病毒性脑炎血清心肌酶的变化及其临床意义

目的研究病毒性脑炎时血清心肌酶的变化及其临床意义。方法收集病毒性脑炎（病脑组）48例,另有体检正常者40例为对照组。采用东芝全自动生化分析仪,以酶速率法测定所有患者的血清天冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）、肌酸激酶（CK）、肌酸激酶心肌型同工酶（CK-MB）、a-羟丁酸脱氢酶（a-HBDH）水平。结果62．5％（30／48）病脑组血清心肌酶出现异常,与对照组比较差异有统计学意义（P〈0．01）;病脑组患者血清中AST、LDH、CK水平明显高于对照组（P〈0．05或〈0．01）,病脑组CK-MB、a-HBDH水平与对照组比较,差异无统计学意义（P〉0．05）。结论病毒性脑炎常伴随心肌细胞损伤,血清心肌酶水平升高,对该类患者应常规行血清心肌酶测定。     

病毒性脑炎患儿神经元特异性烯醇化酶、髓鞘碱性蛋白、S-100蛋白水平及临床意义

目的分析病毒性脑炎患儿脑脊液和血清中神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)和S-100蛋白(S-100)水平。方法将205例病毒性脑炎患儿设为观察组(按不同病情严重程度分为轻症组112例和重症组93例),将同期门诊体检的200名健康儿童设为对照组,比较不同组别受检儿童脑脊液和血清中NSE、MBP、S-100水平。结果观察组入院24 h脑脊液和血清中NSE、MBP、S-100水平高于对照组,且轻症组上述指标水平低于重症组,差异均有统计学意义(P 0.05);血清NSE、MBP、S-100联合检测的敏感度(91.22%)、准确度(89.14%)均高于单项指标检测,差异有统计学意义(P 0.05),联合检测与单项检测的特异度比较,差异无统计学意义(P 0.05)。结论脑脊液和血清中NSE、MBP、S-100水平与病毒性脑炎患儿病情密切相关,血清NSE、MBP、S-100联合检测具有较高的诊断价值。     

中枢神经系统感染血清心肌酶的变化及其临床意义

目的研究成年人中枢神经系统感染时血清心肌酶的变化及其临床意义。方法收集病毒性脑炎（病脑组）45例和结核性脑膜炎（结脑组）22例,另有体检正常者40例为对照组。采用东芝全自动生化分析仪,以酶速率法测定所有患者的血清天冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）、肌酸激酶（CK）、肌酸激酶心肌型同工酶（CK-MB）、α-羟丁酸脱氢酶（α-HBDH）水平。结果62.2％（28／45）病脑组血清心肌酶出现异常,与对照组比较差异有统计学意义（P〈0.01）;18.2％（4／22）结脑组血清心肌酶出现异常,与对照组比较,差异无统计学意义（P〉0.05）。病脑组患者血清中AST、LDH、CK水平及结脑组血清中AST、CK水平均明显高于对照组（P〈0.05或〈0.01）,病脑组CK-MB、α-HBDH水平及结脑组LDH、CK-MB和α-HBDH水平与对照组比较,差异无统计学意义（P〉0.05）;结脑组CK水平明显低于病脑组（P〈0.05）。障碍组血清心肌酶水平均明显高于无障碍组（P〈0.05）。结论中枢神经系统感染常伴随心肌细胞损伤,血清心肌酶水平升高,对该类患者应常规行血清心肌酶测定。     

病毒性脑炎患儿脑脊液和血清中NSE、CK-BB、LDH的变化及相关性研究

目的分析病毒性脑炎患儿脑脊液和血清中神经元特异性烯醇化酶(NSE)、肌酸激酶同工酶(CK-BB)、乳酸脱氢酶(LDH)变化的相关性,并评价上述指标变化对病毒性脑炎患儿病情监测及预后评估的意义。方法选择轻度病毒性脑炎(轻症组)、重度病毒性脑炎(重症组)以及非感染性偏头痛(对照组)患儿各30例,采集轻症组、重症组患儿急性期(入院后24 h内、发病3 d内)、恢复期(治疗后7 d)以及对照组急性期静脉血和脑脊液,分别测定NSE、CKBB、LDH,比较组患者上述指标的变化情况。结果急性期3组患儿从对照组到轻症组、重症组,脑脊液、血清NSE、CK-BB、LDH水平依次升高差异有统计学意义(P0.05);恢复期重症组患儿的脑脊液、血清NSE、CK-BB、LDH较轻症组差异均有统计学意义(P0.05);轻症组、重症组恢复期的脑脊液、血清NSE、CK-BB、LDH与急性期比较差异均有统计学意义(P0.01);轻症组、重症组的脑脊液NSE、CK-BB与血清NSE、CK-BB均呈显著正相关(P0.01)。结论联合检测NSE、CK-BB、LDH有利于病毒性脑炎患儿的早期诊断;脑脊液、血清NSE、CK-BB水平变化存在显著相关性,上述指标检测建议采用血清检测代替脑脊液检测,能够减轻腰椎穿刺痛苦易于被患儿家长接受。     

血清S100B蛋白测定对儿童自身免疫性脑炎早期识别的临床意义

目的 探讨血清S100B蛋白测定对儿童自身免疫性脑炎（AE）早期识别的临床意义。方法 选取30例AE患儿为AE组、30例病毒性脑炎患儿为病毒性脑炎组、30名健康儿童为健康对照组，分别检测3组的血清S100B蛋白、神经元特异性烯醇化酶（NSE）、基质金属蛋白酶（MMP）水平，使用受试者操作特征（ROC）曲线分析血清S100B蛋白、NSE、MMP水平对儿童AE早期识别的预测价值。比较不同分期、不同病情程度和不同预后AE患儿的血清S100B蛋白水平。结果 AE组的血清S100B蛋白、NSE、MMP水平高于病毒性脑炎组、健康对照组，且病毒性脑炎组的血清S100B蛋白、NSE、MMP水平高于健康对照组（P <0.05）。血清S100B蛋白、NSE、MMP水平预测AE时，血清S100B蛋白的AUC最高，为0.881，明显高于NSE(Z=2.142,P=0.032)和MMP(Z=2.360,P=0.018)。急性发作期、重症、预后不良的AE患儿血清S100B蛋白水平分别高于恢复期、轻症、预后良好的AE患儿（P <0.05）。结论 血清S100B蛋白测定对儿童AE的早期诊断有较高价值，且S...     

心肌及脑损伤指标在儿童手足口病病情评估中的意义

目的探讨心肌损伤及脑损伤指标检测在儿童手足口病(HFMD)病情评估中的临床意义。方法将116例HFMD患儿分为轻症组92例,重症组24例,另选40例健康儿童作为对照组。所有患儿和对照组儿童均检测心肌酶谱指标,包括肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)和乳酸脱氢酶(LDH),同时检测血清肌钙蛋白(c Tn I)、高敏C反应蛋白(hs-CRP)和神经元特异性烯醇化酶(NSE)水平,比较3组间的差异。结果轻症组和重症组心肌酶谱、c Tn I和hs-CRP水平均显著高于对照组,且重症组显著高于轻症组,差异均有统计学意义(P0.01)。轻症组NSE水平略高于对照组,但差异无统计学意义(P0.05),而重症组NSE水平显著高于对照组和轻症组,差异有统计学意义(P0.01)。结论早期联合检测HFMD患儿血液中心肌酶谱、c Tn I、hs-CRP及NSE水平,可相互弥补在半衰期、特异性或敏感性等方面的劣势,有助于准确判断病情程度,早期识别重症征象,改善疾病预后。     

手足口病患儿白细胞、超敏C-反应蛋白及心肌酶谱检测的临床意义

目的探讨早期检测手足口病(HFMD)患儿血清白细胞计数(WBC)、超敏C-反应蛋白(hs-CRP)及心肌酶谱水平的临床意义。方法选择临床诊断为HFMD的患儿76例为观察组,其中并发脑炎、脑膜炎、脑脊髓炎、肺水肿、循环衰竭等之一或多种者29例为重症组,其余47例为轻症组;另选择同期进行体检的健康儿童51例为对照组。于清晨空腹采集静脉血3 ml,采用显微镜计数法检测血清WBC水平,采用日立7180全自动生化分析仪检测心肌酶谱,采用免疫散射比浊法检测hs-CRP水平。结果观察组WBC、hs-CPR、天门冬氨酸氨基转移酶(AST)、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、乳酸脱氢酶同工酶1(LDH-1)及α-羟丁酸脱氢酶(α-HBDH)水平均高于对照组,组间比较差异有统计学意义(P0.05);重症组WBC、hs-CPR、AST、CK-MB、CK、LDH、LDH-1及α-HBDH水平高于轻症组,组间比较差异有统计学意义(P0.05)。结论 HFMD患儿WBC、hs-CRP及心肌酶谱呈增高状态,联合检测有助于HFMD及HFMD并发心肌损伤的早期诊断。     

婴幼儿支气管哮喘患儿血清心肌酶变化及其临床意义

目的研究婴幼儿支气管哮喘患儿血清心肌酶的变化,以便在诊治过程中采取综合措施。方法选择河北省阳原县人民医院2008-11-2011-03住院支气管哮喘患儿50例,其中轻症支气管哮喘35例(轻症组),重症支气管哮喘15例(重症组)。另选22例健康儿童作为对照组。采用Olympus AU 2700型全自动生化分析仪测定支气管哮喘患儿急性期、恢复期及对照组儿童血清天门冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶(α-HBDH)及其同功酶(CK-MB)等多项心肌酶指标。结果与对照组相比,轻症及重症哮喘组患儿血清AST、LDH、α-HBDH、CK、CK-MB水平均明显升高(P<0.01),重症哮喘组上述指标明显高于轻症哮喘组(P<0.01)。与急性期相比,恢复期这些心肌酶指标均趋向正常水平。结论婴幼儿支气管哮喘患儿血清心肌酶有不同程度升高,病情越重,心肌酶升高越明显。     

中枢神经系统感染患儿血清心肌酶变化及临床意义

目的探讨血清心肌酶谱在小儿中枢神经系统感染 ( ICNS)的变化及临床意义。方法应用全自动生化分析仪测定 6 8例 FCNS患儿 AST、m-AST、LDH、HBDH、CK、CK-MB活性 ,并与正常对照组比较。结果 ICNS患者血清 AST、m-AST、LDH、HBDH、CK、CK-MB均增高 ,昏迷儿高于非昏迷儿 ,惊厥儿高于非惊厥儿。结论 ICNS时血清心肌酶谱增高 ,且与病情轻重高度相关。测定心肌酶活性可作为判断病情及预后的良好指标     

病毒性脑炎患者脑脊液和血清中S-100b蛋白、神经元特异性烯醇化酶水平的变化及其临床意义

目的分析病毒性脑炎患者脑脊液和血清中神经元特异性烯醇化酶(NSE)、S-100b蛋白的变化情况及意义。方法选取到2016年1月至2018年12月PICU治疗的80例病毒性脑炎患儿,分为轻症组(n=38例)与重症组(n=42例),同时选取同期住院治疗的非颅内感染患儿50例作为对照组,所有患儿均进行NSE、S-100b蛋白检测。结果重症组、轻症组脑脊液、血清的S-100B蛋白、NSE均明显高于对照组(P0.05);重症组上述指标明显高于轻症组(P0.05)。恢复期、急性期患儿上述指标均明显高于对照组(P0.05);急性期患儿上述指标均明显高于恢复期(P0.05)。结论检测脑脊液、血清NSE、S-100b蛋白变化可了解病毒性脑炎患儿的病情严重程度及进展情况,为临床治疗提供参考。     

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.     

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.     

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.