2型糖尿病周围神经病变的危险因素及神经元特异性烯醇化酶的相关性

目的:探讨糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的相关危险因素及DPN患者血清中神经元特异性烯醇化酶(neuron-specific enolase,NSE)水平的变化及临床意义。方法:根据是否合并周围神经病变,将736例2型糖尿病(type 2diabetes mellitus,T2DM)患者分为DPN组(n=450)和单纯T2DM(SDM)组(n=286)。分析两组病程、有无合并高血压、性别、年龄、体质指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、NSE与DPN发生的相关性及NSE水平与其他指标的相关性。结果:住院T2DM患者DPN的患病率为61.1%。与SDM组相比,DPN组T2DM病程较长、高血压比例较高、年龄较大(P0.05);两组NSE浓度差异无统计学意义。Logistic回归分析示,T2DM病程、年龄、HbA1c是DPN发生的独立影响因素(P0.05)。多重线性回归分析示,DBP、BMI与NSE水平独立相关(P0.05)。结论:T2DM病程长、高龄、HbA1c水平高可导致DPN的发生;NSE可能不是DPN潜在的生物学标志物。     

血清空腹C肽水平与2型糖尿病周围血管并发症相关性

目的:探讨血清空腹C肽与2型糖尿病周围血管并发症的关系.方法:糖耐量异常患者(IGT组)72例,2型糖尿病患者(T2DM组)140例,同期健康体检者50名为对照组(NC组).T2DM组根据有无冠心痛再分为糖尿病合并周围血管并发症组(T2DM合并PVD组)68例,糖尿病无周围血管并发症组(T2DM无PVD组)72例,比较各组血清空腹C肽、血脂、空腹血糖等指标.结果:T2DM组血清空腹C肽高于IGT组、NC组(P＜0.05);T2DM合并PVD组血清空腹C肽水平低于T2DM无PVD组(P＜0.05);IGT组血清空腹C肽水平高于NC组,但差异无统计学意义(P＞0.05).T2DM合并PVD与空腹C肽、年龄、糖尿病病程、空腹血糖相关(P＜0.01).结论:糖尿病合并周围血管并发症的发生与发展除与年龄、糖尿病痛程、空腹血糖等有关外,还可能与空腹C肽水平有关,血清空腹C肽可能成为糖尿病周围血管痛变的早期预测指标.     

2型糖尿病周围神经病变相关危险因素分析

目的分析糖尿病周围神经病变(DPN)的相关危险因素。方法对住院的178例2型糖尿病(DM)患者,根据有无合并周围神经病变进行分组,对相关因素年龄、病程、体质量指数、血压、血糖、血脂、血尿酸、糖化血红蛋白(HbAlc)、尿微量白蛋白/肌酐(尿A/C)等进行比较,用多元回归方法对影响周围神经病变的因素进行分析。结果与非DPN组比较,DPN组年龄更大、病程更长,并且尿A/C高于对照组(P<0.05),多因素Logistic回归分析表明年龄、病程是两个相对独立的危险因素。结论年龄大、病程长的糖尿病患者发生DPN的危险增加。     

血清空腹C肽水平与2型糖尿病周围血管并发症相关性

目的:探讨血清空腹C肽与2型糖尿病周围血管并发症的关系。方法:糖耐量异常患者(IGT组)72例,2型糖尿病患者(T2DM组)140例,同期健康体检者50名为对照组(NC组)。T2DM组根据有无冠心病再分为糖尿病合并周围血管并发症组(T2DM合并PVD组)68例,糖尿病无周围血管并发症组(T2DM无PVD组)72例,比较各组血清空腹C肽、血脂、空腹血糖等指标。结果:T2DM组血清空腹C肽高于IGT组、NC组(P<0.05);T2DM合并PVD组血清空腹C肽水平低于T2DM无PVD组(P<0.05);IGT组血清空腹C肽水平高于NC组,但差异无统计学意义(P>0.05)。T2DM合并PVD与空腹C肽、年龄、糖尿病病程、空腹血糖相关(P<0.01)。结论:糖尿病合并周围血管并发症的发生与发展除与年龄、糖尿病病程、空腹血糖等有关外,还可能与空腹C肽水平有关,血清空腹C肽可能成为糖尿病周围血管病变的早期预测指标。     

2型糖尿病合并糖尿病性周围神经病56例临床分析

目的 分析探讨影响2型糖尿病（12DM）合并糖尿病性周围神经病（DPN）的相关因素及临床特点。方法 对56例糖尿病合并糖尿病性周围神经病患者进行回顾性分析。结果 与糖尿病性周围神经病（DPN）有关的危险因素包括：血糖水平，糖尿病病程。与年龄、性别关系不显著，弥可保疗效显著。结论 血糖控制不佳，病程长更易患糖尿病性周围神经病（DPN）。     

高频超声检测2型糖尿病周围神经病变患者足部肌肉萎缩

目的探讨高频超声技术对2型糖尿病(T2DM)及合并周围神经病变(DPN)患者足部肌肉萎缩的诊断价值。方法收集106例T2DM患者,分为两组:A组56例,为T2DM伴DPN患者,B组50例,为T2DM不伴DPN患者;另选同期50名健康志愿者作为对照(C组)。应用高频超声观察受试者非优势足趾短伸肌(EDB)和第一、二跖趾间肌群(MIL),测量EDB横径、厚度和横截面积以及MIL厚度。结果 A组EDB横径、厚度和横截面积及MIL厚度均显著小于B组和C组(P均<0.01);B组EDB横径和横截面积及MIL厚度显著小于C组(P均<0.01)。结论高频超声技术能够客观评价T2DM及合并DPN患者足部肌肉萎缩。     

瞬时波强技术评价2型糖尿病合并周围神经病变患者颈动脉弹性

目的 探讨瞬时波强(WI)技术在评价2型糖尿病(T2DM)合并周围神经病变(DPN)患者的颈动脉弹性中的临床应用价值.方法 收集88例T2DM患者,根据是否合并DPN分为A、B两组,A组43例为T2DM未合并DPN患者,B组45例为T2DM合并DPN患者;另选同期42名健康志愿者作为对照(C组).应用WI技术测量患者颈总动脉弹性的相关参数,并进行统计学分析.结果 A、B两组血管硬化参数(β)、血管压力应变弹性模量(Ep)、脉搏波传导速度(PWVβ)均高于C组(P均＜0.05);B组β、Ep、PWVβ高于A组(P均＜0.05);A组及B组瞬时加速度波强(W1)、瞬时减速度波强(W2)、血管顺应性(AC)低于C组(P均＜0.05);B组W1、W2、AC低于A组(P均＜0.05).3组间负向波面积(NA)、管径面积(NAd)的差异均无统计学意义(P均＞0.05).结论 WI技术可以便捷、无创地评价T2DM合并DPN患者颈动脉弹性的异常改变.     

中性粒细胞与淋巴细胞比值、胱抑素C在2型糖尿病周围神经病变中的诊断价值

目的 探讨中性粒细胞与淋巴细胞比值(NLR)、胱抑素C(CysC)在2型糖尿病周围神经病变(DPN)中的诊断价值。方法 将2019年1月至2020年4月本院收治的350例在2型糖尿病患者纳入研究。依据肌电图检测结果将其分为198例单纯在2型糖尿病患者(DM组)和152例在2型糖尿病合并DPN患者(DPN组)。比较两组基线资料及实验室检测指标。采用Logistic回归分析2型糖尿病患者发生DPN的危险因素。采用受试者工作特征(ROC)曲线探讨NLR、CysC对DPN的诊断价值。结果 与DM组相比,DPN组年龄、糖尿病病程及CysC、淋巴细胞计数(LYM)、NLR、尿素氮(BUN)、空腹血糖(FPG)水平显著增加(P<0.05)。Logistic回归分析显示年龄、糖尿病病程、NLR、CysC、FPG是发生DPN的危险因素(P<0.05)。NLR和CysC诊断DPN的ROC曲线下面积分别为0.599和0.614。结论 NLR、CysC对DPN诊断有一定价值,NLR和CysC升高是DPN的危险因素,对DPN的预测价值较高。     

不同年龄层次糖尿病患者并发周围神经病变 的危险因素比较

目的:探讨不同年龄层次的2型糖尿病并发周围神经病变(DPN)患者的危险因素的差异。方法:2型糖尿病患者178例纳入研究。根据有无并发周围神经病变,分为非DPN组54例和DPN组124例;再根据年龄差异将124例DPN组分为老年DPN组(年龄≥60岁)和普通DPN组(年龄60岁);收集各组一般资料及血液检测结果,并进行统计分析。结果:非DPN组和DPN组患者的年龄、糖尿病病程、糖化血红蛋白(HbA1c)、2 h餐后血糖(PG)、3 h PG、尿微量白蛋白(ALB)、尿肌酐(UCr)、尿A/C差异有统计学意义(均P0.05);Logistic多因素回归分析显示患者的年龄、糖尿病病程是发生DPN的影响因素。非DPN组、普通DPN组和老年DPN组的年龄、HbA1c、3h PG、Cr、尿A/C差异均有统计学意义(均P0.05);老年DPN组和普通DPN组患者的Cr和尿A/C差异均有统计学意义(均P0.05)。结论:年龄及糖尿病病程是2型糖尿病并发DPN的影响因素;老年DPN患者出现糖尿病肾病的几率会增大。     

2型糖尿病合并周围神经病变内皮素及一氧化氮水平监测

目的探讨血浆内皮素(ET)及血清一氧化氮(NO)在2型糖尿病合并周围神经病变时的浓度变化。方法糖尿病合并周围神经病变组36例,糖尿病无周围神经病变组30例,正常对照组30例。结果DPN组ET水平显著高于DM组(P<0·001),DM组ET水平显著高于正常对照组(P<0·001)。DPN组NO水平显著低于DM组(P<0·001),DM组NO水平显著低于正常对照组(P<0·001)。直线相关分析显示ET与NO呈负性相关。结论ET、NO的检测作为血管内皮受损的指标,对DPN的发生及病情的判断有参考价值。     

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.