高效液相色谱-荧光检测法快速测定脊髓和脑内氨基酸

目的 建立快速测定脊髓和脑内氨基酸浓度的方法.方法 通过邻苯二甲醛和β-巯基乙醇柱前衍生、反相高效液相色谱结合荧光（激发波长280 nm,发射波长340 nm）检测氨基酸浓度.用0.1 mol/L磷酸盐缓冲液（pH值6.00～6.25）和甲醇（46%）混合液（加入四氢呋喃2%）作流动相,流速为1 ml/min.结果 在0.1～40.0 μmol/L范围内,氨基酸浓度与相对峰面积之间的相关系数（r）均值为0.999 2,日内和日间变异系数（CV）分别为2.41%～5.23%、3.51%～6.48%,平均回收率为90.13%～98.47%.结论 本法灵敏度高、快速、简便易行,可用于脊髓和脑内氨基酸测定.     

高效液相色谱-荧光法测定SLE患者血清色氨酸及其代谢产物

目的建立一种同时测定血清色氨酸(tryptophan,Trp)、犬尿氨酸(kynurenine,Kyn)和犬尿喹啉酸(kynurenic acid,Kyna)的高效液相色谱-荧光检测法(HPLC-FD),并用此法检测SLE患者血清中Trp及其代谢产物Kyn、Kyna的含量。方法血清标本经0.624 mol/L的高氯酸溶液去除蛋白质后取上清液20μl直接进样分析测定。色谱柱为Hypersil C18柱,流动相为0.20mol/L醋酸锌、8.3 mmol/L醋酸和2.5%的乙腈;流速为1.5 ml/min;荧光检测激发波长和发射波长在0~11 min分别为365nm和480 nm,11~15.5 min变换为344 nm和404 nm,15.5~20 min为254 nm和404 nm。采用建立的方法测定体检健康者和SLE患者血清Trp、Kyn和Kyna的含量。结果Trp的线性范围为0.610~196μmol/L,最低检出浓度为0.005μmol/L,平均回收率为103.71%;Kyn线性范围为0.049~98μmol/L,最低检出浓度为0.025μmol/L,平均回收率为97.45%;Kyna线性范围为1.05...     

高效液相色谱法同时测定血清色氨酸和犬尿氨酸浓度的方法建立及应用

目的建立一种高效液相色谱-紫外检测法同时测定血清中色氨酸(Trp)和犬尿氨酸(Kyn)浓度的方法。方法色谱柱采用Agilent Hypersil ODS(125.0mm×4.0mm,5μm),流动相为15mmol/L乙酸钠缓冲液(pH4.0)和乙腈95∶5(V/V),流速为0.8ml/min,柱温25℃,紫外检测λKyn=360nm,λTrp=278nm。结果Kyn和Trp的保留时间分别为3.3min和5.2min,线性范围分别为0.083~21.000μmol/L和2.650~678.000μmol/L,检测限分别为0.028μmol/L和0.053μmol/L,日内和日间相对标准偏差分别低于5%和10%,回收率分别为91.99%~113.89%和95.81%~118.82%。结论该方法简便、快速、特异,适合于临床检测。     

HPLC法测定奈韦拉平的血药浓度

目的:建立高效液相色谱法测定奈韦拉平血药浓度的方法。方法:采用Hypersil C18柱(150 mm×4.6 mm,0.5μm);流动相∶乙腈:0.01 mol/L磷酸二氢钠(含0.01 mol/L三乙胺,磷酸调pH至5.0)=18∶82;流量:1.0mL/min;检测波长:240nm。结果:线性范围0.1~5.0 mg/L(r=0.9996);最低检测浓度为0.1 mg/L;日内、日间相对标准差(RSD%)均小于10%;低、中、高三个浓度的提取回收率分别为99.98%、99.41%和100.53%。结论:该法简便、快速、准确,专属性高,适用于奈韦拉平药动学和生物等效性研究。     

高效液相色谱-荧光法同时测定血清中的色氨酸和酪氨酸

目的建立一种高效液相色谱（HPLC）-荧光法（FD）同时测定血清色氨酸（Trp）和酪氨酸（Tyr）的方法。方法色谱条件：Megres C18色谱柱（250 mm×4.6 mm,内径为5μm）,流动相为10%乙腈溶液,流速为1.2 mL/min,Tyr和Trp的荧光检测激发波长和发射波长分别为λexTyr=228 nm、λexTrp=285 nm和λemTyr=306 nm、λemTrp=353 nm。血清样本经5%高氯酸溶液去除蛋白质后取上层清液直接进样进行分析测定。且对样本的保存方法进行了探讨。结果 Tyr的保留时间为3.4 min,线性范围为0.275~275μmol/L,最低检出浓度为0.004μmol/L,回收率为90.5%~108.8%。Trp的保留时间为7.6 min,线性范围为0.490~196μmol/L,最低检测浓度为0.005μmol/L,回收率为88.8%~97.2%。Tyr和Trp的日内、日间测定的相对标准偏差均〈5%,苯丙氨酸、5-羟色胺、犬尿喹啉酸、犬尿氨酸和肌酐等物质对该法均无干扰。样本应-20℃冰冻保存。结论该方法简便、快速、敏感、特异,可同时测定血清Tyr和Trp,适合于临床和科研应用。     

高效液相色谱法快速测定氨基酸类神经递质

目的建立一种同时快速测定大鼠纹状体中谷氨酸(G lu)、天冬氨酸(Asp)、γ-氨基丁酸(GABA)、甘氨酸(G ly)、牛磺酸(Tau)5种氨基酸类神经递质的高效液相色谱法。方法采用Krom asil C18(4.6×250 mm,5μm)为色谱柱,丹酰氯为柱前衍生试剂,以曲唑酮为内标,以0.1 mol/L醋酸钠缓冲液∶甲醇=58∶42、14 mmol/L庚烷磺酸钠为流动相等度洗脱。结果在1~200 mg/L范围内,各组分线性关系良好(r=0.999)。各氨基酸的平均回收率为79.1%~92.9%。结论本方法简便、快速、准确,可用于临床大样本测定和研究神经及精神疾病氨基酸类神经递质的改变。     

毛细管电泳分离脑脊液中神经递质类氨基酸及其临床应用

目的建立快速测定人脑脊液中神经递质类氨基酸的方法。方法用高效毛细管电泳-激光诱导荧光法检测了40例正常脑脊液、38例病毒性脑炎病人脑脊液、42例脑出血病人脑脊液神经递质类氨基酸。结果在20 min内分离出4种氨基酸,线性范围为0.1~50μmol/L,峰的迁移时间RSD 0.56%~2.06%,峰面积RSD 2.24%~3.79%;回收率为98%以上。结论高效毛细管电泳-激光诱导荧光法具有快速、准确、灵敏的特点,可作为临床检测脑脊液标本中的神经递质类氨基酸的方法。     

脑蛋白水解物注射液中氨基酸含量测定分析方法

目的:建立高效液相色谱分离检测脑蛋白水解物注射液各种氨基酸的测定方法。方法:氨基酸含量测定采用异硫氰酸苯酯柱前衍生化;色谱柱为C18柱(VP-DOS;150mm×4.6mm);流动相:A为0.1mol/L醋酸钠溶液(冰醋酸调节pH6.5)-乙腈(93:7),B为水-乙腈(1:4);检测波长:254nm;流速:1mL/min;柱温:40℃。结果:16种氨基酸在32min内完全分离,各种氨基酸之间没有出现干扰现象,且多次重复测定结果误差很小。结论:建立的高效液相色谱法准确性高、重现性好,可以有效地控制脑蛋白水解物注射液的质量。     

Nitro-PAPS直接光度法测定血清锌

目的建立一种快速、简便、灵敏的血清锌分光光度测定法。方法在非离子型表面活性剂Tween-80及TritonX-100存在下,用水溶性试剂2-(5-硝基-2-吡啶偶氮)-5-[N-正丙基-N-(3-磺酸丙基)氨基]苯酚二钠(简称N itro-PAPS)作显色剂直接光度法测定血清锌。结果本法显色络合物最大吸收波长为580 nm,线性范围达71.2μmol/L,表观摩尔吸光度为1.38×105L/(mol.cm),回收率为98.2%~101.9%,批内变异系数(CV)为2.4%,批间CV为3.5%,与原子吸收分光光度法(AAS)比较,Y=0.997X 0.17,P>0.05,r=0.9913,60例健康人血清锌含量为(9.3~20.9)μmol/L(x-±2s)。结论本法血清用量少,不必去蛋白,具有操作快速、简便、结果灵敏可靠等优点,适用于血清锌的手工测定和自动分析。     

高效液相色谱法在类风湿关节炎患者血清TRP和KYN检测中的应用与临床价值

目的 探讨高效液相色谱荧光检测法(HPLC-FLD)同时测定血清色氨酸(TRP)和犬尿氨酸(KYN)对诊断类风湿关节炎(RA)的临床意义.方法 血清标本加等量5%(V/V)高氯酸溶液去除蛋白,离心取上清液20 μl,直接进样分析.色谱柱为HpemilC_8柱(300 mm×6.0 mm i.d,10 μm);流动相为0.25 mol/L醋酸锌和50 mmol/L醋酸溶液(含3%乙腈),流速为1.5 ml/min;0～10 min荧光检测器的激发波长和发射波长分别为365 nm和480 nm,10 min后激发波长和发射波长分别变换为254 nm和404 nm.同时,用该方法测定120名健康成人和110例RA患者血清TRP、KYN和TRP/KYN比值(K/T),并评价其诊断RA的敏感度、特异度和方法学效能.结果 血清标本的KYN和TRP保留时间分别为8.1和11.5 min,两者分离良好.KYN线性范围为0.098 ～19.600 μmol/L,最低检测浓度为0.04 μmol/L;回收率为90.8%～96.2%,日内变异系数为3.68%,日间变异率为4.97%.TRP的线性范围为4.9～196.0μmol/L.最低检测限为0.005 μmol/L,回收率为92.6～106.9%,13内变异系数为3.63%,日间变异系数为4.44%.在本试验的色谱条件下测定苯丙氨酸(Phe)、酪氨酸(Tyr)、犬尿喹啉酸(KYNA)、5-羟色胺(5-HT)和Cr均无干扰.RA组患者血清KYN含量和K/T比值[(2.06±0.38) μmol/L和(55.46±5.81)×10~(-3)]与健康对照组[(1.51±0.35)μmol/L和(32.54 ±9.00)×~(-3)]比较,均显著升高(U=3 251.0,t=10 741,P均为0.000),而RA组TRP含量[(38.24±5.27)μmol/L]与健康对照组[(47.52±5.79)μmol/L]比较,则显著降低(t=10.399,P=0.000).K/T比值诊断RA的敏感度、特异度分别为83.6%(92/110)、85.8%(103/120).结论 HPLC-FLD同时测定血清TRP和KYN的方法精密度、回收率、抗干扰能力、线性范围等均符合临床检测要求.K/T比值可作为RA的辅助性诊断指标.     

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.     

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.     

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.     

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.