眼轴长度及性别对近视患者角膜曲率的影响

目的探讨影响近视患者中央角膜曲率（Kmean）及球镜屈光度的因素。方法2008年3月～8月，使用角膜地形图测量157例（313眼）近视患者Kmean和角膜后表面高度。用A超测量眼轴长度和中央角膜厚度．验光测出球镜屈光度。分析可能影响Kmean及球镜屈光度的多个因素。其中男79例（157眼），女78例（156眼）；年龄18-45岁，中位年龄20岁。近视病程1～30年。近视球镜屈光度（-5．65±2．74）D。结果眼轴长度、中央角膜厚度、角膜后表面高度、眼压、Kmean和球镜屈光度分别为：（26．00±1．04）mm、（540．50±31．02）um、（26．96±6．05）um、（17．05±2．48）mmHg（1mmHg=0．133kPa）、（43．30±1．46）D、（-5．65±2．27）D。Kmean的影响因素有：眼轴长度（β1=0．411，P=0．000）、性别（βi=-0．278，P=0．000）、中央角膜厚度（βi=-0．180，P=0．000）（Kmean（D）=63．9790．599×眼轴长度（mm）-0．813×性别（男=1，女=0）-0．009x中央角膜厚度（um），R=0．583，F=25．804，P=0．000）]。球镜屈光度的影响因素有：眼轴长度（βi=-0．911，P=0．000）、Kmean（βi=-0．477，P=0．000）和性别（βi=0．183，P=0．000）[球镜屈光度（D）=76．5851．990×眼轴长度（mm）0．714×Kmean（D）＋0．801x性别（男=1，女=0），R=0．837，F=117．295，P=0．000）]。结论眼轴长度、中央角膜厚度和性别都对Kmean有影响，眼轴增长是近视的主要原因。     

急性白血病患者血浆锌含量变化与多药耐药关系的探讨

【目的】探讨急性白血病（AL）患者血浆锌含量变化与病情及临床疗效的关系。【方法】采用原子吸收分光光度法,检测52例AL患者血浆锌含量及免疫组化法检测化疗后33例AL患者骨髓单个核细胞p-糖蛋白的表达。【结果】①52例AL患者,其中初治未化疗19例血浆锌含量（2．62±1.12μg／mL）较正常对照组（4．28±1．68μg／mL）明显减低（P〈0．01）,化疗后病情缓解16例锌含量（4．66±2．18μg／mL）较难治／复发17例（3．34±0．93μg／mL）明显增高（P〈0．05）,缓解组血浆锌含量较初治未化疗组明显增高（P〈0．01）;②17例难治／复发AI。患者其中15例骨髓单个核细胞P-gP表达阳性细胞率与血浆锌含量呈明显的负相关（r=0．69,P〈0．01）。【结论】①AL患者血浆锌含量变化与病情及临床疗效有关。②AL患者血浆锌含量测定可作为判断病情、疗效及预后指标之一。锌可能参与AL多药耐药的发生。     

干预治疗对肥胖儿童颈动脉弹性指标的影响

【目的】探讨对肥胖儿童实施干预治疗后颈动脉弹性功能的变化。【方法】利用血管回声跟踪（Echo～Tracking，ET）技术检测肥胖儿童干预治疗前、后双侧颈动脉弹性系数（Eρ）、硬化度（β）、顺应性（AC）及内中膜厚度（IMT），比较干预治疗前及治疗6个月、1年后各指标的变化。【结果】与干预治疗前比较：治疗后6个月Eρ、β降低，有统计学差异（P〈0．05），AC增高，但差异无统计学意义（P〉0．05）；治疗后1年Eρ、β降低，AC增高，均有统计学差异（P〈0．05）。治疗1年与治疗6个月的组间比较：Eρ、β降低，AC增高，均有统计学差异（P〈0．05）。治疗前后IMT变化均无统计学意义（P〉0．05）。【结论】ET技术可早期、敏感、无创的评价肥胖儿童干预治疗效果，并可动态随访。     

外伤性暂时性近视的临床特征分析

【目的】探讨外伤性近视的临床特点及其预后。【方法】回顾性研究26例（32眼）外伤性近视患者的临床资料,重点分析其小瞳检影验光、散瞳检影验光、矫正视力和视力恢复时间。【结果】小瞳检影验光发现所有外伤眼均存在近视性屈光改变,其中93.8%的外伤眼表现为轻、中度近视。睫状肌麻痹剂散瞳后验光发现所有外伤眼的近视度数均显著减轻甚至消失。经合适的凹透镜矫正后所有外伤眼视力均可达1.0。且大多数可在4周内恢复至伤前视力。【结论】外伤性近视大多数表现为轻、中度近视,经治疗后一般在4周内可以恢复,且预后良好。     

长沙市1045名小学生屈光状态调查及相关影响因素分析

【目的】分析小学生眼屈光状态的变化及相关影响因素。【方法】对长沙市小学生共1045例（2090眼）进行视力、电脑自动验光、问卷调查。问卷调查项目包括：学生父母的屈光状态、学生的用眼和生活习惯等。【结果】在2090眼中正视眼1254眼（60．0％）,远视眼84眼（4．0％）,近视眼752眼（36．0％）,低度近视602眼（28．8％）,中、高度近视150眼（7．2％）。在752例近视眼中,左眼367眼（17．6％）,右眼385眼（18．4％）,左眼与右眼近视检出率比较差异无统计学意义（ P ＞0．05）。男生1098眼有360眼近视（32．8％）,女生992眼392眼近视（39．3％）,男生与女生近视检出率比较差异有统计学意义（ P ＜0．05）。随着学龄增加,正视眼检出率由1年级72％降至6年级45％,比较差异有统计学意义（ P＜0．05）,近视检出率由1年级21．3％升至6年级53．5％,比较差异有统计学意义（ P ＜0．05）。进行多因素非条件Logistic回归分析,结果显示,用眼距离近、父母均近视、作业时间长、用电子产品时间长、缺少户外锻炼是小学生近视发病的危险因素。【结论】小学生近视屈光状态随年龄呈显著递增趋势,其主要影响因素与遗传、用眼习惯、作业时间长、过多使用电子产品、缺少户外锻炼等密切相关,应予以重视。     

眼轴长度与角膜屈光力、近视度的相关分析

目的　分析眼轴长度与角膜屈光力、近视度的关系。方法　受检者 3 0 5人 5 90眼 ,验光检影后按屈光度≤ -3 .0 0D、>-3 .0 0D～ -6.0 0D、>～ 6.0 0D分为低、中、高度近视组。用DGH 40 0 0型超声仪、12 990 N型曲率仪分别测定眼轴长度和角膜屈光度 ,每眼 3次 ,取平均值作相关统计处理。结果眼轴长度与角膜水平、垂直径屈光力相关检验 ,r值为-0 .4712和 -0 .3 95 3 (P <0 .0 0 1) ,各近视度组角膜屈光力相关分析均为负的直线相关 (P <0 .0 0 1) ,角膜水平和垂直径屈光力相关分析r值为 + 0 .890 8(P <0 .0 0 1)。眼轴长度和近视屈光度相关检验r值为 + 0 .65 0 0 (P <0 .0 0 1)。结论　在近视眼中 ,随着眼轴延长 ,其角膜屈光力呈相应减弱趋势 ,而眼轴延长时近视屈光度随之加重。眼轴与角膜屈光力呈负相关 ,与近视度呈正相关 ,由此认为角膜屈光力对近视度的加重无决定意义 ,眼轴变长才是近视度增高的主导因素。     

1%阿托品眼膏控制青少年早期近视的疗效观察

目的：探讨1%阿托品眼膏控制青少年早期近视的疗效。方法：将60例（120眼）轻度近视患者随机分为治疗组和对照组各30例。对照组常规验光配镜,治疗组间断应用1%阿托品眼膏配合＋1.00 D凸透镜辅助视近,2年后观察两组的远视力、屈光度、眼压、眼轴、角膜曲率值的变化。结果：治疗组视力下降率为33%,明显低于对照组的80%。治疗起始时治疗组的屈光度为（-0.94±0.30）D,对照组为（-1.00±0.44）D,2年后治疗组的屈光度（-0.94±0.40）D,而对照组为（-2.06±0.40）D,对照组屈光度下降较治疗组明显（P〈0.01）。治疗组2年后眼轴增长至（24.52±0.49）mm,对照组眼轴增长至（25.23±0.58）mm,两组比较差异有统计学意义（P﹤0.01）,所有观察对象均未出现眼压升高。两组角膜曲率在治疗前后比较差异均无统计学意义。结论：间断应用1%阿托品眼膏联合轻度凸透镜视近能够有效控制并延缓近视发展,长期使用2年未发现明显的不良反应,患者能够耐受治疗。     

LASIK治疗近视的疗效分析

目的：分析280例（555眼）近视患者行准分子激光原位角膜磨镶术（LASIK）后的疗效。方法：将280例近视患者按术前屈光度分为3组：Ⅰ组-0．75D～-6．00D295眼；Ⅱ组-6．25D～-10．00D238眼；Ⅲ组-10．25D～-14．OOD22眼。术后随访6个月至1年。结果：Ⅰ组术后裸眼视力1．0～1．5有295眼，矫正率为100％；Ⅱ组术后裸跟视力LO～L5有232跟，矫正率为97．48％；Ⅲ组术后裸眼视力0．5～1．0有18眼，矫正率为81．8％。结论：LASIK治疗近视安全有效，其预测性、稳定性好，预防和处理术后并发症是手术成功的重要保证。     

骨桥蛋白与白细胞介素4在支气管哮喘患者血清中的表达及意义

【目的】探讨骨桥蛋白（OPN）与血清白细胞介素-4（IL-4）在支气管哮喘患者血清中的表达及其临床意义。【方法】收集在本院门诊或住院部接受治疗的支气管哮喘患者157例,患者病情稳定后出院,根据入院时情况,分为缓解期43例（A组）、轻度急性发作期42例（B组）、中度急性发作期39例（C组）和重度急性发作期33例（D组）及常规体检者110例为对照组（E组）,检测A、B、C、D、E组患者血清OPN、IL-4水平、痰细胞分类计数和肺功能[一秒用力呼气容积（FEV1）、呼气峰流速值（PEF）、FEV1／FVC]并比较。【结果】E组、A组、B组、C组、D组OPN水平分别为（164．58±21189）pg／mL、（274．72±38．73）pg／mL、（426．92±42．18）pg／mL、（683．15±55．92）pg／mL及（882．67±98．13）pg／mL,随着病情的加重OPN水平依次升高;且B、C、D组患者血清OPN水平显著高于A组及E组（P〈0．05）,而D组患者显著高于B、C组（P〈0．05）。B、C、D组血清IL-4水平分别为（388．52±64．73）pg／mL、（475．62±61．29）pg／mL、（514．81±87．32）pg／mL,显著高于A组（314．27±73．85）pg／mL及E组（192．5±38．24）pg／mL,其差异有统计学意义（P〈0．05）,但A组与E组比较差异无统计学意义（P〉0．05）。相关分析显示：急性发作期患者OPN水平与FEV1（r=-0．474,P=0．008）、PEF％预计值（r=-0．382,P=0．019）、FEV1／FVC（r=-0．492,P=0．007）呈负相关,与IL-4（r=0．526,P=0．003）、诱导痰细胞总数（r=0．314,P=0．011）、嗜酸粒细胞百分比（r=0．374,P=0．019）呈正相关。【结论】随着支气管哮喘患者病情的发展,其血清浆中OPN和血清IL-4水平均显著升高,且OPN与IL-4具有相关性,可作为哮喘控制水平的评价指标。     

近视屈光度与眼轴长度的相关性分析

目的 探讨近视屈光度与眼轴长度的相关程度。方法 以2004年2月至2005年2月在本院门诊就诊的部分近视患者，应用眼科A型超声生物测量仪，对82例（164只眼）患者的近视屈光程度和屈光各要素（眼轴长度、前房深度、晶体厚度、玻璃体腔长度）测量值进行分析。结果 眼轴长度（标准化回归系数b’j=0．909）及玻璃体腔长度（标准化回归系数b’j=0．893）均与近视屈光度呈显著正相关；用逐步回归多元线性分析法分析玻璃体腔长度、晶体厚度及前房深度各屈光要素，其中玻璃体腔长度对眼轴长度的影响最大。结论 眼轴增长是近视眼发生、发展的重要因素，尤其对中、高度近视眼作用更为显著；眼轴长度的增长基本为玻璃体腔的延长。     

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.     

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.     

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.     

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.     

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.