复方中和剂对隐形眼镜护理液中和效果观察

目的观察复方中和剂对隐形眼镜护理液中和效果。方法采用悬液定量杀菌试验程序,对由硫代硫酸钠、卵磷脂、吐温组成的复方中和剂中和含有双胍类杀菌成分的隐形眼镜护理液的效果进行了检测。结果用含5g/L硫代硫酸钠、5 g/L卵磷脂、10 g/L吐温80组成的复方中和剂可有效中和含双胍类和表面活性剂的隐形眼镜护理液的残留作用,中和剂鉴定试验结果符合规范规定的技术指标。结论鉴定试验证明,该复方中和剂可用于含双胍类杀菌成分的隐形眼镜护理液杀菌试验。     

隐形眼镜护理液杀灭微生物效果及防腐性能的试验观察

目的了解隐形眼镜护理液的杀菌效果及防腐性能。方法采用悬液定量杀菌试验方法观察护理液对各种微生物杀灭效果及防腐作用。结果用含聚六亚甲基双胍1.8μg/ml护理液原液作用1.5 h,对大肠杆菌、金黄色葡萄球菌、铜绿假单胞菌、白色念珠菌的杀灭率均为100%,对茄科镰刀霉菌的杀灭率为99.95%。在护理液内分别加入含菌量为1.0×105~1.0×106cfu/ml的大肠杆菌、金黄色葡萄球菌、铜绿假单胞菌、白色念珠菌,保持14 d时细菌减少率>99.9%;于14 d后再加入终浓度为1.0×104~1.0×1065cfu/ml试验菌保持到第28 d减少率>99.9%。结论该隐形眼镜护理液具有良好的杀菌性能和防腐作用。     

31种消毒剂中和剂鉴定试验分析

目的研究消毒剂中和剂鉴定试验方法及其结果评价。方法采用悬液定量和载体定量试验程序对不同类型消毒剂的中和剂进行鉴定并对结果作出评价。结果共进行4类消毒剂31份试验,其中悬液定量试验法鉴定中和剂有8份各组完全符合判定要求,另15份均出现第1、2组无菌生长现象,第3、4、5组菌数符合结果判定要求。载体定量法鉴定中和剂试验每次都出现第1、2组无菌生长,第3、4、5组均符合判定要求。将消毒剂浓度降低后重复试验,结果第1、2组多数有菌生长。结论在消毒剂杀菌效果试验中,按照企业申报的消毒剂浓度进行中和剂鉴定试验时,因第1、2组无菌生长而无法判定结果时,适当降低浓度后进行重复试验,可获得判定该中和剂有效的试验结果。     

双胍类隐形眼镜护理液对白色念珠菌的杀灭效果影响因素研究

目的研究双胍类隐形眼镜护理液对白色念珠菌的杀灭效果及其影响因素。方法采用悬液定量试验进行了实验室观察。结果含聚六亚甲基胍1.0mg/L的该护理液原液于常温下作用6h,对白色念珠菌国内株和美国株的杀灭率分别为78.21%和95.27%。将护理液分别置于玻璃管、聚丙烯塑料管、聚苯乙烯塑料管内浸泡作用均为6h,对白色念珠菌平均杀灭率分别为64.55%、76.41%、95.73%。将护理液分别置于不同形状容器即尖底聚丙烯塑料管、圆底聚丙烯塑料管内浸泡作用6h,对白色念珠菌平均杀灭率分别为77.41%和78.89%。混合菌悬液用或不用玻璃珠进行振荡混合,用于杀菌试验,计算出平均杀灭率分别为78.21%和78.94%;菌悬液振荡混合90s和20s,用于杀菌试验,计算出平均杀灭率分别为80.18%和79.27%。结论该护理液对相同菌株不同来源的白色念珠菌杀灭效果存在差异,不同材质的盛放容器对该护理液杀菌效果有显著影响。     

消毒剂杀菌效果试验中中和剂同步稀释效果鉴定方法

目的研究高浓度消毒剂杀菌效果评价中和剂中和效果鉴定难题。方法通过同时降低中和剂和消毒剂试验浓度,按悬液定量方法进行鉴定试验。结果鉴定试验结果表明,含氯消毒剂、含碘消毒剂和过氧乙酸等3类9种消毒剂在有效成分含量为500mg/L且中和剂为原液条件下进行试验,第1、2组均无菌生长,但其他组生长菌数正常。将各消毒剂与中和剂均降低10倍浓度进行中和剂鉴定试验,结果第1、2组生长菌数符合《消毒技术规范》的要求,第3、4、5组菌落误差在允许范围内,可判定中和剂鉴定试验结果符合要求。结论对有效杀菌浓度标示过高的消毒剂,在进行中和剂鉴定试验中,可采用同时降低消毒剂和中和剂浓度的方法进行试验,只要中和剂本身有效,可以避免第1、2组无菌生长的问题。     

高浓度氯已定类消毒剂的中和剂筛选研究

目的观察三种中和剂对高浓度氯已定类消毒剂的中和作用,以筛选出可有效中和高浓度氯已定类消毒剂的中和剂配方。方法分别采用载体定量与悬液定量鉴定试验,对三种不同配方的中和剂中和高浓度氯已定类消毒剂效果进行评价。结果在载体定量鉴定试验中,使用中和剂A不能有效中和10 g/L葡萄糖氯已定醇对金黄色葡萄球菌与白色念珠菌的残留作用。在相同条件下,使用中和剂B和中和剂C均可以有效中和该葡萄糖氯已定醇溶液对试验菌的残留作用。在悬液定量鉴定试验中,使用中和剂A亦不能中和含量10g/L葡萄糖酸氯己定醇对金黄色葡萄球菌与白色念珠菌的残留作用。使用中和剂B只能中和该葡萄糖酸氯己定醇对白色念珠菌的残留作用,使用中和剂C均可中和10 g/L葡萄糖氯已定醇溶液对两种试验菌的残留作用。结论中和剂A和B作为常规氯己定中和剂不能有效中和葡萄糖酸氯己定醇,而中和剂C则可用于高浓度葡萄糖氯已定醇溶液杀菌试验。     

一种隐形眼镜护理液杀灭微生物效果的试验观察

一种隐形眼镜护理液主要杀菌成分为聚六亚甲基胍。采用悬液定量杀菌试验对该护理液杀灭细菌繁殖体和酵母菌的效果进行了实验室观察,以便了解其消毒效果。结果,以该护理液原液对大肠杆菌、金黄色葡萄球菌和绿脓杆菌作用3 h,杀灭率均达到100%;对白色念珠菌作用6 h,杀灭率为97.60%。体积分数10%小牛血清对其杀菌效果无明显影响。用该护理液原液浸泡隐形眼镜新镜片6 h,对镜片上金黄色葡萄球菌平均消除率为99.92%,对白色念珠菌平均消除率为99.45%。结论,该护理液原液对细菌繁殖体和酵母菌具有很好的杀灭效果,性能稳定。     

隐形眼镜护理液杀菌效果影响因素研究

目的研究不同因素对隐形眼镜护理液杀菌效果的影响,提高隐形眼镜护理液使用的科学性。方法采用悬液定量杀菌试验方法,在实验室进行了影响因素观察。结果作用温度在22℃条件下,含聚胺丙基双胍的隐形眼镜护理液杀菌效果明显高于20℃条件下的杀菌效果。随作用时间延长,该护理液杀菌效果增加。试验在塑料试管内作用,护理液杀菌效果比在玻璃试管内作用好。结论隐形眼镜护理液的杀菌效果受作用温度和时间影响明显,还会受到试验材料的影响。     

改进中和剂鉴定试验方法的研究

目的改进中和剂鉴定试验方法,以解决消毒剂标示使用浓度过高而造成判定困难的问题。方法采用悬液定量杀菌试验程序鉴定中和剂效果的方法,对改进后中和剂鉴定试验方法的效果进行了观察。结果按照产品标示浓度进行中和剂鉴定试验,第1、2组无菌生长,按照2002年版《消毒技术规范》规定,判定设计的中和剂对二氧化氯和碘伏消毒剂中和效果不合格。通过降低产品标示浓度和调整作用时间,按原程序进行中和剂鉴定试验,结果所有实验组生长菌数全部符合设计要求,判定中和剂有效。结论消毒产品标示浓度过高,需要对其试验浓度进行适当降低,以最低有效杀菌浓度进行中和剂鉴定试验,应更符合试验实际要求。     

降低消毒剂作用浓度后中和剂鉴定试验效果观察

目的研究降低消毒剂浓度后中和剂鉴定试验结果能否证明中和剂有效。方法采用悬液定量试验程序鉴定中和剂效果的方法,对降低消毒剂浓度进行中和剂鉴定试验评价其中和效果。结果按照2002年版《消毒技术规范》规定的6组设计试验,对第3、4、5组菌数符合要求而第1、2组无菌生长的高浓度消毒剂,降低浓度后进行重复试验,第1、2组有菌生长,且符合菌数规定要求。结论依据企业申报的消毒剂浓度进行中和剂试验时第1、2组无菌生长,通过降低浓度进行试验可获得判定该中和剂有效的理想试验结果。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.