血浆置换前后患者肝功能、凝血功能和补体的变化

目的探讨重型肝炎患者血浆置换治疗前后肝功能、凝血功能和补体的变化。方法对136例重型肝炎患者血浆置换（Plasma exchang,PE）治疗前后的PT、APTT、TT、Fib、AT、D-D、肝功能以及补体C3、C4进行检测,观察治疗前后指标的变化。结果凝血指标PT、APTT、TT在PE治疗后明显缩短（P均〈0.001）;Fib治疗后明显增加（P〈0.05）;D-二聚体明显减少（P〈0.001）,AT活性明显增加（P〈0.001）,TBiL、DBiL、ALT、ALP、TBA明显下降（P均〈0.001）,PA和补体C3、C4明显升高（P均〈0.001）。结论血浆置换是治疗重型肝病的一种有效方法,能改善重型肝炎患者的凝血及肝功能,同时补充了蛋白质、补体,纠正了异常免疫反应。     

血浆置换治疗33例慢性重型肝炎病人的疗效观察

目的 探讨血浆置换术治疗慢性重型肝炎的疗效.方法 回顾性分析33例采用血浆置换术进行治疗的重型肝炎患者治疗前后肝、肾功能指标的数据,分析血浆置换治疗重型肝炎的效果.结果 患者治疗前后血清胆红素、血清转氨酶、白蛋白、球蛋白、前白蛋白、总胆固醇、胆碱脂酶、凝血酶原时间、国际标准化比率有明显改善.结论 血浆置换术能改善重型肝炎的肝功能和凝血功能指标,缓解病情,是一种有效的辅助治疗手段.     

血浆置换治疗对重型病毒性肝炎血清内毒素和炎性介质的影响

目的：应用血浆置换技术，探讨其对重型病毒性肝炎患者体内内毒素和炎性因子水平的影响。方法：50例例重型病毒性肝炎患者和血浆置换治疗，于血浆置换治疗前，治疗结束时，治疗后24小时，48小时分别抽血测血清内毒素（ET）、TNFα及IL－6的水平。结果：重型生地炎患者血清内毒素、TNFα、IL－6的水平明显升高，血浆置换治疗结束时血清内毒素、TNFα、IL－6的水平明显低于治疗前水平（P＜0．05）。治疗后48小时内毒素、TNFα、IL－6的水平有所上升，但存活组较治疗前明显下降（P＜0．05），而死亡组与治疗前无明显变化（P＞0．05）。结论：血浆置换治疗能有效清除重型病毒性肝炎血清内毒素和炎性介质，治疗后血清内毒性和炎性介质的水平动态变化可能是判断血浆置换治疗重型病毒性肝炎预后的一个指标。     

人工肝支持系统治疗重型肝炎26例分析

目的:研究人工肝支持系统对重型肝炎的临床疗效.方法:对26例重型肝炎患者根据病情分别选择血浆置换、血浆置换联合血液滤过等人工肝支持方法进行治疗,比较治疗前后患者临床症状、肝功能、肾功能、血氨、凝血功能等指标.结果:治疗后患者症状明显缓解,血清总胆红素、总胆汁酸、血氨下降,凝血酶原时间缩短,凝血酶原活动度上升(P<0.01).结论:人工肝支持系统能显著改善重型肝炎患者临床症状及生化指标,提高近期存活率.     

103例慢性乙型重型肝炎血浆置换治疗的疗效观察

目的观察血浆置换治疗慢性乙型重型肝炎的疗效。方法对103例慢性乙型重型肝炎患者进行血浆置换,观察血浆置换对慢性乙型重型肝炎患者有效率和病死率及生化指标的影响。结果血浆置换治疗慢性重型肝炎能明显降低病死率,显著改善肝功能等血清生化指标,提高抢救成功率。结论血浆置换治疗慢性乙型重型肝炎有肯定的治疗效果。     

103例慢性乙型重型肝炎血浆置换治疗的疗效观察

目的 观察血浆置换治疗慢性乙型重型肝炎的疗效.方法 对103例慢性乙型重型肝炎患者进行血浆置换,观察血浆置换对慢性乙型重型肝炎患者有效率和病死率及生化指标的影响.结果 血浆置换治疗慢性重型肝炎能明显降低病死率,显著改善肝功能等血清生化指标,提高抢救成功率.结论 血浆置换治疗慢性乙型重型肝炎有肯定的治疗效果.     

血浆置换对慢性乙型重型肝炎患者血清病毒负荷的影响

[目的]探讨血浆置换对慢性乙型重型肝炎患者血清病毒负荷的影响及其临床意义.[方法]101例慢性乙型重型肝炎患者,分为血浆置换(PE)治疗组和对照组,分别检测血浆置换治疗前后肝功能、乙肝标志物、HBV定量水平;比较死亡组与存活组血浆置换治疗后血清总胆红素和HBV定量水平.[结果]慢性乙型重型肝炎患者PE治疗前肝功能和HBVDNA定量水平明显升高,PE术后肝功能和HBVDNA定量水平有显著下降,同对照组相比差异有显著性(P＜0.01);死亡者PE治疗后总胆红素及HBVDNA定量水平同存活者相比差异有显著性(P＜0.01).[结论]PE可明显改善肝功能,降低血清HBVDNA定量水平,对外周血HBV有较强的清除作用.PE术后总胆红素和HBVDNA定量水平可以成为预测重肝治疗效果的一个指标.     

护理程序在重型肝炎行血浆置换患者中的应用

目的:探讨护理程序在重型肝炎行血浆置换(TPE)患者中的应用方法及临床效果。方法:对21例重型肝炎行TPE治疗患者按护理程序进行护理,比较治疗前后患者临床症状及肝功能、凝血功能等指标变化情况。结果:本组患者治疗前后肝功能、凝血功能指标及临床症状比较差异有统计学意义(P<0.05)。结论:对重型肝炎行TPE治疗患者按照护理程序进行系统护理有助于治疗顺利进行,提高疗效,减少并发症发生,改善患者生存质量。     

血浆置换对慢性乙型重型肝炎患者血清细胞因子的影响及意义

目的：观察血浆置换对慢性乙型重型肝炎患者血清肿瘤坏死因子-α（TNF-α）、白介素-10（IL-10）及白介素-18（IL-18）水平的影响，并探讨其临床意义。方法：56例慢性乙型重型肝炎患者，分别在血浆置换治疗前后检测血清TNF-α、IL-10及IL-18水平，并与健康对照组比较。结果：慢性乙型重型肝炎患者治疗前血清TNF-α、IL-18的水平明显升高，而IL-10的水平显著下降，同健康对照组相比均有显著差异（P〈0．01）；血浆置换组治疗后血清TNF-α及IL-18的水平较治疗前显著下降（P〈0．01），IL-10的水平较治疗前显著升高（P〈0．01）。结论：血浆置换可降低血清TNF-α、IL-18的水平，并且升高IL-10的水平，通过调整细胞因子的平衡，保护肝细胞，促进病情的恢复。     

血浆置换联合中药治疗慢性乙型重型肝炎临床研究

目的:研究血浆置换联合中药方重肝合剂治疗慢性乙型重型肝炎的疗效。方法:将72例早中期慢性乙型重型肝炎患者随机分为2组,每组36例。对照组给予内科综合治疗及血浆置换,治疗组在此基础上加用重肝合剂,比较2组在治疗第6周末的肝功能、凝血功能、疗效及血浆置换次数。结果:2组症状均有明显改善,2组综合疗效相当,没有显著性差异(P>0.05);2组肝功能指标均明显改善,与治疗前比较均有显著意义(P<0.01或0.05),而治疗组总胆红素(TBIL)、谷草转氨酶(AST)水平降低更为明显(P<0.05);治疗组进行血浆置换(3.3±1.6)次,对照组(5.5±1.8)次,2组比较差异有显著意义(P<0.05)。结论:血浆置换联合中药方重肝合剂治疗早、中期慢性乙型重型肝炎,可促进胆红素的代谢,减少血浆置换治疗次数,改善患者预后。     

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.     

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.     

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.