膜性内障的后房型人工晶体植入术

目的：探讨膜性内障的后房型人工晶体植入术的临床效果。方法：对25例(27只眼)膜性内障施行囊膜剪除植入后房型人工晶体。结果：术后分别随访3个月～2a，27只眼中矫正视力10以上5眼占18．5％．0.5～0.818眼占66.7％，未见严重并发症。结论：膜性内障植入后房型人工晶体改普视力满意，是治疗单眼无晶体眼的有效方法。     

白内障与人工晶体植入术疗效分析

目的探讨在早期恢复视力中，白内障摘除术人工晶体植入术矫正无晶体眼的疗效和分析。方法病例56例(87只眼)，其中老年性的内障囊外摘除术27只眼，并发障8只眼，后房型人工晶体植入52只眼。结果56例(87只眼)中术后矫正视力≥0．2～0．5的27只眼，占总数的31％；术眼视力达≥1．0的52只眼，占总数的59．7％。结论白内障人工晶体植入术，可使用周边及后囊保持完整性，术后早期获得良好的矫正视力。     

外伤性自内障人工晶状体植入术探讨

目的；探讨外伤性白内障人工晶状体植入术。方法：外伤性白内障80例（80只眼），全部植入后房型人工晶状体。结果：视力在0．5以上者铝只曩．占60％，外伤性自内障术后常出现角膜水肿、前房渗出、虹膜炎性反应。结论：外伤性白内障的手术时机、术中皮质处理根据伤眼具体情况而定，后囊破裂者尽可能利用残留的前后囊膜作支撑植入后房型人工晶状体。     

无晶体眼的后房型人工晶体植入术

探讨提高无晶体眼视力的有效手段方法。方法：根据原有条件采用不同的手术方式植入后房型人工晶体。结果；１４１例术后平均随访７．８个高力达０．５及以上者占８６．３％。结论；采用适当的手术方式，是治疗无晶体眼的有效方法。     

儿童无晶体眼后发性白内障人工晶体植入

目的：应用显微手术治疗儿童无晶体眼后发性白内障二期IOL植入观察。方法：手术包括后发障膜的切除，虹膜后粘连的分离及后房型IOL植入。结果：28例32只眼，随访6～28个月，单眼脱盲率90．6％，视力低于0．5的眼与弱视等因素有关。结论：IOL植入是儿童无晶体眼后发障，防治弱视、恢复视力有效的方法。     

新型弹性开放禅前房型人工晶体植入术的临床应用

目的：探讨新型弹性开放禅前房型人工晶体植入术的临床应用。方法：回顾性总结弹性开放禅前房型人工晶体植入术的体会，观察其疗效及并发症。结果：术后矫正视力≥０．５者１５例（６２．５％），无一例有继发性青光眼、角膜失代偿、前房出血等严重并发症发生。结论：新型弹性开放禅前房型人工晶体植入术操作简单，安全可靠，作为无条件植入后房型人工晶体时的一种补救措施，值得信赖。     

眼球穿通伤所致白内障106例手术分析

目的:探讨眼球穿通伤所致不同类型白内障的手术时机和手术方法.方法:对106例(106眼)外伤性白内障行白内障摘除联合人工晶体植入术.其中79例晶体囊膜损伤范围较大、皮质释放伴高眼压,于伤后8～22 d手术;22例囊膜损伤范围较小、无皮质释放,于伤后6～12周手术;5例膜性障于伤后1～3 a手术.常规植入后房型人工晶体96例,后房型人工晶体缝线固定9例.结果:术后随访3～36个月,矫正视力≥1.0者12只眼,占11.3%;0.5～0.9者35只眼,占33%;0.1～0.4者55只眼,占51.9%;0.1以下者4只眼,占4%.结论:晶体囊膜破口小,宜在眼部情况稳定后手术;囊膜破口大,皮质释放者宜尽早手术.术中对晶体囊膜的处理是手术的关键.     

外伤性白内障两种治疗方法疗效比较

目的：比较晶体囊外摘除联合人工晶体植入术（ＥＣＣＥ＋ ＰＣ·ＩｏＬ） 与晶体切割联合前房型人工晶体植入术（晶切＋ ＡＣ·ＩｏＬ） 治疗外伤性白内障的疗效。方法：通过两种术式治疗４６ 例外伤性白内障。其中行ＥＣＣＥ＋ＰＣ·ＩｏＬ术２６ 眼，晶切＋ ＡＣ·ＩｏＬ２０ 眼。结果：矫正视力≥０．１ 者ＥＣＣＥ组２５ 眼，占９４．１％ ，晶切组１８ 眼，占９０％ ，矫正视力＞ ０．４ 者，ＥＣＣＥ组２２ 眼，占８４．６％ 。晶切组４ 眼占２０％ ，ＥＣＣＥ组明显高于晶切组，差异有显著性（Ｐ＜ ０．０５） ．结论：ＥＣＣＥ＋ ＰＣ·ＩｏＬ植入术及晶体切割ＡＣ·ＩｏＬ植入术均能有效治疗外伤性白内障， 但疗效以ＥＣＣＥ＋ ＰＣ·ＩｏＬ植入为优     

外伤性白内障两种治疗方法疗效比较

目的：比较晶体囊外除联合人工晶体植入术(EOCE PC·IoL)与晶体切割联合前房型人工晶体植入术(晶切 AC·IoL)治疗外伤性自内障的疗效。方法：通过两种术式治疗46例外伤性自内障。其中行BCCE PC·IoL术26眼，晶切 AC·IoL，20眼。结果：矫正视力≥0.1ECCE组25眼，占94.1％．晶切组18眼．占90％．矫正视力>0.4．ECCE组22眼，占84.6％。晶切组4眼占20％．ECCE组明显高于晶切组，差异有显性(P<0.05)结论：ECCE PC·IoL，植入术及晶体切割AC·kL植入术均能有效治疗外伤性白内障．但疗效以BCCE PC·IoL植入为优。     

硅油填充术后白障摘除及人工晶体植入术

目的：对硅油填充术后白内障手术结果进行回顾性总结,方法：行白内障囊外除联合人工晶体植入晶体植入及取出硅油。结果：经６～２０个月随访,２３例（２３只眼）,术后视力≥０．１（６０．８７％）≥０．３９眼（３９．１３％）,术中后囊破裂８只眼,结论：硅油填充术后的白内障囊外除联合人工晶体植入术与同时取出硅油是一种较理想的方法。     

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.