2型糖尿病患者CA199水平与血糖的关系

目的:观察2型糖尿病患者血清CA199水平与糖化血红蛋白(HbA1c)的关系.方法:收集90例健康对照(对照组)与156例住院2型糖尿病患者,其中糖尿病患者按HbA1c水平分为良好( ＜ 6.5%)、尚可(6.5 ～ 7.5%)、控制差( ＞ 7.5%)3组,采用电化学发光法测定血清CA199,比较4组CA199水平.结果:(1)HbA1c控制差组的CA199水平[(18.67 ± 8.29)U/mL]显著高于其他3组[对照组(10.52 ± 4.31)U/mL,良好组(11.03 ± 5.04)U/mL,尚可组(12.51 ± 6.60)U/mL,P ＜ 0.01];(2)CA199高于正常水平的患者,经控制血糖2周后,CA199水平下降至(35.63 ± 3.30)U/mL,与治疗前(40.20 ± 1.01)U/mL比较差异有统计学意义(P ＜ 0.01).结论:糖尿病患者CA199水平较正常人高,血糖控制差的糖尿病患者CA199水平明显高于血糖控制尚可及良好的患者.     

2型糖尿病患者血糖及糖化血红蛋白水平与CA199的相关性研究

目的分析2型糖尿病患者血糖水平,特别是糖化血红蛋白(HbA1c)水平对血清糖类抗原199(CA199)水平的影响。方法选取健康体检者100例纳入对照组,该院254例糖尿病患者纳入研究组。研究组按HbA1c水平分为血糖控制良好亚组、血糖控制一般亚组及血糖控制差亚组。检测所有研究对象HbA1c、CA199、空腹血糖(FPG)水平并进行分析。结果研究组FPG、HbA1c、CA199水平明显高于对照组,差异有统计学意义(P0.05)。血糖控制差亚组FPG、HbA1c、CA199水平与对照组、血糖控制良好亚组及控制一般亚组比较,差异有统计学意义(P0.05)。控制差亚组及血糖控制一般亚组FPG、HbA1c、CA199水平较对照组稍高,差异有统计学意义(P0.05)。血清CA199水平与FPG、HbA1c均呈线性相关关系,相关系数分别为0.233、0.384(P0.05)。结论 2型糖尿病患者血清CA199水平高于健康人,HbA1c与CA199水平密切相关。     

血清糖类抗原199在阻塞性黄疸中升高的分析

目的探讨血清糖类抗原199(CA199)水平升高在不同性质的阻塞性黄疸患者中的应用。方法选取血清CA199水平高于参考值的21例良性阻塞性黄疸患者(良性组)和24例恶性阻塞性黄疸患者(恶性组)为研究对象,动态监测治疗前后患者血清CA199与直接胆红素(DBIL)变化及相关性。结果良性阻塞性黄疸患者与恶性阻塞性黄疸患者中治疗前血清CA199及DBIL水平差异无统计学意义(P0.05),治疗后良性阻塞性黄疸患者血清CA199及DBIL水平明显下降,较治疗前差异有统计学意义(P0.05),而恶性组患者治疗前后血清CA199及DBIL水平比较,差异无统计学意义(P0.05)。结论血清CA199不是肿瘤特异度非常高的标志物,不能作为判断良恶性疾病的唯一标志,动态监测治疗前后血清CA199变化及与DBIL的相关性有助于良恶性肿瘤的鉴别。     

2型糖尿病患者血清CA199与血糖水平的相关性分析

[目的]探讨2型糖尿病患者血清CA199水平与血糖的关系.[方法]将本院收治的385例2型糖尿病患者(剔除糖尿病肾病、消化道疾病、肿瘤患者)根据CA199水平分为CA199阳性组(n=80),CA199阴性组(n =305),比较两组患者的空腹血糖(FBG)、糖化血红蛋白(HbA1C)、体质量指数(BMI)及血糖控制平稳后CA199水平变化.[结果]CA199阳性组FBG,HbA1C较阴性组显著升高,且两组相比较差异有显著性(P＜0.05),两组BMI比较差异无显著性(P＞0.05).阳性组血糖控制平稳后复测CA199较初入院时显著下降,且差异有显著性(P＜0.05).[结论]2型糖尿病患者CA199升高与血糖控制不达标有关.     

视网膜病变的轻重分级及与糖化血红蛋白和空腹血糖的相关性比较

目的探讨糖化血红蛋白(HbAlc)、空腹血糖(FBG)和视网膜病变(DR)的相关性。方法 89例糖尿病患者根据眼底镜检查结果分为视网膜病变组(DR)56例,非视网膜病变组(NDR)33例。另设健康对照组27例。结果糖尿病DR组HbAlc显著高于NDR组和健康对照组,差异有统计学意义(P0.05);FBG水平DR和NDR组间差异无统计学意义(P0.05)。糖尿病DR和NDR组与健康对照组间FBG差异有统计学意义(P0.05)。结论控制血糖、降低HbAlc水平,有助于降低糖尿病DR发生的危险。HbAlc是糖尿病患者长期血糖控制情况的一个良好指标。     

多项肿瘤标志物联合检测在妇科肿瘤诊断中的临床价值

目的探析联合检测癌胚抗原(CEA)、糖类抗原153(CA153)、糖类抗原125(CA125)及糖类抗原199(CA199)在妇科肿瘤诊断中的临床价值。方法选取2013年1~12月该院收治的疑似妇科肿瘤患者100例,分为良性卵巢肿瘤组(59例)和卵巢癌组(41例);另选取同期体检健康者100例纳入对照组,应用瑞士罗氏Cobas e411全自动化学发光免疫分析仪检测各组血清CEA、CA153、CA125、CA199水平。结果与对照组比较,良性卵巢肿瘤组患者血清CEA、CA153、CA125及CA199水平均升高,差异均有统计学意义(P0.05);卵巢癌组患者血清CEA、CA153、CA125及CA199水平也均升高,差异均有统计学意义(P0.05)。两组肿瘤患者血清CEA、CA153、CA125、CA199联合检测阳性率均高于各项肿瘤标志物单项检测,差异均有统计学意义(P0.05)。结论 CEA、CA153、CA125及CA199联合检测对妇科肿瘤的诊断具有重要的临床价值,有助于临床早期筛查,值得临床推广。     

2型糖尿病及其糖尿病肾病患者血清肿瘤标志水平分析

目的探讨2型糖尿病及其糖尿病肾病患者血清中4种肿瘤标志物(AFP、CEA、CA125和CA199)的水平变化。方法收集2型糖尿病患者207例(T2DM组)、2型糖尿病肾病患者45例(DKD组),选取同期健康体检者231例作为对照组,采用雅培i2000全自动生化分析仪检测4种肿瘤标志物。比较3组4种血清肿瘤标志物水平。根据糖化血红蛋白(HbA1c)水平将2型糖尿病患者进行再分组,比较各组间4种肿瘤标志物水平。同时利用Spearman秩相关法分析空腹血糖、HbA1c和4种肿瘤标志物之间的相关性。结果 T2DM患者的血清CEA、CA125和CA199水平较对照组明显增高。与对照组和T2DM组相比,DKD患者血清中CA125和CA199水平均显著增高。不同HbA1c水平组CA125和CA199水平比较,差异有统计学意义(P0.05)。空腹血糖、HbA1c与CEA、CA125、CA199之间呈正相关(P0.05)。结论 2型糖尿病及其糖尿病肾病患者部分血清肿瘤标志物水平升高。空腹血糖、HbA1c与CEA、CA125、CA199之间呈正相关,且血糖控制不理想时,CA199和CA125水平升高更明显。     

联合检测HE4、CA125和CA199在卵巢癌和良性卵巢囊肿的应用价值探讨

目的探讨联合检测人附睾蛋白4(HE4)、糖类抗原125(CA125)和糖类抗原199(CA199)在卵巢癌和良性卵巢囊肿中的应用价值。方法采用化学发光免疫分析法检测45例原发性卵巢癌患者(卵巢癌组)、60例良性卵巢囊肿患者(良性疾病组)和30例体检健康者(对照组)血清HE4、CA125和CA199水平,并进行比较分析。结果卵巢癌组患者血清HE4、CA125和CA199水平均高于良性疾病组与对照组,差异均有统计学意义(P0.05);良性疾病组患者血清CA125水平高于对照组,差异有统计学意义(P0.05),但血清HE4、CA199水平与对照组比较差异均无统计学意义(P0.05);三者联合检测用于诊断卵巢癌患者的灵敏度提高到82.2%,而特异度也保持在90.0%。结论联合检测HE4、CA125和CA199对卵巢癌的早期诊断及鉴别具有重要的临床意义。     

胰腺癌患者检测TSGF、CA199、CA242、AMS及LPS的临床意义

目的探讨检测恶性肿瘤特异性生长因子(TSGF)、糖类抗原199(CAl99)、糖类抗原242(CA242)、淀粉酶(AMS)和脂肪酶(LPS)对诊断胰腺癌的临床意义。方法采用生化比色法检测26例胰腺癌患者、29例胰腺炎和33例正常对照组TSGF水平、酶免法(ELISA)检测CAl99、CA242水平及采用酶法检测AMS和LPS水平。结果胰腺癌患者组TSGF、CAl99、CA242水平明显高于胰腺炎组和正常对照组(P<0.05),AMS和LPS含量与胰腺炎组无显著性差异(P>0.05),正常对照组AMS和LPS含量与胰腺炎组有显著性差异(P<0.05)。结论TSGF、CAl99、CA242、AMS和LPS联合检测对诊治胰腺癌及判断预后具有重要的指导意义。     

CA125、CA199与胃癌病程发展及预后的关系

目的探究糖类抗原125(CA125)、糖类抗原199(CA199)与胃癌病程发展及预后的关系。方法选取2017年1月至2018年1月于该院接受治疗的82例胃癌患者作为患者组;另选取同期于该院体检合格的50例健康者作为对照组;比较两组血清CA125、CA199水平。将82例胃癌患者按照病理检查结果分为Ⅰ期(23例)、Ⅱ期(22例)、Ⅲ期(20例)与Ⅳ期(17例),对比不同分期胃癌患者CA125、CA199水平;对82例胃癌患者实施为期16个月的随访,按照临床结局分为死亡组(21例)与存活组(61例),对比两组血清CA125及CA199水平。结果患者组CA125及CA199水平均高于对照组(P 0.05)。胃癌Ⅰ、Ⅱ期与Ⅲ期比较,CA125及CA199水平差异均有统计学意义(P0.05);Ⅰ、Ⅱ期与Ⅳ期比较,CA125及CA199水平差异均有统计学意义(P0.05)。死亡组血清CA125、CA199水平均高于存活组(P0.05)。结论 CA125及CA199在不同病程胃癌患者中水平差异较为明显,可用于胃癌病程判断,对胃癌的预后判断也有一定应用价值。     

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.