IRIS IQ200分析仪测定健康人群尿液有形成分参考值范围调查

目的调查上海地区健康人群尿液有形成分正常参考值范围。方法在上海2家医院（上海浦东新区人民医院、上海东方医院），使用相同仪器，检测健康人群随机中段尿，了解健康人群红细胞、白细胞、上皮细胞及管型的数量。研究期间使用IRIS公司的质控液进行室内质控监测，保证结果的准确性和稳定性。结果IRIS IQ200检测尿液有形成分生物参考值范围如下。1）红细胞：儿童0～4个／μL，成人0～6个／μL（男）；儿童0～5个／μL，成人0～9个／μL（女）；2）白细胞：儿童0～3个／μL，成人0～5个／μL（男）；儿童0～6个／μL，成人0～10个／μL（女）；3）上皮细胞：儿童0～3个／μL，成人0～5个／μL（男）；儿童0～5个／μL，成人0～12个／μL（女）；4）管型：0～1个／μL。正常人群尿液红细胞、白细胞、上皮细胞及管型检测结果性别之间、儿童与成人之间（管型除外）差异均有统计学意义。结论本研究为IRIS IQ200分析仪对健康人随机红细胞、白细胞、上皮细胞及管型的正常参考值范围建立基础性数据，为临床疾病判断提供了依据。     

UF-1000检测正常儿童尿液有形成分的调查

目的：应用UF-1000检测1279例正常儿童尿液的有形成分，为临床建立正常儿童尿有形成分的生物参考范围提供依据。方法：应用UF-1000全自动尿有形成分分析仪检测1279例正常儿童晨尿中红细胞、白细胞、上皮细胞及管型并对检测结果进行统计分析。结果：UF-1000检测尿液有形成分生物参考范围：（1）红细胞：男：0～15个／μl；女：0～19个／μl；（2）白细胞：男：0～8个／μl；女：0～22个／μl；（3）上皮细胞：男：0～11个／μl；女：0～13个／μl；（4）管型：0～1．1个／μl。结论：1～12岁正常儿童尿液中红细胞白细胞上皮细胞数性别之间差异存在统计学意义，年龄之间差异无统计学意义，管型数性别与年龄之间差异均无统计学意义，在临床应用时应注意不同性别间参考范围的差异。     

儿童UF-100尿沉渣分析仪参考值范围调查

目的确立四川地区儿童应用UF-100尿沉渣分析仪检测尿沉渣的参考值范围。方法用UF-100尿沉渣分析仪对四川地区2422名1个月至7岁儿童的随机尿进行检测分析。结果尿液有形成分：白细胞：男性0～7.4个/μl,女性0～8.9个/μl;红细胞：男性0～7.4个/μl,女性0～7.7个/μl;上皮细胞：男性0～4.0个/μl,女性0～5.2个/μl;管型：男性0～0.5个/μl,女性0～0.3个/μl;细菌：男性0～2457个/μl,女性0～2333个/μl。尿液有形成分均存在性别差异（P〈0.05）。结论UF-100分析仪测定儿童尿液红细胞、白细胞、上皮细胞管型、细菌结果与性别有关,参考值范围的确立,为临床诊断和治疗提供了依据。     

AVE763C型尿沉渣分析仪有形成分参考区间的调查

目的调查秭归地区健康人群尿液有形成分的参考区间。方法共收集1～90岁1305例体检健康者中段尿液标本,并在收集后2h内对样本用AVE763C尿沉渣分析仪进行检测。结果AVE763C检测秭归地区健康人群尿液有形成分生物参考区间：红细胞（RBC）：男性：儿童组0～6／μ1,成人组0～6／μl;女性：儿童0～6／μl,成人组0～9／μ1;白细胞（WBC）：男性：儿童组O～4／μl,成人组O～7／μl;女性：儿童组O～5／μ1,成人组O～13／μ1;上皮细胞（EC）：男性：儿童组0～4／pl,成人组O～7／μl;女性：儿童组O～5／μl,成人组O～22／μl;管型（CAST）：男性：O～2／μl;女性：O～2／μl。结论尿液有形成分生物参考区间应按性别、年龄分别设定。     

UF-1000i尿液分析仪有形成分生物参考区间的调查

目的 调查荆州医学实验室UF-1000i尿液分析仪有形成分主要报告参数的正常生物参考区间.方法 在进行严格室内质量控制的前提下,用UF-1000i尿液分析仪检测健康人群(1 860名,其中男1 050名、女810名,年龄0～91岁)随机尿液的有形成分.结果 UF-1000i尿液分析仪的有形成分生物参考区间为:①红细胞(/μl):男:儿童0～15.0,成人0～23.2,老人0～15.8;女:儿童0～18.0,成人0～23.7,老人0～17.6.②白细胞(/μl):男:儿童0～16.6,成人 0～19.1,老人0～18.0;女:儿童0～16.8,成人0～32.2,老人0～22.5.③管型(/μl),0.90.④病理管型(/μl):0.50.⑤上皮细胞(/μl):男:儿童0～13.0,成人0～13.6,老人0～14.4;女:儿童0～12.7,成人0～33.0,老人0～23.0.⑥小圆细胞(/μl):男:儿童0～7.4,成人0～7.7,老人0～7.3;女:儿童0～6.1,成人0～6.8,老人0～5.3.⑦结晶(/μl):男:儿童0～104.8,成人0～254.3,老人0～201.9;女:儿童0～81.7,成人0～356.8,老人0～203.9.⑧电导率(mS/cm):男:儿童2.2～33.1,成人8.8～36.3,老人7.8～33.6;女:儿童2.0～30.4,成人5.9～37.3,老人5.7～31.1.⑨细菌计数(/μl):男:儿童0～64.0,成人0～58.8,老人0～80.4;女:儿童0～110.4,成人0～131.9,老人0～83.0.结论 本研究为建立本实验室的尿液有形成分生物参考区间提供了基础性数据,也为建立中国健康人群随机尿液有形成分参考区间提供参考.     

383例健康成人尿液有形成分参考值的调查

目的 调查本地健康成人尿液有形成分生理参考范围。方法 选取我院健康体检成人共383人，采集随机中段尿液定量计数红细胞（RBC）、白细胞（WBC）及上皮细胞（EPC）的数量。实验期间．进行了严格的室内质量控制，保征结果的准确性和稳定性。结果 尿有形成分生理参考范围．一次性尿板法：男性和女性RBC分别为0～4．0μl,0～5．2μl，WBC分别为0～8．3μl、0～15，2μl，EPC分别为0.2～80μl,0～18．4μl。AVE-763分析仪：男性和女性RBC分别为0～3．5μl、0.6．2μl．WBC分别为0.8．0μl,0～12．30μl，EPC分别为0～4．0μl、0～17．25μl。尿有形成分红细胞、白细胞及上皮细胞检测结果性别之间差异显著。结论 为建立本地区健康人群随机尿液红细胞、白细胞及上皮细胞生物参考范围打下了基础，为尿有形成分检查规范化、标准化推广和临床应用提供依据。     

陕西省咸阳地区正常人群尿液有形成分参考区间的建立

目的建立咸阳地区正常人群尿液有形成分生物参考区间。方法应用UF-1000i尿液有形成分分析仪对咸阳地区1 067例正常人群(男性640例,女性427例,年龄1～90岁)进行尿液有形成分检测,对结果进行统计分析。结果咸阳地区正常人群尿液有形成分参考区间:白细胞(WBC,/μl):男性0.40～13.48,女性0.67～18.88;红细胞(RBC,/μl):男性0.30～15.98,女性0.40～21.73;上皮细胞(EC,/μl):男性0.10～11.18,女性0.40～21.50;管型(CAST,/μl):男性0.00～1.22,女性0.00～1.30;细菌(BACT,/μl):男性0.90～130.81,女性1.74～371.99。结论初步建立了适合咸阳地区正常人群的尿液有形成分参考区间,为尿液有形成分检查规范化、标准化提供参考。     

中国健康人尿液显微镜检测法有形成分结果调查

目的调查中国健康人群尿有形成分参考范围。方法在北京、长沙、南昌、西安、武汉和杭州6个城市的9家医院,使用一次性计数板镜检法和尿沉渣分析仪法,对3 757人(男性2 128人,女性1 629人,年龄1~92岁)随机中段尿液定量计数红细胞、白细胞及上皮细胞数。9家医院在同期2个月内完成调查。研究期间,各实验室均进行严格的室内质量控制,保证结果的准确性和稳定性。结果尿液有形成分参考范围,一次性计数板法,红细胞:男性0~4μ/l(儿童),0~4.5μ/l(成人);女性0~6μ/l(儿童),0~7μ/l(成人);白细胞:男性0~3μ/l(儿童),0~6/μl(成人);女性0~4μ/l(儿童),0~14μ/l(成人);上皮细胞:男性0~2.5/μl(儿童),0~3.25/μl(成人);女性0~3.8μ/l(儿童),0~28.0μ/l(成人)。AVE-763分析仪,红细胞:男性0~4μ/l(儿童),0~4.5μ/l(成人);女性0~7.3μ/l(儿童),0~7.5μ/l(成人);白细胞男性:0~3.5μ/l(儿童),0~5.75μ/l(成人);女性0~4.5μ/l(儿童),0~13.5μ/l(成人);上皮细胞:男性0~2μ/l(儿童),0~3.41μ/l(成人);女性0~4.3μ/l(儿童),0~28.0μ/l(成人)。尿有形成分红细胞、白细胞及上皮细胞检测结果性别之间、儿童与成人之间差异显著。结论本次调查为建立中国健康人群随机尿液红细胞、白细胞及上皮细胞生物参考范围打下了基础,为尿沉渣检查规范化、标准化推广和临床应用提供依据。     

Sysmex UF-1000i尿液有形成分分析仪生物参考区间的建立及验证

目的根据尿液有形成分分析仪Sysmex UF-1000i的性能,建立并验证适合本实验室检测系统、就诊人群的生物参考区间,为尿液有形成分检查的标准化、规范化提供依据。方法选择400例在中国中医科学院西苑医院体检科进行健康体检的个体作为研究对象,留取新鲜清洁中段尿,使用全自动尿液有形成分分析仪Sysmex UF-1000i对尿液中的红细胞、白细胞、上皮细胞、管型、细菌和电导率进行检测,并通过显微镜检查进行复检筛选,用于建立尿液分析参考区间。结果以X95%表示生物参考区间上限,白细胞:男性0-7.41/μl、女性0-12.47/μl;红细胞:男性0-11.41/μl、女性0-17.36/μl;上皮细胞:男性0-4.02/μl、女性0-25.33/μl;管型:0-1.08/μl;细菌:男性0-26.44/μl、女性0-749.77/μl;电导率7.4-36.98m S/cm。结论按性别建立适合本实验室的尿液有形成分参考区间并验证,为尿液有形成分检查规范化、标准化提供依据。     

健康成年人尿沉渣定量捡测评价

目的 用UF-100尿沉渣分析仪检查,获得健康成年人尿液有形成分的参考值。方法用UF-100全自动尿沉渣分析仪器,随机检测382例健康成年人不离心尿液标本,进行定量分析。结果 尿液有形成分存在性别差异（P〈0.05）;白细胞：男性0～2.5个/HPF,女性0～4.5个/HPF;红细胞：男性0～2.4个/HPF,女性0～7.4个/HPF;上皮细胞：男性0～1.17个/HPF,女性0～3.99个/HPF;管型：男性0～2.25个/LPF,女性0～2.40个/LPF;细菌：男性0～828.89个/HPF,女性0～773.55个/HPF;结晶：男性0～1.09/μl,女性0～1.37/μl;非溶解红细胞：男性0～10.52/μl,女性0～18.38/μl;电导率：男性0～28.66ms/cm,女性0～27.00ms/cm。结论 UF-100尿沉渣分析仪确立的健康成年人尿沉渣有形成分的参考值,为临床诊断和治疗疾病提供了依据。     

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.