体液游离氨基酸反相高效液相色谱测定法

介绍了以异硫氰酸苯酯为柱前衍生剂，蛋氨酸砜为内标物，在反相高效液相色谱仪上测定体液２９例游离氨基酸的方法，线性范围在０．０１－１０．００μｍｏｌ／之间，最低检测浓度为μｍｏｌ／Ｌ氨基酸浓度与相对响应值之间的相关系数均在０．９９４以上，批内变异系数为１．５％－４．８％。批间变异系数为３．２％－５．１％。１５例健康者和１８例肾病患者血清游离氨基酸含量测定结果表明，两者必需氨基酸与非必需氨基酸比值之间的     

血清结合胆红素的酶法测定

目的 建立用胆红素氧化酶（ＢＯＤ）作为催化剂，选择性地测定血清结合胆红素（ＣＢ）的新方法。方法 测定条件为：０．１ｍｏｌ／Ｌ甘氨酸缓冲液、ｐＨ１０．０，ＢＯＤ活性０．５～０．８Ｕ／反应管，反应时间２分钟。结果 线性至少可达到２２０μｍｏｌ／Ｌ；精密度为批内ＣＶ１．７１～３．９８％、批间ＣＶ８．０～９．７２％；正常参考值范围为０～３．１４μｍｏｌ／Ｌ；与偶氮法所测结果相关性较好。结论 本文所建立的Ｃ     

高效液相色谱荧光检测法测定尿雌三醇

报告用高效液相色谱测定孕妇尿内总雌三醇的方法，尿标本在酸水解后用乙醚提取Ｅ３，蒸于乙醚，残留物用流动相重组，标本成分用Ｃ８柱分离，以２８５ｎｍ波长激发，在６１０ｎｍ测定Ｅ３的自然荧光。本法批内ＣＶ为１．２％－１．５％批间ＣＶ分别为２．３％和４．０％本法在４．３３－１３８．７１μｍｏｌ／Ｌ（１．２５－４０．００ｍｇ／Ｌ）间呈线性，最低检出１．８μｍｏｌ／Ｌ（０．５２ｍｇ／Ｌ，信号／噪声比为３）。     

胆红素氧化酶法测定血清结合胆红素

介绍使用国产胆红素氧化酶和二牛磺酸胆红素校准物建立血清结合胆红素测定方法。测定缓冲液为０．１ｍｏｌ／Ｌ柠檬酸盐缓冲液（ｐＨ＝５．０），胆红素氧化酶浓度５００Ｕ／Ｌ，反应（终点）时间１５分钟。本法线性范围可达２４０μｍｏｌ／Ｌ，批内不精密度＜１０％，回收率为９８．３％～１０７．１％，与重氮方法比较，回归方程为Ｙ（酶法）＝０．９５６Ｘ（重氮法）－０．５１３。本法测定人血清结合胆红素参考值２．５７±２．５６μｍｏｌ／Ｌ（ｎ＝９５）。     

高效液相色谱检测胆红素及其临床应用

由于常规的血清胆红素检测方法不能灵敏、准确的测定结合胆红素。笔者参考国外文献采用国产填料和试剂建立了敏感和特异的高效液相色谱胆红素测定法，结果表明本法可对血清胆红素作出较为灵敏和准确的测定，未结合胆红素批内和批间变异系数（ＣＶ）值分别为９．８％～１０．９％和７．３％～１２．７％，结合胆红素批内和批间ＣＶ值分别为２．５％～９．２％和９．７％～１１．０％；未结合和结合胆红素的最低检出浓度分别为０．０５μｍｏｌ／Ｌ和０．０２μｍｏｌ／Ｌ。同时采用本法分析了部分肝病患者和健康人血清胆红素，并对其临床意义进行了初步探讨。     

胆红素氧化酶法测定血清结合胆红素

介绍使用国产胆红素氧化酶和二牛磺酸胆红素校准物建立血清结合胆红素测定方法。测定缓冲液为０．１ｍｏｌ／Ｌ柠檬酸盐缓冲液（ｐＨ＝５．０），胆红素氧化酶浓度５００Ｕ／Ｌ，反应（终点）时间１５分钟。本法线性范围可达２４０μｍｏｌ／Ｌ，批向不精密度＜１０％，回收率为９８．３％～１０７．１％，与重氮方法比较，回归方程为Ｙ（酶法）＝０９５６Ｘ（重氮法）－０．５１３。本法测定人血清结合胆红素参考值２．５７±２．５     

尿葡萄糖二酸测定及对药物性肝炎鉴别诊断的评价

本文根据酶竞争抑制原理，应用自动生化分析仪测定尿液中葡萄糖二酸（ＵＧＡ），提高了测定效率、精密度和准确性。本法天内ＣＶ为３．１％，回收率９６．５％，线性范围０～１８０μｍｏｌ／Ｌ。４８例健康人ＵＧＡ为１．８～３１．３μｍｏｌ／ｇ．Ｃｒ，非药物性肝炎病人为４．２～５６．８μｍｏｌ／ｇ．Ｃｒ、药物性肝炎病人为１９．６～５５３μｍｏｌ／ｇ．Ｃｒ，以５０μｍｏｌ／ｇ．Ｃｒ作为切割值，其鉴别诊断效率为８７．８％。同时也观察到某些药物对测定有负干扰。     

偶氮氯磷Ⅲ比色法测定血清钙的实验研究

本文对偶氮氯磷Ⅲ（ＣｈｌｏｒｏｐｈｏｓｐｈｏｎａｚｏⅢ）比色法测定血清钙的实验方法作了系统性研究。结果表明：显色剂中偶氮氯磷Ⅲ浓度以１２０μｍｏｌ／Ｌ为宜，反应最适ｐＨ为２．８～３．２，最佳检测波长为６２０ｎｍ，灵敏度为１ｍｍｏｌ／Ｌ＝０．１６４Ａ，线性为４．５ｍｍｏｌ／Ｌ，批内（ｎ＝２０）和批间（ｎ＝４０）ＣＶ分别为２．０８％和２．２６％，平均回收率为１００．２％。本法（Ｙ）与ＡＡＳ法（Ｘ１）及ＡｒｓｅｎａｚｏⅢ法（Ｘ２）结果比较：Ｙ＝０．９８５６Ｘ１＋０．０３７０、ｒ＝０．９９１２，Ｙ＝０．９５４０Ｘ２＋０．１３６５、ｒ＝０．９８８７．溶血、脂血、黄疸不干扰测定，当标本中Ｍｇ２＋、Ｃｕ２＋、Ｆｅ２＋、Ｚｎ２＋分别达５ｍｍｏｌ／Ｌ、２ｍｍｏｌ／Ｌ、３００μｍｏｌ／Ｌ、３００μｍｏｌ／Ｌ时也不影响测定结果。     

高效液相色谱荧光检测法测定尿雌三醇

报告用高效液用色谱（ＨＰＬＣ）测定孕妇尿内总雌三醇（Ｅ＿３）的方法。尿标本在酸水解后用乙醚提取Ｅ＿２，蒸干乙醚，残留物用流动相（甲醇／乙腈／水＝４０／１７／４３）重组。标本成分Ｃ＿８柱分离，以２８５ｎｍ波长激发，在６１０ｎｍ测定Ｅ＿３的自然荧光。本法批内ＣＶ为１２％～１．５％（ｘ＝３２．７～１２８．２ｕｍｏｌ／Ｌ），批间ＣＶ别为２．３％和４０％（分别是３８．４和９８．９ｕｍｏｌ／Ｌ）。本法在４．３３～１３８．７ｕｍｏｌ／Ｌ（１２５～４０．００ｍｇ／Ｌ）间呈线性，最低检出１．９ｕｍｏｌ／Ｌ（０．５２ｍｇ／Ｌ，信号／噪声比为３）。     

血清氯葡萄糖苷酶动力分析法

葡萄糖苷酶动力学测定血清氯，在７０－１４０ｍｍｏｌ／Ｌ间线性良好，精密度验批内变异数为２．１０％，批间变异系数为２．２６％；平均回收率为９９．２％；与电极法相关试验ｒ＝０．９５２５，Ｙ酶法＝３．４＋０．９８Ｘ电极法，差异不显著。ＴＢＩＬ８４μＭＯＬ／ｌ，ｔｇ２．１ｍｏｌ／Ｌ，Ｃｈｏ９．６ｍｍｏｌ／Ｌ对测定结果无影响，试剂在４℃冰箱保在保存１０ｄ内起始吸光度不高于０．１５０。     

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.