微波加牵引治疗腰椎间盘突出症200例疗效分析

微波加牵引治疗腰椎间盘突出症200例，治愈显效率81％，总有效率98％；单独牵引治疗50例为对照．治愈显效率26％；总有效率66％。两组治愈显效及有效率经统计学处理P<0.01．有非常显性差异。微波治疗无创伤．无痛苦．疗效显，配合牵引可大大提高临床治疗效果。     

旋转复位与牵引治疗神经根型颈椎病的随机对照疗效分析

目的：探讨旋转复位手法治疗神经根型颈椎病的效果。方法：选择100例神经根型颈椎病患者，随机分为手法组和牵引组，两组均加物理因子治疗(超短波和电脑中频)。治疗4周及8周后评定疗效。结果：在4周后手法组有效43例，总有效率为86．0％；牵引组有效29例，总有效率为58．0％，两组差异有显著性意义(χ^2=5．49，P&;lt;0．05)；在8周后手法组总显效例数42例，总显效率为84．0％；牵引组总显效例数27例，总显效率54．0％，两组差异有显著性意义(χ^2=5．79，P&;lt;0．05)，说明手法组有效率较牵引组高。结论：旋转复位手法较颈椎牵引疗效佳。     

牵引治疗脊髓型颈椎病疗效观察

目的：观察牵引治疗脊髓型颈椎病的疗效．探讨去除脊髓型颈椎病病因的最佳方法。方法：采用坐式颈椎牵引．对128例脊髓型颈椎病患按发病症状、体征及发病部位不同进行严格掌握牵引角度．牵引力及牵引时间给予治疗。结果：治愈率3．1％．显效率21.9％,好转率72.7％,无效23％,总有效率97．7％。结论：改变了传统的认为脊髓型颈椎病不宜牵引的看法．认为牵引对脊髓型颈椎病是行之有效的方法,但颈椎牵引角度．牵引力和牵引时间要掌握适当。     

牵引综合治疗颈椎病105例初步观察

分别采用牵引多加功能康复仪和牵引加场效应治疗颈椎病105例。男47例，女58例。结果表明，牵引加多功能康复仪治疗，显效率56．9％；牵引加场效应治疗仪（魔带）治疗，显效率50％，两组差异无显著性意义（P＞0．05）。神经根、椎动脉型颈前屈30°位疗效满意，脊髓型颈屈中穴位效果最佳，伴有项韧带钙化者颈屈30°位效果差。     

牵引治疗脊髓型颈椎病疗效观察

目的：观察牵引治疗脊髓型颈椎病的疗效,探讨去除脊髓型颈椎病病因的最佳方法。方法：采用坐式颈椎牵引,对１２８ 例脊髓型颈椎病患者按发病症状、体征及发病部位不同进行严格掌握牵引角度,牵引力及牵引时间给予治疗。结果：治愈率３．１％ ,显效率２１ ．９ ％ ,好转率７２．７％ ,无效２ ．３ ％ ,总有效率９７ ．７ ％ 。结论：改变了传统的认为脊髓型颈椎病不宜牵引的看法,认为牵引对脊髓型颈椎病是行之有效的方法,但颈椎牵引角度,牵引力和牵引时间要掌握适当。     

自拟中药方辨证治疗颈椎病的效果评定

104例颈椎病患者分为治疗组54例，对照组50例。治疗组给予中医辨证内外用药及颈椎牵引法，对照组采用口服西药双氯芬酸钠缓释胶囊(戴芬)加颈椎牵引方法。结果表明治疗组显效率为75．9％，总有效率为92．6％；对照组显效率为50．0％。总有效率为82．0％。同时对治疗前后患者的疼痛进行VAS评分。两组比较，治疗组的显效率高于对照组(X^2=7．53，P&;lt;0．01)；且治疗组的疼痛缓解程度明显优于对照组(t’=10．17,P&;lt;0．01)。说明中医辨证内外用药加颈椎牵引是治疗颈椎病的有效方法，并能提高疗效。     

三维牵引治疗腰椎间盘突出症的疗效及JOA对其预测价值

目的：观察计算机控制三维牵引治疗腰椎间盘突出症的临床疗效，探讨腰椎间盘突出症患者的JOA水平对疗效的预测价值。为这一技术的临床疗效预测提供依据，实现量化控制。方法：采用通过JOA下腰痛评分系统评分，根据分值水平（由低到高）将156例腰椎间盘突出症患者分为3组，均采用计算机控制三维牵引治疗，牵引距离55～65mm，下倾角度-8—-12°，旋转角度±10～15°，观察疗效与JOA分值的关系。结果：A组（11～15分）有效率和显效率分别达96．2％、52．8％，B组（16～21分）有效率和显效率分别达95．83、58.3％，C组（22—26分）有效率和显效率分别达74．2％和29．0％。结论：计算机控制三维牵引治疗腰椎间盘突出症对较低分水平（〈21分，临床症状、体征较重）之间的临床疗效无明显差异，对较低分水平比对高分水平（〉22分，临床症状、体征较轻）的临床疗效均显著。[著者文摘]     

神经根型颈椎病平仰卧位加压牵引治疗体会

目的：研究运用平仰卧位加压牵引方法治疗神经根型颈椎病。方法：９３例患者随机抽样分组以不同的牵引方法，两组均并配合其它同样辅助疗法。结果：平仰卧位加压牵引组显效率９１．５％，优于对照组。结论：平仰卧位加压牵引方法疗程短、疗效快，既安全又方便，易被患者接受     

磁热振配合牵引治疗腰椎间盘突出症

目的观察磁热振疗对腰椎间盘突出症的治疗意义方法９２例腰椎间盘突出症病人分为２组：单纯腰椎牵引组４０例，磁热振加腰椎牵引组５２例。腰椎牵引首次牵引重量为病人体重的一半，以后根据病情适当调整。采用间歇牵引方式。磁热振仪磁场强度为１２０～６２０Ｇａｕｓ，温度为４０～６０℃。结果单纯牵引组治愈显效率４２％；磁热振加牵引组治愈显效率９６％。两组治愈显效率相比，Ｐ＜０．０５，有显著差异。～１０次时磁热振加牵引组有效３５例；单纯牵引组有效１５例。两组起效次数相比差异显著，Ｐ＜０．０１。结论磁热振疗法同时具有交变与脉冲磁场相交替、温热及微振功能，可较快地缓解肌肉痉挛，增强腰椎牵引的疗效。     

远红外线磁疗型颈椎牵引器的临床研究

目的：探讨远红外线磁疗型颈椎牵引器的临床疗效，并验证其在家庭中应用的多功能颈椎牵引治疗作用及安全性。方法：选择神经根型颈椎病患者60例，实验组应用远红外线磁疗型颈椎牵引器行家庭牵引治疗30例，与医院中的牵引治疗30例对照分析。结果：实验组治愈2例、显效8例、有效17例、无效3例，其总有效率为90％；在医院中做牵引治疗30例，结果显示临床治愈4例、显效16例、有效19例。其总有效率为100％，两组的总有效率比较，r=3．1579，P&;gt;0．05．差异无显著性意义；两组的总显效率分别为33．3％和66．7％，两组的显效率比较，r=6．6667，P&;lt;0．01，差异有显著性意义。结论：远红外线磁疗型颈椎牵引器可采用仰卧位牵引，悬挂在椅子上使用，牵引角度和重量可灵活调节，磁疗和远红外线效果伍用，方便颈椎病患者的家庭治疗。     

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.