“脑震荡”患者EEG、BEAM对照分析

本文对50例脑震荡患者进行BEAN检测,并与常规EEG进行对照分析。结果显示:50例脑震荡患者中,42例(82％)BEAM显示局部δ、θ波高能量异常局灶性频域,EEG阳性率18例(36.0％),二者差异非常显著。BEAM比EEG更能判断出脑震荡患者的微细异常脑电活动,并提供客观依据。     

磁石枕治疗顽固性幻听疗效与脑电地形图变化的关系

目的 磁石枕治疗顽固性幻听疗效与脑电地形图变化的关系。方法 磁石枕、氯氮平两组患在入组前及治疗3个月后的脑电地形图检测对比。结果 顽固性幻听患在入组前脑电地形图θ、δ、β频域在各脑区功率值明显增高，而α频域则明显降低，经磁石枕3个月治疗后，各频域、各脑区的功率值趋于正常。氯氮平组治疗3个月后，θ、δ、β各频域、各脑区的功率值变化不明显。可是α频域的功率值则明显增高。结论 磁石枕的疗效与脑电地形图的改善有密切关系，α频域的增高与氯氮平的副作用有关。     

原发性高血压患者的脑电地形图改变

目的：通过患者脑地形图改变的特点探讨高血压对大脑的影响。方法：使用国产BIE-ND7脑电地形图仪对600例血压异常的患者进行脑地形图(BEAM)检查，其结果与200例正常健康人(对照组)的脑地形图结果进行比较。结果：各种高血压患者，BEAM均有不同程度的改变，主要表现为病理性δ、θ波的出现和功率增高及α1，α2功率降低和α1、α2出现的位置异常(前移，泛化)，其中轻度高血压(高血压Ⅰ级)、单纯收缩期高血压主要表现为α1，α2前移、泛化，随着高血压的时间延长和病情加重，不无例外的出现异常δ和θ波，Ⅱ、Ⅲ级高血压同时出现α功率降低(甚至消失)，说明高血压使大脑血流供应障碍，继而造成大脑功能紊乱和损害。结论：脑地形图能比较灵敏的反映高血压患者脑功能的变化情况和大脑受损害的程度，从而为临床治疗提供参考和依据。     

磁石枕治疗顽固性幻听疗效与脑电地形图变化的关系

目的磁石枕治疗顽固性幻听疗效与脑电地形图变化的关系。方法磁石枕、氯氮平两组患者在入组前及治疗3个月后的脑电地形图检测对比。结果顽固性幻听患者在入组前脑电地形图θ、δ、β频域在各脑区功率值明显增高,而α频域则明显降低,经磁石枕3个月治疗后,各频域、各脑区的功率值趋于正常。氯氮平组治疗3个月后,θ、δ、β各频域、各脑区的功率值变化不明显,可是α频域的功率值则明显增高。结论磁石枕的疗效与脑电地形图的改善有密切关系,α频域的增高与氯氮平的副作用有关。     

长期吸烟对脑电活动影响的研究

目的 研究长期吸烟对脑电活动的影响。方法 对２８６例长期吸烟者进行脑电图及脑电地形图检查,按吸烟指数分轻、中、重三个组,研究吸烟对脑电活动的变化。结果 轻度吸烟组脑电图和脑电地形图无明显变化。中、重度吸烟组脑电活动有明显异常改变,表现为α节律明显变慢,θ指数增高,θ频带在中央、顶、枕区能量值增高。结论 长期吸烟对脑电活动有明显影响。     

帕金森病痴呆患者的脑电活动研究

目的：通过比较帕金森病（PD）患痴呆组与非痴呆组的脑电图特点，探讨PD患痴呆与脑电活动的关系。方法：将经临床确诊的PD患分为痴呆组和非痴呆组，分别作脑电图（EEG）描记，结果：痴呆组EEG异常率明显高于非痴呆组（P＜0．01）；痴呆程度与EEG异常程度有关，痴呆组EEGα波低波幅，低波率，低指数及有泛化均显高于对照组（P＜0．05或P＜0．01），痴呆组异常EEG快波（β）与慢波（θ，δ）出现率均高于对照组，但以θ，δ波为（P＜0．01或P＜0．05）。结论：EEG可用以帮助判断PD痴呆的严重程度，并可作为评价PD智能状况的一个参考指标。     

血液流变性的变化对脑功能的影响

本文用计算机处理的脑电功率谱（ＡＰＳ）指标 及 观察脑动脉硬化病人其血流变正常或高粘血症下的脑电功率谱改变，探讨了血流变变化对脑功能的影响。结果提示：高粘血症时，脑电活动抑制，表现为慢波活动（δ、θ）增多，而快波活动（α、β）相应减少。     

帕金森病记忆障碍的脑电活动研究

目的:通过比较帕金森病(PD)患者记忆障碍组与健康老年人的脑电图特点,探讨帕金森病记忆障碍与脑电活动的关系。方法:选择50例PD记忆障碍患者为试验组进行脑电图(EEG)检查,同时取35例健康老年人为对照组进行记忆测定和EEG检查。结果:试验组EEG异常率明显高于对照组(P<0.01);试验组EEG波低波幅者、低波率者、低指数者及有泛化者均显著高于对照组(P<0.05或0.01);试验组异常EEG快波(β)及慢波(θ、δ)出现率均高于对照组,但以θ、δ波为著(P<0.05)。结论:记忆测定和EEG检查对判断PD的认知功能障碍有实用价值。     

动态脑电图θ节律监测在癫痫部分性发作类型中的诊断价值

目的：观察动态脑电图θ节律在癫痫部分性发作类型中的诊断价值。方法：采用8000型8导动态脑电图（AEEG）监测仪对86例临床确诊或疑诊为癫痫部分性发作类型的病人及86例正常人进行24hAEEG监测。结果：病例组86例．AEEG检测出现θ节律活动67例（77．9％），其中一般活动形式15例（17．4％），阵发性活动52例（60．5％），在θ节律活动基础上伴有痫样放电的41例（61、2％）；对照组86例，出现θ节律活动14例（16．3％），一般活动形式11例（12．8％），阵发性活动3例（3．5％）；两组脑电阵发性θ节律活动形式比较，差异有显著性（P〈0．001）。结论：AEEG监测中出现阵发性θ节律活动对癫痫部分性发作类型的诊断有一定的价值。     

650例脑电地形图和脑电图检查的比较

对６５０例临床已确诊的几种主要脑部疾患的检查资料，进行分析比较，结果表明，脑电地形图（ＢＥＡＭ）的异常率为９２．９２％，脑电图（ＥＥＧ）的异常率为８３．０８％。在定位上脑电地形图的异常率是一侧或局限性为３０％，弥漫性为８２．８％，脑电图的异常率是一侧或局限性为２４．３％，弥漫性为５８．６％。两项比较，对脑部弥漫性病变检查，ＢＥＡＭ优于ＥＥＧ，但ＢＥＡＭ是在ＥＥＧ采样分析后产生，故需两项结合分析，其准确性才能更高。     

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.