国产奎硫平与利培酮治疗首发精神分裂症对照研究

目的　比较奎硫平与利培酮治疗首发精神分裂症的疗效和安全性。方法　将 12 0例首发精神分裂症患者随机分为研究组 (奎硫平治疗组 ) 6 0例和对照组 (利培酮治疗组 ) 6 0例。研究组奎硫平剂量范围 10 0～ 80 0mg·d-1,对照组利培酮剂量范围1.0～ 6 .0mg·d-1,疗程均为 8w。在治疗前及治疗第 2、4、8w末采用PANSS评定临床疗效 ,治疗期间采用TESS评定药物不良反应 ,并进行比较分析。结果　奎硫平的治疗有效率为 6 8.3% ,利培酮的治疗有效率为 70 .0 % ,两组疗效无显著性差异。不良反应研究组较对照组少。其中震颤、静坐不能、肌强直等的发生率研究组显著少于对照组 (P <0 .0 1)。结论　奎硫平与利培酮治疗首发精神分裂症疗效高、耐受性好 ,两药差异不显著。     

国产奎硫平与利培酮治疗首发精神分裂症对照研究

目的比较奎硫平与利培酮治疗首发精神分裂症的疗效和安全性。方法将60例首发精神分裂症患者随机分为奎硫平治疗组和利培酮治疗组各30例,奎硫平治疗平均剂量为650±117mg·d-1,利培酮治疗平均剂量为4.0±1.8mg·d-1,疗程均为8w。于治疗前及治疗第2、4、6、8w末采用阳性和阴性症状量表、副反应量表评定临床疗效及不良反应。结果奎硫平治疗显效率为76.7%,利培酮为70%,两组差异无显著性(P>0.05),疗效相当;两组多在用药初期出现不良反应,且发生率较低,程度较轻,均可耐受,经对症处理后均可缓解或消失。结论奎硫平与利培酮治疗首发精神分裂症的疗效相当。     

奎硫平治疗老年精神分裂症对照研究

目的比较奎硫平和奋乃静治疗老年精神分裂症的疗效和安全性。方法将100例老年精神分裂症患者随机分为奎硫平及奋乃静组各50例,疗程8w,治疗8w末评定临床疗效及不良反应。结果奎硫平与奋乃静对老年精神分裂症的疗效无显著性差异(P>0.05),奎硫平组的不良反应低于奋乃静组。结论奎硫平治疗老年期精神分裂症安全,疗效确切,不良反应少。     

奎硫平治疗老年期首发精神分裂症对照研究

目的探讨奎硫平治疗老年期首发精神分裂症患者的疗效及安全性。方法将64例老年期首发精神分裂症患者随机分为两组各32例,分别服用奎硫平、奋乃静治疗,疗程8w。于治疗前及治疗第2w、4w、6w、8w末采用简明精神病量表评定临床疗效,副反应量表评定不良反应。结果治疗8w末奎硫平组显效率84．4％,奋乃静组为81．3％;简明精神病量表评分两组治疗2w末起均较治疗前有极显著性下降（P〈0．01）,并随着治疗时间的延续呈持续性下降。两组间同期评分比较均无显著性差异（Pa〉0．05）。奎硫平组肌强直、震颤、扭转性痉挛、视物模糊不良反应发生率均显著低于奋乃静组（P均〈0．05）。结论奎硫平治疗老年首发精神分裂症疗效显著,安全性高,依从性高。     

奎硫平与利培酮治疗精神分裂症对照研究

目的探讨奎硫平治疗精神分裂症的效果与不良反应。方法将60例精神分裂症患者随机分为奎硫平治疗组和利培酮治疗组,每组各30例,进行临床对比研究,疗程均为8w。于治疗前及治疗第1、2、4、8w末采用阳性与阴性症状量表评价临床疗效、副反应量表评价不良反应。疗效标准:以阳性与阴性症状量表减分率≥75%为痊愈,≥50%为显著性进步;≥25%为好转,<25%为无效。结果奎硫平治疗有效率为70.0%,利培酮治疗有效率为66.7%,两组比较差异无显著性。奎硫平组锥体外系不良反应明显少于利培酮组,其它不良反应因子两组比较差异均无显著性(P>0.05)。结论奎硫平治疗精神分裂症疗效肯定,不良反应少,依从性好。     

奎的平与氯氮平治疗精神分裂症疗效比较研究

目的探讨奎的平与氯氮平治疗精神分裂症的疗效和安全性。方法将68例精神分裂症患者随机分为研究组（奎的平治疗）与对照组（氯氮平治疗）各34例。治疗期间研究组脱落1例,实际完成33例,对照组脱落2例,实际完成32例。两组疗程均为8w。于治疗前及治疗第2、4、8w末采用阳性与阴性症状量表评定临床疗效,副反应量表评定不良反应,并进行对比分析。结果研究组显效率69．7％,有效率93．9％;对照组显效率68．8％,有效率93．8％,两组间比较均无显著性差异（P〉0.05）。研究组不良反应较对照组少且轻。结论奎的平治疗精神分裂症疗效确切,不良反应少,服药依从性好。     

奥氮平治疗首发精神分裂症疗效观察

目的评价奥氮平治疗首发精神分裂症的疗效与安全性。方法对36例住院首发精神分裂症患者给予奥氮平治疗,起始剂量5mg·d-1,1w内根据病情调整至治疗剂量10～25mg·d-1,平均剂量16.33±5.24mg·d-1。疗程8w。分别于治疗前及治疗第2、4、8w末采用潘氏量表评定临床疗效,副反应量表评定不良反应。结果治疗2、4、8w末潘氏量表评分与治疗前比较差异有极显著性(P均<0.01)。其中痊愈15例(41.7%),显进12例(33.3%),进步6例(16.7%),无效3例(8.3%),总有效率91.7%。不良反应轻微,无明显心血管系统不良反应。结论奥氮平治疗首发精神分裂症安全有效,值得临床推广应用。     

奎的平与氯丙嗪治疗首发精神分裂症疗效对比研究

目的 评价奎的平治疗首发精神分裂症的疗效与不良反应。方法 采用国产奎的平与氯丙嗪随机治疗148例精神分裂症,其中奎的平75例,300-600mg·d-1;氯丙嗪73例,300-600mg·d-1,观察8w。以阳性与阴性症状量表(PANSS)及不良反应量表(TESS)评定症状、疗效和安全性。结果奎的平与氯丙嗪对精神分裂症均有确切的疗效,奎的平有效率89.3％,氯丙嗪有效率89.04％。两组无显著性差异。奎的平组较氯丙嗪组副反应少且轻,其中活动减少、锥体外系反应、抗胆碱能、头昏等发生率显著低于氯丙嗪组(P<0.01或0.05)。结论奎的平是一种安全、快速、有效的抗精神病药物。     

小剂量奎的平治疗40例老年器质性精神障碍

目的探讨小剂量奎的平治疗老年器质性精神障碍的疗效及安全性。方法对40例首发器质性精神障碍的老年患者给予小剂量奎的平治疗8w,采用阳性与阴性症状评定量表、药物副反应量表评定临床疗效及不良反应。结果奎的平治疗老年器质性精神障碍显效率为82.1%,起效时间为2w末,有效剂量为12.5～75mg·d-1,不良反应轻微。结论小剂量奎的平治疗老年器质性精神障碍疗效显著,安全性高,耐受性好,可作为老年人一线抗精神病药。     

奎硫平与氟哌啶醇治疗首发女性精神分裂症对照研究

目的探讨奎硫乎治疗首发女性精神分裂症的临床疗效及安全性。方法将60例女性精神分裂症患者随机分为两组,每组30例,研究组口服奎硫平治疗,对照组口服氟哌啶醇治疗,观察54w。于治疗前及治疗2w、4w、8w、54w末采用阳性与阴性症状评定量表评定临床疗效、副反应量表评定不良反应。结果治疗8w末研究组有效率93．3％,对照组为90．0％;54w末分别为100％和81．48％,研究组有效率显著高于对照组（P〈0．01）。治疗2w末起两组阳性与阴性症状量表评分均较治疗前下降显著（P〈0．01）,治疗54w末研究组较对照组下降更显著（P〈0．01）。治疗8w末研究组肌强直、静坐不能、视力模糊、吞咽困难、口干、失眠、便秘、血清催乳素升高等不良反应发生率均显著低于对照组（P〈0．05或0．01）。结论奎硫平能显著改善女性精神分裂症患者的阳性与阴性症状,且安全性高,依从性好。     

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.