三种治疗翼状胬肉手术方法的临床观察

目的 :比较翼状胬肉手术治疗三种方法的疗效。方法 :对 15 6例 (16 2眼 )翼状胬肉病例 ,随机分三组 ,A组行翼状胬肉结膜下转移术 ,4 6例 (6 0眼 ) ;B组行翼状胬肉切除术 ,术中应用丝裂霉素c,5 8例 (6 0眼 ) ;C组行翼状胬肉切除术联合自体结膜瓣移植术 ,术中应用丝裂霉素c ,5 2例 (5 6眼 )。结果 :A组术后复发 10眼 ,复发率 2 1.74 % ;B组术后复发 2眼 ,复发率 3.33% ;C组术后复发 1眼 ,复发率 1.79%。结论 :翼状胬肉切除术联合自体结膜瓣移植术 ,术中应用丝裂霉素c ,手术复发率低 ,术后效果好。     

丝裂霉素C联合结膜移植治疗翼状胬肉的临床观察

目的观察丝裂霉素C联合自怵结膜移植在翼状胬肉切除术中的疗效：方法对51例翼状胬肉患者在术中应用0．02％丝裂霉素C联合自体结膜移植。结果51例，60只眼，其中初发性翼状胬肉41只眼，复发性翼状胬肉19只限，术后结膜移植片平整、光滑、愈合良好。全部病例植片均成活，无感染，无脱落，随访3～12个月，初发性翼状胬肉2例复发，复发性翼状胬肉3例复发：结论在翼状胬肉切除术中一次性运用低浓度丝裂霉素C（0．02％）联合自体结膜移植，是治疗翼状胬肉防止其复发的较好方法。     

逆行切除联合丝裂霉素C治疗翼状胬肉疗效观察

目的：探讨逆行切除联合丝裂霉素C治疗翼状胬肉的疗效。方法：采用逆行切除联合丝裂霉素C治疗翼状胬肉48例（56眼）。结果：翼状胬肉56眼治愈，治愈率94．6％；3眼复发，复发率5．4％。未见感染、角膜上皮缺损、角巩膜坏死等并发症。结论；逆行切除联合丝裂霉素C治疗翼状胬肉效果良好，复发率低，值得临床推广。     

新鲜羊膜移植联合丝裂霉素C治疗复发性翼状胬肉的疗效观察

目的：观察新鲜羊膜移植联合丝裂霉素C治疗复发性翼状胬肉的临床疗效。方法：对32例（38眼）复发性翼状胬肉行翼状胬肉切除联合新鲜羊膜移植加丝裂霉素C治疗,观察术后角膜上皮愈合、胬肉复发情况。结果：术后随访3～24个月,有2眼复发,复发率为5.26%。结论：新鲜羊膜移植联合丝裂霉素C治疗复发性翼状胬肉降低了复发率,无严重手术并发症,是一种安全有效的手术方法。     

综合治疗翼状胬肉临床观察

目的 探讨对各期翼状胬肉采取综合治疗的方法。方法 观察分析260例患者（310只眼）不同方式翼状胬肉切除术联合应用丝裂霉素C（MMC）、平阳霉素等治疗后，随访半年以上的结果。结果 10眼复发，复发率为3．2％。其中原发性6只眼，复发性4只眼。结论 综合治疗翼状胬肉，可降低复发率。     

"V"型结膜切口联合丝裂霉素C治疗原发性翼状胬肉34例

[目的]探讨“V”型结膜切口翼状胬肉切除联合丝裂霉素C治疗原发性翼状胬肉的临床疗效。[方法】对34例患者46只眼原发性翼状胬肉采取“V”型结膜切口行翼状胬肉切除＋丝裂霉素C,术后观察愈合、复发情况。[结果]本组患者46只眼术后随访1～6个月,复发3例,复发率为6．52％。[结论]“V”型结膜切口联合丝裂霉素C治疗翼状胬肉疗效肯定,复发率低,值得广泛开展。     

三种方法治疗112例翼状胬肉的临床效果观察

目的观察单纯翼状胬肉切除、胬肉切除联合丝裂霉素治疗与胬肉切除加自体角膜缘上皮联合球结膜移植治疗翼状胬肉的临床疗效。方法选择符合手术标准的翼状胬肉患者93例112只眼,分为A（38眼）、B（38眼）、C（36眼）三组。A组翼状胬肉单纯切除,B组胬肉切除联合丝裂霉素治疗,C组胬肉切除加自体角膜缘上皮联合球结膜移植。观察三组术后角结膜愈合情况以及胬肉复发率。结果随访12～30月,复发率A组23.68%,B组10.53%,C组无复发病例。C组与A、B组比较,差异均有统计学意义（P〈0.05）。结论 胬肉切除加角膜缘干细胞联合结膜移植是处理胬肉复发的最佳方式。该手术较简便,成功率高,复发率低。     

翼状胬肉术中使用丝裂霉素C的临床疗效观察

目的：观察翼状胬肉转移术中局部应用丝裂霉素C（MMC）的临床疗效。方法：随机选择翼状胬肉患者共68例（68只眼），随机分成对照组，MMC组，观察术后角膜愈合、角膜缘新生血管及球结膜是否有结膜翼状胬肉样组织增生。结果：随访6个月-27个月，对照组34例11例复发（32．3％），MMC组34例3例复发（8．6％），两组问复发率有显著性差异P〈O．Ol。结论：单纯的手术切除不能从根本上阻止翼状胬肉的复发，翼状胬肉转移术中使用MMC手术操作简便安全，成功率高，是处理翼状胬肉复发的最佳手术方式。     

两种手术方式治疗复发翼状胬肉疗效比较

目的比较翼状胬肉切除术中应用丝裂霉素C（MMC组）和翼状胬肉切除加角膜缘干细胞移植术（移植组）治疗复发翼状胬肉的手术效果。方法回顾性统计分析两种手术方式的手术时间、术后复发率及并发症等。结果移植组5眼复发,复发率13.9%;MMC组3眼复发,复发率9.7%。移植组手术时间比MMC组长。移植组、MMC组均未见严重的并发症。结论两种手术方式都是治疗复发翼状胬肉较好的方法。     

角膜缘干细胞移植联合丝裂霉素C治疗翼状胬肉的疗效分析

目的：探讨自体角膜缘干细胞移植联合丝裂霉素C在治疗翼状胬肉中的疗效。方法：自体角膜缘干细胞联合丝裂零素C治疗翼状胬肉40侧（49眼）。结果：术后随访10-18月发现47眼翼状胬肉颈部切除的角膜缘区无复发，2眼复发，复发率为4．08％。结论：自体角膜缘干细胞移植联合丝裂霉素C治疗翼状胬肉是一种有效的方法且复发率低。     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。