输血前老年住院患者梅毒血清学检测结果分析

目的：调查60岁以上老年住院患者输血前的梅毒血清学检测情况,并分析其在老年梅毒诊断中的临床价值。方法选取2011年1月1日至2012年2月22日阜阳市人民医院输血前做梅毒血清学检测的60岁以上老年住院患者8303例,用酶联免疫吸附试验（ELISA）筛查梅毒特异性抗体,阳性样本用梅毒螺旋体明胶凝集试验（TPPA）复查,两者均阳性判为梅毒螺旋体（TP）抗体阳性,并对其进行快速血浆反应素试验（RPR）和免疫印迹试验（WB）。结果8303例老年患者血清中,TP抗体阳性者109例,阳性率为1．31％;男性组阳性率（1．70％）明显高于女性组（0．85％）,90～99岁组阳性率（10．17％）明显高于其他老年组,差异均有统计学意义（P＜0．05）。RPR阳性率为39．45％,有38例滴度小于1∶8。随机抽取50例 T P抗体阳性样本,经 T P‐WB‐IgG确认,阳性符合率为70．0％,其TP‐WB‐IgM的阳性率为4．0％。结论老年住院患者 TP抗体阳性率高龄组高于低龄组,男性高于女性,多数为既往感染或隐性感染。     

快速血浆反应素试验及酶联免疫吸附试验在梅毒诊断中的应用

目的：梅毒早期诊断中,两种梅毒血清学检测方法在临床诊断中应用价值及评价。方法对该院2012年01月01日至2013年12月31日门诊体检、住院输血及进行术前检查者的共8813例血清标本采用酶联免疫吸附测定（ELISA ）进行梅毒螺旋体（TP）抗体（TP‐Ab）检测。对TP‐Ab为阳性的标本再用快速血浆反应素试验（RPR）进行检测;247例梅毒高危人群应医生要求同时检测RPR及TP‐Ab的ELISA检测（TP‐ELISA）。结果共计9060例患者中,TP‐ELISA（＋）RPR（＋）的患者89例,其中84例为梅毒确诊患者,5例患者为梅毒潜伏感染;TP‐ELISA（＋）RPR（－）的患者202例,其中26例为梅毒治愈患者,9例患者为梅毒感染早期,167例患者原因不明;TP‐ELISA（－）RPR（＋）的患者3例,都是RPR的生物学假阳性。结论 ELISA方法应用于梅毒的初筛,RPR试验用于梅毒治疗期间的疗效观察,联合两种方法对梅毒进行血清学检测有助于对梅毒的诊断和指导临床用药。     

血清程序性死亡分子-1水平与梅毒患者驱梅治疗效果的相关性探讨

目的 探讨血清程序性死亡分子-1(programmeddeath-1,PD-1)水平与梅毒患者驱梅治疗效果的相关性。方法 本研究采用回顾性研究方法,将2017年2月至2022年2月安徽省黄山市人民医院收治的86例梅毒患者作为研究对象,检测患者血清PD-1水平,常规驱梅治疗后接受为期6个月的随访,统计患者驱梅治疗效果,比较患者治疗前后血清PD-1水平变化情况。以血清PD-1水平四分位数分为四组,检验血清PD-1水平与梅毒患者驱梅治疗效果的相关性;绘制受试者工作特征（receiver operatingcharacteristic,ROC）曲线分析血清PD-1对驱梅治疗效果的预测价值。结果 86例梅毒患者治疗后血清PD-1水平为（33.28±3.14）ng/ml,低于治疗前（43.95±5.33）ng/ml,差异有显著性（P<0.05）。86例梅毒患者驱梅治疗无效15例,无效率为17.44%。治疗无效组患者治疗前血清PD-1水平为（48.36±4.14）ng/ml,明显高于治疗有效组患者（43.01±5.11）ng/ml,差异有显著性（P<0.05）。根据治疗前血清PD-1水平...     

获得性梅毒的葡萄膜炎临床特征和治疗

目的：分析获得性梅毒患者的葡萄膜炎（梅毒性葡萄膜炎）临床特征,观察其治疗效果。方法回顾性分析15例（22只眼）经临床及血清学检查确诊的梅毒性葡萄膜炎患者临床资料,确诊后均行驱梅治疗,并随诊观察6个月以上。结果15例（22只眼）患者中,男9例,女6例。发病年龄为（47．3±5．2）岁。7例患者为双眼发病,8例为单眼发病。病程2 d ～1．5年,平均病程2．2±1．6月。患者均以视力下降或眼前黑影飘动等为主诉就诊。初诊平均视力0．15±0．21;9例患者（14只眼,63．6％）表现为全葡萄膜炎,6例（8只眼,36．4％）表现为后葡萄膜炎、视神经视网膜炎。玻璃体均有尘状混浊,眼底检查视网膜色泽污浊灰暗,黄斑中心凹反射消失,13例（20只眼,90．9％）可见视盘充血或水肿,21只眼行眼底血管造影检查显示,所有患眼均有程度不等的斑驳状背景荧光增强改变,20只眼的视乳头有荧光素着染或渗漏,16只眼的视网膜静脉有荧光素渗漏,4只眼出现黄斑囊样水肿。经驱梅治疗半年后随访时,视力提高19只眼（86．4％）,所有患眼炎症消退。结论梅毒性葡萄膜炎是一种可以治愈的疾病,早期诊断、正规治疗后患者的预后较好。     

梅毒荧光吸收试验在早期梅毒和先天性梅毒诊断中的价值

[目的]探讨梅毒荧光吸收实验（FTA-ABS）对早期梅毒和先天性梅毒中的诊断价值。[方法]利用FTA-ABS、TPHA和RPR同时检测88例梅毒患者、74例非梅毒患者以及82例正常体检者的血清。[结果]3种实验的特异性分别为FTA-ABS 100％、TPHA 98．1％、RPR 92、9％，FTA-ABS与TPHA比较无显著性差异（P〉0．05），但高于RPR（P〈0．01）；3种实验的敏感性分别为FTA-ABS 96．6％、TPHA 88.6％、RPR 83．0％，FTA-ABS与TPHA、RPR比较有显著性差异（P〈0．05、P〈0．01）。对一期梅毒的敏感性为FTA-ABS 100％、TPHA 87.1％、RPR 83．9％；对二期梅毒的敏感性均为100％；对三期梅毒的敏感性为FTA-ABS 92.8％、TPHA 100％、RPR 92．8％；对先天性梅毒的敏感性为FTA-ABS 87.5％、TPHA 62．5％、RPR 43．8％，FFA-ABS与TPHA、RPR比较，诊断一期梅毒和先天性梅毒具有显著性差异（P〈0.05、P〈0.01），诊断二期和三期梅毒无显著性差异（P〉0．05）。[结论]FTA-ABS是诊断早期梅毒和先天性梅毒的敏感性指标。     

梅毒血清学检测方法的应用价值

目的：探讨梅毒血清学试验在梅毒诊断检测中的临床应用价值和意义。方法收集经临床确诊的梅毒血清10666及50683份健康体检阴性的血清样本。全部血清标本分别进行梅毒甲苯胺红不加热血清反应素试验（TRUST ）、梅毒螺旋体抗体酶联免疫吸附试验（TP-ELISA）、梅毒螺旋体明胶颗粒凝集试验（TPPA）,检测梅毒螺旋体抗体。结果3种方法检测10666份血清中,TRUST、TP-ELISA、TPPA 敏感度、特异度分别为72．01％、99．85％、99．88％及93．50％、99．96％、99．97％,TRUST敏感度与TP-ELISA及TPPA比较差别有统计学意义（χ2＝39．43,52．67,P＜0．01）,TP-ELISA敏感度及与 TPPA比较差别无统计学意义（χ2＝98．0,P＞0．05）。结论 TRUST、TP-ELISA、TPPA 3种方法的敏感性、特异性依次增高,对梅毒的诊断及早期诊断具有重要的临床应用价值。     

妊娠梅毒母婴阻断治疗效果及护理

目的探讨母婴阻断治疗及护理对妊娠梅毒患者的影响。方法采用回顾性方法对住院分娩的108例妊娠梅毒患者及婴儿资料进行随访分析,比较治疗与非治疗患者妊娠结局及新生儿预后情况。结果108例妊娠梅毒孕妇分娩孕周平均（38．22±1．795）周,早产5例占4．63％,治疗组足月产率98．51％高于未治疗组的90．24％,但差异无统计学意义（x2=2．29,P〉0．05）;治疗组孕妇分娩的先天梅毒患儿为4．48％少于未治疗组的29．27％,差异有统计学意义（x2=13．07,P〈0．01）;孕妇在孕期未行正规治疗或未治疗者,及新生儿诊为先天梅毒者,立即进行驱梅治疗,79．63％血浆反应素环状卡片试验（RPR）在1岁内全部转阴,79．41％梅毒螺旋体颗粒凝集试验（TPPA）在18个月内转阴,其余均为2～3年内转阴。结论加强妊娠梅毒孕妇的孕期保健和管理工作,做好宣传教育和婴儿的随访监测工作,对预防先天性梅毒及保证婴儿的健康成长有重要意义。     

76例潜伏梅毒患者及其性伴侣梅毒螺旋体血清学检测

目的了解潜伏梅毒患者及其性伴侣在血清学方面的异同。方法对76倒潜伏梅毒患者及其性伴侣进行梅毒甲苯胺红不加热血清学试验（TRUST）和梅毒螺旋体明胶凝集试验（TPPA）检测分析。结果潜伏梅毒患者女性明显高于男性,由于性伴侣检出梅毒而追踪发现的仅有24例,占24．0％,76例潜伏梅毒患者中,血清TRUST滴度介于1：2～1：64之间,性伴侣血清TRUST滴度介于1：2～1：32之间,3个月后复查TRUST滴度明显下降,1年后TRUST转阴。结论必须加强对潜伏梅毒患者的筛查和性伴侣的追查,同时对确诊患者进行血清学评估和治疗,对减少梅毒的发病率及降低艾滋病的感染率有重要意义。     

免疫相关因素与梅毒血清固定的研究进展

梅毒是由梅毒螺旋体（treponema pallidum,TP）感染引起的一种慢性全身性经典性传播疾病,可侵犯全身各组织器官,造成多器官的损害,亦可通过胎盘传播引起流产、早产、死产、胎传梅毒等。部分梅毒患者经过正规驱梅治疗后,梅毒血清反应素抗体可在1～2年内转阴;但有部分患者的梅毒血清反应素抗体滴度下降至一定水平（一般≤1∶8）后不再变化,即梅毒血清固定现象。有学者认为梅毒血清固定与以下因素有关[1]：疾病早期未得到及时的诊断和治疗;梅毒病期、类型、开始治疗的时间早晚;曾有过复发或再感染;体内仍有潜在的病灶存在;无症状神经梅毒及合并其他疾病。近年来研究显示血清固定现象和患者机体的免疫反应有密切关系。本文主要从免疫学角度对免疫相关因素与梅毒血清固定的关系作一简要综述。     

早期先天性梅毒62例临床分析

【目的】分析早期先天性梅毒临床表现,随访其治疗效果。【方法】对62例确诊为早期先天性梅毒患儿资料进行分析与随访。【结果】青霉素治疗后,临床症状好转率达100％,28例获得随访,快速血浆反应素试验(RPR)3个月阴转率3．6％,6个月阴转率71．4％,12个月阴转率92．4％,骨损害恢复正常时间1年左右。【结论】早期先天性梅毒早期诊断后及时正规的“驱梅”治疗,疗效佳,预后好。     

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.     

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.