针药结合对缺血性脑血管病患者血浆神经肽的影响

目的 临床观察针刺结合生脉注射液静滴治疗缺血性脑血管病的疗效，并从神经肽的角度探讨其可能机制。方法 观察针药结合治疗前后缺血性脑血管病患的神经功能缺损程度变化情况，并用放免法测定治疗前后血浆中内皮素-l(ET-1)、降钙素基因相关肽(CGRP)、心钠素(ANP)、C-型利钠肽(CNP)、β-内啡肽(β-EP)的含量。结果 针药结合治疗缺血性脑血管病的总有效率为9l％，患神经功能的改善与血浆中ET-1(r=0．393，P=0．029)。CGRP(r=-0．432，P=0．009)，β-EP(r=0．449，P=0．007)变化的相关性具有显性意义。结论 针刺结合生脉注射液静滴是临床治疗缺血性脑血管病的一种有效方法，患神经功能的康复可能与本方法具有调节ET-1，CGRP,β-EP这3种神经肽的作用相关。     

85例缺血性脑血管病患者血浆CGRP、NPY的改变

目的 :探讨缺血性脑血管病两种神经肽与疾病的关系。方法 :应用放射免疫法检测急性缺血性脑血管病血浆中CGRP、NPY的含量 ,结果 :急性脑梗塞患者CGRP显著低于健康对照组 (P <0 .0 1) ;NPY则显著高于健康对照组 (P <0 .0 1)。结论 :CGRP、NPY参与缺血性脑血管病的发病过程。     

血浆内皮素-1及降钙素基因相关肽与类风湿关节炎的 相关性分析

目的　为了探讨神经肽-降钙素基因相关肽(CGRP)内皮素-1(ET-1)在类风湿关节炎(RA)发病机制中的作用。方法采用放射免疫分析法测定了35例RA病人和25例健康人血浆ET-1和CGRP水平。结果　A相对活动组血浆ET-1显著高于健康人和RA相对稳定期组(P<0.01),而CGRP则显著低于健康人和RA相对稳定期组（P<0.05),而CGRP与治疗前相比有明显差异(P<0.05)。直线相关分析表明血浆ET-1与CGRP呈显著负相关。结论　ET-1与CGRP的失衡可能是RA发生发展的重要因素。测定血浆ET-1和CGRP水平的变化,可望作为判断RA病情严重程度和治疗效果的一个指标。     

妊高征患者血浆内皮素—1和降钙素基因相关肽的改变

目的观察妊高征患者血浆内皮素-1和降钙素基因相关肽的变化。方法用特异性放射免疫分析法测定了50例妊高征(PIH)患者血浆内皮素-1(ET-1)和降钙素基因相关肽(CGRP)水平,以20例正常晚期妊娠孕妇做为对照组。结果PIH患者血浆ET-1水平为(70.23±10.21)pg/mg,高于对照组的(43.06±4.22)pg/mg(P＜0.001),且病情越重,含量越多。血浆CGRP为(22.32±2.31)pg/mg,明显低于对照组的(36.38±2.68)pg/mg(P＜0.01),病情越重,含量越低。ET-1含量与CGRP水平呈显著负相关(r=-0.547P＜0.001)。结论血浆内皮素升高继发降钙素基因相关肽含量降低,可能是妊高征发病因素之一。     

偏头痛患者及接受三叉神经刺激的大鼠血中神经肽水平的改变

目的:探讨与血管舒缩有关的神经肽以及类阿片肽在偏头痛发病中的主次作用.方法:偏头痛患者156例,正常对照者82名,于肘静脉采取血样.SD大鼠26只,分为预实验组6只,三叉神经刺激组10只与假手术组10只,分别适时采取血样.采用放射免疫方法测定血样中的神经肽含量.结果:与对照组相比,头痛间歇期患者β-内啡肽(β-EP)降低,而神经肽Y(NPY)升高;头痛缓解4天内的患者降钙素基因相关肽(CGRP)、P物质(SP)、血管活性肠肽(VIP)降低,而强啡肽A(DynA)与亮啡肽(LEK)无变化.与假手术组相比,三叉神经刺激大鼠血中NPY、CGRP、SP、VIP升高,而β-EP、LEK与DynA无变化.比较偏头痛者与大鼠三叉神经刺激后血中神经肽改变,唯一的不一致是偏头痛者β-EP降低.结论:β-EP的降低很可能为偏头痛发病的关键环节,而其余肽类含量改变则是继发现象.     

联合放疗与介入治疗对胰腺癌患者的意义

目的探讨放疗与介入治疗对胰腺癌的疗效,对患者血浆β-内啡肽(β-EP)、前列腺素E2(PGE2)、降钙素基因相关肽(CGRP)及远期生存率的影响。方法以该院就诊的100例胰腺癌患者作为研究对象,回顾性分析其临床病历资料,将其分为观察组(n=52)与对照组(n=48)。其中对照组使用介入治疗,而观察组患者使用介入治疗与放疗,对比2组患者的治疗效果。结果观察组患者治疗总有效率明显高于对照组,差异有统计学意义(χ~2=5.565,P=0.018)。观察组患者各种不良反应发生率明显低于对照组,差异有统计学意义(P0.05)。治疗前,2组患者血浆β-EP、PGE_2、CGRP水平,疼痛评分及肿瘤坏死体积差异均无统计学意义(P0.05),而在治疗后,观察组PGE_2、CGRP水平,疼痛评分明显低于对照组,而β-EP水平及肿瘤坏死体积明显高于对照组,差异均有统计学意义(P0.05)。观察组患者3年生存率明显高于对照组,差异有统计学意义(P0.05)。结论放疗与介入治疗可降低胰腺癌患者血浆β-EP、PGE_2、CGRP水平,减轻患者疼痛,改善患者生存质量,治疗效果显著,安全可靠,该方法值得在临床上进一步推广。     

老年缺血性脑血管病者血浆内皮素-1、降钙素基因相关肽与粘度相关分析

目的探讨82例老年不同类型脑缺血性中风患者血浆中内皮素-1(ET-1),降钙素基因相关肽(CGRP)与多切变粘度相关性改变对缺血性脑血管病的影响.方法用放免分析法(RiA)检测.结果ET-1改变与多切变粘度呈正相关,而CGRP的血浆水平与多切变粘度呈负相关,这两种相关性在脑梗塞组的低切变率时较显著,但,P>0.05.结论(1)ET-1除对脑血流和对血管有收缩、调节作用外,并能使血粘度升高,参与脑梗塞的形成机制.(2)对ET-1和血粘度增高的脑梗塞患者,应尽早进行稀释和放射介入治疗.(3)血浆ET-1、CGRP、血粘度水平变化与脑损伤程度有关.     

针刺对偏头痛大鼠血浆神经肽的影响

目的:探讨针刺治疗偏头痛对降钙素基因相关肽(calatoningene-ralatedpeptide,CGRP)、P物质、内皮素、神经肽Y、心钠素、神经降压肽(neurotensin,NT)的影响。方法:将40只SD大鼠数字表法随机分为正常对照组、模型对照组、针刺对照组和针刺治疗组。按各组方案造模,或针刺治疗后,采用放射免疫法测定颈静脉血浆中多种神经肽的含量。结果:模型对照组CGRP(319.64±53.12)ng/L;P物质(126.76±39.29)ng/L;心钠素(366.11±83.12)ng/L;内皮素(785.00±186.64)ng/L;神经肽Y(4567.06±1041.86)ng/L均较正常对照组(152.87±31.82),(57.43±21.03),(278.31±58.76),(516.88±126.89),(3232.75±424.87)ng/L有明显升高(t=2.283～2.791,P<0.05或0.01),而模型对照组NT(56.64±21.21)ng/L较正常对照组(113.12±35.92)ng/L明显降低(t=2.842,P<0.01);针刺治疗组CGRP(148.54±19.18)ng/L;P物质(60.76±22.31)ng/L;心钠素(287.63±68.64)ng/L;内皮素(524.38±122.55)ng/L;神经肽Y(3324.56±576.77)ng/L均明显下降(t=2.833～2.481,P<0.05或P<0.01),NT(101.13±27.69)ng/L较模型对照组明显升高(t=2.669,P<0.05)。结论:针刺调节脑神经肽的合成与释放,是其治疗偏头痛的主要因素之一。     

98例急性脑血管病患者血浆中NT、CGRP及NPY的含量分析

目的 :测定急性脑血管病患者血浆中三种神经肽的含量 ,分析其含量水平与疾病发生的关系。方法 :应用放射免疫法同时测定 98例急性脑血管病患者及 37例健康对照组血浆中神经降压素 (NT)、降钙素基因相关肽(CGRP)和神经肽Y(NPY)的含量。结果 :脑梗塞组CGRP含量显著低于脑出血组 (     

急性缺血性脑血管病循环血小板生成素和血管活性肽类的动态变化

目的　研究急性缺血性脑血管病早期循环血小板生成素 (TPO)、内皮素 (ET)和降钙素基因相关肽 (CGRP)水平的动态改变及与血小板PL计数的关系。方法　采用放射免疫法及血常规检查检测 13例患者治疗前、治疗 4h、第 2天及第 3天的循环血液TPO、ET、CGRP及PL。治疗分别采用尿激酶溶栓和 /或常规治疗。结果　①患者血液TPO、ET、CGRP水平均较正常明显升高 ,差异显著。其中TPO、ET升高持续至来诊后第 3天TPO分别为 (12 4 70± 12 6 2 )ng/L、(12 1 5 6± 13 31)ng/L、(12 5 6 5± 16 98)ng/L、(117 0 0± 7 0 5 )ng/L对比 (90 0 0± 5 0 0 )ng/L ,P <0 0 1;②比较不同类型缺血性脑血管病或 /和不同治疗方法各时间点的血液TPO、ET、CGRP水平无显著差异 ;③TPO、ET、CGRP、PL之间均无相关性 ;而患者年龄与CGRP呈显著性负相关 (r=- 0 4 5 5 ,P =0 0 0 2 )。结论　急性缺血性脑血管病早期血清TPO升高 ,其升高受到血小板以外的因素调节 ;溶栓治疗对TPO水平无影响。血浆CGRP水平随年龄增长而降低可能是老年人易发生脑血管痉挛的原因之一     

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.