幽门螺杆菌感染与三种常见慢性胃炎关系的临床分析

目的:观察幽门螺杆菌(HP)感染与3种常见慢性胃炎(慢性浅表性胃炎、慢性糜烂性胃炎、胆汁反流性胃炎)的关系。方法:273例通过胃镜检查确诊为慢性浅表性胃炎、慢性糜烂性胃炎以及反流胃炎的患者,并用胃活检组织尿素酶试验检测幽门螺杆菌(HP)感染情况。结果:慢性浅表性胃炎124例,HP阳性67例,阳性率为54.0%;慢性糜烂性胃炎96例,HP阳性89例,阳性率92.7%,胆汁反流性胃炎53例,HP阳性15例,阳性率34.0%。3组间HP阳性率比较有统计学意义(P<0.01)。结论:这3种常见慢性胃炎与HP感染存在着显著性差异。     

幽门螺杆菌感染对血清一氧化氮及十二指肠胃反流的影响

目的 :探讨慢性胃炎患者中幽门螺杆菌 (H .pylori)感染与血清一氧化氮 (NO)和十二指肠胃反流 (DGR)之间的关系。方法 :对 6 5例慢性胃炎患者 ,用同位素99MTC -EHIDA测定十二指肠胃胆汁反流 ,硝酸还原酶法测定血清NO含量 ,采用胃黏膜经Giemsa染色后检测H .pylori,用ELISA法测定血清H .pylori-IgG。结果 :H .pylori阳性组血清NO含量 (113.4 5± 2 4 .89μmol/L)显著高于H .pylori阴性组血清NO含量 (86 .34± 19.7μmol/L ,P <0 .0 5 ) ;H .pylori阳性组十二指肠胃反流率 6 8.6 % (2 4 /35 )显著高于H .pylori阴性组十二指肠胃反流率 4 0 .0 % (12 /30 ) (P <0 .0 5 ) ;H .pylori阳性组中DGR阳性组患者血清NO含量 (12 1.0 8± 2 1.2 7μmol/L)显著高于DGR阴性组患者 (86 .2 3± 18.12 μmol/L ,P <0 .0 5 ) ;H .pylori阴性组中DGR阳性组的血清NO含量与DGR阴性组及对照组相对比结果无显著差异 (P >0 .0 5 )。结论 :NO可能是DGR形成的重要介质 ,除H .pylori感染之外 ,可能有其他因素参与DGR形成 ,并与H .pylori有明显协同作用     

十二指肠胃反流模型大鼠胃黏膜组织Cyclin D1、p16蛋白表达

[目的]探讨十二指肠胃反流(DGR)引起大鼠胃黏膜损伤及癌变的发病机制.[方法]健康成年雄性SD大鼠(75只)随机分为两组.①DGR模型组(55只)根据手术造模方式及反流量大小分为全反流组与部分反流组;②假手术对照组(20只)采用pH监测仪测定胃液pH,用酶法测定胃液胆汁酸(TBA),确定DGR模型成功.进行为期3个月和9个月胃黏膜损伤的动态观察.S-P分析不同病变胃黏膜组织CyclinD1、p1 6蛋白的表达.[结果]DGR模型大鼠胃液pH及TBA明显升高(P＜0.01),证明DGR模型成功.模型大鼠病理改变出现浅表性胃炎→萎缩性胃炎→异型增生的动态演变过程.萎缩性胃炎组及异型增生时CyclinD1蛋白表达显著高于假手术对照组及浅表性胃炎组(P ＜0.05),癌基因Cyclin D1为高表达.在萎缩性胃炎与异型增生之间Cyclin D1表达差异无显著性(P＞0.05).而p1 6蛋白表达则相反,在假手术对照组最高,在异型增生最低,两组之间差异有显著性(P＜0.01),p16在异型增生时为低表达.Cyclin D1与p16表达呈负相关.[结论]Cyclin D1、p16蛋白表达异常是DGR胃黏膜损伤及癌变的分子机制之一.     

慢性胆囊炎与萎缩性胃炎相关性分析

目的：探讨慢性胆囊炎与萎缩性胃炎相关性。方法：应用^99mTc—EHIDA核素十二指肠胃反流显相检查的方法，分析98例萎缩性胃炎患者胆汁反流发生率。结果：98例萎缩性胃炎患者，发生十二指肠胃反流46例，发生率为46．9％，其中伴有慢性胆囊炎46例，发生十二指肠胃反流34例，发生率73．9%，发生率高，与不伴有胆囊疾病者相比，差异有显著性（P〈0．05）。结论：萎缩性胃炎常伴有胆汁反流，尤其是伴有胆囊疾病者胆汁反流发生率高，慢性胆囊炎与萎缩性胃炎有一定相关性，HP感染对十二指肠胃反流无明显影响。     

十二指肠-胃反流物成分对胃黏膜的影响

目的:探讨原发性十二指肠胃反流(DGR)是否造成胃黏膜的病理性损害以及十二指肠液中各种成分与动态pH的变化和胆红素吸收值(ABS)的关系。方法:应用带胃管的便携式pH监测仪和Bilitec2000,同步监测14例原发性病理性DGR患者和15名健康志愿者的胃内24h胆汁反流和pH变化情况。根据胃内pH和ABS的对应变化,实时抽吸胃液送检,测出胃液中胆汁酸(BA)、总胆红素(TBIL)、淀粉酶(AMY)和脂肪酶(LIP)的浓度。结果:ABS与TBIL、BA以及pH值与AMY浓度呈正相关。重度胃炎组的BA高于轻、中度组。白天胃液中AMY和LIP分别高于夜间;而夜间的BA、TBIL和DBIL较高。结论:胃腔内的pH值变化主要是胰液反流而非胆汁反流所致。胃黏膜的损伤程度主要与BA的反流有关,胰液反流对胃黏膜的损伤弱于胆汁反流。胃腔中TBIL可以作为胆汁反流性胃炎的监测指标,而不是诱发或导致胃炎的因素。     

莫沙必利及铝镁加混悬液治疗胆汁反流性胃炎的临床研究

[目的]探讨莫沙必利及铝镁加混悬液对胆汁反流性胃炎的疗效及胃内24h胆汁的影响.[方法]55例经胃内24h胆汁监测证实的胆汁反流性胃炎患者随机分3组.A组20例,予以莫沙必利5mg,每天3次,治疗4周;B组15例,予以铝镁加混悬液15mL,每天3次,治疗4周;C组20例,予以莫沙必利5mg,每天3次,及铝镁加混悬液15mL,每天3次,治疗4周.分别于治疗前及治疗4周后观察3组患者腹胀、上腹痛、恶心及呕吐症状变化,并于治疗后复查胃内24h胆汁监测.[结果]治疗后3组患者症状均明显减轻(P＜0.05),但各组间症状有效率的比较差异无显著性.3组患者治疗后胃内24h胆汁反流总时间百分比均显著减小(P＜0.05),但减小幅度各组间比较差异无显著性(P＞0.05).[结论]莫沙必利可减少胃内胆汁反流,铝镁加混悬液可结合胆酸,均为治疗胆汁反流性胃炎的有效药物.     

胃肠超声显像诊断碱性反流性胃炎的价值

我院门诊在接受胃肠超声检查的患者中检出 132例的半流质显像剂从十二指肠逆向反流胃窦及胃腔 ,经胃镜和胃内p H值检测对比 ,其中 12 9例为胆汁反流性胃炎 (DGR)。我们在此对胃肠超声显像诊断碱性反流性胃炎的可行性和重复性进行分析并加以评价。1　对象和方法本组男 79例 ,女 5 0例 ;其中 2 0岁以下 ,6 0岁以上各 8例 ,2 0～ 6 0岁 113例 ,大多数患者均有食欲减退、腹部不适或疼痛腹胀嗳气、呕吐 ,个别患者因未能及时确诊 ,合理治疗而身体明显消瘦。 12 9例中吸烟者 85例 ,饮酒者 73例 ;合并胆结石、胆囊炎的 37例 ,有 3例属于生理性肠胃…     

胆汁反流性胃炎

胆汁反流性胃炎又称碱性反流性胃炎，是由于含有胆汁的十二指肠内容物异常地反流入胃引起的胃粘膜炎症。病因和发病机制正常情况下常存在一些无害的十二指肠胃反流（即生理性反流）。然而，胃窦幽门区有能力阻止十二指肠内容物入胃，胃窦部充分的蠕动也可迅速将通过幽门的...     

细胞核DNA含量在胃粘膜癌变过程中的变化及意义

目的分析不同病变胃粘膜细胞核DNA含量 ,进行DNA倍体检测 ,探讨DNA倍体与胃粘膜癌变的关系。方法采用流式细胞术分别对正常胃粘膜 15例 ;慢性浅表性胃炎 36例 ;慢性萎缩性胃炎 5 7例 ,其中不伴肠化 2 0例、伴肠化 37例 ;慢性萎缩性胃炎 4 8例 ,其中伴轻度不典型增生 16例、伴中度不典型增生2 3例、伴重度不典型增生 9例 ;胃溃疡 2 5例和胃癌 36例的细胞核DNA含量进行检测。结果正常胃粘膜 ,慢性浅表性胃炎 ,慢性萎缩性胃炎不伴肠化、伴肠化 ,慢性萎缩性胃炎伴轻度不典型增生、伴中度不典型增生、伴重度不典型增生 ,胃溃疡 ,胃癌细胞核DNA异倍体检出率分别为 0 ,0 ,0 ,10 .81% ,0 ,8.70 % ,5 5 .5 6 % ,4 .0 0 % ,4 4 .4 4 %。慢性萎缩性胃炎伴重度不典型增生及胃癌细胞核DNA异倍体检出率最高 ,但两者相比较 ,差异无显著性 (P >0 .0 5 )。结论DNA异倍体的出现可能是胃癌前病变发生癌变的一个重要标志物。     

胃内胆汁反流检测对原发性胆汁反流性胃炎胃黏膜损伤的诊断意义

目的研究胃内胆汁反流检测对原发性胆汁反流性胃炎胃黏膜损伤的诊断意义。方法通过电子胃镜检查以及24小时胃内pH和胆红素监测,将原发性胆汁反流性胃炎伴胃内病理性胆汁反流患者分为两组,即伴镜下胃黏膜糜烂组和不伴镜下胃黏膜糜烂组,比较两组胃内pH和胆红素各项指标的差异。结果胆红素监测中,伴镜下胃黏膜糜烂组与不伴镜下胃黏膜糜烂组餐时长反流次数[(1.3±0.1)次vs(0.6±0.3)次]、最长反流时间[(268.3±43.7)min vs(151.4±27.7)min]、餐时最长反流时间[(8.6±2.3)min vs(4.3±1.5)min]、餐后最长反流时间[(38.9±11.3)min vs(17±7.1)min]以及餐时胆红素吸收值>0.14总时间[(16.4±7.5)min vs(9.0±3.6)min]比较差异均有统计学意义(P<0.05);两组胃内pH各项指标比较差异均无统计学意义(P>0.05)。结论在原发性胆汁反流性胃炎中,胆汁反流可以导致胃黏膜损伤;胃内胆红素监测有助于了解胃内胆汁反流的程度、状态与胃黏膜损伤的关系。     

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.