精神障碍新住院患者代谢综合征现状及各组分临床分析

目的明确精神障碍新住院患者代谢综合征（Metabolicsyndrome，MS）检出率及其各组分组成状况，并进行临床分析。方法随机调取2012年1月至2012年12月赣州市第三人民医院精神障碍新住院患者的2281份病历．采集入院时的生化结果、体格检查结果等各项相关数据。结果采用中华医学会糖尿病分会MS的诊断标准（CDS2004），精神障碍新住院患者MS检出率为3．1％。MS各组分按检出率大小依次为血脂紊乱、高血压、肥胖、高血糖。肥胖伴高血压、高血脂是MS中最常见的组合，占MS的36．6％。结论本次调查新人院的精神障碍患者MS检出率为3．1％，结果较为理想。     

干部人群中代谢综合征及其各组分的发病情况调查分析

目的：探讨干部人群中代谢综合征（metabolic syndrome，MS）及其组分的发病特征。方法：对参加健康体检的564例处、厅级干部，进行身高、体重、腰围、血压、血脂、血糖等指标检测，根据国际糖尿病联盟（IDF）全球共识定义诊断MS并进行统计分析。结果：MS总检出率为23．1％，男性高于女性（25．4％vs14．6％，P〈0．05），中年男性的检出率最高（26．9％）。血脂紊乱、超重／肥胖、中心肥胖、高血压、糖代谢异常检出率分别为63．8％、47．9％、37．9％、29．1％、30．0％。MS中，3项组合异常率最高，占63．1％，以中心肥胖＋高血压＋高甘油三酯血症的组合形式最常见。结论：干部人群MS及其各组分的检出率呈较高水平。在干部保健中，加强心血管危险因素的监测，早期诊断并积极干预MS，对降低心血管病的发病率和死亡率，改善预后有重大意义。     

老年代谢综合征及合并疾病分析

【目的】探讨老年体检人群代谢综合征（Ms）的患病率,各年龄段MS的分布及合并心脑血管代谢疾病状况。【方法】进行体检的1665例老年人,按60～69岁;70～79岁;≥80岁年龄段分为三组,分析各组冠心病、肥胖、高血压、高血糖、血脂异常等及患病情况。【结果】MS在老年人群中的患病率为24．5％,MS患者中,高血压患病率73．7％,高血糖患病率49．8％,血脂异常的患病率达43．6％,肥胖症为35％。MS患者患冠心痛、高尿酸血症、脂肪肝、脑卒中等疾病的患病率显著高于非MS受检者。【结论】MS的高患病率预示心脑血管代谢疾病患病率的增加。     

老年男性腰围与代谢综合征的调查分析

目的探讨老年男性腰围与代谢综合征（MS）之间的相关性,分析代谢综合征的危险因素,对积极开展早期防治工作提供参考依据。方法以2005年国际糖尿病联盟（IDV）制订的代谢综合征全球共识作为标准,对1700例60岁及以上的老年男性进行了调查,按照腰围进行分层,分析不同腰围人群代谢综合征的患病率及各项代谢指标的异常情况。结果本组腰围≥90cm患者占36．41％,中心性肥胖为63．58％,高血压为59．35％,血糖异常为40．76％,高甘油三酯血症为33．88％;92．57％的患者有不同程度的代谢异常,合并2种及以上代谢异常者占71．05％;当腰围≥90cm时,代谢综合征的患病率随腰围的增加而上升,腰围增加与代谢异常数量之间呈正相关（r=0．479,P〈0．01）;腰围的增加与体重指数、收缩压、舒张压、甘油三酯正相关,与高密度脂蛋白胆固醇之间呈负相关（r=-0．2702,P〈0．01）;腰围≥90cm组高血压的患病率明显高于腰围〈90cm组（P〈0．01）。结论老年男性腰围水平变化与代谢综合征的发生有相关性,代谢综合征的患病率和代谢指标异常数量随着腰围的增加而升高。     

老年代谢综合征患者临床特点及控制达标情况分析

目的了解老年代谢综合征（MS）患者的临床特点、用药情况及代谢异常组分的控制达标状况。方法回顾性分析2006年8月至2009年8月在本院体检或住院MS患者共267例,其中老年人145例,中年人122例。分析中、老年患者MS各组分的差异,老年患者用药情况以及各代谢异常组分控制达标水平。结果老年MS患者的空腹血糖、餐后血糖和收缩压均高于同性别的中年患者,而舒张压无显著差异。老年患者的尿酸水平高于中年患者。老年MS合并糖尿病患者中,97．3％应用药物控制血糖,以磺脲类、α-糖苷酶抑制剂、胰岛素为主,药物联合治疗的达标率为64．7％;老年MS合并高血压患者中,94．7％服用降压药物,以钙通道阻滞剂（CCB）和血管紧张素Ⅱ受体阻滞剂（ARB）为主,两种以上降压药物联合治疗的达标率为56．2％。结论老年MS患者各组分的异常程度和出现频率均不同于中年人,老年MS患者的治疗比例较高,但各组分控制达标率仍不高,联合治疗可有效提高各组分的控制达标率。     

军队部分离退休干部高血压患病情况分析

目的分析2002-2007年军队60～81岁部分离退休老年干部高血压患病率及有关特点。方法以800例60～81岁心血管病危险因素调查结果为研究样本，对老年人高血压的患病率、高血压的类型、高血压患者合并其他心血管危险因素等情况进行分析。结果（1）该人群60～81岁高血压的患病率、治疗率、控制率分别为61．4％，62．8％，23．1％；（2）随着年龄增长，男女高血压患病率呈持续增加趋势P〈0．05；（3）老年人单纯收缩期高血压患病率为27．9％，占老年高血压的45．5％；（4）老年高血压合并至少一种其他心血管危险因素的比例为86．7％。结论高血压是军队老年离退休干部的常见心血管疾病，单纯收缩期高血压是老年高血压的常见类型，老年高血压患者绝大多数合并有其他心血管危险因素。     

睡眠呼吸障碍对高血压患者肾功能的影响

目的 了解住院高血压患者中SDB的患病情况及对肾功能的影响。方法 对新入院的107名高血压患者行随机的床旁EMBLETTA9导联睡眠HOLTER诊断，监测8小时的睡眠，筛选出SDB患者，分组分析血肌酐、尿酸、电解质等指标。结果81例患者合并SDB，患病率75．7％，其中男性患病率82．0％，女性67．4％。合并SDB的高血压患者血尿酸水平明显增高，而血肌酐水平、肌酐清除率无明显差异。结论 高血压住院病人中SDB患病率明显高于一般人群；合并SDB的高血压患者血尿酸水平明显增高，可能预示着肾功能的早期损害。     

柳州市事业单位3311例中老年人代谢综合征患病率调查

目的：调查柳州市事业单位中老年人代谢综合征(metabolic syndrome，MS)的患病率，为其防治提供基础数据依据。方法：对柳州市事业单位3311例中老年人(男1998例，女1313例)进行身高、体质量、血压、空腹血脂、空腹血糖等指标检测；按中华医学会糖尿病学会提出的标准诊断代谢综合征，并进行统计分析。结果：柳州市事业单位中老年人MS总患病率为17．73％，男性患病率（19．87%)高于女性(14．47％)(x^2=15．836，P&;lt;0．001)。MS患者中高三酰甘油和高血压的检出率分别为82．96％和82．19％。男性低高密度脂蛋白胆固醇检出率(56．17％)高于女性(35．79％)(x^2=21．354，P&;lt;0．001)，而女性空腹血糖升高检出率(79．47％)高于男性(61．96%)(x^2=17．995，P&;lt;0．001)。结论：本组中老年人中MS患病率已达较高水平，高三酰甘油、高血压和高体质指数是影响代谢综合征的主要因素。     

酒泉市成人代谢综合征患病率分析

目的评价酒泉市人群中代谢综合征的患病情况。方法酒泉市成人正常体检者7672例，男3906例，女3766例，平均年龄41．5岁，进行体重、血压、血脂及血糖等指标检测，依据2004年中华医学会糖尿病分会制定的适合中国人的代谢综合征（MS）的诊断标准。结果该地区MS的患病率为13．1％，男性患病率14．4％高于女性（P〈0．01）患病率11．6％，随年龄增大而增高，55—65岁组代谢综合征的检出率最高42．5％。肥胖、高血压、空腹血糖增高、高甘油三酯者患病率为14．2％、12．7％、9．4％、16．6％。结论我市代谢综合征的患病率已达较高水平，肥胖、高血压、空腹血糖增高、高甘油三酯对代谢综合征有重要影响；提示在临床工作中要重视对代谢综合征的干预和控制，以预防心血管病的发生。     

老年人代谢综合征两种诊断标准调查结果比较

目的用两种代谢综合征(MS)诊断标准调查老年人MS的患病情况,并对其各组分异常情况进行对比分析。方法对辖区离退休老干部进行心血管病流行病学调查,用ATPⅢ和CDS标准诊断MS。结果ATPⅢ、CDS标准诊断MS的患病率分别为21.53%和32.35%,两种标准MS的患病率差异有统计学意义(P<0.01)。ATPⅢ标准诊断的MS患者有93.13%符合CDS诊断标准。CDS标准中的血糖、超重或肥胖组分异常率明显高于ATPⅢ中的血糖、肥胖组分(P<0.01),而TG、HDL-C组分则低于ATPⅢ,差异均有统计学意义(P<0.05或P<0.01);两种MS诊断标准中的高血压组分异常率最高,均在93.0%以上。结论老年人MS的患病率高于普通成年人群,用CDS标准诊断老年人群,代谢综合征患病率高,能尽早发现MS患者,对预防老年人心血管疾病有益。     

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.