兰州市452份不同年龄段颈椎病患者调查问卷多因素Logistic回归分析

目的:颈椎病的发生呈现低龄化的趋势,为了探讨有效的预防措施,调查分析了兰州市不同年龄段颈椎病患者的发病原因.方法:采用自行设计的调查表,由甘肃省中医院等4个医疗机构中的相关专业人员负责收集资料,对2004-02/2005-02年到上述医院就诊的颈椎病患者500人进行了详细的登记(性别、年龄、职业、确诊时间、颈椎病诱发和加重的主要原因、检查结果).共收集到完整调查表452份,按年龄分为＜30岁组96人、30～50岁组200人、＞50岁组156人.采用等级相关、x2检验以及Logistic回归方法分析各种诱因与各年龄段间的相关性.结果:①对引发颈椎病的10种主要诱因经单因素分析后,按相关度大小依次为:长期低头工作、自然退变、颈部外伤、颈部受凉、高枕睡眠、潮湿的环境、颈椎发育性因素、精神紧张、过度疲劳、咽喉炎.②颈椎发育性因素和颈部外伤,＜30岁的颈椎病患者与其他两个年龄段相比,差异有显著性意义(P＜0.01).③长期低头工作、高枕睡眠、精神紧张,30～50岁的颈椎病患者与其他两个年龄段相比,差异有显著性意义(P＜0.01).④自然退变、颈部受凉,＞50岁的颈椎病患者与其他两个年龄段相比,差异有显著性意义(P＜0.01).结论:外伤和颈椎发育性因素、工作行为因素、自然退变因素分别是青、中、老年颈椎病患者的主要诱因.     

上海市徐汇区颈椎病患病情况调查分析

目的：研究和分析上海市徐家汇社区颈椎病的患病情况和致病因素,为颈椎病的防治提供依据。方法：采用自行设计问卷调查表对徐家汇社区常住居民1 326例进行颈椎病患病率问卷调查,内容包括性别、年龄、职业、临床症状、受凉、劳累、精神紧张、辅助检查等;对既往或疑有颈椎病的患者进行临床确诊和影像学检查;并对所得资料进行统计分析。结果：颈椎病患病率为19.1%,51～60岁年龄段的患病率为33.8%,明显高于其他年龄段（P〈0.05）;logistic回归分析显示年龄、职业、受凉、精神紧张等因素为颈椎病致病的危险因素;颈椎影像学检查示椎体增生及椎间隙变窄的发生率较高。结论：徐家汇社区颈椎病的患病率较高,急需通过健康宣教等方法进行社区干预。     

颈部后伸肌群功能锻炼与合理用枕对恢复颈椎生理曲度的影响

目的:探讨颈部后伸肌群功能锻炼与合理用枕对颈椎曲度异常患者恢复生理曲度的临床价值,为颈椎病的临床诊治提供方法和思路。方法:选取有明显颈椎生理曲度异常的颈型颈椎病患者60例,随机分为治疗组和对照组各30例,对照组患者行颈椎牵引治疗,治疗组患者行颈部后伸肌群功能锻炼加牵引治疗,住院治疗2周,出院指导功能锻炼12周后,观察2组患者治疗前后的症状、评分、X线变化。结果:2组2有效率及X线结果比较,差异无统计学意义。2组治疗后评分比较,P=0.043,差异有统计学意义。结论:颈部后伸肌群功能锻炼与颈椎牵引相结合的治疗方式优于单纯的牵引治疗,对颈型颈椎病患者具有治疗作用。     

自制改良型颈椎枕在颈椎病患者术后的应用

目的 探讨改良型颈椎枕在颈椎病患者术后的临床应用效果.方法 选取122例手术治疗的颈椎病患者,按随机数字表法分为观察组和对照组,各61例,2组患者均行颈椎病术后常规护理,对照组应用沙袋或佩戴颈托,观察组应用改良型颈椎枕,根据患者个体需求,选择合适型号的颈椎枕,观察2组患者颈部切口疼痛、颈部舒适度及睡眠质量情况.结果 观察组患者颈部切口疼痛、颈部舒适度、睡眠质量明显优于对照组,差异有统计学意义(P＜0.05).结论 自制改良型颈椎枕应用于颈椎病术后患者,保持有效的颈部制动,减轻切口疼痛,提高舒适度,改善睡眠质量,促进患者快速康复.     

256例高性能战斗机飞行员颈椎X线表现分析

目的通过分析256例战斗机飞行员颈椎X线平片表现,对飞行员颈椎病的早期诊断和治疗提供依据。方法选自2015-02—2016-06来战略支援部队兴城疗养院疗养期间进行过颈椎X线检查的256例战斗机飞行员,对这些颈椎X线检查结果进行研究分析。结果 256例飞行员各年龄段都以颈椎生理曲度改变最常见,总发病率为62.5%,而间隙狭窄,骨质增生,韧带钙化发病率分别为28.1%,34.4%,14.5%,并随着年龄的增长,颈椎各项X线病理改变都有所增加。结论根据256例飞行员颈椎X线检查分析,总结出造成飞行员颈椎病的一些影响因素,为飞行员颈部健康提供合理的参考。     

针灸临床讲座(13)颈椎病

颈椎病(cervical spondylosis)又称颈椎综合征,是指因颈椎间盘退变,颈椎骨质增生,韧带及关节囊的退变、肥厚等病变,刺激或压迫颈神经、神经根、脊髓、交感神经和周围软组织而引起的综合症候群。该病症状复杂,缠绵难愈。本病治疗方法很多,多采用保守治疗。针灸治疗有疗效显著、不良反应少等优点。1病因颈椎病的发生主要与年龄、职业、劳动强度、外伤、生活习惯(如高枕睡眠或枕头不当,长期低头工作,颈部长时间单一姿势,头顶重物、饮酒等)、解剖变异、气候、遗传因素等有关。中医认为本病多由风寒湿外邪侵袭或外受创伤,颈部气血闭阻,经络运行不…     

治病求本原则在神经根型颈椎病患者健康教育中的应用

目的:探讨中医治病求本护理原则在神经根型颈椎病患者健康教育中的应用效果。方法:将2015年4月~2016年3月我院神经根型颈椎病住院患者72例随机等分为对照组和试验组,对照组按照国家中医药管理局颁布的项痹病(神经根型颈椎病)中医护理方案进行健康教育;试验组根据中医治病求本原则对健康教育内容按急性期、缓解期、康复期分阶段宣教。观察两组患者生活方式改变情况及颈椎功能障碍指数。结果:出院时试验组患者在改变不良体位、调整睡眠状态、避免颈部受凉、加强颈肩部肌肉锻炼生活方式的改变率高于对照组(P0.05);出院时颈椎功能障碍指数低于对照组,差异具有统计学意义(P0.05)。结论:应用中医治病求本原则指导神经根型颈椎病患者健康教育可促进患者改变不良生活方式,降低患者的颈椎功能障碍指数,提高患者的康复效果。     

对颈椎病X线诊断的再认识及临床分析

颈椎病是多发病、常见病，近来发病率呈增高趋势，发病年龄趋向年轻化。颈椎病是由于颈椎间盘退变、颈椎骨质增生以及颈椎关节急慢性损伤等引起的颈椎内外平衡失调，刺激和压迫颈部的血管、神经、脊髓而产生的一组临床综合征。虽然CT、MRI技术对颈椎病变的诊断日益明确，但常规的X线检查仍是经济、直观、方便有效且易行的检查手段，在基层医院仍为诊断颈椎病的首选方法。本文对我院近年经X线诊断为颈椎病的120例患者的X线平片进行分析，旨在进一步认识X线对颈椎病的诊断价值，并对其临床与X线表现之间的关系进行初步研究，现总结资料报告如下。     

简易颈椎操对颈椎活动度和疼痛改善作用的效果观察

目的:创编一套简易颈椎保健操,观察其对颈椎功能的影响。方法:招募颈部不适伴有颈椎活动度下降或者颈部疼痛的大学生志愿者132名,练习简易颈椎操8周,坚持下来111名。锻炼前后分别评定颈椎活动度和颈部疼痛分级。结果:锻炼后颈椎前屈、左右侧屈、左右旋转活动度较锻炼前增加,颈部疼痛评分较锻炼前降低,差异均有统计学意义(P0.001)。结论:该简易颈椎保健操能增加颈椎活动度,减轻颈部疼痛,对颈椎病有一定防治作用。     

溃疡性结肠炎患病危险因素Logistic回归分析

目的 探讨溃疡性结肠炎(UC)发生的危险因素,为临床预防和诊治提供依据.方法 选取2009年1月至2013年12月就诊的UC患者39例作为观察组,选择同期健康体检者51例作为对照组.分析性别、年龄、吸烟史、饮酒史、心理应激状况、家族史、文化程度、饮用牛奶、感染性肠病等观察指标在UC发生中的作用.结果 单因素分析显示,UC患者中有家族史、精神紧张、经常饮用牛奶、有感染性肠病比率明显高于健康对照组(P ＜0.05,P＜0.01),有吸烟史比率明显低于健康对照组(P＜0.05);多因素Logistic回归分析结果显示,家族史(OR=1.893,P=0.003),感染性肠病(OR=6.316,P=0.000),精神紧张(OR=1.046,P=0.001),饮用牛奶(OR=2.196,P=0.008)等因素是UC发病的独立危险因素,而吸烟(OR=6.354,P=0.000)为保护性因素.结论 UC发生是多因素共同作用的结果.家族史、饮用牛奶、感染性肠病、精神紧张是UC发病的独立危险因素,而吸烟是其保护性因素.     

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.