前白蛋白和C反应蛋白测定在诊断小儿呼吸道感染中的意义

目的探讨血清前白蛋白（PA）和C反应蛋白（CAP）在小儿呼吸道感染中的临床价值。方法检测78例呼吸道感染患儿（细菌感染组41例，病毒感染组37例）和42例无感染的体检儿童（对照组）血清PA和CRP的含量。结果细茼感染组较病毒感染组、对照组PA明显降低，CRP则明显升高，差异有统计学意义（P〈0．001）；细菌感染组治疗后PA和CRP均恢复正常值。结论小儿呼吸道急性感染时，PA、CRP的检测有助于疾病早期的鉴别诊断，动态检测其变化对疗效判断有一定的价值。     

血清前白蛋白和C反应蛋白检测在儿童感染性疾病中的应用

目的探讨血清中前白蛋白(PA)、C-反应蛋白(CRP)的检测对儿童早期感染的鉴别诊断和疗效判断的价值.方法检测感染患儿50例及体检儿童20例血常规和血清中PA、CRP的含量.结果 (1) 细菌感染组与病毒感染组、对照组相比较,PA明显降低,CRP则明显升高,差异有显著性(P<0.001). (2) 细菌感染组治疗前后PA、CRP的比较,差异有显著性(P<0.001).结论小儿急性感染时,PA、CRP的检测有助于疾病早期的鉴别诊断,动态检测其变化对疗效判断有一定的价值.     

C-反应蛋白和血清前白蛋白检测在老年患者急性呼吸道感染性疾病中的应用

目的　评价C 反应蛋白 (CRP)和血清前白蛋白 (PA)在区分老年患者急性呼吸道感染病原体的应用价值。方法　检测 1 6 2例急性呼吸道感染期老年患者及 5 0名健康老年人血清CRP和PA的含量。结果　细菌感染组与病毒感染组、对照组相比较 ,PA明显降低 ,CRP则明显升高 ,差异有显著性 (P <0 .0 1 ) ;支气管炎和肺炎患者血清CRP水平差异无显著性 (P >0 .0 5 ) ;细菌感染组治疗前后CRP和PA比较 ,差异均有显著性 (P <0 .0 1 )。结论　在老年患者急性呼吸道感染时 ,血清中CRP和PA的含量呈不同程度的变化有助于疾病的早期鉴别诊断 ,动态检测其变化对疗效判断有一定的价值     

高敏C反应蛋白在儿童急性呼吸道感染的应用探讨

目的探讨患儿全血中CRP、WBC及其分类对儿童早期感染鉴别诊断的价值。方法检测患儿801例和体检儿童50例的CRP、wBC水平并对其分类。结果细菌感染组CRP、WBC、中性粒细胞百分率较对照组明显升高,差异有统计学意义（P〈0．001）;病毒感染组与对照组差异无统计学意义（P〉0．05）。细菌感染组与病毒感染组比较,CRP、WBC、中性粒细胞百分率差异有统计学意义（P〈0．001）。183例CRP〉5．0mg／L患儿抗生素治疗后,CRP下降明显,治疗前、后CRP差异有统计学意义（P〈0．001）,WBC差异无统计学意义（P〉0．05）。结论CRP、WBC、中性粒细胞百分率的检测有助于患儿呼吸道感染疾病早期的鉴别诊断,可指导合理使用抗生素并判断其疗效。     

C反应蛋白检测在儿童急性肺部感染中的应用价值

目的：了解C反应蛋白（cRP）对儿童急性肺部感染的鉴别及疗效判断价值。方法：检测2004年1月至2007年12月急性肺部感染患儿与正常对照组（无感染）儿童血清CRP。结果：（1）急性肺部感染患儿血清CRP阳性率显著高于正常对照组，P〈0．01。（2）疾病恢复期CRP迅速下降。结论：检测儿童急性肺部感染血清CRP浓度对鉴别细菌和非细菌感染、疴隋变化及疗效判断具有一定价值。     

80例感染性疾病患儿血清C反应蛋白和前清蛋白检测分析

目的探讨儿童感染性疾病患者血清C反应蛋白（CRP）和前清蛋白（PA）水平的检测对感染性疾病的诊断及鉴别诊断和疗效判断的意义。方法随机选择80例感染性疾病患儿及50名健康体检儿童,行血清CRP和PA检测,患儿同时行血常规检测,必要时行血清学检查和微生物培养。结果（1）感染细菌的患儿CRP和PA水平与感染病毒患几及健康对照组相比,CRP明显升高,PA明显降低,二者差异有统计学意义（P〈0．01）;（2）感染细菌患儿应用抗生素治疗前后1周的CRP和PA水平,相比差异有统计学意义（P〈0．01）。结论儿童急性细菌性感染时,检测其血清CRP和PA水平有助于临床早期诊断和鏊剐诊断,连续检测其CRP和PA水平还有助于观察疗效和用药评估。     

血清C-反应蛋白和前白蛋白检测在儿童急性呼吸道感染中的应用

目的探讨C-反应蛋白（CRP）和前白蛋白（PA）在区分儿童急性呼吸道感染病原体中的作用。方法采用速率散射比浊法检测40例感染患儿及20例体检儿童血清CRP和PA的含量。结果细菌感染组与健康对照组比较,CRP明显升高,PA明显降低,差异有统计学意义（P〈0.01）。病毒感染组与健康对照组比较,CRP、PA差异无统计学意义（P〉0.05）。结论儿童急性呼吸道感染时,血清中CRP、PA的检测有助于疾病早期的鉴别诊断。     

血清降钙素原和C反应蛋白在全身感染性疾病中的临床意义

目的：探讨感染性疾病中血清降钙素原（PCT）和C-反应蛋白（CRP）的变化及其临床意义。方法：检测血清中PCT、CRP的含量。结果：细菌感染组的PCT、CRP升高均有统计学意义（P〈0．01）,病毒感染组的PCT、CRP升高均无统计学意义（P〉0．05）,细菌感染组治疗前后PCT、CRP比较差异有统计学意义（P〈0．01）。结论：感染时PCT、CRP的检测有助于疾病的鉴别诊断,动态检测其变化对疗效判断有一定的价值。     

C-反应蛋白和血清前白蛋白检测在老年患者急性呼吸道感染性疾病中的应用

目的评价C-反应蛋白(CRP)和血清前白蛋白(PA)在区分老年患者急性呼吸道感染病原体的应用价值.方法检测162例急性呼吸道感染期老年患者及50名健康老年人血清CRP和PA的含量.结果细菌感染组与病毒感染组、对照组相比较,PA明显降低,CRP则明显升高,差异有显著性(P<0.01);支气管炎和肺炎患者血清CRP水平差异无显著性(P>0.05);细菌感染组治疗前后CRP和PA比较,差异均有显著性(P<0.01).结论在老年患者急性呼吸道感染时,血清中CRP和PA的含量呈不同程度的变化有助于疾病的早期鉴别诊断,动态检测其变化对疗效判断有一定的价值.     

C-反应蛋白检测在小儿急性呼吸道感染诊断中的临床应用

目的探讨c-反应蛋白检测在小儿急性呼吸道感染诊断中的作用。方法检测急性呼吸道细菌感染组89例、病毒感染组78例、肺炎支原体感染组84例及健康儿童60例的CRP水平。结果与对照组比较,细菌感染组和肺炎支原体感染组CPP水平明显升高（P〈0．01）,且细茵感染组比肺炎支原体感染组升高明显（P〈0．05）,而病毒感染组则无明显升高（P〉0．05）。细菌感染组和肺炎支原体感染纲治疗前后CRP水平比较差别均有统计学意义（P〈0．01）。结论在小儿急性呼吸道感染时,血清CRP水平检测有助于疾病的早期诊断,动态检测其变化时疗效判断有一定价值。     

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.     

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.     

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.     

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.     

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.