人细小病毒B19抗体及抗心磷脂抗体(aCL)在流产人群中的检测价值

目的探讨人细小病毒B19抗体及抗心磷脂抗体(aCL)在流产人群中的检测价值,为流产的预防提供理论依据。方法本研究观察对象为2015年1月-2017年1月于我院妇产科就诊的386例自然流产患者以及年龄配对的200例自愿终止妊娠的孕产妇,分别设为观察组与对照组。抽取空腹肘静脉血4ml,离心分析血清后采用酶联免疫吸附试验(ELISA)检测两组孕产妇血清aCLIgG、aCLIgM水平和B19IgG、B19IgM水平,比较两组孕产妇B19IgG、B19IgM、aCLIgG、aCLIgM阳性率以及血清平均水平。结果观察组B19IgG、B19IgM、aCLIgG、aCLIgM阳性率分别为5.08%、41.71%、52.33%、55.44%,对照组分别为6.00%、11.00%、7.00%、7.00%,观察组均显著高于对照组,差异具有统计学意义(P0.05);观察组血清B19IgG、B19IgM、aCLIgG、aCLIgM水平分别为(1.65±0.23)U/mL、(1.76±0.27)U/mL、(4.54±0.23)U/mL、(22.43±3.32)U/mL,对照组分别为(0.67±0.12)U/mL、(0.54±0.15)U/mL、(2.34±0.15)U/mL、(6.51±1.02)U/mL,观察组均显著高于对照组,差异具有统计学意义(P0.05)。结论自然流产孕产妇B19抗体、aCL抗体水平均显著高于正常孕产妇,提示其可能参与孕产妇流产的发生,动态监测B19抗体、aCL抗体水平对自然流产的预防具有十分重要的意义。     

不孕不育患者血清中抗精子抗体与抗心磷脂抗体的检测价值

目的探讨抗精子抗体(AsAb)、抗心磷脂抗体(ACA)在不孕不育患者中的检测价值。方法采用酶联免疫吸附试验检测878例不孕不育患者及20例健康对照组血清中的AsAb及ACA。结果不孕不育组抗精子总抗体(AsAbT)的总阳性率为21.4%,IgM阳性率为13.5%;健康组AsAbT总阳性率为7.5%,IgM为0%,P<0.01。不孕不育组ACA检测总阳性率为36.6%,其中IgA阳性率为5.1%,IgG阳性率为30.5%,IgM为12.3%;健康组阳性率为5.0%,其中IgG阳性率为5.0%,IgM为2.5%,P<0.05。结论 AsAb、ACA与不孕不育关系密切,其检测有助于免疫性不孕不育的诊断。     

反复自发性流产与抗心磷脂抗体和抗精子抗体之间的关系研究

目的 :探讨妊娠早期 (妊娠 5～ 11周 )反复自发性流产 (RSA )与抗心磷脂抗体 (ACA )和抗精子抗体(ASA)之间的关系。方法 :用ELISA法检测 3 3 8例反复自发性流产患者 (研究组 )血清ACA IgM和ACA IgG以及ASA IgM和ASA IgG。选择 69例无流产史并已分娩的妇女作为对照组。结果 :研究组ACA IgM和ASA IgM阳性检出率与对照组相比 ,差异有非常显著意义 (P <0 0 1) ;ACA IgG和ASA IgG阳性检出率与对照组相比 ,差异无显著意义 (P >0 0 5 ) ;研究组ACA IgM或ACA IgG的阳性检出率以及ASA IgM或ASA IgG阳性检出率与对照组相比差异有极其显著意义 (P <0 0 0 1)。结论 :妊娠早期反复自发性流产与抗心磷脂抗体和抗精子抗体之间有密切关系     

ACA及AsAb检测诊断不孕的临床价值分析

目的探讨对不孕患者行抗精子抗体(AsAb)、抗心磷脂抗体(ACA)诊断的临床价值。方法选择2017年1月～2018年1月就诊于我院的84例不孕女性患者为观察组,选择同期在我院行健康体检的妇女84例为对照组。采集静脉血检测血清AsAb、ACA。对比两组AsAb、ACA阳性率及其抗体阳性率。结果观察组AsAb、ACA阳性率分别为25.00%、23.81%,均高于对照组,差异有统计学意义(P0.05);观察组AsAb-免疫球蛋白M(IgM)、AsAb-免疫球蛋白G(IgG)、AsAb-免疫球蛋白A(IgA)阳性率分别为15.48%、10.71%、8.33%,均高于对照组,差异有统计学意义(P0.05);观察组ACA-IgM、ACA-IgG阳性率分别为13.10%、20.24%,均高于对照组,差异有统计学意义(P0.05);观察组ACA-IgA阳性率略高于对照组,差异无统计学意义(P0.05)。结论 AsAb、ACA是不孕发生的重要免疫因素,其中AsAbIgM、ACA-IgG与不孕密切相关,检测AsAb、ACA利于临床查找免疫性不孕的病因,指导治疗。     

抗心磷脂抗体与抗子宫内膜抗体在反复自然流产中的诊断分析

目的探讨反复自然流产(RSA)患者抗心磷脂抗体(ACA)与抗子宫内膜抗体(EmAb)指标的临床意义。方法收取该院2014年1月至2016年8月收治的96例RSA患者作为RSA组,同时选取50例健康孕妇作为对照组,比较两组ACA、EmAb阳性率。根据自然流产次数,将RSA组患者分为自然流产3次组与自然流产3次组,比较组间ACA、EmAb阳性率。结果与对照组相比,RSA组患者ACA、EmAb阳性率明显升高,组间比较差异均有统计学意义(P0.05)。与自然流产3次组相比,自然流产3次组患者ACA、EmAb阳性率明显升高,组间比较差异均有统计学意义(P0.05)。结论 RSA组患者ACA、EmAb阳性率明显升高,且随着流产次数的增加而升高。RSA患者应常规检查ACA、EmAb,并纠正抗体阳性状态,以提高妊娠成功率。     

冠心病患者血清抗凝血酶原抗体的检测

目的检测冠心病(CHD)患者血清中抗凝血酶原抗体(aPT)的含量,以探求其与该病的临床相关性。方法应用间接ELISA法检测HCD患者血中的aPT(IgG及IgM型)及总抗磷脂抗体(aPL)(IgG及IgM型),同时计算其阳性率和优势比(OR,95%置信区间)。结果49例CHD病人IgG,IgM,IgG/IgM-aPL的阳性率分别为22.4%,14.3%和28.6%,而对照组分别为5%,5%和10%,说明aPL在CHD病人中有明显的升高(除了IgM外,P<0.05)。CHD病人的IgG,IgM,IgG/IgM-aPT的阳性率分别为12.2%,10.2%和18.4%,对照组为2.5%,2.5%和5%,虽aPT有高于对照组的趋势,但无统计学意义(均P>0.05)。尽管如此,在AMI病人中aPL和aPT均比OMI和AP病人高,aPT更为明显。结论aPT可能是AMI的危险因素之一。aPL和aPT在一些CHD病人血清中有较高的水平,检测这些患者血中的aPL及aPT,将有助于进一步完善抗磷脂抗体综合征(APS)的临床研究及这些疾病的预防、诊断及治疗。     

系统性红斑狼疮患者自身抗体、免疫球蛋白及补体的变化及临床意义

[目的]探讨系统性红斑狼疮(SLE)患者自身抗体、免疫球蛋白及补体的变化及其临床意义.[方法]比较SLE患者与健康对照组的免疫球蛋白、补体水平;将SLE患者的自身抗体、补体等SLE活动指标进行相关性分析.[结果]SLE组的IgG、IgA、IgM水平显著高于对照组,其差异均有统计学意义(P＜0.05);SLE组的补体C3、C4水平显著低于对照组,其差异均有统计学意义(P＜0.01);SLE组的自身抗体谱中抗核抗体(ANA)阳性率最高;ANA、抗双链脱氧核糖核酸(dsDNA)抗体的阳性强度评分与补体C3、C4水平均呈负相关(P＜0.05),两者均与SLE活动指标的数目呈正相关(P＜0.05),但抗dsDNA抗体的相关性要高于ANA;补体C3、C4水平与SLE活动指标的数目均呈负相关(P＜0.05);抗史密斯(Sm)抗体等其余抗体的阳性强度评分与补体C3、C4水平、SLE活动指标数目的相关性均无统计学意义(P＞0.05).[结论]结合自身抗体、补体、免疫球蛋白及其他多项SLE活动指标可更准确地诊断SLE,尤其是当SLE标记性抗体抗dsDNA抗体、抗Sm抗体均阴性时,参考ANA、补体C3、C4水平等其他活动指标能减少SLE的漏诊,并能更好地判断SLE活动度,指导治疗、观察疗效及判断预后.     

抗着丝点抗体阳性的原发性胆汁性肝硬化患者临床分析

目的:探讨原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)患者抗着丝点抗体(anticentromere antibody,ACA)与临床表现间的关系.方法:156例PBC患者,分为ACA阳性组46例,ACA阴性组110例,比较2组临床表现,肝功能及免疫学指标.结果:ACA阳性组患者乏力、黄疸发生率低于ACA阴性组(P＜0.05).2组肝功能各指标比较差异无统计学意义(P＞0.05).ACA阳性组IgM水平和CD4+水平较ACA阴性组高(P＜0.05).结论:ACA阳性PBC患者临床表现隐匿,易漏诊.     

抗精子抗体对不孕不育症的影响

目的：研究在不孕不育症患者中检测抗精子抗体（AsAb）的临床意义。方法以76对正常生育夫妇为对照组,56对不孕症夫妇为不孕组,43对自然流产夫妇为自然流产组,对比3组抗精子抗体的阳性率。结果对照组、不孕组、自然流产组抗精子抗体阳性率分别为11.8%（9/76）、26.8%（15/56）和46.5%（20/43）。3组抗精子抗体阳性率经卡方检验两两比较,差异均有统计学意义（P＜0.05）。结论抗精子抗体与不育症及自然流产关系密切。     

阿司匹林加强的松治疗ACA阳性早孕复发性流产的疗效

[目的]探讨阿司匹林加强的松治疗抗心磷脂抗体(ACA)阳性早孕复发性流产的临床疗效.[方法]对本院因ACA阳性所致复发性流产者32例,随机分成两组:对照组给予人绒毛膜促性腺激素,每日1 000～2 000单位;治疗组在对照组的基础上加服小剂量阿司匹林50～80 mg/d,强的松10 mg/d,治疗至妊娠3个月.[结果]对照组妊娠至足月分娩4例,占25%,治疗组妊娠至足月分娩12例,占75%,两组有显著差异(P＜0.05).[结论]小剂量阿司匹林加强的松治疗ACA阳性早孕复发性流产效果良好.     

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.