壳聚糖宫颈抗菌膜促进宫颈环形电切术术后宫颈创面恢复的临床观察

目的:观察宫颈环形电切术(LEEP)后应用西欧斯壳聚糖宫颈抗菌膜促使创面愈合、预防术后出血的临床效果。方法:选择因宫颈病变需作LEEP的患者100例,随机分成两组,采用西欧斯壳聚糖宫颈抗菌膜局部用药者50例作为治疗组,LEEP术后自然修复50例作为对照组。结果:治疗组阴道出血量、持续时间及阴道流液少于对照组(P<0.05或P<0.01),创面愈合时间较对照组缩短(P<0.05)。结论:西欧斯壳聚糖宫颈抗菌膜局部用药具有减少创面感染、渗出、出血和促进LEEP后创面愈合的作用。     

壳聚糖宫颈抗菌膜促进宫颈环形电切术术后宫颈创面恢复的临床观察

目的：观察宫颈环形电切术（LEEP）后应用西欧斯壳聚糖宫颈抗菌膜促使创面愈合、预防术后出血的临床效果。方法：选择因宫颈病变需作LEEP的患者100例，随机分成两组，采用西欧斯壳聚糖宫颈抗菌膜局部用药者50例作为治疗组。LEEP术后自然修复50例作为对照组。结果：治疗组阴道出血量、持续时间及阴道流液少于对照组（P〈0．05或P〈0．01），创面愈合时间较对照组缩短（P〈0．05）。结论：西欧斯壳聚糖宫颈抗茵膜局部用药具有减少创面感染、渗出、出血和促进LEEP后创面愈合的作用     

壳聚糖宫颈抗菌膜联合宫颈环形电切术治疗宫颈病变效果观察

目的观察壳聚糖宫颈抗菌膜联合宫颈环形电切术(loop electrosurgical excision procedure,LEEP)治疗宫颈病变的临床效果。方法选择宫颈病变100例,随机分为观察组和对照组各50例。观察组予LEEP术后采用壳聚糖宫颈抗菌膜局部用药;对照组仅采用LEEP治疗,观察两组术后阴道排液、脱痂期阴道出血及宫颈创面愈合情况。结果 LEEP术后1～2 d观察组阴道排液明显增多率高于对照组,差异有统计学意义(P<0.05)。两组均于术后7～15 d出现不同程度阴道出血,两组极少量出血与多于月经量出血的发生率比较差异有统计学意义(P<0.05);治疗后观察组不同阴道出血时间发生率与对照组比较差异有统计学意义(P<0.01)。观察组术后1、2、3个月创面治愈率明显高于对照组,差异均有统计学意义(P<0.01)。结论 LEEP术后局部应用壳聚糖宫颈抗菌膜具有减少创面感染、渗出、出血和促进创面愈合的作用。     

应用壳聚糖宫颈抗菌膜对宫颈创面愈合的影响及安全性

目的研究壳聚糖宫颈抗菌膜对于宫颈环形电切术（LEEP）后患者的治疗意义。方法选取合川区人民医院门诊收治的需行LEEP的148例女性患者作为研究对象,随机分成研究组和对照组。对照组患者于LEEP后给予口服抗生素治疗,研究组在口服抗生素的基础局部应用壳聚糖宫颈抗菌膜,观察并记录两组患者的阴道流血流液情况和创面愈合情况。结果研究组LEEP后出血量较少,仅4例阴道出血大于月经量,占5.4%;对照组术后出血大于月经量者12例,占16.2%。研究组阴道平均出血时间为（8.12±3.24）d,平均流液时间为（7.82±2.67）d,创面平均愈合时间为（3.61±0.78）周,均明显短于对照组的（15.83±2.58）d、（18.26±3.14）d、（5.72±1.12）周,两组比较差异有统计学意义（P〈0.05）。结论局部应用壳聚糖宫颈抗菌膜有利于预防LEEP后出血和感染,促进LEEP后患者的创面愈合。     

妇炎平合剂促进宫颈术后创面愈合临床观察

目的:观察妇炎平合剂治疗宫颈术后阴道排液、出血及创面愈合情况。方法:将因宫颈病变经LEEP、微波手术治疗的72例患者随机分为治疗组和对照组,每组36例,2组均在月经干净3~7d进行宫颈LEEP、微波手术。治疗组在手术结束后口服妇炎平合剂,对照组手术结束后单纯观察。比较2组患者治疗后阴道排液、阴道出血情况。结果:治疗组治疗后阴道排液量、阴道排液时间、阴道出血量及阴道出血时间均显著少于对照组,P0.05。结论:妇炎平合剂有利于减少宫颈术后阴道排液量及出血量,有利于缩短阴道排液及出血时间,促进伤口愈合。     

外敷宫颈抗菌膜内服“止血促愈汤”辅助宫颈环切术后宫颈创面恢复的临床观察

【目的】探讨宫颈环切术（Leep）后应用壳聚糖宫颈抗茵膜外敷及内服中药“止血促愈汤”,预防术后出血、促使宫颈创面愈合的临床效果。【方法】选择行电子阴道镜＋活检,诊断为宫颈病变需做Leep术的患者78例,随机分成两组,观察组39例,Leep术后采用壳聚糖宫颈抗菌膜外敷宫颈及术后内服中药“止血促愈汤”10d,对照组术后自然修复。【结果】观察组阴道出血量,出血持续时间及阴道排液创面愈合时间显著少（短）于较对照组（P〈0．01或P〈0．05）。【结论]Leep术后采用壳聚糖宫颈抗茵膜局部用药及内服中药,具有减少创面结痂脱落出血、防止创面渗出、感染,减少术后阴道排液、促进创面愈合的作用。     

中西医结合治疗宫颈糜烂的临床观察

目的观察西瓜霜、纳米银用于宫颈糜烂微波治疗后的临床疗效。方法 150例宫颈糜烂患者随机分为A、B、C组,其中A、B组在微波治疗后阴道分别应用西瓜霜、纳米银,C组微波治疗后阴道不用药物,比较3组的治疗效果。结果患者均于术后12周复查,3组患者的宫颈创面完全愈合,有效率为100%。A组、B组分别与C组比较,术后阴道排液量、阴道流血量和持续时间、创面愈合时间差异均有统计学意义(P均<0.05)。结论西瓜霜、纳米银用于宫颈糜烂微波治疗后,能有效地缩短微波治疗后的阴道排液时间及出血时间,减少术后阴道排液和流血量,促进宫颈创面愈合,提高疗效。     

壳聚糖宫颈抗菌膜治疗宫颈电环切除术后阴道出血疗效观察

目的探讨壳聚糖宫颈抗菌膜治疗宫颈电环切除术后阴道出血的临床疗效。方法将83例宫颈电环切除术后阴道出血的患者随机分成两组,A组局部应用壳聚糖宫颈抗菌膜压迫,B组用碘仿纱布压迫,比较两组止血时间,宫颈外观恢复情况。结果 A组止血时同明显短于B组,宫颈外观恢复好于B组。结论壳聚糖宫颈抗菌膜治疗宫顼电环切除术后阴道出血效果好,使用方使,有推广价值。     

Leep术后联合保妇康栓治疗慢性宫颈炎疗效观察

目的 探讨Leep(宫颈环形电切除术)联合保妇康栓治疗慢性宫颈炎的疗效.方法 回顾分析2009-01-2009-12靖江市生祠医院经Leep治疗慢性宫颈炎患者170例,其中100例为保妇康栓治疗组,70例为对照组,进行阴道排液量,排液时间、出血量、出血时间、宫颈创面愈合程度及愈合时间情况的比较.结果 经Leep术联合保妇康栓治疗的病例均获得成功.与对照相比,具有出血量少、出血时间短、阴道排液量少,排液时间短等优点.结论 保妇康栓可安全有效的用于慢性宫颈炎Leep术后治疗的辅助治疗.     

宫腔镜宫颈病变电切术与宫颈环形电切术治疗低级别宫颈上皮内瘤变的临床研究

目的比较宫腔镜宫颈病变电切术(TCRC)与宫颈环形电切术(LEEP)治疗低级别宫颈上皮内瘤变(CIN)的临床疗效。方法 84例低级别CIN患者(≤CINⅡ),分别采用TCRC与LEEP进行治疗,观察2组手术时间、术中出血量、术后出血及排液时间、创面愈合时间及病理诊断符合率。结果 TCRC组术中出血量少于LEEP组[(5.3±1.7)mL vs.(10.2±5.0)mL,P<0.05],术后2组出血及排液时间、创面愈合时间、病理诊断符合率、宫颈狭窄发生率比较均无统计学意义。结论 TCRC和LEEP是治疗低级别CIN的有效方法,TCRC在术中出血及对宫颈深部病变者术后优于LEEP。     

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.