妊娠高血压综合征患者血浆血管性血友病因子及其裂解酶的测定及临床意义

目的检测正常孕妇及妊娠高血压综合征(PIH)患者血浆血管性血友病因子(vWF:Ag)水平及vWF裂解酶(vWF-CP)活性,探讨vWF及vWF-CP在PIH中的临床意义。方法采用残余胶原结合实验法及ELISA法分别对35例正常孕妇及52例PIH患者血浆vWF-CP活性及vWF:Ag水平进行检测。结果正常妊娠妇女血浆vWF:Ag(103．4±68．4)％显著高于正常非孕妇(78．4±51．6)％(P＜0．01),而血浆vWF-CP活性(76．3±1 8．4)％显著低于正常非孕妇(84．7±2．1)％(P＜0．05)。轻度妊高征妇女血浆vWF:Ag(98．8±48．5)％及vWF-CP活性(70．4±2 1．8)％与正常妊娠妇女无显著性差别(P＞0．05),而中、重度妊高征妇女血浆vWF:Ag(148．4±75．6)％显著高于正常妊娠妇女(P＜0．01),血浆vWF-CP活性(60．8±19．8)％显著低于正常妊娠妇女(P＜0．05)。结论妊高征患者血浆vWF升高,vWF-CP活性低下,参与妊高征的发生、发展,内皮损伤可能是致妊高征患者血浆vWF升高,vWF-CP活性低下的原因。     

早期妊娠妇女血浆中血小板活化因子含量和血小板活化因子-乙酰水解酶活性的变化及意义

目的:探计早期妊娠妇女血浆中血小板活化因子(platelet-activating factor,PAF)的含量、血小板活化因子-乙酰水解酶(PAF-acetyl-hydrolase,PAF-AH)的活性变化及意义.方法:通过病史询问、妇科检查及B超确定早孕.采用生物法检测120例早期妊娠妇女和20例正常非孕妇女血浆中的PAF含量,同时采用酶水解底物显色法测定血浆中的PAF-AH活性,放射免疫法检测血清中的hCG-β.结果:早期妊娠妇女血浆中PAF含量为(12.5±4.3)ng/mL,正常非孕妇女为(6.7±2.8)ng/mL,两组比较差异有显著性(P＜0.01);早期妊娠妇女血浆中PAF-AH活性为(17±1.1)nmol/(min·mL),正常非孕妇女为(32±1.8)nmol/(min·mL),两组比较差异有显著性(P＜0.01).结论:早期妊娠妇女血浆中PAF含量和PAF-AH活性的变化在妊娠的发生和发展中起着较为重要的作用.     

内皮细胞损伤标志物在妊高征患者中的变化

目的：探讨孕妇血浆中内皮细胞损伤标志物内皮素（ET－1）、血栓调节蛋白（TM）、血管性假血友病因子（vWF）水平变化与妊高征（PIH）发病的关系。方法：应用放射免疫吸附法和酶联免疫吸附法，分别测定66例妊高征患者（轻度20例，中度24例，重度22例）和24例正常晚期孕妇（对照组）血浆中的ET－1、TM、vWF水平。结果：PIH各组ET－1水平明显高于对照组（P＜0．01），轻度PIH患者TM、vWF水平与对照组比较，差异无显著性（P＞0．05），中度PIH患者TM、vWF水平与对照组比较，差异有显著性（P＜0．05），重度PIH患者TM、vWF水平与对照组比较，差异有非常显著（P＜0．01）。结论：血管内皮细胞损伤是妊高征的重要发病机制。3个分子标志物水平升高越显著妊高征患者病情就越重，检测其水平对妊高征的诊断，观察病情及防止子痫的发生均有意义。     

妊娠高血压综合征患者血浆11-去氢-血栓烷B_2测定及其临床意义

目的 观察妊娠高血压综合征(PIH)患者体内血小板活化状态.方法 采用酶联免疫吸附法(ELISA)检测38例PIH患者血浆11-去氢-血栓烷B2(DH-TXB2),同时测定TXB2,并与正常未孕组比较.结果 与正常未孕组及正常孕妇组比较,PIH患者血浆DH-TXB2、TXB2均显著增高(P＜0.01及P＜0.05),且DH-TXB2增高程度明显高于TXB:,中、重度PIH患者血浆DH.TXB2湿著高于正常妊娠及轻度PIH组.结论 血浆DH-TXB2水平测定是准确反映血小板活化的指标,PIH患者体内血小板高度活化.     

手足口病患儿血浆血管性血友病因子、D-二聚体的临床研究

目的:观察手足口病(HFMD)患儿血管性血友病因子( vWF)及D-二聚体(D-dimer) 的变化, 并探讨其临床意义.方法:采用免疫比浊法检测记录并比较83例HFMD患儿急性期及恢复期血浆vWF、D-dimer 水平, 并与健康儿童( 对照组) 作比较.结果:血浆vWF 水平, 一般组急性期为(157.54 ± 4.84)%, 恢复期(90.06 ± 1.84)%, 对照组(91.35 ± 3.81)%, 急性期与恢复期比较差异有显著性( P ＜ 0.01), 恢复期与对照组比较差异无显著性(P ＞ 0.05); 重症组急性期为(175.22 ± 10.86)%, 恢复期(97.17 ± 5.31)%, 急性期与对照组比较差异有显著性(P ＜ 0.01),与一般组比较差异无显著性 (P ＞ 0.05), 恢复期与对照组比较差异无显著性(P ＞ 0.05).血浆D-dimer水平, 一般组急性期为(0.822 2 ± 0.038 8)μg/mL, 恢复期(0.220 3 ± 0.013 2)μg/mL, 对照组(0.214 5 ± 0.023 2)μg/mL, 急性期与恢复期比较差异有显著性(P ＜ 0.01), 恢复期与对照组比较差异无显著性(P ＞ 0.05); 重症组急性期为(0.910 6 ± 0.042 4)μg/mL, 恢复期(0.242 2 ± 0.035 1)μg/mL, 急性期与对照组比较差异有显著性(P ＜ 0.01),与一般组比较差异无显著性 (P ＞ 0.05), 恢复期与对照组比较差异无显著性(P ＞ 0.05).结论:HFMD患儿血浆vWF 、D - dimer水平急性期明显高于恢复期.     

血浆Hcy、Fa水平与妊娠高血压综合征的相关性研究

目的探讨血浆同型半胱氨酸(Hcy)、叶酸(Fa)水平与妊娠高血压综合征(PIH)发病的相关性。方法选取2016年4月至2017年4月在该院妇产科住院分娩的PIH患者70例为PIH组,选取同期健康孕妇70例为对照组,均行Hcy、Fa水平检测,统计比较其水平变化,并分析其与PIH的相关性。结果 PIH组孕早期、孕中期及孕晚期Fa水平[(7.18±1.81)ng/mL、(6.21±2.37)ng/mL、(4.68±1.44)ng/mL]明显低于对照组[(9.66±3.01)ng/mL、(9.51±2.47)ng/mL、(9.23±2.18)ng/mL],差异均有统计学意义(P0.05);PIH组Hcy水平[(15.08±8.01)μmol/L、(17.41±3.18)μmol/L、(19.38±2.30)μmol/L]明显高于对照组[(6.47±2.41)μmol/L、(5.97±2.01)μmol/L、(7.16±1.94)μmol/L],差异有统计学意义(P0.05);经logistic分析,Fa水平与PIH发生呈负相关,而Hcy水平与PIH发生呈正相关。结论血浆Fa水平降低及Hcy水平升高是PIH发病的危险因素,可通过对其水平测定判断PIH的发生,便于早期采取治疗措施。     

围生期妇女血清N末端B型钠尿肽原水平测定及意义

目的 探讨围生期妇女血清N末端B型钠尿肽原(NT-proBNP)水平和意义.方法 采用电化学发光法分别检测57例正常妊娠妇女分娩前后、21例妊娠期高血压疾病患者和6例围生期心肌病患者血清NT-proBNP水平.结果 正常妊娠组妇女分娩前血清NT-proBNP浓度为(69.1±44.3)ng/L,分娩后血清NT-proBNP浓度为(138.8±110.6) ng/L,均比对照组(43.2±27.9)ng/L高,差异有统计学意义(P＜0.05);患者组妊娠期高血压疾病患者和围生期心肌病患者血清NT-proBNP浓度分别为(247.6±162.8)ng/L和(1 836.3±1 126.4)ng/L,比正常妊娠组明显增高(P＜0.05).结论 围生期妇女血清NT-proBNP水平不同于正常育龄未孕妇女,血清NT-proBNP水平检测对早期发现围生期妇女心功能异常有重要意义.     

两种不同脊神经阻滞对妊娠高血压综合征患者血浆一氧化氮水平影响的比较

目的本研究通过对蛛网膜下腔阻滞和硬膜外阻滞两种不同脊神经阻滞方法后,妊娠高血压综合征(PIH)患者血浆一氧化氮水平的测定,比较两者效果,为临床治疗PIH提供更佳的方法.方法采用Griess法测定20例重度PIH患者经蛛网膜下腔阻滞和硬膜外阻滞(每组各10例)后血浆一氧化氮水平.以10例健康非妊娠妇女(NNP)及20例同期住院正常晚妊妇女(NLP)做对照.结果PIH患者经蛛网膜下腔阻滞和硬膜外阻滞后,两组患者的收缩压和舒张压相比有显著降低(P＜0.05),但两组间相比无显著性差异(P＞0.05).NLP组体内血浆一氧化氮的浓度(49.99±6.86mmol/L)与NNP组(43.99±4.05mmol/L)相比明显升高(P＜0.05),PIH患者体内血浆一氧化氮的浓度(38.11±4.953mmol/L)与NLP妇女相比明显降低(P＜0.01).蛛网膜下腔阻滞后NLP组(66.8±6.51mmol/L),PIH组(53.96土3.58mmol/L)较阻滞前明显升高(P＜0.01).硬膜外阻滞后,NLP组(67.95±6.79mmol/L),PIH组(70.88±7.6mmol/L)血浆一氧化氮的浓度较阻滞前升高更明显(P＜0.01).同时发现NLP组蛛网膜下腔阻滞和硬膜外阻滞两种阻滞方法对血浆一氧化氮水平影响无显著差异(P＞0.05),而PIH组硬膜外阻滞组较蛛网膜下腔阻滞组血浆一氧化氮水平升高更明显(P＜0.01).结论PIH患者血浆一氧化氮水平低于正常晚妊娠女.脊神经阻滞使PIH患者血浆NO水平升高,硬膜外阻滞较蛛网膜下腔阻滞具有更好的效果.     

益气温阳护卫汤对哮喘豚鼠血浆sICAM-1水平的影响

目的观察益气温阳护卫汤对哮喘豚鼠血浆可溶性细胞间粘附分子1(sICAM-1)水平的影响.方法将豚鼠随机分为正常组、哮喘组、地塞米松组、玉屏风散组及益气温阳护卫汤低剂量组、中剂量组、高剂量组.于诱喘后24min,采集血浆标本,采用ELISA法测血浆sICAM-1 .结果哮喘组血浆sICAM-1水平为(141.94±78.24)ng/ml,与其它各组比较有显著性差异(P＜0.05);正常组水平最低为(24.68±13.87)ng/ml(P＜0.05);玉屏风散组为(78.37±21.07)ng/ml与其它各组比较有显著性差异(P＜0.05);低剂量组、中剂量组分别为(72.44±15.46)ng/ml,(62.89±17.18)ng/ml与地塞米松组(55.08±18.22)ng/ml及高温组(48.62±18.32)ng/ml比较有显著性差异(P＜0.05);而低剂量组与中剂量组比较无显著性差异(P＞0.05);地塞米松组与高剂量组比较亦无显著性差异(P＞0.05).结论益气温阳护卫汤可以降低哮喘豚鼠血浆sICAM-1的水平.     

妊娠高血压综合征患者血浆内皮素含量变化与意义

[目的]探讨妊娠高血压综合征（HDP）患者血浆内皮素（ET）含量的变化及意义.[方法]选择50例妊高征患者（HDP组）,其中妊娠期高血压组12例,轻度子痫前期组20例 ,重度子痫前期组18例 ;50例正常晚期孕妇（对照组）.采用放射免疫法测定各组血浆ET水平,分析其意义.[结果]HDP组的ET水平（110.12 ±22.46 ng/mL）显著高于对照组（67.33 ±11.34）ng/mL（ P 〈0.001）.妊娠期高血压组的ET水平（80.12 ±13.95） ng/mL与轻度子痫前期组（124.57 ±25.58） ng/mL、重度子痫前期组（175.41±48.55） ng/mL、对照组比较差异有显著性（ P 〈0.05）;轻度子痫前期组显著低于重度子痫前期组（ P 〈0.01）.[结论]血浆ET水平的变化在妊高征病理生理过程中起重要作用.     

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.     

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.