洛伐他汀对原发性肾病综合征患者微炎症状态的影响

【目的】观察洛伐他汀对原发性肾病综合征患者炎症反应标记物白细胞介素-6(IL-6)和C反应蛋白(CRP)的影响,探讨他汀类药物对原发性肾病综合征患者微炎症状态的疗效。【方法】原发性肾病综合征患者36例,随机分为洛伐他汀治疗组和非洛伐他汀治疗组,分别观察治疗前、治疗16周后甘油三酯(TG)、总胆固醇(TC)、IL-6和CRP水平。【结果】①原发性肾病综合征患者TG、TC、IL-6、CRP水平均显著高于健康人群(P<0.01);②治疗16周后,洛伐他汀治疗组TC、TG、IL-6、CRP的水平与治疗前相比均明显下降(P<0.01),与非洛伐他汀治疗组相比也显著降低(P<0.05)。【结论】应用洛伐他汀治疗能改善原发性肾病综合征患者的微炎症状态。     

百令胶囊联合替米沙坦治疗早期糖尿病肾病的临床观察

【目的】观察百令胶囊联合替米沙坦对早期糖尿病肾病(DN)的作用效果及其可能机制。【方法】60例早期DN患者随机分为替米沙坦对照组和百令胶囊加替米沙坦实验组,治疗疗程为3个月;比较两组尿微量白蛋白排泄率(UAER)和血清肌酐及C反应蛋白(CRP)水平的变化。【结果】两组治疗后血清肌酐、UAER和CRP水平较治疗前明显下降,实验组治疗后血清肌酐、CRP及UAER水平较对照组亦明显降低(P<0.05)。【结论】百令胶囊加替米沙坦联合治疗早期DN疗效显著。     

腹腔置管灌洗对急性重症胰腺炎患者炎症因子水平的影响

【目的】探讨腹腔置管灌洗对急性重症胰腺炎（SAP）患者炎症因子水平影响。【方法】选择2014年1～12月本院普外科室收治的临床诊断为SAP患者82例,按照随机数法将其患者分为观察组（n＝46）和对照组（n＝36）。观察组给予腹腔置管灌洗合并常规治疗,对照组给予单纯常规治疗。比较两组患者不同时间内毒素、肿瘤坏死因子‐α（TNF‐α）、白细胞介素‐6（IL‐6）、IL‐8和C反应蛋白（CRP）动态变化规律,以及两组患者预后指标的差异。【结果】治疗7d后,观察组和对照组血清内毒素、TNF‐α、IL‐6、IL‐8水平均低于治疗前及治疗2d后,差异均具有统计学意义（均P＜00．5）;对照组治疗4d后,血清IL‐6水平低于治疗后2d;治疗4d、7d后,观察组内毒素、TNF‐α、IL‐6、IL‐8、CRP均明显低于对照组同时间点（均P＜00．5）。观察组ICU停留时间短于对照组,胰腺感染率和器官功能障碍综合征（MODS）发生率均低于对照组,差异均有统计学意义（均P＜00．5）;两组患者均无住院死亡病例。【结论】腹腔置管灌洗可降低SAP患者相关炎症反应因子水平,降低胰腺感染率和多器官功能障碍发生率,改善患者预后。     

阿托伐他汀联合缬沙坦治疗早期糖尿病肾病的疗效观察

【目的】探讨阿托伐他汀联合缬沙坦干预早期糖尿病肾病(DN)的临床疗效。【方法】80例早期DN患者随机分为两组,治疗组以缬沙坦80 mg/d口服,同时给予阿托伐他汀20 mg/d口服;对照组仅给缬沙坦80mg/d,其他治疗方法两组相同,疗程为4个月。【结果】两组治疗后血清肌酐、血丙二醛(MDA)、C反应蛋白(CRP)、尿白蛋白排泄率(UAER)均明显降低(P<0.05);治疗组治疗后CRP和MDA、UAER较对照组明显下降(P<0.05)。【结论】阿托伐他汀与缬沙坦联合应用比单用缬沙坦能更有效地减轻蛋白尿和保护肾脏。     

凯时注射液治疗脑梗死的临床观察

【目的】探讨凯时注射液治疗脑梗死的疗效。【方法】选择脑梗死患者58例,分为治疗组35例及对照组23例。治疗组采用凯时注射液10μg,静脉滴注,每日1次,疗程为15d。对照组采用复方丹参注射液20ml,静脉滴注,每日1次,疗程同治疗组。【结果】治疗组神经功能缺损评分积分下降明显,与对照组相比差异有显著性(P<0.01),脑梗死体积减少程度与对照组相比差异亦有统计学意义(P<0.05)。【结论】凯时注射液对脑梗死疗效显著,能降低致残率,改善脑梗死预后。     

腹腔镜术后腹腔灌洗、持续循环式腹膜透析治疗重症急性胰腺炎的临床研究

目的观察腹腔镜术后腹腔灌洗、持续循环式腹膜透析(CCPD)治疗重症急性胰腺炎(SAP)的临床效果及安全性。方法将68例SAP患者随机分为治疗组32例与对照组36例,治疗组于腹腔镜下手术,术后灌洗引流与CCPD交替进行,病情稳定后(约需3 d)单一行腹腔灌洗;对照组给予常规治疗。结果治疗组急性生理与慢性健康评分(APACHEⅡ)及Balthazar CT积分从第1天即下降明显(P0.05),而对照组在第3天才显著下降,且治疗组各时点积分均较对照组明显降低(P0.05)。治疗组各时相点血浆中促炎细胞因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及C反应蛋白(CRP)含量与治疗前比较呈明显降低趋势(P0.01),白细胞介素-10(IL-10)含量呈明显升高趋势(P0.01),与对照组比较各时点各细胞因子含量差异有统计学意义意义(P0.05)。结论腹腔镜术后灌洗引流与CCPD治疗SAP具有方法简单、安全、快捷、创伤小、并发症少及无需抗凝等优点,无血液动力学影响,患者有较好的耐受性等特点,是一种治疗SAP的有效方法。     

血清C反应蛋白水平与脑卒中的病情及预后的关系

目的:探讨急性脑卒中患者发病早期血液中C反应蛋白(CRP)含量高低与病情严重程度及预后的影响.方法:对155例患者血清CRP含量进行测定.其中脑梗死41例(脑梗死组),脑出血40例(脑出血组),腔隙性梗死33例(脑隙性梗死组)及非脑卒中41例(对照组).结果:(1)脑卒中患者CRP阳性率明显较对照组升高(P<0.01);其中脑出血组较脑梗死组CRP水平高(P<0.05),脑梗死组较腔隙性梗死组水平高(P<0.05),而腔隙性梗死组与对照组比较无明显升高(P>0.05).结论:急性脑卒中患者早期血清CRP升高提示病情严重且预后不良.     

贝尔面瘫患者血浆内皮素和一氧化氮含量的检测及临床意义

【目的】探讨内皮素(ET)和一氧化氮(NO)在贝尔面瘫发病中的作用及其与预后的关系。【方法】分别采用放射免疫分析法和比色法测定21例贝尔面瘫患者治疗前、后及20例正常者的血浆ET及NO的含量。【结果】贝尔面瘫患者的血浆ET水平明显高于正常对照组(P<0.01);而血浆中的NO水平明显低于正常对照组(P<0.01)。【结论】ET异常增高和NO持续低水平状态可引起微循环障碍,在贝尔面瘫发病中起着重要作用,检测ET和NO水平可作为判断患者预后的一个有用指标。     

C反应蛋白在冠心病诊断中的作用

【目的】探讨C反应蛋白(CRP)在冠心病诊断中的作用。【方法】对入选患者稳定性心绞痛(SA)组、不稳定性心绞痛(UA)组、急性心肌梗死(AMI)组、陈旧性心肌梗死(OMI)组共84 例及对照组22 例分别空腹采静脉血3 ml,CRP测定采用快速免疫比浊法,测定CRP含量。【结果】SA组、UA组及OMI组血CRP含量与对照组比较,差异显著(P<0.05),AMI组与对照组比较,差异非常显著(P<0.01);AMI组与SA组、UA组、OMI组的CRP值比较,差异显著(P<0.05);UA组与SA组、OMI组的CRP值比较,差异显著(P<0.05)。【结论】CRP与冠心病严重程度及演变状况有关,并有利于早期诊断和预后判断。     

腹腔灌洗对重症急性胰腺炎APACHEⅡ评分和腹痛的影响

目的 探讨腹腔灌洗对重症急性胰腺炎(SAP)患者急性生理和慢性健康评分系统Ⅱ(APACHEⅡ)评分和腹痛的影响.方法 灌洗组32例SAP患者进行腹腔灌洗,对照组39例,均行综合内科治疗,比较两组患者的APACHEⅡ评分和腹痛评分.结果 两组治疗前APACHEⅡ评分和腹痛评分差异无显著性意义(P＞0.05).治疗第1～3天灌洗组APACHEⅡ评分较对照组显著降低 (P＜0.01),第4～5天无显著性差异.治疗后灌洗组腹痛评分均较对照组明显下降(P＜0.05 ).结论 腹腔灌洗可以降低SAP患者的APACHEⅡ评分和改善腹痛.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。