育龄妇女TSH、FT_3和FT_4参考范围的建立

目的:建立本实验室健康育龄妇女血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)和游离四碘甲状腺原氨酸(FT4)水平的参考区间。方法:采用化学发光技术检测2 745名健康育龄妇女血清TSH、FT3和FT4水平。结果:健康育龄妇女的血清TSH水平为0.61-5.53μIU/mL(2.39μIU/mL),FT3为3.81-5.74 pmol/L(4.72 pmol/L)FT4为12.00-21.61 pmol/L(16.2 pmol/L),其中TSH、FT3和FT4的异常率分别为4.95%、4.88%、4.92%。结论:不同实验室应建立各自检测系统的参考区间。     

脑出血患者治疗前后血清TT3、TT4、血糖、胰岛素的变化及临床意义

目的：观察脑出血患治疗前后血清TT3、TT4、血糖及胰岛素的变化。方法：测守44例无甲状腺疾病及糖尿病史的脑出血患治疗前后TT3、TT4，血糖，胰岛素水平，以39例健康体检中，老年人为正常对照。结果：脑出血患治疗前与正常人相比TT3、TT4、降低（P＜0．01），血糖升高（P＜0．01），胰岛素无显差异（P＞0．05）。治疗后与正常人相比，TT3、TT4、血糖，胰岛素均值接近，脑出血患治疗后与治疗前相比TT3、TT4升高（P＜0．01），血糖下降（P＜0．01），胰岛素无变化，结论：脑出血患急性期可出现TT3、TT4降低，应激性血糖升高，动态观察这些指标，可作为判断病情，估计预后的方法。     

老年人慢性心力衰竭患者甲状腺激素变化的临床意义--附48例检测分析

目的探讨老年人慢性充血性心力衰竭(慢性心衰)患者甲状腺激素水平的变化及临床意义.方法采用全自动化学发光免疫分析系统检测48例慢性心衰患者、36名正常对照组的血清甲状腺激素水平并作比较.结果慢性心衰患者的三碘甲状腺原氨酸(triiodothyronine,T3)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)水平[(1.18±0.80)nmol/L、(3.1±0.5)pmol/Ll)与对照组[(1.75±0.76)nmol/L、(4.4±0.6)pmol/L]比较差异均有统计学意义(P＜0.05),且慢性心衰组随着心力衰竭的加重,T3、FT3水平逐渐降低;而甲状腺素、游离甲状腺素、促甲状腺素则无明显改变.其中43例慢性心衰患者治疗前后的T3[(1.19±0.45)nmol/L、(1.45±0.23)nmol/L])、FT3[(3.3±0.8)pmol/L、(3.6±1.2)pmol/L])水平比较差异均有统计学意义(P＜0.01,P＜0.05).结论老年人慢性心衰患者甲状腺激素水平的变化,对判断其心功能损害程度、治疗效果和预后具有一定的临床意义.     

FT3、FT4、TSH与T3、T4联检评价甲状腺功能及意义

目的探讨甲状腺功能亢进、甲状腺功能减退患者血清中FT3、FT4、TSH与T3、T4水平的变化，以及在评价甲状腺功能中各项指标的诊断符合率及其临床意义。方法应用化学发光免疫分析法测定60例甲状腺功能亢进患者和10例甲状腺功能减退患者血清中的FT3、FT4、TSH与T3、T4的含量，并与50例健康人作对照进行比较。结果疾病组与健康对照组T3、T4、FT3、FT4、TSH血清测定结果比较，差异有统计学意义（P〈0．05）；疾病组与健康对照组T3、T4、FT3、FT4、TSH的诊断符合率比较，差异无统计学意义（P〉0．05）。结论FT3、FT4、TSH与T3、T4联检评价甲状腺功能，对于甲状腺疾病的早期诊断、鉴别诊断及预后判断有着非常重要的临床意义；对临床医生合理用药，提高甲状腺疾病的治愈率和好转率有着科学的指导意义。     

晚期血吸虫病患者甲状腺激素监测的临床意义

目的观察晚期血吸虫病患者血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、反三碘甲状腺原氨酸(rT3)及其比值的升降变化,评价其预后判断价值。方法将138例晚期血吸虫病患者按尿钠排泄率分为轻型(35 mmol/d)85例、中型(10～30 mmol/d)27例、重型(<10 mmol/d)26例。用放射免疫法检测晚期血吸虫病患者治疗前、后和30名正常对照者T3、T4、rT3水平,计算T3/rT3比值及T4/rT3比值,同时检测肝功能指标[总胆红素(TBil)、总蛋白(TP)、白蛋白(Alb)、丙氨酸氨基转移酶(ALT)],分析其与肝脏功能代偿机制的相关性及其与预后的关系。结果 138例晚期血吸虫病患者中轻型患者T3、T4水平均低于正常对照组(P<0.05),中、重型组较轻型组下降幅度更大(P<0.01、P<0.001);患者组rT3水平与正常对照组比较有不同程度升高,且中、重型组较轻型组上升幅度更为明显(P<0.001)。T3/rT3及T4/rT3比值随患者临床分型的加重(轻、中、重型)而进一步下降(P<0.01、P<0.001)。26例晚期血吸虫病重型患者中伴难治性腹水者治疗前T3/rT3及T4/rT3比值均低于伴非难治性腹水者(P<0.001);出院时伴非难治性腹水患者T3/rT3及T4/rT3比值明显升高(P<0.05),而伴难治性腹水患者则持续降低(P<0.05),提示预后不良。动态监测26例晚期血吸虫病重型患者T3/rT3及T4/rT3比值,19例最终痊愈患者逐渐上升直至恢复至正常水平,4例病情加重者呈逐步下降趋势,而3例死亡病例则快速下降至最低值(0.10±0.05)。结论晚期血吸虫病患者T3/rT3和T4/rT3比值变化为肝功能受损的敏感指标,其动态监测对晚期血吸虫病患者的预后判定有重要意义。     

充血性心力衰竭患者血清甲状腺激素水平变化及其临床意义

目的探讨慢性充血性心力衰竭(CHF)患者血清甲状腺激素变化及其临床意义。方法采用自动化学发光免疫分析法检测40例CHF患者及22例健康者血清三碘甲状腺原氨酸(T3),总甲状腺素(T4)及其游离成份值和促甲状腺激素(TSH)的浓度,比较两组间的差异,并对CHF患者进行亚组分析。结果CHF组T3、T4、FT3较健康组下降,TSH高于健康组,FT4两组间比较无显著差异,且心功能越差,FT3水平越低。结论CHF患者血清FT3水平能作为判断心衰严重程度的指标之一。     

血清TT3、FT3、TT4、FT4以及TSH检测意义

目的探讨TT3、FT3、TT4、FT4以及TSH在甲状腺疾病患者中检测的价值;总结分析各指标变化情况。方法收集分析本院200例甲状腺疾病患者,并选取健康者50例作为对照组。用化学发光分析法检测各组甲状腺功能,并对各组各指标的检测值进行比较。结果甲亢组T3、T4、FT3、FT4均高于健康对照组,甲减组T3、T4、FT3、FT4均低于健康对照组。TSH含量甲亢组低于健康对照组,甲减组明显高于健康对照组。与健康对照组比较其差异均有统计学意义。甲亢组FT3诊断符合率为96%,TSH为96%,T3为92%,FT4为90%,T4为88%。甲减组TSH诊断符合率为100%,FT4为93%,T4为90%,FT3为77%,T3为70%。结论 FT3、T3、TSH在甲亢诊断中有临床意义;FT4、T4、TSH在甲减诊断中有临床意义。     

108例颅脑外伤患者血清T3水平的变化

以往对颅脑外伤患者病情严重程度及预后估计通常是借助临床表现及结合头部放射形态学检查结果进行综合评价。我们通过检测颅脑外伤患者血清三碘甲状腺原氨酸(T3)水平,旨在探讨血清T3水平变化是否能成为对患者病情及预后判断的量化指标。1临床资料1.1病例:选择2002年1月—2006年12月本院急诊救治的颅脑外伤患者共108例,其中男80例,女28例;平均年龄(35.79±9.16)岁;分型〔1〕:特重型9例,重型46例,中型25例,轻型28例。表1 108例患者血清T3水平及死亡情况分型例数(例)血清T3均值(x±s,nm o l/L)正常数〔例(%)〕降低数〔例(%)〕病死率〔例(%)〕…     

慢性心力衰竭32例的血清甲状腺素变化

目的　探讨慢性心力衰竭 (CHF)患者血清三碘甲状腺原氨酸 (T3 )值的变化。方法　对比分析32例CHF患者的血清T3 值和 30例健康对照组的血清T3 值。结果　Ⅱ级CHF患者血清T3 值为 (1 0±0 5 2 )ng/ml,Ⅲ级CHF患者血清T3 值为 (0 81± 0 4 7)ng/ml,Ⅳ级CHF患者血清T3 值为 (0 6 3± 0 5 7)ng/ml,健康对照组血清T3 值为 (2 0 3± 0 4 5 )ng/ml,各级CHF血清T3 值均有下降 ,与健康对照组比较 ,差异有显著意义 (P <0 0 5 )。结论　CHF患者的血清T3 水平有降低。     

磁性均相酶免疫技术测定血清TSH、FT3、FT4的临床应用

本实验室 2 0 0 1年开始用深圳新产业生物化学工程有限公司提供 (由瑞士引进 )的SEROZYME磁性均相酶标免疫技术系统 ,开展了以检测内分泌激素为主的检测方法。主要检测促甲状腺激素 (thyroid stimulat inghormone ,TSH)、三碘甲腺原氨酸 (triiodothyronine ,T3)、四碘甲状腺氨酸 (thyroxine ,T4 )、游离三碘甲腺原氨酸 (FT3)、游离甲状腺素 (freethyroxine ,FT4 )等项目。为了评价该技术的可靠性及仪器性能 ,参考有关文献及该公司的磁性分离酶联免疫测定方法和临床应用方案及SEROZYME III型吸光值测定仪、磁性仪器使用说明等 ,…     

缺血性心肌病患者血清DKK3、Gal-3表达水平及与心室重构的关系

目的 分析缺血性心肌病(ICM)患者血清抑癌基因DKK3、半乳糖凝集素-3(Gal-3)的表达水平及与心室重构的关系.方法 收集2018年1月—2020年5月收治的ICM 61例为ICM组,另选取同期体检健康志愿者53例为健康组.比较两组血清DKK3、Gal-3表达水平以及心功能指标[左心室射血分数(LVEF)、左心房...     

Multiple-drug-resistant mutants of feline immunodeficiency virus selected with 2',3'-dideoxyinosine alone and in combination with 3'-azido-3'-deoxythymidine.

Mutants of feline immunodeficiency virus (FIV) were selected in cell culture in the continuous presence of 10 microM (each) 3'-azido-3'-deoxythymidine (AZT) and 2',3'-dideoxyinosine (ddI). These mutants (AIR-1 and AIR-3) displayed a 13-fold resistance to AZT but had less than a 2-fold decrease in susceptibility to ddI. Interestingly, the AIR mutants were cross-resistant to phosphonoformate (PFA) and were hypersensitive to 2',3'-dideoxycytidine (ddC). Mutants of FIV were also selected in the presence of 10 microM ddI alone (DIS-1, DIS-2c), and these displayed a two- to fourfold decrease in susceptibility to ddI. Like the mutants selected with the combination of AZT plus ddI, DIS-1 and DIS-2c were cross-resistant to PFA and were hypersensitive to ddC. However, they remained as susceptible as wild-type FIV to AZT. Thus, the mutants selected with the combination of AZT plus ddI have phenotypes which reflect those obtained by selection with these drugs individually.     

Human immunodeficiency virus inhibition is prolonged by 3''-azido-3''-deoxythymidine alternating with 2'',3''-dideoxycytidine compared with 3''-azido-3''-deoxythymidine alone.

The inhibition of the lymphadenopathy-associated virus strain of human immunodeficiency virus (HIV) by alternating regimens of two dideoxynucleosides, 3'-azido-3'-deoxythymidine (AZT) (zidovudine) and 2',3'-dideoxycytidine (ddC), was determined in CEM cells. Cultures infected with virus for 2 h were treated with clinically achievable concentrations of AZT, ddC, or a 3-day-alternating regimen of AZT and ddC. Media were completely changed every 3 days and replaced with antiviral agent, and virus production was assayed by p24 antigen and virus-specific DNA. Cells treated with no antiviral agent exhibited breakthrough infection by day 6 in culture, whereas cells treated with 0.1, 1.0, or 3.0 microM AZT had a prolonged time to viral breakthrough. For each regimen of AZT alternating with 0.05 or 0.1 microM ddC, there was consistently prolonged HIV inhibition compared with continuous treatment with AZT alone. The viral suppression achieved with the alternating combinations required AZT as well as ddC and was superior to 3 days of treatment with ddC alternating with 3 days of no antiretroviral treatment. Levels of unintegrated HIV DNA paralleled the detection of p24 antigen, with the most prolonged inhibition of virus-specific DNA occurring with AZT alternating with ddC (compared with all regimens except continuous treatment with ddC). These data suggest that alternating regimens of AZT and ddC not only might decrease toxicity associated with the two drugs but may prove to be more efficacious than AZT alone.     

支气管哮喘患儿的心理特征分析及心理干预

目的:探讨哮喘患儿的心理特征与放松训练、家庭应对指导、认知和脱敏治疗等心理干预措施,对治疗儿童哮喘的临床疗效.方法:对112例6～14岁的哮喘儿童进行问卷调查.同时采用随机对照方法,分为干预组(n=58)和对照组(n=54),两组给予同样药物治疗,干预组同时进行心理干预,干预前后观察两组临床疗效、复发情况及行为问题检出率等.结果:大多数哮喘儿童存在比较明显的心理障碍.通过心理干预治疗,干预组在临床疗效、复发情况及行为问题检出率等方面均优于对照组(P<0.01).结论:哮喘儿童存在比较明显的心理障碍,针对哮喘患儿的心理特点给予药物辅以心理干预治疗,其疗效优于单纯药物治疗.     

Chapter 3. Coordination and collaboration with interface units

Purpose

To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on enhancing coordination and collaboration between the ICU and other key stakeholders.

Methods

Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including coordination and collaboration.

Results

Key recommendations include: (1) establish an Incident Management System with Emergency Executive Control Groups at facility, local, regional/state or national levels to exercise authority and direction over resource use and communications; (2) develop a system of communication, coordination and collaboration between the ICU and key interface departments within the hospital; (3) identify key functions or processes requiring coordination and collaboration, the most important of these being manpower and resources utilization (surge capacity) and re-allocation of personnel, equipment and physical space; (4) develop processes to allow smooth inter-departmental patient transfers; (5) creating systems and guidelines is not sufficient, it is important to: (a) identify the roles and responsibilities of key individuals necessary for the implementation of the guidelines; (b) ensure that these individuals are adequately trained and prepared to perform their roles; (c) ensure adequate equipment to allow key coordination and collaboration activities; (d) ensure an adequate physical environment to allow staff to properly implement guidelines; (6) trigger events for determining a crisis should be defined.

Conclusions

Judicious planning and adoption of protocols for coordination and collaboration with interface units are necessary to optimize outcomes during a pandemic.

     

Pharmacokinetics of 3''-azido-3''-deoxythymidine and its catabolites and interactions with probenecid in rhesus monkeys.

The pharmacokinetics and metabolism of 3'-azido-3'-deoxythymidine (AZT) were investigated in rhesus monkeys after subcutaneous administration of 33.3 mg of AZT per kg of body weight alone or in the presence of 100 mg of probenecid per kg. In addition to unchanged drug, two catabolites, 5'-O-glucuronide (GAZT) and 3'-amino-3'-deoxythymidine (AMT), were detected in plasma within 30 min. GAZT exhibited a kinetic profile similar to that of AZT, with an elimination half-life of approximately 1 h, while AMT was more variable, with an apparent half-life of 1.6 +/- 1.5 h. Approximately 90% of the total administered dose was recovered in urine within 24 h as AZT, GAZT, AMT, and the 5'-O-glucuronide of AMT. AZT and AMT demonstrated similar cerebrospinal fluid (CSF) penetration 1 h after AZT treatment, while GAZT poorly crossed the blood-brain barrier. Concomitant administration of probenecid greatly altered the pharmacokinetics of AZT, GAZT, and AMT, resulting in prolongation of their apparent elimination half-lives, increased concentrations in plasma, and marked reduction in renal clearances. In addition, the CSF/plasma concentration ratios for AZT and its catabolites were greatly increased, suggesting that probenecid inhibits efflux of AZT and its catabolites from CSF to plasma. The substantial levels of AMT in plasma suggest that this catabolite affects the pharmacodynamic properties of AZT in relation to its activity against human immunodeficiency virus replication and cytotoxicity to host cells. Enhanced AMT levels in plasma in the presence of probenecid may decrease the therapeutic efficacy of the AZT-probenecid combination.     

3D-SPACE与3D-MEDIC序列神经成像对腰骶丛显示的对比研究

目的探讨3D-SPACE与3D-MEDIC序列神经成像对腰骶丛的显示效果。方法选取行腰骶部或盆腔MRI检查的健康志愿者86例,均行常规腰椎磁共振(MRI)、3D-SPACE与3D-MEDIC序列扫描,计算2种序列的_(神经根)信噪比值(SNR_(神经根))、肌肉信噪比值(SNR_(肌肉))、神经根和肌肉的对比度噪声比值(CNR_(神经根/肌肉))及图像质量评分。结果 3DMEDIC序列的SNR_(神经根)、SNR_(肌肉)、CNR_(神经根/肌肉)明显高于3D-SPACE序列(P0.05),各部位图像质量评分均明显高于3D-SPACE序列(P0.05)。结论相较于3D-SPACE序列,3D-MEDIC序列能更清晰显示腰骶神经丛的解剖形态,是常规腰椎MRI的重要补充。