血必净注射液治疗脓毒性休克的前瞻性随机对照研究

目的:研究血必净注射液治疗脓毒性休克患者的临床疗效。方法:将2006年4月—2007年3月收入江苏省苏北人民医院危重病医学科的48例脓毒性休克患者随机分为对照组和血必净组,每组24例。对照组按照脓毒性休克治疗指南进行治疗;血必净组在对照组治疗基础上加用血必净注射液50 ml静脉滴注,每日2次,连续用7 d。记录治疗前后患者的生命体征、白细胞计数(WBC)和Marshall评分,并抽取外周血,采用酶联免疫吸附法(ELISA)检测血清白细胞介素-6(IL-6)和IL-10水平,并记录患者28 d的病死率。结果:疗程结束时血必净组体温〔(37.2±0.6)℃比(37.9±0.6)℃〕、WBC〔(9.6±2.2)×109/L比(11.2±1.5)×109/L〕、Marshall评分〔(2.1±1.9)分比(2.8±1.8)分〕、IL-6〔(0.37±0.34)ng/L比(2.33±2.06)ng/L〕、IL-10〔(0.82±0.66)ng/L比(2.98±1.99)ng/L〕及28 d的病死率(4.2%比25.0%)明显低于对照组(P<0.05或P<0.01)。结论:血必净注射液可以改善脓毒性休克患者预后,其作用机制可能为通过调控炎症反应实现。     

胱抑素C在肾脏疾病诊断中的应用研究

目的探讨胱抑素C(CysC)临床检测在肾脏疾病中的应用。方法选择2018年1月—2020年12月枣庄矿业集团枣庄医院收治的150例肾脏疾病患者作为肾脏疾病组,并根据疾病类型分为肾功能不全代偿组、肾功能不全失代偿组、肾功能衰竭组,每组各50例;另外选择同期50名健康体检者作为正常对照组。采用免疫比浊法检测CysC,采用酶偶联率法检测尿素,采用比色法检测血肌酐(SCr),比较并分析各组上述指标水平以及阳性检出率的差异。结果肾脏疾病组的CysC、尿素、SCr水平〔CysC(mg/L):5.05±0.46比1.03±0.17,尿素(mmol/L):12.62±1.78比5.37±1.22,SCr(μmol/L):165.44±25.78比80.45±10.36〕和阳性检出率〔CysC:88.00%(132/150)比0.00%(0/50),尿素:60.67%(91/150)比0.00%(0/50),SCr:67.33%(101/150)比2.00%(1/50)〕均明显高于正常对照组(均P0.05)。肾功能衰竭组的CysC、尿素、SCr水平〔CysC(mg/L):5.22±0.51比4.56±0.82、2.65±0.32,尿素(mmol/L):22.75±4.13比10.38±1.52、5.78±1.25,SCr(μmol/L):750.60±35.58比174.51±19.67、92.45±20.36〕和阳性检出率〔CysC:100.00%(50/50)比86.00%(43/50)、78.00%(39/50),尿素:92.00%(46/50)比78.00%(39/50)、12.00%(6/50),SCr:98.00%(49/50)比82.00%(41/50)、22.00%(11/50)〕均明显高于肾功能不全失代偿组和肾功能不全代偿组(均P0.05),且肾功能不全失代偿组的CysC、尿素、SCr水平〔CysC(mg/L):4.56±0.82比2.65±0.32,尿素(mmol/L):10.38±1.52比5.78±1.25,SCr(μmol/L):174.51±19.67比92.45±20.36〕及阳性检出率〔CysC:86.00%(43/50)比78.00%(39/50),尿素:78.00%(39/50)比12.00%(6/50),SCr:82.00%(41/50)比22.00%(11/50)〕均明显高于肾功能不全代偿组(均P0.05)。结论 CysC在肾脏疾病诊断中价值较高,可为该疾病的临床诊断和治疗方案制定提供参考。     

阻塞性睡眠呼吸暂停低通气综合征患者手术前后血中CRP、TNF-α、IL-8的变化

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者手术前后血中C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)水平的变化。方法选取67例经多导睡眠监测仪(PSG)证实的重度OS-AHS患者作为研究组,同时以30例与研究对象相匹配的健康人群做对照。用放射免疫法检测血清中TNF-α及IL-8,用乳胶增强免疫比浊法检测血清中CRP。结果术前OSAHS组血清CRP〔(7.01±0.33)mg/L〕、TNF-α〔(1.82±0.36)μg/L〕、IL-8〔(227.18±88.17)ng/L〕水平明显高于对照组〔(2.87±0.21)mg/L、(0.99±0.31)μg/L、(153.23±62.11)ng/L〕(P均<0.05);术后OSAHS组血清CRP〔(3.27±0.33)mg/L〕、TNF-α〔(1.11±0.27)μg/L〕、IL-8〔(149.73±66.12)ng/L〕水平较术前明显下降(P均<0.05),与对照组水平比较差异无统计学意义(P均>0.05)。结论 OSAHS患者术前血清中CRP、TNF-α、IL-8水平失衡,经过鼻持续正压通气及手术治疗后,3种因子水平可下降至正常水平。CRP、TNF-α及IL-8可做为OSAHS诊治的有效指标。     

7 473例健康体检者血脂和血糖检测结果分析

目的分析不同性别和年龄健康体检者血脂指标与空腹血糖(FBG)水平以及异常情况分布。方法选择曲靖市第二人民医院体检中心2019年1—9月接待的7 473名健康体检者作为研究对象,根据年龄分为7组,分别为≤30岁、31～40岁、41～50岁、51～60岁、61～70岁、71～80岁、≥81岁组。采用酶法检测血脂指标〔包括总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)〕,采用己糖激酶法检测FBG,分析并比较不同性别和不同年龄组上述指标的检测结果以及异常情况。结果男性的FBG、TC、TG、LDL-C水平均明显高于女性〔FBG(mmol/L):5.30±1.45比5.06±1.16,TC(mmol/L):4.48±0.94比4.40±0.91,TG(mmol/L):2.36±2.32比1.63±1.58,LDL-C(mmol/L):2.85±1.99比2.75±1.80,均P0.05〕,HDL-C水平明显低于女性(mmol/L:1.22±0.30比1.38±0.30,P0.05)。随年龄增加,FBG、TC、TG、LDL-C水平均逐渐升高,FBG在71～80岁组达最高〔(5.99±1.87)mmol/L〕,TC在61～70岁组达最高〔(4.79±1.01)mmol/L〕,TG在51～60岁组达最高〔(2.35±2.28)mmol/L〕,LDL-C在61～70岁组达最高〔(3.02±0.82)mmol/L〕,之后各指标均有所下降;不同年龄组血脂指标和FBG水平比较差异均有统计学意义(均P0.05)。男性FBG、TG、LDL-C升高比例均明显高于女性〔FBG:8.4%(398/4 753)比3.5%(94/2 720),TG:30.3%(1 441/4 753)比15.0%(408/2 720),LDL-C:11.7%(554/4 753)比9.2%(250/2 720),均P0.05〕。随年龄增加,FBG、TG、LDL-C升高比例均逐渐升高,FBG在71～80岁组达最高〔21.2%(46/217)〕,TG在41～50岁组达最高〔28.5%(628/2 207)〕,LDL-C在61～70岁组达最高〔19.6%(103/526)〕,之后上述指标升高比例均有所下降;不同年龄组比较差异均有统计学意义(均P0.05)。结论高脂血症和糖尿病的发生与人们的年龄增长、不良饮食习惯及生活方式有着密切关系,且高血脂和高血糖的发病呈现年轻化趋势;重视健康体检者的血脂和血糖筛查结果,倡导良好饮食习惯和生活方式对预防疾病有重要意义。     

中重度痔疮采用吻合器痔上黏膜环切术联合硬化剂注射术治疗的临床效果分析

目的研究分析中重度痔疮采用吻合器痔上黏膜环切术(PPH)联合硬化剂注射术治疗的临床效果。方法从我院中重度痔疮患者中随机选取172例进行临床研究,并按照痔疮患者治疗方法将其分为治疗组(采用PPH联合硬化剂注射术治疗)和对照组(采用外剥内扎术治疗),各为86例,分析两组患者临床治疗效果及血清炎症因子含量变化情况。结果治疗组患者住院时间、术中出血量、术后镇痛、肛门功能恢复时间、并发症发生率和治疗总有效率分别为:(5.5±2.2)d、(18.7±5.5)ml、3.5%、(6.5±1.6)d、4.7%和95.3%;对照组患者住院时间、术中出血量、术后镇痛、肛门功能恢复时间、并发症发生率和治疗总有效率分别为:(10.7±3.7)d、(34.2±5.7)ml、38.4%、(9.2±1.8)d、25.6%和83.7%;治疗组均优于对照组,差异均有统计学意义(P<0.05)。治疗后,治疗组血清炎症因子肿瘤坏死因子α(TNF-α)和白细胞介素-1(IL-1)分别为:(1.76±0.43)ng/L和(5.62±0.74)ng/L,对照组血清炎症因子TNF-α和IL-1分别为:(3.48±0.72)ng/L和(8.42±0.51)ng/L,治疗组比对照组均明显下降,差异均有统计学意义(P<0.05)。结论 PPH联合硬化剂注射术在治疗中重度痔疮临床上具有良好治疗作用,对中重度痔疮患者临床症状具有显著改善作用。     

溃疡性结肠炎患者血清和结肠组织白细胞介素8和白细胞介素10的表达

目的 检测溃疡性结肠炎(UC)患者的结肠组织及血清中白细胞介素8(IL-8)和白细胞介素10(IL-10)的含量,探讨IL-8和IL-10在UC发病中的作用及其相关性.方法 用放射免疫分析检测70例经内镜检查确诊的UC患者(UC组)结肠组织和血清标本,并与30例正常对照组(健康志愿者)比较.结果 UC组中患者血清和结肠组织中IL-8含量均比正常对照组升高,且随着病变范围的扩大和病变程度的加重逐渐升高(均P<0.01),轻度、中度、重度UC患者血清中IL-8含量分别为(107±11)ng/L、(151±36)ng/L、(201±47)ng/L(均P<0.01),结肠组织中分别是(300±10)ng/g、(777±96)ng/g、(907±185)ng/g,而血清和结肠组织中IL-10含量比对照组降低,且随着病变程度加重逐渐降低.轻度、中度、重度UC患者血清中IL-10含量分别为(41±11)ng/L、(35±14)ng/L、(20±6)ng/L(均P<0.01),结肠组织中分别是(80±12)ng/g、(61±11)ng/g、(20±10)ng/g;IL-8和IL-10表达水平呈负相关.结论 促炎因子IL-8含量升高,抑炎因子IL-10含量降低,体内免疫调节失衡,易诱发UC;IL-8、IL-10水平与疾病严重程度显著相关.     

低糖血症与急性失代偿性肝硬化患者 病死率增加的相关性研究

目的 探讨低糖血症与急性失代偿性肝硬化患者病死率增加的相关性.方法 回顾性分析2011年12月至2014年12月就诊于河北医科大学第二医院肝胆外科的120例失代偿性肝硬化患者的临床资料,将患者分为低糖血症组(血糖<5.0 mmol/L,21例)、正常血糖组(血糖5.1~10.0 mmol/L,84例)、高糖血症组(血糖>10.1 mmol/L,15例),比较3组患者肝癌、代偿失调症状、已知糖代谢紊乱发生率及住院情况、肝功能指标和血气分析指标的差异,对患者的年龄、肝癌、腹水、肝肾综合征、脑病、出血、黄疸、糖代谢紊乱等资料进行单因素分析,将有统计学差异的危险因素进行多因素logistic回归分析,筛选出患者病死率增加的危险因素.结果 低糖血症组患者肝肾综合征发生率〔42.9%(9/21)比22.6%(19/84)、33.3%(5/15)〕、黄疸发生率〔38.1%(8/21)比20.2%(17/84)、13.3%(2/15)〕、重症加强治疗病房(ICU)入住率〔14.3%(3/21)比10.7%(9/84)、13.3%(2/15)〕、住院病死率〔23.8%(5/21)比10.7%(9/84)、20.0%(3/15)〕均显著高于正常血糖组和高糖血症组(P<0.05或P<0.01);低糖血症组患者天冬氨酸转氨酶〔AST(U/L):628.412±78.625比170.167±87.035、156.716±98.047〕、总胆红素〔TBil(μmol/L):154.122±34.201比86.712±48.905、74.313±39.883〕、血肌酐〔SCr (μmol/L):160.243±56.341比107.211±59.692、121.342±84.059〕及国际标准化比值(INR:1.951±0.987比1.439±0.919、1.423±0.653)水平均显著高于正常血糖组和高血糖组,3组比较差异有统计学意义(P<0.05或P<0.01);碳酸氢根〔HCO3-(mmol/L):18.154±10.937比23.135±11.119、19.081±12.022〕和剩余碱〔BE (mmol/L):-7.578±2.042比-1.648±0.887、-5.402±2.005〕均低于正常血糖组和高糖血症组,3组比较差异有统计学意义(均P<0.01);3组pH值水平比较差异亦有统计学意义(7.352±2.878比7.461±2.036、7.219±2.017, P<0.01),3组丙氨酸转氨酶(ALT)、血氨、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、乳酸(Lac)比较差异均无统计学意义(均P>0.05).单因素分析显示:高龄、肝癌、肝肾综合征、出血、黄疸、糖代谢紊乱低糖血症是急性失代偿性肝硬化患者的死亡危险因素(P<0.05或P<0.01);多因素logistic回归分析显示:高龄〔优势比(OR)值=2.101,95%可信区间(95%CI)=1.297~3.403,P=0.000〕、肝肾综合征(OR值=3.032,95%CI=1.462~6.286,P=0.000)、低糖血症(OR值=3.267,95%CI=2.135~4.999,P=0.031)是导致患者死亡的危险因素.结论 低糖血症与急性失代偿性肝硬化患者病死率增加有一定的相关性.     

麝香酮对SH-SY5Y神经细胞缺氧/缺糖和再给氧损伤的保护作用

目的:研究麝香酮对神经细胞缺氧/缺糖和再给氧损伤的保护作用。方法:培养SH-SY5Y神经细胞。采用含连二亚硫酸钠的无糖Earle液模拟造成缺氧/缺糖和再给氧损伤;用苔盼蓝染色计数法测定细胞死亡率,用四甲基偶氮唑盐(MTT)比色法测定细胞存活率,用Hoechst 33342和碘化丙啶(PI)原位双染法荧光显微镜检测细胞坏死率和细胞凋亡率,用比色法测定乳酸脱氢酶(LDH)漏出率;并评价药效。结果:与正常对照组比较,缺氧/缺糖和再给氧损伤模型组细胞存活率显著下降〔(100.0±4.4)%比(25.6±3.7)%〕,细胞死亡率〔(5.0±2.2)%比(71.2±9.2)%〕、坏死率〔(2.6±1.2)%比(46.8±10.4)%〕、凋亡率〔(3.1±0.8)%比(16.0±4.9)%〕、LDH漏出率〔(20.1±5.8)%比(66.4±7.6)%〕均显著升高(P均<0.01)。麝香酮各终浓度组的细胞存活率显著提高〔(42.7±1.2)%~(47.8±1.7)%,P均<0.01〕,细胞死亡率〔(22.7±5.2)%~(36.1±5.9)%〕、坏死率〔(24.3±8.3)%~(28.9±8.7)%〕、凋亡率〔(7.8±3.1)%~(10.4±4.9)%〕、LDH漏出率〔(37.6±4.1)%~(40.6±2.4)%〕均显著下降(P<0.05或P<0.01)。结论:麝香酮对SH-SY5Y神经细胞缺氧/缺糖和再给氧损伤具有显著的保护作用,提示麝香酮可能应用于中风病急性期的治疗。     

不同程度支气管肺发育不良早产儿神经系统发育对比研究

目的探讨不同程度支气管肺发育不良(bronchopulmonary dysplasia,BPD)早产儿神经系统发育特征及预后。方法 116例BPD早产儿,其中轻度68例(轻度组),中重度48例(中重度组),分析2组围生期高危因素和治疗情况;矫正胎龄40周时,2组行头颅MRI检查评估脑白质损伤(white matter damage,WMD)情况,行脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)检查评估BAEP异常程度分级;矫正年龄6个月时,2组应用Gesell发育量表评估神经系统发育情况。结果中重度组患儿出生后体质量生长迟缓、院内脓毒症发生率(33.3%、25.0%)高于轻度组(10.3%、7.4%),机械通气时间[6.2(0,8.7)d]和总氧疗时间[55.8(41.6,62.7)d]长于轻度组[2.1(0,4.6)d、36.2(32.6,45.7)d](P0.05);矫正胎龄40周时,中重度组患儿WMD分级与BAEP异常程度均高于轻度组(P0.05),BPD严重程度与BAEP异常程度呈正相关(r=0.652,P=0.001);矫正年龄6个月时,中重度组患儿精细运动能区、认知能区、语言能区、社交行为能区和发育商评分[(89.2±14.1)、(91.6±13.6)、(90.6±14.4)、(94.3±14.1)、(90.7±8.2)分]均低于轻度组[(96.7±12.5)、(98.3±16.7)、(95.8±15.5)、(99.8±15.8)、(95.6±9.8)分](P0.05),中重度组患儿精细运动能区、认知能区、语言能区、社交行为能区和发育商85分比率(33.3%、41.7%、33.3%、31.3%、31.3%)均高于轻度组(16.2%、20.6%、16.2%、13.2%、11.8%)(P0.05),大运动能区评分[(90.3±12.6)分]及85分比率(18.8%)与轻度组[(92.2±10.8)分、13.2%]比较差异无统计学意义(P0.05)。结论中重度BPD可加重早产儿WMD程度和脑干听觉神经损伤,增加早产儿6个月时神经行为障碍发生率,临床可通过控制中重度BPD发生,改善早产儿预后。     

参芪扶正注射液对脓毒症患者免疫功能的影响

目的 观察参芪扶正注射液对脓毒症患者外周血T细胞亚群、T细胞凋亡和细胞因子的影响并探讨其意义.方法 选择天津医科大学总医院普通外科收治的40例脓毒症患者,按随机数字表法分为常规治疗组(20例,给予常规西医治疗)和参芪扶正治疗组(20例,在西医常规治疗基础上加用参芪扶正注射液 250 mL静脉滴注,每日1次),两组均以7 d为1个疗程.两组患者均于治疗1、3、7 d进行急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分;用流式细胞仪检测外周血T细胞亚群CD4+、CD8+、CD4+/CD8+和细胞凋亡情况,用酶联免疫吸附试验(ELISA)检测外周血细胞因子肿瘤坏死因子-α(TNF-α)、白细胞介素 (IL-6、IL-10)水平.结果 两组治疗后3 d APACHEⅡ评分均较治疗后1 d明显降低,并持续到治疗后7 d,且参芪扶正治疗组的降低程度较常规治疗组更显著(分:10.05±3.71比13.15±4.65,P<0.05).随着治疗时间的延长,两组外周血TNF-α、IL-6水平均逐渐下降;IL-10水平先升高,到7 d时又下降;7 d时参芪扶正治疗组TNF-α和IL-6明显低于常规治疗组〔TNF-α(ng/L):204.6±18.1比218.9±21.3,IL-6(ng/L):3.68±0.30比3.95±0.49,均P<0.05〕;而参芪扶正组与常规治疗组IL-10比较差异无统计学意义(ng/L:173.8±23.3比174.8±18.9,P>0.05).两组治疗后1、3、7 d CD4+T细胞和CD4+/CD8+先下降后上升,CD8+T细胞逐渐下降及CD4+、CD8+T细胞凋亡率先升后降,参芪扶正治疗组治疗后7 d CD4+T细胞、CD4+/CD8+及CD4+T细胞凋亡率与常规治疗组比较差异均有统计学意义〔CD4+T细胞:(38.3±4.7)%比(35.5±5.5)%,CD4+/CD8+:1.55±0.29比1.36±0.27,CD4+T细胞凋亡率:(11.2±3.8)%比(14.1±5.5)%,均P<0.05〕;两组各时间点CD8+T及其细胞凋亡率比较差异均无统计学意义(均P>0.05).结论 参芪扶正注射液可有效降低脓毒症患者CD4+T细胞凋亡率,增加CD4+T细胞和CD4+/CD8+,降低炎症指标,改善脓毒症患者的免疫功能及病情严重程度.     

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.     

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.     

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.     

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.