脑脊液Tau蛋白测定在老年性痴呆诊断中的意义

目的 探讨阿尔茨海默病（AD）患脑脊液Tau蛋白含量变化的临床意义。方法 采用夹心酶联免疫吸附法（ELISA）测定了18例AD、16例多发性梗死性痴呆（MID）、19例其他神经系统疾病患脑脊液中Tau蛋白含量。结果 脑脊液中Tau蛋白含量，3组间差异有非常显意义（P＜0．01）；AD组与MID组间及AD组与对照组间差异均有非常显意义（分别为P＜0．01和P＜0．01）；MID组和对照组间差异无显意义（P＞0．05）。AD组患脑脊液中Tau蛋白含量随年龄有增高趋势，但统计学检验与年龄无相关关系（P＞0．05）。轻、中、重度痴呆患间的差异无显性（P＞0．05）。结论 脑脊液Tau蛋白的升高有助于AD的诊断和鉴别诊断。     

吗啡控释片剖宫产术后镇痛88例临床分析

目的 探讨吗啡控释片术后镇痛效果及对子宫缩复影响。方法 选择剖宫产术产妇264例随机分成3组，I组术后予吗啡控释片塞肛；Ⅱ组术毕单次硬膜外腔注入少量稀释吗啡；Ⅲ组哌替啶肌肉注射。分别观察术后镇痛效果、持续时间、子宫缩复情况。结果 镇痛效果比较：I组与Ⅱ组无显差异（P＞0．05）I组与Ⅲ组有显性差异（P＜0．05）。子宫缩复：I组与Ⅱ组有显性差异（P＜0．05）；I组与Ⅲ组无显性差异（P＞0．05）。结论 吗啡控释片镇静痛效果满意，使用简便，是一种较理想的术后镇痛方法。     

推拿并中药外敷治疗慢性膝关节滑膜炎疗效分析

目的：观察推拿结合中药外敷治疗慢性膝关节滑膜炎的效果。方法：69例患，随机分推拿结合中药外敷治疗组（治疗组）39例，中药外敷结合理疗治疗组（对照组）30例。结果：治疗组显效率71．8％，总有效率97．4％；对照组显效率43．3％，总有效率76．7％。两组显效率比较，差异有显性意义（P＜0．05）。总有效率比较，差异也有显性意义（P＜0．05）。结论：推拿结合中药外敷治疗慢性膝关节滑膜炎明显提高疗效。     

缬沙坦治疗原发性高血压男患勃起功能障碍(附130例临床观察)

目的：探讨缬沙坦治疗原发性高血压男患勃起功能障碍（ED）的有 性及安全性。方法：轻中度原发性高血压ED田患260例，随机分为治疗组及对照组各130例，治疗组给予缬沙坦80mg，1次／d，口服；对照组给予氨氯地平5mg,1次／d，口服，疗程均8周，观察两组治疗前后勃起功能指数（IIEF）变化，降压效果及对肾功能，血电解质的影响。结果：治疗组IIEF明显高于对照组（P＜0．01），两组降压效果无明显差异（P＞0．05），缬沙坦对肾功能及血电解质无明显影响（P＞0．05），结论：缬沙坦可明显改善原发性高血压男患勃起功能障碍。     

失语症早期康复的方法及疗效

目的：探讨失语症早期康复的方法及疗效。方法：将60例失语症患随机分为早期康复组、延迟康复组、对照组。合理组合语言训练手段进行1个月的治疗。用中国康复中心失语检查法（Chinese rehabilotation research center aphasia examination,CRRCAE)在治疗前后进行评价并进行3组间比较。结果：治疗前3组间CRRCAE评分无显差异（P＞0．05）。治疗后，早期康复组和延迟康复组与对照组比，均有极显差异（P＜0．01）。早期康复组与延迟康复组比，有显差异（P＜0．05）。结论：（1）语言康复训练对失语症患语言功能的恢复有肯定疗效。（2）早期语言康复较延迟康复，康复效果更明显。（3）合理组合语言训练手段更适合个体化的治疗。     

慢性心力衰竭患者血清睾酮和雌二醇测定及其意义

目的：探讨慢性心力衰竭患血清睾酮和雌二醇的改变及临床意义。方法：采用放射免疫法测定110例慢性心力衰竭（CHF）患血清睾酮和雌二醇水平。结果：CHF组血清雌二醇、睾酮和雌二醇／睾酮比值均显低于对照组（P均＜0．05）；I、Ⅱ、Ⅲ度心力衰竭组间血清睾酮和雌二醇依次递减，方差检验具有显性差异（P＜0．01）；住院期间死亡组血清雌二醇水平显低于好转出院（P＜0．05），但睾酮无显差异（P＞0．05）。结论：测定血清睾酮、雌二醇水平，有助于慢性心力衰竭发病机理的探讨和预后的判断。     

降纤酶溶栓治疗急性脑梗塞34例临床分析

目的：为了初步研究降纤酶溶栓治疗脑梗塞的效果及安全性。方法：将急性脑塞分为溶栓组和对照组，溶栓组（34例）给予降纤酶治疗；对照组（22例）用复方丹参注射液，分别观察疗效。结果：治愈显效率溶栓组高于对照组（P＜0.05），分别为52.94％，22.73％，早期疗效（治疗6h内）溶栓组优于对照组。结论：降纤酶静脉溶栓治疗安全有效，早期疗效显著。     

托玛琳治疗退行性骨关节疾病和软组织伤病的作用

目的 观察托玛琳对退行性骨关节疾病、软组织伤病的作用。方法 随机选择退行性骨关节疾病、软组织损伤等患60例，随机分为观察组和对照组各30例。观察组采用含托玛琳的德玛健康寝具进行治疗。对照组患视病变的不同分别采用较常用的理疗方法进行治疗。分别采用目测类比评分（VAS）和临床疗效评定来评定治疗效果。结果 两组治疗前与治疗后的疼痛评分和症状评分比较均差异有非常显性意义（P＜0．01）；两组之间比较，治疗后的疼痛评分和临床症状评分差异无显性意义（P＞0．05），临床治疗有效率也差异无显性意义（P＞0．05）。结论 托玛琳对软组织伤病和机体组织退行性疾病等引起的各种临床症状和体症有明显的治疗和缓解作用。     

认知治疗对改善精神分裂症患者自知力的疗效分析

目的：探讨认知治疗对精神分裂症患自知力的作用。方法：将100例精神分裂症患随机分成对照组和研究组50例，两组均接受抗精神病药物治疗，研究组另加认知治疗，两组分别于疗效及疗后3个月进行简明精神病评定量表（BPRS）和自知力与治疗态度问卷表（ITAO）评查，结果BPRS和ITAQ疗效评查两组比较差异无显性意义（P＞0．05），疗后评查两组比较差异有显性意义（P＜0．05），结论：认知治疗有助于精神分裂症患自知力恢复和病情改善。     

刺络拨罐加紫外线对带状疱疹的镇痛治疗作用观察

目的 探讨刺络拔罐加紫外线对带状疱疹的镇痛及治疗作用。方法 利用刺络拔罐、紫外线、超短波对76例带状疱疹患分两组进行临床观察，治疗前后分别对患行疼痛评分测定并进行对照比较。结果 两组患治疗前疼痛评分差异无统计学意义（P＞0．05），6次治疗后两组的疼痛评分差异有非常显意义（P＜0．01），两组疗效比较差异有非常显意义（P＜0．01）。结论 刺络拔罐加紫外线治疗带状疱疹镇痛效果及疗效均明显优于超短波加紫外线组。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.