哮喘病人血一氧化氮及其合成酶、血管内皮素的变化

目的:为探讨支气管哮喘与血一氧化氮及其合成酶、血管内皮素的关系。方法:测定了轻度发作的支气管哮喘病人31例及对照组30例的全血一氧化氮及其合成酶、血管内皮素。结果:哮喘组与对照组的血管内皮素分别为(44.45±25.76)pg/ml和(33.43±22.88)pg/ml(P<0.05),血一氧化氮两组分别为(37.65±17.20)μmol/ml和(42.81±19.42)μmol/ml(P>0.05),血一氧化氮合成酶活性分别为22.81±5.53和22.14±4.53(P>0.05)。结论:研究观察到血管内皮素可能在支气管哮喘气道炎症之中起重要病理生理作用,但未观察到一氧化氮及其合成酶在轻度发作的支气管哮喘病人中的变化。     

新生儿缺氧缺血性脑病血浆一氧化氮及一氧化氮合成酶水平对预后判断的意义

目的：探讨新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy，HIE)时一氧化氮、一氧化氮合成酶(Nitrogen monoxide synthase，NOS)水平的变化及其对预后判断及恢复期指导的意义。方法：采用比色等方法测定32例HIE患儿及30例正常新生儿血浆一氧化氮、一氧化氮合成酶活性水平。结果：正常对照组一氧化氮、NOS水平分别为(72．84&;#177;12．35)trmol／L和(0．203&;#177;0．05)kU／g，HIE组为(129．80&;#177;3266)μmol／L和(0．352&;#177;0．124)kU／g；其中轻度HIE为(105．65&;#177;36．30)μmol／L和(0．289&;#177;0．09)U／mg；中度HIE为(135．03&;#177;24．40)μmol／L和(0．325&;#177;0．16)kU／g；重度HIE组为(144．55&;#177;26．32)μmol／L和(0．364&;#177;0．01)kU／g。HIE急性期一氧化氮、NOS水平校正常新生儿明显升高(t=-8．97，P&;lt;0．01)，中、重度HIE升高更显著(t=-10．62，-12．01，P&;lt;0．01)，中、重度HIE患儿较轻度HIE患儿升高明显(t=-2．12．-2．92，P&;lt;0．05，P&;lt;0．01)。中、重度HIE之间则无明显差别。结论：一氧化氮、NOS水平高低与HIE患儿脑损伤程度和预后有关，可作为判断HIE患儿病情恢复及预后的指标之一。     

不同浓度外源性内皮素1刺激大鼠脑皮质神经元增加释放一氧化氮：首次国内实验直接证实

目的：观察不同浓度内皮素1刺激大脑皮质神经元增加释放一氧化氮的作用。方法：实验于2002-03／2003-02在暨南大学医学院病理教研室、生命科学技术学院组织移植与免疫实验中心实验室进行。①取新生SD大鼠大脑皮质细胞，神经元体外原代培养至第7天，以10，100nmol的内皮素1刺激神经元，对照组加入等体积磷酸盐缓冲液，以硝酸还原酶法测定间接反映一氧化氮的含量，检验内皮素1对神经元释放一氧化氮的累积效应。分别检测加药前、加药后30min，6h培养基中的一氧化氮浓度。②将培养的神经元分成5组，对照组，10nmol／L内皮素1组、10nmol／L内皮素l+3μmol／L选择性内皮素受体一抗拮剂BQ123组、10nmol／L内皮素1+3μmol／L选择性内皮素受体n抗拮剂BQ788组、10nmol／L内皮素1+3μmol／L非特异性内皮素受体抗拮剂PD145065组。测定加药后6h各培养液中一氧化氮浓度。结果：①10nmol／L，100μmol／L内皮素1组在加药后30min一氧化氮浓度与对照组基本一致，加药后6h培养液中一氧化氮浓度高于对照组(P&;lt;0．05)。②10nmol／L内皮素1组和100nmol／L内皮素l组在加药30min和6h时一氧化氮浓度基本一致(P&;gt;0．05)。③不同内皮素受体拮抗剂对外源性内皮素1刺激神经元释放一氧化氮的影响：10nmol／L内皮素1组、10nmol／L内皮素1+3p．mol／L选择性内皮素受体A抗拮剂BQl23组一氧化氮浓度高于对照组(P&;lt;0．05)。10nmol／L内皮素1+3p．mol／L选择性内皮素受体n抗拮剂BQ788组、10nmol／L内皮素1+3p．mol／L非特异性内皮素受体抗拮剂PD145065组明显低于10nmo|／L内皮素1组(P&;lt;0．01)。结论：10nmol／L和100nmol／L内皮素1对培养液中一氧化氮的影响基本接近，提示内皮素l对皮质培养神经元释放一氧化氮增加的作用在10-100nmol／L间无剂效关系。选择性内皮素受体B抗拮剂BQ788或非特异性内皮素受体抗拮剂PDl45065可完全阻断内皮素1刺激神经元释放一氧化氮的作用，选择性内皮素受体A抗拮剂BQ123对内皮素1刺激神经元释放一氧化氮无影响，提示内皮素1是通过内皮素受体B刺激神经元释放一氧化氮。     

吸烟对冠心病患者血浆同型半胱氨酸的影响

目的探讨吸烟对冠心病患者血浆同型半胱氨酸（HCY）的影响,为冠心病患者早期治疗提供依据。方法将所有研究对象分为4组：①冠心病吸烟组74例;②冠心痛不吸烟组46例;③健康吸烟组42例;④健康不吸烟组26例。又根据吸烟指数将所有入选的吸烟者分成3组：重度吸烟组40例、中度吸烟组44例和轻度吸烟组32例。采用酶联免疫吸附测定（ELISA）法检测血浆HCY水平。结果血浆HCY水平在冠心病吸烟组、冠心病不吸烟组、健康吸烟组、健康不吸烟组中依次降低（15．79±4．18）μmol／L、（12．12±2．43）μmol／L、（10．85±3．78）μmol／L、（7．26±3．15）μmol／L（P〈0．01）,在健康不吸烟组、轻度吸烟组、中度吸烟组、重度吸烟组血浆HCY水平依次增高（7．26±3．15）μmol／L、（9．58±4．06）μmol／L、（13．32±3．26）μmol／L、（15．43±3．18）μmol／L（P〈0．01）。结论吸烟使冠心病患者和健康者血浆HCY水平升高,HCY水平随吸烟指数的增加而升高。     

阻塞性睡眠呼吸暂停综合征患者血管内皮功能损害和相关炎症因子的研究

目的探讨阻塞性睡眠呼吸暂停综合征（OSAHS）严重程度和血管内皮功能损害及相关炎症因子的关系。方法选择在本院呼吸科和心内科住院的0sAHS患者120例,并按0sAHs的严重程度分为轻度、中度和重度3组,分别测定3组患者的血管性血友病因子（vWF）、C反应蛋白（CRP）、白细胞介素6（IL-6）及一氧化氮（N0）的水平,并应用高频超声检测血管内皮功能的主要指标（肱动脉基础内径,反应性充血后肱动脉内径变化率,口服硝酸甘油后肱动脉内径变化率,峰值流速变化率）。结果重度OSAHS组的vWF、CRP、IL－6水平分别为（356．3±59．7）％、（35．54-15．2）mg／L、（41．2±8．5）ng／L明显高于中度的（248．7±51．3）％、（26．2±12．3）mg／L、（34．7±7．6）ng／L和轻度组的（135．8±48．6）％、（15．3±8．9）mg／L、（25．9±6．8）ng／L,中度组明显高于轻度组（P〈0．05）,而重度组反应性充血后肱动脉内径变化率、峰值流速变化率、NO平均水平分别（7．19±2．08）％、（46．86±9．98）％、（7．8±5．6）μmol／L明显低于中度组的（13．45±3．01）％、（54．26±10．05）％、（10．6±6．1）／μmol／L和轻度组的（21．10±2．25）％、（67．215±11．86）％、（15．6±7．3）μmol／L,中度组低于轻度组（P〈0．05）。结论0SAHS严重程度和血管内皮功能损害程度及其炎症因子密切相关。     

新生儿缺氧缺血性脑病血浆一氧化氮及一氧化氮合成酶水平对预后判断的意义

目的探讨新生儿缺氧缺血性脑病 (hypoxic-ischemic encephalopathy , HIE)时一氧化氮、一氧化氮合成酶 (Nitrogen monoxide synthase , NOS)水平的变化及其对预后判断及恢复期指导的意义. 方法 采用比色等方法测定 32例 HIE患儿及 30例正常新生儿血浆一氧化氮、一氧化氮合成酶活性水平. 结果 正常对照组一氧化氮、 NOS水平分别为 (72.84± 12.35) μ mol/L和 (0.203± 0.05) kU/g, HIE组为 (129.80± 32.66) μ mol/L和 (0.352± 0.124) kU/g;其中轻度 HIE为 (105.65± 36.30) μ mol/L和 (0.289± 0.09) U/mg;中度 HIE为 (135.03± 24.40) μ mol/L和 (0.325± 0.16) kU/g;重度 HIE组为 (144.55± 26.32) μ mol/L和 (0.364± 0.01) kU/g. HIE急性期一氧化氮、 NOS水平校正常新生儿明显升高 (t=- 8.97, P< 0.01),中、重度 HIE升高更显著 (t=- 10.62,- 12.01,P< 0.01),中、重度 HIE患儿较轻度 HIE患儿升高明显 (t=- 2.12,- 2.92,P< 0.05,P< 0.01).中、重度 HIE之间则无明显差别. 结论一氧化氮、 NOS水平高低与 HIE患儿脑损伤程度和预后有关,可作为判断 HIE患儿病情恢复及预后的指标之一.     

同型半胱氨酸水平与脑梗死患者严重程度及神经缺损功能的关系研究

目的探讨同型半胱氨酸水平(homocysteine,Hcy)与脑梗死患者严重程度及神经缺损功能的关系。方法选取本院近3年(2013年7月-2016年7月)收治脑梗死患者160例,患者均符合脑梗死诊断标准。依据MRI影像资料显示脑梗死直径将脑梗死患者分为脑梗死严重组(45例,直径6cm)、脑梗死中度组(60例,直径4～6cm)、脑梗死轻度组(55例,直径4cm);依据神经功能缺损评分(CNDS)标准,将脑梗死患者分为神经缺损重度组(40例,CNDS:31～45分),神经缺损中度组(58例,CNDS:16～30分),神经缺损轻度组(62例,CNDS:0～15分)。同期入院体检健康者160例作为健康组。评价健康组和患者组Hcy水平,以及患者组中各亚组Hcy水平。结果患病组血清Hcy水平(20.34±6.48)μmol/L显著高于健康组(8.57±3.06)μmol/L(P0.05);患者脑梗死程越严重,血清Hcy水平越高,脑梗死轻度组、中度组、重度组血清Hcy水平分别为(16.36±5.23)μmol/L,(21.48±6.41)μmol/L和(26.39±8.25)μmol/L,且三组之间差异有统计学意义(P0.05);患者神经功能缺损越严重,血清Hcy水平越高,神经功能缺损轻度组、中度组、重度组之间血清Hcy水平分别为(15.76±5.18)μmol/L,(21.27±6.23)μmol/L和(26.05±8.12)μmol/L,且三组之间差异显著(P0.05)。结论相对于健康者,脑梗死患者血清Hcy水平明显较高,且与脑梗死严重程度和神经功能缺损程度相关,可作为脑梗死病情预测的灵敏指标。     

活血化瘀药对大鼠脑缺血再灌注血管源性脑水肿的影响

目的：探讨预防性应用活血化瘀药对大鼠脑缺血—再灌注所致血管源性脑水肿的作用。方法：大鼠138只单纯随机分为：对照组；假手术组；低剂量短时干预组；高剂量短时干预组；低剂量长时干预组和高剂量长时干预组，采用线栓法制备大鼠大脑中动脉阻塞模型。测定大鼠神经功能缺损程度，检测脑水含量、血清及脑匀浆一氧化氮含量及光镜、电镜的病理改变。结果：药物干预组鼠神经功能缺损程度较对照组轻(P&;lt;0．01)，药物干预组血清一氧化氮含量：假手术组(106．5&;#177;7．5)μmol／L，低剂量短时干预组(94．6&;#177;7．9)μmol／L，高剂量短时干预组(104．7&;#177;6．1)μmol／L，低剂量长时干预组(104．6&;#177;5．6)μmol／L，高剂量长时干预组(112．6&;#177;9．3)μmol／L较对照组(85．7&;#177;6．1)μmol／L高，差异有显著性意义(t=-7．673～-2．832．P&;lt;0．05)，脑匀浆一氧化氮含量：假手术组(46．9&;#177;7．8)μmol／L，低剂量短时干预组(85．9&;#177;5．2)μmol／L，高剂量短时干预组(86．7&;#177;5．3)μmol／L，低剂量长时干预组(81．6&;#177;3．9)μmol／L，高剂量长时干预组(65．5&;#177;7．2)μmol／L较对照组(99．8&;#177;2．6)μmol／L低(t=7．011～20．361，P&;lt;0．01)，病理损害较对照组轻。结论：活血化瘀药能减少缺血再灌注大鼠脑的一氧化氮产生，降低血管源性脑水肿的程度，减轻神经细胞损伤，具有抗缺血再灌注损伤作用。     

β_2-微球蛋白联合血清胱抑素C在高胆红素血症新生儿肾功能评估中的价值

目的探讨β_2-微球蛋白及血清胱抑素C(Cys C)在高胆红素血症新生儿肾功能评估中的价值。方法收集2013年2月至2014年12月在我院儿科住院治疗的高胆红素血症伴有肾功能损害的新生儿76例,根据胆红素水平分为轻度组(轻度组(TBil 221~256μmol/L)21例,中度组(TBil 256~342μmol/L)29例,重度组(TBil342μmol/L)26例,另选年龄、性别相匹配的正常足月新生儿23例作为对照组。测定比较各组血Scr、BUN、β_2-微球蛋白、Cys C浓度,分析TBil与β_2-微球蛋白、Cys C的关系,观察治疗前后患儿Scr、BUN、TBil、β_2-微球蛋白、Cys C变化情况。结果重度组血Scr、BUN水平明显高于对照组和轻度组、中度组(P0.05),对照组和轻度组、中度组间Scr、BUN水平无统计学差异(P0.05);轻度组、中度组、重度组β_2-微球蛋白、Cys C水平明显高于对照组(P0.05),中度组、重度组β_2-微球蛋白、Cys C水平明显高于轻度组(P0.05),重度组明显高于中度组(P0.05)。高胆红素血症患儿血β_2-微球蛋白、Cys C与TBil水平呈正的相关性(P0.05)。治疗后患儿血TBil、Scr、BUN、β_2-微球蛋白、Cys C水平均明显低于治疗前(P0.05)。结论高胆红素血症早期可导致新生儿不同程度的肾功能损害,具有可逆性,及时治疗可部分恢复。β_2-微球蛋白、Cys C水平是新生儿高胆红素血症早期肾功能损害的敏感指标。     

母乳性黄疸婴儿免疫功能研究

目的探讨母乳性黄疸婴儿免疫功能水平的变化。方法母乳性黄疸患儿53例,按血清总胆红素(totalbilirubin,TBIL)水平分为重度组(TBIL≥342μmol/L)12例、中度组(256μmol/L0.05);轻度组IgG,IgA,IgM,C3及C4水平与对照组比较差异无统计学意义(P>0.05);重度组治疗后IgG,IgA,IgM,C3及C4水平均高于治疗前,差异有统计学意义(P<0.05)。结论母乳性黄疸患儿TBIL水平≥342μmol/L时,免疫功能低下,早期干预可短期恢复免疫损伤。     

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.     

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.