改良式口炎涂剂在小儿白血病化疗后口腔黏膜炎中的应用

目的探讨改良式口炎涂剂应用于小儿自血病大剂量化疗后所致口腔黏膜炎的效果。方法将大剂量化疗后合并口腔黏膜炎的76例急性白血病患儿,随机分为对照组和实验组,对照组采用碳酸氢钠＋制霉菌素涂抹口腔黏膜炎局部;实验组采用改良式口炎涂剂涂抹口腔黏膜炎局部,观察并比较两组的疗效及不同级别口腔黏膜炎用药的效果。结果实验组应用改良式口炎涂剂涂抹口腔黏膜炎局部疗效明显优于对照组（P〈0．05）,对于Ⅱ级以上的口腔黏膜炎治疗效果更好（P〈0．01）。结论改良式口炎涂剂可广泛应用于小儿化疗后口腔黏膜炎的治疗,特别对于Ⅱ级以上的口腔黏膜炎疗效更好。     

思密达对小儿溃疡性口腔炎护理效果研究

目的:比较冰硼散与思密达治疗小儿口腔炎的效果,为临床选择小儿口腔炎的最佳护理方案提供依据.方法:将2008年6月～2010年12月就诊的76例小儿口腔炎患儿随机分成试验组40例(局部涂思密达)和对照组36例(局部涂冰硼散),观察比较2种药物护理效果.结果:两组在年龄、黏膜的损害程度、全身状态无显著差异.具有可比性.试验组疗效优于对照组(P＜0.05),溃疡愈合时间亦优于对照组(P＜0.05).结论:思密达效果优于冰硼散,值得临床推广应用.     

局部用药治疗小儿疱疹性口炎62例分析

目的探讨病毒唑针、思密达、维生素B2、鱼肝油混悬溶液局部涂口腔,治疗疱疹性口炎的临床效果。方法选择2007-01-2007-12来承德县妇幼保健院就诊的6月龄~5岁的患儿62例作为研究对象。结果通过药物治疗总有效率达97.8%。结论利用病毒唑针、思密达、维生素B2、鱼肝油混悬溶液局部涂口腔,治疗疱疹性口炎临床效果显著,值得推广。     

含冰块涂思密达粉防治化疗性口腔炎的护理观察

目的 探讨干预化疗性口腔炎的有效方法.方法 将80例恶性肿瘤化疗的患者随机分为2组各40例.观察组在化疗开始前给予冰块含服,出现Ⅰ度口腔溃疡加用思密达粉局部黏膜喷撒,用至溃疡愈合.对照组化疗开始前给予口泰漱口,出现Ⅰ度口腔溃疡即加用锡类散局部涂抹,嘱患者不可将药物吞下,用至溃疡愈合.比较两组干预后口腔炎的发生率和口腔溃疡程度和愈合时间.结果 口腔炎发生率:观察组5%(2/40),对照组45%(18/40),差异有统计学意义(P<0.01).口腔溃疡严重程度:观察组Ⅰ度2例,对照组Ⅰ、Ⅱ度14例,Ⅲ度4例,差异有统计学意义(P<0.001).口腔炎愈合时间:观察组2例Ⅰ度溃疡患者愈合时间平均3.5 d,对照组2例Ⅰ度溃疡患者愈合时间平均5.5 d,因样本量小,未做统计学分析.结论 化疗期间口腔含服冰块加思密达粉局部外涂,能更好地预防化疗性口腔炎,并促进其愈合.对口腔溃疡的治疗效果因样本量不够,有待进一步深入研究.     

思密达与碘甘油混合液治疗化疗性口腔黏膜炎的效果观察

目的探讨思密达与碘甘油混合液局部涂抹治疗化疗性口腔黏膜炎的效果。方法将肿瘤化疗后发生口腔黏膜炎的患者130例,按照随机数字表分为两组,观察组63例,对照组67例。对照组采用生理盐水400ml＋庆大霉素64万u＋维生素B12 500mg复合液漱口,每天4次,每次含漱1min;观察组在对照组的基础上,采用思密达3g粉剂倒入碘甘油瓶内（10m1）混合后搅拌均匀,涂抹于患处,每天4次。两组患者连续干预5d后比较其疗效。结果两组患者口腔黏膜炎治疗效果比较,差异有统计学意义,观察组治疗效果明显优于对照组（P〈0．001）。结论思密达与碘甘油混合液治疗化疗性口腔黏膜炎效果显著,建议其将作为治疗成年肿瘤患者化疗性口腔黏膜炎的一线治疗手段。     

思密达联合阿昔洛韦治疗小儿疱疹性口腔炎疗效观察

目的了解思密达联合阿昔洛韦治疗小儿疱疹性口腔炎的临床疗效。方法将我科2006年3月至2007年3月诊断为疱疹性口腔炎的115例患儿随机分为治疗组58例和对照组57例,两组均同时给予阿昔洛韦静脉滴注,治疗组另外给予思密达局部涂抹,并对其临床疗效进行统计学分析。结果治疗组的总有效率为96.6%,而对照组为78.9%,两者相比,差异有统计学意义（P〈0.01）。结论思密达联用阿昔洛韦治疗小儿疹性口腔炎有较好的疗效。     

传统护理方法与三步法功能锻炼对全膝关节置换术后患者关节功能恢复的比较

目的：比较传统的临床护理方法与三步法功能锻炼对人工全膝关节置换（TKA）术后患关节功能恢复的效果。方法：将108例TKA患随机分为对照组（A组）及试验组（B组）。A组实施传统的临床护理方法，即功能制护理，B组实施三步法功能锻炼。结果：B组较A组术后膝关节活动度改善显。B组较A组缩短住院日7．54d。结论：三步法功能锻炼传统的临床护理方法改善患膝功能状态，恢复患膝关节活动度效果显，缩短了患的住院天数。     

浅析白血病患者化疗后口腔炎的个性化护理效果

目的：探讨白血病患者化疗后口腔炎的个性护理化效果。方法：抽取我院2015年3月—2016年3月收治的64例白血病化疗患者,作为此次的研究对象,随机分为护理组和常规组,各32例。对护理组的32例患者采取个性化护理,对常规组采用化疗后的常规化护理。比较两组患者口腔炎的发生情况以及护理后患者对护理过程的满意度。结果：采用个性化护理的护理组口腔炎发生率12.5%,明显低于采用常规护理的常规组患者口腔炎发生率34.3%;两组患者的满意度对比,护理组的护理满意度达到81.5%,明显高于常规组28.1%,两组比较具有统计学意义（P＜0.05）。讨论：采用个性化护理可以有效预防白血病患者化疗后发生口腔炎,明显降低患者发生口腔炎的发生率,提高患者对临床护理的满意度,具有临床应用和推广价值。     

高氧口含雾化结合药液含漱对提高化疗性口腔炎疗效的观察

目的探讨高氧口含雾化结合药液含漱对化疗性口腔炎的临床治疗价值。方法将73例化疗性口腔炎患者随机分为A组（36例）和B组（37例）。A组采用单纯药液含漱；B组采用药液含漱＋高流量氧口含雾化。观察记录2组患者恢复普通进食时间、体温恢复时间、口腔溃疡痊愈的时间。结果恢复普通进食时间、体温恢复正常时间、口腔溃疡痊愈的时间B组均较A组显著提前（P〈0．05）。结论药液高氧口含雾化能提高化疗性口腔炎的疗效，减少患者的痛苦。     

热疗联合胸腔内注射药物治疗肺癌胸水的观察与护理

目的 观察热疗联合胸腔内注射药物治疗恶性胸水的疗效、生存质量和不良反应，解决恶性胸水疗效不稳定的问题。方法 确诊为肺腺癌或鳞癌所致的恶性胸水初治患者50例，随机分为2组，A组局部热化疗，B组单纯局部化疗。2组患者均胸腔穿刺抽液或胸腔闭式引流排尽胸水；A组胸腔内注入顺铂50mg、白介素-2400万U，然后进行患侧胸腔的深部热疗；B组仅胸腔内注入顺铂50mg、白介素-2400万U。护理要点为重视热疗前护理，加强热疗中观察及热疗反应的护理。结果 A组总有效率88％，B组为60％，2组比较有显著性差异（P〈0．05）；生活质量改善率，A组72％，B组40％，2组比较有显著性差异（P〈0．05）。结论 热疗联合胸腔内注射药物治疗恶性胸水疗效确切。不良反应小，安全性高。     

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.     

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.