复方樟柳碱注射液治疗缺血性视神经病变的疗效观察

目的：观察复方樟柳碱注射液对缺血性视神经病变的疗效。方法：根据有无联合应用复方樟柳碱注射液缺血性视神经病变将患者分为治疗组95例（122眼）和对照组89例（109眼）。评价治疗前后视力、视野改变情况。结果：经过1疗程治疗后,治疗组视力、视野情况明显优于对照组,两组间差异有显著性。结论：联合应用复方樟柳碱注射液能够显著改善缺血性视神经病变患者的预后。     

复方樟柳碱联合腺苷钴胺治疗缺血性视神经病变的疗效观察及护理

目的探讨复方樟柳碱联合腺苷钴胺治疗缺血性视神经病变的疗效及护理。方法将60例缺血性视神经病变患者随机分成观察组(30例)和对照组(30例),观察组给予复方樟柳碱注射液(由北京紫竹药业有限公司生产)颞浅动脉旁注射联合腺苷钴胺(重庆药友有限公司生产)1.5 mg肌肉注射,对照组给予复方樟柳碱注射液颞浅动脉旁注射联合维生素B120.5 mg肌肉注射,两组均治疗1个疗程(14 d)后观察疗效。结果观察组显效18例,好转12例,无效0例;对照组显效12例,好转10例,无效8例,经t检验两组差异有统计学意义(t=4.66,P0.05)。结论复方樟柳碱联合腺苷钴胺治疗缺血性视神经病变较常规治疗起效快,作用明显,安全有效。     

银杏达莫注射液联合复方樟柳碱注射液治疗缺血性视神经病变——附50例报告

目的:观察银杏达莫注射液联合复方樟柳碱注射液对缺血性视神经病变的疗效和安全性.方法:将100例(共100只眼)缺血性眼底病患者,随机分为对照组和治疗组,每组各50例.对照组采用妥拉唑林注射液25 mg患侧颞浅动脉旁皮下注射,每日1次.治疗组用银杏达莫注射液25 mL加生理氯化钠250 mL静脉滴注,每日1次,复方樟柳碱注射液每次2 mL患侧颞浅动脉旁皮下注射,每日1次.2组疗程均为20日.结果:治疗组总显效率为88%,对照组为32%,2组比较差异有统计学意义(P＜0.01).治疗组在治疗过程中有2例(4%)出现轻度口干,对照组未发现不良反应.结论:银杏达莫注射液联合复方樟柳碱注射液治疗缺血性视神经病变安全、有效.     

复方樟柳碱注射液治疗视网膜动脉阻塞的临床观察

目的观察眼局部注射复方樟柳碱注射液治疗视网膜动脉阻塞的临床效果。方法选入医院门诊2013年8月-2018年8月间诊断为单眼视网膜动脉阻塞的病例56例56只眼,随机分成对照组28例(28只眼)和治疗组28例(28只眼)。对照组给予扩血管、营养神经药物、吸氧等一般治疗,治疗组在对照组治疗的基础上加用复方樟柳碱注射液,患眼颞浅动脉旁皮下注射。2周为一个疗程,共治疗2个疗程。观察治疗后的视力、视野以及眼底变化情况。结果治疗组总有效率为96.4%,对照组总有效率为78.6%,两组比较差异有统计学意义(P 0.05)。结论复方樟柳碱注射液治疗视网膜动脉阻塞,有显著疗效。     

经颅视神经管减压联合复方樟柳碱治疗外伤性视神经损伤的疗效

目的 观察经颅视神经管减压术联合复方樟柳碱治疗外伤性视神经损伤的治疗效果,探讨外伤性视神经病变的有效治疗方法.方法 将 32例(32眼)外伤性视神经患者随机分为经颅视神经管减压术联合复方樟柳碱治疗组(治疗组)16例(16眼),经颅视神经管减压术联合其他药物治疗组(对照组)16例(16眼).比较2组临床疗效.结果 治疗组显效6例,有效4例,无效6例,总有效率62.5%,对照组显效3例,有效3例,无效10例,总有效率37.5%.2组总有效率相比,差异有统计学意义(P<0.01),结论经颅视神经管减压联合复方樟柳碱治疗外伤性视神经病变是一种可供选择的,确切、彻底、安全有效的治疗手段.     

复方樟柳碱注射液治疗缺血性视神经病变的效果评价

探究复方樟柳碱注射液治疗缺血性视神经病变的效果。选取诊治为缺血性视神经病变患者40例,按照就诊ID号随机分为观察组与对照组,对照组实行常规治疗,观察组实行复方樟柳碱注射液联合常规治疗,比较两组治疗后MS光感度及治疗效果。经过2周治疗,观察组治疗有效率为95.0%、MS光感度为(19.1±1.4)均优于对照组的75.0%和(15.8±1.5),差异存在统计学意义(P0.05)。采用复方樟柳碱注射液联合常规治疗缺血性视神经病变具有良好的治疗效果和安全性,可有效改善患者视力水平和疾病症状,可在临床推广应用。     

复方樟柳碱治疗缺血性眼底病变的临床疗效观察

探究复方樟柳碱治疗缺血性眼底病变的临床疗效。选取2014年12月~2016年3月本院收治的80例缺血性眼底病变患者,采用随机分组方式,将其分为观察组与对照组,各40例。对照组,给予常规治疗,观察组,在常规治疗基础上,联合复方樟柳碱治疗,观察两组患者治疗效果和并发症。观察组治疗总有效率为95%,明显高于对照组的80%,差异具有统计学意义(P0.05)。同时,两组患者均无明显的不良反应。针对缺血性眼底病变患者,联合复方樟柳碱治疗,效果显著,值得广泛推广。     

复方樟柳碱对颅脑外伤合并外展神经损伤的疗效分析

目的 探讨复方樟柳碱注射液对颅脑外伤合并外展神经损伤的修复作用,经患者本人及家属同意,行复方樟柳碱注射液眼部穴位注射治疗.方法 回顾性分析2010-01-2011-05因颅脑外伤及颅内血管病变在我院康复中心进行康复治疗的患者,同时经我科会诊确诊为颅脑外伤合并外展神经损伤的共49人(53眼),其中24人(25眼)为复方樟柳碱组(治疗组),在接受康复治疗的同时行复方樟柳碱穴位注射治疗,14 d连续注射为1个疗程,实际观察时间以患者真实治疗次数为准,注射部位为受伤眼侧的太阳穴(颞浅动脉旁),注射方式为皮下注射;另25人.(28眼)为单纯康复综合治疗组(对照组),在康复中心行相关康复治疗.结果 在因外伤或自身血管病变导致颅脑损伤合并外展神经损伤的患者中,经复方樟柳碱穴位注射治疗,取得比较满意的疗效.治疗组有效14眼(治愈10眼,好转4眼),有效率56％,对照组有效7眼(治愈1眼,好转6眼),有效率25％.结论 复方樟柳碱穴位注射联合康复综合治疗颅脑外伤合并外展神经损伤效果明显.     

非动脉炎性前部缺血性视神经病变缺血部位和程度的评估及病因探讨

目的:探讨非动脉炎性前部缺血性视神经病变(nonarteriticanterioris-chemicopticneuropathy,NAION)的临床特征。方法:分析广州医学院第二附属医院眼科2000-01/2003-01已确诊的NAION患者72例(80眼),男39例(44眼),女33例(36眼);单眼发病64例(89%),双眼发病8例(11%)。排除标准:所有患者均无巨细胞性动脉炎的表现。纳入标准:病史、症状、眼底、视野、FFA结果均符合NAION的诊断标准。经视力、视野、眼底和荧光眼底血管造影(flouresceinfundusangiography,FFA)等检查确诊的前部缺血性视神经病变72例(80眼)的临床资料进行分析。结果:72例中伴有高血压动脉硬化28例(30眼),伴有糖尿病20例(24眼),伴高血脂症14例(15眼),青光眼4例(5眼),白内障术后2例(2眼),原因不明4例(4眼)。眼底视盘水肿色淡,其中呈象限性水肿21眼,半侧水肿19眼,全视盘水肿28眼,无水肿12眼。FFA早期视盘全部或部分荧光充盈延缓或缺损,显示缺血的部位和范围;晚期荧光充盈各异,缺血区呈强荧光或弱荧光,其中主要为强荧光,有68眼(85%),多见于病程较短者;视盘持续弱荧光者12眼(15%),见于病程较长者。FFA显示缺血累及的部位和范围伴有相应视野缺损者60眼(75%)。结论:前部缺血性视神经病变是一种多因性眼病,而高血压、视网膜动脉硬化、糖尿病、高血脂症     

形觉剥夺性弱视145例临床分析

目的:观察形觉剥夺性弱视的主要发病原因和影响临床治疗效果的因素.方法:回顾性分析145例(216眼)形觉剥夺性弱视患者的临床资料.结果:145例(216眼)形觉剥夺性弱视患者中,先天性白内障69例(117眼),先天性上睑下垂58例(81眼),角膜病等其他疾病共18例(18眼).平均随访24个月,基本治愈36眼(16.67%),好转127 眼(58.80%),无效53 眼(24.54% ),有效率为75.46%.临床治疗效果与手术年龄、单眼或是双眼发病、治疗依从性有关,其中手术年龄小、双眼发病、术后弱视治疗依从性好的患者疗效好,而手术年龄大、单眼发病、术后弱视治疗依从性差的患者疗效不好,两者间差异存在统计学意义(P ＜ 0.05).结论:先天性白内障和先天性上睑下垂是形觉剥夺性弱视的主要发病原因,治疗效果取决于手术年龄、患者的依从性,以及单眼或是双眼发病.     

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.