sIL-33联合CEA、CA19-9检测对结直肠癌的诊断价值

目的研究结直肠癌(CRC)患者血清白介素-33(s IL-33)水平,评价其对CRC诊断的临床意义。方法收集121例CRC患者的术前血清标本与临床病理资料,以81例体检健康者、33例肠息肉患者作为对照。用ELISA法检测s IL-33含量,分析其与临床病理参数的关系,并采用ROC曲线、Logistic回归分析比较s IL-33、CEA和CA19-9单独检测或3者联合检测的诊断价值。结果 CRC患者s IL-33含量[172.44(108.08,321.57)pg/m L]显著高于肠息肉组[67.31(37.72,130.44)pg/m L]和体检健康组[71.73(36.80,85.53)pg/m L],差异有统计学意义(P均0.01)。s IL-33与CRC的分化程度、肿瘤部位有关,差异有统计学意义(P均0.01)。s IL-33、癌胚抗原(CEA)和糖链抗原19-9(CA19-9)3者联合检测的敏感性(80.99%)、准确率(86.38%)和曲线下面积AUCROC(0.933 4)均比单独检测高,其特异性(92.11%)也处于较高水平,具有较好的诊断价值。结论s IL-33、CEA和CA19-9 3者联合检测对CRC诊断具有较好的临床应用价值,可作为潜在的血清学标志物。     

血清SCC、CEA、CA125与CA19-9水平联合检测对早期宫颈癌患者诊断准确率的影响

目的:探讨血清糖类抗原19-9(CA19-9)、CA125、癌胚抗原(CEA)、鳞状细胞癌抗原(SCC)水平联合检测对早期宫颈癌患者诊断准确率的影响。方法:选取我院2015年11月—2017年12月71例宫颈癌患者设为恶性组、71例宫颈良性病变患者设为良性组,另选取同期健康体检者71例设为对照组。抽取所有受检者空腹静脉血,经酶联免疫吸附法测定血清CA19-9、CA125、CEA、SCC水平,对比三组及恶性组不同病理类型患者血清肿瘤标志物水平,并统计CA19-9、CA125、CEA、SCC单独及联合诊断宫颈癌价值。结果:三组血清CA19-9、CA125、CEA、SCC水平间存在明显差异(P0.05),且恶性组各指标水平高于良性组及对照组(P0.05);腺癌患者血清CA19-9、CA125、CEA水平高于鳞癌患者,腺癌患者SCC水平低于鳞癌患者(P0.05);联合诊断敏感度(90.14%)、准确度(93.43%)高于CA19-9、CA125、CEA、SCC(P0.05)。结论:联合SCC、CEA、CA125、CA19-9诊断宫颈癌可提高敏感度及准确度,且利于鉴别宫颈癌病理类型。     

结直肠癌患者血清富含半胱氨酸蛋白61水平及其临床诊断价值研究

目的探讨血清富含半胱氨酸的血管生成诱导因子61(Cyr61)水平用于结直肠癌(CRC)患者辅助诊断的临床价值。方法回顾性纳入该院2014年2月至2017年10月就诊的初治CRC患者87例(CRC组),同时纳入结直肠腺瘤患者42例(结直肠腺瘤组)及体检健康者43例(健康对照组)。所有患者就诊时记录一般情况,检测血清Cyr61、癌胚抗原(CEA)及糖类抗原19-9(CA19-9)水平,使用受试者工作特征曲线(ROC曲线)评估Cyr61的诊断价值。结果CRC组Cyr61水平[(204.26±65.04)pg/mL]显著高于结直肠腺瘤组[(127.11±41.81)pg/mL]及健康对照组[(118.03±42.98)pg/mL],差异有统计学意义(P0.05)。CRC组不同临床分期患者Cyr61水平由高至低为Ⅳ期[(243.28±69.28)pg/mL]、Ⅲ期[(207.39±57.85)pg/mL]、Ⅰ~Ⅱ期[(172.94±48.58)pg/mL]。CRC组患者血清Cyr61水平与CEA(r=0.473,P0.05)及CA19-9(r=0.518,P0.05)、TNM分期(r=0.482,P0.05)呈显著正相关。区别诊断CRC与结直肠腺瘤时,Cyr61、CEA及CA19-9的ROC曲线下面积(AUC)分别为0.761、0.751及0.747,Cyr61+CEA+CA19-9的AUC为0.842;区别CRC与健康对照组时,Cyr61、CEA及CA19-9的AUC分别为0.866、0.831及0.818,Cyr61+CEA+CA19-9的AUC为0.924。结论血清Cyr61水平在CRC中存在显著升高,且Cyr61单独或联合常规指标用于CRC的筛查诊断具有良好的临床价值。     

血清TK1、CEA、CA19-9检测在胃癌诊断中的应用及与胃癌病理特征的相关性

目的 研究血清胸苷激酶1(TK1)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)检测在胃癌诊断中的应用及与胃癌病理特征的相关性。方法 选取武功县人民医院2020年收治的80例胃癌患者为胃癌组,同期80例胃良性病变患者为良性病变组,50例健康体检者为对照组,检测并比较3组血清TK1、CEA、CA19-9水平;比较不同病理特征胃癌患者血清TK1、CEA、CA19-9水平;绘制受试者工作特征曲线评估血清TK1、CEA、CA19-9单独及联合检测对胃癌的诊断效能;利用Spearman相关分析血清TK1、CEA、CA19-9与胃癌病理特征的相关性。结果 胃癌组血清TK1、CEA、CA19-9水平高于良性病变组及对照组,差异有统计学意义(P<0.05)。血清TK1、CEA、CA19-9联合检测诊断胃癌的曲线下面积为0.888,灵敏度为97.50%,特异度为96.25%。随着分化程度的升高,胃癌患者血清TK1、CEA、CA19-9水平逐渐下降,差异有统计学意义(P<0.05);随着TNM分期的升高,胃癌患者血清TK1、CEA、CA19-9水平逐渐升高,差异有统计学意义(P<...     

围术期CEA及CA19-9检测水平对结直肠癌术前分期及术后预后的影响

目的探讨围术期癌胚抗原(CEA)及糖类抗原19-9(CA19-9)检测水平对结直肠癌的术前分期及术后预后的价值。方法回顾性分析该院2013年1月至2014年6月收治的病理检查结果为结直肠腺癌的患者275例的临床资料,包括术前和术后血清CEA和CA19-9水平及临床病理检查资料和预后情况。结果术前血清CEA和CA19-9水平与肿瘤TNM分期、淋巴结转移、浸润深度相关。术前及术后CEA水平与患者3年无进展生存期、总生存期相关。结论术前CEA及CA19-9可辅助诊断结直肠癌,血清CEA水平对结直肠癌患者的预后有一定预测价值,且对病理分期有一定参考价值。     

血清CEA、CA19-9、CA724联合检测对胃癌的诊断价值

目的探讨血清癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原724(CA724)联合检测对胃癌的诊断价值。方法选择胃癌患者、胃部良性疾病患者和健康体检者,各40例,分别设为胃癌组、良性组和对照组。应用放射免疫分析法检测3组患者血清CEA、CA19-9、CA724水平。结果胃癌组血清CEA、CA19-9、CA724水平均显著高于良性组和对照组(P0.01);胃癌组CEA、CA19-9、CA724联合检测阳性检出率显著高于任何一种标志物单独检测(P0.05或P0.01);联合检测的灵敏度高于血清CEA、CA19-9、CA724单独检测,差异有统计学意义(P0.05或P0.01)。结论血清CEA、CA19-9、CA724水平对于胃癌的诊断具有重要意义,联合检测可提高诊断灵敏度。     

肿瘤标志物联合检测对胰腺癌的诊断价值

目的 探讨与胰腺癌发生、发展有密切关系的血清糖类抗原19-9(CA19-9)、糖类抗原242 (CA242)以及癌胚抗原(CEA)等肿瘤标志物对于胰腺癌诊断的临床价值.方法 2010年5月至2012年5月,病理证实的30例胰腺癌患者为观察组,以同期30例健康体检者为对照组,采用RIA法,根据试剂盒操作要求,进行血清CA19-9、CA242以及CEA的检测.结果 与对照组相比,观察组患者血清CA19-9、CA242以及CEA水平明显升高,差异有统计学意义(P＜0.05).肿瘤标志物单一诊断时,CA19-9的诊断价值相对较高,而CEA的诊断价值最差,而联合检测时,其敏感性达到93.3％,特异性为67.7％.结论 血清CA19-9、CA242以及CEA等肿瘤标志物联合检测,可以为胰腺癌诊断提供特异性、高效的理论依据.     

4种肿瘤标志物联合检测诊断肺癌的价值分析

目的探讨血清癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原125(CA125)联合神经特异性烯醇化酶(NSE)检测诊断肺癌的价值。方法将病理确诊的48例肺癌患者和40例肺部良性病变患者分别为肺癌组和良性病变组,另选取同期门诊常规体检的35名健康人设为健康组。比较3组受试者血清CEA、CA19-9、CA125和NSE水平,分析CEA、CA19-9、CA125和NSE联合检测诊断肺癌的敏感度、特异度和准确度。结果肺癌组血清CEA、CA19-9、CA125、NSE水平均显著高于良性病变组和健康组(P 0.05)。TNMⅢ～Ⅳ期患者血清CEA、CA19-9、CA125、NSE水平均显著高于TNMⅠ～Ⅱ期患者(P 0.05)。血清CEA、CA19-9、CA125、NSE联合检测诊断肺癌的敏感度、准确度均显著高于各指标单项检测(P 0.05),而联合检测与单项检测的特异度差异无统计学意义(P 0.05)。结论血清CEA、CA19-9、CA125、NSE联合检测诊断肺癌的敏感度、准确度均较高,可为临床筛查、诊断提供可靠依据。     

血清CEA、CA199、CA72-4和CA125水平在胃癌临床病理分期中的价值分析

[目的]探讨胃癌患者血清中糖类抗原199(CA199)、糖类抗原72-4(CA72-4)、糖类抗原125(CA125)、癌胚抗原(CEA)的表达水平在胃癌临床诊断中的价值.[方法]选取本院收治的200例胃癌患者、60 例胃良性病变患者及60 例健康体检者为研究对象,检测三组血清中CEA、CA19-9、CA72-4、CA125 四项指标的浓度,分析其肿瘤标记物与胃癌临床病理的关系.[结果]胃癌组患者血清CEA、CA19-9、CA72-4、CA125含量明显高于胃良性病变组及健康对照组,差异有统计学意义(P<0.05);胃癌组四种肿瘤标志物的血清学水平随着分期的升高而升高,CA199和CA72-4在Ⅰ期和Ⅱ期的两组间比较,差异无统计学意义(P>0.05),其余各指标各组间比较显示差异有统计学意义(P<0.05);四种肿瘤标志物联合检测的灵敏度和特异度分别为 88.7％ 和 82.2％,其灵敏度明显高于单项检测,统计分析显示差异有统计学意义(P<0.05).[结论]联合检测CEA、CA19-9、CA72-4、CA125肿瘤标志物可提高胃癌诊断的灵敏度,在判断胃癌临床病理分期方面有重要价值.     

血清肿瘤标志物检测在肺癌诊断中的意义

目的探讨肿瘤标志物在肺癌患者血清中的水平及其在肺癌鉴别诊断中的价值。方法应用放射免疫法和酶联免疫法、化学发光法检测98例肺癌患者、30例肺良性病变患者及42例健康者的血清中糖类抗原125(CA125)、糖类抗原15-3(CA15-3)、糖类抗原19-9(CA19-9)、细胞角蛋白19片段(Cyfra21-1)、神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、鳞癌抗原(Scc)的水平。结果肺癌组血清7项肿瘤标志物含量均高于肺良性病变组及健康组;CEA、CA15-3、CA125在肺腺癌中的水平最高,NSE在肺小细胞癌中的水平最高,CYFRA2-1在肺鳞癌中的水平最高,5项联合检测肺鳞癌、肺腺癌、肺小细胞癌的一项阳性率可分别达97.7%、100.0%、95.6%。结论各项肿瘤标志物对肺癌的检测都有一定意义,不同病理类型各有特点,联合检测多种肿瘤标志物可以提高肺癌诊断的敏感性,同时对于确定其临床分期和鉴别病理类型具有一定的意义。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.