维吾尔语-汉语双语失语症检测法的编译及初步临床应用

目的 编译维吾尔语-汉语双语失语症检测法（UC BAT）量表并运用于维吾尔语-汉语双语失语症患者的语言功能评估。 方法 采用双语失语症检测法（BAT）量表的汉语版,根据维语的语言学特点和BAT量表的翻译要求编译维语版,初步应用临床,通过双语历史筛查维-汉双语失语症患者,检测各语言能力并分析各病理语言特点。 结果 编译了UC BAT量表,并将其应用临床筛查20例维-汉双语失语患者,评估各语言能力,其中男13例,女7例患者20例,其中男13例,女7例;年龄25～74岁,平均（43.5±12.4）岁;受教育年限1～15年,平均（11.3±3.7）年;习得汉语的平均年龄和平均年限分别是（9.4±3.2）岁和（9.5±5.1）年。运动性失语7例,基底节性失语3例,经皮质运动性失语3例,命名性失语3例,经皮质混合性失语1例,经皮质感觉性失语1例,感觉性失语1例,完全性失语1例。基底节性失语、经皮质运动性失语、命名性失语患者在听理解、口语表达、阅读理解和书写的两种语言得分无差异,运动性失语患者在听理解、阅读理解和书写的两种语言得分有差异,其他的失语类型只有一个样本,不能假设检验。 结论 应用UC BAT量表获得的数据为双语失语症的调查研究、诊断及治疗提供有益的依据。     

双语失语检查法的初步临床应用及体会

研究失语机制是探讨语言认知过程的一项重要方法。目前我国对失语症患者多采用汉语失语检查法、汉语失语症检查法（草案）、西方失语成套测验及波士顿检查法等进行检查，而对双语失语研究甚少。我们采用由Michel制定的双语失语症检查法普通话及粤语版本分别检查了3例具备双语条件的失语症患者。现将结果报道如下。     

脑卒中后不同类型失语症的自然恢复状况研究

目的：研究脑卒中后不同类型失语症的自然恢复状况.方法：应用汉语失语检查法在患者生命体征平稳神志清楚、能够耐受坐位30min以上时进行第一次语言功能评估.评估结果按Benson分类方法进行失语症分类.患者在脑卒中后第3个月、第6个月、第9个月、第12个月分别进行语言功能评估.所有患者在发病后12个月内均未接受正规语言治疗.结果：共收集80例脑卒中后失语症患者,分为10类失语症.Broca失语18例,Wernicke失语10例,传导性失语6例,经皮质运动性失语4例,经皮质感觉性失语4例,经皮质混合性失语5例,完全性失语12例,命名性失语4例,基底节性失语10利,丘脑性失语7例.结论：脑卒中后失语症患者无论属于何种类型都有不同程度语言功能的自然恢复.这种自然恢复在发病后3个月内比较明显.口语的自然恢复程度在各个阶段均大于书面文字.不同类型汉语失语症自然恢复的程度是不同的.     

急性脑血管病患者汉语失语症早期康复的研究

目的探讨早期康复对语言功能恢复的作用.方法将60例急性脑血管病汉语失语症患者随机分组,其中的30例患者分别于发病7天内和8-14天内进行28天的语言康复训练;另外30例患者不做语言康复训练为对照组.在康复训练前及28天后和3个月后追踪分别用汉语失语检查法测查此60例患者的失语商,并进行自身和三组间比较.结果应用语言康复训练效果更好(P＜0.01),康复训练越早越好(P＜0.05).结论语言康复训练对急性脑血管病汉语失语症患者语言功能的恢复起着重要作用,早期康复效果明显且稳定.     

失语症类型与病变部位之间关系的临床研究

目的：通过对脑梗死后具有明显失语症临床表现的98例患者进行失语症的分类及CT、MRI研究，揭示失语症类型与病变部位之间的关系。方法：选择符合病例入选标准的98例急性脑梗死患者。应用北京医科大学第一医院神经内科的汉语失语检查法中的利手评定标准进行利手判定、西部失语成套测验进行失语症的分类、波士顿诊断性失语严重程度分级标准进行失语症严重程度分级及CT、MRI检查。结果：98例失语症患者均为右利手，失语症类型分别为Broca失语21例。Wemicke失语15例，传导性失语2例；经皮质运动性失语8例，经皮质感觉性失语7例，经皮质混合性失语12例。完全性失语23例，命名性失语10例；病变部位位于经典的语言中枢的有56例，38例为非语言中枢受累；波士顿诊断性失语严重程度分级标准评定结果为0级28例，1级30例，2级14例，3级16例，，4级10例，其中0级、1级病变部位多为语言中枢。结论：失语症的类型与经典的语言中枢并不完全相符，非语言中枢病变也可引起失语，病变部位位于语言中枢的失语严重程度较大。     

皮质下失语症的特点及其相关机制探讨

皮质下失语症是指病变部位局限于丘脑、基底核-内囊区、脑室周围白质的失语症。其可表现为具有特征性的皮质下失语综合征,主要包括丘脑性失语症和基底核性失语症。也可表现为其他各种类型的失语症。对其机制目前主要有3种解释:①神经功能联系不能理论:即皮质下病变阻断了皮质下与皮质的功能联系,使皮质区因传入减少而发生功能和代谢下降,导致失语。所伴随的皮质低灌注是低代谢的结果,而不是其原因。②皮质下结构参与语言活动,其损害直接导致失语。③皮质下损害导致皮质的血流低灌注(血肿影响、缺血半暗带),由此引起失语。目前最多达到共识的是对第一种解释。     

失语症患者近期自然恢复的观察

对２３例急性脑血管病所致的失语患者进行连续８周的失语检查,结果：自然恢复是在中风后２周最快,６周后逐渐减慢。说和听较读和写恢复好。各类失语中皮质下失语、传导性失语、命名性失语、经皮质性失语及Ｂｒｏｃａ失语恢复较好;而Ｗｅｒｎｉｃｋｅ失语、经皮质混合性失语及完全性失语恢复较差;脑出血较脑梗塞恢复要好;皮质下病变较皮质性变变恢复要。提示：失语症是一随时间变化的动态状况。     

粤语失语症的评价与语言治疗初探

目的：探讨粤语失语症的评价和语言训练特点。方法：根据中国康复研究中心失语症检查（ＣＲＲＣＡＥ）法,编译成适合粤语方言特点的检查法,对１０例粤语失语症患者进行评价,并进行语言对其中４例普通话－粤语双语失语症患者进行粤语与普通话双重刺激训练。结果：诊断运动性失语３例,完全性失语２例,经皮质运动性失语１例,经皮质混合性失语２例,命名性失语１例,底节性失语１例。语言治疗后,患者听理解,复述,口语表达,朗读     

维吾尔语版失语症量表的信度和效度研究

摘要 目的：对维吾尔语版失语检查量表进行信度和效度检验。 方法：通过对汉语版失语症量表（ABC）进行翻译和回译,并进行语言的调适和预测试后,将其运用于104例符合入选标准的脑血管病后的维吾尔族失语症患者,均在入院时进行语言功能评定,其中30例失语症患者在住院后1周再次进行第2次测评。对评定结果进行失语症分类和数据汇总,采用Spearman秩相关检验量表的重测信度,应用因子分析法检验量表的结构效度,同时进行内在信度及分半信度检验。 结果：维吾尔语版失语症检查量表的重测信度较好,除书写检查中的两个分项目低于0.7外,其余22个分项目的重测信度均＞0.7;量表总的内在信度系数（Cronbach α系数）和拆分为4个部分（口语表达、听理解、阅读和书写）的Cronbach α系数均＞0.7;量表的分半信度为0.906;因子分析结果提示该量表的结构效度较好。 结论：维吾尔语版失语症检查量表在对维吾尔语失语症患者的诊断、分类和量化方面具有较好的信度和效度,是一种可用于维吾尔族失语症患者的较理想的评定工具,对维吾尔族失语症患者的语言功能评定有良好的应用前景。     

皮质下失语患者的口语表达障碍: 18例分析

目的 分析皮质下失语患者在口语表达中音位障碍和词汇障碍特点以及可能的病理机制,为言语康复训练提供依据. 方法 用汉语失语检查法( ABC法)对武汉大学人民医院神经内科收治的 18例左侧皮质下血管病变引起的丘脑性失语和基底核性失语患者进行检查.分析两类失语患者在复述中音位错误和视命名中词汇错误出现的次数,并进行比较. 结果 皮质下失语的音位错误中音素替代最多(各自出现 27次 /84.4%, 10次 /66.7%),环境错误最少各自 2次.在词汇错误中丘脑性失语最多的类型是语义上位关系词替代( 32次 /42.5%),基底核性失语是音位错语( 11次 /26.8%),丘脑性失语与基底核性失语相比差异有显著性意义(χ 2=18.828,P< 0.05). 结论 皮质下失语患者在口语表达中的不同特点,揭示皮质下结构参与了语音、词汇-语义的组织表达.     

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.