促肾上腺皮质激素对高脂血症兔模型血脂及肾功能的影响

目的:观察促肾上腺皮质激素(ACTH)对高脂血症模型新西兰兔血脂及肾功能的影响.方法:健康雄性新西兰兔30只,饲以2.5%猪油、1.25%胆固醇、0.75%蛋黄粉持续8周.高脂血症模型建立后将其随机分为ACTH组n=15)和对照组(n=15).ACTH组予ACTH1-24100 μg/(kg·d)皮下注射1周,对照组每天予等量生理盐水皮下注射.分别检测并比较两组高脂饮食前后血脂及肾功能情况.结果:ACTH组兔血清TC、HDL及LDL下降,而TG则上升,其中HDL和TG差异有统计学意义,且血Cr显著降低.结论:ACTH具有一定的降脂及改善肾功能效应.但其机制复杂.仍有待于进一步深入研究.     

促肾上腺皮质激素对兔血脂以及肾上腺的影响

目的:观察促肾上腺皮质激素氨基末端活性肽(ACTH1-24)对正常饮食兔血脂及肾上腺的影响。方法:将20只新西兰白兔随机分为ACTH1-24组(n=10)和对照组(n=10)。ACTH1-24组予ACTH1-24100μg/(kg·d)肌肉注射1周,对照组每天予等量的生理盐水肌肉注射。分别检测并比较两组血脂及肾上腺的情况。结果:与对照组相比,ACTH1-24组经ACTH1-24作用后血脂明显下降,并有改善肾功能的趋势,肾上腺增生明显,这与在人类研究观察到的结果十分相似。结论:新西兰兔能够作为研究促肾上腺皮质激素降脂机制研究的合适的动物模型。     

预致敏受者尸体肾移植术后的急性排斥反应

目的：预致敏肾移植受者的增加已是目前肾移植成功的重大影响因素。观察人类白细胞抗原氨基酸残基配型及新型免疫抑制剂治疗方案对预致敏患者肾移植术后急性排斥反应的治疗效应，寻找提高移植物存活率的最佳方案。方法：选择2003—01／2005—08在首都医科大学附属北京友谊医院行肾移植手术的患者396例，患者均知情同意。分组：①预致敏组（n=32）：即术前致敏患者。采用诱导治疗（抗淋巴细胞球蛋白100mg／d，3～7d）＋三联免疫抑制剂维持治疗方案（他克莫司＋霉酚酸酯＋激素）。②对照组（n=364）：未致敏患者。采用三联免疫抑制剂维持用药方案。比较两组患者肾移植术后6个月内急性排斥反应发生率、移植肾功能延迟恢复发生率及移植肾，患者1年存活率，同时分析人类白细胞抗原氨基酸残基配型对移植肾急性排斥反应的影响。结果：396例患者全部进入结果分析。①两组患者肾移植术后急性排斥反应发生率差异无显著性意义（P〉0．05）。预致敏组患者移植肾功能延迟恢复发生率显著高于对照组（P〈0．01）。②两组患者1年存活率差异无显著性意义（P〉0．05）。预致敏组患者1年移植肾存活率低于对照组（P〈0．05），如果去除患者死亡因素的影响，两组患者1年移植肾存活率差异无显著性意义（P〉0．05）。③预致敏组患者人类白细胞抗原氨基酸残基相配率高于对照组（P〈0．05）。预致敏组中氨基酸残基配型3-4错配患者的急性排斥反应发生率显著高于0-2错配患者（P〈0．01），高度致敏患者（移植术前群体反应抗体〉50％）急性排斥反应发生率显著高于低度致敏患者（群体反应抗体10％-20％）（P〈0．01）。结论：供受者之间良好的人类白细胞抗原氨基酸残基分型及采用新型免疫抑制药物治疗方案，对预防及减轻致敏患者移植术后急性排斥反应疗效确切，并可以缩短致敏患者等待移植手术的时间。     

辛伐他汀在原发性高血压治疗中的作用

目的观察辛伐他汀在高血压病治疗中的作用。方法将267例原发性高血压患者随机分为观察组(n=141)和对照组(n=126)。观察组患者给予非洛地平5 mg/d+辛伐他汀20 mg/d口服,对照组患者仅给予非洛地平5 mg/d口服。对比治疗前及治疗12周后患者血压、总胆固醇、低密度脂蛋白胆固醇、甘油三酯、高密度脂蛋白胆固醇的变化。结果与对照组相比,12周后观察组患者血压、总胆固醇、低密度脂蛋白胆固醇、甘油三酯显著下降(P<0.05或P<0.01);高密度脂蛋白胆固醇变化差异无统计学意义(P>0.05)。结论辛伐他汀与长效二氢吡啶类钙拮抗剂联用,协同作用明显,可更好地降低血压,改善血脂,从而更好地降低靶器官损伤,改善预后,且服用方便,副作用少。     

生物免疫诱导治疗对肾移植患者机体免疫状态的影响

背景：目前生物制剂参与的免疫诱导治疗逐渐成为肾移植免疫抑制治疗方案的重要组成部分，既能有效预防急性排斥反应的发生，又能避免并发症的发生。目的：探讨不同生物制剂在肾移植免疫诱导治疗中对机体免疫状态及移植肾功能状态的影响。方法：回顾分析110例肾移植受者临床资料，根据应用生物免疫诱导治疗情况分组，单克隆抗体组（n=35）肾移植受者接受巴昔利单克隆抗体治疗，多克隆抗体组（n=43）肾移植受者接受兔抗人胸腺细胞免疫球蛋白治疗，对照组（n=32）肾移植受者未接受生物制剂免疫诱导治疗。对比分析3组受者在肾移植后1，4，12周的淋巴细胞绝对值、外周血CD4＋T淋巴细胞亚群数量，并评价移植后12周内移植肾功能状态和感染并发症发生情况。结果与结论：单克隆抗体组、多克隆抗体组急性排斥反应发生率低于对照组（P〈0.05），多克隆抗体组感染并发症发生率高于单克隆抗体组、对照组（P〈0.05）。单克隆抗体组、多克隆抗体组移植后1，4，12周淋巴细胞绝对值均低于对照组（P〈0.05）。多克隆抗体组移植后1，4，12周外周血CD4＋T淋巴细胞亚群数量低于单克隆抗体组、对照组（P〈0.05）。表明生物制剂参与的肾移植免疫诱导治疗方案可有效抑制移植受者活化T淋巴细胞功能状态，降低移植肾早期急性排斥反应的发生，但应用兔抗人胸腺细胞免疫球蛋白的感染并发症发生率较高。     

大剂量咪唑立宾联合环孢素预防肾移植术后巨细胞病毒感染:随机对照

目的:体外研究显示大剂量咪唑立宾具有抑制巨细胞病毒复制的作用.文章拟验证大剂量咪唑立宾联合环孢素对肾移植术后巨细胞病毒感染的预防作用及其安全性.方法:①实验对象:选择2006-06/2007-02于解放军总医院第三○九临床部泌尿外科首次行肾移植的受者30例,对实验及治疗方案均知情同意,且得到医院伦理道德委员会批准.②实验分组及方法:将30例受者按随机数字表法分成2组,咪唑立宾组(n=15):环孢素 咪唑立宾 醋酸泼尼松;对照组(n=15):环孢素 麦考酚酸酯 醋酸泼尼松.③实验评估:观察肾移植术后90 d两组受者巨细胞病毒感染、排斥反应、骨髓抑制和高尿酸血症发生情况.结果:30例受者全部进入结果分析.术后90 d咪唑立宾组受者的巨细胞病毒感染率低于对照组(P=0.047),两组急性排斥反应、骨髓抑制、高尿酸血症发生率差异无显著性意义(P > 0.05).结论:使用剂量为3 mg/(kg·d)的咪唑立宾可以降低巨细胞病毒感染率,同时能有效预防急性排斥反应发生,且不会加重咪唑立宾的毒副作用.     

不同剂量阿托伐他汀对脑梗死患者颈动脉粥样硬化及炎性因子的影响

目的探讨不同剂量阿托伐他汀对脑梗死患者颈动脉粥样硬化、炎性因子的影响。方法 90例脑梗死患者随机分为对照组(n=30)、观察A组(n=30)、观察B组(n=30)。对照组仅给予常规治疗,观察A组在常规治疗基础上给予阿托伐他汀钙10 mg,观察B组在常规治疗基础上给予阿托伐他汀钙20 mg。比较3组颈动脉粥样硬化、炎性因子的变化。结果治疗6个月后,观察A组与观察B组炎性因子与血脂水平较治疗前显著降低(P0.05),且观察B组显著低于观察A组(P0.05)。对照组与观察A组患者IMT、斑块面积无显著改变(P0.05),观察B组IMT显著降低,斑块面积显著缩小(P0.05)。结论阿托伐他汀能有效调节血脂,降低血清炎性因子水平,稳定斑块性质,且20 mg较10 mg效果更为明显。     

急性冠脉综合征早期应用辛伐他汀疗效观察

目的　观察急性冠脉综合征 (ACS)早期应用辛伐他汀对血脂、缺血事件发生的影响。方法　将 4 0例ACS患者随机分为治疗组 (n =2 0 )和对照组 (n =2 0 ) ,治疗 2 4周 ,观察用药前后血脂、缺血事件发生情况。结果　治疗组用药后血脂明显下降 (P <0 . 0 5 ) ,对照组用药前后血脂无显著变化 (P >0 .0 5 )。缺血事件的总发生例数治疗组明显低于对照组 (χ2 =4 . 80 ,P =0 . 0 2 85 )。两组治疗前后肝、肾功能、肌酸磷酸激酶均无明显变化。结论　ACS早期应用辛伐他汀可明显降低缺血事件。     

维生素E对妊娠糖尿病患者血浆C-反应蛋白和血脂水平的影响

目的观察妊娠糖尿病(gestational diabetes mellitus,GDM)患者应用维生素E干预治疗前后血浆C-反应蛋白(CRP)、血脂水平的变化。方法选择符合诊断标准的妊娠糖尿病患者22例,随机分为观察组(n=11)和对照组(n=11),两组均制订个性化的饮食及运动计划并予皮下注射胰岛素,在此基础上观察组口服维生素E 30 mg/d。观察两组治疗前及治疗后2、4周血清CRP、血脂水平并进行比较。结果观察组应用维生素E治疗后2周血清CRP、总胆固醇、甘油三酯、低密度脂蛋白胆固醇浓度较治疗前均显著降低(P0.05),高密度脂蛋白较治疗前显著升高(P0.05),治疗后4周上述改变更为明显(P0.05);对照组治疗后上述指标与治疗前比较无明显变化(P0.05);治疗后2、4周两组上述指标比较差异均有统计学意义(P0.05)。结论维生素E能缓解GDM患者体内炎症反应并降低血脂浓度,从而改善GDM患者的临床症状及减少对胎儿的不良影响。     

血清SAA和ACTH表达水平与重症细菌感染性疾病的关系及对患者治疗效果的评估

目的探讨血清淀粉样蛋白A(SAA)和促肾上腺皮质激素(ACTH)表达水平与重症细菌感染性疾病的关系,分析其对患者治疗效果的评估价值。方法选取秦皇岛市第一医院2018年1月至2019年1月重症监护室收治的126例感染性疾病患者,根据微生物培养结果分为细菌感染组(n=74)和非细菌感染组(n=52),另选取同期60例体检健康者为对照组。对比各组血清SAA、ACTH水平及白细胞计数(WBC),观察细菌感染组治疗后各时间段血清SAA、ACTH水平及WBC和序贯器官衰竭估计评分(SOFA)评分变化;ROC曲线分析血清SAA、ACTH水平及WBC对重症细菌感染性疾病的诊断价值。结果细菌感染组血清SAA、ACTH水平及WBC值明显高于非细菌感染组(P<0.001),且感染组血清SAA、ACTH水平及WBC值明显高于对照组(P<0.001);细菌感染组治疗后1 d、7 d、14 d、出院前血清SAA、ACTH水平及WBC和SOFA评分逐渐降低。ROC曲线显示,WBC诊断重症细菌感染性疾病的AUC与SAA、ACTH诊断差异无统计学意义(P>0.05),SAA联合ACTH诊断重症细菌感染...     

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.