前列腺素E1治疗糖尿病周围神经病变疗效观察

目的　观察前列腺素E1对糖尿病周围神经病变患者的疗效。方法　将 92例糖尿病合并周围神经病变患者随机分为 3组。A组 :30例 ,生理盐水 10 0ml 前列腺素E12 0 μg ,生理盐水 2 5 0ml 复方丹参注射液 2 0ml静脉滴注 ;B组 :30例 ,生理盐水 10 0ml 前列腺素E12 0 μg静脉滴注 ;C组 :32例 ,生理盐水2 5 0ml 复方丹参注射液 2 0ml静脉滴注 ,均为每日一次 ,疗程 14d。结果　 3组的显效率及总有效率分别为 :30 %、93.3% ;16 .7%、70 % ;9.4 %、5 3.1%。各组治疗前后及各组间治疗后神经传导速度比较均有显著性差异 ,治疗过程中无明显不良反应。结论　前列腺素E1是一种治疗糖尿病周围神经病变安全有效的药物 ,联合复方丹参注射液效果更好。     

运动序贯治疗老年2型糖尿病合并下肢血管病变的追踪观察

目的　评价凯时注射液配合运动序贯治疗老年糖尿病下肢血管病变的远期疗效。方法　6 0例患者随机分2组对照观察,观察组30例,予生理盐水10 0ml静滴,凯时注射液2 0 μg经输液器小壶滴入,1次/d ,治疗10d后辅以6个月低强度运动。对照组30例,单纯凯时治疗10d。结果　观察组凯时治疗一疗程后API、MN值较治疗前升高,执行运动方案6个月后观察指标较药物治疗后无明显变化,P >0 .0 5。对照组凯时治疗后MN、API升高,但6个月后各指标下降,P <0 .0 1。结论　运动序贯治疗可一定程度上稳定远期疗效     

前列腺素E1脂微球制剂与川芎嗪联合治疗老年2型糖尿病下肢血管病变的临床研究

白晓宁,侯敏全,王惠芳〔摘要〕目的:观察前列腺素E1脂微球制剂与川芎嗪联合治疗老年2型糖尿病下肢血管病变的临床效果。方法:将老年2型糖尿病下肢血管病变患者116例随机分为前列腺素E1组58例,联合川芎嗪组58例。治疗前经降糖和降压药物使血糖和血压保持稳定。前列腺素E1组给前列腺素E1脂微球制剂20μg,加生理盐水20mL静脉注射,1次/d;联合川芎嗪组在应用前列腺素E1同时,用盐酸川芎嗪注射液160mg,加生理盐水250mL静脉滴注,1次/d。4周1个疗程。治疗前后分别检测血液流变学、足背动脉血流量及踝/肱动脉压比值。结果:单用前列腺素E1组及联合川芎嗪组在改善老年2型糖尿病下肢血管病变的临床症状方面均有良好的效果,但联合川芎嗪组比单用前列腺素E1组的治疗效果更佳(P<0.01)。在血液流变学、足背动脉血流量、踝/肱动脉压比值治疗前后各项指标的改善方面,联合川芎嗪组比单用前列腺素E1组的治疗效果差异亦有统计学意义(均为P<0.05)。两组治疗期间和治疗后均无明显不良反应,耐受性好。结论:前列腺素E1脂微球制剂与川芎嗪联合治疗能明显改善老年糖尿病2型下肢血管病变的临床症状和血液动力学,且不良反应少而轻微,是防治老年2型糖尿病下肢血管病变的有效治疗方法。     

硬膜外麻醉联合前列腺素E1用于早期Buerger病的疗效观察

目的 :观察硬膜外麻醉联合前列腺素E1用于早期Buerger病的治疗效果。方法 :选择早期(1、2期 )Buerger病 10 5例 ,随机分成A、B、C三组 ,每组 35人 :A组病人为单纯静脉应用前列腺素E1治疗 ;B组病人单纯进行硬膜外麻醉 ;C组病人为硬膜外麻醉联合前列腺素E1治疗。三组均为两周一个疗程 ,分别记录一个疗程前及疗程后一周复查病人时的彩色多普勒超声下患肢动脉截面积扩张率 (△S % )、收缩期血流峰值上升加速度 (a)、血流阻力指数 (RI) ,分别比较每组内各指标治疗前、后的数据 ,结果 :A组的△S %、a、RI治疗前、后变化不大 ,差异不具有显著性意义 (P >0 .0 5 ) ;B组的变化较大 ,差异具有显著性意义 (P <0 .0 5 ) ;C组的变化最大 ,差异具有极显著性意义(P <0 .0 1)。结论 :硬膜外麻醉联合前列腺素E1能更为有效的治疗早期Buerger病     

凯时不同给药方法治疗糖尿病并发症的效果比较

[目的]比较凯时治疗糖尿病血管和神经病变时两种不同给药方法效果.[方法]A组:凯时10 μg 生理盐水100mL静脉榆注,持续10 d;B组:凯时10 μg 生理盐水20 mL 弥可保500 μg直接静脉推注,持续10 d.[结果]A组病人静脉穿刺点随着血管走向皮肤有红、肿、痛;而B组病人皮肤局部反应明显少于A组.[结论]B组给药方法值得在临床上推广.     

凯时不同给药方法治疗糖尿病并发症的效果比较

[目的]比较凯时治疗糖尿病血管和神经病变时两种不同给药方法效果。[方法]A组:凯时10μg+生理盐水100mL静脉输注,持续10d;B组:凯时10μg+生理盐水20mL+弥可保500μg直接静脉推注,持续10d。[结果]A组病人静脉穿刺点随着血管走向皮肤有红、肿、痛;而B组病人皮肤局部反应明显少于A组。[结论]B组给药方法值得在临床上推广。     

两种给药途径治疗下肢深静脉血栓形成的效果观察

目的　选择理想的给药途径 ,治疗下肢深静脉血栓形成。方法　将 1 1 2例确诊为下肢髂 股静脉血栓形成的患者随机分为两组 ,上肢静脉输注组 5 4例 ,患肢静脉输注组 5 8例 ,记录经溶栓治疗 1 0～ 1 5d后 ,患侧肢体症状改善情况。结果　患肢静脉输注组好转治愈率 ( 94 .8%)明显高于上肢静脉输注组 ( 85 .2 %) ,P <0 .0 1。结论　患肢静脉输注溶栓药物治疗下肢深静脉血栓形成效果显著 ,值得推广。     

前列腺素E_1治疗老年糖尿病足疗效观察

目的 :观察脂化前列腺素E1对糖尿病足 (DF)的疗效。方法 :将 5 6例DF患者随机分为 2组 ,在基础治疗相同的情况下 ,治疗组 36例采用脂化前列腺素E1治疗 ,对照组 2 0例采用 6 5 4 2注射液治疗。观察脂化前列腺素E1对DF的下肢动脉血流动力学、肌电图、血液流变学、血脂的影响。结果 :治疗组总有效率为 83 .33 % ,对照组为 45 .0 0 % (P <0 .0 1) ,治疗组疗效优于对照组。在改善患者下肢动脉血流动力学、肌电图、血液流变学、血脂方面 ,治疗组亦优于对照组(P <0 .0 1～ 0 .0 5 )。结论 :脂化前列腺素E1治疗DF有较好疗效     

前列腺素E1治疗急性肾功能衰竭

目的 :探讨前列腺素E1(PGE1)在治疗急性肾功能衰竭中的作用。方法 :对我院 34名急性肾功能衰竭 (ARF)患者应用速尿 ,小剂量多巴胺、PGE1和血液透析等综合治疗 ,并根据是否应用PGE1分为治疗组和对照组。治疗组PGE110 μg～ 2 0 μg/d ,其它治疗与对照组相同 ,观察肾功能恢复正常所需时间。结果 :治疗组肾功能恢复正常时间明显短于对照组 (0 .0 1

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不同时机口服美林拮抗白细胞介素-2发热反应的临床观察

[目的]探讨用关林减轻白细胞介素-2（IL-2）发热反应的用药时机。[方法]9例恶性实体肿瘤患儿共28个疗程140次用IL-2进行免疫治疗，按使用美林时机分组，对照组40次，按传统的治疗护理方案，即在静脉输注后体温达39℃时遵医嘱口服美林；实验1组50次，在静脉输注1．5h～2．0h时遵医嘱口服关林；实验2组50次在静脉输注结束时体温未达高峰时遵医嘱口服美林，观察降温疗效。[结果]对照组中有30次在静脉输注完后1h～2h达体温峰值。6次体温峰值达39℃以上；实验1组体温峰值降低的次数明显高于实验2组和对照组（P〈0．05），总有效率也高于实验2组和对照组（P〈0．05）。而实验2组和对照组无显著差异（P〉0.05）。[结论]在静脉输注白细胞介素-21．5h～2．0h口服美林，能显著提高对抗IL-2引起机体发热反应的有效率，提高病人在用药过程中的耐受力，减轻病人痛苦。     

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.