高原汽车驾驶员腰痛的流行病学调查

目的 了解高原汽车驾驶员腰痛的患病情况、流行特征。方法 通过问卷方式调查高原汽车驾驶员腰痛的流行病学特征。结果 （1）高原汽车驾驶员腰痛的患病率为86．1％，明显高于对照组（P＜0．01）。（2）高原缺氧反应、吸烟、长途驾驶均与腰痛有关。结论 本组平均年龄小而腰痛患病率高与高原恶劣的工作环境和劳动强度过大等因素有关。腰痛是与职业相关的亚临床症候群。     

高原汽车驾驶员腰痛的流行病学调查

目的了解高原汽车驾驶员腰痛的患病情况、流行特征。方法通过问卷方式调查高原汽车驾驶员腰痛的流行病学特征。结果(1)高原汽车驾驶员腰痛的患病率为86.1%,明显高于对照组(P<0.01)。(2)高原缺氧反应、吸烟、长途驾驶均与腰痛有关。结论本组平均年龄小而腰痛患病率高与高原恶劣的工作环境和劳动强度过大等因素有关。腰痛是与职业相关的亚临床症候群。     

护士职业高原压力源调查分析与应对

目的:通过对我院护士职业高原压力源现状调查与分析,探讨其成因、影响因素,找到预防和应对方法,改善或缓解职业高原的发生。方法:查阅有关文献资料,自制问卷调查表对755名在职护士进行调查;将结果编码后计算出最后得分,利用统计学软件进行关联分析,找出职业高原的压力源相关因素。结果:不同职称、学历、年龄、工作性质护士均存在不同程度职业高原压力源情况,在被调查的755名在职护士中,有轻度职业高原211名,中度职业高原392名,重度职业高原152名,呈现出以中度职业高原压力源现象为主的现状。结论:职业高原受个人、组织、环境方面诸多负面因素影响,个人通过积极应对、自我调节、学会减压释放,组织鼓励其参与管理或决策,增强归属感、认同感,实现自我的需要,可以顺利走出职业高原误区。     

办公室人员腰痛患病率抽样调查及康复相关因素分析

目的：明确办公室人员腰痛的患病率和分布情况及康复相关因素，为康复治疗干预和健康宣教等工作提供依据。方法：采用多阶段整群抽样方法，选取300名广州市办公室工作人员作为调查对象，使用统一的结构式问卷进行访问调查，对结果进行统计学分析。结果：共完成291份调查，应答率为97％。受访者年龄18—69（34．04±10．31）岁，腰痛患病率为41．9％。腰痛与工作体位有关（P=0．023）；每日同一体位工作时间〉2h是腰痛的危险因素（P=0．005，OR=3．342，CI：1．445—7．733），年龄对于办公室工作人员患腰痛是影响因素之一（P〈0．001）。康复相关因素分析中发现：被访者中对治疗腰痛最认同的方法是中医推拿按摩54．6％，其次为理疗18．2％；有68．7％的人知道运动也能够治疗腰痛；85．9％的人知道预防对于腰痛的重要性，其中只有10％的人知道如何预防：受访者治疗腰痛时首先选择保健按摩医院（中心）的占26．8％，康复科则列第4位13．1％。结论：广州市办公室人员腰痛的患病率较高，与年龄、体位和工作时间有关；他们对康复相关因素及现代康复治疗手段的认识度不高，值得业界关注。     

腰椎间盘突出症患者的下肢压痛点及其临床意义

目的：研究腰椎间盘突出症患者的下肢压痛点并探讨其临床意义。方法：检查１７４名腰椎间盘突出症患者下肢臀中肌,臀大肌,股四头肌,股二头肌。半腱半膜肌,胫骨前肌,腓肠肌内侧头和腓肠肌外侧头以及坐骨神经,胫神经共计１０个压痛点。结果：１２７名患者（７３％）存在下肢压痛点,但Ｌ４－５椎间盘突出与Ｌ５－Ｓ１突出患者的阳性率无显著差别（Ｐ〉０．０５）,压痛点总数与年龄成正相关（Ｐ〈０．０５）,与直腿胎高试验阳性     

中国国家女子赛艇运动员慢性腰痛对运动训练的影响及其相关因素

目的：调查女子赛艇运动员慢性腰痛对运动训练的影响，分析其相关影响因素。 方法：于2004—01备战奥运会冬训期间，调查中国国家女子赛艇队43名运动员，平均年龄（23&;#177;4）岁。训练项目为负重深蹲，高翻，卧拉，卧推，提壶铃，负重腰腹肌练习，5000m测功仪训练，12km长划，5km长跑等交替进行，采用运动员心理社会适应能力问卷评定慢性腰痛的主观感觉情况，应用5000m测功仪进行运动成绩测定，采用腰背痛诊断标准评定女子运动员慢性腰痛的患病率，采用目测类比评分法及传统压痛测定法评定疼痛程度。 结果：所有调查对象全部进入结果分析，无脱落。①腰痛分布情况：41名女子赛艇运动员有23名发生腰痛，患病率为56％。腰痛发生时间5个月～5年，平均腰痛时间为（2．42&;#177;1．6）年。棘上韧带损伤和腰肌筋膜炎分别为13例，腰椎间盘突出症3例，腰3横突综合征2例，腰椎小关节紊乱症1例。②5000m测功仪成绩测定及运动员心理社会适应能力问卷调查结果：慢性腰痛对运动员日常生活、运动训练、心理、社会适应能力及运动量完成情况均产生不同程度的影响，从5000m测功仪成绩可见，慢性腰痛运动员成绩明显好于无腰痛运动员[（1105．11&;#177;30．92，1129．62&;#177;39．14）s，（P〈0．05）]。③慢性腰痛对运动员运动训练影响的显著相关项目：年龄、运动训练年限与腰痛对运动训练的影响呈高度负相关，即年龄越大，感觉腰痛对训练的影响越大，运动训练年限越长腰痛对运动训练的影响越大。心理、社会适应能力及训练完成百分比与腰痛对运动训练的影响呈高度正相关，即感觉腰痛对训练的影响越小，完成训练的量越大。腰痛对心理及社会适应影响较小的运动员运动训练的影响也越小。 结论：慢性腰痛对运动训练有一定程度的影响，运动量完成情况及心理、社会适应能力与慢性腰痛对运动训练的影响呈高度正相关，年龄、运动训练年限与其呈高度负相关。     

某三级甲等医院临床护士腰痛情况调查与分析

目的：掌握临床护士腰痛发病情况以及相关职业因素,加强护士职业保护。方法：采用自行设计调查问卷对692名护士进行问卷调查。结果：护士腰痛发病率高达97.4%,年龄、护龄、夜班频度、弯腰频度、弯腰时间、科室的差异导致了腰痛频度的差异。结论：医院有关部门应重视护士腰痛的职业防护,促进护士身体健康。     

超声诊断右肾多发结石、右输尿管下段囊状扩张伴多发结石1例

患者,女,40岁,以右侧中、下腹钝痛及右侧腰背部疼痛来我院就诊。体格检查：右侧腰背部叩击痛（＋）,右侧中、下腹部有压痛,无反跳痛。实验室检查：尿常规提示：红细胞：＋＋。余（-）。     

摩托车驾驶员人格与其驾驶行为和交通事故发生的关系

目的：通过问卷调查分析摩托车驾驶员的人格因素与驾驶行为、事故之间的相关性。 方法：于2004-09／10随机抽取重庆市区及郊县的摩托车驾驶员共800名进行问卷调查，均自愿参加调查。利用自编的摩托车驾驶员驾驶行为问卷（分为冲动行为、超速及违规行为、错误行为和警觉安全行为4个子因素）、中国人人格量表（可以测量中国人人格的7个维度及其相关的18个小因素）、修订的Zuekerman的感觉寻求量表以及个人资料表（包括性别、年龄、文化程度、婚姻状况、驾驶年限、每年驾驶的公里数、有无驾照和事故等）对摩托车驾驶员进行测试。 结果：剔除回答不完整或怀疑不真实的问卷，获得内容详实问卷621份，有效率为77．6％。①人格因素与驾驶行为的相关性：除活跃与错误行为、爽直与安全警觉行为、淡泊与超速及故意违规行为相关不显著外，其余人格因素和感觉寻求与四种驾驶行为均有显著相关性（r=-0．48～0．53，P〈0．05-0．01）。②人格对驾驶行为的预测作用：耐性、严谨、自制、利他、重感情等人格因素对驾驶行为有显著的预测作用（F=38．11-202．18，P〈0．01）。③碰撞事故中事故驾驶员和安全驾驶员的人格差异：摩托车事故驾驶员的自制、沉稳和宽和因子分均显著低于安全驾驶员（z=-3．87-2．16，P〈0．05-0．01），而严谨因子分却显著高于安全驾驶员（z=3．29，P〈0．01）。④非碰撞事故中事故驾驶员和安全驾驶员的人格差异：事故驾驶员的乐观、沉稳、宽和、机敏和淡泊因子分均显著低于安全驾驶员（z=-2．81～-2．31。P〈0．05～0．01）。 结论：摩托车驾驶员的人格与其驾驶行为和交通事故的发生有关，因此在提高摩托车驾驶员技能水平的同时，也要注意对其进行人格方面的教育。     

腰背部肌肉锻炼操在预防ICU护士腰背痛中的应用

[目的]观察自制腰背部肌肉锻炼操在重症监护病房（ICU）护士腰背痛中的应用效果.[方法]选择河北省4所三级甲等医院107名ICU 护士,视觉疼痛评分（visualanalogscale,VAS）大于4分,有与职业相关的腰背痛史大于3个月,将107名ICU 护士随机分为干预组和对照组.干预组给予每次30min人体力学知识培训和20min腰背部肌肉锻炼操指导;对照组只进行30min人体力学知识培训.干预前、干预3周、干预12周和干预24周采用VAS评分对疼痛程度进行评价.[结果]干预12周与干预24周时干预组VAS评分均低于对照组（P=0.001）.[结论]腰背部肌肉锻炼操能有效缓解ICU 护士职业性腰背痛.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.