准分子激光屈光性角膜切削术后泪膜功能分析

目的：探讨准分子激光角膜切削木(photorefeactive keratectomy PRK)后泪膜功能的改变;方法:对59例近视患者l18只眼进行了泪膜功能检测，观察PHK术前及术后10天、1个月、3个月，角膜荧光素染色试验，泪膜破裂时间(break-up time,BUT)，泪液分泌量。结果：PRK术前，术后10天、1月、3月平均泪液分泌量为16、2l、15．97、10、11、12．88mm；平均BUT为15．53、11．01、9．87、11．32s，PRK术后3个月内BUT明显缩短，差异有显著意义。PRK术后泪液分泌量亦明显减少。术后10天角膜荧光素染色比术前加重。结论：PRK术后可导致泪液缺乏，泪膜稳定性下降，产生干眼症状，主要原因可能与术后角膜知觉减退有关。     

绷带式角膜接触镜联合药物治疗与单纯药物治疗高压电弧致中度角膜损伤的对照研究

目的探讨绷带式角膜接触镜联合药物治疗对比单纯药物治疗高压电弧所致角膜损伤的疗效差异。方法回顾性收集2014年9月至2019年9月北京积水潭医院眼科收治的高压电弧致中度角膜损伤患者35例,根据治疗方法不同分为两组,其中绷带式角膜接触镜联合药物治疗组18例(36眼),单纯药物治疗组17例(34眼)。以患者不良反应、疼痛缓解情况、角膜愈合情况以及视力恢复情况为观察指标。结果两组不良反应及并发症差异无显著性。联合治疗组治疗后1d的好转率、治疗后3d、7d的治愈率均显著高于单纯药物治疗组(P<0.05);联合治疗组治疗后各时间点的疼痛程度评分均明显低于单纯药物治疗组(P<0.01);联合治疗组角膜完全愈合时间为(4.05±1.62)d,明显短于单纯药物治疗组的(5.82±2.28)d,差异有显著性(P<0.01);联合治疗组视力恢复时间为(4.27±2.15)d,明显快于单纯药物治疗的(6.14±2.65)d,差异有显著性(P<0.01)。结论绷带式角膜接触镜联合药物治疗较单纯药物治疗明显提高高压电弧致中度角膜损伤疗效。     

硬性透气性角膜接触镜应用及护理研究进展

<正>硬性透气性角膜接触镜(rigid gas permeable contact lens,RGP)利用镜片与眼表泪液膜有效弥合,从而重塑角膜前表面,显著降低棱镜效应,消除不等视,使视网膜像无明显缩小和变形[1],在显著屈光参差、高度角膜散光、圆锥角膜、无晶体眼等中的临床应用越来越广泛。虽然RGP在应用时具有透氧性好和生物相容性好等特点,符合人体角膜生理结构,长期配戴的安全性较高。但是如果配     

青光眼小梁切除术后结膜渗漏患者佩戴软性角膜接触镜的护理

目的:探讨软性角膜接触镜在治疗青光眼小梁切除术后结膜渗漏的疗效及护理方法.方法:将我院15例青光眼小梁切除术后结膜渗漏佩戴软性角膜接触镜治疗的患者给予细致护理.结果:15例患者术后3 ～9 d结膜渗漏均愈合,住院期间无1例出现眼部感染及角膜缺氧等并发症.结论:对佩戴软性角膜接触镜的患者给予细致护理,能够免除患者二次手术,节约费用,减轻患者心理压力,促进疾病恢复,提高患者满意度.     

近视眼患者角膜屈光力与角膜表面对称性的相关性分析

目的探讨近视患者角膜屈光力与角膜表面对称性的相关关系。方法对近视患者眼1472只(其中男性眼715只,女性眼757只)、行PRK手术后1年的患者眼161只和行LASIK手术后1年的患者眼158只进行统计学分析,研究角膜平均屈光力(ACP)与角膜表面非对称指数(SAI)的相关关系。结果ACP与SAI在男性和女性中均存在明显的正相关关系(Pearson相关系数为分别为0·120、0·108,P<0·01),PRK术后1年,ACP与SAI之间无明显相关关系(偏相关系数为-0·110,P=0·165);LASIK术后1年,ACP与SAI之间无明显相关关系(Pearson相关系数为-0·066,P=0·413)。结论近视患者角膜屈光力与角膜表面对称性存在明显的正相关关系,准分子激光屈光性手术可以改变这种相关性。     

硅水凝胶角膜接触镜在LASIK术后早期的应用

目的评价硅水凝胶角膜接触镜在准分子激光原位角膜磨镶术（LASIK）后早期应用的临床安全性和有效性。方法30例近视患者（60眼）自身对照,每例患者在LASIK手术结束时随机选取一眼佩戴PureVision角膜接触镜,术后第1天取出,分别记录术后1d、3d、7d的主观症状评分、角膜荧光素染色（FL）、泪膜破裂时间（BUT）以及泪液分泌试验（Sit）。戴镜眼组和未戴镜眼组之间以及两眼各自分别进行上述时间点不同观察指标的统计学分析。结果主观症状戴镜眼组在术后1d比未戴镜眼组轻（Z=2．60,P〈0．01）,在术后3d、7d两组差异无统计学意义;戴镜眼组在术后1d角膜荧光素染色（FL）阳性率比未戴镜眼组低（x^2=12．912,P〈0．01）;在术后3d、7d两组差异无统计学意义。戴镜眼组在术后1d（t=2．51,P〈0．05）、3d（t=2．03,P〈0．05）、7d（t=1．94,P〈0．05）泪膜破裂时间（BUT）均比未戴镜眼组长,差异有统计学意义。两组术后3天、7天BUT值均比术后1天增加（F=3．02,P〈0．05;F=4．77,P〈0．01）。戴镜眼组在术后1d（t=2．06,P〈0．05）、3d（t=1．89,P〈0．05）比未戴镜眼组基础泪液分泌量多,差异有统计学意义。术后7天两组差异无统计学意义。结论硅水凝胶角膜接触镜对于促进角膜愈合、缓解疼痛刺激有显著疗效,适宜于LASIK术后早期配戴。     

绷带式角膜接触镜辅助治疗神经麻痹性角膜炎的护理

目的探讨绷带式角膜接触镜辅助治疗神经麻痹性角膜炎过程中护理干预的重要作用。方法采用病例对照研究,选取2011年1月-2015年1月神经麻痹性角膜炎患者25例(25眼),将入选患者随机分为两组,治疗组12例(12眼)佩戴绷带式角膜接触镜联合药物治疗;对照组13例(13眼)仅用与治疗组相同的药物治疗。分别评估治疗后3d,7d,14d,21d角膜好转率、治愈率及并发症情况。护士参与有关绷带式角膜接触镜摘戴操作、心理护理、使用指导、维护保养及健康宣教等。结果治疗组佩戴绷带式角膜接触镜第7天好转率为58%,第14天治愈率为67%,与对照组比较差异有统计学意义(P0.05)。在观察期间没有出现并发症。结论短期内佩戴绷带式角膜接触镜联合药物治疗可以加速角膜上皮的愈合,且积极的护理干预,对有效提高神经麻痹性角膜炎患者治愈率发挥了重要作用。     

角膜屈光手术后急性结膜炎患者的护理

准分子激光角膜屈光手术因有较好的预测性和安全性被广泛运用于矫正屈光不正的患者。准分子激光手术对患眼导致的医源性创伤及术后一段时间内应用糖皮质激素可导致患者局部抵抗力减弱 ,从而易引发患眼角膜及结膜的炎症。现对我中心部分LASIK术后急性结膜炎患者的护理进行总结如下 :1　临床资料1.1　方法　观察 112 4例LASIK术后患者的恢复情况 ,对术后发生急性结膜炎的病例进行了发病时间、可能被感染环节、结膜炎症对角膜瓣的影响及临床治疗情况的统计 ,同时进行了部分病例的结膜囊细菌培养。1.2　结果　发生急性结膜炎 2 3例 (4 6眼 )…     

绷带式角膜接触镜治疗角膜相关疾病临床价值

目的探讨绷带式角膜接触镜治疗角膜相关疾病的临床应用价值。方法角膜相关疾病患者84例(84眼),根据治疗方式分为观察组42例(42眼)和对照组42例(42眼)。对照组采用常规药物治疗,观察组在常规药物治疗基础上佩戴绷带式角膜接触镜进行治疗;2组分别于治疗后第1、7、21天采用角膜上皮荧光染色检测角膜上皮愈合情况,并评估眼部疼痛程度。结果 2组治疗后21d角膜上皮荧光染色评分和眼部疼痛评分均低于治疗后1、7d(P0.05);观察组治疗后7、21d角膜上皮荧光染色评分[(1.81±0.08)、(0.71±0.09)分]和眼部疼痛评分[(1.07±0.04)、(0.12±0.05)分]均低于对照组[(2.21±0.12)、(1.29±0.10)分,(1.90±0.13)、(1.07±0.10)分],差异均有统计学意义(P0.05);观察组患者绷带镜配戴过程中无角膜穿孔、感染、失明等并发症发生。结论佩戴绷带式角膜接触镜可促进角膜上皮的愈合、减轻患者疼痛,有效改善患者不适症状,提高角膜相关疾病治愈率。     

软性角膜接触美容镜片的制作及应用

角膜接触镜是人们通常说的隐形眼镜。从最早出现的角巩膜接触镜到硬性角膜接触镜，到现在出现了以聚甲基丙烯酸羟乙酯（PHEMA）为主要原料制成的软性角膜接触镜，由于它的亲水性，提高了角膜的透氧性，配戴起来较适应．近十几年来，软性角膜接触镜的应用在我国逐渐推广开来，应用的范围亦不局限于矫正屈光不正，还应用于药物吸收和释放等。本文提及的则是美容方面的应用。制作软性角膜接触美容镜片（美容片），主要是针对一些先天或后天失明，或是意外虹膜损伤，产生畏光症状而设置．过去通常采用装义眼的方法来补救，病人不仅要经受手术…     

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.     

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.     

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.     

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.