四氧化二氮中毒致肺损伤后ANP、MetHb和病理学变化研究

目的复制四氧化二氮(N2O4)吸入致肺损伤动物模型,检测心钠素(ANP)、高铁血红蛋白(MetHb)和肺病理学变化,研究其肺损伤机制。方法实验动物为美国癌症研究所(ICR)小鼠16只,随机分成正常组和中毒组,每组8只。分时相(24 h、48 h、72 h)取血测定ANP和MetHb含量,同期进行肺病理学检查。结果 N2O4中毒后,各组动物均出现肺水肿,同期血清ANP含量呈进行性升高,全血MetHb也较正常组显著增高。结论测定ANP可以及时反映N2O4中毒后发生肺水肿伤情变化,MetHb也在其中扮演了重要角色,实时监测二者含量可用于指导临床救治。     

盐酸氨溴索对放射性肺炎患者血清肺表面活性物质结合蛋白-A、D的影响

目的观察盐酸氨溴索对放射性肺炎患者血清肺表面活性物质结合蛋白-A、D(SP-A、SP-D)的影响。方法选择140例胸部恶性肿瘤接受放射治疗后出现放射性肺炎患者,随机分为对照组与观察组,各组均70例患者。对照组:给予放射性肺炎常规治疗,观察组:基础治疗同对照组,另给予盐酸氨溴索雾化吸入。采用酶联免疫吸附法(ELISA)检测患者治疗前、治疗3、6周后血清SP-A、SP-D及血清炎性因子肿瘤坏死因子-α(TNF-α)的变化。结果两组治疗3、6周后血清SP-A、SP-D水平较治疗前逐渐升高,但观察组治疗后血清SP-A、SP-D水平升高幅度低于对照组(P0.05);治疗后3周、6周,两组患者血清TNF-α水平均有降低(P0.05),且观察组血清TNF-α较对照组下降更显著,差异有统计学意义(P0.05)。结论盐酸氨溴索雾化吸入能够有效促进肺泡-毛细血管屏障的修复,降低恶性肿瘤放射性肺炎患者血清SP-A、SP-D及炎性因子TNF-α的水平。     

人参二醇对四氧化二氮染毒鼠α1-抗胰蛋白酶水平的影响

目的　探讨人参二醇对四氧化二氮 (N2 O4)染毒鼠血清蛋白醇抑制物水平的影响 ,寻找简便易行的N2 O4中毒防治新途径。方法　LACA雄性小鼠 ,18～ 2 2g,共 12 3只。按体重随机分成对照组、染毒组、染毒加人参二醇组 ,每组 4 1只。模型制作 :对照组及染毒组每只小鼠均给予腹腔注射生理盐水 0 2mL ,人参二醇组每只小鼠给予腹腔注射人参二醇 0 2mL ,连续 7d。复制N2 O4急性中毒性肺水肿模型 ,中毒后 15min、1h分别腹腔内注射上述药物共 2次。注射完毕后观察小鼠的表现和存活情况。 7d后取眼球静脉血血清 ,- 2 0℃保存。测定血清α1-抗胰蛋白酶 (α1-AT)水平。结果　正常对照组小鼠经过腹腔注射人参二醇后 ,血清α1-AT水平无明显变化。而N2 O4染毒小鼠在伤后 1h ,与对照组比较 ,其血清α1-AT明显下降 ,在统计学上具有显著差异 (P <0 0 0 1)。人参二醇组小鼠在受伤后 1h ,其血浆α1-AT也有不同程度的下降 ,但下降程度明显低于单纯N2 O4组 (P <0 0 0 1)。染毒后 4 8h ,对照组血清α1-AT水平与染毒组无明显差异 ,而人参二醇治疗组α1-AT水平较其他两组明显升高 ,具有显著统计学差异 (P <0 0 1)。结论　人参二醇能够减轻急性中毒性肺水肿小鼠血清α1-AT的下降。其具体机制尚有待于进一步研究。     

思密达联合乌司他丁对百草枯中毒大鼠肿瘤坏死因子-α、转化生长因子-β1的影响

目的:观察思密达联合乌司他丁(UTI)给药对急性百草枯(PQ)中毒大鼠血浆肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)的干预作用,探讨其可能的作用机制。方法:将104只SD大鼠随机分为生理盐水对照组(A组)8只、染毒对照组(B组)32只、UTI对照组(C组)32只、思密达联合UTI干预组(D组)32只。染毒后第1、3、5、7天分批处死各组存活大鼠,测定血浆TNF-α、TGF-β1含量。结果:B、C、D组血浆TNF-α、TGF-β1水平于染毒后第1天开始明显升高,与A组比较差异均有统计学意义(P0.01);染毒后第1、3天,C组TNF-α、TGF-β1水平低于B组,差异有统计学意义(P0.05);染毒后第1、3、5、7天,D组TNF-α、TGF-β1表达明显低于B组,差异均有统计学意义(P0.01),且D组TNF-α、TGF-β1水平也低于C组,差异有统计学意义(P0.05,P0.01)。结论:思密达联合UTI能够有效降低PQ中毒大鼠TNF-α、TGF-β1水平,减轻PQ对大鼠的损伤作用。     

肺结核患者血清与痰上清液中TNF-α、IL-4、IFN-γ、TGF-β的表达及意义

目的探讨肺结核患者血清与痰上清液中白介素4(IL-4)、肿瘤坏死因子α(TNF-α)、γ干扰素(IFN-γ)、转化生长因子β(TGF-β)的表达及临床意义。方法 40例肺结核患者空腹抽取外周静脉血、采集痰上清液,酶联免疫吸附法(ELISA)检测两者中的IL-4、TNF-α、IFN-γ、TGF-β水平,聚合酶链式反应法(PCR)检测结核菌的感染程度。结果肺结核患者痰上清液中IL-4、TNF-α、IFN-γ、TGF-β水平显著高于血清中(P0.01);痰菌量4+的痰上清液中的IL-4、TNF-α、IFN-γ、TGF-β的水平显著高于痰菌量+~3+的(P0.05);痰上清液中IL-4水平与TNF-α水平呈正相关(r=0.543,P0.05),血清中IFN-γ与TGF-β呈正相关(r=1.137,P0.05)。结论肺结核患者痰上清液中IL-4、TNF-α、IFN-γ、TGF-β表达水平明显高于外周血,随着痰菌量的增多,痰上清液中IL-4、TNF-α、IFN-γ、TGF-β的表达水平不同程度升高。     

血清TGF-β1、TIMP-1、TNF-α及IL-17在膝关节骨性关节炎患者血清变化情况及其与病情严重程度的关系

目的 探讨血清转化生长因子β1蛋白(Transforming Growth factor β1 protein, TGF-β1)、基质金属蛋白酶组织抑制因子-1(Tissue inhibitor of matrix metalloproteinase 1,TIMP-1)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)及白介素-17(Interleukin-17,IL-17)在膝关节骨性关节炎患者血清变化情况及其与病情严重程度的关系。方法 本研究入选的100例患者均来自于2018年7月至2021年7月期间锦州市中心医院收治的KOA患者，将其作为研究组；另外，选取同期骨科收治的70例非KOA患者作为对照组。2组患者血清TGF-β1、TNF-α以及IL-17水平均采用酶联免疫吸附试验法(Enzyme linked immunosorbent assay, ELISA)进行检测，TIMP-1水平则采用ELISA双抗体夹心法进行检测。比较2组患者血清TGF-β1、TIMP-1、TNF-α及IL-17水平；比较KOA患者不同K-L分级血清TGF-β1、TIMP-1、...     

血清单核细胞趋化蛋白-1、肿瘤坏死因子-α和转化生长因子-β1的检测在早期糖尿病肾病中的诊断价值

目的探讨2型糖尿病患者血清单核细胞趋化蛋白-1(MCP-1)、肿瘤坏死因子-α(TNF-α)和转化生长因子-β1(TGF-β1)的检测在早期糖尿病肾病诊断中的临床价值。方法选择2型糖尿病患者120例,根据尿白蛋白排泄率(UAER)将其分为UAER正常组、UAER增高组,另选健康体检者60例作为对照组,ELISA法检测3组研究对象血清MCP-1、TNF-α与TGF-β1的表达水平,并分析各指标的阳性率,比较单独检测与联合检测在诊断糖尿病肾病中的效率。结果 UAER正常组MCP-1、TNF-α与TGF-β1表达水平显著高于对照组,差异有统计学意义(P0.05)。UAER增高组患者的MCP-1、TNF-α与TGF-β1水平显著高于UAER正常组,差异有统计学意义(P0.05)。UAER增高组患者的MCP-1、TNF-α与TGF-β1的阳性率均显著高于其他两组,差异有统计学意义(P0.05)。3项指标联合检测对糖尿病肾病的灵敏度及特异度均显著高于单一检测结果,差异有统计学意义(P0.05)。结论 MCP-1、TNF-α与TGF-β1的检测对早期糖尿病肾病的诊断具有一定参考价值,3项指标联合检测的诊断价值高于单一检测。     

TGF-β1、TNF-α、IL-6与多囊卵巢综合征发病关系的探讨

目的：探讨TGF-β1、TNF-α、IL-6与多囊卵巢综合征(PCOS)发病的关系。方法：酶联免疫吸附试验(EusA)检测血清TGF-β1、TNF-α、IL-6水平，放射免疫法(RIA)检测血清胰岛素水平，葡萄糖氧化酶法检测血糖水平，化学发光仪检测血清甾体激素水平。结果：(1)TGF-β1水平在PCOS组高于对照组，在两组中与其他指标均无相关性；TNF-α水平在PCOS组明显高于对照组，且与IL-6水平呈明显正相关，与胰岛素敏感指数(ISI)呈明显负相关，与睾酮(T)和雄烯二酮(A2)呈正相关，在两组中均与BMI呈正相关；IL-6水平在PCOS组明显高于对照组，且与BMI呈正相关，与空腹胰岛素(FIN)水平呈明显正相关，与ISI呈明显负相关，对照组中与各项指标无相关性。（2）PCOS组有IR者TNF-α、IL-6、FIN明显高于无IR者。结论：TGF-β1、TNF-α、IL-6都与PCOS的发病有关，TGF-β1可能主要影响胰岛素的敏感性和糖代谢，TNF-α、可能主要通过影响外周组织对胰岛素的敏感性和导致局部雄激素水平升高来发挥作用，IL-6主要与IR有关，TNF-α和IL-6有协同作用，能加重PCOS病情的发生发展。     

矽肺患者检测血清转化生长因子-β_1和肿瘤坏死因子-α意义研究

目的观察矽尘接触者和矽肺患者的血清转化生长因子-β1(TGF-β1)和肿瘤坏死因子-α(TNF-α),探讨TGF-β1、TNF-α在矽肺发生发展中的作用。方法采用ELISA法对100名不接触粉尘的对照人群,200名接触矽尘1年以上的接尘工人,32名矽尘作业观察对象(原0+患者)及130例矽肺患者,检测其血清TGF-β1、TNF-α水平。结果与对照组对照:接尘组、观察对象组和矽肺组TNF-α水平明显高于正常对照组,差异有高度统计学意义(P<0.01);与接尘组对照:矽肺组TNF-α水平明显高于接尘组(P<0.01),观察对象组高于接尘组(P<0.05);与对照组及接尘组对照:TGF-β1矽肺组明显高于正常对照组及接尘组,差异有高度统计学意义(P<0.01)。结论外周血TGF-β1、TNF-α水平与肺纤维化的发生发展关系紧密,检测其表达水平对职业健康监护、职业病诊断、治疗提供了有力的依据。     

自体骨髓干细胞移植治疗肝硬化患者血清IL-18、TNF-α、TGF-β1、HGF水平变化及临床意义

目的研究自体骨髓干细胞移植治疗肝硬化患者血清血清白细胞介素18(IL-18)、肿瘤坏死因子α(TNF-α)、转化生长因子β1(TGF-β1)、肝细胞生长因子(HGF)的水平变化及其临床意义。方法对36例经自体骨髓干细胞移植治疗的失代偿期肝硬化患者,在术前及术后2、4、8、12周分别抽取静脉血,用ELISA法检测其IL-18、TNF-α、TGF-β1、HGF水平。结果从术前到术后12周IL-18、TNF-α、TGF-β1呈下降趋势,而HGF呈现上升趋势,在不同时间段间比较,差异有统计学意义(P<0.05)。结论患者血清IL-18、TNF-α、TGF-β1、HGF检测对干细胞移植治疗肝硬化的效果评价有一定的临床意义。     

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.