Hcy与CysC联合检测在2型糖尿病并发症中的应用价值

目的研究血清同型半胱氨酸(Hcy)与胱抑素C(CysC)联合检测在2型糖尿病并发症中的应用价值。方法选取2015年6月至2017年6月该院确诊为2型糖尿病的139例糖尿病患者分为糖尿病无并发症组(38例)、糖尿病合并视网膜病变组(31例)、糖尿病合并肾病组(34例)、糖尿病合并冠心病组(36例),选取同期健康体检者设为对照组(52例),采用酶循环法及胶乳增强透射比浊法分别测定各组血清Hcy与CysC的水平并进行比较。结果糖尿病无并发症组及糖尿病合并各种并发症组Hcy与CysC的水平均明显高于对照组,差异有统计学意义(P0.05),其中以糖尿病合并冠心病组Hcy水平最高,以糖尿病合并肾病组CysC水平最高。糖尿病合并各种并发症组的Hcy与CysC水平与糖尿病无并发症组比较,差异有统计学意义(P0.05)。糖尿病合并并发症组的Hcy与CysC联合检测的阳性率与对照组比较,差异有统计学意义(P0.05)。糖尿病合并各种并发症组的Hcy与CysC联合检测的阳性率与糖尿病无并发症组比较,差异有统计学意义(P0.05)。结论 Hcy、CysC与糖尿病并发症有十分密切的关系,是糖尿病并发症的重要预测因子。     

前列腺癌患者血清胱抑素C水平的实验室评价

目的评价前列腺癌患者血清CysC水平。方法选择前列腺癌患者32例前列腺良性疾病患者62例,以及健康男性体检者50例作为对照研究对象,检测受试者胱抑素C(CysC)、前列腺特异性抗原(PSA)水平。结果前列腺癌组血清CysC水平明显高于前列腺良性疾病组及对照组,差异有统计学意义(t=4.322,P=0.000 1;t=5.098,P=0.000 1);而前列腺良性疾病组与对照组血清CysC水平比较,差异无统计学意义(t=1.877,P=0.063 2)。不同年龄前列腺癌患者血清CysC水平间差异无统计学意义(P0.05)。前列腺癌患者血清CysC阳性率明显高于血清PSA阳性率,差异有统计学意义(χ~2=3.91,P0.05)。结论血清CysC在前列腺癌患者中的检出阳性率明显高于血清PSA检出阳性率,有望取代血清PSA作为临床灵敏度和特异度更高的前列腺癌早期筛查和诊治新标志物。     

多囊卵巢综合征患者血清和卵泡液中Adropin水平对胚胎发育质量的影响

目的探讨血清和卵泡液中Adropin水平对行辅助生殖治疗的多囊卵巢综合征(PCOS)患者体外受精(IVF)胚胎结局的影响。方法选取在该院就诊并首次行IVF治疗的PCOS患者30例作为PCOS组,30例输卵管因素不孕患者作为对照组,通过酶联免疫吸附试验(ELISA)试剂盒检测两组血清和卵泡液中Adropin水平,同时测定患者血清中基础性激素和人绒毛膜促性腺激素日性激素等指标。结果 PCOS组患者的血清和卵泡液中Adropin水平显著低于对照组,差异有统计学意义(P0.001);卵泡液中Adropin水平显著低于血清Adropin水平,差异有统计学意义(P0.001);血清和卵泡液中Adropin水平与获卵数呈负相关性(P0.05);血清Adropin水平还与多原核(PN)受精率呈负相关性(P0.05),但与正常受精率呈正相关性(P0.05)。结论血清Adropin水平能够提示胚胎实验室进行早期干预以改善PCOS患者的卵母细胞发育与受精情况。     

血清CysC、UTRF、α1MG联合检测对早期糖尿病肾病诊断的临床价值

目的研究血清胱抑素C(CysC)、尿转铁蛋白(UTRF)、α1微球蛋白(α1MG)联合检测对早期糖尿病肾病(DKD)诊断的临床价值。方法选取2016年1月到2017年1月在该院治疗的165例糖尿病患者为研究对象,根据尿清蛋白排泄率(UAER)水平分为单纯糖尿病组(DM组)和糖尿病肾病(DKD)组,另选取83例健康体检者作为对照组。使用全自动生化分析仪检测3组受试者血清CysC、血肌酐(SCr)、血尿素氮(BUN)水平,免疫比浊法检测UTRF、α1MG及尿微量清蛋白(MALB)水平。结果与对照组及DM组相比,DKD组血清CysC、UTRF、α1MG及MALB水平水平明显升高,差异具有统计学意义(P0.05)。与DM组相比,DKD组患者SCr、BUN水平升高,但差异无统计学意义(P0.05)。早期DKD患者血清CysC、UTRF、α1MG阳性检出率明显高于SCr和BUN,差异均具有统计学意义(P0.05)。血清CysC、UTRF、α1MG与MALB、SCr、BUN均呈正相关。血清CysC水平与α1MG水平呈正相关关系。血清CysC、UTRF和α1MG三项指标联合检测灵敏度达到92.9%,明显高于单项指标检测,差异均具有统计学意义(P0.05)。结论血清CysC、UTRF、α1MG联合检测对DKD早期诊断具有重要的临床价值。     

血清Cys-C与尿α1-MG水平联合检测对2型糖尿病肾损害早期患者阳性检出率的影响

目的:探讨血清胱抑素C(Cys-C)与尿α1-微量球蛋白(α1-MG)水平联合检测对2型糖尿病肾损害早期患者阳性检出率的影响。方法:选取2015年12月~2017年5月我院140例2型糖尿病患者,根据尿蛋白水平分为肾损害组(n=52)与无肾损害组(n=88),另选取同期健康体检者60例作为对照组。检测三组血清CysC与尿α1-MG水平,统计三组血清Cys-C与尿α1-MG及联合检测阳性率。结果:肾损害组血清Cys-C、尿α1-MG水平高于无肾损害组、对照组,差异有统计学意义(P0.05);肾损害组血清Cys-C、尿α1-MG及联合检测阳性率高于无肾损害组、对照组,无肾损害组高于对照组,差异有统计学意义(P0.05);无肾损害组联合检测阳性率高于血清Cys-C、尿α1-MG单独检测,差异有统计学意义(P0.05)。结论:血清Cys-C与尿α1-MG均可作为肾损害早期检测指标,联合检测可有效提高2型糖尿病肾损害早期患者阳性检出率。     

心脏X综合征患者血清对氧磷酶1活性变化及阿托伐他汀的干预作用

目的:探讨血清对氧磷酶-1(PON-1)活性水平的变化在心脏x综合征(CSX)发病机制中的作用及阿托伐他汀对其的影响.方法:选取健康体检者30例为对照组,CSX患者64例,非心脏X综合征(NCSX)组患者32例:(1)观察各组血清PON-1活性;(2)64例CSX患者随机分为对照组(n=32,常规治疗)和治疗组(n=32,在常规治疗基础上加用阿托伐他汀20 mg睡前),观察两组治疗前后血清PON-1活性.结果:CSX患者血清PON-1活性明显低于健康对照组和NCSX组(均P＜0.01).CSX组中治疗组治疗后血清PON-1活性明显高于CSX组中对照组治疗后(P＜0.01).结论:PON-1活性降低与CSX的发生有一定关系,阿托伐他汀可升高CSX患者血清PON-1活性.     

血清基质金属酶-2和胱抑素C在糖尿病肾病中的诊断价值

目的 探讨2型糖尿病患者(T2DM)血清基质金属蛋白酶-2(MMP-2)及胱抑素C(CysC)的水平在糖尿病肾病(DN)发生与发展中的诊断价值.方法 根据尿清蛋白排泄率(UAER),将63例2型糖尿病患者分为3组:正常清蛋白尿组26例;微量清蛋白尿组21例;大量清蛋白尿组16例.健康体检者为健康对照组(20例).采用酶联免疫吸附法(ELISA)测定血清MMP-2,用免疫比浊法检测血清CysC水平.结果 糖尿病患者各组血清MMP-2水平均低于健康对照组,大量清蛋白尿组的MMP-2水平与健康对照组和微量清蛋白尿组相比明显降低,差异有统计学意义(P<0.05).糖尿病患者各组血清CysC水平均高于健康对照组,大量清蛋白尿组的CysC水平明显高于正常清蛋白尿组和微量清蛋白尿组,差异有统计学意义(P<0.05).结论 血清MMP-2可能参与了DN的发生与发展,血清CysC水平随病情的发展逐渐升高,对于DN的早期诊断具有重要意义.     

血清HE4和胱抑素C在妊娠性糖尿病肾病早期诊断的临床价值

目的探讨人血清附睾蛋白(HE4)及胱抑素C(CysC)在妊娠性糖尿病肾病早期诊断的应用价值。方法选取妊娠性糖尿病患者(GDM组)60例,健康妊娠孕妇(健康对照组)40例,根据尿白蛋白排泄率(UAER),依照Mogensen分期将GDM患者分为单纯GDM组、早期肾病组及临床肾病组,分别检测各组血清HE4、CysC、尿素(BUN)、肌酐(Cr)及尿微量白蛋白(mALB)水平,并对结果进行统计分析。结果 GDM组血清HE4、CysC和尿mALB水平明显高于对照组,差异具有统计学意义(P0.05),且GDM各组间血清HE4、CysC和尿mALB水平差异均具有统计学意义(P0.05),与对照组相比,单纯GDM组血清HE4、CysC和尿mALB水平升高不明显(P0.05);临床肾病组血清BUN、Cr水平与其他各组比较,差异均有统计学意义(P0.05),而在单纯GDM组、早期肾病组和对照组之间比较,差异均无统计学意义(P0.05);GDM组血清HE4及CysC与血清BUN、Cr及和尿mALB均呈正相关;GDM早期肾病组和临床肾病组血清HE4的敏感度为72.73%和88.89%,CysC的敏感度为68.18%和86.11%,联合检测的敏感度为89.14%和98.45%。结论妊娠性糖尿病肾病早期肾损伤时血清HE4显著升高,并与肾功能损伤程度呈正相关,表明HE4可能与妊娠性糖尿病肾病发生发展有关,其与血清CysC联合检测可能对妊娠糖尿病肾病早期诊断及病情监测具有重要临床价值。     

血清胱抑素C和尿微量清蛋白联合检测在糖尿病早期肾损伤诊断中的意义

目的探讨血清胱抑素C（CysC）和尿微量清蛋白（mALB）联合检测对糖尿病早期肾损伤的诊断价值。方法对81例2型糖尿病患者根据尿清蛋白排泄率的不同分为A组和B组,40例健康体检者为对照组,采用免疫比浊法分别检测血清CysC和mALB水平。结果糖尿病B组患者血清CysC和mALB水平均高于糖尿病A组和健康对照组患者,差异有统计学意义（P〈0.05）,糖尿病B组患者血清CysC水平与mALB水平呈正相关,糖尿病患者联合检测的阳性率明显高于单项检测,差异有统计学意义（P〈0.05）。结论血清CysC和mALB可作为反映糖尿病患者肾功能早期损伤情况的指标,联合检测对及时准确地诊断糖尿病早期肾损伤有重要的临床诊断价值。     

超敏C-反应蛋白联合胱抑素C检测诊断2型糖尿病肾病的临床价值

目的探讨血清超敏C-反应蛋白(hs-CRP)联合血清胱抑素C(CysC)检测在2型糖尿病肾病(DN)的临床意义。方法分别对50例2型糖尿病肾损害患者(糖尿病肾损害组)和55例健康体检者(对照组)血清胱抑素C(CysC)、尿素(Urea)、肌酐(Cr)、hs-CRP水平进行检测。结果 2型糖尿病肾损害患者CysC、Urea、Cr、hs-CRP水平明显高于对照组,差异均有统计学意义(P0.01),CysC与hs-CRP联合检测阳性率与其各单项检测比较差异有统计学意义(P0.05),联合检测阳性率明显高于各单项检测。结论胱抑素C及血清hs-CRP是糖尿病肾损害敏感指标,联合检测对及时准确地诊断糖尿病肾损害有重要的临床价值。     

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.