学龄期近视进展儿童调节功能的客观检查和分析

目的　对学龄期近视进展儿童进行调节功能的客观检查与分析，观察调节功能与近视进展之间的相关性。方法　选取2017年至2018年在首都医科大学附属北京同仁医院视光学门诊定期就诊的71名学龄期儿童为研究对象，根据受试者近年的屈光度进展速度，按≤0.50 D·a^-1、>0.50~1.00 D·a^-1、>1.00~1.50 D·a^-1、>1.50 D·a^-1分为4组，使用人眼调节分析仪对受试者进行调节功能的客观测量与分析，记录不同调节刺激视标下4组的客观调节反应值和客观调节微波动值，并作对比。结果　在所有调节视标上，各组随着调节刺激幅度增加，客观调节反应值也逐渐增加，4组在不同调节刺激视标下的客观调节反应值及平均的客观调节反应值差异均无统计学意义（均为P＞0.05）。≤0.50 D·a^-1、>0.50~1.00 D·a^-1、>1.00~1.50 D·a^-1、>1.50 D·a^-1近视进展速度组调节微波动值分别为（62.2±5.6）D、（62.5±5.3）D、（66.5±6.0）D和（58.0±6.5）D，4组间差异有统计学意义（F=6.424，P=0.001），在+0.50~-0.50 D、-2.00 D调节刺激视标下，4组的客观调节微波动值比较差异均有统计学意义（均为P＜0.05），在其余调节刺激视标下差异均无统计学意义（均为P＞0.05）。结论　对于学龄期儿童的近视进展速度，客观调节微波动值相对于客观调节反应值可能是一个更为敏感的相关指标。     

Effects of second-hand smoking on lung functions in athlete and non-athlete school-aged children – observational study

BackgroundSecond-hand smoking or environmental tobacco smoke is a critical health risk. Children are the most vulnerable to second-hand smoking because of their small bronchial ducts, less developed immunity, and low-physical activity.ObjectivesThe purpose of this study was to ascertain the effects of second-hand smoking on lung functions in athlete and non-athlete school-aged children.MethodsThis observational study included forty-six school-aged children, their age was 8–15 years, assigned to three groups; 2 study groups and 1 control group (n=15). The study groups comprised of 16 football players, and of 15 cyclists. Lung functions were evaluated recording forced vital capacity, forced expiratory volume in 1 sec and peak expiratory flow using digital spirometer.ResultsAll measures were recorded in definite values and the children were also classified into second-hand smoking (SH), or non-exposed to tobacco smoking (NE). The findings presented a significant increase (p<0.05) of the study groups in forced vital capacity, forced expiratory volume in 1 sec and peak expiratory flow solely for the non-exposed children. However, there were non-significant differences between the cyclists and football players or between the passive smoking children and non-exposed children in any of the two study groups (p>0.05).ConclusionThe outcomes of this study suggest beneficial influences of the sports activity on the lung functions, without different influences of the cyclists and football players on the lung functions.     

椎弓根螺钉三椎体内固定对脊椎爆裂性骨折患者椎体与神经功能状态的影响观察

目的:探讨椎弓根螺钉三椎体内固定对脊椎爆裂性骨折患者椎体与神经功能状态的影响.方法:选取2013年7月至2015年1月于本院进行治疗的58例脊椎爆裂性骨折患者为研究对象,对其进行回顾性研究,将其根据手术方式不同分为对照组(短节段椎弓根内固定组)29例和观察组(椎弓根螺钉三椎体内固定组)29例,然后将两组患者手术前与手术后不同时间的伤椎恢复指标与血清神经功能相关指标进行比较.结果:观察组手术后不同时间的伤椎恢复指标中的后凸Cobb角、椎体平移率、椎体高度丢失率与血清神经功能相关指标中的BDNF、NSE、NGF及S100B均显著好于同期的对照组指标,并且明显好于其治疗前,均有显著性差异(P＜0.05).结论:椎弓根螺钉三椎体内固定可更为有效地恢复脊椎爆裂性骨折患者椎体参数,并且更有助于神经功能状态的恢复.     

Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomized trial

To compare pulmonary effects, postoperative pain and fatigue, morbidity, patient satisfaction, and cost of different anesthetic techniques for inguinal hernia repair, 50 patients were randomized to local and general anesthesia groups (LA and GA). All patients received the same premedications and the same postoperative analgesic regimen. The standardized postoperative analgesic, intramuscular pyroxicam 20 mg, was given to all patients in the recovery room and an additional 20 mg on the same day was given as requested by each patient. Pulmonary function studies and arterial blood gas analysis were performed 1 h prior to the operation and at the postoperative 8th and 24th hours. All patients underwent Lichtenstein's tension-free hernioplasty. Postoperative pain and fatigue were registered 8 h and 24 h after the operation. A questionnaire was filled out by the patients, and they were asked to give grades for the general comfort of the anesthesia and the surgical procedure (1=worst, 10=best). Postoperative pulmonary function tests were significantly poorer in the GA group both on 8th- and 24th-hour measurements (P<0.05). Patients who underwent LA had significantly lower PCO₂ and higher PO₂ at the postoperative 8th hour (P<0.05). Mean postoperative pain and fatigue scores revealed a significant difference in favor of local anesthesia at only the 8th hour (P<0.05). There were two complications, one in each group (a hematoma in LA and a urinary retention in GA). Patient satisfaction grades were not different in the two groups. We conclude that LA in inguinal hernia repair does not adversely affect pulmonary functions, patients feel less pain, and patient satisfaction is comparable to that with GA. Electronic Publication     

Disability,depression and somatization in a low back pain population

Objective: The aim of this study was to determine the prevalence of low back pain (LBP) in a primary care setting population and examine its association with the symptoms of depression and somatization. Methods: This is a cross‐sectional study, utilising a survey carried out in primary health care clinics (PHCs) in Al‐Ain, United Arab Emirates (UAE). A multistage stratified sampling design was used and a representative sample of 1304 UAE nationals aged 18–65 years who attended PHC clinics for any reason were included and 1103 (84.5%) subjects agreed to participate and responded to the questionnaire during a period from June 2001 to January 2002. A specially designed questionnaire with three parts was used for the data collection: socio‐demographic information of the studied subjects, modified version of the Roland‐Morris scale for evaluating back‐related functional disability and SCL‐90 R for depression and somatization subscales was used to assess depressive and somatic symptoms. Results: Of the total number of subjects surveyed (1103), 586 (53.1%) were men and 517 (46.9%) women. The mean age was 34.9 ± 13.4 years for men and 33.5 ± 11.8 years for women. The prevalence of LBP in the studied subjects was 64.7% (95% CI, 60.7–68.5] with 46.7% among men and 53.3% among women. There were a significant differences between the subjects with LBP and without LBP with respect to gender (P < 0.001), body mass index (BMI) (P < 0.001), occupational status (P < 0.001) and living environment (P = 0.016). Functional disability was higher in patients with LBP. Young patients in aged 15–34 years, patients with preparatory/secondary educational level and students showed higher depressive symptoms. A similar pattern was found in patients with somatic symptoms. Factor analysis revealed a strong association between depression and somatization in LBP patients. Conclusions: Functional disability was higher in with LBP. Furthermore, symptoms of depression and somatization are prevalent among LBP patients.     

肺癌患者红细胞免疫功能和T淋巴细胞亚群的检测及临床意义

作者对62例肺癌患者进行红细胞免疫功能及T淋巴细胞亚群测定，并与20例正常人对照。结果显示：肺癌组红细胞膜C3b受体活性（RBC－C3bRR）、CD3 、CD4 、CD4 ／CD8 比值均低于正常人（P＜0．05～0．01），红细胞膜的吸附免疫复合物（RBC－ICR）、CD8 均高于正常人（P＜0．05～0．01），因此认为红细胞免疫及T淋巴细胞亚群测定对肺癌的诊断、治疗及病情预后估计有一定价值。     

指示肺通气不均匀性的熵变及其同其他指标的理论比较

熵代表无序的水平，作者使用通气的熵变（ＥＣＶ）指示肺通气的不均匀性，ＥＣＶ定义为当前泡潮气量趋近于零时每摩尔被吸入气体从不均匀通气到均匀通气的熵变的极限。本文从熵的基本公式民地出ＥＣＶ的计算方程。用几个数学模型肺将ＥＣＶ同其他７个洗出指标进行了比较。８个指标中，只有ＥＣＶ仅取决于通气分布，其他７个指标不仅取决于通气分布，还同潮气量和死腔的大小有关。这影响了它们评价肺通气不均匀性的效果，ＥＣＶ的另一     

On information field of clinical diagnosis

“Field” is a universal phenomenon existing in both nature and society, and determines the existence and significance of all materials or information. The man being has always been generating and carrying a large quantity of life information in his whole life. Each piece of life information has an independent information field. The life information field includes such three subfields as bioinformation field, psychoinformation field and psycho-bioinformation field.The clinical diagnosis information field which is a specific information field within the information field of human activities consists of all information concerning man‘s health. Only after we have cognized and ascertained the clinic diagnosis information field, can we accurately utilize its function to serve the human being.     

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.     

Accommodative hysteresis under static and dynamic stimulus conditions

The influence of continuous variation in dioptric demand on the accommodative hysteresis induced at near distances was examined in 14 visually-normal young adults. Tonic accommodation was measured before and after 10 minutes of sustained focus using a constant stimulus at 5 D, 6.5 D, and 8 D, as well as a stimulus which slowly and alternately increased and decreased over the continuous range from 5 D to 8 D. For approximately half the subjects, dioptric demand had to be very high (8 D) under static conditions to produce moderate but significant hysteresis, yet little or no attenuation of the effect occurred under the dynamic condition. For other subjects who consistently showed very large tonic changes (1.4 D or more) under static conditions, the hysteresis effect generated under dynamic conditions was greatly reduced (approximately 50 per cent) in magnitude. These findings suggest that the degree to which continuous variation in dioptric demand will disrupt the adaptive process may depend on individual differences in the rate and/or maximum level of tonic accommodative change. Such a relationship could have bearing on the particular strategy recommended for individuals who tend to experience blur at distance following nearwork.