杭州市健康人群血液流变学及血脂测定结果分析

目的 了解血流变学及血脂结果 在健康人群中的关系.方法 547例健康体检者男322例,女225例,女性平均年龄为(45.96±11.51岁),男性平均年龄为(44.27±11.35)岁,并按年龄段分为五组;分别用全自动血流变仪测定血液流变学指标及全自动血生化仪测定总胆固醇(TC)、甘油三酯(TG)、高密度胆固醇(HDL)、低密度胆固醇(LDL)、载脂蛋白Al(APOA)、载脂蛋白B(APOB)指标.结果 男性组与女性组血流变指标LBV、MBV、HBV、HBVI、LBVI、CV比较,差异均有统计学意义(t=3.20～11.73,P均＜0.05),男性组与女性组血脂指标除总胆固醇外,TC、TG、HDL、LDL、APOA1、APOB差异均有统计学意义(t=2.34～11.12,P均＜0.05).年龄段在4l～50岁的男性血液流变学与血脂结果 比较,差异均有统计学意义(r=-0.33～0.25,P均＜0.05).结论 322例男性体检41岁以上组血液流变学与血脂检测结果 呈显著相关性,对此类人群应在健康体检中引起重视.     

促甲状腺激素与血糖、血脂水平的相关性研究

目的探讨体检人群促甲状腺激素(TSH)的升高情况及其与血糖、血脂各指标之间的相关性。方法回顾性分析2017年1-5月该院1 070例体检人群TSH、血清总胆固醇(CHOL)、血清三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、血糖(GLU)、糖化血红蛋白(HbA1c)等指标,按性别和年龄进行统计,并分析TSH与血糖、血脂水平的相关性。结果共检出TSH阳性者118例,阳性率为11.03%,其中男性58例,阳性率为9.40%,女性60例,阳性率为13.25%,男女间TSH阳性率差异有统计学意义(χ2=9.819,P0.05)。TSH与TG、LDL、GLU呈成正相关(r分别为0.006、0.048、0.021,P分别为0.038、0.017、0.045),与HDL呈负相关(r=-0.017,P=0.024),而与CHOL、HbA1c无相关性(P0.05)。TSH升高组与TSH正常组相比,CHOL水平差异有统计学意义(P0.05)。结论 TSH的升高已经成为影响人类健康的一个重要因素,应该更加重视。     

某医院健康体检人群血糖与血脂的关系研究

目的探讨该院健康体检人群血糖与血脂的情况及相关性研究。方法收集该院1 000例健康体检者的血清,分别测定各项血脂和血糖水平,包括空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C),并分析血糖水平与各项血脂水平之间的相关性。结果 FBG水平随年龄增长而上升,TG、TC和LDL-C水平也随年龄增长而增长;FBG水平与TG水平之间呈正相关(r=0.175,P0.05);FBG与HDL-C之间呈负相关(r=-0.165,P0.05);在高FBG组和FBG正常组之间,TG、TC、HDL-C水平差异有统计学意义(P0.05),两组间TC升高率分别为58.1%和36.0%,差异有统计学意义(P0.05);TC升高组和TC正常组的FBG水平分别为(5.15±1.45)mmol/L和(4.77±0.75)mmol/L,FBG升高的发生率分别为9.46%和4.76%,差异有统计学意义(P0.05)。结论健康体检人群的FBG与血脂水平存在相关性,积极治疗高血糖有利于控制血脂,积极控制血脂则有利于糖尿病的防治。     

不同人群sdLDL-C水平及其与血脂组分的相关性分析

目的调查不同人群小而密低密度脂蛋白胆固醇(sdLDL-C)水平,分析其与血脂组分的相关性。方法选取于该院进行体检和门诊就医人员共986例作为研究对象。其中血脂正常者654例,并根据性别和年龄划分;血脂增高者根据空腹TG和LDL-C分为高TG组、高LDL-C组、联合增高组。测定上述人群血清sdLDL-C、LDL-C、TG、TC、HDL-C、ApoAⅠ和ApoB水平,并分析sdLDL-C与TG、TC、HDL-C、ApoAⅠ、ApoB的相关性。结果男、女sdLDL-C 70岁之后开始下降,差异有统计学意义(P0.05);sdLDL-C水平总体均值男性高于女性,差异有统计学意义(P0.05)。各血脂增高组sdLDL-C水平、sdLDL-C/LDLC均高于血脂正常组,差异均有统计学意义(P0.05)。sdLDL-C与TC、TG、ApoB呈正相关(r分别为0.254、0.589、0.302),与HDL-C和ApoAⅠ呈负相关(r分别为-0.421、-0.275、-0.311)。结论sdLDL-C与TC、TG、ApoB呈正相关,与HDL-C、ApoAI呈负相关,能较准确地反映机体脂质代谢整体状况。     

汕尾市城区体检人群尿酸和血脂异常率及尿酸与血脂的相关性分析

目的了解汕尾市城区体检人群尿酸和血脂异常率及尿酸与血脂的相关性。方法选取2018年12月至2019年12月在该院体检中心接受体检的8909例健康体检人群为研究对象,检测其血清尿酸(UA)、三酰甘油(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-L)、低密度脂蛋白胆固醇(LDL-C)水平。将研究人群按性别分为男、女两组。比较两组UA、TG、TC、HDL-L、LDL-C水平;统计UA、TG、TC、HDL-L、LDL-C的异常率,分析UA水平与血脂的相关性。将各性别组中的研究人群再分成正常UA组与高UA组,比较其血脂水平及异常率。结果研究人群中,UA、TG、TC、HDL-L及LDL-C的总异常率分别为34.1%、27.3%、47.9%、2.9%、26.3%,且男性高于女性(P<0.05)。男性UA、TG、TC及LDL-C水平高于女性,HDL-L水平低于女性,差异均有统计学意义(P<0.05)。男性与女性的UA水平与TG、TC、LDL-C呈正相关(r=0.21、0.26,0.09、0.18,0.09、0.24;P<0.05),与HDL-C呈负相关(r=-0.13、-0.18,P<0.05)。高UA组TG、TC及LDL-C水平高于正常UA组,HDL-C水平低于正常UA组(P<0.05)。高UA组TG、TC、LDL-C的异常率比正常UA组高(P<0.05)。结论该市城区体检人群男性UA、TG、TC及LDL-C水平和异常率均高于女性,UA水平升高与血脂异常存在一定的相关性。     

某高校教职工近3年血脂、血糖与性别、年龄、体质量指数的相关性研究

目的探讨某高校教职工总胆固醇(TC)、三酰甘油(TG)与性别、年龄、体质量指数(BMI)及血糖(GLU)水平的相关性。方法回顾性分析2016-2018年重庆某高校1 100例职工健康体检的相关数据,最终纳入890例体检者作为研究对象。根据年龄分为3组,测定其血清TC、TG和GLU水平,分别比较TC和TG在各年龄组及性别组间的差异,并分析TC和TG与年龄、BMI和GLU的相关性;并纵向分析不同年龄组TC、TG和GLU在近3年内是否存在差异。结果 TC与TG在不同年龄组与性别组分别存在显著差异,其中,女性TC、TG水平显著高于男性(P=0.023、0.019);TC和TG有随年龄增长而升高的趋势(r=0.32,P0.05;r=0.21,P0.05),且与BMI有相关性(r=0.22,P0.05;r=0.19,P0.05),与GLU均无相关性(P0.05)。青年组和老年组各项指标近3年间差异无统计学意义(P0.05),中年组TC和GLU近3年差异均有统计学意义(P0.05),TG差异无统计学意义(P0.05)。结论 TC、TG与性别、年龄和BMI有相关性,但与GLU无相关性;高校教职工在刚入职期TC、TG和GLU变化不明显,随年龄增长,在稳定期及退休期,其脂蛋白代谢紊乱趋势增高,且男性趋势更明显。     

多器官功能障碍综合征患者循环内皮细胞数量和血脂水平变化及临床意义

目的:探讨循环内皮细胞(CEC)数量与血脂水平与多器官功能障碍综合征(M ODS)的关系及其意义。方法:用等密度梯度离心法分离35例M ODS患者CEC,常规进行血脂测定,并与20名健康体检者进行比较。同时用急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)对M ODS患者的严重程度进行评分,并与CEC数量与血脂水平进行相关性分析。结果:与正常对照组比较,M ODS组CEC数量明显增加,差异有显著性(P<0.01)。M ODS组甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL C)均明显低于正常对照组,差异均有显著性(P<0.05或P<0.01)。TG、TC、LDL C水平与CEC数量呈明显负相关(TG:r=0.396,P<0.05;TC:r=0.672,P<0.05;LDL C:r=0.486,P<0.05)。M ODS组APACHEⅡ评分与CEC数量呈正相关(r=0.436,P<0.05),与TG、TC、LDL C水平呈负相关(TG:r=0.372,P<0.05;TC:r=0.425,P<0.05;LDL C:r=0.487,P<0.05)。结论:M ODS患者血管内皮细胞功能受损,血脂水平下降,血脂水平结合CEC数量可更为准确地预测疾病的严重程度。     

血尿酸与其他代谢指标的相关性研究

目的探讨影响血尿酸(UA)的相关代谢指标。方法选取符合纳入标准的10 000名体检者作为研究对象。采集受试者收缩压(SBP)、舒张压(DBP),血清UA、血脂相关指标[包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)]、糖化血红蛋白(Hb A1c)、空腹血糖(FBG)。按照性别和UA分组,分析血UA与其他代谢指标的相关性。结果 (1)高尿酸血症(HUA)检出率为26.2%,男性检出率为25.1%,女性检出率为32.4%,性别比较,差异有统计学意义(P0.05);(2)男女之间年龄、Hb A1c、TC、TG和LDL-C等指标比较,差异无统计学意义(P0.05),女性BMI、FBG、SBP、HDL-C和DBP高于男性,男性血UA水平高于女性(P0.05);(3)女性HUA患者年龄、体质量指数(BMI)、SBP、DBP、FBG和TG高于尿酸正常组(NUA组),HDL-C低于HUA组;男性HUA年龄、BMI、SBP、DBP和TG高于NUA组,而HDL-C低于NUA组(P0.05)。女性UA水平与年龄、BMI、SBP、DBP、FBG、TC、TG水平呈正相关;男性UA与年龄、BMI、SBP、DBP、TC、TG水平呈正相关(P0.05);血尿酸水平与HDL-C呈负相关(P0.05)。结论性别、BMI、血压、血糖、TG及TC、LDL-C和HDL-C与HUA的发生有关。     

血生化检验中血液胆固醇异常与ApoB代谢缺陷的关系研究

目的分析血生化检验中血液胆固醇异常与载脂蛋白B(ApoB)代谢缺陷的相关性。方法将2015年10月～2017年10月行体检的395例健康体检者(对照组)及181例血脂异常患者(观察组)纳入研究,对以上576名研究对象进行FBG、2hPBG、TG、TC、LDL﹣C、HDL﹣C、ApoB水平检测,比较两组各项血生化指标的差异,同时分析ApoB与其他血脂指标之间的相关性。结果继发性血脂水平异常比例(81.22%)明显高于原发性血脂水平异常(18.78%),差异具有统计学意义(P0.05)。观察组FBG、2hPBG、TG、TC、LDL-C、HDL-C、ApoB水平与对照组比较,有显著差异(P0.05)。多元分析结果显示,观察组ApoB与FBG、2hPBG、TG、TC、LDL-C、HDL-C等水平之间具有一定相关性,差异具有统计学意义(P0.05)。结论血脂异常以继发性为多见,血脂异常者FBG、2hPBG、TG、TC、LDL-C、HDL-C等水平有异于健康人群,ApoB的代谢缺陷与血胆固醇异常具有密切的关系。     

中老年男性动脉弹性与血清尿酸及血脂的相关性

目的研究中老年男性动脉弹性与血清尿酸及血脂水平的相关性。方法选取男性体检者279例,进行体格、生化及动脉弹性检查,根据脉搏波传导速度(PWV)测定分为动脉硬化组138例,非动脉硬化组141例,分析动脉弹性与血清尿酸、血脂水平之间的相关性。结果与非动脉硬化对照组比较,动脉硬化组血清尿酸[(409.38±92.78)mmol/L比(433.84±93.43)mmol/L]、三酰甘油(TG)[(1.64±0.83)mmol/L比(2.26±1.37)mmol/L]水平显著升高(P0.05或P0.01),而低密度脂蛋白(LDL)、高密度脂蛋白(HDL)及总胆固醇(TCH)水平差异无统计学意义。Pearson相关性分析显示,年龄、腰围、TG与肱-踝脉搏波传导速度存在明显的正相关(r=0.169~0.439,P0.05或P0.01)。结论 TG水平与动脉硬化密切相关,同时高尿酸血症、肥胖、高血压及血糖异常是中老年男性动脉硬化的危险因素。     

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.     

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.     

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.