帕金森病患者血清同型半胱氨酸及血尿酸水平检测的临床意义

目的探讨血清同型半胱氨酸(Hcy)和血尿酸(UA)的水平与帕金森病(PD)的相关性。方法检测58例帕金森病患者和50例健康老人的血清同型半胱氨酸及血尿酸水平。结果帕金森病组的Hcy浓度明显高于健康老年组,差异有统计学意义[(25.89±3.01)μmol/L比(13.29±2.13)μmol/L,P0.01],帕金森病患者UA水平的明显低于健康老年组,差异有统计学意义[(267.34±68.43)μmol/L比(341.26±52.75)μmol/L,P0.01)]。结论帕金森病患者会出现血清同型半胱氨酸水平升高及血尿酸水平的降低。高同型半胱氨酸血症及低血尿酸水平可能参与帕金森病的发生发展过程。     

老年高血压合并2型糖尿病患者血清同型半胱氨酸和血尿酸的变化及意义

目的探讨血清同型半胱氨酸（Hey）、血尿酸（SUA）与老年原发性高血压合并2型糖尿病（T2DM）的关系。方法对55例老年（≥60岁）单纯高血压患者（单纯高血压组）、50例高血压合并T2DM患者（高血压合并T2DM组）与61名正常对照者（对照组）用荧光偏振免疫法测定血清Hey及SUA含量并进行统计学分析。结果高血压合并T2DM组与对照组比较差异有统计学意义,Hcy分别为[（18．36±7．75）μmol／L与（13．05±4．13）μmoL／L,P〈0．01）]、SUA分别为[（321．50±79．34）mmol／L与（294．07±59．55）mmol／L,P〈0．05）];单纯高血压组与对照组比较差异有统计学意义,Hcy分别为[（18．20±6．15）μmol／L与（13．05±4．13）μmol／L,P〈0．01）]、SUA分别为[（329．91±76．12）mmol／L与（294．07±59．55）mmol／L,P〈0．01）];高血压合并T2DM组与单纯高血压组比较差异无统计学意义,Hcy分别为[（18．36±7．75）μmol／L与（18．20±6．15）μmol／L,P〉0．05）]、SUA分别为[（321．50±79．34）mmol／L与（329．91±76．12）mmol／L,P〉0．05）。结论高Hcy血症、高SUA血症可能是老年高血压合并T2DM发生的危险因素。     

老年帕金森病患者发生认知障碍的影响因素研究

目的：探讨老年帕金森病患者发生认知障碍的影响因素。方法将74例老年帕金森病患者按有无认知障碍分为观察组31例和对照组43例,统计两组临床资料并进行对比分析,对观察组认知障碍状况进行多因素Logistic回归分析。结果观察组帕金森病病程≥3 a、学历高中以下、从事体力劳动者构成比及汉密顿抑郁量表总分、血浆同型半胱氨酸水平均显著高于对照组（P＜0．05或0．01）,血尿酸水平显著低于对照组（P＜0．01）。观察组认知障碍状况与患者帕金森病病程、职业性质、学历及血浆同型半胱氨酸水平显著相关（O R＝0．963、1．030、1．073、1．812,P＜0．05）。结论帕金森病病程长、受教育程度低、从事体力劳动者及血浆同型半胱氨酸水平升高是引起患者发生认知障碍的主要危险因素,临床上应有针对性地进行早期干预,以减少认知障碍的发生。     

急性脑梗死患者血浆BNP与Hcy检测的临床价值

目的探讨血浆B型脑钠肽（BNP）与同型半胱氨酸（Hcy）在急性脑梗死患者中的含量变化及其临床意义。方法采用化学发光法测定80例脑梗死急性期患者血浆BNP与Hcy浓度,并以30例健康自愿体检者作对照。结果急性脑梗死组血浆BNP、Hey水平[（153．24±69．76）ng／L,（30．34±9．46）μmol／L]显著高于与正常对照组[（85．16±28．15）ng／L,（11．54±3．29）μmol／L],差异具有统计学意义（P〈0．01）。大、中面积脑梗死组血浆BNP、Hcy水平均显著高于小面积脑梗死组,差异具有统计学意义（P〈0．01）。结论急性脑梗死患者血浆BNP和Hcy水平明显升高,它们与脑梗死的发生密切相关,可能在脑梗死的发病过程中起重要作用。     

脑梗塞患者血清同型半胱氨酸水平的变化

[目的]探讨脑梗塞患者血清同型半胱氨酸（homocysteine,Hcy）水平的变化。[方法]应用循环酶法测定42例脑梗塞患者和23例健康正常人（对照组）血清同型半胱氨酸,比较脑梗塞患者血清同型半胱氨酸水平的变化。[结果]脑梗塞组血清HCY水平（20．39±3．17）μmol／L,高于对照组（12．06±2．45）μmol／L。[结论]脑梗塞患者血清同型半胱氨酸水平明显升高,HCY是脑梗塞的独立危险因素之一。     

先兆子痫患者血浆ADMA与同型半胱氨酸水平相关性研究

目的：探讨先兆子痫患者血浆不对称性二甲基精氨酸（asymmetric dimethylarginine,ADMA）水平与同型半胱氨酸（homocysteine,Hcy）水平的相关性,以及 ADMA、Hcy 水平与先兆子痫的关系。方法用酶联免疫吸附法检测91例先兆子痫患者血浆 ADMA 及血浆 Hcy 水平。以80例血压正常的健康孕妇为对照。结果先兆子痫组血浆 ADMA 水平（0.625±0.186μmol／L）显著高于对照组（0.524±0.106μmol／L）（P ＜0.05）;先兆子痫组血浆 Hcy 水平（12.447±6.134μmol／L）显著高于对照组（8.207±2.797μmol／L）（P ＜0.05）。先兆子痫组血浆 ADMA 水平与 Hcy 水平呈正相关（r＝0.623,P ＜0.05）。结论先兆子痫患者的血浆中不对称性二甲基精氨酸和同型半胱氨酸是升高的,这说明 ADMA 和 Hcy 的升高与先兆子痫的发生、发展有关, ADMA、Hcy 可能是先兆子痫的危险因子。降低患者升高了的同型半胱氨酸和 ADMA 可能有助于治疗先兆子痫。     

冠心病患者血清同型半胱氨酸水平的变化及其临床意义

【目的】研究冠心病患者血清同型半胱氨酸（Hcy）水平的变化及其临床意义。【方法】运用循环酶法测定冠心病患者和正常人血清Hcy水平。【结果】稳定型心绞痛（SAP）组、不稳定型心绞痛（UAP）组、心肌梗死型冠心病（AMI）组和对照组血清Hcy水平分别为（12．76士4．89）μmol／L、（17．69土7．11）μmol／L、（26．734士13．56）／μmol／L、（9．90士2．56）／μmol／L;SAP组、UAP组、AMI组血清Hcy水平明显高于对照组（p〈0．01）;AMI组Hcy水平明显高于sAP组、uAP组（P〈O．01）;UAP组Hcy水平高于SAP组（P〈0．01）。【结论】临床上常规检测Hcy,对高Hcy患者给予干预治疗,以降低高Hcy血症是防治冠心病的重要途径。     

高同型半胱氨酸血症与老年人认知功能障碍相关性研究

目的通过对秦皇岛市部分地区老年人认知功能障碍的发生情况的调查,分析高同型半胱氨酸血症（homocysteine,Hcy）是否为老年人认知功能障碍的独立危险因素;并分析高Hcy血症与认知功能障碍程度之间的相关性。方法以秦皇岛市部分地区进行大规模流行病学调查1 010例老年人中筛查出的认知功能障碍患者112例,其中轻度认知障碍组67例,痴呆组45例;以流行病调查结果认知功能正常人群898例中随机选取100例为对照组。对影响认知功能的可能危险因素血同型半胱氨酸以及年龄、受教育程度、吸烟史、饮酒史、高血压、血糖、血脂等引入非条件Logistic回归分析,判断高同型半胱氨酸血症是否为认知功能障碍的独立危险因素;并对轻度认知功能障碍患者及痴呆患者和认知功能正常对照组三者间血浆同型半胱氨酸含量进行比较。结果通过非条件logistic回归分析,矫正了年龄、文化程度、吸烟、饮酒、高血压、血糖、血脂等因素,得出高Hcy血症是认知功能障碍的独立危险因素;且认知障碍程度与Hcy含量相关。轻度认知功能障碍组Hcy（20.03±9.02）μmol/L;痴呆组Hcy（26.11±13.29）μmol/L;痴呆组及轻度认知障碍组Hcy均高于老年正常对照组（16.34±6.76）μmol/L,差异有统计学意义（P〈0.05）。结论高Hcy是老年人认知功能障碍的危险因素,且认知障碍程度与Hcy含量高低相关。     

维持性血液透析患者血浆同型半胱氨酸水平及叶酸、维生素B12的干预效果

目的评价补充叶酸（FA）和维生素B12（VitB12）对维持性血液透析（MHD）患者血浆同型半胱氨酸（Hey）水平的影响。方法将61例MHD患者随机分为治疗组（30例）和非治疗组（31例）,治疗组给予FA15mg／d口服,VitB120．15mg／d肌注,疗程为8周。同时测定61例MHD患者和40名正常对照者血浆Hcy浓度和血清FA、VitB12水平。结果MHD患者血浆Hcy水平[（52．6±21．6）μmol／L]明显高于正常对照组[（10．1±3．6）μmol／L]（P〈0．001）。FA、VitB,2治疗8周后,治疗组MHD患者的血清VitB12[（638．9±229．0）ng／L]和FA水平[（17．7±4．6）μg/L）]明显高于非治疗组[（450．3±195．9）ng／L、（7．2±2．3）μg／L]（P〈0．001）,血浆Hcy水平[（28．8±5．5）μmol／L]低于非治疗组[（50．0±18．8）μmol／Lj（P〈0．001）。血浆Hey水平与叶酸、VitB。：水平均呈负相关。结论MHD患者普遍存在高Hcy血症。FA和VitB12能降低血浆Hcy浓度,对预防MHD患者心脑血管疾病的发生具有重要意义。     

体检人群同型半胱氨酸检测分析

目的了解长沙地区体检人群体内血清同型半胱氨（Hey）浓度水平和特点,分析讨论旨在引起对Hcy常规检测的重视。方法基于小分子捕获技术（SMT）的S-腺苷同型半胱氨酸的方法。结果341例人群血清Hcy浓度（μmol／L）43．25±19．23,71．26（243／341）的结果高于正常值5～15μmol／L水平,男性血清Hey浓度（μmol／L）48．97±20．52,女性Hcy浓度（μmoL／L）26．03±11．35,不同性别血清Hcy浓度差异有统计学意义（P〈0．05）,随年龄的增加血清Hey浓度增加明显,差异有统计学意义（P〈0．05）。结论同型半胱氨酸是一个反映身体健康状况十分重要的指标,应像对待血压、血脂、血糖一样把它作为常规的预防筛选检测指标项目用于临床。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.