阿托伐他汀短期治疗对脑梗死患者血脂和炎性标志物表达的影响

目的:研究阿托伐他汀短期应用对脑梗死(CI)患者血脂、血小板聚集率和炎性标志物表达的影响。方法:经头颅CT、MRI证实为脑梗死的患者40例,随机分为阿托伐他汀治疗组(阿托伐他汀20mg,每晚1次)和对照组各20例,于21 d后分别测定血脂、血小板聚集率和炎性标志物。结果:阿托伐他汀组患者治疗后的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)较治疗前有明显降低(P<0．05或P<0．01),纤维蛋白原(Fg)、血小板聚集率无显著差异(P>0．05)。对照组各项指标的变化均无显著差异(P>0．05)。结论:阿托伐他汀可在短期降低CI患者的血脂、CRP水平,但对Fg、血小板聚集率无明显影响;CI患者早期还是要考虑进行多方面的综合治疗。     

阿托伐他汀和普伐他汀治疗原发性高脂血症的比较

目的比较阿托伐他汀和普伐他汀治疗原发性高脂血症的疗效和安全性。方法 61例原发性高脂血症的患者随机分两组 ,阿托伐他汀组 3 2例 ,10mg/d口服 ;普伐他汀组 2 9例 ,2 0mg/d口服。疗程 8周 ,观察降脂疗效和不良反应。结果阿托伐他汀组总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)与治疗前比较均有显著下降 (P <0 .0 1) ,阿托伐他汀组降低TC、LDL C的作用优于普伐他汀组 (P <0 .0 5 )。两组不良反应相似 ,均较轻微。结论阿托伐他汀治疗原发性高脂血症的疗效明显优于普伐他汀 ,不良反应轻微 ,耐受性良好     

不同剂量阿托伐他汀对不稳定型心绞痛患者血管内皮功能及血小板活化的影响

目的 探讨不同剂量阿托伐他汀对不稳定型心绞痛患者血管内皮功能及血小板活化的影响.方法 78例不稳定型心绞痛患者随机分成阿托伐他汀10mg治疗组(n=39例)和阿托伐他汀20mg治疗组(n=39例).所有患者分别于入院时及用药4周后取血,行血小板胞质内α-颗粒膜糖蛋白( CD62p)、血清一氧化氮(N0)、血浆内皮素-1(ET-1)测定.另选本院同期健康体检的30例作为对照组,要求采血前2周内未服用药物.结果 不稳定型心绞痛患者血NO水平显著低于正常组,ET-1、CD62p水平明显高于正常组(P＜0.01).治疗4周后两组血清NO水平显著升高、ET-1、CD62p水平明显降低,阿托伐他汀20mg治疗组效果显著优于阿托伐他汀10mg治疗组(P＜0.01).结论 阿托伐他汀有改善不稳定型心绞痛患者内皮功能,抑制血小板活性作用,且有剂量依赖性.     

氟伐他汀对2型糖尿病72例血脂的影响分析

目的探讨氟伐他汀对2型糖尿病合并高脂血症的调节作用及安全性。方法 72例2型糖尿病合并高脂血症患者,在积极控制血糖基础上,每晚顿服,氟伐他汀40mg疗程8周。结果治疗8周后,血清胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)明显降低,高密度脂蛋白胆固醇(HDL)升高不明显。结论氟伐他汀是2型糖尿病高脂血症有效调脂药物。     

脑梗塞患者活化血小板的检测

目的 :检测脑梗塞患者体内活化血小板的含量。方法 :用流式细胞仪 (FCM)检测活化血小板标志物CD6 2 p、CD6 3的含量 ,并与正常对照组比较。结果 :脑梗塞患者血小板CD6 2 p、CD6 3的表达量为 47 2 6± 19 6 8、5 2 14± 16 89,均明显高于正常对照组CD6 2 p,CD6 3的表达量 4 5 1± 3 16 ,6 73± 2 6 7(P <0 0 1)。结论 :脑梗塞患者血栓的形成与血小板的活化密切相关 ,且活化血小板的检测可以作为脑梗塞早期诊断一项较特异的指标。     

冠心病患者CD62p及血小板参数的观察

目的　探讨冠心病 (CHD)患者血小板活化 (CD6 2p)和血小板参数的变化。方法　用流式细胞仪、血球计数仪及血小板聚集仪分别对 89例CHD和 60名健康人的CD6 2p、血小板四项参数及血小板最大聚集率(PAGM )进行测定。结果　CHDCD6 2p、血小板平均体积 (MPV)、血小板分布宽度 (PDW ) ,PAGM明显高于对照组 (P <0 .0 0 1) ,血小板数 (PLT)明显低于对照组 (P <0 .0 0 1) ,而血小板压积 (PCT)两组差异无显著性。CHD患者CD6 2p与PAGM、MPV均有正相关关系 ,而与PLT、PDW及PCT无相关性。急性心肌梗死患者 (AMI)CD6 2p、MPV明显高于心绞痛 (AP)组 (P <0 .0 0 1) ,而PLT明显降低 (P <0 .0 0 1)结论　检测CD6 2p、血小板四项参数及PAGM可较全面地反映不同类型的CHD患者的血小板形态、功能和活化状态 ,对疾病的预防、疗效观察有一定意义     

蚓激酶联合氟伐他汀治疗糖尿病合并脑梗死的疗效及对患者神经功能的影响

目的探讨蚓激酶联合氟伐他汀治疗糖尿病合并脑梗死的疗效。方法选取122例糖尿病合并脑梗死患者为研究对象,按照实际治疗方法分为对照组(n=62,采取常规治疗+氟伐他汀治疗)与观察组(n=60,采取常规治疗+蚓激酶联合氟伐他汀治疗),观察两组治疗1个月后疗效,治疗前、治疗2周和1个月后对患者进行日常生活能力量表(ADL)、美国国立卫生院神经功能缺损量表(NIHSS)评估,并测定患者全血黏度、纤维蛋白原、血小板聚集率、血浆黏度、超敏C反应蛋白(hs-CRP)。结果观察组治疗1个月后临床有效率明显高于对照组(P0.05);治疗2周和1个月后,观察组ADL评分明显升高,NIHSS评分明显下降,血浆黏度、血小板聚集率、纤维蛋白原、全血黏度、hs-CRP水平明显下降,与治疗前比较,差异均有统计学意义(P0.05)。观察组治疗2周和1个月后ADL、NIHSS、血浆黏度、血小板聚集率、全血黏度、hs-CRP评分均明显优于对照组,差异有统计学意义(P0.05)。结论氟伐他汀联合蚓激酶治疗糖尿病合并脑梗死患者,能明显改善患者的神经功能和日常生活能力,疗效显著,值得推广。     

氟伐他汀降脂疗效的临床观察

作者 1 999年 2～ 8月应用氟伐他汀 (北京诺华制药产品 ,来适可 )治疗原发性高脂血症患者 ,现将结果报告如下。1　资料和方法5 8例原发性高脂血症患者随机分为治疗组和对照组各 2 9例 ,治疗组年龄 5 6± 1 1岁 (2 5～ 74岁 ) ,男 1 7例 ,女 1 2例 ;对照组年龄 6 0± 1 0岁 (3 5～ 6 9岁 ) ,男 1 6例 ,女 1 3例。治疗组服氟伐他汀钠 (来适可 ) 2 0ｍｇ/ｄ ,对照组服美降之 (美国默沙东大药厂产品 ) 2 0ｍｇ/ｄ。两药均在晚餐时服用 ,疗程 2月 ,于每月末采血测肝肾功能、血糖、血脂、末稍血常规、尿常规、心电图。血脂疗效评定标准采用 1 993…     

鱼油和阿托伐他汀对高脂血症患者血脂和相关炎症因子水平影响的比较

目的:比较鱼油和阿托伐他汀对高脂血症患者血脂、超敏C反应蛋白和CD40水平的影响,同时比较高脂血症患者与健康者相关炎症因子水平。方法:选择2005-05/11无锡第一人民医院体检中心体检的高脂血症患者62例(高脂血症组),男44例,女18例。纳入标准:符合原发性高脂血症诊断标准,且均对治疗方案和检测项目知情同意。选择2005-11/12本院体检中心体检的健康者35名(正常对照组),男28名,女7名。将高脂血症患者按随机抽签法分为2组:阿托伐他汀组32例和鱼油组30例。阿托伐他汀组:每天晚餐前服用阿托伐他汀10mg。鱼油组:每天服用3次鱼油胶囊,1.0g/次,1次/d。两组均干预8周。于治疗前及治疗4和8周后测定血清总胆固醇(胆固醇氧化酶法)、三酰甘油(酶法)、载脂蛋白A1及载脂蛋白B(免疫比浊法)、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇(均相测定法中的选择性反应法)、超敏C反应蛋白(胶乳法),以及CD40(流式细胞仪)水平。计量资料组间均数比较用成组t检验,多组间比较用方差分析和q检验,方差不齐用秩和检验。结果:高脂血症患者62例和正常对照组35名均进入结果分析。①高脂血症患者炎症因子水平变化:高脂血症组CD40表达明显高于正常对照组[(10.23±5.07)%,(7.93±4.12)%,t=2.289,P<0.05],超敏C反应蛋白虽然也高于正常对照组,但差异不明显[(2.30±2.70),(1.68±2.03)g/L,P>0.05]。②阿托伐他汀及鱼油作用后血脂及炎症因子变化:两组用药前的血脂水平、超敏C反应蛋白和CD40相近。阿托伐他汀组治疗4周后总胆固醇、低密度脂蛋白胆固醇和载脂蛋白B较治疗前显著下降(F=31.569,31.677,40.726,P<0.01),8周后三酰甘油和载脂蛋白A比治疗前也有明显下降(F=3.237,P<0.05;F=6.729,P<0.01),其他指标则在治疗前后均没有显著变化。鱼油组治疗4周后血脂、超敏C反应蛋白和CD40与治疗前相近,治疗8周后三酰甘油水平与CD40较治疗前下降(F=2.913,2.683,P<0.05),载脂蛋白B较治疗前也显著下降(F=5.279,P<0.01),余指标则与治疗前差异不明显。③阿托伐他汀组治疗4和8周后总胆固醇和载脂蛋白B水平明显低于鱼油组(t=-5.292,-5.892,P<0.01),CD40在治疗8周明显高于鱼油组(t=2.287,P<0.05)。结论:①阿托伐他汀降低总胆固醇和低密度脂蛋白胆固醇效果优于鱼油,鱼油主要降低三酰甘油。②高脂血症患者较健康者CD40表达明显上调,但超敏C反应蛋白水平则与健康者接近。鱼油下调CD40比阿托伐他汀起效更快。     

氟伐他汀治疗老年人早期慢性肾功能不全的临床观察

[目的]观察氟伐他汀治疗糖尿病和高血压病所致慢性肾功能不全的临床效果.[方法]选取50例确诊为糖尿病和高血压病所致早期慢性肾功能不全患者,随机分为治疗组(常规治疗 氟伐他汀40 mg,口服,每天一次)和对照组(常规治疗).6个月后观察治疗效果,常规检测血肌酐、尿素氮、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、24 h尿蛋白量和纤维蛋白原.[结果]6个月治疗后,与治疗前相比两组患者血肌酐、尿素氮和24 h尿蛋白降低(P＜0.05),且治疗组低于对照组(P＜0.05);两组患者总胆固醇、甘油三酯、低密度脂蛋白和纤维蛋白原均较治疗前降低,高密度脂蛋白较治疗前升高(P＜0.05);且治疗组均低于对照组,但差异不具有统计学意义(P＞0.05).[结论]氟伐他汀治疗糖尿病和高血压病所致肾功能不全取得较好效果.     

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。