光学相干断层扫描在青光眼早期诊断中的应用价值

目的探讨频域光学相干断层扫描(OCT)对发现和诊断早期青光眼的应用价值。方法将84例(160眼)行眼底视乳头OCT检查的患者按检查结果分为3组:疑似青光眼组(SG组,34例,68眼)、确诊青光眼早中期组(DG早中期组,40例,72眼)和正常组(10例,20只眼)。分别对各组采集的各象限(颞侧、上方、鼻侧、下方)视神经纤维层(RNFL)厚度、平均RNFL、视盘参数(水平及垂直杯盘比、杯/盘面积比)的数据进行比较;将OCT测得的各组眼的平均RNFL厚度值与视野平均缺损(MD)进行直线相关性分析。结果 SG组下方、上方象限及平均RNFL厚度,DG早中期组下方、上方、鼻侧、颞侧象限及平均RNFL厚度均明显低于正常组(均P<0.05);SG组鼻侧、颞侧RNFL厚度与正常组比较差异均无统计学意义(均P>0.05)。DG早中期组各象限(上方、下方、鼻侧)及平均RNFL厚度明显低于SG组(均P<0.05);颞侧RNFL厚度比较差异无统计学意义(P>0.05)。DG早中期组及SG组的水平及垂直杯盘比、杯/盘面积较正常组明显变大(均P<0.05)。各组的平均RNFL厚度值与MD呈高度正相关(r=0.703,P=0.00)。结论频域OCT能直观、精确地以图像及数据的方式显示视神经病变的微观层面,能检测出视野损害前的早期青光眼RNFL局限性损害,具有简便、非侵入性、重复性好、可长期随访等特点,有利于对青光眼患者的早期诊断。     

轻、 中度非增生性糖尿病视网膜病变(NPDR)患者视盘周围视网膜神经纤维层厚度的变化及护理措施

目的 观察分析轻、中度非增生性糖尿病视网膜病变(NPDR)患者视盘周围视网膜神经纤维层(RNFL)厚度的变化,并总结其护理措施.方法 选取我院于2013年1月~2014年1月收治的108例2型糖尿病患者,共216只眼,根据糖尿病视网膜病变分期标准,分为轻度NPDR组(52例,104只眼)、中度NPDR组(56例,112只眼),选择同期健康体检者40例作为对照组,所有患者均接受光学相干断层扫描,分析不同病变组患者视盘周围视RNFL厚度的变化,并对其护理措施进行分析总结.结果 轻度NPDR组视盘周围RNFL厚度为(102.34±8.45)μm;中度NPDR组视盘周围RNFL厚度为(101.54±6.01)μm,低于对照组的(106.48±9.24)μm(P<0.05).轻度NPDR组上方、下方RNFL厚度均较对照组低(均P<0.05);中度NPDR组上方、下方、鼻侧、颞侧RNFL厚度均较对照组低(均P<0.05).结论 糖尿病患者视盘周围神经纤维层厚度变化随着视网膜程度的增加而逐渐降低,加强糖尿病早期光学相干断层定量检测,密切观察患者视盘周围RNFL厚度变化,同时加强糖尿病早期护理指导,对预防糖尿病的发展有重要的临床价值.     

光学相干断层扫描技术在Leber家族遗传视神经病变不同病程中的应用

目的探讨Leber家族遗传视神经病变(LHON)中视盘周围视网膜神经纤维层(RNFL)厚度与病程发展之间的关系。方法选择确诊LHON并行频域光学相干断层扫描(FD-OCT)检查视盘周围RNFL厚度的患者58例(共116只眼),分析不同病程阶段的RNFL平均厚度变化、各象限厚度变化及RNFL厚度与患者视力的相关性。结果 LHON患者各象限RNFL厚度:上方>下方>鼻侧>颞侧。随着病情进展,RNFL厚度呈先增厚,之后逐渐变薄趋势。病程前3个月RNFL增厚,其中上方和下方象限较显著。病程4～6个月RNFL薄变明显,上方和下方象限RNFL厚度均下降约70μm,而鼻侧和颞侧象限下降约20μm。6个月之后,各象限RNFL厚度薄变幅度减缓并逐渐趋于稳定。不同病程组之间LHON患者检查时平均视力差异有显著性(P=0.000);但病程与患者视力无明显相关性(P=0.052),患者的视力在病程4～6个月期间降至最低,随后又逐渐提高。不同病程患者视力与其RNFL厚度无明显相关性(P=0.384)。结论 LHON患者各象限中,颞侧RNFL厚度最薄。病程的前3个月RNFL增厚,4～6个月各象限RNFL薄变明显,提示病程6个月之内是修复受损视网膜神经节细胞的最佳时间窗。     

光学相干断层扫描测量视网膜神经纤维层厚度及视盘参数在青光眼早期诊断中的应用价值

目的对OCT测量视网膜神经纤维层厚度及视盘参数在青光眼早期诊断中的应用价值进行探究。方法选取32只眼疑似闭角型青光眼(SG)患者、34只眼慢性闭角型青光眼(CACG)早中期患者以及同期10只正常眼对其进行OCT(光学相干断层扫描)RNFL(视网膜神经纤维层)厚度检测,比较各自组RNFL厚度及相关视盘参数数据(视乳头水平、垂直杯盘比及杯/盘面积比的均数)。结果三组视盘参数中的水平杯盘比、垂直杯盘比以及杯/盘面积比相比均具有统计学差异(P 0.05);健康组上方、下方以及平均RNFL厚度均与疑似SG组具有明显差异,(P 0.05);鼻侧、颞侧RNFL厚度相比无明显统计学差异,(P0.05);健康组各象限RNFL厚度以及平均RNFL厚度与CACG组相比具有明显差异,(P 0.05);疑似SG组上方、下方、鼻侧以及平均RNFL厚度相比于CACG组具有明显差异,(P 0.05),颞侧RNFL厚度相比无明显统计学差异,(P0.05)。结论临床应用OCT测量视网膜神经纤维层厚度及视盘参数,实现了对病情进展的监测,有利于青光眼的早期诊断。     

应用OCT研究高度近视视网膜神经纤维层厚度及影响因素

目的 研究高度近视患者视网膜视神经纤维层(RNFL)变异情况及其与屈光度、年龄、性别和眼别的关系。 方法 选择高度近视172眼,应用光学相干断层成像术(OCT)检测全周和各象限RNFL的厚度,使用多元线性回归分析全周及4个象限的平均厚度与屈光度、年龄、性别和眼别的。 结果 高度近视172只眼RNFL平均厚度分别为全周(112.523±12.053)μm、上方(134.942±21.016)μm、下方(135.488±25.058)μm、颞侧(112.198±27.145)μm,鼻侧(68.3895±17.554)μm;高度近视RNFL全周平均厚度与屈光度的偏相关系数为-1.225,与性别的偏相关系数为5.415,与年龄的偏相关系数为-0.117。RNFL上方平均厚度与年龄的偏相关系数为-0.623,与眼别的偏相关系数为4.780。RNFL下方平均厚度与性别的偏相关系数为6.632。RNFL颞侧平均厚度与性别的偏相关系数为10.048,与屈光度的偏相关系数为4.264。RNFL鼻侧平均厚度与眼别的偏相关系数为-6.905。 结论 年龄、性别、屈光度是高度近视患者RNFL平均厚度的影响因素,眼别是RNFL上方和颞方平均厚度的影响因素,RNFL厚度影响因素的研究为高度近视合并青光眼的早期诊断和随诊提供依据,对加强高度近视患者病情进展的监测和健康宣教有重要意义。     

激光眼底扫描仪在开角型青光眼诊断中的应用

目的评价激光眼底扫描仪对原发性开角型青光眼 (POAG )的诊断价值。方法利用海德堡共焦激光眼底扫描仪(HRT Ⅱ )检测高度近视合并可疑青光眼者、POAG患者和正常人的盘沿面积、盘沿体积和神经纤维层 (RNFL)厚度 ,对比 3者之间的关系。结果POAG患者、高度近视并可疑青光眼和正常人各象限盘沿面积、盘沿体积和RNFL厚度存在显著差异 (P <0 0 5 )。结论激光眼底扫描仪 (HRT Ⅱ )可应用于原发性开角型青光眼的诊断。     

视网膜神经纤维层厚度与糖尿病周围神经病变的相关性研究

目的探讨不同程度糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)患者视网膜神经纤维层(retinal nerve fiberlayer,RNFL)厚度的变化。方法选择2014年1月—2016年2月在保定市第二中心医院内分泌科住院治疗的DPN 120例作为观察组,另选择同期在该院体检的健康体检者50例作为对照组。比较两组RNFL厚度以及观察组不同程度患者RNFL厚度。结果观察组视盘上方、下方RNFL厚度小于对照组,平均RNFL厚度大于对照组,两组比较差异有统计学意义(P0.05)。不同程度DPN患者视盘上方、下方及平均RNFL厚度总体比较差异有统计学意义(P0.05);不同程度DPN患者随病情加重,视盘上方、下方及平均RNFL厚度渐减小,差异有统计学意义(P0.05)。结论 DPN程度与RNFL厚度有一定相关性,随着DPN程度加重,RNFL厚度有逐渐变薄趋势。临床可根据RNFL厚度结合实际评估DPN患者发生及病情进展情况。     

糖尿病视网膜病变患者全视网膜激光光凝术后视网膜神经纤维层厚度的变化

目的 探讨糖尿病视网膜病变(DR)患者全视网膜激光光凝术(PRP)后视网膜神经纤维层(RNFL的变化。方法 选取2016年3月至2019年1月在漯河市第三人民医院治疗的300例DR患者,所有患者均采取PRP治疗,分别于术后1周、4周、6个月、1年进行随访,测量全周以及各个象限RNFL的厚度值。结果 PRP治疗后,RNFL厚度会逐渐增厚,术后4周时RNFL厚度最厚,随后逐渐变薄。与术前、术后1周、术后4周相比,术后6个月、术后1年的上方、下方、鼻侧、颞侧及全周RNFL平均厚度均明显变薄(P 0. 05)。与术后6个月相比,术后1年的上方、下方、鼻侧、颞侧及全周RNFL平均厚度比较,差异未见统计学意义(P 0. 05)。结论 PRP治疗可引起RNFL变薄,但术后6个月开始逐步稳定,术后1年基本稳定,在治疗时应注意视网膜神经细胞保护。     

眼反应分析仪ORA与Goldmann压平眼压计的对比研究

目的 比较Goldmann 压平眼压计(Goldmann applanation tonometer,GAT) 与非接触眼反应分析仪ORA(Ocular Response Analyzer,ORA)测量眼压的差异，以评价ORA 在眼压测量中的临床应用价值。方法 81例154眼进行ORA与Goldmann压平眼压计测量，并用改进的光学相干断层扫描仪(OCT)测量中央角膜厚度(CCT)。结果 ORA 直接眼压值（IOPG）平均值为（19.88±10.33）mmHg, 校正眼压值（IOPcc）平均值为（21.56±13.52）mmHg，Goldmann眼压计测得的眼压（IOP-GAT）平均值为（18.82±8.89）mmHg，ORA结果与IOP-GAT比较均有明显差异（P=0.000）。正常眼压者平均CCT为（545.49±38.92）µm，IOPG、IOP-GAT与CCT相关（r=0.501, P = 0.000; r =0.364, P = 0.000）, IOPcc与CCT无相关性（r =0.093, P = 0.349）。结论 眼反应分析仪ORA的眼压测量值与Goldmann 压平眼压计的测量值相比偏高，差值随着眼压升高而增大，IOPcc不受角膜厚度影响，可能是排除角膜厚度因素影响更接近真实的眼压结果。     

超声生物显微镜在正常人和部分眼外肌病中的应用

目的研究超声生物显微镜(ultrasound biomicroscope,UBM)在眼外肌病中的应用方法.方法选择正常人15只眼,共同性斜视患者12例(24只眼),V型斜视4例(8只眼),甲状腺相关性免疫眼眶病(TRIO)6例(12只眼),眼外肌缺如1例(1只眼),用UBM测量眼4条直肌止端的位置及厚度.结果正常人15只眼的4条直肌止端的平均厚度分别为内直肌(0.38±0.06)m,外直肌(0.40±0.10)m,上直肌(0.36±0.08)mm,下直肌(0.44±0.05)mm.上直肌止端厚度比下直肌减少,差异有显著性意义(P=0.002),双眼各同名直肌止端厚度的差异和内、外直肌止端厚度的差异均无显著性意义(P＞0.05).共同性斜视患者各条眼外肌止端厚度与正常人比较,除上直肌厚度增加,差异有显著性意义外(P=0.028),其余差异均无显著性意义(P＞0.05).斜视患者的上直肌比下直肌厚度减少,差异有显著性意义(P=0.002).在V型斜视患者中证实外直肌止端向下偏移,而内直肌止端向上偏移.在TRIO患者中证实眼外肌的肌止端有不同程度的增厚.眼外肌缺如时UBM在眼球前部不能探测到眼外肌或仅能测及极薄的高回声.结论应用UBM并结合其他影像学方法为临床医生研究斜视发病机制提供了更多的途径,并可帮助术者合理地设计斜视手术.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.