激光在医学基础和临床研究中的应用

目的：对从激光与生物体作用所产生的各种生物效应的角度所进行的研究加以综述，从而体现激光在医学基础研究、诊断和治疗等方面的应用。 资料来源：应用计算机检索美国EBSCO全文数据库、Pubmed数据库1995-07／2005-07的文章，检索关键词为“laser，laser medicine。medical application，Doppler’seffect，laser photodynamic therapy，FCM，LSCM”。限定文章语言种类为English，研究对象为人类。同时用计算机检索中国学术期刊全文数据库、http：//www．wanfangdata．com．cn-中国数字化期刊群、维普全文数据库1998-08／2005-9期间的相关文章，检索主题词为“激光、医学应用、多普勒效应、光动力学疗法、激光流式细胞术、激光扫描共聚聚焦显微镜、激光理疗”，限定文章语言种类为中文。另外，还手工查阅了胡新珉《医学物理学》，朱菁《激光医学》等相关内容。 资料选择：纳入标准：①有关激光医学基础方面的研究。②有关激光诊断和治疗方面的研究。排除标准：①较陈旧的文献。②重复研究。③综述文献。资料提炼：共收集到152篇有关的文章，排除重复或类似的同一研究，22篇符合研究要求。 资料综合：①激光生物效应：研究发现，激光作用于生物体会产生物理、化学或生物学的效应。激光正是通过这些效应来达到医学基础研究、诊断和治疗疾病的目的。②激光诊断技术：激光诊断具有灵敏、快速、准确等特点，为诊断学向非侵入性、微量化、自动化及实施快速方向发展开辟了新途径。③激光治疗技术：研究发现，激光治疗的适应症现在已经涉及到临床所有各科。大体可分为激光手术治疗、激光非手术治疗和激光光敏治疗3类。此外，激光在医学上的应用还有很多方面，它对基因工程和细胞工程都有着重要的意义。 结论：激光技术既是能量载体，又是信息载体。作为能量载体。激光可用于疾病治疗，作为信息载体，它又可用于疾病诊断，二者的结合构成了激光医学。     

眼内激光在玻璃体和手术中的应用

目的：观察眼内激光在玻璃体切除术中治疗视网膜病变，封闭视网膜裂孔的作用。方法：回顾性分析56例（56眼）玻璃体切除手术，病种有增殖性糖尿病性视网膜病变，视网膜静脉周围炎，视网膜静脉阻塞，外伤性玻璃体出血（共33例）以及复杂性视网膜脱离（23例），在术中施行了眼内光凝，封闭裂孔或光凝视网膜新生血管区及无灌注区。结果：复杂性视网膜脱离23例，视网膜复位19例，其余33例均手术成功。结论：眼内激光是治疗多种视网膜病变的有效方法，是玻璃体切除手术中一个重要步骤。     

激光多普勒血流计在脑瘤术中的应用

激光多普勒血流计在脑瘤术中的应用张荣伟，张洪俊，解相礼激光多普勒血流计（ｌａｓｅｒ－Ｄｏｐｐｌｅｒｆｌｏｗｍｅｔｅｒ，ＬＤＦ）是根据激光多普勒原理研制的测量微循环血流量的一种仪器．是组织血流量测定的一种新的技术手段，国外学者临床应用效果满意Ｕ·’‘，...     

激光在治疗声门型喉癌中的应用

微创手术治疗喉癌已被大家广泛使用.本科采用激光手术治疗32例声门型喉癌患者取得良好疗效,报告如下. 1 临床资料 1.1 临床资料:32例患者根据国际抗癌联合会1987年TNM分期标准分为Tis 2例,T1a 18例,T1b 5例,T2 7例;前联合受侵犯者4例.男31例,女1例;年龄30～78岁,平均51.3岁.     

激光手术在复杂肛门瘘管治疗中的应用

目的：复杂肛门瘘管激光手术治疗可获得满意效果，只要充分掌握好治疗过程中的关键环节，手术并发症完全可以避免。此方法可作为治疗时优选。     

整体护理在准分子激光术中的应用

准分子激光术治疗近视眼是我国近十多年来开展的一项新型治疗近视眼的技术,2003年11月以来,我们开展此技术治疗近视患者8 240例(16 280只眼)。为了确保准分子激光手术顺利进行,并获得优良的视觉质量,2005年11月～2010年12月,我们对6 740例(13 288只眼)近视患者行准分子激光术治疗,经精心护理,效果满意。现报告如下。     

多普勒超声在周围血管及内脏血管流量测定中的理论问题与技术问题

作肌血管因素、血流流速剖面等方面，对多普勒超声在周围血管及内脏血管的流量测定中的问题进行了分析，认为必须使用新颖超声技术，在瞬时内同时获得血管截面及流速剖面真实信息，方可获得比较精密的流量。     

声诺维超声造影与激光多普勒评价兔VX2肝癌血流灌注的实验对照研究

目的用激光多普勒对照研究声诺维超声造影评价兔VX2肝癌血流灌注的可靠性.方法团注法声诺维超声造影及激光多普勒分别扫查8只兔VX2肝癌表面及左肝正常肝组织,绘制时间-强度曲线获取峰值强度(PI),激光多普勒计算局部平均血流灌注量,2种方法统计学分析其相关性.结果VX2肝癌表面及其旁肝组织的峰值强度分别为(3.69±1.02)、(2.55±1.13);VX2肝癌表面及正常肝组织的平均血流灌注量分别是(2.93±0.68)、(0.96±0.34),经统计学分析2种方法相关性良好(r=0.97,P＜0.01;r=0.94,P＜0.01).结论声诺维超声造影评价肝癌和正常肝脏组织血流灌注可靠,具有较广阔的应用前景.     

电视纤维喉镜下半导体激光在喉内手术中的应用

目的 探讨电视纤维喉镜下半导体激光治疗声带良性病变及喉癌前病变的手术方法、疗效和适应证。方法 1998年1月～2001年4月间，94例喉内病变均在局部麻醉下行半导体激光手术治疗。结果 全部病例全在半导体激光下完成。1例声带白斑半年后复发，在支撑喉镜下声带部分切除术。1例喉乳头状瘤1年后复发，再次半导体激光治疗。其余病例随访1年6个月均无复发。结论 半导体激光治疗喉内病变，适应证广，准确，术后反应轻微，保留了发声功能，是一种较好的微创手术方式。     

钬激光在关节镜手术中的应用进展

随着关节镜技术的不断发展 ,钬激光作为一种安全有效的镜下操作工具 ,也得到了广泛应用。这一技术于 90年代初在美国最先应用于临床[1] ,我国于 93年引进了该项技术 ,历经近十年的应用 ,取得了良好效果。现结合有关文献 ,综述如下 :1　钬激光的发展史70年代末 ,关节镜广泛应用于骨科临床 ,为 80年代初激光的应用打下了良好的基础。最初主要使用CO2 激光 ,它具有切割准确、组织损伤小等优点[2 ] ,但因为器械笨重 ,容易出现皮下气肿、严重的滑膜炎等并发症 ,使用 1 0余年也未能普及。其后钕激光 (Nd-YAG)因为水吸收性差 ,使用时对靶组织周…     

Guidelines for clinical research in complementary medicine

There are several stages in preparing clinical research studies. Stage 1 includes identifying the purpose of the inquiry and finding the essential financial resources. Careful thinking about the clinical practice to be investigated and the allocation of time for research is also necessary. Stage 2 involves assessing the feasibility of the study. Statistical decisions are best made before data are collected, and this means consultation with a statistician or methodologist. There has to be ethical approval from the cooperating institution. A thorough search of the literature is fundamental. In Stage 3, the final trial is designed, ethical approval obtained, and the proposal is submitted for funding. In the final stage, Stage 4, the trial is carried out, analyzed, and prepared for publication.     

检验医学实践中科研思路的形成

科研设计是目前检验医学一个明显的薄弱环节，随着医学科学的发展和检验医学的确立，以往那种从属和被动局面应在我们努力之下予以改观。我们应站在主持和主动位置参与科研课题的设计和实施。为参与或主持设计。一些科研思路的建立必须掌握。为此，在多年的科研活动中，有关课题设计思路的一些个人经验体会简述如下，供同道参考。     

Melatonin: perspectives in laboratory medicine and clinical research

We are presently at a point in human pineal research where we have recognized through melatonin assay the presence of pineal dysfunction in a variety of disease categories. Melatonin may now be quickly and accurately quantified in a range of body fluids, and our well-developed knowledge of the basic biochemistry and neuroanatomical connections of the pineal enables us to see at least how abnormalities in melatonin secretion occur, if not why. The reported increases in melatonin secretion in early malignancy with a reduction in secretion during the neoplastic process is interesting, as is the great decline in the elevated melatonin level of oncological patients following institution of chemotherapy. The correlations between estrogen receptor status of breast cancer and melatonin level, and between neoplastic status of the prostate and melatonin secretion, points to interesting differential diagnostic utilities of melatonin analysis in these conditions. Furthermore, an etiological involvement of melatonin in neoplasia is suggested by experiments which have demonstrated the capacity of melatonin to induce mitotic arrest, and to increase the affinity of mammary carcinoma estrogen receptors for their substrate. These are important observations among many others of direct relevance to research and treatment in oncology, and warrant much further investigation. Melatonin assay may also prove useful in the prognostic monitoring of patients treated for melatonin-secreting pineal tumors, and in such cases may form a logical part of follow-up investigation in the screening for metastatic complication. In psychiatry research, melatonin analysis has functioned as a tool by which alterations in pineal function within specific psychiatric diagnoses have been demonstrated and assessed. Its uses in the assessment of the effects of antidepressant drugs on central beta-receptor function, as a tool in the investigation of light-induced alterations in pineal function in manic-depressive individuals, and as a tool in the investigation of the putative pineal-adrenocortical functional interaction have produced the fundamental building blocks of modern research into the pineal and psychiatry. The experimental clinical utility of melatonin assay is not localized to oncology and psychiatry, and significant alterations in melatonin secretion have been reported in several other disease categories. Indeed, the demonstration of markedly elevated melatonin secretion in patients with spina bifida occulta might suggest that assay of melatonin in amniotic fluid could be useful as an experimental adjunct in the prenatal diagnosis of this condition.(ABSTRACT TRUNCATED AT 400 WORDS)     

近红外光在现代医学中的应用和研究进展

近红外光对活体组织具有更好的穿透深度和生物相容性,最大限度地减少了组织中照射的散射和衰减,近年来已用于体内成像、3D图像可视化、光热疗法、药物释放和体内光遗传学等多个方面,在生物医学领域有着非常广阔的前景。目前近红外在临床医学中的应用愈发广泛,包括与多种分子成像方式结合,使用纳米探针,发挥光声成像作用;开发不同性能的光热剂,通过光能和热能的转化,实现近红外光疗法;结合3D打印这一新兴技术,个性化定制支架或植入物,利用近红外光的时空可调性,使得诊断与治疗同时进行,实现精准化医疗。     

The intensive care medicine clinical research agenda in paediatrics

Background

Intensive Care Medicine set us the task of outlining a global clinical research agenda for paediatric intensive care (PIC). In line with the clinical focus of this journal, we have limited this to research that may directly influence patient care.

Methods

Clinician researchers from PIC research networks of varying degrees of formality from around the world were invited to answer two main questions: (1) What have been the major recent advances in paediatric critical care research? (2) What are the top 10 studies for the next 10 years?

Results

(1) Inclusive databases are well established in many countries. These registries allow detailed observational studies and feasibility testing of clinical trial protocols. Recent trials are larger and more valuable, and (2) most common interventions in PIC are not evidenced-based. Clinical studies for the next 10 years should address this deficit, including: ventilation techniques and interfaces; fluid, transfusion and feeding strategies; optimal targets for vital signs; multiple organ failure definitions, mechanisms and treatments; trauma, prevention and treatment; improving safety; comfort of the patient and their family; appropriate care in the face of medical complexity; defining post-PICU outcomes; and improving knowledge generation and adoption, with novel trial design and implementation strategies. The group specifically highlighted the need for research in resource-limited environments wherein mortality remains often tenfold higher than in well-resourced settings.

Conclusion

Paediatric intensive care research has never been healthier, but many gaps in knowledge remain. We need to close these urgently. The impact of new knowledge will be greatest in resource-limited environments.

     

Methodology in diagnostic laboratory test research in clinical chemistry and clinical chemistry and laboratory medicine

BACKGROUND: The application of epidemiologic principles to clinical diagnosis has been less developed than in other clinical areas. Knowledge of the main flaws affecting diagnostic laboratory test research is the first step for improving its quality. We assessed the methodologic aspects of articles on laboratory tests. METHODS: We included articles that estimated indexes of diagnostic accuracy (sensitivity and specificity) and were published in Clinical Chemistry or Clinical Chemistry and Laboratory Medicine in 1996, 2001, and 2002. Clinical Chemistry has paid special attention to this field of research since 1996 by publishing recommendations, checklists, and reviews. Articles were identified through electronic searches in Medline. The strategy combined the Mesh term "sensitivity and specificity" (exploded) with the text words "specificity", "false negative", and "accuracy". We examined adherence to seven methodologic criteria used in the study by Reid et al. (JAMA1995;274:645-51) of papers published in general medical journals. Three observers evaluated each article independently. RESULTS: Seventy-nine articles fulfilled the inclusion criteria. The percentage of studies that satisfied each criterion improved from 1996 to 2002. Substantial improvement was observed in reporting of the statistical uncertainty of indices of diagnostic accuracy, in criteria based on clinical information from the study population (spectrum composition), and in avoidance of workup bias. Analytical reproducibility was reported frequently (68%), whereas information about indeterminate results was rarely provided. The mean number of methodologic criteria satisfied showed a statistically significant increase over the 3 years in Clinical Chemistry but not in Clinical Chemistry and Laboratory Medicine. CONCLUSIONS: The methodologic quality of the articles on diagnostic test research published in Clinical Chemistry and Clinical Chemistry and Laboratory Medicine is comparable to the quality observed in the best general medical journals. The methodologic aspects that most need improvement are those linked to the clinical information of the populations studied. Editorial actions aimed to increase the quality of reporting of diagnostic studies could have a relevant positive effect, as shown by the improvement observed in Clinical Chemistry.     

Role of MR imaging in sports medicine research. Basic science and clinical research studies

The advent and advancement of MR imaging have provided an entire new dimension for medical imaging. MR imaging has been especially useful because of its capacity to image nonmineralized tissues with a very high degree of resolution. Although modalities such as ultrasound and scintigraphy have proven useful for specific purposes, it is MR imaging that has the most utility and capabilities, especially in the area of sports-induced injuries. The technology associated with MR imaging has expanded greatly, and it continues to evolve at a rapid pace. The result has been an ever-increasing diagnostic capability that has become more economic with time. As described previously, MR imaging is gaining importance in the area of comparative medicine for animal athletes as well. It is also interesting to note that MR imaging now has a greater potential for monitoring physiological and biochemical changes as well as anatomic ones. Some newer MR units actually include physiologic data acquisition components. Consequently, new bioassays and nondestructive tissue tests can be performed to further understand the molecular biology and ongoing cellular processes in any given condition. Coupled with MR spectroscopy, the enhanced MR techniques should continue to contribute to the overall information that will be integrated into the training and rehabilitation of patients with sports-induced inflammation and injuries. The authors support and encourage ongoing efforts in the area of MR imaging research, both basic science and clinical studies.