光学相干断层扫描技术诊断RPE脱离

目的:观察黄斑区视网膜色素上皮(RPE)脱离的光学相干断层扫描(OCT)图像特征。方法:并发黄斑区RPE脱离的眼底病病例共48例(52眼),进行黄斑区OCT检测,观察其图像特征,并结合FFA结果进行分析。结果:根据形态特征,RPE脱离可分为两种,浆液性RPE脱离和出血性RPE脱离。前者见于部分中心性浆液性脉络膜病例(16例)、特发性浆液性RPE脱离(7例)、部分视网膜下新生血管病变的病例(10例),后者仅见于部分视网膜下新生血管病变的病例(16例)。结论:OCT能够直观形象地显示RPE脱离的形态特征,准确地测量RPE脱离的范围大小。     

Is it necessary to shave the pubic and genital regions of patients undergoing endoscopic urological surgery?

To determine whether postoperative urinary infections were related to shaving before undergoing endoscopic urological surgery, 90 patients were randomly assigned to shaving or not shaving. Urinary cultures revealed infection in 10 patients. Half of them had been shaved, suggesting that this practice does not affect the incidence of urinary infections.     

Prevention of central venous catheter-related bloodstream infections using non-technologic strategies.

OBJECTIVE: To evaluate the incidence of nosocomial bacteremias related to the use of non-impregnated central venous catheters (CVCs) when only non-technologic strategies were used to prevent them. DESIGN: This was a prospective study of infectious complications of CVCs placed in intensive care unit (ICU) patients from April 1997 to December 2001. SETTING: The medical-surgical ICU of a tertiary-care, university-affiliated hospital in Argentina. METHODS: We studied all patients admitted to the ICU using non-impregnated CVCs. Maximal sterile barrier precautions (ie, use of cap, mask, sterile gown, sterile gloves, and large sterile drape), strict handwashing, preparation of the patients' skin with antiseptic solutions, insertion and management of catheters by trained personnel, and continuing quality improvement programs aimed at appropriate insertion and maintenance of catheters were employed. RESULTS: During the study period, 2,525 patients were admitted to the ICU. Eight hundred sixty-eight patients had 1,037 CVCs inserted. The number of CVC-related bloodstream infections (BSIs), acquired in the ICU, was 2.7 per 1,000 CVC-days (13 nosocomial CVC-related BSIs during 4,770 days of CVC use). Microorganisms isolated included methicillin-susceptible Staphylococcus aureus (n = 6), methicillin-resistant S. aureus (n = 2), coagulase-negative methicillin-resistant Staphylococcus (n = 2), Escherichia coli (n = 1), Klebsiella pneumoniae (n = 1), and Enterobacter cloacae (n = 1). CONCLUSIONS: A low rate of catheter-related BSI was achieved without antimicrobial-impregnated catheters. The incidence of CVC-associated bacteremias corresponded to the 10th to 20th percentile range of the National Nosocomial Infections Surveillance System hospitals for the same type of ICU.     

溶血磷脂酸对人视网膜色素上皮细胞增殖的影响

目的 :探讨建立体外原代培养人类视网膜色素上皮细胞 (RPE)方法。方法 :取自愿者贡献的意外事故成年眼球 ,用 0 .2 5 %胰酶消化获取人RPE细胞、置 15 %胎牛血清的DMEM培养液中培养 ,细胞接近融合状态时进行传代培养。用溶血磷脂酸 (lysophosphatidicacid ,LPA)观察RPE增殖的影响。结果 :RPE原代细胞镜下为圆形 ,大小不一 ,内含较多的色素颗粒 ,胞核无法辨认。原代细胞培养贴壁后第 3天增殖速度明显加快 ,至 4～ 5d即可基本融合 ,细胞浆内色素颗粒则随传代次数增多而逐渐减少。第 3代培养的视网膜色素上皮细胞膜表面可见微绒毛 ,细胞质内细胞器丰富 ,线粒体量多 ,体积较小 ,内外膜分界清晰 ,嵴较短。色素颗粒散在分布于胞浆内 ,多数细胞质内含量较少 ,呈高电子密度包含物。LPA对原代培养的视网膜色素上皮细胞增殖有促进作用。结论 :LPA可促进人类RPE细胞体外培养的增殖 ,第 3代培养的视网膜色素上皮细胞可保留原代细胞的生物学特性     

眼挫伤黄斑损害的光学相干断层扫描观察

目的 观察眼挫伤所致黄斑损害的光学相干断层扫描(optical cohrence tomgraphy，OCT)图像特征。方法 对64眼经检眼镜或荧光素眼底血管造影(FFA)诊断为眼挫伤美斑损害者进行OCT检查，观察其图像特征。结果 5眼表现为神经上皮浆液性脱离；4眼表现为神经上皮层问水肿；4眼表现为出血性包素上皮脱离；6眼表现为视网膜内出血；8眼表现为神经上皮层变薄；3眼表现为黄斑区增生膜形成：26眼表现为黄斑区裂孔形成，其中24眼为全层裂孔，仅2眼为板层裂孔；1眼为视网膜脱离；7眼黄斑区0cT图像未发现明显异常。结论 眼挫伤黄斑损害的OCT图像可以提供黄斑区解剖结构改变的重要信息，有助于对病变进行诊断、评估及追踪观察。     

特发性黄斑裂孔的OCT诊断标准

目的 观察特发性黄斑裂孔的光学相干断层扫描(Optical Coherence Tomography，OCr)图像特征。总结Gass分期的诊断标准。方法 对133例(143只眼)临床诊断为特发性黄斑裂孔的患者进行OCT检查。根据Gass分期的原则进行分期。结果依据Gass分期的原则，将143只患眼分为4期，各期OCT图像特征如下：Ⅰ期：共29只眼，黄斑中心凹轮廓变浅或消失，中心凹下可见低反射区，其中14只眼发现伴有黄斑前膜增生，7只眼伴有玻璃体黄斑牵引；Ⅱ期：共17只眼，神经上皮全层破裂形成孔，孔表面有可以贴附的孔盖；Ⅲ期：共83只眼，神经上皮全层破裂，孔盖游离或未见孔盖，伴不同程度裂孔周围囊样水肿；Ⅳ期：共14只眼，裂孔形态与Ⅲ期相似，但合并玻璃体后脱离。结论 OCT能直观、形象地显示特发性黄斑裂孔的形态特征，比较准确地进行分期，在特发性黄斑裂孔的诊断及术式选择等方面有重要作用。     

Spectacle use and reduced unaided vision in third grade students: a comparative study in different educational settings

Background: The development of myopia is influenced by hereditary factors, environmental factors and geneenvironment interaction. Reading and near‐work activity are associated with myopia and myopic progression. This study sought to determine and compare the prevalence of reduced unaided vision and spectacle use among third grade Israeli students from three different educational settings. Method: A sample of 917 students (mean age 8.5 years, range seven to 10 years) was drawn from the three Israeli educational streams: secular, Orthodox and ultra‐Orthodox. Children in the ultra‐Orthodox education pathway begin studying at the age of three years and their daily reading involves sustained near work with increased accommodative effort accompanied by head‐rocking movements. Reduced distance vision was used to indicate the likely development of or an increase in the amount of myopia. Spectacle lenses were measured to determine the prevalence of myopia. Results: Of the 917 students studied, 103 (11.2 per cent) wore spectacles (14.2 per cent of the males and eight per cent of the females); 82.5 per cent of those who wore spectacles were myopic. Males from ultra‐Orthodox schools had the highest rate of reduced unaided vision (72.5 per cent) compared with males from secular schools (27.3 per cent), males from Orthodox schools (59.3 per cent) or with females from all three groups (average of 34.8 per cent, p < 0.0001, chi squared). Males had a higher rate of reduced unaided vision, especially in the Orthodox and ultra‐Orthodox schools. Conclusions: Our study suggests that Jewish ultra‐Orthodox males have a higher prevalence and degree of myopia. The study habits of young children, including exposure to prolonged near tasks, high accommodative demands and possibly optical defocus induced by body sway, may contribute to the development of myopia.     

微机在高压氧舱中的应用

利用微机及其附属设备，实现高压氧舱操作全过程氧浓度监控的自动化。     

检测HBV DNA评价感染HBV饮食服务人员的传染性

目的　检测饮食服务人群HBV感染状况 ,研究HBVDNA阳性者的家庭聚集性 ,探讨其传染性 ,为修订相应法规提供依据。方法　用反向间接血凝法检测HBsAg ,用赖氏法检测ALT ,酶联免疫吸附试验检测HBVM ,聚合酶链反应 微孔杂交法和荧光定量PCR法检测HBVDNA。对HBVDNA阳性者的家庭聚集性进行对照研究。结果　在 14 4 92名饮食服务人员中检出HBsAg阳性 4 96人 ,阳性率 3.4 2 %。其中HBsAg≥ 1∶5 12或ALT >4 0者 137人 ,占阳性者的 2 7.6 2 %。ALT <4 0 ,HBsAg <1∶5 12 ,且HBeAg阳性者 5 5人 ,占 15 .32 %。在HBsAg <1∶5 12、ALT <4 0、且HBeAg阴性的 30 4人中检出HBVDNA阳性者 113人 ,阳性率 34.6 7%。HBVDNA阳性者的家庭聚集率为 86 .4 9% ,家庭成员HBV感染率为 6 4 .38% ,相对危险性 6 .5 8。HBVDNA阳性者的家庭成员HBV感染呈家庭聚集性。结论　血清学检验结果同时表现为HBsAg <1∶5 12、ALT <4 0、HBeAg阴性、符合现行法规要求 ,但HBVDNA阳性的在岗饮食服务人员是HBV的危险传染源。