1002例消化性溃疡临床分析

目的：为研究消化性溃疡的发病特点。方法：回顾性分析我院12年内1002例消化性溃疡的临床资料。结果：消化性溃疡的检出率为21．51％，男女之比为3．21：1，十二指肠溃疡占80．04％,胃溃疡占14．37％，两者之比为5．57：1。结论：消化性溃疡检出率十二指肠溃疡多于胃溃疡，好发于气温易变的春秋季节，好发部位十二指肠溃疡以球部前壁与大弯侧为多；胃溃疡以胃角与胃体部为多；消化性溃疡的高峰年龄为21～50岁；并发症以出血为最多。     

236例消化性溃疡的发病特点及胃镜特征

本院1986年11月至1996年10月行胃镜检查1053例，其检出消化性溃疡(PU)236例，检出率224％；其中十二指肠溃疡(DU)190例，占805％；胃溃疡(GU)32例，占13．6％；二之比为59：1；复台性溃疡(CU)14例，占5.9％。PU中男164例，占69.5％，女72例，占30.5％；DU中男132例，占69.5％，女58例，占30.5％：男女之比为均为23：1。GU中男20例，占62.5％，女12例，占37.5％，男女之比17：1。CU中男12例，女2例，男女之比为6：1。DU30岁～39岁组最多，占37.4％。CU30岁～39岁组占43.8％，50岁以上占37．5％。CU40岁～59岁组占64.3％。春季、夏季、秋季、冬季PU发病分别为23.3％、17.8％、25.8％和33.1％。DU92．6％发生在十二指肠球部，球后溃疡占7.4％。位于球前壁、大弯、小弯和后壁的溃疡依次为43.5％、21.5％、20.9％和6.7％。GU部位：幽门前区和胃窦46.9％，胃角43.8％,胃体3.1％，胃底6.2％。CU中的胃溃疡数与十二指肠溃疡数之比为1.4：1；其胃部溃疡92.3％发生在胃角、胃窦和幽门前区；其十二指肠溃疡44.4％位于球前壁。DU中霜斑样溃疡占11.1％。PU的伴随疾病中，检出各类慢性胃炎71.6%;DU伴发疣状胃炎都13.7％。     

老年人消化性溃疡166例胃镜分析

目的了解我院老年人消化性溃疡（Pu）发病特点。方法分析166例老年人消化性溃疡胃镜报告结果。结果老年人PU的检出率为10.78％,男女之比为4.35：1;胃溃疡（GU）占62.65％,十二指肠溃疡（DU）占30.72％,GU与Du之比为2.08：1,复合性溃疡占6.62％,多发性溃疡占24.1％。结论老年人PU的患者男性多于女性,Gu多于DU,GU的好发部位是胃窦和胃角,DU的好发部位是十二指肠球前壁;PU的幽门螺杆菌（Hp）感染率为81.93％。     

临床消化性溃疡的表现

消化性溃疡（PU）约95％以上是胃溃疡（GU）和十二指肠溃疡（DU），DU比GU多见，两者之比为3—4：1。本文将对各种类型PU的临床表现进行讨论。     

少数民族贫困地区消化性溃疡的发病情况分析

目的 了解少数民族贫困地区消化性溃疡的发病情况，从而揭示消化性溃疡的发病是否存在民族差异。方法 对我院2005年3～11月经胃镜检查诊断为胃溃疡与十二指肠溃疡的患者为对象，进行回顾分析。结果 在602例的胃镜检查者中，检查出消化性溃疡共计147例，占24．5％，其中男93例，在检查的男患者中占33％，女54例，在检查的女患者中占17％，男女患病之比为2：1。十二指肠溃疡与胃溃疡的发病比例为1．4：1，复合性溃疡占溃疡病的17％。结论 少数民族贫困地区溃疡患者男性多于女性，与其他地区相比．女性比例较高，胃溃疡和复合性溃疡比例较高，提示消化性溃疡的发病存在民族差异。     

消化性溃疡1142例胃镜分析

目的了解地区性消化性溃疡病发病学特点。方法对10年间经胃镜检查诊断为消化性溃疡的病例进行系统分析。结果①共检出1142例溃疡,十二指肠球部溃疡632例,胃溃疡433例,复合性溃疡77例。②溃疡患者男女之比为2．77：1。③溃疡患者平均年龄40．7岁,球溃疡以30岁以下居多,占40．82％;胃溃疡患者中以大于50岁居多,占35．10％;复合性溃疡大于50岁者最多,占40．26％。④消化性溃疡发病的高峰季节是秋季（9～11月）和春季（3～5月）。结论①病变好发部位以球溃疡最多见,胃溃疡次之,复合性溃疡最少。②溃疡发病男性明显高于女性,与其不艮生活习惯有关。     

湘南地区6873例消化溃疡的胃镜分析

目的了解湘南地区消化性溃疡发病特点。方法对近5年来郴州市5家综合性医院经胃镜检查诊断为消化性溃疡的病例进行统计分析。结果共检出6873例消化性溃疡，十二指肠溃疡4595例，胃溃疡1653例，复合性溃疡625例。溃疡患者男女之比为3．68-1。溃疡患者平均年龄46．2岁，十二指肠溃疡以40岁以上居多，胃溃疡以50岁以上居多，复合性溃疡以50岁以上居多。结论病变好发部位以十二指肠溃疡最多见，胃溃疡次之，复合性溃疡最少。溃疡发病男性明显高于女性。     

中西医结合护理消化性溃疡的研究进展

消化性溃疡（pepticulcer，PU）是指胃溃疡和十二指肠溃疡，全世界约有10％的人一生中患过此病。20世纪70年代以来，西方国家Pu的发病率明显下降，而在中国则呈逐年增加的趋势；PU占国内胃镜检查人群的10．3％～32．6％，以20～50岁居多，男性多于女性（2～5：1）。     

老年性溃疡病的临床特点（附106例临床分析）

本文报告106例50～85岁的溃疡病患者，并将50～64岁初老组和65岁以上的老年组进行比较，总结分析出老年性溃疡病以胃溃疡常见(57．5%)，十二指肠溃疡(34．0％)，胃十二指肠之比1．7：1。溃疡部位多在幽门胃窦部胃角部(85．5％、79．9％)，病程2／3在10年以内，3／5病人临床症状不典型，高位性溃疡占胃溃疡18．0％，并发症多(61．3％)，且以出血占多数(42．5％)等方面的特点。     

肝源性溃疡的发生及临床特点

目的：研究肝源性溃疡的发生及临床特点。方法：以1999年1月至2002年6月本院肝硬化患者219例为观察对象常规作胃镜检查。结果：肝源性溃疡的发生率为32．0％；肝源性溃疡的发生率与肝功能Child-Pugh改良分级、食道静脉曲张、门脉高压性胃病、性别无关，各组差异无显著性（P＞0．05）；幽门螺杆菌（Hp）阳性组肝源性溃疡发生率（42．4％）显著高于Hp阴性组（18．1％）（P＜0．005）;胃溃疡、十二指肠溃疡及复合溃疡之比1：4．27：1．09；溃疡面积相对小而浅表，多发性溃疡发生率高（83％），以十二指肠多发浅表小溃疡最常见（57％）；肝源性溃疡75．7％无典型的溃疡相关症状，出血占肝硬化上消化道出血18．0％。结论：Hp感染是肝源性溃疡的重要致病因素，溃疡以十二指肠多发浅表小溃疡最常见，肝源性溃疡绝大多数无溃疡相关症状。     

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.