白内障超声乳化人工晶体植入52例临床分析

目的 探讨白内障行超声乳化吸除术的临床疗效和并发症。方法 对52例(56只眼)白内障患者进行超声乳化及人工晶体植入术。结果术后1wk、1mo和3mo裸眼或矫正视力≥0．5者分别为85．71％、94．56％、96．42％。结论 白内障行超声乳化吸除和人工晶体植入术，具有满意的疗效，术后并发症少。     

基层医院开展超声乳化白内障吸除人工晶体植入术的临床观察

目的：观察超声乳化白内障吸除人工晶体植入术临床疗效及并发症。方法：对68例（68只眼）白内障患者实施巩膜遂道切口，超声乳化白内障吸除术联合后房型PMMA人工晶体植入。结果：术后1周，1个月和3个月裸眼或矫正视力≥0．6者分别为82．35％，85．29％，88．23％。结论：超声乳化白内障吸除人工晶体植入术，疗效满意。     

60例中老年白内障患者手术临床效果分析

目的分析白内障现代囊外摘除人工晶体植入术和超声乳化白内障吸除人工晶体植入术治疗糖尿病性白内障的疗效及并发症。方法选择2005年1月-2007年12月期间确诊为糖尿病的白内障60例（73眼），40眼Ⅱ～Ⅲ级核，采用超声乳化白内障吸除后房型人工晶体植入术；33眼Ⅳ～Ⅴ级核，采用现代白内障囊外摘除后房型人工晶体植入术。结果术后视力均有不同程度的提高，其中54眼（73.97％）术后1周裸眼视力≥0．4。术中术后主要并发症经处理对术后视力元影响。结论采取恰当的术式，白内障现代囊外摘除人工晶体植入术和超声乳化白内障吸除人工晶体植入术治疗糖尿病性白内障疗效肯定。     

儿童白内障手术治疗的远期疗效及并发症的临床观察

【目的】探讨超声乳化手术治疗儿童白内障的疗效及并发症。【方法】采用白内障超声乳化吸除并（或不并）人工晶体植入术治疗儿童白内障56例68眼,随访3～5年,观察其视功能恢复及并发症情况。【结果】99．8％的患儿视力均有提高,视力≥0．5者占57％,主要并发症有葡萄膜炎、角膜水肿、后囊膜浑浊、继发性青光眼、人工晶体移位等。【结论】采用超声乳化治疗儿童白内障远期疗效可靠,但术后青光眼,虹膜炎的发生率较高,应予以重视。     

白内障超声乳化联合人工晶体植入术2 580例的临床分析

目的：观察超声乳化白内障吸除联合人工晶体植入术的临床疗效及并发症.方法：对2 580例（2 776眼）白内障患者进行超声乳化白内障吸除联合人工晶体植入术的临床资料进行回顾性分析.结果：术后1 d、1个月和3个月裸眼或矫正视力≥0.5者分别占64.0%、89.0%、90.0%.结论：超声乳化白内障吸除联合人工晶体植入术具有手术切口小、组织损伤轻微、术后散光轻、视力恢复好、并发症少等优点,疗效满意.对几种常见的并发症应注重预防及正确处理.     

巩膜外垫压术后的白内障超声乳化术

目的:探讨原发性视网膜脱离巩膜外垫压术后,超声乳化白内障吸除人工晶体植入术的疗效和并发症。方法:回顾性观察了1998年1月至2003年6月原发性视网膜脱离巩膜外垫压术后患者22例(23眼)行超声乳化白内障吸除人工晶体植入术。记录手术前后的最佳矫正视力,术中、术后的并发症。结果:23眼术后最佳矫正视力≥0.1者18眼(75%),其中9眼(39.1%)≥0.3,随访期间(6～40个月)内未发现视网膜再脱离,平均随访时间16.5个月。1眼出现后发性白内障,行激光晶状体后囊膜切开术。结论:原发性视网膜脱离巩膜外垫压术后行超声乳化白内障吸除人工晶体植入术,可获得良好的手术效果,是一种较理想和安全的手术方法。     

糖尿病患者白内障超声乳化术联合人工晶体植入临床疗效分析

目的评价糖尿病患者白内障超声乳化联合人工晶体植入术的疗效和并发症。方法糖尿病合并白内障67例74眼行超声乳化联合人工晶体植入术（A组），其中32眼植入Pharmacia 812CPMMA人工晶体．42眼植入Acrysof丙烯酸酯折叠式人工晶体。手术结果与糖尿病合并白内障31例31眼的囊外摘除联合人工晶体植入术（B组）及非糖尿病老年性白内障61例66眼超声乳化联合折叠式人工晶体植入术（C组）进行对比分析。结果A组术后3天视力≥0．5者56眼（75.6％），术后1月视力≥0.5者61眼（82．4％），术后前色素膜炎4眼（5．4％），术后3～6月后囊膜混浊率8眼（10．8％），与B组比较，差异有显著性意义，P〈0.05。结论糖尿病患者白内障超声乳化联合优质人工晶体植入并发症少，具有更好的视力效果。     

白内障超声乳化吸除及人工晶体植入术的护理

[目的]总结白内障超声乳化吸除及人工晶体植入术的护理。[方法]回顾性分析244例行超声乳化吸除及人工晶体植入术的白内障病人的临床资料。[结果]本组病人无一例发生严重并发症；术后1个月所有病人裸眼视力均有不同程度的提高，其中裸眼视力≥0．6为202例，0．3～0．6为29例，0．1～0．3为13例。[结论]加强白内障超声乳化吸除及人工晶体植入术病人的护理对病人术后视力的恢复非常重要。     

非穿透小梁切除术联合白内障超声乳化吸除术治疗青光眼合并白内障的临床研究

目的评价非穿透小梁切除术联合超声乳化吸除术治疗青光眼合并白内障的手术疗效。方法对18例(24眼)青光眼合并白内障的患者采用经上方巩膜瓣下非穿透小梁切除结合白内障超声乳化吸除人工晶体一期植入术治疗,观察眼压、视力、滤过泡状态及并发症。随机选用同时期小梁切除术联合白内障超声乳化吸除人工晶体一期植入术患者29例(29眼)做对照。术后随访6个月,观察平均眼压、手术并发症、术后视力、滤过泡形成情况。结果术后观察组平均眼压、手术并发症明显低于对照组,术后视力、滤过泡形成情况同对照组相比无统计学差异。结论非穿透小梁切除术联合超声乳化吸除术治疗青光眼合并白内障疗效满意,手术后反应轻,是较为理想的治疗青光眼合并白内障的术式。     

高龄老人行超声乳化白内障吸除及人工晶体植入术56例

目的:评价超声乳化白内障吸除及人工晶体植入术对高龄老人的可行性及安全性。方法:对90岁及以上高龄白内障患者56例(64眼)行超声乳化白内障吸除及人工晶体植入术。结果:经过1～12个月的随访,术后裸眼视力≥0.6者45眼,占70%;≥0.3者56眼,占88%;≥0.05者63眼,占98%。术后角膜水肿发生率较低。结论:超声乳化技术对高龄老人白内障摘除安全有效,手术复明效果满意。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.