正常成人胰腺超声背向散射积分的测定

目的 测定正常成人胰腺背向散射积分（IBS）值，为进一步研究胰腺不同病变的IBS变化提供正常参考值。 方法 对120例正常成人胰腺进行IBS联机分析测定，将受试者分为2个年龄组：Ⅰ组〈50岁；Ⅱ组≥50岁，分别检测每位受检者胰头、胰体、胰尾的IBS值，以其所在深度时间增益补偿（TGC）均值对实测IBS值进行标化。 结果 正常成人胰腺头、体、尾的标化IBS值比较差异无显著性意义（P〉0．05）；不同性别组胰腺标化1BS值比较差异无显著性意义（p〉0．05）；不同年龄组胰腺的标化IBS值比较差异有显著性意义（p〈0．05）。 结论 正常成人胰腺的的标化IBS值稳定，可重复性好，超声背向散射积分为无创判定胰腺组织的微细变化提供了新的技术手段。     

糖尿病患者胰腺的超声组织定征研究

目的探讨超声组织定征背向散射积分(IBS)技术在糖尿病患者胰腺检测中的临床应用价值。方法对90例2型糖尿病患者及95例正常成人胰腺进行IBS联机分析测定。结果糖尿病组胰腺的IBS值明显高于正常对照组(P<0.05);糖尿病不同病程组胰腺IBS值比较差异有显著性意义(P<0.05)。结论IBS值能客观、准确地反映出2型糖尿病患者胰腺组织的病理改变情况,为临床检测糖尿病胰腺提供了一项数字定量化、标准化的新指标。     

正常成人乳腺超声背向散射积分的测定

目的测定正常成人乳腺超声背向散射积分（IBS）,为进一步研究乳腺不同病变的IBS变化提供正常参考值。方法对105例正常成人分为2组：绝经前组（〈50岁）79例,绝经后组（〉50岁）26例,选取19例乳腺腺瘤患者为对照。检测受检者乳腺的IBS：峰谷值、平均强度和离散度,以其所在深度时间增益补偿均值对实测IBS值进行标化。结果正常成人绝经前后乳腺的标化IBS无统计学差异（P〉0．05）;正常乳腺平均强度大于乳腺腺瘤（P〈0．05）,而峰谷值、离散度值无统计学差异（P〉0.05）。结论正常成人乳腺的标化IBS值稳定,可重复性好,IBS为无创性判定乳腺组织的疾病提供了新方法。     

背向散射积分技术在正常视网膜及视网膜疾病诊断中的应用

目的 利用背向散射积分（IBS）技术检测健康成人、高血压及糖尿病患者的视网膜IBS值，以期为临床诊断与鉴别诊断各类眼底病变提供参考依据。方法应用HP Sonos 5500型超声仪，对120例健康成年人、40例高血压患者及40例糖尿病患者的视网膜IBS值进行检测。结果校正IBS值（IBS％）随着年龄的增长而增大，IBS％与年龄呈正相关（r=0．82）；高血压组视网膜的IBS％高于健康成人组，两组间差异有统计学意义（P〈0．01）；糖尿病组视网膜的IBS％高于健康成人组，两组间差异有统计学意义（P〈0．01）；高血压及糖尿病两组间差异无统计学意义（P〉0．05）。结论健康成人视网膜的IBS％随着年龄的增长而增大；高血压和糖尿病患者视网膜的IBS％高于相应年龄的健康成人。     

超声背向散射积分对2型糖尿病早期肾病的定量评价

目的应用超声背向散射积分（IBS）技术定量评价2型糖尿病肾病（DN）早期肾脏微观组织结构的变化。方法2型糖尿病（DM）患者按照尿微量白蛋白分为两组，正常蛋白尿阶段Ⅰ组、微量蛋白尿阶段Ⅱ组及正常对照组，各30例，对肾皮质、肾髓质、肾窦IBS3项参数[峰值（PPI）、平均值（AII）、离散度（SDI）]进行测定及对比分析。采用肾窦AII对肾皮质和肾髓质的AII进行标准化。结果（1）肾皮质及肾髓质标化AII，对照组〈Ⅰ组〈Ⅱ组，三组差异显著（P〈0．05）；（2）DM组及对照组AII均为肾窦〉肾皮质〉肾髓质，三者差异显著（P〈0．05）；（3）肾皮质、肾髓质、肾窦PPI、SDI，三组间无统计学差异（P〈0．05）。结论2型糖尿病早期肾病患者的肾皮质与肾髓质声学密度随着病情的进展有逐渐增高的趋势，IBS技术有助于DN的早期发现和定量分析。     

超声组织定征技术在糖尿病视网膜病变中的应用

目的 探讨利用背向散射积分技术检查糖尿病患者的视网膜背向散射积分值（IBS），以期为临床诊断糖尿病视网膜病变提供有效的方法。 方法 糖尿病患者78例（150只眼），正常对照组90例（180只眼），分别测量每位受检者的鼻侧、中部及颞侧的视网膜IBS值。 结果 视网膜鼻侧、中部及颞侧的IBS校正值（IBSG）间无统计学差异；糖尿病组视网膜的IBS值高于对照组，两组间有显著的统计学差异（P〈0．01）；糖尿病组视网膜的校正IBS值（IBS％）高于对照组，两组间有非常显著的统计学差异（P〈0.01）。 结论 糖尿病患者视网膜的IBSG明显高于对照组；背向散射积分技术是评价糖尿病视网膜病变的有效手段。     

超声心动图评价2型糖尿病患者左心室功能的临床研究

目的应用应变率成像（SRI）技术和背向散射积分（IBS）技术评价2型糖尿病对患者左室功能的影响,探讨SRI和IBS评价2型糖尿病患者左室功能的临床价值。 方法2型糖尿病患者55例,根据临床糖尿病微血管病变出现与否分为：无微血管病变组（Ⅰ组）（30例）和有微血管病变组（Ⅱ组）（25例）;正常对照组30例。获取心尖两腔观、三腔观和四腔观的组织速度成像（TVI）图像,应用SRI技术分析左室各节段心肌的应变率曲线,并计算左室平均峰值应变率（SR）;获取胸骨旁长轴切面最佳的左室心肌背向散射积分图像,应用IBS技术测定室间隔及左室后壁心肌的心动周期时间平均背向散射积分（IBS）、校正IBS（IBS%）、IBS周期变化幅度（CVIB）以及室间隔与后壁IBS跨壁梯度（TGIB）。 结果与正常对照组相比,（1）收缩功能指标中仅糖尿病2组的SSR有明显降低（P〈0.01）;（2）两组糖尿病的舒张功能指标SRE、SRE/SRA均有显著降低（P〈0.01）,同时糖尿病Ⅱ组的A和SRA亦有明显升高（P〈0.05）;（3）两组糖尿病的室间隔及左室后壁的心肌IBS%,TGIB均有显著性增高;CVIB显著性降低,其中以糖尿病Ⅱ组的改变更明显。 结论SRI技术和IBS技术能早期检测到糖尿病患者的左室功能异常和心肌病变。     

糖尿病合并胃溃疡临床分析

目的分析比较糖尿病合并胃溃疡的临床特点。方法对2006年11月2009年11月收治的228例糖尿病合并胃溃疡患者74例,以同期非糖尿病228例中检出胃溃疡53例为对照组,进行比较。结果糖尿病组胃溃疡患病率高于对照组,有显著性差异（P〈0.05）;糖尿病组餐后腹胀发生率高于对照组,差异有显著性差异（P〈0.05）;而上腹痛、恶心呕吐和返酸暖气等症状明显低于对照组（P〈0.05）。糖尿病组Hp阳性率与对照组比较差异无显著差异（P〉0.05）。经治疗后,糖尿病组胃溃疡愈合率明显低于对照组,具有统计学意义（P〈0.05）。结论重视2型糖尿病合并胃溃疡的特点,对糖尿病胃溃疡病变的防治有重要的指导意义。     

背向散射积分技术在检测移植肾慢性排异反应中的应用价值

目的应用背向散射积分技术检测移植肾脏疾病,并初步探讨背向散射积分技术在检测移植肾慢性排斥反应中的应用价值。方法将全部研究对象分为病例组和正常对照组,应用HP5500型超声诊断仪分别检测其肾脏的图像平均强度（AII）、图像峰-峰强度（PPI）,并计算标化的背向散射积分（IBS％）、标化的图像峰-峰强度（PPI％）,分别对各值进行分析比较。结果（1）病例组肾皮质IBS％值较正常对照组增高（P〈0．05）,PPI值、PPI％值较正常对照组增高,但无统计学意义。（2）病例组（②、③、④）随肾功能损害程度的加重,[肾皮质-肾髓质IBS％]值逐渐下降,与正常对照（①）组均存在差别,但均无统计学意义。结论（1）应用IBS技术可以实现超声对肾脏病变的定性、定量诊断。（2）IBS值可以反映移植肾脏慢性排异反应的声学改变。     

声触诊组织定量技术检测胰腺弹性评估2型糖尿病微血管并发症的价值

目的 探讨应用声触诊组织定量技术测量胰腺组织剪切波速度（SWV）评估2型糖尿病微血管并发症的可行性。方法 应用声触诊组织定量技术分别检测2型糖尿病患者有微血管并发症组（47例）、无微血管并发症组（68例）及正常对照组（115例）患者的胰腺头、体及尾部SWV值,比较三组间各部位胰腺SWV值的差异。探讨影响2型糖尿病胰体SWV值的相关因素。结果 有微血管并发症组和无微血管并发症组胰腺头、体及尾部SWV值均明显高于正常对照组,差异均有统计学意义（均P＜0.01）;有微血管并发症组胰体SWV值明显高于无微血管并发症组,差异有统计学意义（P＜0.01）。2型糖尿病患者的胰体SWV值与微血管并发症（标准化系数Beta=0.208,P=0.022）、年龄（标准化系数Beta=0.265,P=0.004）及总胆固醇（标准化系数Beta=0.223,P=0.011）呈正相关。结论 2型糖尿病患者胰体SWV值的增加与微血管并发症显著相关,胰体SWV值在评估糖尿病微血管并发症中有一定的价值。 关键词 2型糖尿病;微血管并发症;声触诊组织定量技术;剪切波速度     

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.     

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.     

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.     

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.     

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.