同时测定血浆血管紧张素Ⅰ、Ⅱ和醛固酮的液相色谱 串联质谱法的建立与评价

目的 建立同时测定血浆中血管紧张素Ⅰ(AngⅠ)、血管紧张素Ⅱ(AngⅡ)和醛固酮(Aldo)的液相色谱串联质谱(LC-MS/MS)法。方法 将200μL血浆和温育液在37℃温育3 h后，加入同位素内标，用固相萃取法提取各激素。通过LC-MS/MS分析AngⅠ、AngⅡ和Aldo,最终用标准曲线定量。结果 AngⅠ、AngⅡ和Aldo的线性范围分别为0.2～50.0、0.002～0.500、0.02～5.00 ng/mL,定量限(LOQ)为0.2、0.002、0.02 ng/mL。3种分析物的回收率在91%～103%之间。方法灵敏度高、重现性好，变异系数(CV)分别为1.4%～4.6%(AngⅠ)、2.1%～5.1%(AngⅡ)、2.4%～5.2%(Aldo)。健康人血浆中AngⅠ、AngⅡ、Aldo的浓度范围分别为1.4～11.8、0.003～0.016、0.02～0.20 ng/mL。方法无明显基质效应和携带污染。结论 建立了一种可同时准确、快速测定血浆AngⅠ、AngⅡ和Aldo的LC-MS/MS方法。     

全血免疫抑制剂ID-LC-MS/MS候选参考方法的建立和性能评价

目的 建立同位素稀释液相色谱串联质谱（ID-LC-MS/MS）检测全血免疫抑制剂（他克莫司、西罗莫司、依维莫司和环孢素A）的候选参考方法,并评价其性能。方法 采用蛋白沉淀法（PPT）对全血样本进行前处理,采用ID-LC-MS/MS定量检测他克莫司、西罗莫司、依维莫司和环孢素A。对建立的候选参考方法的分析性能（线性、定量限、基质效应、精密度和正确度等）进行评估。结果 ID-LC-MS/MS检测他克莫司、西罗莫司、依维莫司和环孢素A的总检测时间为4.5 min;环孢素A的线性范围为10～500 ng/mL,定量限为10 ng/mL;他克莫司、西罗莫司和依维莫司的线性范围均为1～50 ng/mL,定量限均为1 ng/mL。4种免疫抑制剂的相对基质效应范围均≤8.64%,批内、批间变异系数（CV）均≤5%,加标回收率为98.84%～100.99%。他克莫司的扩展测量不确定度≤7.91%(k=2)、西罗莫司≤7.97%(k=2),依维莫司≤7.14%(k=2),环孢素A≤7.91%(k=2)。结论 成功建立了ID-LC-MS/MS检测全血他克莫司、西罗莫司、依维莫司和环孢素A的候选参考方法,可用...     

异欧前胡素对大鼠成骨细胞增殖与分化的影响

背景:植物雌激素有防治绝经后妇女骨质疏松的作用已得到公认,其作用机制之一是促进了成骨细胞的增殖与分化.目的:观察香豆素类植物雌激素异欧前胡素体外对大鼠成骨细胞增殖与分化的影响.设计、时间及地点:对比观察实验,于2006-09/2007-12在河北医科大学药学院完成.材料:出生24 h内SD大鼠,异欧前胡素为中国药品生物制品检定所产品.方法:采用改良组织块法分离培养新生大鼠颅骨成骨细胞,将异欧前胡素以1×10-5～1×10-9 mol/L浓度加入细胞培养体系,以未加入药物为空白对照组.作用24,48,72 h后,以MTT法检测成骨细胞的增殖情况,以对硝基苯二钠基质动力学法测定细胞内碱性磷酸酶的活性,以改良Lowry法测总蛋白水平.主要观察指标:成骨细胞的增殖率和碱性磷酸酶活性.结果:大鼠成骨细胞在不同浓度异欧前胡素中培养24 h,未观察到促增殖作用.培养48 h后,开始出现促增殖作用增强,有效浓度为1×10-9～1×10-8 mol/L.培养72 h后,继续有促增殖作用,有效浓度为1×10-8～1×10-7 mol/L.大鼠成骨细胞在不同浓度异欧前胡素存在下培养48 h,未观察到促分化作用,培养72 h后,开始出现促分化作用,有效浓度为1×10<'-6>～1×10-5 mol/L,其他浓度作用不明显.结论:异欧前胡素体外能促进大鼠成骨细胞的增殖与分化.     

液相色谱串联质谱法分析血清中脂溶性维生素的性能评价及临床应用

目的 建立液相色谱串联质谱法定量分析血清中脂溶性维生素的方法,并进行性能分析评价以及初步临床应用。方法 采用液相色谱串联质谱法定量检测血清中脂溶性维生素含量,并检测2022年11月至2023年11月在苏州大学附属第一医院产科门诊产检的1 113例孕妇血清中的脂溶性维生素。参照《液相色谱串联质谱临床检测方法的开发与验证》进行血清中脂溶性维生素高效液相色谱串联质谱检测方法的方法学验证。结果 液相色谱串联质谱法定量检测血清中脂溶性维生素,包括维生素A、维生素E、维生素D2、维生素D3、维生素K1,线性范围分别为40～4 000 ng/mL、0.5～50μg/mL、2～200 ng/mL、5～250 ng/mL、0.1～10 ng/mL,检出限分别为2.50 ng/mL、0.10 ng/mL、0.40 ng/mL、1.00 ng/mL、0.02 ng/mL,定量下限分别为10.00 ng/mL、0.50 ng/mL、1.00 ng/mL、5.00 ng/mL、0.10 ng/mL,批内变异系数(CV)和批间CV均小于15%,回收率分别为91.25%～107.18%、90.00%～105.51%...     

液相色谱串联质谱检测血清万古霉素方法的建立及临床验证

目的建立一种基于同位素内标法定量的血清万古霉素液相色谱串联质谱检测方法(LC-MS/MS), 并进行临床应用评估。方法方法学评价类研究。收集2021年3月至2022年6月就诊于浙江大学医学院附属邵逸夫医院且接受万古霉素静脉给药治疗的221例患者的临床血清样本, 其中男142例, 女79例, 年龄(59.31±15.32)岁, 检测其谷浓度。收集体检中心30名体检结果均正常的表观健康人剩余血清样本作为空白基质用于方法学评价, 其中男 15 名, 女 15 名, 年龄(35.65±9.86)岁。使用AB Sciex Triple Quad 4500 MD 液相色谱串联质谱系统, 采用Phenyl-Hexyl色谱柱进行分离, 柱温40 ℃, 以含0.1%甲酸的水溶液和含0.1%甲酸的甲醇溶液梯度洗脱, 以万古霉素-[d12]三氟乙酸盐作为内标(IS), 建立定量方法, 并对方法的敏感度、特异度、线性、回收率、精密度、基质效应、残留进行性能验证。结果万古霉素的检出限是0.2 mg/L, 最低定量限是0.5 mg/L, 在浓度1～50 mg/L范围内线性关系良好(R2=0.998 4), 准确度...     

人血清哇巴因UPLC-MS/MS检测方法的建立和方法比对

目的建立超高效液相色谱串联质谱(UPLC-MS/MS)检测人血清哇巴因的方法。方法采用高特异性的UPLC-MS/MS,以氘标记的哇巴因-d3作为内标。样本采用固相萃取(SPE)前处理方法,以反相色谱柱负离子模式及电喷雾电离源(ESI)检测血清哇巴因水平。对建立的方法进行方法学(基质效应、回收率、准确度、批内精密度、批间精密度及稳定性)验证。采用建立的UPLC-MS/MS方法检测20名体检健康者及40例高血压患者血清哇巴因水平,并与酶联免疫吸附试验(ELISA)进行比较。结果 UPLC-MS/MS检测血清哇巴因的标准曲线范围为0.02～5.0 ng/mL,最低定量检测限(LLOQ)为0.02ng/mL。采用ABN固相萃取小柱进行样本前处理的基质效应较小,且回收率较高,达85%。LLOQ和低值(0.06 ng/mL)、中值(0.6 ng/mL)、高值(4 ng/mL)质控品的准确度分别为108.0%、89.2%、101.0%、103.0%。3个水平质控品的批内变异系数(CV)分别为2.87%、1.95%、0.56%,批间CV分别为5.98%、1.90%、0.75%。样本室温过夜放置16 h及样本前处理后室温放置自动进样器48 h的偏差均15%。采用UPLC-MS/MS检测哇巴因,正常对照者及高血压患者血清中均未检测到哇巴因。采用ELISA测定血清哇巴因,高血压患者为0.096 ng/mL,正常对照者为0.062 ng/mL。UPLC-MS/MS检测5个水平(0.02、0.05、0.10、0.20、0.50 ng/mL)的哇巴因标准品,其测定结果与对应的哇巴因标准品浓度呈正相关,且线性较好(r20.99),准确度较高;而ELISA检测5个水平哇巴因标准品的结果均很接近(0.024 9～0.029 6 ng/mL)。结论建立了检测人血清哇巴因的UPLC-MS/MS方法,未检测到正常人及高血压患者的血清哇巴因。UPLC-MS/MS与ELISA检测血清哇巴因的结果存在较大差异。     

血清总同型半胱氨酸候选参考测量程序(液相色谱串联质谱法)的建立及性能评估

目的建立一种基于液相色谱串联质谱(LC-MS/MS)技术的血清总同型半胱氨酸(Hcy)候选参考测量程序并对其性能进行评价。方法采用一种简单的蛋白沉淀方法对血清样本进行前处理,然后采用LC-MS/MS定量检测总Hcy,参照美国临床实验室标准化协会(CLSI) C62-A文件和C50-A文件对建立的候选参考方法进行线性、检测限与定量限、基质效应、精密度、正确度等基本分析性能验证。结果 LC-MS/MS检测总Hcy的线性范围为0.5～200.0μmol/L。定量限和检测限分别为0.31 nmol/g、0.06 nmol/g。3种不同比例(1∶1、80∶20、20∶80)的血清与溶液混合物的相对基质效应分别为1.94%、1.91%、1.78%。批内、批间变异系数(CV)分别为2%和1%。3种浓度(30.58、49.21、65.42 nmol/g)的加标样本平均加标回收率分别为99.8%、100.2%、100.8%。测定NIST SRM 1950标准物质的结果偏移1%。样本处理后分别在室温[(23±2)℃]和自动进样器(温度为10℃)中放置24 h,检测结果均非常稳定。结论成功建立了基于LC-MS/MS技术的血清总Hcy候选参考测量程序。该参考测量程序准确度高、精密度好,能够用于常规临床检验方法的量值溯源,保证测定结果的准确性。     

尿中性粒细胞明胶酶相关脂质运载蛋白化学发光检测方法的建立及性能评价

目的建立定量检测尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的化学发光法并评价。方法以辣根过氧化物酶标记NGAL单抗、磁微粒包被NGAL单抗,基于化学发光平台,采用双抗体夹心法模式,建立尿液NGAL定量检测方法,并评价空白限、线性范围、精密度、干扰、回收率和方法学等指标。结果空白限为0.1 ng/mL,线性范围为10～1 500 ng/mL,分析内和分析间精密度(CV)均小于8%,血红蛋白100 mg/dL、三酰甘油3 000 mg/dL、胆红素50 mg/dL、抗坏血酸10 mg/dL、肌酐1 000 mg/dL、尿素12.5 g/dL干扰率小于10%;回收率为90.9%～103.1%;第95位百分位数法确定本方法参考区间为0～111.08 ng/mL;与Abbott NGAL检测试剂进行方法学对比,相关系数(r)为0.990 5,总符合率为96.1%。结论本研究建立的尿液NGAL定量检测方法性能良好,具有一定的临床应用价值。     

LC-MS/MS法和HPLC法检测人血清中利培酮和九羟利培酮血药浓度的对比研究

目的 验证液质联用质谱(LC-MS/MS)法和高效液相色谱(HPLC)法检测人血清中利培酮和九羟利培酮血药浓度结果的可靠性,并分析两种方法检测结果的差异性.方法 对实验室目前在用的LC-MS/MS法和HPLC法检测人血清中利培酮和九羟利培酮血药浓度的方法学进行验证,合格后再分别对该院住院患者的60份血清标本进行相关检测.采用配对t检验、Pearson相关分析、散点图和Bland-Altman偏差图对其检测结果的相关性及差异进行评价.结果 LC-MS/MS法和HPLC法的方法学验证均符合要求,检测结果呈正相关;LC-MS/MS法和HPLC法检测利培酮和九羟利培酮结果比较,差异有统计学意义(P<0.05);LC-MS/MS法检测利培酮与九羟利培酮的结果分别比HPLC法检测结果高1.97和1.38 ng/mL,95％ 置信区间分别为-5.81～9.74、-10.28～11.66.结论 LC-MS/MS法和HPLC法可同时运用于日常检测人血清中利培酮和九羟利培酮血药浓度,检测结果可靠但存在差异,如果是需要长期监测的患者建议一直选用同一种方法检测.     

可溯源干血片样本类固醇激素标准曲线的建立

目的 建立可溯源的干血片样本19种类固醇激素液相色谱-串联质谱(LC-MS/MS)标准曲线。方法收集乙二胺四乙酸抗凝新鲜全血,用0.9%NaCl溶液清洗血细胞,将清洗后的血细胞和无类固醇激素的血浆按0.55∶0.45比例混合,制备模拟全血。根据拟制备标准曲线浓度添加不同量类固醇激素至模拟全血样本中,制备不同浓度的类固醇激素标准曲线干血片。采用液相色谱-串联质谱(LC-MS/MS)检测各标准曲线干血片类固醇激素含量,分析其线性范围,并对类固醇激素标准曲线干血片进行性能验证。结果 类固醇激素标准曲线干血片中孕烯醇酮、孕酮、可的松、脱氢表雄酮的线性范围为0.25～100 ng/mL,11-脱氧皮质酮、21-脱氧皮质醇、18-羟皮质醇、11-酮睾酮的线性范围为0.05～20ng/mL,皮质酮、11-羟睾酮的线性范围为0.025～10 ng/mL,17-羟孕酮、18-羟皮质酮、11-脱氧皮质醇、雄烯二酮、11-羟雄烯二酮、睾酮的线性范围为0.1～40 ng/mL,皮质醇的线性范围为1.5～600 ng/mL,17-羟孕烯醇酮的线性范围为0.2～80 ng/mL,硫酸脱氢表雄酮的线性范围为25～1...     

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.