原发性闭角型青光眼急性发作时超声生物显微镜特征分析

目的 探讨原发性闭角型青光眼急性发作时的超声生物显微镜特征.方法 选取原发性闭角型青光眼急性发作的患者30 例(30 眼)作为急性发作组,选取眼内压经药物控制良好的原发性慢性闭角型青光眼患者30 例(30 眼)作为对照组.所有患者均于就诊当日行超声生物显微镜检查,测量两组的前房深度及颞侧、鼻侧、上方及下方4 个象限的距离巩膜突500 μm 处房角开放距离、小梁网睫状突距离及虹膜睫状突距离,两组之间各项均值分别进行比较和分析.结果 急性发作组前房深度为(1.55 ±0.27 )mm,对照组为(1.78 ±0.26 )mm,两组之间比较差异具有统计学意义(t ＝-3.40,P ＝0.001 ).急性发作组颞侧、鼻侧、上方及下方四个象限的房角开放距离分别为(0.051 ±0.082 )mm 、(0.010 ±0.033 )mm 、(0.012 ±0.041 ) mm 、(0.039 ±0.086 )mm;对照组分别为(0.136 ±0.064 )mm 、(0.130 ±0.102 )mm 、(0.115 ±0.093 )mm 、(0.097 ±0.071 )mm,两组比较均差异具有统计学意义.急性发作组4 个象限小梁网睫状突距离分别为(0.606 ±0.122 )mm 、(0.656 ±0.091 )mm 、(0.624 ±0.124 )mm 、(0.579 ±0.142 )mm;对照组分别为(0.815 ±0.155 )mm 、(0.775 ±0.164 )mm 、(0.721 ±0.117 )mm 、(0.810 ±0.162 )mm,两组比较均具有统计学意义.急性发作组4 个象限虹膜睫状突距离分别为(0.125 ±0.086 )mm 、(0.153 ±0.138 )mm 、(0.150 ±0.127 )mm 、(0.114 ±0.081 )mm;对照组分别为(0.372 ±0.130 )mm 、(0.383 ±0.122 )mm 、(0.357 ±0.098 )mm 、(0.395 ±0.157 )mm,两组比较均具有统计学意义.结论 原发性闭角型青光眼急性发作时前房更浅,房角更窄,睫状体的位置更加贴附于小梁网和虹膜,采用超声生物显微镜检查能从解剖学上进一步认识原发性闭角型青光眼急性发作的发病机制.     

原发性闭角型青光眼生物结构的超声测量

目的：探讨原发性闭角型青光眼的生物结构特点。方法：应用Alcon公司眼科专用A／B型超声诊断系统对32例60只各型原发性闭角型青光眼进行A超测量（包括眼轴长度，前房深度，晶体厚度）和角膜直径测量，以30例60只正常眼对照，并进行相关比较及统计学分析。结果：两组中各项均值均有显差异。结论：原发性闭角型青光眼在解剖上存在晶体较厚，相对晶体位置较前，视轴较短，晶体厚度／眼轴长度系数较大，前房较浅和角膜横径较小等特点。     

超声乳化摘除晶状体治疗闭角型青光眼的探讨

目的：观察超声乳化摘除晶状体联合后房型人工晶体植入术治疗闭角型青光眼的疗效。方法：回顾分析我科自2002年3月-2006年12月收治的27例33眼闭角型青光眼患者；采用常规白内障超声乳化术联合后房型人工晶体植入术。观察手术前后眼压、视力变化。随访5个月-2年，平均13个月。结果：术后随访所有病例眼压均正常（8．1～18．7mmHg），平均（13．4±3．2）mmHg，术后视力全部提高，26眼（78．8％）提高视力在3行以上，有2例发生虹膜后粘连。结论：超声乳化摘除晶状体联合后房型人工晶体植入治疗闭角型青光眼是一种较好的手术方式。     

慢性闭角型青光眼一眼急闭急性发作1例分析

对慢性闭角型青光眼一眼急闭急性发作1例分析如下。1病历摘要女,77岁。2009-09-09因双眼眼前朦胧半个月来诊。检查:视力:右眼0.5,矫正0.8,左眼0.8,矫正1.0。眼压:右眼25.7mm Hg,左眼16.3mm Hg,右眼球结膜无充血,角膜清,前房浅,瞳孔大,直径约5mm,虹膜膨隆,眼底:视盘界清色淡,血管向鼻侧移位,C/D约0.8。左眼瞳孔不大,前节大致同右     

急性闭角型青光眼的护理

我科2002—10-2006—11对急性闭角型青光眼进行急救治疗与护理，收到良好效果，总结如下。 1临床资料 本组31例38只眼，男7例，女24例，年龄30-40岁4例，40-75岁27例，治愈28例，好转3例，住院时间3～20d，平均9d。     

急性闭角型青光眼误诊23例分析

目的 分析23例急性闭角型青光眼首诊于非眼科专业科室误诊的原因及如何降低其误诊率.方法 对误诊的23例病例进行分析.结果 误诊为脑血管疾病17例,胃肠道疾病4例,高血压病2例,确诊后22例24眼行抗青光眼手术,1例1眼行球后注射氯丙嗪治疗,视力＞0.3者12例14眼,0.02～0.3者5例5眼,手动2例2眼,光感3例3眼,无光感1例1眼.结论 非眼科专业医师要提高对急性闭角型青光眼的诊断意识,重视眼部检查是避免误诊的关键.     

急性闭角型青光眼误诊10例分析

目的：分析急性闭角型青光眼误诊的原因及预防。方法：对我院10例误诊的急性闭角型青光眼病例进行分析。结果：10例中误诊为高血压3例,偏头痛2例,脑梗死1例,重感冒2例,胃肠炎2例。确诊后行抗青光眼手术,好转率100%。结论：内科医生对本病认识水平不足是本组病例误诊的主要原因,提高疾病认识,详细询问病史和重视眼部检查是避免误诊的关键。     

急性闭角型青光眼误诊1例分析

急性闭角型青光眼是最常见的致盲眼病，发作期常表现为头痛，眼胀痛、视物模糊伴有恶心、呕吐、血压升高等全身症状，常首诊于神经内科。临床常因经验不足而极易被误诊。现将误诊为脑血管病的1例分析如下。     

原发性闭角型青光眼晶状体形态变化的超声诊断价值

目的 评价超声检查晶状体形态在原发性闭角型青光眼(PACG)诊断中的价值.方法 超声检测20例PACG患者和22例正常人为对照组的晶状体中央部和周边部厚度,分析晶状体前表面曲率,研究晶状体在PAOG发生和发展中的病理机制.结果 与对照组比较,PACG组晶状体增厚,前表面曲率增大且相对位置偏前.结论 超声诊断晶状体增厚、前表面曲率变大及相对位置前移为临床诊断提供更为直观的形态学依据.     

晶体因素在原发性闭角型青光眼发病机制中的影响

目的:研究原发性闭角型青光眼(primary angle-closure glaucoma,PACG)发病机制中晶体因素的影响.方法:采用B超、超声生物显微镜及计算机软件对PACG患者(85眼,PACG组)及正常对照者(52眼,正常组)的晶体等参数进行测量和计算.其中急性闭角型青光眼(急闭组)45只眼,慢性闭角型青光眼(慢闭组)40只眼,比较组间晶体参数的差异.结果:PACG组晶体厚度(包括中央部和周边部厚度)、眼轴长度、晶体前表面曲率半径、晶体后表面曲率半径、相对晶体位置、前房深度和虹膜晶体接触距离与正常组比较,差异有显著性(P<0.01):PACG组的晶体直径、体积与正常组比较,差异无显著性(P>0.05).急闭组与慢闭组相比.前者前房更浅,相对晶体位置更偏前,差异有显著性(P<0.01).结论:PACG的发病与其自身晶状体解剖结构异常有关,晶体因素导致的瞳孔阻滞是PACG发病的主要诱因,包括晶状体增厚、前后表面曲率半径减小和相对位置偏前、虹膜晶体接触距离增大等.     

ULTRASOUND IMAGING MEASUREMENT OF THE TRANSVERSUS ABDOMINIS IN SUPINE,STANDING, AND UNDER LOADING: A RELIABILITY STUDY OF NOVICE EXAMINERS

Background

Military personnel and first responders (police and firefighters) often carry large amounts of gear. This increased load can negatively affect posture and lead to back pain. The ability to quantitatively measure muscle thickness under loading would be valuable to clinicians to assess the effectiveness of core stabilization treatment programs and could aid in return to work decisions. Ultrasound imaging (USI) has the potential to provide such a measure, but to be useful it must be reliable.

Purpose

To assess the intrarater and interrater reliability of measurements of transversus abdominis (TrA) and internal oblique (IO) muscle thickness conducted by novice examiners using USI in supine, standing, and with an axial load.

Study Design

Prospective, test‐retest study

Methods

Healthy, active duty military (N=33) personnel were examined by two physical therapy doctoral students (primary and secondary ultrasound technicians) without prior experience in USI. Thickness measurements of the TrA and IO muscles were performed at rest and during a contraction to preferentially activate the TrA in three positions (hook‐lying, standing, and standing with body armor). Percent thickness changes and intraclass correlation coefficients (ICC) were calculated.

Results

Using the mean of three measurements for each of the three positions in resting and contracted muscle states, the intrarater ICC (3,3) values ranged from 0.90 to 0.98. The interrater ICC (2,1) values ranged from 0.39 to 0.79. The ICC values of percent thickness changes were lower than the individual ICC values for all positions and muscle states.

Conclusion

There is excellent intrarater reliability of novice ultrasound technicians measuring abdominal muscle thickness using USI in three positions during the resting and contracted muscle states. However, interrater reliability of two novice technicians was poor to fair, so additional training and experience may be necessary to improve reliability.

Level of Evidence

2b     

前房内碎核白内障摘除并人工晶体植入的治疗效果

目的探讨小切口前房内碎核白内障摘除人工晶体植入术的疗效及并发症。方法白内障病人190例203眼,120眼采用小切口前房内碎核白内障摘除联合人工晶体植入术（简称小切口组）;同期83眼采用超声乳化白内障摘除联合人工晶体植入术（简称phaco组）。结果小切口组术后3 d视力≥0.5者74眼（61.7%）,phaco组54眼（65.1%）,两组比较差异无显著性（χ2=0.24,P〉0.05）;小切口组术后1月视力≥0.5者98眼（81.7%）,phaco组72眼（86.7%）,两组比较差异无显著性（χ2=1.48,P〉0.05）。两组术后散光均较小,小切口组主要并发症为可逆性角膜混浊、术中虹膜脱出、前房出血、前房炎症反应。结论小切口前房内碎核白内障摘除联合人工晶体植入术治疗白内障创伤小、术中术后并发症少、效果好、技术难度小,适合基层医院推广应用。     

THE RELIABILITY OF REHABILITATIVE ULTRASOUND IMAGING IN THE MEASUREMENT OF INFRASPINATUS MUSCLE FUNCTION IN THE SYMPTOMATIC AND ASYMPTOMATIC SHOULDERS OF PATIENTS WITH UNILATERAL SHOULDER IMPINGEMENT SYNDROME

Background:

Rehabilitative ultrasound Imaging (RUSI) is increasingly used in the management of musculoskeletal conditions as it provides an objective measure of muscle function while being less invasive than needle electromyography. While research has documented the ability to reliably measure trunk muscles in patients with back pain, no study to date has used RUSI to quantify infraspinatus muscle function in patients with shoulder impingement syndrome (SIS).

Hypothesis/Purpose:

The purpose of this study was to examine the intra‐rater and inter‐rater reliability of measuring infraspinatus muscle thickness with RUSI and to compare such measures during resting versus contracted muscle states and in the symptomatic versus asymptomatic shoulders in patients with SIS.

Study Design:

Cross‐sectional, measurement study

Methods:

Fifty‐two participants with unilateral SIS underwent a standard baseline examination to include RUSI of the infraspinatus muscle bilaterally. Images were acquired at rest and during a submaximal isometric contraction, by two novice examiners. The isometric contraction was elicited by having prone participants externally rotate their shoulder from a position of 90° abduction into a dynamometer and hold a static force of 20 mmHg (approximately 20‐30% maximal voluntary contraction). Images were captured using a standardized placement of the transducer placed just inferior to the spine of the scapula along the medial scapular border and measured off‐line using Image J software (V1.38t, National Institutes of Health, Bethesda, Maryland).

Results:

Estimates (ICCs) for thickness measurements ranged between 0.96 and 0.98 for intra‐rater reliability and between 0.87 and 0.92 for inter‐rater reliability. Reliability was substantially lower (ICC = 0.43 to 0.79) for calculations of percent thickness change. The infraspinatus muscle was significantly thicker when contracted (19.1mm) than during rest (16.2mm) in both shoulders (p < 0.001). There was also a statistically significant interaction between contraction state and shoulder (p = 0.026), indicating that the change in thickness that occurred during contraction was significantly smaller in the symptomatic shoulder than in the asymptomatic shoulder.

Conclusion:

RUSI measurements of infraspinatus muscle thickness appear to be highly reliable, both within the same examiner and between different examiners, in patients with SIS. Moreover, such measurements were different in rested and contracted states of the infraspinatus, as well as, between the symptomatic and asymptomatic shoulders of patients with unilateral SIS.

Level of evidence:

Level 2     

基于深度学习的超声图像左心室射血分数自动测量研究

为提高基于超声心动图Simpson法的左心室射血分数（LVEF）测量的效率,提出了一种深度学习自动测量LVEF的方法。首先,建立卷积神经网络（CNN）,利用收集的38153张标记的数据对网络进行训练测试和验证,将采集到的超声心动图数据自动分成五类,从而获取到心尖二腔切面（A2C）和心尖四腔切面（A4C);其次,建立全卷积网络,以VGG-19为主干架构,利用收集的3871张 A2C 和 4679张A4C数据进行训练验证,对自动获得的A2C和A4C的左心室进行自动分割,并计算得出LVEF。测试结果显示,该方法在得到A2C和A4C的准确率达96.8%,而分割真阳性率达到88.8%,所得LVEF误差率为0.038947。由于所提出的方法是完全利用机器去完成,较传统的方法精度和效率更高。     

应用国产ELISA试剂盒对乙肝标志物检测中HBeAb影响因素的分析

乙型病毒性肝炎是一个全球性的问题，严重地威胁着人类的健康。我国地处高发区，乙肝的诊断主要依靠血清学指标的检测，特别是酶联免疫吸附试验（ELISA）。乙肝标志物中HBeAg转阴，并产生HBeAb是判断病情趋向和药物疗效的一个重要指标。因此，正确地检出HBeAb对临床医生判断病情起着重要的作用。     

氯沙坦对高血压并阵发性心房颤动病人左心房功能影响

目的通过超声心动图观察氯沙坦对高血压并阵发性心房颤动（房颤）病人左心房功能的影响,探讨房颤预防及治疗的方法。方法将76例高血压并阵发性房颤病人随机分为氯沙坦组（n=38）和非洛地平组（n=38）,选择20例健康成年人做对照组,分别在用药前和用药后4、12、24周行超声心动图检查。结果12周后氯沙坦组与治疗前比较及与非洛地平组同期治疗后比较,左心房前后径、左心房上下径、左心房最大容积均减小,心房充盈速度、左心房射血力均明显增加（F=23．83～35．84,q=3.036～18．528,P〈0．05、0．01）。氯沙坦组的窦性心律维持率高于非洛地平组（x^2=4．338、4．828,P〈0．05）。结论氯沙坦在改善高血压并阵发性房颤病人的左心房功能的同时,能有效维持窦性心律。     

B型超声测量眼轴长度的价值

目的 探讨B型超声测量眼轴长度的价值。方法 选择白内障或并发视网膜病变病人70例140只眼。分别用A型及B型超声进行眼轴长度测量,按照眼轴的长度分为3组：A组〈24 mm,B组24～26 mm;C组〉26 mm。应用t检验比较两种仪器测量各组眼轴长度的均值。结果 A、B两组共100只眼,A、B型超声测量眼轴长度的差别无统计学意义（P〉0.05）。C组40只眼,A、B型超声测量眼轴长度的差别有统计学意义（t=2.11,P〈0.05）,与常规A型超声测量法相比,B型超声术后残余屈光在1 D以上的比例减少30%。结论 B型超声测量眼轴长度简便、准确,尤其是测量高度近视眼或玻璃体视网膜病变眼优于A型超声。     

RELIABILITY AND ACCURACY OF A GONIOMETER MOBILE DEVICE APPLICATION FOR VIDEO MEASUREMENT OF THE FUNCTIONAL MOVEMENT SCREEN DEEP SQUAT TEST

Background/Purpose

The squat is a fundamental movement of many athletic and daily activities. Methods to clinically assess the squat maneuver range from simple observation to the use of sophisticated equipment. The purpose of this study was to examine the reliability of Coach''s Eye (TechSmith Corp), a 2‐dimensional (2D) motion analysis mobile device application (app), for assessing maximal sagittal plane hip, knee, and ankle motion during a functional movement screen deep squat, and to compare range of motion values generated by it to those from a Vicon (Vicon Motion Systems Ltd) 3‐dimensional (3D) motion analysis system.

Methods

Twenty‐six healthy subjects performed three functional movement screen deep squats recorded simultaneously by both the app (on an iPad [Apple Inc]) and the 3D motion analysis system. Joint angle data were calculated with Vicon Nexus software (Vicon Motion Systems Ltd). The app video was analyzed frame by frame to determine, and freeze on the screen, the deepest position of the squat. With a capacitive stylus reference lines were then drawn on the iPad screen to determine joint angles. Procedures were repeated with approximately 48 hours between sessions.

Results

Test‐retest intrarater reliability (ICC_3,1) for the app at the hip, knee, and ankle was 0.98, 0.98, and 0.79, respectively. Minimum detectable change was hip 6°, knee 6°, and ankle 7°. Hip joint angles measured with the 2D app exceeded measurements obtained with the 3D motion analysis system by approximately 40°. Differences at the knee and ankle were of lower magnitude, with mean differences of 5° and 3°, respectively. Bland‐Altman analysis demonstrated a systematic bias in the hip range‐of‐motion measurement. No such bias was demonstrated at the knee or ankle.

Conclusions

The 2D app demonstrated excellent reliability and appeared to be a responsive means to assess for clinical change, with minimum detectable change values ranging from 6° to 7°. These results also suggest that the 2D app may be used as an alternative to a sophisticated 3D motion analysis system for assessing sagittal plane knee and ankle motion; however, it does not appear to be a comparable alternative for assessing hip motion.

Level of Evidence

3     

运用计算机图像处理系统定量测量肠系膜毛细血管血流动力学参数

本文介绍了一种在计算机图像处理系统上开发的定量测量肠系膜毛 细血管血流动力学参数的新方法。结果表明用此方法所测参数与文献报道相符，从 而使微循环观察研究更为客观、精确和可靠。在微循环的临床和实验研究中具有较 大的应用价值．