脑梗塞并发多器官衰竭患者肿瘤坏死因子含量的观察

目的：检测脑梗塞并发多器官功能衰竭（ＭＯＦ）患者血清肿瘤坏死因子（ＴＮＦ）的含量变化并探讨其意义。方法：单纯急性脑梗塞患者（ＡＣＩ组）２１例，脑梗塞并发多器官功能衰竭患者（ＭＯＦ组）２４例（其中伴上消化道出血１１例，心功能衰竭７例，肾功能衰竭６例）。采用放射免疫方法检测２组患者血清ＴＮＦ的含量。结果：脑梗塞并发ＭＯＦ组ＴＮＦ含量〔（２．４７±０．３９）μｇ／Ｌ〕明显高于ＡＣＩ组〔（１．８９±０．２４）μｇ／Ｌ〕，Ｐ＜０．０１。脑梗塞并发ＭＯＦ组中各亚组间ＴＮＦ〔上消化道出血组（２．５３±０．４３）μｇ／Ｌ，心功能衰竭组（２．０１±０．２８）μｇ／Ｌ，肾功能衰竭组（２．４１±０．３２）μｇ／Ｌ〕差异显著（Ｐ均＜０．０１），尤以上消化道出血组升高明显。结论：ＴＮＦ参与了脑梗塞并发上消化道出血的发病；监测ＴＮＦ变化有助于对脑梗塞并发ＭＯＦ患者的病情观察和预后估计。     

中西医结合治疗对肾病综合征患儿血清肿瘤坏死因子-α的影响

目的：探讨肿瘤坏死因子α（ＴＮＦα）与儿童肾病综合征发病关系及中西医结合治疗对ＴＮＦα的影响。方法：采用放射免疫分析法，对２９例肾病综合征患儿（观察组）进行了治疗前后血清ＴＮＦα的测定，并以１６例健康儿童（对照组）作对照。结果：观察组治疗前ＴＮＦα（３８．５５±９．６１）ｐｍｏｌ／Ｌ显著高于对照组（２０．３７±３．４４）ｐｍｏｌ／Ｌ，Ｐ＜０．０１，且观察组治疗前显著高于治疗后（２２．８０±３．９０）ｐｍｏｌ／Ｌ，Ｐ＜０．０１；肾炎性肾病（４２．８２±５．９６）ｐｍｏｌ／Ｌ，高于单纯性肾病（３５．０６±１０．７２）ｐｍｏｌ／Ｌ，Ｐ＜０．０５；活动期伴感染者（４５．８５±５．１０）ｐｍｏｌ／Ｌ显著高于不伴感染者（３４．７１±９．３９）ｐｍｏｌ／Ｌ，Ｐ＜０．０１。结论：ＴＮＦα参与了儿童肾病综合征的病理损伤过程；用免疫抑制剂和清热解毒、补气活血中药联合可抑制ＴＮＦα的产生。     

地塞米松对肺损伤大鼠肺泡巨噬细胞释放肿瘤坏死因子-α和白细胞介素6的影响

目的：观察博莱霉素（ＢＬＭ）诱发大鼠肺损伤后肺泡巨噬细胞（ＡＭ）释放肿瘤坏死因子 α（ＴＮＦ α）和白细胞介素 ６（ＩＬ ６）的变化及地塞米松（ＤＭ）对ＡＭ 释放ＴＮＦ α和ＩＬ ６的影响。方法：采用生物活性法测定ＴＮＦ α和ＩＬ ６。结果：灌注ＢＬＭ 后ＡＭ 释放ＴＮＦ α〔（５８．９５±１３．２１）ｋＵ／Ｌ〕和ＩＬ ６〔（３５．００±１０．００）ｋＵ／Ｌ〕明显高于对照组〔ＴＮＦ α为（２３．６３±５．５０）ｋＵ／Ｌ,Ｐ＜ ０．００１;ＩＬ ６ 为（２１．１７±６．０４）ｋＵ／Ｌ,Ｐ＜０．０１〕,ＤＭ 能够抑制ＡＭ 释放ＴＮＦ α和ＩＬ ６,并且与其剂量相关（随ＤＭ 浓度的增加,ＡＭ 分泌ＴＮＦ α和ＩＬ ６ 水平逐渐降低）。ＢＬＭ 组支气管肺泡灌洗液（ＢＡＬＦ）中细胞总数（４．８８±０．６５）×１０６ 也明显高于对照组〔（１．４７±０．４１）×１０６,Ｐ＜ ０．００１〕。结论：ＤＭ 能以剂量依赖方式抑制ＡＭ 释放ＴＮＦ α和ＩＬ ６     

新生儿休克时血浆肿瘤坏死因子的测定及其意义

目的：探讨肿瘤坏死因子（ＴＮＦ）在新生儿休克中的作用。方法：应用放射免疫方法检测３６例新生儿休克患儿血浆ＴＮＦ水平。结果：休克组治疗前血浆ＴＮＦ浓度〔（６０４．２６±１．２６）ｎｇ／Ｌ〕显著高于正常对照组〔（３２８．３８±１．１５）ｎｇ／Ｌ〕，Ｐ＜０．０１；感染性休克组〔（６５６．１４±１．４６）ｎｇ／Ｌ〕高于非感染性休克组〔（４６８．７９±１．３２）ｎｇ／Ｌ〕，Ｐ＜０．０５；死亡组〔（６８６．１３±１．１９）ｎｇ／Ｌ〕高于存活组〔（４７１．２３±１．２９）ｎｇ／Ｌ〕，Ｐ＜０．０５。血浆ＴＮＦ浓度与患儿器官损伤数呈正相关趋势，ｒ＝０．３１，Ｐ＞０．０５。结论：ＴＮＦ参与新生儿休克的病理生理过程，且与休克预后有关     

清除血液中内毒素、肿瘤坏死因子和白细胞介素-1对实验性内毒素休克时肺损伤的保护作用

目的：了解内毒素（ＬＰＳ）、肿瘤坏死因子（ＴＮＦ）和白细胞介素１（ＩＬ１）对实验性内毒素休克时肺损伤的保护作用。方法：实验分３组：Ⅰ组为假灌流组，Ⅱ组、Ⅲ组大鼠在内毒素休克早期开始分别给予活性炭（Ⅱ组）、大孔树脂ＡｍｂｅｒｌｉｔｅＸＡＤ７（Ⅲ组）血液灌流，结果与Ⅰ组作比较。结果：Ⅱ组ＬＰＳ、ＩＬ１水平明显降低，而Ⅲ组ＴＮＦ水平明显降低。Ⅱ组、Ⅲ组外周血白细胞数分别为（４．０±０．４）×１０９／Ｌ和（３．９±０．４）×１０９／Ｌ，均明显高于Ⅰ组〔（３．１±０．２）×１０９／Ｌ〕，Ｐ均＜０．０１；支气管肺泡灌洗液（ＢＡＬＦ）中的白细胞数〔（８．５±０．１）×１０９／Ｌ，（８．９±０．１）×１０９／Ｌ〕、肺系数（０．６４±０．０６，０．６６±０．０６）以及肺组织浸润的中性分叶核粒细胞数（２９．６±７．９／ＨＰ，３４．５±４．１／ＨＰ）均明显低于Ⅰ组〔（１２．３±１．８）×１０９／Ｌ，０．７５±０．０７，４８．６±６．６／ＨＰ〕，Ｐ均＜０．０１或＜０．０５。Ⅱ组、Ⅲ组的肺组织学改变亦较Ⅰ组明显减轻。结论：清除血液中致病介质可能对内毒素休克时的肺损伤产生保护作用。     

大鼠严重烫伤并发心肌损害时肿瘤坏死因子的变化

目的：探讨炎症介质在严重烧伤后心肌损害中的作用。方法：采用大鼠３０％ 体表面积Ⅲ度烫伤模型,随机分为对照组（１０ 只）和烫伤组（５０ 只）,于烫伤后１、３、６、１２ 和２４ 小时检测大鼠血浆肿瘤坏死因子（ＴＮＦ）和肌钙蛋白Ｔ（ＴｎＴ）及心肌组织中ＴＮＦ的含量。结果：烫伤后６ 小时血浆ＴＮＦ水平〔（３．３８±０．９０）μｇ／Ｌ〕较正常对照组〔（１．０８±０．０１）μｇ／Ｌ〕显著升高（Ｐ＜ ０．０１）,１２ 小时达峰值〔（８．０２±１．０５）μｇ／Ｌ〕,伤后２４ 小时〔（６．４４±１．４３）μｇ／Ｌ〕虽有所下降,但仍显著高于正常对照组（Ｐ＜ ０．０１）。心肌组织ＴＮＦ含量伤后１２ 小时〔（２．１５±０．０９）ｎｇ／ｍ ｇ〕显著高于正常对照组〔（０．８８±０．０１）ｎｇ／ｍ ｇ,Ｐ＜ ０．０１〕。血浆ＴＮＦ水平与反映心肌损伤的敏感指标血浆ＴｎＴ的变化密切相关。结论：炎症介质ＴＮＦ在烧伤后心肌损害的发生发展中起重要作用     

金水宝胶囊对慢性肾功能衰竭患者红细胞免疫功能的影响

目的：观察金水宝胶囊对慢性肾功能衰竭（ＣＲＦ）患者红细胞免疫功能的影响。方法：选择３６例ＣＲＦ患者,停用对免疫功能有影响的药物,加用金水宝胶囊２粒,每日３次,并测定红细胞免疫功能及肾功能。并与２０例健康人进行对照。结果：ＣＲＦ患者存在红细胞免疫功能低下,经金水宝胶囊治疗后红细胞Ｃ３ｂ受体花环率（ＲＢＣＣ３ｂＲ,７．８４％±６．３２％比１０．１７％±７．２８％,Ｐ＜０．０５）和红细胞免疫复合物（ＲＢＣＩＣ,３．６５％±１．６１％比２．９３％±１．２４％,Ｐ＜０．０１）明显下降,且能改善贫血〔Ｈｂ从（６．７８±０．４５）ｇ／Ｌ上升至（７．８６±０．２２）ｇ／Ｌ〕及肾功能〔ＢＵＮ从（４１．４５±２．５２）ｍｍｏｌ／Ｌ降至（３０．６９±１．２１）ｍｍｏｌ／Ｌ,ＳＣｒ从（６１２．７１±１０４．２３）μｍｏｌ／Ｌ降至（５１０．４５±９８．３６）μｍｏｌ／Ｌ〕。结论：金水宝胶囊具有调节和保护ＣＲＦ患者红细胞免疫功能的作用,并能改善肾性贫血及改善肾功能。     

急性肺损伤的炎症反应机制与药物治疗探讨

目的：探讨急性肺损伤的炎症反应机制以及雷公藤单体Ｔ４（Ｔ４）对炎症反应的影响。方法：小鼠腹腔注射内毒素（ＬＰＳ）复制急性肺损伤模型。动物分为生理盐水对照组、ＬＰＳ组、Ｔ４组（腹腔注射Ｔ４ ８５ μｇ／ｋｇ）和地塞米松组（地塞米松７０ ｍ ｇ／ｋｇ）。酶联免疫吸附法测定肿瘤坏死因子 α（ＴＮＦ α）、白细胞介素 １β（ＩＬ １β）、ＩＬ ６ 和ＩＬ １０ 浓度。一氧化氮（ＮＯ）的产物ＮＯ－２ 浓度以Ｇｒｉｅｓｓ法测定。以肺湿重与干重比值反映肺含水量。结果：Ｔ４组小鼠肺湿重与干重比值（３．９０±０．６２）与ＬＰＳ组（５．９５±０．９９）比较显著降低（Ｐ＜ ０．０５）。ＬＰＳ组血浆ＴＮＦ α、ＩＬ １β和ＩＬ ６浓度分别为（１３２．５±５．０）ｎｇ／Ｌ、（１８３．７±５８．６）ｎｇ／Ｌ和（３ ２９０．１±９２４．２）ｎｇ／Ｌ,Ｔ４组血浆ＴＮＦ α（０ ｎｇ／Ｌ）与ＬＰＳ组比较显著降低,Ｔ４ 组血浆ＩＬ １β和ＩＬ ６〔（３９．１±３１．８）ｎｇ／Ｌ和（８５９．６±８２９．９）ｎｇ／Ｌ〕与ＬＰＳ组比较亦显著降低。与ＬＰＳ组比较,Ｔ４ 组小鼠肺泡灌洗液中ＴＮＦ α浓度从（２２９．３±２０．３）ｎｇ／Ｌ显著降低到（２８．５±３３．４）ｎｇ／Ｌ。     

无先兆型偏头痛患者脑脊液γ－氨基丁酸含量变化的研究

本文应用放射受体分析法测定了１８例无先兆型偏头痛（ＭＷＡ）患者脑脊液（ＣＳＦ）中γ－氨基丁酸（ＧＡＢＡ）含量的变化，发现ＭＷＡ发作期ＣＳＦ中ＧＡＢＡ含量（３４．４８±２．８９ｐｍｏｌ／ｍｌ）显著高于间歇期（３０．９４±３．０１ｐｍｏｌ／ｍｌ），提示ＧＡＢＡ参与了ＭＷＡ的发病过程。     

急性坏死性胰腺炎早期血清细胞因子的变化及免疫干预的影响

目的：观察大鼠急性坏死性胰腺炎（ＡＮＰ）细胞因子变化及其与病理生理改变的关系,探讨进行免疫干预的可行性。方法：Ｗｉｓｔａｒ大鼠随机分为正常对照组、假手术组、ＡＮＰ组、抗ＴＮＦ单抗（ＴＮＦＭｃＡｂ）干预组和白细胞介素１受体拮抗剂（ＩＬ１ｒａ）干预组。观察各组大鼠胰腺病理、血淀粉酶、ＴＮＦα、ＩＬ１β、肠通透性和内毒素的变化。结果：ＡＮＰ后８小时,血清ＴＮＦα和ＩＬ１β水平升高〔（５６．１６±１７．７５）ｎｇ／Ｌ和（１５５．１４±９３．８３）ｎｇ／Ｌ,Ｐ＜０．０１〕,ＩＬ１ｒａ使ＴＮＦα水平明显下降〔（２１．７３±４．８６）ｎｇ／Ｌ,Ｐ＜０．０１〕。伴随血浆Ｄ乳酸在ＡＮＰ早期升高,血浆内毒素浓度增加〔８小时时（４４９±１６４）ＥＵ／Ｌ,Ｐ＜０．０１〕,ＴＮＦＭｃＡｂ和ＩＬ１ｒａ干预使Ｄ乳酸和内毒素的升高得到了抑制〔血浆内毒素水平分别为（２７４±１１０）ＥＵ／Ｌ和（２２９±７６）ＥＵ／Ｌ,Ｐ＜０．０５和Ｐ＜０．０１〕,胰腺炎组织学评分降低。结论：ＴＮＦα和ＩＬ１β是ＡＮＰ时炎性介质级联反应中的核心因子,在ＡＮＰ严重并发症的发生中起着重要作用;免疫干预有潜在的应用前景。     

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.