应用全自动生化分析仪测定缺血修饰白蛋白

目的建立白蛋白钴结合(ACB)试验检测缺血修饰白蛋白(IMA)。方法应用日立7600型全自动生化分析仪,采用ACB法测定IMA,并测定血清中不同白蛋白浓度,以观察白蛋白对其影响。结果ACB方法批内变异系数(CV)为5.0%,批间CV为1.6%。不同浓度的人血清白蛋白ACB法测定结果是线性的,回归方程为Y=0.029 1.57X,r=0.995,P=0.000。黄疸对测定无明显影响;溶血(5 g/dL)和脂血(0.4%)对测定有干扰。健康人群参考范围为79.6 U/mL。结论IMA是评价心肌缺血的有效诊断工具,采用全自动生化分析仪建立测定IMA的方法方便、简单,可以大批量测定。     

白蛋白钴结合试验测定缺血修饰白蛋白方法学评价

目的白蛋白钴结合（ACB）试验测定缺血修饰白蛋白（IMA）,并确定参考正常范围。方法应用日立7600—120E型全自动生化分析仪,采用ACB法测定IMA。结果ACB法批内变异系数（CV）为1．43％,批间CV为1．70％。不同浓度的IMA结果线性相关,回归方程为Y=-13．752X＋83．835,r=0．9586。脂血（TG≤20．5mmol／L）、黄疸（TBIL≤259．6）,对测定无影响,溶血对IMA测定影响较大。健康人群的参考范围为≥62．84U／ml,心肌缺血患者为54．49U／ml。结论IMA是诊断心肌缺血的有效工具,应用全自动生化分析仪检测IMA快速、准确、简便。     

北京地区汉族人群缺血修饰白蛋白参考范围的建立

目的：应用全自动生化分析仪建立缺血修饰白蛋白（IMA）的生物学参考范围。方法：在Hitachi7170A全自动生化分析仪上设计合理参数,采用白蛋白钴结合（ACB）试验测定IMA,测定561例健康人群血清IMA含量,建立健康人群IMA参考范围。结果：健康人群中小于30岁人群的5%参考下限为67 U/ml,〉30岁人群的5%参考下限为64 U/ml。结论：用全自动生化分析仪建立ACB方法测定的IMA参考范围,有助于临床对心肌缺血的诊断。     

缺血修饰清蛋白全自动分析法的建立及初步性能评价

目的建立缺血修饰清蛋白(IMA)全自动生化分析仪检测方法 ,并对该方法进行初步性能评价。方法采用清蛋白钴结合试验(ACB)测定IMA,利用在分光光度法检测中寻找的高、低浓度样本,在HITACHI-7170A全自动生化分析仪上设计合理参数,建立ACB的校准曲线,并对所建立的方法进行性能分析评价。结果建立的7170A全自动生化分析法测定IMA其健康体检组混合血清和急性冠状动脉综合征(ACS)组混合血清的批内和批间变异系数分别为0.97%和1.46%,1.01%和1.73%,实验的重复性较好。把高、低值按一定比例混合后进行线性回归分析显示,线性回归方程式为:Y=0.1794X+0.029,相关系数(r)=0.9959,线性良好。检测健康对照组和ACS组IMA浓度,检测结果显示,ACS组IMA明显高于健康对照组。结论在HITACHI-7170A全自动生化分析仪成功建立ACB测定IMA的方法 ,本法具有准确性高、重复性好、反应稳定及操作简单等优点,可作为辅助ACS诊断的早期心肌缺血标志物。     

改良缺血修饰白蛋白测定方法（白蛋白-钴结合试验）的建立

目的建立改良的缺血修饰白蛋白（IMA）测定方法[白蛋白-钴结合（ACB）试验]。方法以1-亚硝基-2-萘酚（NN）代替二硫苏糖醇（DTT）作为显色剂,确定试验的基本条件（最佳波长、反应时间、试剂稳定性等）,并对该试验的精密度、敏感性、线性等进行评价。测定急性心肌梗死（AMI）和胸痛患者的IMA值并进行统计学分析。结果改良ACB试验最佳吸收波长为410 nm,反应体系0～25 min时吸光度值变化稳定,试剂在室温和4℃30 d内性能稳定,反应体系线性良好。批内变异系数（CV）为2.67%,批间CV为5.44%。应用显色剂NN对钴离子（Co2＋）的最低检出限为0.488 mg/L,应用DTT为7.812 mg/L。三酰甘油（TG）〈2.02 mmol/L、血红蛋白（Hb）〈6.9 g/L、总胆红素（TBil）〈66.0μmol/L时无干扰。AMI组为（1.195±0.320）吸光度单位（ABSU）,胸痛组为（0.855±0.068）ABSU,二者差异有统计学意义（P〈0.01）。结论以NN作为显色剂测定IMA的ACB试验灵敏、方便、简单,适合批量测定。     

缺血修饰白蛋白在心外器官缺血时的诊断价值研究

目的研究脑组织缺血及慢性肾功能不全时缺血修饰白蛋白的变化及临床意义。方法所有研究对象采用白蛋白钴结合（albumin cobalt binding,ACB）试验测定IMA的ACB值。研究对象分为正常对照组59例,心肌缺血组70例,脑梗死组45例,慢性肾功能不全组54例。结果 （1）正常对照组IMA的ACB值为72.9±8.7 U/ml,阳性率6.8%;心肌缺血组IMA的ACB值为59.0±12.5 U/ml,阳性率为78.6%;脑梗死组IMA的ACB值为61.2±12.4 U/ml,阳性率为57.7%;肾功能不全组IMA的ACB值为60.1±10.5 U/ml,阳性率为68.5%;正常对照组与心肌缺血组、脑梗死组、慢性肾功能不全组比较P=0〈0.05,差异有统计学意义。（2）IMA用于诊断心脑肾缺血的ROC曲线下面积AUC为0.827,最佳界值为64.55U/ml,此时IMA诊断心脑肾缺血的敏感性为69.8%,特异性为93.2%。结论 IMA不仅是评价ACS的指标,心外器官缺血时（脑梗死和慢性肾功能不全）血清IMA水平也升高,有助于对脑梗死和慢性肾脏疾病并发心血管疾病的早期发现。     

血清乳酸全自动测定方法的建立

目的建立一种测定血清乳酸的全自动分析方法。方法采用氧化酶法在贝克曼LX20全自动生化分析仪上进行血清乳酸测定结果所建立的氧化酶法全自动血清乳酸测定方法其血清乳酸回收率为98．49％,线性范围可达16．0mmol／L．批内变异系数（CV）1．83％、批间CV2．25％,轻、中度黄疸和溶血标本对血清乳酸的测定无显著干扰,210例健康儿童血清乳酸值为0．56～2．60mmol／L（x^-±2s）。结论采用氧化酶法测定血清乳酸快速、准确、简便、可靠,线性范围宽,适合临床应用。     

缺血修饰白蛋白对急性心肌缺血的诊断价值

目的探索缺血修饰白蛋白对心肌缺血的诊断价值。方法根据临床体征和心电图检查把病人血清分为心肌缺血病人组与非心肌缺血病人组,心肌缺血组病人48例,非心肌缺血组病人134例,同时选取30例正常健康人血清作为对照组。采用白蛋白-钴结合试验对缺血修饰白蛋白进行检测．测定结果以ACB单位报告,ACB单位的降低反映了IMA水平的升高．具有临床意义。并采用SPSS13．0软件对检测结果进行统计学分析。结果三组标本检测的ACB值呈梯度分布．心肌缺血组ACB的值明显低于非心肌缺血组和健康对照组．而非心肌缺血病人组的ACB值又明显低于健康对照组．均有显著性差异。48例缺血组病人的五种心肌缺血生化标志物的检测中,IMA阳性率和阳性例数明显高于其他四种（LDH,CK,CK—MB,MB）生化指标。结论缺血修饰白蛋白是急性心肌缺血早期．灵敏及特异的生化标志物。     

缺血修饰白蛋白在急性冠脉综合征早期诊断中的价值

目的探讨缺血修饰白蛋白(IMA)对急性冠脉综合征(ACS)的早期诊断价值以及ACS患者血清IMA水平与冠状动脉病变程度的关系。方法在HITACHI公司7170全自动生化分析仪上,用间接白蛋白钴结合试验(ACB法)测定40例急性冠脉综合症患者(包括23例不稳定心绞痛患者和17例急性心肌梗死患者)、18例因胸痛入院的非ACS患者和102例健康门诊体检人员血清IMA含量。将IMA测定结果绘制ROC曲线并通过分析制定区分ACS与对照(非ACS胸痛患者和健康体检者)的最适cutoff值。将冠状动脉病变程度用Gensini积分表示,分析IMA值与冠脉病变严重程度的相关性。结果不稳定心绞痛组和急性心肌梗死组间IMA无差异无统计学意义,ROC曲线下面积为0.789,在cutoff值ABUS/ml=85.34时敏感性和特异性分别为79.2%和70.9%。IMA水平与反应冠脉病变严重程度的Gensini积分的相关系数为0.15。结论 IMA是心肌缺血的敏感指标,区分可逆性缺血与梗死的能力较差,不能反映冠状动脉病变程度。     

免疫透射浊度法测定血清前白蛋白方法学探讨

目的 对免疫透射浊度法测定血清前白蛋白(PA)进行方法学评价。方法采用免疫透射浊度法在岛津CL-7300全自动生化分析仪上测定血清PA。结果血清PA的检出限为20～670mg／L，平均批内和批间变异系数分别为2．57%，3．79％；回收率为(97．5～103．8)％。该法(X)与免疫散射浊度法(y)有良好的相关性，相关系数，r=0．983，相关方程Y=5．528 0．974X。血清甘油三酯(TG)浓度3．5mmol／L以下，血红蛋白(Hb)浓度5g／L以下，胆红素浓度400μmol／L以下对测定基本无干扰。结论此法测定血清前白蛋白操作简单，线性范围宽，重复性好，准确性高，适用于全自动分析仪在常规实验室测定。     

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.