全血2,3—二磷酸甘油酸比色测定法

本文介绍了用磷酸甘油酸变位酶测定２，３－二磷酸甘油酸的比色法。探讨了该法的最适反应条件，最适ｐＨ７．５％￣７．６。线性范围可达６．０ｍｍｏｌ／Ｌ。三份不同浓度标本批内ＣＶ１．１％￣２．１％，批间ＣＶ２．５％￣３．９％。６０例南京地区健康成人２．３－二磷酸甘油酸含量为１．６￣２．７ｍｍｏｌ／Ｌ，平均回收率９４％，与Ｓｉｇｍａ试剂盒比较测定结果无显著性差异（Ｐ〉０．０５），相关性良好，ｒ＝０．９８２。     

邻甲酚酞络合剂速率法测定血清胆碱酯酶

以邻甲酚酞络合剂作指示剂，速率法测定血清胆碱酯酶。最适底物浓度为２０ｍｍｏｌ／Ｌ的氯化酰胆碱，最适ＰＨ８．１，最适邻甲酚酞络合剂浓度２．５ｍｍｏｌ／Ｌ。线性范围０－１０Ｕ／ｍｌ（γ＝０．９９８７）。批内ＣＶ２．６％，批间ＣＶ３．９％。     

血清α－L－岩藻糖苷酶自动分析法

本文报道了血清α－Ｌ－岩藻糖苷酶的自动分析法。酶促反应的最适ｐＨ５．０～５．１，Ｋｍ＝０．１８０ｍｍｏｌ／Ｌ，用柠檬酸－磷酸盐缓冲液可发挥酶的最大催化活性。线性范围为０～５０Ｕ／Ｌ，批内ＣＶ１．５３％～１．７１％，批间ＣＶ３．０％～３．２％。１３７例健康成人血清中酶活力为６．０６±１．３１Ｕ／Ｌ（ｘ±ｓ），男女性别间无显著差异（Ｐ＞０．０５）。本法具有简单、快速、灵敏等特点。     

3－磷酸甘油脱氢酶偶联法测定血清醛缩酶活性

探讨用３－磷酸甘油脱氢酶偶联法测定血清中醛缩酶（ＡＬＤ）活性的最佳反应条件。反应体系的终末浓度：ＴＥＡ１００ｍｍｏｌ／Ｌ，ＦＤＰ４ｍｍｏｌ／Ｌ，碘乙酸０．２２ｍｍｏｌ／Ｌ，ＮＡＤＨ０．２６ｍｍｏｌ／Ｌ，ＧＤＨ≥１０００Ｕ／Ｌ，ＴＰＩ≥１５００Ｕ／Ｌ，ＬＤ≥１０００Ｕ／Ｌ。最适ｐＨ在７．８～８．０，Ｋｍ为７．２×１０－３ｍｍｏｌ／Ｌ。批内ＣＶ：酶活性在７．３４Ｕ／Ｌ和６５．０６Ｕ／Ｌ时，ＣＶ分别为５．７％和１．４％；批间ＣＶ：酶活性在１１．８９Ｕ／Ｌ和１００．０８Ｕ／Ｌ时，ＣＶ分别为６．０％和３．３％，酶活性线性范围至少可达１８０Ｕ／Ｌ。健康人６０名，ＡＬＤ活性为４．５３±１．１７（ｘ±ｓ）Ｕ／Ｌ，男女两组均值无显著性差异。本文对ＴＥＡ－ＨＣｌ（ｐＨ８．０）、Ｔｒｉｓ－ＨＣｌ（ｐＨ８．０）和Ｃｏｌｉｄｉｎｅ－ＨＣｌ（ｐＨ７．５）三种缓冲液用于ＡＬＤ活性测定效果进行了评价，结果表明在ＴＥＡ缓冲液中所测ＡＬＤ活性最高；ＴＥＡ和Ｃｏｌｉｄｉｎｅ两种缓冲液的浓度在２５～１５０ｍｍｏｌ／Ｌ范围内对ＡＬＤ活性无影响，Ｔｒｉｓ缓冲液在５０ｍｍｏｌ／Ｌ时测得酶活性较高，缓冲液浓度过高或过低，酶活性均有所下降     

血清α—L—岩藻糖苷酶自动分析法

本文报道了血清ａ－Ｌ－岩藻糖苷酶的自动分析法。酶促反应的最适ＰＨ５．０－５．１，Ｋｍ－０．１８０ｍｍｏｌ／Ｌ，用柠檬酸－磷酸盐缓冲液可发挥酶的最大催化活性。线性范围为０－５０Ｕ／Ｌ，批内ＣＶ１．５３％－１．７１％，批间ＣＶ３．０％－３．２％。本法具有简单、快速、灵敏等特点。     

聚乙二醇修饰酶法直接测定高密度脂蛋白胆固醇的评价

本文用德国Ｂｏｅｈｒｉｎｇｅｒ Ｍａｎｎｈｅｉｍ公司生产的高密度脂蛋白胆固醇试剂盒在Ｄｌｙｍｐｕｓ ＡＵ－５６０型生化仪上建立了直接法测定血清ＨＬＤ－Ｃ的程序，并对此方法作了初步评价。ＨＤＬ－Ｃ浓度在２．６ｍｍｏｌ／Ｌ范围内线性良好，ｒ＝０．９９９；两组低，中，高浓度的标本批内ＣＶ２．１％－３．３％，批间ＣＶ２．２％－３．６％，平均回收率为９７．５％，浓度为６．２ｍｍｏｌ／Ｌ甘油三酯，１０５．６μ     

LDL—C直接测定法与Friedewald计算结果的比较

用ＤＡ－６１０１ＬＤＬ－Ｃ试剂盒及日立７１７０Ａ生化自动分析仪直接测定血清ＬＤＬ－Ｃ含量。方法批内变异ＣＶ在０．５％～１．４７％，批间变异ＣＶ在２．６０％～３．７３％。平均回收率为１０２．１％，在６．６０ｍｍｏｌ／Ｌ浓度内呈良好的线性关系。ＬＤＬ－Ｃ＜４．５２ｍｍｏｌ／Ｌ时与Ｆｒｉｅｄｅｗａｌｄ公式计算的结果相关良好。方法简单，勿需沉淀分离和其他处理，适宜自动分析。     

血清无机磷的酶法测定

建立了一种酶偶联测定血清无机磷的方法，方法线性范围为０～３ｍｍｏｌ／Ｌ，变异系数批内ｘ＝１．０３ｍｍｏｌ／Ｌ，ｎ＝２０，ＣＶ＝１．２１％，批间：ｘ＝１．２８ｍｍｏｌ／Ｌ，ｎ＝２０，ＣＶ＝３．７％，与钼酸铵紫外光度法相关性为ｒ＝０．９９４２，Ｙ＝０．９５０９Ｘ＋０．０５４１，参考值范围为０．９８～１．５５ｍｍｏｌ／Ｌ。     

选择性抑制法测定淀粉酶同工酶

本文报道用选择性抑制法结合酶偶联法测定淀粉酶（Ａｍ）同工酶。通过数学推导和实验，建立了结果计算公式和标准曲线。方法线性范围０－１１００Ｕ／Ｌ。批内，批间ＣＶ＜９．９％。参考范围：血清Ｐ－Ａｍ７－５５Ｕ／Ｌ，Ｓ－Ａｍ１．８－６８．３Ｕ／Ｌ；尿Ｐ－Ａｍ２．５－２２．６Ｕ／ｍｍｏｌＣｒ，Ｓ－Ａｍ２．２－３１．３Ｕ／ｍｍｏｌＣｒ。本法制备的抑制剂溶液稳定期长，保存，使用方便。     

血清果糖胺的自动分析

本文以四种自动分析仪为例，在研究了各个测定参数后，建立果糖胺（ＧＳＰ）的自动分析方法。基本参数为：温度３７℃，波长５３０ｎｍ，速率法或二点法，延迟时间５～１０分钟，读数时间５分钟，标准曲线模式Ｌｏｇｉｔ／Ｌｏｇ或ｌｉｎｅａｒ，样本／试剂比１：２０．试剂为０．２５ｍｍｏｌ／ＬＮＢＴ，标准用１－脱氧吗啉果糖（ＤＭＦ）。本法的线性范围达６ｍｍｏｌ／Ｌ，并具有良好的精密度与准确度，批内ＣＶ＜２．３％，批间ＣＶ＜４％，平均回收率１０５％。以本法测定的正常值范围为１．０７～１．８３ｍｍｏｌ／Ｌ。     

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.