恶性腹水中可溶性CD44v6的检测及意义

目的　探讨可溶性CD44v6(sCD44v6)对恶性腹水的诊断价值。方法　用酶联免疫吸附试验 (ELISA)检测 10份良性疾病患者腹腔液 (不伴腹水 ) ,14份恶性疾病患者腹腔液 (不伴腹水 ) ,36份肝硬化腹水、8份结核性腹水、2 3份恶性腹水中sCD44v6水平。结果　恶性腹水组sCD44v6水平为 (89 2±38 2 )ng/ml,明显高于肝硬化腹水组 (44 8± 18 0 )ng/ml、结核性腹水组 (5 0 3± 12 6 )ng/ml及良、恶性疾病不伴腹水患者腹腔液组 [(5 1 1± 2 0 3)ng/ml和 (38 4± 12 4 )ng/ml,P <0 0 1];后 4组间比较 ,sCD44v6水平差异无显著意义 (P >0 0 5 )。恶性腹水中卵巢癌腹水组sCD44v6水平 [(89 4± 2 5 7)ng/ml]高于胃癌腹水组 [(83 9± 32 6 )ng/ml]和结肠癌腹水组 [(80 1± 10 0 )ng/ml],但差异无显著意义 (P >0 0 5 )。以 6 2 8ng/ml为阳性界值 ,腹水sCD44v6诊断恶性腹水的敏感性为 73 9% ,特异性为 91 7%。结论　sCD44v6对于良、恶性腹水的鉴别诊断有重要价值。     

胸水中可溶性CD44V6的检测及意义

目的 探讨可溶性CD44V6(sCD44V6)在良恶性胸水中的诊断价值.方法 用酶联免疫吸附试验(ELISA)检测67份恶性胸水(其中肺癌56例、食管癌7例、胃癌4例)、76份良性胸水(其中非特异性疾病64例、结核性12例)的sCD44V6水平,并绘制受试者工作特征(ROC)曲线,评价此项指标在胸水定性诊断中的临床价值.结果 肺癌、食管癌、胃癌的组sCD44V6水平分别为97.9±15.5ng/ml、95.5±25.7 ng/ml及97.3±35.6ng/ml,明显高于良性非特异性疾病组及结核组44.7±18.9ng/ml和47.5±20.3ng/ml,良恶性组比差异有显著意义(P＜0.01).以59.4ng/ml为诊断界点,诊断恶性胸水的敏感度为82.1%,特异性为87.5%.结论 sCD44V6对于良、恶性胸水的鉴别诊断有重要价值.     

胃肠道肿瘤患者血清sCD44v6检测的临床意义

目的探讨检测血清可溶性细胞表面分化抗原可溶性CD44v6(sCD44v6)在胃肠道肿瘤诊断中的价值。方法以酶联免疫吸附测定(ELISA)法检测68例胃肠道肿瘤患者和35例正常体检者sCD44v6的含量,并结合临床资料进行分析。结果肠癌组sCD44v6的水平[(315.67±114.19)ng/ml],胃癌组sCD44v6的水平[(302.53±79.0)ng/ml],明显高于正常对照组[(45.6±9.5)ng/ml]。差异均有显著意义(P均<0.001);肠癌和胃癌伴转移组sCD44v6水平[(421.90±68.09)ng/ml],明显高于未转移组[(257.68±82.84)ng/ml],差异有显著意义(P<0.001)。结论sCD44v6水平与胃肠道肿瘤及其转移有明显关联,其可作为胃肠道肿瘤的诊断、预后诊断的参考指标,及是否伴有转移的预测指标。     

血清可溶性CD44变异性外显子6测定对结直肠癌的临床意义

目的　探讨血清可溶性CD4 4变异性外显子 6 (sCD4 4v6 )对结直肠癌的临床应用价值。方法　 96例不同Dukes 分期结直肠癌患者和 2 4例健康者 ,分别采用 (ELISA)定量检测血清sCD4 4v6含量 ,时间分辨免疫荧光法检测CEA含量 ,并结合临床资料进行分析。结果　结直肠癌患者sCD4 4v6浓度为 (2 75 .3± 1 1 5 .8)ng/ml,显著高于健康对照组 (6 1 .3± 7.8)ng/ml,P <0 .0 5 ,若以健康对照组的 x +2s(76 .9ng/ml)作为正常值上限 ,阳性率为 74 .0 % ;sCD4 4v6水平随癌肿分期和肿瘤转移呈现递增趋势 (P <0 .0 5 )。与CEA相比 ,sCD4 4v6水平在反映癌组织浸润和转移程度上更敏感。结论　结直肠癌患者sCD4 4v6水平和阳性率均显著增高 ,并与肿瘤分期和扩散转移相关 ;术前血清sCD4 4v6水平对结直肠癌患者病程的评估和转移的预测有一定的辅助价值     

结直肠癌患者可溶性CD44v6的检测

目的　探讨检测血清可溶性细胞表面分化抗原 (sCD) 4 4v6在结直肠癌诊断中的价值。方法　以酶联免疫吸附测定 (ELISA)法检测 81例结直肠癌患者术前及术后第 1、5、10天共 4个时间点sCD44v6的变化 ,并结合临床资料进行分析。结果　结直肠癌组sCD44v6的水平 [(2 0 0 .5±31.1) μg/L]明显高于正常对照组 [(4 5 .6± 9.5 ) μg/L]和结肠炎组 [(4 8.3± 7.6 ) μg/L],差异均有显著意义 (P均 <0 .0 5 ) ;结直肠癌伴转移组sCD44v6水平 [(2 80 .1± 2 6 .9) μg/L],明显高于未转移组[(16 0 .9± 34 .4) μg/L],差异有显著意义 (P <0 .0 5 ) ;术后第 1、5、10天sCD44v6水平逐渐下降 ,至第 10天降至正常。结论　sCD44v6水平与结直肠癌及其转移有明显关联 ,其可作为结直肠癌的诊断、预后诊断的参考指标 ,及是否伴有转移的预测指标     

血管内皮生长因子在肺癌患者血清及体液中的表达

目的探讨肺癌患者血清及胸腹水中血管内皮生长因子(VEGF)的临床意义.方法应用酶联免疫法检测55例肺癌患者VEGF水平,同时测定16例肺癌患者术后1个月的VEGF浓度.结果肺癌患者血清中VEGF浓度为(86.27±38.20ng/L)((-x)±s),明显高于血清对照组(P＜0.01);胸腹水中VEGF浓度为(157.51±58.57ng/L)((-x)±s),明显高于良性疾病胸腹水组(P＜0.01).16例肺癌患者术后1个月测定VEGF浓度,有11例VEGF浓度下降,5例VEGF浓度升高,升高组和下降组手术前后测定值差异均有显著性(P＜0.01).结论VEGF浓度测定对肺癌的辅助诊断及检测术后肿瘤复发和转移有一定的临床意义.     

胸水中可溶性CD44V6的检测及意义

目的 探讨可溶性CD44V6(sCD44V6)在良恶性胸水中的诊断价值.方法 用酶联免疫吸附试验(ELISA)检测67份恶性胸水(其中肺癌56例、食管癌7例、胃癌4例)、76份良性胸水(其中非特异性疾病64例、结核性12例)的sCD44V6水平,并绘制受试者工作特征(ROC)曲线,评价此项指标在胸水定性诊断中的临床价值.结果 肺癌、食管癌、胃癌的组sCD44V6水平分别为97.9±15.5ng/ml、95.5±25.7 ng/ml及97.3±35.6ng/ml,明显高于良性非特异性疾病组及结核组44.7±18.9ng/ml和47.5±20.3ng/ml,良恶性组比差异有显著意义(P＜0.01).以59.4ng/ml为诊断界点,诊断恶性胸水的敏感度为82.1%,特异性为87.5%.结论 sCD44V6对于良、恶性胸水的鉴别诊断有重要价值.     

光波/微波组合修复CD44v6抗原及其在78例非小细胞肺癌中的表达

目的:探讨光波/微波(LW/MW)抗原修复对CD44v6抗原性的影响及CD44v6基因表达与非小细胞肺癌(NSCLC)的组织学类型、分化程度以及转移等之间的关系.方法:应用LW/MW-枸椽酸缓冲液(CA)修复抗原,微波-LSAB免疫组化染色,图像分析78例NSCLC中CD44v6的光密度(IOD)值与组织学类型、分化程度和淋巴结转移间关系.结果:LW、MW、LW/MW-CA抗原修复处理的IOD值显著高于未修复组的IOD值(P＜0.01);MW和LW/MW抗原修复处理的IOD值显著高于LW(P＜0.01),LW/MW高于MW(P＜0.05).78例NSCLC的CD44v6阳性细胞的IOD值(131.7±11.8)与10例正常组织的IOD值(92.5±12.4)之间差异有非常显著性(P＜0.01);有淋巴结转移组(148.8±12.7)与无淋巴结转移组(116.9±14.9)间差异有非常显著性(P＜0.01);组织学类型、不同分化程度之间差异无显著性(P＞0.05).结论:LW/MW抗原修复处理可以显著提高CD44v6的IOD值;CD44v6表达强度与淋巴结转移密切相关,可作为预测NSCLC病人预后和发生转移的生物学指标之一.     

糖尿病患者血清超敏C反应蛋白、白细胞介素-6及白细胞介素-10的变化

目的:研究血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)和白细胞介素-10(IL-10)在糖尿病患者中的变化,及其对心血管并发症的预示作用.方法:收集99例糖尿病患者血清,其中胆固醇正常者68例,胆固醇升高者31例,及50例正常体检人员的血清.使用乳胶增强免疫透射比浊法检测hs-CRP,一步酶法检测胆固醇,同时采用ELISA双抗体夹心法测定血清IL-6、IL-10.结果:正常对照组血清hs-CRP、IL-6和IL-10浓度分别为(1.66±0.95)mg/L、(24±8)ng/L和(27±7)ng/L,胆固醇正常糖尿病组血清hs-CRP、IL-6和IL-10浓度分别为(2.77±1.19)mg/L、(25±10)ng/L和(28±8)ng/L,胆固醇升高糖尿病组血清hs-CRP、IL-6和IL-10浓度分别为(5.70±1.81)mg/L、(34±10)ng/L和(21±5)ng/L.与正常对照组、胆固醇正常糖尿病组相比,胆固醇升高糖尿病组hs-CRP、IL-6和IL-10表达水平差异均有统计学意义(分别为P＜0.01、P＜0.05、P＜0.05).与正常对照组比较,胆固醇正常糖尿病组hs-CRP高表达(P＜0.05),而这两组间IL-6和IL-10表达水平差异无统计学意义(P＞0.05).结论:炎症因子hs-CRP在预测糖尿病患者并发冠心病中具有重要的临床意义.     

血清转化生长因子β1与肺癌复发的相关性研究

目的研究转化生长因子β 1(transforming growth factorβ1,TGFβ1)与肺癌复发的关系.方法应用免疫组化方法和酶联免疫吸附方法,分别测定59例肺癌患者肿瘤组织内TGF β1的表达和TGF β1水平.结果肺癌组TGF β1表达显著高于对照组(P＜0.01).肺癌组血清TGF β1平均水平(11.7±1.4 ng/ml)显著高于对照组(4.4±0.2 ng/ml(P＜0.01);放疗后随访期带病生存组血清TGFβ1水平(11.0±2.3 ng/ml)显著高于无病生存组(4.4±0.9 ng/ml;P＜0.01).结论血清TGF β1可作为肺癌的肿瘤标记物.     

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.