作期与间歇期比较,发作期ACA、MCA、PCA的Vs和Vd差异有统计学意义(P0.01或P0.05)。结论 TCD检测对飞行人员TTH的诊断及治疗具有重要的参考价值。     

Ⅱ型糖尿病视网膜血流动力学变化与血糖关系的探讨

目的 :探讨 型糖尿病 (2 - DM)患者视网膜中央动脉 (CRA)的血流动力学变化及与糖化血红蛋白水平之间的关系。方法 :应用彩色多普勒血流显像 (CDFI)对 84例 (16 8眼 ) 型糖尿病患者的视网膜中央动脉进行检测 ,经眼底检查确定有无合并视网膜病变并对合并视网膜病变者进行分型 ,同时检测其糖化血红蛋白的水平。结果 :1.糖尿病各组 CRA的 Vs、 Vd均低于正常对照组 (P<0 .0 5 ) ;RI高于对照组 (P<0 .0 5 ) ;2 .经相关性分析表明 Hb A1c与 型糖尿病患者 CRA的血流速度测值呈负相关 ,与 CRA的 RI呈正相关。结论 :血糖是影响视网膜血流变化的重要因素之一。 CDFI是评价 CRA血流动力学变化的有效方法。     

经颅多普勒超声在小儿颅内高压监测中的应用

目的:探讨经颅多普勒超声(TCD)无创监测小儿颅内高压的临床应用价值。方法:对我院儿科收治的38例颅内高压患儿应用TCD进行床边动态监测,以大脑中动脉(MCA)为靶血管,分析观察组及对照组以及观察组治疗前后TCD的各项参数(Vs、Vd、Vm、PI)的变化。结果:颅内高压患儿的TCD显示:血流频谱在颅内压升高的不同阶段呈现不同的特征性改变;Vd及Vm下降,PI升高,与对照组相比有显著性差异(P<0.01);治疗后Vd、Vm升高,PI降低,Vs变化不显著。结论:TCD可直接显示脑血流灌注的状态,可动态监测颅内压力的变化,对于病情判断以及颅内高压的治疗有重要的临床指导意义。     

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.     

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.     

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.     

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."