1例蛎壳状银屑病患儿的护理

银屑病是一种常见的皮肤病,皮损特征是在红色丘疹或斑块表面覆盖多层银白色鳞屑,轻轻搔抓便有白色鳞屑脱落,以四肢伸侧、头皮和背部居多.银屑病的分类方法有很多,其中蛎壳状银屑病(psoriasis rupioides)是根据皮损发展过程中的形状表现而得名的.该病比较少见,目前尚无相关统计资料.其特征是皮损糜烂、渗出,干燥后形成污褐色鳞屑痂,并重叠堆积,如蛎壳状.广泛的蛎壳状皮损、关节损害及发热等全身症状常常伴发,通常是慢性病程,数年不愈.1个多月以前我院收治1例壳状银屑病患儿,经过我院医护人员精心地治疗和护理,患儿病情好转,现将具体情况介绍如下.     

1例蛎壳状银屑病患儿的护理

银屑病是一种常见的皮肤病，皮损特征是在红色丘疹或斑块表面覆盖多层银白色鳞屑，轻轻搔抓便有白色鳞屑脱落，以四肢伸侧、头皮和背部居多。银屑病的分类方法有很多，其中蛎壳状银屑病（psoriasis rupioides）是根据皮损发展过程中的形状表现而得名的。该病比较少见，目前尚无相关统计资料。其特征是皮损糜烂、渗出，干燥后形成污褐色鳞屑痴，并重叠堆积，如蛎壳状。广泛的蛎壳状皮损、关节损害及发热等全身症状常常伴发，通常是慢性病程，数年不愈。1个多月以前我院收治1例壳状银屑病患儿，经过我院医护人员精心地治疗和护理，患儿病情好转，现将具体情况介绍如下。     

银屑病患者血液流变学、载脂蛋白与CRP检测的临床应用

银屑病是有多种因素引起的顽固复发性炎症性皮肤病，典型皮损为鳞屑性红斑，以皮损覆银白色鳞屑为特点，常易复发。其确切病因尚未清楚。目前认为，银屑病是遗传因素因素与环境因素等多种因素相互作用的多基因遗传病，通过免疫介导的共同通路最后引起角质形成细胞发生增殖。有研究报道，银屑病患者血液粘度升高，存在内源性甘油三醋水平及其运转升高，易伴发高脂血症、动脉硬化等疾病，     

银屑病的临床表现与诊断

1银屑病的临床表现1.1寻常型银屑病损害可见于全身各处,多对称发生。皮损初期为红色丘疹或斑丘疹,粟粒至绿豆大小,以后可逐渐扩大融合成红色斑片,境界清楚,基底浸润明显,皮损表面覆有多层银白色鳞屑,易刮除。去除表面鳞屑可见一层淡红色发亮薄膜,再刮除薄膜,出现筛状小出血点,称为“点状出血现象”。白色鳞屑、发亮薄膜和点状出血是本病的临床特征。1.1.1皮损表现形式点滴状银屑病：表现为粟粒至绿豆大小丘疹,呈点滴状散布全身。钱币状银屑病：损害较大,呈圆形斑片状。地图状银屑病：损害不断扩大,相互融合呈大片不规则状。     

他克莫司治疗肝移植伴银屑病一例

患者男，40岁，体重65kg，1996年底无明显诱因出现头面颈部多发皮损，色艳，鳞屑多，结合活检病理，空军总医院皮肤科确诊为银屑病；此后持续服用中药结合物理疗法治疗银屑病，疗效不佳，至2007年底皮损范围逐渐扩展至全身；肝移植前患者银屑病病情始终处于进行期，即新发皮损多，炎症重，鳞屑较厚，同形反应等表现。     

中药药浴联合紫外线治疗寻常型银屑病的观察护理

<正>寻常型银屑病,是一种临床最常见的银屑病,是反复发作的慢性炎症性皮肤病,是遗传与环境等多种因素相互作用的多基因遗传性疾病,其发生机制与一种免疫介导有关,目前尚无完全治愈的方法。患者主要症状为境界清楚的红斑丘疹鳞屑性皮损,并伴有瘙痒感。为了缓解患者的皮损症状如红斑和鳞屑症状,改善脱屑,减轻瘙痒感,提高患者生活质量,我院应用中     

银屑病患者心身健康状况与心理干预研究现状

银屑病是一种以皮肤代谢障碍产生慢性丘疹红斑鳞屑性皮损为主要特征的疾病,男性患病率高于女性,好发于青壮年。现代医学认为,银屑病是多因素导致的机体免疫功能失衡引起的一种心身疾病,其发病可能与感染、环境、免疫、代谢及精神等诸多因素有关,     

四联法在银屑病治疗中的运用

银屑病俗称"牛皮癣",是一种常见并易复发的以表皮增生和炎症为特征的皮肤病,属祖国医学"白庀"范畴.其皮损以红斑鳞屑为主,强行剥去鳞屑,有点状出血如匕首所刺之状,故称"白庀".四联法是在传统经络理论的基础上,经临床总结出的一套治疗银屑病的新方法.现将其具体疗法特点介绍如下.     

银屑病患者心理分析及心理干预

银屑病俗称"牛皮癣",是以银白色鳞屑、发亮薄膜和点状出血为主的慢性复发性非传染性炎症性皮肤病,病程较长,其鳞屑、皮损等症状及其顽固易复发性,严重影响着患者的心身健康.在治疗银屑病的同时,针对患者的心理问题予以护理干预,能有效缓解或消除患者的不良情绪,帮助患者摆脱银屑病的困扰.为此,我们分析了银屑病患者的心理问题,并予以针对性地护心理干预,取得了较满意的效果,现报告如下.     

银屑病患者性格特征与焦虑抑郁状况调查

银屑病是一种以皮肤代谢障碍产生慢性丘疹红斑鳞屑性皮损为主要特征的疾病。其发病原因与感染、环境、免疫、代谢及精神等诸多因素有关。现代医学认为本病属于心身疾病范畴,心理社会因素对银屑病的影响已受到人们的普遍关注。有文献报道,精神因素是银屑病发作或加重的重要诱因之一。为此,我们对银屑病患者的性格特征与焦虑抑郁状况进行了相关调查,以期为银屑病的预防和治疗提供依据。     

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.