补充多种维生素对血浆同型半胱氨酸水平的影响

目的通过我院干部体检资料的分析,探讨补充多种维生素(多Vit)对血浆同型半胱氨酸(Hcy)水平的影响。方法对1999年度我院干部体检中的正常组589例和1999年4月～2000年10月间住院中的冠心病组179例,用酶联免疫法测定血浆Hcy浓度,电化学发光法测定血清叶酸、VitB12水平,同时调查其是否服用含叶酸的多Vit。结果1.正常组(1)服多Vit组,血清叶酸水平明显高于未服组,而血浆Hcy水平明显低于未服组,血清VitB12水平两组间无明显差异。(2)服用多Vit组,血浆Hcy水平≥15μmol/L者的比例明显低于未服用多Vit组。2.冠心病组(1)Hcy水平明显高于正常组,叶酸水平明显低于正常组,VitB12水平两组间无明显差异。(2)血浆Hcy水平,急性心肌梗死组和心绞痛组明显高于陈旧性心肌梗死组。(3)除心绞痛组,服用多Vit者叶酸水平明显高于未服用者外,冠心病其余二组服用多Vit者Hcy、叶酸、VitB12水平均无显著差异。结论服用含叶酸的多Vit对血浆Hcy水平有明显影响。服用多Vit可提高血清叶酸水平,使正常组血浆Hcy水平降低,减少冠心病的患病率,但对已患有冠心病者补充多Vit对血浆Hcy水平无明显影响。     

同型半胱氨酸与冠状动脉病变的相关性

目的　探讨同型半胱氨酸 (Hcy)与冠状动脉病变的相关性及其致病机制。方法　测定 98冠心病患者和 6 7例对照组血浆Hcy、VitB1 2 、叶酸、内皮素和血清NO。计算冠心病患者的冠脉病变的Gensini积分。结果　 (1)血浆Hcy与VitB1 2 、叶酸均呈负相关 (r=- 0 4 0 7,r =- 0 338,P <0 0 1) ;(2 )冠心病组患者血浆Hcy高于对照组 [(14 12± 4 78) μmol/L ,和 (9 6 2± 2 4 5 ) μmol/L ,P<0 0 1],Hcy与冠脉病变程度呈正相关 (r=0 4 11,P <0 0 1) ,多元回归分析显示Hcy对冠心病的相对危险度 1 2 8(95 %可信区间1 12～ 1 4 7,P <0 0 1) ;(2 )Hcy分别与内皮素和NO呈正相关和负相关 (r=0 4 2 2 ,r=- 0 36 5 ,respective ly,bothP <0 0 1) ,高Hcy患者血管内皮依赖性舒张功能明显受损 [(8 86± 4 33) %和 (15 72± 5 2 8) % ,P<0 0 1]。结论　VitB1 2 和叶酸缺乏可引起Hcy蓄积 ,高Hcy可能损伤血管内皮 ,是冠心病的危险因素。     

酒依赖患者血浆同型半胱氨酸含量的变化

目的比较酒依赖患者的血浆同型半胱氨酸(Hcy)含量与正常人群的区别,探讨酒依赖患者Hcy含量变化及其与叶酸和维生素B12(VitB12)的相关性.方法对酒依赖患者组、正常对照组各20例进行血浆Hcy的测定,同时测定血清叶酸、ViB12的浓度.结果 (1)酒依赖患者血Hcy显著高于对照组(P＜0.01);(2)酒依赖患者叶酸及VitB12水平低于对照组(P＜0.05);(3)Hcy浓度与叶酸水平之间存在相关性(P＜0.05).结论酒依赖患者出现Hcy代谢障碍,其原因可能与血清叶酸、VitB12降低有关.     

妊娠期高血压疾病血浆同型半胱氨酸、叶酸及维生素B12的测定及意义

【目的】了解孕妇血浆叶酸（FA）、维生素B12（Vit B12）和同型半胱氨酸（Hcy）水平与妊娠期高血压疾病的关系。【方法】采用酶免疫检测法检测妊娠期高血压疾病者32例（A组），其中妊娠期高血压13例（A，组），子痫前期及子痫19例（A2组），正常晚期孕妇68例（B组），正常健康育龄妇女32例（C组）血浆Hcy水平；并同时用放射免疫法检测FA及Vit B12水平。【结果】①A组与B组及C组血浆Hcy水平比较，差异有显著性（P〈0．01）；A组、B组及C组血浆FA、VitB12三组比较，差异无显著性（P〉0．05）。②A2组血浆Hcy水平明显高于B组，差异有显著性（P〈0．01），而A2组血浆FA、VitB。2水平低于B组，差异有显著性（P〈0．05）；B组与A1组FA、Vit B12及Hcy水平比较，差异无显著性（P〉0．05）。【结论】高同型半胱氨酸血症（HHcys）可能与妊娠期高血压疾病发病及病情发展有关。     

血脂正常的冠心病患者三项生化指标变化比较

目的探讨血脂正常的冠心病患者血清同型半胱氨酸(Hcy)、叶酸和维生素B12(VitB12)水平的变化及意义。方法选择2012年12月至2014年12月良乡医院血脂正常的冠心病患者322例为冠心病组,并选择同期体检健康人200例为健康对照组。应用化学发光免疫分析技术对冠心病组患者进行血清Hcy、叶酸和VitB12测定,并与健康对照组结果作比较。结果冠心病组患者血清Hcy水平明显高于健康对照组,叶酸明显低于健康对照组,差异均有统计学意义(P0.01),而VitB12与健康对照组比较,差异无统计系意义(P0.05)。结论检测冠心病患者血清Hcy和叶酸水平的变化对冠心病的发生、发展以及疗效观察均具有重要的临床价值。     

补充多种维生素对血浆同型半胱氨酸水平的影响

目的：通过我院干部体检资料的分析,探讨补充多种维生素（多Vit）对血浆同型半胱氨酸（Hcy）水平的影响。方法：对1999年度我院干部体检中的正常组589例和1999年4月－2000年10月间住院中的冠心病组179例,用酶联免疫法测定血浆Hcy浓度,电化学发光法测定血清叶酸、VitB12水平,同时调查其是否服用含叶酸的多Vit。结果：1．正常组：（1）服多Vit组,血清叶酸水平明显高于未服组,而血浆Hcy水平明显低于未服组,血清VitB12水平两组间无明显差异。（2）服用多Vit组,血浆Hcy水平≥15μmol/L者的比例明显低于未服用多Vit组。2．冠心病组：（1）Hcy水平明显高于正常组,叶酸水平明显低于正常组,VitB12水平两组间无明显差异。（2）血浆Hcy水平,急性心肌梗死组和心绞痛组明显高于阵旧性心肌梗死组。（3）除心绞痛组,服用多Vit者叶酸水平明显高于未服用者外,冠心病其余二组服用多Vit者Hcy、叶酸、VitB12水平均无显著差异。结论：服用含叶酸的多Vit对血浆Hch水平有明显影响。服用多Vit可提高血清叶酸水平,使正常组血浆Hcy水平降低,减少冠心病的患病率,但对已患有冠心病者补充多Vit对血浆Hcy水平无明显影响。     

MTHFR C677T/MS A2756G基因多态性及血浆Hcy水平与阿尔茨海默病的关系

目的:探讨亚甲基四氢叶酸还原酶(MTHFR) C677T、蛋氨酸合成酶(MS) A2756G基因多态性及血浆同型半胱氨酸(Hcy)水平与阿尔茨海默病(AD)的关系.方法:用多聚酶链反应技术分析75例AD患者(AD组)及71例健康老人(对照组)的MTHFR C677T、MS A2756G基因多态性及测定血浆Hcy、叶酸和VitB12水平.结果:(1)两组MTHFR C677T、MS A2756G的基因型频率及等位基因频率分布差异无统计学意义(P＞0.05);(2)对照组携带MTHFR T等位基因者血浆Hcv水平升高(P＜0.05);两组血浆Hcy水平与MS基因A2756G基因型不相关(P＞0.05) 结论:MTHFR基因C677T及MS基因A2756G多态性与AD发生不相关,AD患者血浆Hcy水平升高可能主要与体内叶酸、VitB12不足有关     

妊娠期高血压病患者血浆同型半胱氨酸、叶酸、血管内皮生长因子变化及临床意义

目的 了解血浆同型半胱氨酸(Hcy)、叶酸(FA)、血管内皮生长因子(VEGF)的水平与妊娠期高血压疾病(HDP)的关系.方法 选择HDP患者75例,其中妊娠期高血压组(A组)45例,子痫前期、子痫组(B组)30例,并随机选取同期正常晚期孕妇48例(C组)、正常非孕妇30例(D组)为对照组.分别用循环酶法测定血浆Hcy水平,用化学发光法检测血浆FA、维生素B12(Vit B12)水平,采用酶联免疫法检测血浆VEGF水平.结果 (1)B组Hcy水平高于A组(P＜0.05),A组Hcy水平高于C组(P＜0.05),C组Hcy水平高于D组(P＜0.05).(2) B组FA水平低于A组(P＜0.05),A组FA水平低于C组(P＜0.05),C组FA水平低于D组(P＜0.05).(3) B组VEGF水平低于A组(P＜0.05),A组VEGA水平低于C组(P＜0.05).(4) HDP血浆Hcy水平与血浆FA水平呈负相关,HDP血浆VEGF水平与血浆Hcy水平呈负相关.结论 妊娠期FA缺乏导致血浆Hcy水平的升高可能是HDP的发病及病情发展有关;血浆VEGF水平的变化可能是HDP发生、发展的一个重要因素.两者的共同作用可能加剧HDP的病情.     

尿毒症患者血浆同型半胱氨酸及其相关因素的研究

目的　探讨尿毒症患者血浆同型半胱氨酸 (Hcy)的临床意义及其相关因素。方法　分别采用快速高压液相微柱层析法和Immlite全自动化学发光免疫分析仪测定 32例正常人和 32例尿毒症患者血液透析前后的血浆总Hcy和叶酸、维生素B12 浓度。结果　血液透析后血浆Hcy与叶酸较血液透析前明显下降 (P<0 .0 1) ,前者显著高于正常人 (P <0 .0 1) ,后者与正常值比较 ,均无显著差异 (P >0 .0 5 ) ;血液透析前叶酸与Hcy存在明显负相关 ,血浆维生素B12 与Hcy无显著相关性。内瘘堵塞组与非堵塞组比较 :血浆Hcy明显升高(P <0 .0 1) ;叶酸显著降低 (P <0 .0 5 )。结论　所有血液透析患者均存在高Hcy血症 ,可能是血液透析患者内瘘栓塞的危险因素之一。高Hcy血症的形成可能与叶酸相对缺乏有关     

血浆同型半胱氨酸的含量与中青年脑梗死之间关系的探讨

目的探讨血浆同型半胱氨酸的含量与中青年脑梗死之间的关系以及同型半胱氨酸的影响因素.方法检测40例中青年脑梗死患者的血浆同型半胱氨酸(Hcy)、叶酸、VitB12的浓度,正常对照组40例.结果中青年脑梗死患者Hcy高于同年龄健康对照组(P＜0.05),青年脑梗死患者Hcy高于中年脑梗死患者(P＜0.05).中青年脑梗死患者VitB12、叶酸含量均低于同年龄健康对照组(P＜0.05),青年脑梗死患者VitB12、叶酸含量均低于中年脑梗死患者(P＜0.05).而且Hcy浓度与叶酸、VitB12具有相关性(P＜0.05).结论Hcy是脑梗死的一个重要发病因素,并且Hcy对青年脑梗死的影响要大于对中年人,Hcy的水平与叶酸、VitB12的浓度有关.     

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.