磁共振质子波谱与利物浦痫性发作严重程度量表对痫性脑损伤程度评估的一致性比较

目的：评价磁共振质子波谱和利物浦痫性发作严重程度量表反映的痫性脑损伤程度是否一致，为颞叶癫痫的早期诊断治疗提供依据。方法：选择2003-10／2004-03在武汉大学中南医院收治颞叶癫痫患者11例，以11例健康自愿者为正常对照组。所有被试者进行常规头颅MRI检查后，采用磁共振质子波谱检测其双侧近中颞叶脑组织，半定量分析N-乙酰天门冬氨酸、肌酸．胆碱复合物、乳酸等化学物质；比较MRI与磁共振质子波谱对致病灶侧的早期检出率；并采用利物浦痫性发作严重程度量表（分值在0～100，分值越高说明发作程度越重）评估痫性发作严重程度；同时观察N-乙酰天门冬氨酸／（肌酸＋胆碱复合物）比值与痫性发作严重程度的相关性。结果：按意向处理分析，22例被试者均进入结果分析。①N-乙酰天门冬氨酸／（肌酸＋胆碱复合物）比值：癫痫组致病灶侧明显低于对侧和正常对照组（0．522&;#177;0．031，0．749&;#177;0．034，0．754&;#177;0．039，P〈0．01）；致病灶对侧与正常对照组无差异（P〉0．05）。②对致病灶侧的早期检出率：磁共振质子波谱较磁共振高（100％比63．64％，P〈0．05）。③致病灶侧N-乙酰天门冬氨酸／（肌酸＋胆碱复合物）比值与利物浦痫性发作严重程度量表得分具有显著相关性（r=0．969）。结论：与磁共振成像相比，磁共振质子波谱能早期、准确地反映癫痫发作造成的脑损伤，利物浦痫性发作严重程度量表评分与N-乙酰天门冬氨酸／（肌酸＋胆碱复合物）比值能一致反映痫性脑损伤的严重程度。     

质子磁共振波谱和长程脑电图对颞叶癫痫的评估作用比较

目的：探讨质子磁共振波谱分析和脑电图监测对颢叶癫痫病灶定侧的判定价值。方法：选择12例颢叶癫痫患者为观察对象，为苏州大学附属第一医院2003-01／12收治。分别采样双侧近中颢叶质子磁共振波谱，对氮-乙酰天冬氨酸、肌酸、胆碱复合物进行半定量分析，以氮-乙酰天冬氨酸减少／或肌酸+胆碱复合物的增加以及其比值下降定侧判断癫痫灶。所有病例均做长程脑电图监测。结果：按意向处理分析，12例患者均完成了测试。①10例显示-侧氮-乙酰天冬氨酸／(肌酸+胆碱复合物)&;lt;0．68，并与对侧差别&;gt;7％，可以定侧。②脑电图异常9例，其中8例为单侧异常，1例双侧异常。③8例质子磁共振波谱和脑电图定侧一致。脑电图阴性3例中2例质子磁共振波谱可以定侧。结论：质子磁共振波谱在颢叶癫痫定侧诊断方面有较高的敏感性，与脑电图结合可提高定侧诊断的可靠性。     

磁共振质子波谱与利物浦痫性发作严重程度量表对痫性脑损伤程度评估的一致性比较

目的:评价磁共振质子波谱和利物浦痫性发作严重程度量表反映的痫性脑损伤程度是否一致,为颞叶癫痫的早期诊断治疗提供依据。方法:选择2003-10/2004-03在武汉大学中南医院收治颞叶癫痫患者11例,以11例健康自愿者为正常对照组。所有被试者进行常规头颅MRI检查后,采用磁共振质子波谱检测其双侧近中颞叶脑组织,半定量分析N-乙酰天门冬氨酸、肌酸、胆碱复合物、乳酸等化学物质;比较MRI与磁共振质子波谱对致痫灶侧的早期检出率;并采用利物浦痫性发作严重程度量表(分值在0～100,分值越高说明发作程度越重)评估痫性发作严重程度;同时观察N-乙酰天门冬氨酸/(肌酸+胆碱复合物)比值与痫性发作严重程度的相关性。结果:按意向处理分析,22例被试者均进入结果分析。①N-乙酰天门冬氨酸/(肌酸+胆碱复合物)比值:癫痫组致痫灶侧明显低于对侧和正常对照组(0.522±0.031,0.749±0.034,0.754±0.039,P<0.01);致痫灶对侧与正常对照组无差异(P>0.05)。②对致痫灶侧的早期检出率:磁共振质子波谱较磁共振高(100%比63.64%,P<0.05)。③致痫灶侧N-乙酰天门冬氨酸/(肌酸+胆碱复合物)比值与利物浦痫性发作严重程度量表得分具有显著相关性(r=0.969)。结论:与磁共振成像相比,磁共振质子波谱能早期、准确地反映癫痫发作造成的脑损伤,利物浦痫性发作严重程度量表评分与N-乙酰天门冬氨酸/(肌酸+胆碱复合物)比值能一致反映痫性脑损伤的严重程度。     

儿童局灶性颞叶癫痫：3.0T 1H-MRS及MR海马容积分析

目的：探讨3.0T氢质子磁共振波谱(1H-MRS)与磁共振容积测量（vMR）对儿童局灶性颞叶癫痫（fTLE）的诊断价值及临床相关因素分析。材料与方法：对30例经24小时动态脑电图确诊的fTLE患儿（年龄5～14岁,平均8.5岁）行3.0T 1H-MRS分析及vMR测量,并以随机的30名儿童（年龄5～14岁,平均8.8岁）对照,计算患者组双侧海马区代谢产物氮-乙酰天门冬氨酸（NAA）/肌酸（Cr）及海马容积、对照组任一侧海马NAA/Cr及容积,比较患儿病灶侧与病灶对侧、病灶侧与对照组、病灶对侧与对照组之间有否差异。分析癫痫发作频率等临床相关因素与海马萎缩的相关性。结果：患儿病灶侧海马区NAA/Cr（1.47±0.24）较病灶对侧（1.79±0.35）及对照组（1.81±0.27）明显减低,而病灶对侧NAA/Cr与对照组差异不明显;患儿病灶侧海马容积（2.75±0.35）较病灶对侧（3.06±0.46）和对照组（3.11±0.17）亦明显减小(对照组NAA/Cr值及海马容积参考值范围为标准）。此外,fTLE患儿癫痫发作频率与病灶侧海马容积缩小不具有相关性,而热惊厥史对海马体积具有显著影响。结论：3.0T 1H-MRS及vMR测量对儿童局灶性颞叶癫痫病灶具有定位作用,并且能够定量反映患儿海马代谢性异常及形态学改变,是为临床诊治提供可靠依据的无创性检查手段。     

质子磁共振波谱和长程脑电图对颞叶癫痫的评估作用比较

目的:探讨质子磁共振波谱分析和脑电图监测对颞叶癫痫病灶定侧的判定价值。方法:选择12例颞叶癫痫患者为观察对象,为苏州大学附属第一医院2003-01/12收治。分别采样双侧近中颞叶质子磁共振波谱,对氮-乙酰天冬氨酸、肌酸、胆碱复合物进行半定量分析,以氮-乙酰天冬氨酸减少/或肌酸+胆碱复合物的增加以及其比值下降定侧判断癫痫灶。所有病例均做长程脑电图监测。结果:按意向处理分析,12例患者均完成了测试。①10例显示一侧氮-乙酰天冬氨酸/(肌酸+胆碱复合物)<0.68,并与对侧差别>7%,可以定侧。②脑电图异常9例,其中8例为单侧异常,1例双侧异常。③8例质子磁共振波谱和脑电图定侧一致。脑电图阴性3例中2例质子磁共振波谱可以定侧。结论:质子磁共振波谱在颞叶癫痫定侧诊断方面有较高的敏感性,与脑电图结合可提高定侧诊断的可靠性。     

改良质子磁共振波谱技术观察帕金森病患者黑质内神经代谢的改变

目的：使用改良质子磁共振波谱技术，观察原发性帕金森病患者黑质内生物化学代谢物改变，并为该技术在帕金森病病理生理研究和临床诊断中的运用提供理论依据。方法：选择2004-01／2005-04在四川大学华西医院门诊和住院部，依据1984年全国锥体外系疾病讨论制定的诊断标准确诊的原发性帕金森病患者29例，作为帕金森病组。同期纳入年龄大于40岁的健康志愿者29名，为正常对照组。均于四川大学华西医院放射科完成黑质磁共振波谱检测。帕金森病组与正常对照组间年龄、性别分布基本一致，除帕金森病外无其他中枢神经系统相关疾病病史。所有受检者在参与实验前均被告知相关事宜并取得受检者同意。采用多体素质子磁共振波谱技术，检测两组脑黑质N-乙酰天门冬氨酸、含胆碱化合物和肌酸浓度水平，比较两组间上述代谢物浓度及N-乙酰天门冬氨酸／含胆碱化合物、N-乙酰天门冬氨酸／肌酸、含胆碱化合物／肌酸比值的差别，并进一步分析其与帕金森病病理及病理生理过程之间相关性。结果：58例实验对象的黑质磁共振波谱信息全部纳入结果分析。原发性帕金森病患者黑质内N-乙酰天门冬氨酸／含胆碱化合物、N-乙酰天门冬氨酸／肌酸、含胆碱化合物／肌酸比值水平与正常对照组之间差异不显著（P〉0．05）；帕金森病患者黑质内N-乙酰天门冬氨酸和含胆碱化合物水平较正常对照明显降低（P〈0．05）。结论：多体素质子磁共振波谱技术能够更准确检测活体内神经生物化学代谢改变，可为帕金森病的临床诊断和病理生理研究提供有利依据。     

老年痴呆患者海马代谢的磁共振波谱分析

目的探讨利用氢质子磁共振波谱技术研究老年痴呆患者海马代谢变化的临床意义。方法入组者均符合老年痴呆的诊断标准,并排除其他因素引起的痴呆及混合性痴呆,同时选择年龄、性别相匹配的健康志愿者作为正常对照组分别进行常规MRI和磁共振波谱检查,获得双侧海马区N-乙酰天冬氨酸/肌酸、胆碱化合物/肌酸和肌醇/肌酸比值,进行统计学分析。结果正常对照组双侧海马区N-乙酰天冬氨酸/肌酸、胆碱化合物/肌酸和肌醇/肌酸比值差异无统计学意义（均P〉0.05）。老年痴呆组患者左侧海马区肌醇/肌酸比值高于右侧（P〈0.01）,且均高于正常对照组（P左〈0.01,P右〈0.05）,左侧N-乙酰天冬氨酸/肌酸比值低于右侧（P〈0.05）,且均低于正常对照组（P左〈0.01,P右〈0.01）。但胆碱复合物/肌酸比值差异无统计学意义（均P〉0.05）。结论氢质子磁共振波谱成像可显示老年痴呆患者海马的代谢改变,有助于老年痴呆发生风险的预测。     

改良质子磁共振波谱技术观察帕金森病患者黑质内神经代谢的改变

目的:使用改良质子磁共振波谱技术,观察原发性帕金森病患者黑质内生物化学代谢物改变,并为该技术在帕金森病病理生理研究和临床诊断中的运用提供理论依据。方法:选择2004-01/2005-04在四川大学华西医院门诊和住院部,依据1984年全国锥体外系疾病讨论制定的诊断标准确诊的原发性帕金森病患者29例,作为帕金森病组。同期纳入年龄大于40岁的健康志愿者29名,为正常对照组。均于四川大学华西医院放射科完成黑质磁共振波谱检测。帕金森病组与正常对照组间年龄、性别分布基本一致,除帕金森病外无其他中枢神经系统相关疾病病史。所有受检者在参与实验前均被告知相关事宜并取得受检者同意。采用多体素质子磁共振波谱技术,检测两组脑黑质N-乙酰天门冬氨酸、含胆碱化合物和肌酸浓度水平,比较两组间上述代谢物浓度及N-乙酰天门冬氨酸/含胆碱化合物、N-乙酰天门冬氨酸/肌酸、含胆碱化合物/肌酸比值的差别,并进一步分析其与帕金森病病理及病理生理过程之间相关性。结果:58例实验对象的黑质磁共振波谱信息全部纳入结果分析。原发性帕金森病患者黑质内N-乙酰天门冬氨酸/含胆碱化合物、N-乙酰天门冬氨酸/肌酸、含胆碱化合物/肌酸比值水平与正常对照组之间差异不显著(P>0.05);帕金森病患者黑质内N-乙酰天门冬氨酸和含胆碱化合物水平较正常对照明显降低(P<0.05)。结论:多体素质子磁共振波谱技术能够更准确检测活体内神经生物化学代谢改变,可为帕金森病的临床诊断和病理生理研究提供有利依据。     

磁共振氢波谱显示海洛因海绵状白质脑病的特征

背景:以往磁共振波谱研究多用点解析波谱或单体素波谱,其兴趣区主要集中在MRI可见的病灶区,不能显示病灶边缘区的改变状况,而化学位移成像磁共振氢波谱(1H-MRS)检测方法可将检测范围扩大至整个脑部区域。目的:观察海洛因海绵状白质脑病患者的1H-MRS表现,分析其脑内N-乙酰天门冬氨酸、肌酸和胆碱的代谢规律。设计:病例-对照观察。单位:南方医院神经内科。对象:病例组为2005-08/2006-08南方医院神经内科收治的,经临床和影像诊断的海洛因海绵状白质脑病3例(男2例,女1例),对照组为10例同龄健康志愿者。方法:使用Siemens Megnetom Vision Plus1.5T超导MR系统和标准头部线圈,应用化学位移成像法对所有受试者行1H-MRS检查。主要观察指标:观察额、顶和枕叶白质中N-乙酰天门冬氨酸、肌酸和胆碱的水平、代谢图以及它们之间的比例关系。结果:13例受试者均进入结果分析。①N-乙酰天门冬氨酸:病例1的额、顶和枕叶白质低于对照组(79.50±21.65,96.75±16.14,77.05±22.47;146.07±15.49,117.77±14.56,120.83±16.02;P<0.05,0.01),病例2、病例3的顶叶白质低于对照组(87.50±7.89,80.65±11.73,P<0.01)。②肌酸:病例组和对照组无显著性差异(P>0.05)。③胆碱:除病例1额叶白质以外,病例组中均低于对照(P<0.01)。④病例组N-乙酰天门冬氨酸/肌酸比值在各部位均较对照降低,而胆碱/肌酸降低更明显。⑤病灶处N-乙酰天门冬氨酸和肌酸在代谢图中均为低信号。⑥在病灶边缘区,胆碱/肌酸比值有明显反转现象。未见乳酸波。结论:1H-MRS发现海洛因海绵状白质脑病患者脑的物质代谢变化明显大于MRI病灶范围,病灶周围影像正常部位已经有代谢改变。     

颞叶癫痫的质子磁共振波谱与PET/CT及术后病理对照研究

目的：对颞叶癫痫患者术前的质子磁共振波谱（1H MRS）与正电子发射断层扫描（PET/CT）、脑电图（EEG）及术后病理进行对照研究，评价1H MRS对颞叶癫痫的诊断价值。方法：16例颞叶癫痫病人，术前均做发作期间脑电图和/或长程脑电图监测及PET/CT检查。对28例健康志愿者和16例患者分别进行双侧海马的1H MRS采集，定量分析N-乙酰天门冬氨酸（NAA）、肌酸（Cr）和胆碱（Cho）代谢物的变化。3例患者手术切除致痫灶送病检。结果：病侧组、对侧组和对照组的NAA/Cr、Cho/Cr和NAA/（Cho+Cr）值之间的差异均有统计学意义（P<0.05）。16例患者中5例为单侧异常，11例为双侧异常，14例可确定异常侧，定位敏感度87%。结论：患者1H MRS示病侧与EEG、PET和病理改变有较好的对应性，1H MRS不仅可以发现双侧病变，而且可以指出病变严重的一侧，为术前致痫灶的定位提供可靠的依据。     

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.