高压氧为主综合疗法治愈爆震性耳聋2例

目的：探讨脑梗死患应用低能量氦－氖（He-Ne）激光血管内照射（ILIB）的疗效。方法：对30例脑梗死患进行ILIB治疗。结果：经过两个疗程治疗后，总有效率达90％；治疗后全血粘度较治疗前明显改善（P＜0．05－0．01）。结论：ILIB治疗可改变血液流变学性质，是治疗脑梗死的有效手段，同时对预防脑梗死的复发具有重要意义。     

尼莫地平治疗椎基底动脉供血不足的血液流变学及脑干诱发电位观察

目的探讨尼莫地平治疗椎基底动脉供血不足 (VBI)的作用机理。方法 5 0例VBI患者分为尼莫地平治疗组 2 5例和常规治疗组 2 5例 ,治疗前及治疗 1个月后检测血液流变学指标及脑干听觉诱发电位 (BAEP)。结果治疗前VBI患者血液粘度增高 ,表现为全血粘度高低切变值、血浆粘度及血脂增高。BAEP总异常率为 76% ,以脑干型异常为主。治疗后两组血液流变学及神经传导功能均有明显改善 (P <0 0 5 )。与常规治疗组相比 ,尼莫地平组血浆粘度水平降低更显著 (P <0 0 5 ) ,V波峰潜伏期、III V和I V峰间潜伏期明显改善 (P <0 0 5 )。结论尼莫地平可改善VBI患者血液流变学情况及脑神经传导功能。     

氦氖激光血管内照射对重型颅脑损伤患者血液流变学及抗氧化能力的影响

目的：观察低能量氦氖激光血管内照射对重型颅脑损伤患者血液流变学及机体抗氧化能力的影响并探讨其临床意义。方法：将68例重型颅脑损伤患者分为低能量氦氖激光治疗组38例和常规治疗组30例，治疗前后及治疗后1个月检测血液流变学及超氧化物歧化酶（SOD）和丙二醛（MDA）水平，与对照组比较，观察低能量氦氖激光对重型颅脑损伤患者血液流变学及抗氧化能力的影响。结果：重型颅脑损伤患进血液粘度增高，血清SOD活力降低且MDA含量增高（P＜0．05）。与常规治疗组相比，治疗后激光组合血粘度高低切变值和血浆粘度明显改善（P＜0．05），血清SOD活性增高（P＜0．05），MDA含量显著降低（P＜0．05）。结论：低能量氦氖激光血管内照射可改善重型颅脑损伤患者血液流变学情况，提高机体抗氧化能力减轻自由基的损害。     

低能量氦-氖激光血管内照射治疗脑梗死

研究低能量氦－氖激光血管内照射对脑梗死的治疗效果以及对血液流变学的影响。４８例脑梗死患者随机分为常规组和激光组,激光组患者在常规治疗基础 上加用低能量氦－氖激光血管内照射治疗,２组治疗４周后,评估疗效并观察血流流变学及血脂的变化,结果：激光组与常规组痊愈显效率分别为７９．１％和６２．５％。统计分析差异无显著性（Ｐ〉０．０５）。２组治疗后血液流变指标均有明显变化。全血粘度高低切变值。血浆粘度、血脂均明显改善,其中激光组血浆粘度及总胆固醇降低水平较常规组显著（Ｐ〈０．０５）。提示：低能量氦－氖激光血管内照射可改善脑梗死患者血液流变学情况,尤其可降低血浆粘度和总胆固醇水平。治疗效果安全、可靠。     

He-Ne激光血管内照射治疗缺血性脑血管病

目的：观察He-Ne激光血管内照射疗法（ILIB）对缺血性脑血管病的治疗效果。方法：80例确诊为缺血性脑血管病的患者随机分为2组，常规组按神经科常规药物治疗；激光组在此基础上加用He-Ne激光血管内照射治疗，隔日1次，10次1疗程，并在治疗前后进行经颅多普勒（TCD）与脑电地形图（BEAM）检测比较。结果：激光组痊愈率32．5％，临床总有效率95．0％，临床疗效明显高于常规组， 差异有显著性，P＜0．01。治疗前后2组TCD与BEAM检测比较，差异有显著性（P＜0．010。结论：缺血性脑血管病在常规药物治疗基础上加用ILIB可取得更好的临床疗效。TCD与BEAM的检测是评价ILIB治疗缺血性脑血管病敏感指标之一。     

低能量氦氖激光血管内照射疗法对冠心病血脂和血液流变性的影响

目的：探讨低能量氦氖激光血管内照射法(ILIB)对冠心病患者血脂和血液流变性的影响。方法：测定32例冠心病患者（治疗组）应用ILIB治疗前后血脂含量及血液流变学的改变,并与31例口服复方丹参片的冠心病患者（对照组）进行对照。结果：治疗组应用ILIB治疗1 疗程后,胆固醇(CH)、甘油三酯(TG)、低密度脂蛋白(LDL)降低,高密度脂蛋白(HDL)升高,全血低切粘度、高切粘度。血浆粘度、红细胞压积(HCT)也降低,且有显著性;对照组前后无显著变化。结论：冠心病患者应用ILIB治疗后,其CH、TC、LDL降低,HDL升高,血液粘度也降低,说明ILIB可以作为冠心病的非药物治疗。     

低能量氦-氖激光血管内照射对脑梗死患者血脂血流变学的影响

目的 观察氦-氖激光血管内照射对40例脑梗死患者的疗效及血脂、血液流变学的影响。方法 对40例脑梗死患者进行低能量氦-氖激光血管内照射治疗，并与经常规治疗的40例进行对比观察。结果 治疗组治愈34例（85％），好转6例（15％）；对照组治愈28例（70％），好转10例（25％），无效2例（3％）。治疗组治愈率明显优于对照组（P〈0．05），治疗组治疗前后全血黏度及血脂、胆固醇等各项指标差异有显著性（P〈0．05），对照组差异无显著性（P〉0．05）。结论 低能量氦-氖激光血管内照射治疗脑梗死能改善患者的血脂、血液流变学状态，提高疗效，是治疗脑梗死的有效手段之一。     

手法治疗椎动脉型颈椎病的TCD和BAEP观察

目的 观察手法治疗椎动脉型颈椎病的经颅多普勒超声（TCD）和脑干听觉诱发电位（BAEP）变化，从血流速度及神经电生理角度探讨手法治疗的作用机理。方法 将60例椎动脉型颈椎病患者分为手法治疗组30例和常规治疗组30例，治疗前及治疗2周后检查TCD和BAEP，观察手法治疗对椎动脉型颈椎病患者血流速度及脑电生理的影响。结果 （1）2组治疗后总有效率分别为96．6％和90％，其中手法组临床治愈率为46．6％，常规组临床治愈率为33．3％，2组间疗效及平均治疗时间无统计学差异。（2）治疗前疾病组椎基底动脉（VBA）流速明显低于对照组（P＜0．05）。TCD异常率为76．7％（46／60例），以VBA流速降低为主要特点。BAEP异常率为80％（48／60例），以脑干型异常为主。（3）治疗后2组VBA血流速度均有改善，手法治疗组比常规治疗组椎动脉流速改善更显著（P＜0．05）。治疗后2组神经传导功能均有改善，与常规治疗组相比，手法治疗组V波PL，Ⅲ-Ⅴ和Ⅰ-ⅤIPL改善更显著（P＜0．05）。结论 手法治疗可改善椎动脉型颈椎病椎基循环的血流速度及脑干神经传导功能。     

氦—氖激光血管内照射治疗脑梗死及血脂血流检测

目的 观察氦－氖（He-Ne)激光血管内照射（ILIB）对脑梗死的疗效及血脂，经颅多普勒（TCD）血流检测。方法 将71例脑梗死患者随机分为ILIB组（36例）和对照组（35例），比较两组治疗20次前后的疗效及血脂参数变化，并对两组23例大脑中动脉区梗死者治疗前后进行TCD检测，比较大脑中动脉（MCA），大脑后动脉（PCA）及大脑前动脉（ACA）的平均血流速度（Vm)。结论 ILIB组治愈显效率为75％，对照组为51％，总有效率分别为97％和80％（x^2=4.602,P&;lt;0.05)。血脂中总胆固醇（CHO）和载脂蛋白B（APOB）参数两组对比及治疗前后对比有显著性差异（P＜0．05）。TCD检测显示ILIB组治疗后MCA的Vm增加，ACA的Vm减慢。结论 ILIB治疗脑梗死有较高疗效，能改善血脂及血流检测参数。     

氦—氖激光血管内照射治疗脑梗死患者神经心理障碍

目的 探讨低能量氦—氖(He-Ne)激光血管内照射治疗对脑梗死患者神经心理障碍的疗效及可能机制。方法 采用简易智能量表(MMSE)和临床记忆量表(MQ)，对30例脑梗死患者用低能量He-Ne激光血管内照射治疗治疗前后的神经心理功能变化进行测试，并同时观察血脂和血液流变学指标的变化。结果 对照组患者经常规药物治疗后MMSE和MQ为19．02&;#177;8．14和86．03&;#177;13．72；治疗组经加用低能量He-Ne激光血管内照射治疗后MMSE和MQ为25．84&;#177;6．92和93．02&;#177;13．71，可使其智能成绩明显提高(P＜O．01)，并具有降低血脂和提高高密度脂蛋白的作用。结论 脑梗死患者具有较明显的神经心理障碍，低能量He-Ne激光血管内照射配合药物治疗具有良好的疗效。     

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.