山莨菪碱对糖尿病肾病患者尿蛋白的影响

目的 :观察短期应用静脉滴注山莨菪碱 ( 65 4 Ⅱ )对不同时期糖尿病肾病患者肾功能及尿蛋白的影响。方法 :糖尿病肾病患者分为治疗组 46例和对照组 3 9例。两组患者均根据尿蛋白和肾功能的不同再分别分为早期肾病组、临床期肾功能正常组和临床期肾功能不全组 3个亚组。治疗组静脉滴注 65 4 Ⅱ 2 0mg ,每天 1次 ,连续 2 8d。对照组不给上述治疗。控制血压、血脂、血糖等其他治疗方法各组相同。结果 :和对照组比较 ,治疗组患者尿总蛋白和尿白蛋白明显降低 ,其中糖尿病肾病早期组尿总蛋白由治疗前的 ( 0 3 5± 0 0 5 )g/2 4h下降到 ( 0 2 0± 0 0 6)g/2 4h(P <0 0 1) ,尿白蛋白由 ( 192± 75 )mg/2 4h下降到 ( 98± 5 4)mg/2 4h(P <0 0 1) ;在临床期肾功能正常组尿总蛋白由 ( 3 73± 1 98)g/2 4h下降到 ( 2 3 9± 1 48)g/2 4h(P <0 0 1) ,尿白蛋白由 ( 2 85 3± 1791)mg/2 4h下降到( 163 3± 10 90 )mg/2 4h(P <0 0 1) ;在临床期肾功能不全组尿总蛋白由治疗前的 ( 1 90± 0 92 )g/2 4h下降到 ( 1 83± 1 0 9)g/2 4h(P >0 0 5 ) ;尿白蛋白由 ( 14 0 8± 83 6)mg/2 4h下降到 ( 1115± 5 5 6)mg/2 4h(P <0 0 5 )。结论 :短期静脉应用山莨菪碱治疗 ,对不同时期的糖尿病肾病患者均有减少尿蛋白的作     

尿IV型胶原在2型糖尿病肾病早期诊断中的意义

目的　探讨检测尿IV型胶原 (IV C)对 2型糖尿病肾病早期诊断的作用及可能影响因素。方法　选择我院 2 0 0 0年 3～ 12月 2型糖尿病患者 6 0例和健康体检者 2 0例 ,根据尿微量白蛋白排泄率 ,将糖尿病患者均分为 3组 ,每组各 2 0例 ,采用酶联免疫吸附测定法测定尿IV C ,免疫比浊法测尿微量白蛋白 ,同时测定血糖、胰岛素、胰岛素敏感指数、2 4小时动态血压、血脂和相关肾功能指标。结果　正常对照组尿IV C(1.93± 1.12 )mg/L ,糖尿病无肾病组 (6 .6 1± 1.6 4 )mg/L ,糖尿病早期肾病组 (11.35± 3.76 )mg/L。糖尿病临床肾病组 (2 3.4 0± 13.8)mg/L。糖尿病无肾病组中 ,尿白蛋白指数与正常对照组接近 (P >0 .0 5 ) ,而尿IV C的含量与正常对照组比较 ,差异有统计学意义 (P<0 .0 5 )。糖尿病早期肾病组和临床肾病组尿IV C含量明显高于正常对照组 (P <0 .0 1)。糖尿病各组胰岛素敏感指数均低于正常对照组 (P <0 .0 5 )。糖尿病临床肾病组 2 4小时平均血压、白天和夜间平均血压均高于其他 3组 (P<0 .0 5 )。尿IV C多因素相关性分析 ,与病程、尿白蛋白指数、尿α1微球蛋白、尿 β2 微球蛋白、餐后血糖、平均舒张压、夜间血压和N 乙酰 β 葡萄糖酐酶呈正相关关系 ,与胰岛素敏感指数呈负相关关系 (P <0 .0 5 )。结     

厄贝沙坦治疗早期糖尿病肾病的疗效观察

目的 :探讨厄贝沙坦在治疗早期糖尿病肾病的临床疗效。方法 :使用速率散射比浊法测定尿微量蛋白 ,比较厄贝沙坦组与马来酸氨氯地平组在治疗前后尿微量蛋白变化 ,及治疗组内高血压与非高血压组尿微量蛋白的变化。结果 :与对照组相比较 ,厄贝沙坦组在治疗前后尿微量蛋白有明显降低 (P <0 0 5 ) ,高血压组在治疗后微量蛋白的下降要比非高血压组明显。结论 :厄贝沙坦有减少尿蛋白的作用 ,尤其对糖尿病合并高血压病人延缓肾功能损害的进展是有益的。尿微量蛋白的测定有利于对DN患者的早期诊断。     

依那普利联合厄贝沙坦治疗早期糖尿病肾病112例疗效观察

目的观察依那普利联合厄贝沙坦治疗早期糖尿病肾病（DN）的疗效。方法 2型糖尿病早期糖尿病肾病患者112例,将112例入选患者随机分为观察组57例,对照组55例。观察组用依那普利,每次10mg,每日1次,并加用厄贝沙坦每次300mg,每日1次,疗程8周;对照组使用依那普利,每次10mg,每日1次,疗程8周。结果观察组和对照组都能降低患者尿微量白蛋白排泄率,但观察组下降更加明显（P〈0.01）。观察组较对照组收缩压及舒张压均明显下降（P〈0.01）。结论依那普利联合厄贝沙坦治疗早期糖尿病肾病较单独应用依那普利可明显降低患者尿微量白蛋白排泄率;更能有效地降低血压,且无明显不良反应。     

厄贝沙坦对血压正常的老年初期糖尿病肾病患者尿微量白蛋白和超敏C反应蛋白的影响

[目的]观察血压正常的老年初期糖尿病肾病(DN)患者,经厄贝沙坦治疗后尿微量白蛋白(Malb)和超敏C反应蛋白的变化.[方法]58例血压正常伴微量蛋白尿患者,在控制血糖的同时,加服厄贝沙坦75～150 mg/d,在服用6个月、1年时测量其相关尿微量白蛋白(Malb)、超敏C反应蛋白(hs-CRP)、血肌酐(SCr)、糖...     

厄贝沙坦对2型糖尿病肾病微量白蛋白尿的治疗作用

目的 观察厄贝沙坦合并常规治疗方法治疗2型糖尿病肾病微量白蛋白尿患者的效果.方法 将我院80例2型糖尿病肾病微量白蛋白尿患者,随机平均分为两组,在常规降糖、抗凝、降脂、低蛋白饮食治疗的基础上,治疗组:加用厄贝沙坦;对照组:常规治疗未加厄贝沙坦.所有病例于治疗前及治疗3个月、6个月时抽血测定空服血糖(FBG)、餐后血糖(PBG)、内生肌酐清除率(Ccr)、血尿素氮(BUN)、24 h Upro、UAER、ACR检测,然后对治疗前后两组分别进行对比分析.结果 治疗组2型糖尿病肾病微量白蛋白尿患者,在常规降糖、抗凝、降脂、低蛋白饮食治疗的基础,上加用厄贝沙坦,治疗3个月、6个月后24 h Upro、UAER、ACR明显要好于对照组.结论 厄贝沙坦治疗2型糖尿病肾病微量白蛋白尿临床疗效显著可靠.     

缬沙坦治疗早期糖尿病肾病的研究

目的观察血管紧张素 1型受体拮抗剂 (AT1 Ra)缬沙坦对伴微量白蛋白尿的早期糖尿病肾病的治疗作用。方法 64例 2型糖尿病患者 ,2 4小时尿白蛋白排泄率 (2 4h UAER) 2 0～ 2 0 0μg/ min,伴或不伴高血压 ,维持原糖尿病治疗不变 ,分组比较应用缬沙坦 (80mg/ d)或贝那普利 (10 mg/ d)治疗 8周前后平均动脉压 (MAP)、2 4h UAER、Hb A1 c、尿酸 (UA)等指标的变化。结果血压正常的缬沙坦治疗组和贝那普利治疗组 2 4h UAER分别由 (4 9.4± 2 5 .4)μg/ min降至 (3 4.9± 2 0 .4)μg/ min(P<0 .0 1)和由 (4 8.4± 2 6.9)μg/ min降至 (3 3 .5± 19.7)μg/ min(P<0 .0 1)。伴高血压的缬沙坦治疗组 2 4h U AER由 (68.6± 3 4.8)μg/ min降至 (5 0 .3± 3 6.6)μg/min(P<0 .0 1) ;伴高血压的贝那普利治疗组 2 4h UAER由 (66.7± 3 1.0 )μg/ min降至 (4 8.0± 2 5 .6)μg/ min(P<0 .0 1) ,二者疗效相似 ,且均与血压变化不相关。结论 ATl Ra缬沙坦可以降低早期糖尿病肾病的蛋白尿 ,其肾脏保护作用除了与降血压有关 ,还有不依赖降压效应的其他机制     

厄贝沙坦对高血压患者血压及微量白蛋白尿的影响

目的观察厄贝沙坦的降压疗效及对高血压患者尿微量白蛋白的影响。方法将115例患者随机分为3组，A组口服厄贝沙坦150mg／a，B组口服厄贝沙坦300mg／d，C组口服氨氯地平5mg／d，疗程6个月。治疗前后分别观察患者血压、尿微量白蛋白及肝肾功能。结果3组治疗后血压都明显下降，A组和B组治疗6个月后患者尿微量白蛋白明显下降（P〈0．05或P〈0．01），C组治疗后尿微量蛋白虽有下降，但差异无统计学意义（P〉0．05）。结论厄贝沙坦具有平稳的降压疗效，并具有肾保护作用。     

厄贝沙坦联合前列地尔治疗早期糖尿病肾病临床观察

目的：观察厄贝沙坦联合前列地尔治疗早期糖尿病肾病的疗效。方法：选择早期DN患者60例。随机分两组,A组给予厄贝沙坦;B组给予前列地尔注射液和厄贝沙坦,疗程均为4周。观察用药前后24 h尿微量白蛋白定量、血肌酐（SCr）。结果：两组治疗后24 h尿微量白蛋白定量均显著下降（P〈0.05）;B组疗效优于A组（P〈0.01）。结论：说明厄贝沙坦联合前列地尔对降低尿白蛋白有协同作用。     

复方丹参滴丸联合厄贝沙坦对老年早期2型糖尿病肾病患者尿微量白蛋白的影响

目的：探讨复方丹参滴丸联合厄贝沙坦对老年早期2型糖尿病肾病患者尿微量白蛋白水平的影响。方法：将86例老年早期2型糖尿病肾病患者随机分为观察组和对照组各43例,分别给予复方丹参滴丸联合厄贝沙坦和单独厄贝沙坦治疗,观察治疗前后2组的临床疗效及尿微量白蛋白的变化。结果：治疗12周后,2组尿微量白蛋白水平较治疗前均降低（P〈0.05）,且观察组治疗后的尿微量白蛋白水平明显低于对照组（P〈0.05）;2组总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL-C）和高密度脂蛋白（HDL-C）等血脂指标以及糖化血红蛋白（HbA1c）、空腹血糖（FBS）及餐后2h血糖（2hPG）等血糖指标较治疗前均无显著变化（P〉0.05）。结论：复方丹参滴丸联合厄贝沙坦治疗老年早期2型糖尿病肾病,能有效降低患者尿微量白蛋白水平,改善肾功能,且对血脂、血糖水平无显著影响,值得临床推广使用。     

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.     

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.