糖尿病病人早期视网膜神经纤维层厚度观察及护理

[目的]探讨无明显糖尿病(DM)视网膜病变(NDR)及轻、中度非增生性糖尿病视网膜病变(NPDR)病人视盘周围视网膜神经纤维层厚度的变化及护理措施。[方法]选择我院门诊普查的2型糖尿病病人128例(256只眼),依据检查结果按照糖尿病视网膜病变(DR)国际分期标准分为NDR组42例(79只眼)、轻度NPDR组46例(89只眼)、中度NPDR组45例(88只眼)。选择正常人38例(76只眼)为对照组,所有受检者瞳孔散大后均行光学相干断层扫描(OCT)对视盘周围视网膜神经纤维层(RNFL)厚度进行扫描。[结果]DM病人视盘周围视网膜神经纤维层厚度较正常对照组均较薄,NDR组上方象限,轻度NPDR组上、下象限和中度NPDR组各象限及全周平均视网膜神经纤维层厚度与对照组比较差异有统计学意义(P0.05)。[结论]随着DM病人视网膜病变程度的增加,视盘周围RNFL厚度逐渐降低。DM早期OCT定量检测RNFL厚度变化,为严格控制血糖情况下疾病的转归提供了可靠的有力依据。DM早期加强护理指导,对于预防延缓DR发生发展有着重要的意义。     

光学相干断层扫描测量视网膜神经纤维层厚度及视盘参数在青光眼早期诊断中的应用价值

目的对OCT测量视网膜神经纤维层厚度及视盘参数在青光眼早期诊断中的应用价值进行探究。方法选取32只眼疑似闭角型青光眼(SG)患者、34只眼慢性闭角型青光眼(CACG)早中期患者以及同期10只正常眼对其进行OCT(光学相干断层扫描)RNFL(视网膜神经纤维层)厚度检测,比较各自组RNFL厚度及相关视盘参数数据(视乳头水平、垂直杯盘比及杯/盘面积比的均数)。结果三组视盘参数中的水平杯盘比、垂直杯盘比以及杯/盘面积比相比均具有统计学差异(P 0.05);健康组上方、下方以及平均RNFL厚度均与疑似SG组具有明显差异,(P 0.05);鼻侧、颞侧RNFL厚度相比无明显统计学差异,(P0.05);健康组各象限RNFL厚度以及平均RNFL厚度与CACG组相比具有明显差异,(P 0.05);疑似SG组上方、下方、鼻侧以及平均RNFL厚度相比于CACG组具有明显差异,(P 0.05),颞侧RNFL厚度相比无明显统计学差异,(P0.05)。结论临床应用OCT测量视网膜神经纤维层厚度及视盘参数,实现了对病情进展的监测,有利于青光眼的早期诊断。     

光学相干断层扫描观察2型糖尿病患者视盘周围视网膜神经纤维层厚度及黄斑区视网膜厚度的变化

【目的】应用光学相干断层扫描（OCT）观察2型糖尿病患者视盘周围视网膜神经纤维层（RNFL）厚度及黄斑区视网膜厚度的变化。【方法】采用OCT测量正常对照组、无糖尿病视网膜病变（NDR）组及非增殖期糖尿病视网膜病变（NPDR）组患者视盘周围RNFL厚度及黄斑区视网膜厚度的变化。【结果】在视乳头旁RNFL厚度比较中,NDR组与正常对照组比较变薄,NPDR组与正常对照组比较变厚。在黄斑区视网膜厚度比较中, NDR组与正常对照组比较变薄,NPDR组与正常对照组比较变厚。【结论】OCT能定量观察糖尿病患者视盘周围RNFL厚度及黄斑区视网膜厚度的变化,为糖尿病视网膜病变的诊断及治疗提供可靠的检测手段。     

光学相干断层扫描仪对高度近视合并原发性开角型青光眼患者早期诊断的作用

目的 探讨光学相干断层扫描仪对高度近视病情监测和高度近视合并原发性开角型青光眼早期诊断的作用。 方法 应用光学相干断层扫描仪检测正常人、单纯高度近视和高度近视合并原发性开角型青光眼患者视网膜视神经纤维层厚度,分析高度近视和高度近视合并原发性开角型青光眼患者视网膜视神经纤维层全周及各象限的厚度变化。 结果 与正常人比较,高度近视组视网膜视神经纤维层全周、上方、下方、鼻侧厚度变薄,颞侧厚度增加;正常组与高度近视合并原发性开角型青光眼组全周及各象限厚度均明显变薄;与高度近视组比较,高度近视与高度近视合并原发性开角型青光眼组全周及各象限厚度均明显变薄。 结论 光学相干断层扫描仪检测视网膜视神经纤维层厚度改变,有利于高度近视的临床跟踪监测及高度近视合并原发性开角型青光眼早期诊断。     

视神经MRI结合OCT对视神经脊髓炎谱系疾病与多发性硬化患者视功能损害的分析

目的通过视神经增强MRI结合光学相干断层扫描(OCT)观察视神经脊髓炎谱系疾病(NMOSD)和多发性硬化(MS)患者的视路病变长度及强化特点、视网膜神经纤维层(RNFL)和黄斑区神经节细胞复合体(GCC)厚度,分析NMOSD与MS不同疾病导致的视功能损害的特点。方法回顾性收集兰州大学第二医院神经内科收治的NMOSD患者70例、MS患者40例及正常健康人70例。通过视神经增强MRI观察视路病变强化特点并测量病变长度;通过OCT测量RNFL(包括平均和上方、下方、鼻侧、颞侧4个象限)和GCC(包括平均和上方、下方2个象限)的厚度进行比较分析。结果与MS组相比,NMOSD组视路病变强化的现象明显增多,更容易累及视交叉和视束,病变长度也明显增加(P0.01); NMOSD组和MS组RNFL及GCC厚度均较正常对照组减少(P0.01),与MS组相比,NMOSD组RNFL及GCC厚度更薄(P0.01)。结论 NMOSD患者比MS患者视路病变更广泛,可呈现视神经眶内段到视交叉较长节段的病变,且损害程度更严重。     

视网膜相干断层扫描联合Octopus视野计在鉴别青光眼和高眼压中的应用

目的研究视网膜相干断层扫描(OCT)联合Octopus视野计在鉴别正常人、青光眼和高眼压的应用价值。方法收集2013年9月-2015年8月在我院眼科诊治的原发性开角青光眼患者170例(青光眼组),高眼压症患者410例(高眼压组),正常者为对照组80例。均采用OCT联合Octopus视野计检测。结果与正常对照组比较,青光眼组和高眼压组上方、下方、颞侧和鼻侧视网膜神经纤维层厚度及黄斑区视网膜厚度水平均明显降低(P0.05),与高眼压组比较,青光眼组上方、下方、颞侧和鼻侧视网膜神经纤维层厚度及黄斑区视网膜厚度水平均明显降低(P0.05)。与正常对照组比较,青光眼组和高眼压组CA、CV、C/D、水平C/D和垂直C/D均表现出显著增加(P均0.05),而RA和RV则显著降低(P均0.05);与高眼压组比较,青光眼组CA、CV、C/D、水平C/D和垂直C/D均表现出显著增加(P均0.05),而RA和RV则显著降低(P均0.05)。与正常对照组比较,青光眼组和高眼压组MS值显著降低(P0.05),而MD值则明显升高(P0.05);与高眼压组比较,青光眼组MS值显著降低(P0.05),而MD值则明显升高(P0.05)。结论 OCT联合Octopus视野计检测能为高眼压和原发性开角型青光眼的诊断及二者的鉴别提供帮助。     

合并OSA对NAION患者的视网膜神经纤维层厚度的影响

目的:探讨合并阻塞性睡眠呼吸暂停症(Obstructive Sleep Apnea,OSA)对非动脉炎性前部缺血性视神经病变(Non Arteritis Anterior Ischemic Optic Neuropathy,NAION)的视网膜神经纤维层厚度的影响。方法:回顾性分析2018年1月至2019年12月解放军总医院第一医学中心眼科就诊的138例NAION患者的光学相干断层扫描(Optical Coherence Tomography,OCT)和便携式睡眠呼吸监测结果。选择患者的视网膜神经纤维层厚度(Retinal Nerve Fiber Layer,RNFL)测量结果和睡眠呼吸监测相关指标。结果:在诊断NAION的患者中,OSA的患病率达到69. 6%。按照OSA严重程度划分,中度OSA患者和重度OSA患者的左上侧RNFL差异有统计学意义(P=0. 038,P 0. 05);按照低氧程度划分,左眼上侧(P=0. 006,P 0. 05)、鼻侧的RNFL厚度在轻度缺氧和中度缺氧OSA患者组别之间差异有统计学意义(P=0. 012,P 0. 05);左眼的上侧(P=0. 022,P 0. 05)、鼻侧(P=0. 047,P 0. 05)在中度和重度缺氧OSA患者组间差异有统计学意义;左眼下侧的RNFL在中度和重度缺氧OSA患者组间差异有统计学意义(P=0. 026,P 0. 05);右眼的平均RNFL在血氧正常组与重度缺氧组间差异有统计学意义(P=0. 022,P 0. 05)。相关性分析未发现REI指数和RNFL、ODI指数和RNFL有显著相关性。结论:合并OSA的NAION患者的视网膜神经纤维层厚度明显低于非合并OSA的NAION患者。患者的最低血氧饱和度越低,视网膜神经纤维层厚度也越薄,建议合并NAION患者均进行睡眠监测以筛查病因。     

糖尿病视网膜病变视网膜神经纤维层厚度与相关生长因子变化研究

目的探讨糖尿病视网膜病变(DR)患者视网膜神经纤维层(RNFL)与相关生长因子变化情况。方法将研究对象分为糖尿病无视网膜病变(NDR)组41例、轻度非增生性糖尿病视网膜病变(DRP)组23例、中度DRP组25例、重度DRP18例、增生性糖尿病视网膜病变(PDR)组38例、正常对照组35例,比较各组RNFL厚度、神经生长因子(NGF)、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)。结果 RNFL厚度:与正常对照组比较,NDR组、轻度DRP组RNFL厚度减薄,重度DRP组、PDR组RNFL厚度增厚(P005);与NDR组、轻度DRP组比较,中度DRP组、重度DRP组、PDR组RNFL厚度增厚(P005);与中度DRP组比较,PDR组RNFL厚度增厚(P005)。相关生长因子:与正常对照组、NDR组、轻度DRP组比较,中度DRP组、重度DRP组、PDR组NGF、VEGF、bFGF明显升高(P005,P001);与中度DRP组比较,重度DRP组、PDR组NGF、VEGF、bFGF升高(P005);与重度DRP组比较,PDR组NGF、VEGF、bFGF升高(P005)。结论轻度非增生患者视网神经纤维厚度明显减薄,中重度非增生、增生性患者视网神经纤维厚度明显增厚,NGF、VEGF、bFGF变化可能参与了这一演变进展。     

经频域相干光断层扫描检测视乳头形态、RNFL厚度诊断青光眼的价值分析

目的研究经频域相干光断层扫描检测视乳头形态、视网膜神经纤维层(RNFL)厚度诊断青光眼的价值。方法选择2017年1月至2019年3月来郑州市第二人民医院诊治的182例青光眼患者作为研究对象,根据视野平均缺损程度分为早期(73例)与中晚期组(109例),另选取同期进行体检的正常人100人作为对照组,均采用经频域相干光断层扫描检测视乳头形态、RNFL厚度,并对检测结果进行比较分析。结果对照组研究对象视盘面积(DA)为(2. 49±0. 32) mm2,早期组为(2. 43±0. 34) mm2,中晚期组为(2. 39±0. 38) mm2,三组比较差异未见统计学意义(P 0. 05),但早期组、中晚期组患者与对照组其余视乳头形态参数比较差异有统计学意义(P 0. 05);早期、中晚期青光眼患者RNFL厚度均值的ROC曲线下面积(AUROC)和敏感度最高;早期患者杯盘比(C/D)的AUROC和敏感度最大,中晚期患者垂直C/D的AUROC和敏感度最大。结论经频域相干光断层扫描可客观准确的检测视乳头形态以及RNFL厚度的改变,同时视乳头形态以及RNFL厚度参数可作为早期青光眼的诊断指标。     

轻、 中度非增生性糖尿病视网膜病变(NPDR)患者视盘周围视网膜神经纤维层厚度的变化及护理措施

目的 观察分析轻、中度非增生性糖尿病视网膜病变(NPDR)患者视盘周围视网膜神经纤维层(RNFL)厚度的变化,并总结其护理措施.方法 选取我院于2013年1月~2014年1月收治的108例2型糖尿病患者,共216只眼,根据糖尿病视网膜病变分期标准,分为轻度NPDR组(52例,104只眼)、中度NPDR组(56例,112只眼),选择同期健康体检者40例作为对照组,所有患者均接受光学相干断层扫描,分析不同病变组患者视盘周围视RNFL厚度的变化,并对其护理措施进行分析总结.结果 轻度NPDR组视盘周围RNFL厚度为(102.34±8.45)μm;中度NPDR组视盘周围RNFL厚度为(101.54±6.01)μm,低于对照组的(106.48±9.24)μm(P<0.05).轻度NPDR组上方、下方RNFL厚度均较对照组低(均P<0.05);中度NPDR组上方、下方、鼻侧、颞侧RNFL厚度均较对照组低(均P<0.05).结论 糖尿病患者视盘周围神经纤维层厚度变化随着视网膜程度的增加而逐渐降低,加强糖尿病早期光学相干断层定量检测,密切观察患者视盘周围RNFL厚度变化,同时加强糖尿病早期护理指导,对预防糖尿病的发展有重要的临床价值.     

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.