尿胱抑素C检测方法的建立及初步临床应用

目的建立尿胱抑素C检测方法,初步探讨其临床应用价值。方法采用胶体金免疫比浊法检测尿中胱抑素C,并作方法学评价。同时对40例正常人群和135例相关疾病患者检测尿中胱抑素C、α1-微球蛋白和β2-微球蛋白,比较三种蛋白在对照组和各疾病组的阳性率。结果尿胱抑素C检测有较好的检测范围和良好的线性范围,总CV为5.01%,其它蛋白质对试验基本不存在影响。相对于α1-微球蛋白和β2-微球蛋白而言,有较高的灵敏度和特异性。尿胱抑素C没有明显昼夜节律。结论尿胱抑素C是肾脏疾病时肾小管功能障碍的敏感指标。标本可随机留取,有利于常规检验,并可作为体检人群的一个筛查指标。     

血清指标联合β2-MG在糖尿病肾病早期诊断中的应用

分析血清同型半胱氨酸(Hcy)、胱抑素(CysC)、α1-微球蛋白(α1-MG)联合尿β2-微球蛋白(β2-MG)在糖尿病肾病早期诊断中的应用价值。选取41例糖尿病肾病患者为观察组,另选取同期40例健康体检者为对照组,均行血清Hcy、CysC、α1-MG及β2-MG检测,并统计各指标检测阳性率。观察组血清Hcy、CysC、α1-MG、β2-MG水平均高于对照组,差异具有统计学意义(P0.05);β2-MG、Hcy、α1-MG及CysC联合检测阳性率为90.24%均高于各指标单一检测阳性率,差异具有统计学意义(P0.05)。血清同型半胱氨酸、胱抑素、α1-微球蛋白联合尿β2-微球蛋白在早期糖尿病肾病诊断中具有较高诊断价值。     

血清胱抑素C与尿中蛋白指标在糖尿病肾病中的诊断价值

目的观察血清胱抑素C与尿中蛋白指标检测在糖尿病肾病(DN)中的诊断价值。方法选取2014年5月至2016年2月该院100例早期DN患者(观察组),收集同期健康体检者100例作为健康对照组,检测2组研究对象的血清胱抑素C和尿微量清蛋白、α1-微球蛋白、β2-微球蛋白。结果观察组患者血清胱抑素C、尿微量清蛋白、α1-微球蛋白、β2-微球蛋白水平高于健康对照组,差异有统计学意义(P0.05)。结论检测血清胱抑素C与尿中蛋白有助于提高DN的早期诊断率,对其治疗和病情监测具有重要的临床意义。     

血与尿胱抑素C在糖尿病早期肾损伤中的意义

目的探讨胶体金法检测血与尿胱抑素C在糖尿病早期肾损伤中的意义。方法通过检测114例正常人与116例糖尿病患者血及尿中胱抑素C（Cys C）与β2微球蛋白（β2-MG）,采用对比分析,评价正常人群清晨随机尿中尿胱抑素C水平,以及不同糖尿病组（尿微量白蛋白正常及异常组）血、尿胱抑素C与血、尿β2微球蛋白之间的关系。结果在糖尿病早期肾损伤中检测血或尿胱抑素C与检测血及尿β2微球蛋白,经过对比分析,二者均有显著的正相关性;但是单独检测尿胱抑素C,与尿β2微球蛋白相比,二者间没有统计学差别。结论在糖尿病早期肾损伤中检测血或尿胱抑素C同样是一个理想的诊断指标。     

监测血清胱抑素C和尿β_2-微球蛋白在糖尿病肾病中的临床意义

目的探讨监测血清胱抑素C(CysC)和尿β2-微球蛋白(β2-MG)在糖尿病肾病(DN)中的临床意义。方法采用免疫比浊法对95例DN患者进行血清胱抑素C和尿β2-MG的结果测定,并与健康对照组做比较分析。结果 DN患者的血清胱抑素C和尿β2-MG的检测结果均较对照组显著增高,差异有统计学意义(P0.01)。结论监测血清胱抑素C和尿β2-MG是诊断DN早期肾损害较合理有效的指标,具有重要临床意义。     

血清胱抑素C、尿微量蛋白联合检测在2型糖尿病肾损害早期诊断中的临床价值

目的探讨血清胱抑素C在2型糖尿病患者早期肾脏损害诊断中的临床价值。方法采用胶乳增强的散射免疫比浊法测定血清胱抑素C,尿微量白蛋白（MK）,β2微球蛋白（β2-MG）,尿微球蛋白（a1-MG）,转铁蛋白（TRF）,并与健康对照组进行比较。结果 2型糖尿病患者血清胱抑素C,MK、β2-MG、a1-MG、TRF尿浓度比健康对照组显著增高（P〈0.01）。结论肾损害是2型糖尿病的严重并发症之一,血清Cystatin是糖尿病早期肾脏损害的灵敏指标,联合MK、β2-MG、a1-MG、TRF检测,对于2型糖尿病肾脏损害早期的诊断具有重要意义。     

血清同型半胱氨酸等指标联合检测对糖尿病肾病的临床价值

目的探讨血清同型半胱氨酸、血清胱抑素C和尿β2-微球蛋白联合检测对糖尿病肾病的临床价值。方法将102例糖尿病肾病患者按尿液清蛋白排泄率分为A、B、C 3组：正常清蛋白组（A组,n=42）、微量清蛋白组（B组,n=35）、大量清蛋白组（C组,n=25）,同时以20例健康人作为健康对照组。分别检测血清同型半胱氨酸、血清胱抑素C、尿液清蛋白和尿β2-微球蛋白水平,对检测结果采用SAS统计软件进行统计学处理作对比分析。结果糖尿病肾病患者各组间血清同型半胱氨酸、血清胱抑素C和尿β2-微球蛋白检测值比较差异均有统计学意义（P〈0.01）。102例糖尿病肾病患者血清同型半胱氨酸、血清胱抑素C和尿β2-微球蛋白检测值采用多元线性相关分析呈正相关（r为0.250,0.410,0.365;P〈0.01）。结论血清同型半胱氨酸、血清胱抑素C和尿β2-微球蛋白联合检测可以推断糖尿病肾病的损害程度,更全面地评价早期糖尿病肾损害,提示临床应早期干预血清同型半胱氨酸水平。     

尿微量白蛋白、胱抑素C、β_2微球蛋白和尿微量白蛋白/肌酐比值检测在2型糖尿病早期肾损害诊断的临床意义

目的探讨尿微量白蛋白、胱抑素C、β_2微球蛋白和尿微量白蛋白/肌酐比值检测在2型糖尿病早期肾损害诊断中的价值。方法采用胶乳增强免疫比浊法检测胱抑素C、β2微球蛋白,酶法检测尿肌酐,散射比浊法检测尿微量白蛋白。分别对2型糖尿病患者209例,健康体检人群68例为对照进行尿微量白蛋白、胱抑素、β_2微球蛋白和尿肌酐测定,并进行统计学分析。结果 T2DM组各组(正常蛋白尿组、早期DN组与蛋白尿组)的尿微量白蛋白、胱抑素C和尿微量白蛋白/肌酐比值均高于正常对照组(P0.05),早期DN组与蛋白尿组的β_2微球蛋白水平高于正常对照组(P0.05),正常蛋白尿组和正常对照组的β_2微球蛋白水平差别无统计学意义(P0.05)。m ALB、β_2-MG、Cys-C、m ALB/Cr、m ALB+β_2-MG、m ALB+β_2-MG+Cys-C和m ALB+β_2-MG+Cys-C+m ALB/Cr的敏感度依次增高,以m ALB+β_2-MG+Cys-C+m ALB/Cr敏感度最高(P0.05)。结论尿微量白蛋白、胱抑素C、β_2微球蛋白和尿微量白蛋白/肌酐比值检测在2型糖尿病早期肾损害诊断中有重要的临床意义。     

血胱抑素C和尿中4种蛋白联合检测对早期糖尿病肾病的诊断价值

目的探讨血清胱抑素C(CysC)及尿中微量白蛋白(mAlb)、α1微球蛋白(α1-MG)、β2微球蛋白(β2-MG)、视黄醇结合蛋白(RBP)水平检测对早期糖尿病肾病的诊断价值。方法采用免疫透射比浊法对82例已经确诊为糖尿病但尿常规检测尿蛋白阴性的患者和67例健康体检者的血清CysC含量和尿mAlb、α1-MG、β2-MG、RBP进行检测分析。结果糖尿病患者组血清CysC和尿mAlb、α1-MG、β2-MG、RBP含量高于健康对照组,差异具有统计学意义(P均<0.01)。结论联合检测糖尿病患者血清CysC和尿mAlb、α1-MG、β2-MG、RBP4种蛋白对糖尿病肾病的早期诊断具有重要的临床意义。     

胱抑素C与尿微量蛋白及尿酶联合检测在不同程度肾病中的应用价值

目的探讨血清胱抑素C（cystatin C，Cys C）、尿微量蛋白与尿酶联合检测对不同程度肾脏损害的临床诊断价值、可行性和监控作用。方法血清胱抑素C采用颗粒增强透射免疫比浊法（PETIA）分析，对30名健康对照者和98名不同病程的肾功能损害者进行尿微量清蛋白（mAlb）、尿转铁蛋白（UTf）、α1-微球蛋白（α1-MG）、β2-微球蛋白（β2-MG）进行检测分析，动态监测法测N-乙酰-β-D-氨基葡萄糖苷酶（NAG），Jaffe速率法测肌酐。结果血清胱抑素C、尿微量蛋白与NAG／Cr测定结果明显高于健康对照组，其差异有统计学意义（P〈0．01）。但肌酐清除率（Ccr）、血尿素（BUN）、血肌酐（Cr）在早期临床无症状组的比较中，无统计学意义（P〉0．05），单项检测时阳性率较低，联合检测时阳性率可明显提高，可达91．83％；血清胱抑素C、尿微量蛋白与尿酶扣肾病的严重程度呈显著正相关。结论尿蛋白定性阴性不能排除肾脏的早期损伤，血清胱抑素C、尿微量蛋白与尿酶联合检测是诊断肾脏早期损伤的灵敏与可靠的实验室指标，它在肾脏损伤程度的分析中有重要的意义。     

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.     

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.     

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.