GPDA在糖尿病早期肾损害诊断中的应用

目的　研究尿甘氨酰脯氨酸二肽氨基肽酶 (GPDA)诊断糖尿病早期肾损害的价值。方法　采用解放军第 88医院检验科建立的GPDA连续监测法 ,测定 87例非胰岛素依赖型糖尿病(NIDDM)和 72名正常对照的尿液GPDA ,并与其他反映早期肾损害的指标相比较。结果　NIDDM患者尿液GPDA显著高于正常对照组 (P <0 .0 1 ) ,增高程度与NIDDM病程、血糖水平、高血压关系密切。尿GPDA与N 乙酰 β D 氨基葡萄糖苷酶 (NAG)和尿微量白蛋白 (UmA)呈显著正相关。结论　尿液GPDA测定是一项新的预测NIDDM早期肾损害的敏感指标     

尿甘氨酰脯氨酸二肽氨基肽酶测定对重型脑损伤患者早期肾损害的诊断价值

目的研究尿甘氨酰脯氨酸二肽氨基肽酶(GPDA)诊断重型脑损伤早期肾损害的价值。方法选择重型脑损伤患者31例,轻型脑损伤患者28例,正常人对照组30例,采用GPDA连续监测法,分别对其尿中GPDA活性进行测定并与其他反映早期肾损害的指标N-乙酰β-D氨基葡萄糖苷酶(NAG)和尿微量白蛋白(UMA)相比较。结果重型脑损伤患者尿液GPDA的水平[(57.4±33.9)u/(g.Cr)]显著高于正常人对照组[(13.2±6.1)u/(g.Cr)]及轻型脑损伤患者的水平[(21.5±16.9)u/(g.Cr),P<0.01],尿GPDA与NAG及UMA呈显著正相关(r=0.717,r=0.681,P<0.01)。结论尿液GPDA测定是一项新的监测重型脑损伤早期肾损害的敏感指标。     

尿甘氨酰脯氨酸二肽氨基肽酶测定对老年急性脑卒中患者早期肾损害的临床应用

目的研究尿甘氨酰脯氨酸二肽氨基肽酶(GPDA)诊断老年急性脑卒中患者早期肾损害的临床应用价值。方法选择老年急性脑卒中患者57例,正常人对照组30例,其中脑卒中患者分为轻、中、重三组,采用GPDA连续监测法,分别对其尿中GPDA活性进行测定并与其他反映早期肾损害的指标N-乙酰β-D氨基葡萄糖苷酶(NAG)及尿微量白蛋白(UMA)相比较。结果脑卒中患者尿液GPDA的水平[(57.4±33.9)u/(g.Cr)]显著高于正常人对照组的水平[(21.5±16.9)u/(g.Cr),P<0.01],尿GPDA活性与脑卒中的严重程度有关。尿GPDA与NAG及UMA均呈显著正相关(r=0.690,r=0.647,P<0.01)。结论尿液GPDA测定是一项新的监测急性脑卒中早期肾损害的敏感指标。     

尿甘氨酰脯氨酸二肽氨基肽酶诊断肝硬化早期肾损害的临床价值

目的：探讨尿甘氨酰脯氨酸二肽氨基肽酶检测在肝硬化早期肾损害诊断中的临床价值。方法将2011年5月至2013年5月郑州市第二人民医院收治的80例肝硬化早期肾损害患者作为观察组,根据患者血清白蛋白浓度、血清胆红素、食管静脉出血情况、凝血酶原时间、腹水情况等指标将患者随机分为代偿组（45例）与失代偿组（35例）,选取同期40名健康体检人员作为对照组,观察两组的尿甘氨酰脯氨酸二肽氨基肽酶（GPDA）及尿-N-乙酰-β-D-氨基葡萄糖苷酶（NAG）。结果观察组患者GPDA及NAG水平均明显高于对照组,P<0.05;代偿组患者GPDA及NAG水平均明显高于失代偿组,P<0.05。结论采用GPDA检测对肝硬化早期肾损害患者进行诊断,敏感性较高,能够为肝硬化早期肾损害临床诊断及治疗提供有效依据。     

甘氨酰脯氨酸二肽氨基肽酶在肝胆疾病诊断中的价值

甘氨酰脯氨酸二肽氨基肽酶（Slycylprolinedipeptidy laminopeptidase,GPDA），有色特异地水解肽链末端第2位为脯氨酸所形成的肽键（对其他肽键无作用）。用人工合成的X-脯氨酰对硝基苯胺作底物来检测此酶活性发现，以甘氨酰脯氨酸对硝基苯胺为底物时酶活性最强，Km值最小，故称此酶为甘氨酰脯氨酸二肽氨基肽酶或甘氨酰脯氨酸对硝基苯胺酶（glycylproline—p—nitmanilidase）。又由于它也能水解甘氨酰脯氨酰-β-萘胺，故又称为甘氨酰脯氨酰-β萘胺酶（Slycylproly--β-naphthvlamidase）。。     

糖尿病患者尿GPDA与血清脂质变化的关系

目的　探讨糖尿病患者尿甘氨酰脯氨酸二肽氨基肽酶 (GPDA)与血清脂质变化的关系。方法　选择糖尿病患者 2 1 1例 ,正常对照组 98名 ,检测尿GPDA和血清脂质的水平 ,对其相互关系进行分析。结果　糖尿病患者组尿GPDA水平显著高于正常对照组 (t=4 .2 5 5 5 ,P <0 .0 0 1 ) ,血清胆固醇 (TC)、三酰甘油 (TG)、低密度脂蛋白胆固醇 (LDL C)、TC/高密度脂蛋白胆固醇比值 (TC/HDL C)、LDL C/HDL C比值、载脂蛋白B(ApoB)、脂蛋白 (a) [Lp(a) ]水平均高于正常对照组 (P <0 .0 0 1 ) ,而HDL C、载脂蛋白Al(ApoAl)、ApoAl/ApoB比值则明显低于正常对照组 (P <0 .0 1 )。糖尿病患者分组比较 ,血清TC、TG、LDL C、TC/HDL C、LDL C/HDL C、ApoB、Lp(a)随尿GPDA排泄量增多呈增高趋势 ,而HDL C、ApoAl、ApoAl/ApoB比值呈下降趋势。 结论　糖尿病患者伴有脂代谢紊乱 ,并与尿GPDA的升高、肾功能的损害相平行     

甘氨酰脯氨酸二肽氨基肽酶测定及其应用

本文介绍速率法测定血清甘氨酰脑氨酸二肽氨基肽酶(Glycylprolinc dipcptidylaminopeptidase,GPDA)的方法.并应用于自动生化分析仪,测定的最适pH 为8.6,酶活力在1300 U/L 以下成线性,三份高、中、低值酶活力标本批内CV 0.7%～1.4%,批间CV1.2%～4.4%.132例正常人GPDA 为185.2±28.6((?)±s)U/L,65例原发性肝癌组为408.0±216.1 U/L((?)±s),明显高于正常组(p<0.001),且与AFP 水平无相关意义(r=0.0361),24例胃癌和18例肺癌,分别为99.5±16.6 U/L 和111.8±23.0U/L 明显低于正常组(p<0.001),并发现GPDA 在食道癌及贲门癌病人亦有下降趋势(p<0.01)。     

血清GPD—A测定及其在临床诊断中的初步应用

1966年Hopsu-Havu和Glenner首次在鼠的肝肾中发现了一种的二肽氨基肽酶,即甘氨酰脯氨酸二肽氨基肽酶(GPDA)。它存在于人体唾液腺、颌下腺等组织及唾液、血液中,具有水解甘氨酰脯氨酸及其他氨基酸之间肽键的作用。国外学者测定了在不同种类动物及人体中的血清酶活性,发现肝脏疾病,尤其肝癌患者     

连续监测法测定尿亮氨酸氨基肽酶及初步临床应用

目的探讨应用连续监测法测定尿亮氨酸氨基肽酶(LAP)及其临床应用价值.方法用连续监测法对检测条件及干扰因素进行试验观察,选择最适反应条件,同时观测121名正常人和61例糖尿病患者尿LAP水平.结果 LAP在1～3 min时间内吸光度变化与时间成比例,线性范围可达400 U/L.批内CV分别为1.68%,0.72%;批间CV分别为2.86%,2.68%.171μmol/L胆红素、1 000 mg/L血红蛋白、30 g/L葡萄糖对LAP测定无干扰,抗坏血酸对LAP有负干扰.正常人尿LAP参考值范围(x±2s)15.5～48.3 U/g·Cr.糖尿病合并肾损伤组尿LAP明显高于正常对照组和未发生肾损伤组,差异有非常显著性意义(P＜0.001).结论连续监测法检测尿LAP简便、快速,测定尿LAP对诊断糖尿病早期肾损害有一定的价值.     

尿液GPDA测定在泌尿系感染的鉴别价值

目的 测定尿液甘氨酰脯氨酸二肽氨基肽酶(Glycyl-proline dipeptidyl aminopeptidase,GPDA)水平,探讨在肾脏炎症与下尿路感染的鉴别价值。方法 采用连续监测法和速率法检测泌尿系感染者的尿液GPDA及尿肌酐(Cr)水平,并用U／g.Cr的单位表示酶活性单位。通过ROC曲线特性分析尿液GP-DA在泌尿系感染鉴别肾脏炎症时的临界值。结果 ①肾脏炎症组尿液GPDA水平高于对照组,也高于下尿路感染组;肾脏炎症组阳性率显著高于下尿路感染患者(x2=42.928,P<0.01)。提示,检测尿液GP-DA对肾脏炎症与下尿路感染有鉴别价值。②在ROC曲线上,临床的GPDA最佳临界值(Cut off point)为21.4 U／g.Cr。敏感性为84.6％(33／39),特异性为88.1％(37／42),阳性预测值为86.8％(33／38),阴性预测值88.1 ％(37／42),准确度86.4％(70／81)。以21.4 U／g.Cr为鉴别限时,可以较好的筛选肾脏炎症患者。结论 检测泌尿系感染患者尿GPDA水平,对肾脏炎症和下尿路感染的定位鉴别诊断,提供一定的诊断价值,也有利于指导治疗。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.