高效毛细管电泳测定海马组织和脑脊液中氨基酸类神经递质

目的建立测定大鼠海马组织和人脑脊液中氨基酸类神经递质的高效毛细管电泳分析方法。方法用高效毛细管电泳技术,选用总长60 cm、有效长度50.5 cm、直径75μm熔融石英毛细管,在20 kV电压下快速分离4种氨基酸。以100 mmol/L硼酸-三羟甲基氨基甲烷(Tris)(1∶1,含1%异丙醇)为电泳缓冲液(pH值为10.35),激光诱导荧光检测器进行检测,并对此方法进行方法学评价。同时检测45例患者脑脊液的氨基酸含量。结果谷氨酸(GLU)、天冬氨酸(ASP)、γ-氨基丁酸(GABA)、甘氨酸(GLY)4种氨基酸能在15 min内分离,线性范围为1.0~100.0μmol/L,GLU、ASP、GABA、GLY最低检出限分别为10、23、18、15 nmol/L,4种氨基酸的批内精密度范围4.44%~9.72%,批间精密度范围6.96%~10.50%。4种氨基酸的回收率不低于88.1%。全面性大发作癫痫患者GLU、GLY、ASP含量显著高于对照组(P<0.05),而GABA较对照组差异无统计学意义;复杂部分性发作癫痫患者4种氨基酸含量较对照组显著增加(P<0.05)。结论高效毛细管电泳具有快速、灵敏、准确的特点,为临床和科研提供了一种有效的方法。     

高效毛细管电泳法快速测定血清中游离氨基酸

目的 建立快速测定人血清中游离氨基酸的方法.方法 用高效毛细管电泳法对40例健康体检者及32例肾病患者血清氨基酸进行检测.结果 8 min内分离16种氨基酸,线性范围在10～700 μmol/L,最低检出限为2.5～7.9 μmol/L,回收率86.3%～107.4%,批内精密度2.8%～10.3%,批间精密度3.5%～11.6%.对32例肾脏病患者血清中氨基酸测定结果与40例健康对照组氨基酸测定结果进行统计学分析.结论 高效毛细管电泳法具有快速、准确、灵敏等特点,为临床及科研工作中测定氨基酸提供了一种有效的方法.     

毛细管电泳分离脑脊液中神经递质类氨基酸及其临床应用

目的建立快速测定人脑脊液中神经递质类氨基酸的方法。方法用高效毛细管电泳-激光诱导荧光法检测了40例正常脑脊液、38例病毒性脑炎病人脑脊液、42例脑出血病人脑脊液神经递质类氨基酸。结果在20 min内分离出4种氨基酸,线性范围为0.1~50μmol/L,峰的迁移时间RSD 0.56%~2.06%,峰面积RSD 2.24%~3.79%;回收率为98%以上。结论高效毛细管电泳-激光诱导荧光法具有快速、准确、灵敏的特点,可作为临床检测脑脊液标本中的神经递质类氨基酸的方法。     

毛细管电泳测定肝癌肝硬化患者血清氨基酸的临床意义

目的　用毛细管电泳的方法测定肝癌肝硬化患者血清氨基酸变化,并探讨其临床意义。方法　用P/ACEMDQ毛细管电泳仪对2 0例正常人、2 0例肝癌患者及2 0例肝硬化患者的血浆游离氨基酸进行测定。结果　在9min内分离12种氨基酸,线性在2 0～10 0 0 μmol/L范围,回收率为77. 5 %～113 .3% ,批内精密度2 . 6 %～11. 4 % ,批间精密度5 . 8%～19. 7%。对结果进行统计学分析,发现肝硬化组酪氨酸、丝氨酸、色氨酸明显升高,丙氨酸明显下降;肝癌组酪氨酸、半胱氨酸、缬氨酸明显升高,脯氨酸明显下降。结论　毛细管电泳测定血浆游离氨基酸对肝癌肝硬化的诊断和治疗有指导意义。     

毛细管胶束电动色谱法检测尿液肌酸和肌酐含量

目的 建立高效毛细管电泳技术（HPCE）测定尿液中肌酸（Cri）和肌酐（Cr）的方法。 方法 运用毛细管胶束电动色谱技术（MEKC）,以pH 5.5、20 mmol/L的Na₂HPO₄-H₃PO₄（含100 mmol/L SDS）作为电泳缓冲液,非涂层石英毛细管进行分离,样品经过20倍稀释后以1 psi压力进样4 s,15 kV电压下分离尿液中的Cri和Cr,二极管阵列检测器（DAD）（λ=200 nm）检测。 结果 Cri和Cr的线性范围为4.9~2 500 μmol/L和4.9~2 500 μmol/L（r值分别为0.999 8和1）; Cri回收率为97.8%~100.8%、平均99.2%,Cr回收率为99.5%~104%、平均101.8%;Cri迁移时间批内和批间差异（CV）平均值为3.2%和8.0%、Cr为2.3%和6.8%;Cri和Cr的最低检出限分别为1.4 μmol/L和3.31 μmol/L。 结论 本法标本用量小、干扰因素少、精密度和准确度高、线性范围宽、测定成本低廉,可满足临床常规检测要求。     

脑梗塞患者脑脊液兴奋性氨基酸含量的测定及意义

近年许多研究发现,脑缺血时兴奋性氨基酸(EAAS)明显增高,其在神经元缺血损伤中起重要作用。本文应用高效液相色谱法测定了脑梗塞患者和对照组脑脊液兴奋性氨基酸:谷氨酸(GLU)、天门冬氨酸(ASP)和抑制性神经递质γ—氨基丁酸(GABA)水平。探讨其变化规律及在脑梗塞中的临床意义。     

高效毛细管电泳法在血清氨甲蝶呤浓度检测中的应用

目的建立快速检测人血清中氨甲蝶呤药物浓度的方法。方法用高效毛细管电泳技术，选用直径75μm，总长60cm，有效长度50．5cm熔融石英毛细管，以75mmoL／L，pH7．4的磷酸盐为电泳缓冲液，检测波长为306nm，在25kV电压下的快速分离检测氨甲蝶呤，并对此方法进行方法学评价。结果氨甲蝶呤的出峰时间在10min内，线性范围在1.1—1100．0μmol／L间，最低检出浓度为0．55μmoL／L，回收率为88．2％-98．2％，批间精密度为5．4％，批内精密度为4．2％。结论高效毛细管电泳方法具有快速、准确且成本低的特点，为临床和科研中测定血清氨甲蝶呤提供了一种有效的手段。     

高效毛细管电泳法快速测定血清中游离氨基酸

目的建立快速测定人血清中游离氨基酸的方法。方法用高效毛细管电泳法检测了４０例健康人，３２例肾病患者血清氨基酸。结果在８分钟内分离１６种氨基酸，线性在１０～７００μｍｏｌ／Ｌ范围，最低检出限为２．５～７．９μｍｏｌ／Ｌ，回收率为８６３％～１０７．４％，批内精密度为２．８％～１０．３％，批间精密度为３．５％～１１．６％。对３２例肾脏病患者血清中氨基酸测定结果与４０例正常人对照组氨基酸测定值进行统计分析。结论高效毛细管电泳法具有快速、准确、灵敏等特点，为临床及科研工作中测定氨基酸提供了一种有效的方法     

经筋刺法结合加味芍药甘草汤对脑卒中后肢体痉挛患者肌张力及脑脊液γ-氨基丁酸、谷氨酸的影响

目的：探讨经筋刺法结合加味芍药甘草汤在脑卒中后肢体痉挛患者治疗中的效果。方法：选取2020年2月~2021年2月收治的96例脑卒中后肢体痉挛患者,按随机数字表法分为对照组和观察组,各48例。对照组给予巴氯芬片治疗,观察组予以经筋刺法联合加味芍药甘草汤治疗,持续治疗4周。对比两组肌张力、脑脊液γ-氨基丁酸（GABA）及谷氨酸（GLU）水平、不良反应。结果：观察组肌张力评级优于对照组,差异有统计学意义（P＜0.05）。治疗前,两组脑脊液GABA、GLU相比,差异无统计学意义（P＞0.05）;治疗后,观察组脑脊液GABA高于对照组,脑脊液GLU低于对照组,差异有统计学意义（P＜0.05）。两组不良反应发生率相比,差异无统计学意义（P＞0.05）。结论：经筋刺法与加味芍药甘草汤能够提高脑卒中后肢体痉挛患者肌张力,改善其GABA、GLU水平,且无不良反应,安全可行。     

戊四氮致痫大鼠脑内氨基酸含量的测定

目的：探讨氨基酸类神经递质在癫痫发病中的作用。方法：采用反相高效液相色谱（HPLC）荧光法检测了戊四氮（PTZ）致痫大鼠和正常大鼠海马、皮层脑组织中Asp、Glu、GABA、Gly的含量变化。结果：FTZ致痫组与正常对照组相比，海马Asp、Glu及GABA含量略增高，但统计学上无显著差异（P〉0．05）；皮层Asp和Glu含量明显增高（P〈0．05），GABA略增高，但统计学上无显著差异（P〉0．05）。结论：兴奋性和抑制性氨基酸在癫痫发病中具有重要的作用，可能参与癫痫的发生和发展。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.