经阴道超声及宫腔造影对鉴别子宫内膜息肉与其他病变的意义

目的分析子宫内膜病变的声像图和血流特征,并评价经阴道彩色多普勒超声宫腔造影对子宫内膜息肉的诊断价值。方法采用经阴道彩色多普勒加宫腔造影,分别对19例子宫内膜息肉和32例子宫内膜其他病变之声像图、彩色血流及频谱表现进行对比,全部病例经宫腔镜及手术后的病理证实。结果经阴道彩色多普勒超声检诊子宫内膜息肉,清晰显示了内膜与黏膜下肌层之界限和息肉的病变边界,还显示了息肉蒂基底的彩色血流或黏膜下肌瘤周边彩色血流环,适时加做宫腔造影则更有益于对细小病变的诊断。结论经阴道彩色多普勒超声加做宫腔造影可大大提高对子宫内膜息肉与子宫内膜其他病的鉴别诊断水平。     

Development of neurochemical separation of ON and OFF channels at retinal ganglion cells

Anatomical and physiological segregation of neurons into ON (brightening detector) and OFF (darkening detector) channels in the retina and subsequent visual system ensure the high sensitivity required for contrast detection and spatial discrimination. This segregation is finest at the visual axis. Neurochemically, ON and OFF ganglion cells at the visual axis seem to be distinguished by different inhibitory transmitters but not excitatory transmitters. Microiontophoretic studies of inhibitory transmitters on the retinal ganglion cells in kittens and adult cats suggest that this neurochemical distinction is poor in immature ganglion cells at the visual axis. Initially both ON and OFF cells seem to be supplied by GABAergic, glycinergic, and catecholaminergic amacrine cells, but in adults, ON cells remain supplied only by GABAergic amacrines, while OFF cells are supplied by glycinergic amacrines. Postnatal elimination of multiple inputs and strengthening of the appropriate inputs, as seen in the central nervous system, also seem to occur at the retinal neurotransmitter synapses during development.     

Recognition performance and perceived quality of video enhanced for the visually impaired

Subjects with central field loss (CFL) individually selected enhancement parameters to improve visibility of static video images. The effect of enhancement on performance and on perceived quality of motion video was assessed. Performance, e.g. recognition of visual details, was assessed by having subjects answer questions regarding visual information contained in the video motion segments that were enhanced using the individually-selected parameters. Enhancement did not improve subject performance on questions about video content. This result might be due to a ceiling effect limitation of the performance assessment method. In a second procedure, subjects' continuous perceptions of quality (using an adjective-based rating scale) were made while the enhancement parameters were abruptly switched among multiple values; these included the individually-selected enhancements, as well as unenhanced, over-enhanced, and degraded segments. The results indicate that adaptive enhancement (individually-tuned using a static image) adds significantly to perceived image quality when viewing motion video. Subjects who selected stronger contrast enhancement also perceived the enhancement to provide a larger benefit in image quality.     

超声心动图对主动脉窦瘤破裂合并畸形的诊断价值

目的 评价超声心动图对主动脉窦瘤破裂合并畸形的诊断价值，探讨漏诊原因，以提高诊断阳性率。方法 回顾分析23例主动脉窦瘤破裂合并畸形的超声心动图特征，比较超声心动图与手术诊断结果。结果 超声心动图对主动脉窦瘤破裂合并畸形诊断符合率为86．95％（20／23），漏诊率为13．04％（3／23）。结论 超声心动图检查对诊断主动脉窦瘤破裂合并畸形有重要的临床价值，全面掌握超声知识，仔细认真地检查可避免漏诊。     

Early assessment of renal resistance index after kidney transplant can help predict long-term renal function.

BACKGROUND: Color Doppler ultrasonography of intrarenal arterial resistance index (RI), performed early after kidney transplant, has proven to reliably predict short-term allograft function. The aim of this study was to assess whether it could also predict long-term renal function. METHODS: We retrospectively analysed 76 kidney transplant patients who underwent RI assessment within 1 month after the transplant, subdivided into two groups according to RI values, lower (group A) or higher (group B) than its median value (0.635). RESULTS: Compared with group A subjects, the patients of group B were older at the time of transplant (42 +/- 9 vs 35 +/- 8 years; P = 0.001), the donor age was also older (41 +/- 16 vs 33 +/- 13 years; P = 0.02) and had a slightly higher proteinuria (0.54 +/- 0.5 vs 0.32 +/- 0.2 g/24 h; P = 0.02). Serum creatinine, ciclosporin or tacrolimus trough level, arterial blood pressure, number of human leukocyte antigen (HLA) mismatches, anti-hypertensive medications and incidence of delayed graft function were not significantly different between the two groups. By univariate analysis, RI turned out to directly correlate with the recipient age, donor age and daily proteinuria (P = 0.007, P = 0.0007 and P = 0.02, respectively). Multivariate analysis showed that only donor and recipient age maintained their independent predictive value on RI. Kaplan-Meier analysis, considering a serum creatinine increase >50% as the endpoint of the study, showed a statistically significant different graft survival in the two groups (log-rank test = 5.489; P = 0.01). The univariate relative risk of deterioration of graft function among patients with higher RI was 3.77. Proteinuria and recipient age increased the risk as well. CONCLUSIONS: Our data seem to suggest that early determination of RI can help predict long-term graft function in kidney transplant recipients.     

Spectral characteristics of early receptor potential in congenital red-green color blindness

The spectral response curve (amplitude versus wavelength) of the R₂ of the early receptor potential (ERP) was studied in normal, protan, and deutan subjects. The R₂ amplitude peaked at 520nm in most normal subjects. The R₂ at long wavelengths was smaller than normal in protans and larger than normal in deutans when the maximum amplitudes were normalized to 100% at the peak. The ratio of the R₂ amplitude at 460 nm to that at 600 nm clearly differed between protans and deutans. The ERP and the rapid off-response, which is mainly due to the cessation of the late receptor potential, were recorded in the same subjects. The ratio of the sensitivity of the rapid off-response at 500 nm to that at 600 nm was correlated with the ratio of the R₂ amplitude at 460 nm to that at 600nm (correlation coefficient, 0.823, p < 0.001). This study, in conjunction with our previous study, indicates that the abnormality is in the outer segments of the cones in protans and deutans.     

Assessment of functional vision and its rehabilitation

This article, based on a report prepared for the International Council of Ophthalmology (ICO) and the International Society for Low Vision Research and Rehabilitation (ISLRR), explores the assessment of various aspects of visual functioning as needed to document the outcomes of vision rehabilitation. Documenting patient abilities and functional vision (how the person functions) is distinct from the measurement of visual functions (how the eye functions) and also from the assessment of quality of life. All three areas are important, but their assessment should not be mixed. Observation of task performance offers the most objective measure of functional vision, but it is time‐consuming and not feasible for many tasks. Where possible, timing and error rates provide an easy score. Patient response questionnaires provide an alternative. They may save time and can cover a wider area, but the responses are subjective and proper scoring presents problems. Simple Likert scoring still predominates but Rasch analysis, needed to provide better result scales, is gaining ground. Selection of questions is another problem. If the range of difficulties does not match the range of patient abilities, and if the difficulties are not distributed evenly, the results are not optimal. This may be an argument to use different outcome questions for different conditions. Generic questionnaires are appropriate for the assessment of generic quality of life, but not for specific rehabilitation outcomes. Different questionnaires are also needed for screening, intake and outcomes. Intake questions must be relevant to actual needs to allow prioritization of rehabilitation goals; the activity inventory presents a prototype. Outcome questions should be targeted at predefined rehabilitation goals. The Appendix cites some promising examples. The Low Vision Intervention Trial (LOVIT) is an example of a properly designed randomized control study, and has demonstrated the remarkable effectiveness of vision rehabilitation. It is hoped that further similar studies will follow.     

强心力胶囊治疗充血性心力衰竭彩色多谱勒超声心动图检测指标分析

目的观察强心力胶囊对慢性充血性心力衰竭患者心脏左心室功能的影响。方法运用彩色多谱勒超声心动图,测量慢性充血性心力衰竭患者左心室舒张末及收缩末内径(D s和Dd)、左心室每搏量(SV)、心输出量(CO)、左心室短轴缩短率(FS)和射血分数(EF)等指标。结果强心力胶囊治疗后患者收缩末期内径(D s)、流量指标(SV和CO)和泵功能指标(EF和FS)均有明显改善,但治疗后收缩末期内径D(d)和E A/比值无明显变化。结论强心力胶囊具有治疗充血性心力衰竭的作用。     

下肢深静脉瓣功能不全的二维及彩色多普勒超声诊断

目的 探讨下肢深静脉瓣功能不全的二维及彩色多普勒超声声像图改变。方法 应用二维及彩色多普勒超声检查下肢深静脉瓣功能不全36例，47条腿，观察下肢静脉血管及瓣膜的解剖结构和血流动力学改变。结果 有静脉瓣功能不全的患肢静脉管腔内径均有不同程度增宽，瓣膜均有不同程度的改变，脉冲多普勒显示返流频谱返流时间大于0.5s。结论 该检查对诊断下肢深静脉瓣功能不全有较高的实用价值。