肌钙蛋白T检测在判断尿毒症合并心肌损伤中的意义

应用酶联免疫方法对７５例正常人，８０例行血液透析治疗的尿毒症患者血清心肌特异性肌钙蛋白Ｔ（ｃＴｎＴ）进行检测，并同时观察肌酸激酶（ＣＫ）、肌酸激酶－ＭＢ亚单位（ＣＫ－ＭＢ）水平。结果显示：正常人血清ｃＴｎＴ浓度极低，５６例ｃＴｎＴ测定值为０，最高值为００３μｇ／Ｌ。尿毒症患者血清ｃＴｎＴ测定范围０００～３９４μｇ／Ｌ，其中３４例（４２５％）血清ｃＴｎＴ浓度＞０．２μｇ／Ｌ（阳性界限值），范围０２２～３．９４μｇ／Ｌ，增加１１～１９７倍，仅３例患者同时伴ＣＫ、ＣＫ－ＭＢ升高。血清ｃＴｎＴ升高与尿素氮（ＢＵＮ）、肌酐（Ｃｒ）无相关性。研究提示：ｃＴｎＴ升高的尿毒症患者可能伴有急性心肌细胞损伤，其中部分患者可能存在急性粟粒样或小灶状心肌梗塞。血清ｃＴｎＴ测定对诊断尿毒症合并心肌损伤较ＣＫ、ＣＫ－ＭＢ具有更高的灵敏性和特异性。     

心脏肌钙蛋白T测定对老年不稳定型心绞痛患者预后的预测(摘要)

不稳定型心绞痛（ＵＡＰ）患者４１例，男性２１例，女性２０例，平均年龄６５．６±４．４岁。其中初发劳累型６例，恶化劳累型１５例，自发型１７例，变异型３例。并排除ＡＭＩ。健康老年人２０例，稳定型心绞痛（ＳＡＰ）患者１９例，男性２２例，女性１７例，平均年龄６５±４岁。就诊或住院后６ｈ、２４ｈ及４８ｈ～７２ｈ各取静脉血一次。定量测定血清ＴｎＴ及ＣＫＭＢ，取其峰值进行统计。选择ＴｎＴ≥０．２μｇ／Ｌ作为心肌损伤临界值。住院期间出现心脏事件为研究终点。健康老年人ＴｎＴ值为（０．０２±０．０４）μｇ／Ｌ，Ｓ…     

心脏肌钙蛋白T对不稳定性心绞痛危险分层的价值

目的：探讨心脏肌钙蛋白Ｔ（ｃＴｎＴ）对不稳定心绞痛（ＵＡ）危险分层的临床价值。方法：用酶联免疫法测定１１２例ＵＡ患入院即刻、第２、３日血浆ｃＴｎＴ≥０．１ｎｇ／ｍｌ或〈０．１ｎｇ／ｍｌ将患分为ｃＴｎＴ升高组和ｃＴｎＴ正常组;观察住院期间两组急性心肌梗死（ＭＡＩ）、心脏性死亡和难治性心绞痛的发生率。结果：在１１２例ＵＡ患中,ｃＴｎＴ升高４４例（３９％）,ｃＴｎＴ正常６８例（６１％）。住院期间发生ＡＭＩ１２例（１０．７％,死亡５例（４．５％）,非致死性心肌梗死及心脏性死亡１５例（１３．４％）。其中ｃＴｎＴ升高组的死亡率较ｃＴｎＴ正常组有升高趋势,但差异无显性;而ｃＴｎＴ升高组ＡＭＩ、非致死性心肌梗死及心脏性死亡的发生率显高于ｃＴｎＴ正常组（Ｐ〈０．０１）。校正年龄、性别、心绞痛分级、心电图改变等因素后,ｃ     

先天性心脏病心内直视手术中影响CK、CK-MB、LDH及肌钙蛋白T变化的因素探讨

随机选择先天性心脏病患者５０例,于手术前后不同时间采血测定其肌酸激酶（ＣＫ）、肌酸激酶同功酶（ＣＫ－ＭＢ）、乳酸脱氢酶（ＬＤＨ）、肌钙蛋白Ｔ（ｃＴｎＴ）,探讨先天性心脏病心内直视手术中有关因素对心肌细胞损害程度。结果显示：①严重创伤组与普通创伤组比较,ＣＫ、ＣＫ－ＭＢ、ＬＤＨ（Ｐ〈０．０１）、ｃＴｎＴ（Ｐ〈０．００１）均有显著性差异。②主动脉阻断时间〉６０分钟与〈３０分钟组比较,停机时ＣＫ、ＣＫ－     

肌钙蛋白T对缺血性心肌细胞损伤的诊断及其对溶栓疗效的判定价值

目的：评价肌钙蛋白Ｔ（ＴｎＴ）血清浓度变化对缺血性心肌细胞损伤的诊断及其对溶栓疗效的判定价值。方法：采用酶联免疫吸附法测定１６１例急性心肌梗死及５７例心绞痛患者ＴｎＴ浓度动态变化。结果：急性心肌梗死发病后２、４、６小时ＴｎＴ的阳性率分别为５８．０％、６８．６％、９０．９％，１０小时至５天为１００．０％，７、１０、１４、１７、２１天分别为９１．７％、６６．７％、２２．０％、１２．１％、９．２％，明显高于血清肌酸激酶及血清肌酸激酶ＭＢ同工酶（Ｐ＜０．０１）。ＴｎＴ诊断急性心肌梗死的敏感性和特异性为１００．０％及９１．８％。溶栓再通组ＴｎＴ呈双峰性曲线，未通组呈单峰性曲线，其峰值时间（４２．０２±１．６５小时）早于双峰性曲线的晚期峰时间（７５．１０±１．３３小时，Ｐ＜０．０１），其浓度（１４．６２±１．９１μｇ／Ｌ）明显高于双峰性曲线的晚期峰值（７．０２±０．８５μｇ／Ｌ，Ｐ＜０．０１）。结论：ＴｎＴ是一灵敏度高、特异性强的心肌损伤性血清标志物，对急性心肌梗死溶栓有无再通有一定判定价值。     

血清肌钙蛋白Ⅰ浓度对急性心肌梗塞溶栓疗效的判定价值探讨

目的观察急性心肌梗塞（ＡＭＩ）患者接受静脉溶栓治疗时,血清肌钙蛋白Ⅰ（ｃＴｎⅠ）浓度变化,探讨其对溶栓疗效的判定价值。方法选择ＡＭＩ患者５３例,２６例接受溶栓治疗。采用ＯＰＵＳ自动生化分析仪,以ＥＬＩＳＡ法测定ｃＴｎⅠ浓度。结果显示：（１）从发病到达ｃＴｎⅠ峰值时间,２２例溶栓再通组（１５．７±３．９小时）比４例溶栓未通组（２２．０±２．３１小时）及２７例未溶栓组（２６．２±１１．１小时）均明显提前（Ｐ＜０．０５）。（２）血清ｃＴｎⅠ峰值水平在溶栓再通组（３２８．０±２４５．２μｇ／Ｌ）比溶栓未通组（１７０．５±５０．２μｇ／Ｌ）及未溶栓组（１３０．７３±１００．０３μｇ／Ｌ）明显增高（Ｐ＜０．０１）。（３）以ｃＴｎⅠ峰值到达时间≤１８小时判定ＡＭＩ后溶栓再通,其敏感性、准确性（分别为７２．７％和７３．１％）,均高于ＣＫ－ＭＢ≤１４小时（分别为６３．６％和６５．４％）,特异性二者相同（均为７５％）。结论血清ｃＴｎⅠ水平,在ＡＭＩ溶栓再通患者中峰值时间前移,其≤１８小时对ＡＭＩ溶栓再通具有一定的判定价值。     

心肌肌钙蛋白T对不稳定型心绞痛患者心脏事件的预测价值(摘要)

本文探讨血清心肌肌钙蛋白Ｔ（ｃＴｎＴ）对不稳定型心绞痛患者心脏事件的预测价值。１　资料与方法　　选择了１９９６年３月至１９９８年３月在我院住院治疗的不稳定型心绞痛（ＵＡＰ）患者２０６例,按Ｂｒａｕｎｗａｌｄ分级标准分为３级;入院后０～４小时及１２～２４小时静脉采血各１次,检测血清ｃＴｎＴ浓度;随访时间定为入院后６个月内。血清ｃＴｎＴ的测定方法为酶联免疫吸附一步夹心法。血清ｃＴｎＴ的正常值：≤０．２μｇ／Ｌ。　　统计学处理：数据以ｘ±ｓ表示;两组间均数的比较用ｔ检验;两组间率的比较用四格表χ２检…     

糖尿病患者血清生长激素与肌酐清除率

测定了１６例胰岛素依赖型糖尿病（ＩＤＤＭ）患者，１９例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者和２３例对照者的血清生长激素（ＧＨ）水平。在ＩＤＤＭ组，无论是肌酐清除率（Ｃｃｒ）正常或减低，其ＧＨ值均为２．５３±１．７３μｇ／Ｌ，均高于对照组的０．７１±０．５３μｇ／Ｌ（Ｐ＜０．０５），ＧＨ与Ｃｃｒ呈负相关（ｒ＝０．６３，Ｐ＜０．０１），ＮＩＤＤＭ组Ｃｃｒ＜５０ｍｌ／ｍｉｎ者ＧＨ值为１．８３±０．４７μｇ／Ｌ显著高于对照组（Ｐ＜０．０５）和Ｃｃｒ＞８０ｍｌ／ｍｉｎ组（ＧＨ０．８３±０．４９μｇ／Ｌ，Ｐ＜０．０５）。糖尿病（ＤＭ）伴微血管并发症者，ＧＨ值为２．９２±１．７０μｇ／Ｌ，高于无此并发症者ＧＨ１．２４±０．９７μｇ／Ｌ，（Ｐ＜０．０１），认为ＧＨ与ＤＭ微血管并发症有关。     

老年不稳定型心绞痛患者纤维蛋白、纤维蛋白原及其降解产物的变化

目的探讨凝血系统在老年人不稳定型心绞痛（ＵＡ）发生和发展中的作用。方法采用一组抗纤维蛋白单克隆抗体（ＳＺ－５８、６４、６５）酶免疫分析法测定２６例老年ＵＡ患者、２４例稳定型心绞痛（ＳＡ）患者和２０例健康老年人（对照组）血浆纤维蛋白原（Ｆｇ）、可溶性纤维蛋白复合物（ＳＦＣ）及血清纤维蛋白降解产物（ＦＤＰ）的浓度。结果ＵＡ患者心绞痛发作时血浆Ｆｇ、ＳＦＣ及血清ＦＤＰ浓度（分别为３．７±０．６ｇ／Ｌ、４９．６±１９．３ｍｇ／Ｌ、３２５．６±７９．４μｇ／Ｌ）显著高于ＳＡ患者心绞痛发作时（分别为３．２±０．６ｇ／Ｌ、２０．９±１０．４ｍｇ／Ｌ、２２４．４±４７．４μｇ／Ｌ）和健康对照组（均为Ｐ＜０．０１），后两者间差异无显著性。ＵＡ发作终止后血浆Ｆｇ和血清ＦＤＰ浓度高于健康对照组，但差异无显著性。结论血栓形成是老年人ＵＡ发生和发展的重要因素之一。     

长期慢性咽炎与隐袭性风湿活动所致心脏瓣膜病变之间关系的研究

目的：明确长期慢性咽炎与隐袭性风湿活动所致的风湿性心脏瓣膜病之间的关系。方法：从２３８例慢性咽炎病人中，筛选７６例初次就诊时抗链球菌溶血素Ｏ（ＡＳＯ）在４００ｋＵ／Ｌ～５００ｋＵ／Ｌ，无明确风湿热表现和病史者随访观察，用二步半定量溶血法检测ＡＳＯ，同时检测肌酸激酶同功酶ＭＢ（ＣＫＭＢ）、心室碎裂电位（ＶＦＰ）切迹数（ＮＶＦＰ），并用超声心动图观察心脏瓣膜形态。结果：①７６例中１例在随访第３年患典型风湿热。３２例于随访第１、第２或第３年后ＡＳＯ持续低于４００ｋＵ／Ｌ者，无检出二尖瓣病变。②４３例ＡＳＯ长期在４００ｋＵ／Ｌ～５００ｋＵ／Ｌ，且ＣＫＭＢ、ＮＶＦＰ长期在正常高限者，随访第７年后有１６例发现二尖瓣增厚，但尚无狭窄和关闭不全。③有二尖瓣增厚病变者ＣＫＭＢ、ＮＶＦＰ明显高于无病变者（Ｐ＜００５），但ＡＳＯ水平无显著差异（Ｐ＞００５）。结论：ＡＳＯ、ＣＫＭＢ、ＮＶＦＰ持续在正常高限的长期慢性咽炎病人中，部分存在隐袭性风湿活动，并可由此导致风湿性心脏瓣膜病变。     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.     

Dénervation rénale pour HTA réfractaire sans anesthésie générale : intérêt d’un protocole MEOPA Morphine. Expérience préliminaire

Renal denervation using the technique of radiofrequency is used only recently for the treatment of resistant hypertension. Normally, it is done under general anesthesia because the ablation point technique is painful. We suggest an alternative to general anesthesia comprising an association of morphin 0.1 mg/kg IV to MEOPA (gas combining oxygen and azot protoxyd) delivered through an oxygen mask. Our series includes 12 consecutive patients treated between October 2011 and June 2013, the first five patients (group 1) have received only an hydroxizin and morphin sedation. Every five have felt the ablation painful, in two cases bearable pain (EVA < 5), in three cases intense (EVA > 5) pain leading to increasing doses of morphin, (total dose of 0.25 mg/kg in two cases, 0.17 mg in one case). For the seven following patients, a protocol including hydroxyzin, morphin and MEOPA given through a mask has been set up. Only one patient has felt a mild pain (EVA 5) leading to an increasing dose of morphin (total dose 0.17 mg/kg). None of the six other patients has felt any pain during the procedure. The average dose of morphin is 0.17 mg/kg in group 1, 0.11 mg/kg in group 2. This is a preliminary study; if confirmed, it will allow a lot of hospitals without on-site possibilities of general anesthesia, to realize such procedures. Conclusion: regarding pain, the procedure of renal ablation was well tolerated for six among seven patients receiving the association MEOPA and IV morphin. In contrast, in the five patients treated only with IV morphin, we observed a less good tolerance to pain and the need to increase the doses of IV morphin.     

Scale‐up of TB and HIV programme collaborative activities in Zambia – a 10‐year review

Objective To review the activities, progress, achievements and challenges of the Zambia Ministry of Health tuberculosis (TB)/HIV collaborative activities over the past decade. Methods Analysis of Zambia Ministry of Health National TB and HIV programme documents and external independent programme review reports pertaining to 2000–2010. Results The number of people testing for HIV increased from 37 557 persons in 2003 to 1 327 995 persons in 2010 nationally. Those receiving anti‐retroviral therapy (ART) increased from 143 in 2003 to 344 304 in 2010. The national HIV prevalence estimates declined from 14.3% in 2001 to 13.5% in 2009. The proportion of TB patients being tested for HIV increased from 22.6% in 2006 to 84% in 2010 and approximately 70% were HIV positive. The proportion of the HIV‐infected TB patients who: (i) started on ART increased from 38% in 2006 to 50% in 2010; (ii) commenced co‐trimoxazole preventive therapy (CPT) increased from 31% in 2006 to 70% in 2010; and (iii) were successfully treated increased to an average of 80% resulting in decline of deaths from 13% in 2006 to 9% in 2010. Conclusions The scale‐up of TB/HIV collaborative programme activities in Zambia has steadily increased over the past decade resulting in increased testing for TB and HIV, and anti‐retroviral (ARV) rollout with improved treatment outcomes among TB patients co‐infected with HIV. Getting service delivery points to adhere to WHO guidelines for collaborative TB/HIV activities remains problematic, especially those meant to reduce the burden of TB in people living with HIV/AIDS (PLWHA).     

C-MET在非小细胞肺癌对表皮生长因子受体酪氨酸激酶抑制剂耐药中的作用研究进展

以表皮生长因子受体(EGFR)为靶点的酪氨酸酶抑制剂(TKI)是近年来非小细胞肺癌(NSCLC)治疗的重大突破.但是随着临床的广泛应用,耐药成为新的难点.新近研究已发现对EGFRTKI的耐药产生主要涉及原癌基因C-MET的扩增突变.C-MET是原癌基因,是蛋白产物肝细胞生长因子/离散离子(HGF/SF)的受体,具有酪氨酸酶活性,C-MET基因扩增激活ErbB3-PI3K信号途径导致NSCLC对EGFR-TKI产生耐药,大量研究证实NSCLC患者对EGFR-TKI耐药约20％归因于C-MET基因扩增.     

Artificial intelligence in pancreaticobiliary endoscopy

Artificial intelligence (AI) applications in health care have exponentially increased in recent years, and a few of these are related to pancreatobiliary disorders. AI‐based methods were applied to extract information, in prognostication, to guide clinical treatment decisions and in pancreatobiliary endoscopy to characterize lesions. AI applications in endoscopy are expected to reduce inter‐operator variability, improve the accuracy of diagnosis, and assist in therapeutic decision‐making in real time. AI‐based literature must however be interpreted with caution given the limited external validation. A multidisciplinary approach combining clinical and imaging or endoscopy data will better utilize AI‐based technologies to further improve patient care.