角膜塑形镜矫正近视对角膜形态的影响

目的探讨配戴角膜塑形镜矫正近视对角膜形态的变化和影响。方法采用美国进口E&E公司提供的角膜塑型镜(夜戴型),矫治青少年近视118例(235眼)中、低度近视(-4.75±1.85)D,分别测量戴镜前和戴镜后1周、2周、1个月和3个月角膜曲率(K值)、角膜厚度及裸眼视力,采用t检验分析。结果戴镜后角膜曲率明显下降,与戴镜前比较差异有统计学意义(P<0.05);戴镜后2周、1个月、3个月与戴镜后1周比较差异无统计学意义(P>0.05)。戴镜后角膜中央厚度变薄,与戴镜前比较差异有统计学意义(P<0.05),戴镜后2周、1个月、3个月与戴镜后1周比较差异无统计学意义(P>0.05)。裸眼视力明显提高,与戴镜前比较差异有统计学意义(P<0.05),戴镜后2周、1个月、3个月与戴镜后1周比较差异无统计学意义(P>0.05)。结论配戴角膜塑形镜后角膜中央变平坦、中央厚度变薄。主要变化表现在戴镜后1周之内,1个月趋于稳定。角膜上皮无损伤,裸眼视力明显提高。     

夜间配戴角膜塑形镜对不同屈光度青少年近视患者泪液的影响

目的分析夜间配戴角膜塑形镜对不同屈光度青少年近视患者泪液的影响。方法我院收治的青少年近视患者150例共292只眼,按屈光度不同分为低度近视组(-3.00～-1.00 D) 65例128只眼,中度近视组(-6.00～-3.25 D) 85例164只眼,夜间配戴角膜塑形镜矫正近视,比较不同时间点两组泪膜破裂时间(BUT),泪液基础分泌量[SchirmerⅠ试验(SIT)],角膜上皮荧光素染色检查(CFS)的变化情况,并观察不良反应。结果与戴镜前比较,戴镜后1周、1月、3月、6月两组BUT显著缩短(P0.05),戴镜后1周BUT缩短较明显,1月时BUT缩短最显著,戴镜后3月BUT恢复上升,低度近视组BUT大于中度近视组(P0.05);戴镜后1周、1月、3月、6月两组SIT无显著变化,组间比较差异无统计学意义(P 0.05);戴镜后CFS以Ⅰ级染色为主,戴镜后1周、1月、3月、6月两组CFS例数显著增多(P0.05),但组间比较差异无统计学意义(P0.05),戴镜过程中,两组患者眼压均正常,未出现明显不良反应。结论夜间配戴角膜塑形镜矫治不同屈光度青少年近视,对患者泪液基础分泌量无明显影响,但会缩短泪膜破裂时间,增加角膜上皮荧光素染色,建议患者戴镜后按时进行复查。     

糖尿病性白内障超声乳化术后角膜水肿的效果和特征观察

目的研究糖尿病性白内障超声乳化术后角膜水肿和角膜内皮细胞形态学变化。方法随机选取70例(72眼)非胰岛素依赖型糖尿病合并老年性白内障患者(糖尿病组)和68例(73眼)单纯老年性白内障患者(对照组)行白内障超声乳化联合人工晶体植入术,观察术前、术后1周、1个月、3个月的角膜中央区皮细胞密度、六角形细胞密度以及变异系数。结果术后角膜内皮细胞密度和六角形细胞比例逐渐下降,降变异系数逐渐增加。糖尿病组术前内皮细胞密度与对照组比较差异未见统计学意义,六角形细胞密度和变异系数差异有统计学意义(P0.01)。术后3个月与对照组相比较时发现三项指标均差异均有统计学意义(P0.01),并且糖尿病组患者的三项指标变化更为明显。结论糖尿病性白内障患者较单纯的老年性白内障患者的内皮细胞状况差,在超声乳化术后更容易受损出现角膜水肿。     

佩戴角膜塑型形镜对儿童青少年干眼症状的临床观察研究

目的：观察青少年配戴角膜塑形镜前后各项干眼指标,使用OSDI量表进行评分和数据分析,探讨不同时长配戴角膜塑形镜对青少年干眼症状的影响。 方法：选择2019年7月-2020年12月在我院就诊后准备配戴角膜塑形镜的近视患者60例（60眼）,年龄（12.81±1.83）岁,在戴镜前,戴镜后1个月、3个月、12个月应用眼表疾病指数评分表(OSDI )、泪膜破裂时间（BUT）来评估患者的干眼症状以及严重程度。 结果：60例患者,戴镜后1个月OSDI评分就较戴镜前显著升高（P＜0.01）,戴镜后3个月和1年OSDI评分与戴镜前相比较都有所上升,差异具有统计学意义（P<0.05）。戴镜后BUT没有明显变化（P>0.05）。 结论：配戴角膜塑形镜后虽然BUT并未达到诊断干眼的标准,但会对青少年的主观干眼症状产生影响,临床护理应对这一现象引起重视。     

白内障伴糖尿病患者超声乳化手术后角膜内皮细胞丢失的研究

目的探究伴糖尿病白内障患者超声乳化手术后角膜内皮细胞丢失的情况。方法选取我院2016年7月~2017年6月期间眼科收治的82例(128眼)白内障患者。按照是否伴有糖尿病分为糖尿病组40例(64眼)和非糖尿病组42例(64眼)。两组均行白内障超声乳化手术,对比两组患者角膜中央区内的内皮细胞密度、六角形细胞比例和角膜厚度情况。结果两组患者术后1d、1周及3月角膜中央区内的内皮细胞密度、六角形细胞比例均低于术前,差异有统计学意义(P0.05),两组患者术后1d、1周及3月角膜厚度均高于术前,且糖尿病组患者1d、1周及3月角膜中央区内的内皮细胞密度、六角形细胞比例均明显低于非糖尿病组,差异有统计学意义(P0.05),糖尿病组患者1d、1周及3月角膜厚度均明显高于对照组,差异有统计学意义(P0.05)。结论白内障超声乳化手术对白内障患者内皮细胞具有一定损害,且糖尿病白内障患者更易受到损害。     

Ahmed青光眼阀植入后角膜内皮细胞的变化

背景:青光眼阀通常植入到眼球颞上方位置,由于角膜内皮细胞不能再生,颞上方内皮细胞的创伤修复主要靠其他区域健康内皮细胞的扩展和延伸来补偿,因此会出现内皮细胞密度的下降和形态改变.目的:观察Ahmed青光眼阀植入前后角膜内皮细胞密度及形态学的变化规律.方法:在34例(34眼)疑难青光眼患者眼球颞上象限行Ahmed青光眼阀植入,移植前及移植后3,6个月对角膜中央、颞上、颞下、鼻上及鼻下区内皮摄像后测定分析,得出角膜内皮细胞密度,并取全角膜平均值,同时观察角膜内皮细胞形态变化,统计六角形细胞所占比例.结果与结论:Ahmed青光眼阀植入后全角膜内皮细胞的平均密度有所下降,并在一段时间内呈渐进性趋势(P<0.05),其中角膜颞上区较中央区下降明显,角膜中央区内皮细胞密度移植前后无明显变化.移植后角膜内皮细胞在形态学方面也发生了变化,六角形细胞比例下降,多边形细胞比例增加(P<0.05).结果显示,Ahmed青光眼阀植入后6个月内角膜内皮细胞密度呈渐近性下降趁势,形态学特征亦有所改变.提示植入过程中应注意眼内操作的轻柔性,从而降低对角膜内皮细胞的损害,并延长对移植后患者角膜内皮的监测时间.     

两种黏弹剂对超声乳化术兔角膜内皮细胞的影响

目的：观察在超声乳化术中使用两种不同黏弹剂(Viscoat和Amvisc Plus)对角膜内皮细胞的保护作用，以及角膜内皮细胞损伤的形态学分析。方法：实验于2003—06／2004-01在锦州医学院实验动物中心实验室和锦州市亚东眼科医院实验动物中心实验室进行。3．5月龄纯种日本大耳白兔12只，雌雄不限，体质量1．8～2.0ks。随机分为3组：正常对照组(为正常的兔角膜内皮细胞)，Viscoat组(应用Viscoat弥散性黏弹剂)，Amvisc Plus组(应用Amvisc Plus内聚性黏弹剂)，每组4只动物。于术前、术后即刻和术后6h采用Tomey EM-1000型接触性角膜内皮显微镜进行角膜内皮细胞形态学定量测定：角膜内皮细胞密度、细胞面积、变异系数及六边形细胞(正常角膜内皮细胞形态)百分率；术后6h光镜下计算内皮细胞存活率；术后6h透射电镜下观察各组角膜内皮细胞超微结构的变化。结果：12只大耳白兔均进入结果分析。①术前各组间各项指标均无显著性差异。②术后即刻角膜内皮细胞密度和平均面积各组间无显著性差异(P&;gt;0．05)；术后6h，Viscoat和Amvisc Plus组细胞密度均较正常对照组降低(P&;lt;0．05)，平均面积均较正常对照组增加(P&;lt;0．05)。术后即刻和6h六边形细胞百分率均低于正常对照组(P&;lt;0．05)，变异系数均大于正常对照组(P&;lt;0．05)。③角膜内皮细胞活性率Viscoat组高于Amvisc Plus组[(93．78&;#177;3．14)％，(80．77&;#177;3．91)％，(P&;lt;0．05)]。④角膜中央1mm区域取材的透射电镜切片示Viscoat组角膜内皮损害小于Amvisc Plus组。结论：角膜内皮细胞形态学分析较细胞密度和平均面积的改变能更灵敏地反映角膜内皮的变化。在相同的手术条件下，Viscoat黏弹剂对角膜内皮细胞的保护能力优于Amvisc Plus。     

角膜塑形镜对角膜内皮细胞和角膜厚度的影响

  目的  探讨配戴夜戴型角膜塑形镜1年对角膜内皮细胞和角膜厚度的影响。  方法  观察2008年8月至2009年2月8~14岁在本院配戴角膜塑形镜随诊数据完整者40例(79眼), 配戴前与配戴后6个月及1年进行角膜内皮细胞和角膜厚度的测定与比较, 同时观察裸眼视力、屈光度和角膜地形图的变化。  结果  配戴后6个月及1年与配戴前比较角膜内皮细胞密度均无明显降低(P > 0.05)。细胞变异系数和六角形细胞比率在6个月时无明显变化, 而在1年时分别轻度增加和减少, 与配戴前比较差异均具有统计学意义(P < 0.05);角膜厚度在配戴后6个月及1年与配戴前比较无明显改变, 差异无显著统计学意义(P > 0.05)。配戴后1年裸眼视力、屈光度和角膜地形图(K值)与配戴前比较差异均有显著统计学意义(P < 0.01)。  结论  角膜塑形镜降低近视屈光度、控制近视发展效果明显, 但长期配戴对角膜内皮细胞形态有轻度影响, 必须严密观察和随诊, 以确保长期治疗的有效性和安全性。     

角膜塑形镜停戴后屈光状态及角膜形态的变化研究

目的研究角膜塑形镜停戴后屈光状态及角膜形态的变化。方法收集2014年1月~2015年1月配戴角膜塑形镜并且停戴一段时间的100例患者的一般资料。根据近视球镜度数分为A组、B组,每组50例。A组球镜度数≤-4.00D,B组球镜度数-4.00D。每组再根据角膜塑形镜停戴时间分为A1、A2、B1、B2,每组39列。A1、B1停戴时间1-3个月,A2、B2停戴时间超过3个月。观察四组屈光状态及角膜形态的变化。结果四组球镜度数与戴镜前相比,差异有统计学意义(P0.05);客观电脑验光仪结果显示,A1、B1在角膜平、陡K值及平均K值方面与治疗前相比,差异有统计学意义(P0.05)。结论给予近视眼患者配戴3个月及以上角膜塑形镜,角膜形态和角膜中央厚度基本恢复原状,停戴后近视度数无明显增加现象,角膜塑形镜对中高度数效果并不明显。     

青少年近视病人配戴角膜塑形镜的护理

<正>角膜塑形术是一种通过"反几何"设计的特殊的硬性高透氧性角膜接触镜压迫角膜中央区,借助镜片本身和眼睑的压力使角膜中央变平坦,角膜曲率变小,以降低角膜屈光力,起到暂时降低近视度数,提高裸眼视力的作用。角膜塑形镜由于夜间戴镜,白天裸眼视力正常,并且可以有效延缓近视增加,已被广泛应用于矫正青少年近视[1-3]。尽管现代角膜塑形镜采用全新设计和高透氧性材料,且有较严格的验配程序,但是由于其直接接触角膜、闭眼状态下戴镜、戴镜人群主要是青     

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.