超声分析病理性近视眼球后血流变化及其与病理性近视特征性改变的关系

目的应用超声分析病理性近视眼球后血流变化特征,探讨其与病理性近视特征性改变(最佳矫正视力、屈光度、眼轴及视网膜脉络膜萎缩等)的关系。方法选取20例正常视力者(正常组,40只眼)、20例中低度近视者(中低度近视组,40只眼)及20例病理性近视者(病理性近视组,40只眼),应用彩色多普勒超声记录其等效球镜度数、眼轴、最佳矫正视力、视网膜脉络膜萎缩程度及眼球后多普勒血流参数,并对病理性近视眼球后血流行偏相关性分析。结果病理性近视组与中低度近视组和正常组比较,眼动脉舒张末期血流速度(EDV)、阻力指数(RI)、视网膜中央动脉收缩期峰值血流速度(PSV)、EDV、RI,以及睫状后动脉PSV、EDV、RI差异均有统计学意义(均P0.05);中低度近视组各参数与正常组比较差异均无统计学意义。偏相关性分析显示视网膜中央动脉PSV与眼轴和年龄均呈负相关(r=-0.40、-0.33,均P0.05),RI与年龄呈负相关(r=-0.43,P0.05),睫状后动脉PSV与年龄、最佳矫正视力及视网膜脉络膜萎缩程度均相关(r=-0.57、0.43、-0.42,均P0.05)。结论病理性眼球后血流的改变具有一定特征性,其与眼轴、最佳矫正视力及视网膜脉络膜萎缩程度均有一定相关性。     

病理性近视眼球后血流变化特征分析

【】目的 采用超声多普勒技术,探讨病理性近视及中低度近视、正视眼多普勒球后血流变化特征,及与病理性近视特征性改变(最佳矫正视力,屈光度、眼轴、视网膜脉络膜萎缩等)的关系。方法 对20例(40眼)正视眼、20例(40眼)中低度近视眼及病理性近视眼20例 (40眼 )分别记录其等效球镜度数、眼轴、最佳矫正视力(BCVA)、视网膜脉络膜萎缩程度、多普勒球后血流参数等并对所取得数据采用SPSS 21.0对病理性近视眼球后血流进行偏相关性分析。结果 病理性近视眼患者球后血流较正视眼及中低度近视眼球后血流明显下降；偏相关性分析显示CRA的PSV与眼轴(r= -0.40)、年龄(r= -0.33),CRA的RI与年龄(r= -0.43),PCA的PSV与年龄(r=-0.57)、BCVA(r=0.43)、视网膜脉络膜萎缩(r= -0.42)具有显著相关性(P＜0.05)。结论 病理性眼球后血流的改变与眼轴(AL)、最佳矫正视力(BCVA)、视网膜脉络膜萎缩程度具有显著相关性。     

高度近视成人患者脉络膜厚度的影响因素研究

目的探讨高度近视成人患者脉络膜厚度的影响因素。方法以2012年5月至2014年5月收治的40例40眼高度近视患者作为研究组,以同期体检的40例40眼正常人作为对照组,比较两组的脉络膜厚度、眼轴长度并进行线性相关性分析。结果研究组的中心凹下脉络膜厚度和脉络膜厚度均比对照组薄(P0.05),研究组的眼轴长度大于对照组(P0.05),研究组高度近视患者脉络膜厚度变薄和眼轴长度延长病理特征表现明显;研究组受检眼球中心凹颞侧2 500μm处的脉络膜最厚,为198μm,且呈现从颞侧到鼻侧逐渐变薄的趋势;对照组受检眼球中心凹处的脉络膜最厚,为309μm,且呈现出从中心凹处往鼻侧和颞侧逐渐变薄的趋势,鼻侧最薄为217μm,颞侧最薄为263μm。研究组每个点的脉络膜厚度均比对照组薄(P0.05);多元线性分析结果显示,脉络膜厚度与研究对象的年龄、屈光度数和眼轴长度有相关性(P0.05),且脉络膜厚度与研究对象的年龄(r=-0.9497)、屈光度数(r=-0.9536)和眼轴长度(r=-0.9029)呈负相关(r-1)。结论患者年龄、眼轴长度和屈光度数是影响高度近视成人患者脉络膜厚度的因素,且脉络膜厚度与患者的年龄、眼轴长度和屈光度数呈负相关性。     

后巩膜葡萄肿超声显像

后巩膜葡萄肿超声显像河南省眼科研究所李舒茵，李蕴随本文对５５例双眼变性近视伴后巩膜葡萄肿（１１０眼）患者，用美国产ＯＰＨＴＨＡＳＯＮＩＣＡ／ＢⅢ＋眼科专用扫描仪进行探查。直接接触法。Ａ超自动测量眼轴长度１０次，取平均值；Ｂ超观察后巩膜葡萄肿形态、位置...     

原发性急性闭角型青光眼脉络膜厚度变化及相关影响因素

目的探讨原发性急性闭角型青光眼(APACG)脉络膜厚度变化及相关影响因素。方法选取2015年1~12月在该院眼科门诊就诊的120例APACG患者,另选取同期行常规眼科检查的120例健康体检者为健康对照组,采用谱域相干断层深度增强扫描测定两组脉络膜厚度,采用单因素及多因素回归Logistic分析影响APACG患者脉络膜厚度变化相关危险因素。结果 APACG组受检眼球中心凹颞侧2 500μm处脉络膜最厚为(198.52±5.45)μm,呈颞侧至鼻侧逐渐变薄的趋势;健康对照组受检眼球中心凹处脉络膜最厚为(307.25±12.48)μm,呈中心凹处往鼻侧及颞侧逐渐变薄的趋势。APACG组脉络膜厚度、眼球中心凹下脉络膜厚度较健康对照组薄,差异有统计学意义(P0.05);而眼轴长度、玻璃体长度、屈光度、前房深度、晶体厚度均大于健康对照组,差异有统计学意义(P0.05);两组性别、年龄、眼压比较差异无统计学意义(P0.05)。经Pearson相关分析显示,年龄、眼轴、屈光度与APACG组黄斑中心凹下脉络厚度(SFCT)呈负相关(r分别为-0.412、-0.358、-0.367,P0.05),而与前房深度呈正相关(r=0.429,P0.05),而与眼压、晶体厚度、玻璃体长度无相关性(P0.05)。年龄、眼轴、屈光度数是影响APACG患者脉络膜厚度变薄的独立危险因子。结论 APACG患者脉络膜厚度变化与部位有关,其中黄斑中心凹下脉络厚度最厚,年龄、眼轴、屈光度数与APACG患者SFCT呈负相关,且是APACG患者脉络膜变薄的独立危险因素。     

病理性近视眼底病变的光相干断层扫描病理形态学改变

目的：观察病理性近视眼底病变的光相干断层扫描（OCT）病理形态学改变特征。方法：临床检查确诊为病理性近视患者100例（172眼）行OCT检查。用Macular Thickness Map、Fast Macular Thickness及Line程序扫描黄斑区、视乳头、颞侧大血管弓、色素改变及近视弧等部位。结果：将病理性近视眼底病变按部位不同分为4类，其中，玻璃体视网膜界面病变中89眼（51．7％）可见玻璃体后皮质黏附，黄斑全层裂孔15眼（8．7％），黄斑板层孔2眼（1．2％），黄斑前膜（EMR）11眼（6．4％）。视网膜神经上皮层改变中13眼（7．6％）发生无黄斑裂孔的后极部神经上皮层浅脱离，其中5眼（2．9％）可见后极部视网膜脱离周边部网膜外层劈裂，神经上皮层内层劈裂3眼（1．2％）。33眼（20％）发生视乳头颞侧近视弧处视网膜神经上皮层浅脱离。色素上皮厦脉络膜病变中140眼（81．4％）视网膜色素上皮不均匀萎缩，Fuchs斑10眼（5．7％），近视弧165眼（95．9％），后极部脉络膜广泛萎缩117（68．0％）眼。黄斑区脉络膜新生血管25眼（14．5％）。巩膜改变中后巩膜葡萄肿146眼（84．9％）。结论：OCT可活体观察病理性近视的眼底组织病理学改变，对分析其眼底病变特征及病程观察有重要价值。     

高度近视眼视网膜神经纤维层和脉络膜厚度及相关因素分析

目的探讨成年高度近视患者视网膜神经纤维层(retinal nerve fiber layer,RNFL)及脉络膜厚度与正常对照组的差异及其与眼轴长度、屈光度、年龄的关系。方法 2013年3月至2015年3月在爱尔集团成都康桥眼科医院就诊的高度近视患者85例(150眼)为高度近视组,同期健康志愿者80例(160眼)为正常对照组。采用频域光学相干断层扫描(spectral-domain optical coherence tomography,SD-OCT)加强深度扫描(enhanced depth imaging,EDI)模式,3.46 mm扫描视盘周围RNFL厚度及盘周脉络膜厚度,以6 mm的扫描线对黄斑部进行0o扫描,测量黄斑中心凹下的脉络膜厚度。比较组间RNFL厚度和脉络膜厚度的差异,并分析其与眼轴长度、屈光度和年龄的关系。结果高度近视眼和正视眼RNFL厚度分别为(85.35±12.31)μm和(108.42±9.42)μm,中心凹下脉络膜厚度分别为(167.23±45.26)μm和(342.25±58.39)μm,盘周脉络膜厚度分别为(141.38±48.93)μm和(198.85±63.23)μm。与正常对照组比较,高度近视组RNFL厚度和脉络膜厚度明显变薄(P0.01)。高度近视RNFL和脉络膜厚度与眼轴长度、屈光度、年龄均呈负相关(P0.05)。结论高度近视眼患者RNFL和脉络膜厚度较正常人明显变薄,且与眼轴长度、屈光度、年龄密切相关。     

角膜塑形镜矫正青少年低、中度近视的效果观察及相关因素分析

目的 研究角膜塑形镜矫正青少年低、中度近视患者的临床效果,并分析影响疗效的相关因素。方法 选取2018年2月至2020年8月江苏盛泽医院收治的80例低、中度近视患者为研究对象进行回顾性分析,患者均接受角膜塑形镜矫正术。随访记录角膜塑形镜治疗效果,根据疗效不同将患者分为有效组（71例）和无效组（9例）,分析影响疗效的相关因素。结果 80例患者干预2年,显效48例,有效23例,无效9例,总有效率为88.75%。有效组患者近视程度重于无效组,眼轴长度长于无效组,角膜散光度低于无效组（P<0.05）。多因素Logistic分析结果显示,近视程度低（95%CI=0.701～0.976,OR=0.827,P=0.024）、眼轴长度短（95%CI=0.449～0.878,OR=0.628,P=0.007）及角膜散光度高（95%CI=1.727～3.622,OR=2.501,P=0.002）是影响角膜塑形镜疗效的独立危险因素。结论 角膜塑形镜干预治疗青少年低、中度近视患者效果显著,其疗效与近视程度、眼轴长度及角膜散光度有关,临床应引起重视。     

后巩膜加固术后眼表改变研究现状

<正>病理性近视又称变性近视,是眼科常见的致盲性眼病之一。临床认为屈光度-6. 00D以上可能为病理性近视,屈光度-8. 00D以上为较肯定的病理性近视。病理性近视表现为眼轴进行性延长,导致玻璃体混浊、液化,伴视网膜脉络膜退行性改变、黄斑变性等,从而引起视功能障碍,严重影响视觉质量。我国病理性近视的患病率远高于世界整体水平。多数学者认为后巩膜加固术是目前治疗病理性近视、延缓眼轴延长的唯一安全有效的手术方法。眼表疾病是临床常见的眼病,主要是眼表角结膜组     

不同血管通路类型对维持性血液透析患者生存影响的研究CSCD

目的探讨不同血管通路类型对维持性血液透析(maintenance hemodialysis,MHD)患者3年生存的影响。方法前瞻性队列研究设计,纳入2017年1月1日~2017年12月31日在海南省人民医院血液透析的MHD患者216例,随访3年。根据血管通路类型分2组:自体动静脉内瘘(autostatic arteriovenous fistula,AVF)组和带隧道涤纶套导管(tunneled cuffed catheter,TCC)组。观察终点为患者3年全因死亡。结果(1)216例患者中年龄≥60岁者86例(39.8%),糖尿病肾病60例(27.8%),男性132例(61.1%),TCC组55例(25.5%)。(2)2组死亡原因构成比无统计学差异(χ^(2)=0.676,P=0.879);AVF组第一位死亡原因是心血管事件(39.5%),其次是感染(30.2%),TCC组分别是感染(39.3%)和心血管事件(35.7%)。(3)随访期间AVF组累积生存率高于TCC组(χ^(2)=9.618,P=0.002)。(4)单因素分析显示:年龄(OR=2.854,95%CI:1.766~4.612,P<0.001)、透析龄(OR=0.973,95%CI:0.963~0.983,P<0.001)、原发病(OR=2.296,95%CI:1.435~3.673,P=0.001)、血管通路类型(OR=2.091,95%CI:1.294~3.378,P=0.003)、白蛋白(OR=4.281,95%CI:2.050~8.938,P<0.001)和胸部CT影像(OR=0.409,95%CI:0.255~0.655,P<0.001)是影响患者全因死亡的重要因素。(5)多因素COX回归分析:校正原发病、年龄、透析龄、白蛋白、血管通路及胸部CT影像后,维持性血管通路类型(OR=0.921,95%CI:0.545~1.557,P=0.759)对全因死亡无直接影响;透析龄(OR=0.976,95%CI:0.966~0.986,P<0.001)、低白蛋白(OR=2.898,95%CI:1.327~6.330,P=0.008)和胸部CT影像改变(OR=2.060,95%CI:1.258~3.376,P=0.004)是全因死亡的独立危险因素。结论AVF与TCC作为MHD血管通路对患者生存无直接影响;积极纠正营养不良,提高白蛋白水平及有效防治肺部炎症,改善CT影像异常可提高患者生存率。     

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.