休克期大面积切痂对严重烫伤大鼠T淋巴细胞CD25表达的影响

目的：观察休克期大面积切痂对严重烫伤大鼠T淋巴细胞表达CD2s的变化情况，以了解其对烧伤免疫的影响。方法：对比观察正常大鼠，严重烫伤大鼠休克期大面积切痂和常规治疗组伤后第1、5、9天外周血T淋巴细胞表达CD25和脾脏T淋巴细胞活化后CD25的表达的变化情况。结果：（1）与正常对照组比较，严重烫伤大鼠伤后外周血T淋巴细胞中CD25的表达及脾脏T淋巴细胞经活化后CD25的表达较正常组均明显下降（P〈0．01或P〈0．05）；（2）休克期切痂组与常规治疗组相同时相点比较CD25的表达明显升高（P〈0.01或P〈0．05）。结论：（1）严重烫伤大鼠免疫状况发生了明显改变；（2）休克期大面积切痂可以促进烫伤大鼠外周血和脾脏经活化后T淋巴细胞CD25表达的恢复，改善其免疫功能。     

休克期切痂对烫伤大鼠Th1/Th2型细胞因子的影响

目的：探讨烫伤大鼠伤后不同时间切痂对辅助性T淋巴细胞亚群Th1／Th2细胞功能性极化的影响。方法：160只健康雄性Wistar大鼠制备背部30％总体表面积Ⅲ度烫伤模型，随机分为单纯烫伤对照组以及伤后8、24和96h切痂组。在伤后4、12、24、48、96、120和168h活杀动物采集血液和脾脏标本；酶联免疫吸附法(ELISA)检测血浆、脾脏匀浆中的γ-干扰素(IFN-γ)和白介素-4(IL-4)含量。结果：烫伤4h大鼠上述细胞因子均迅速上升，Th1型细胞因子IFN-γ在伤后24h达峰值，其后逐渐下降；Th2型细胞因子IL-4进行性升高；伤后7d出现明显偏向Th2型反应的现象。切痂组两型Th细胞因子的变化幅度小于单纯烫伤对照组，其中8h切痂组变化最小，24h和96h切痂组次之。结论：休克期切痂有利于抑制严重烧伤后Th2的漂移。     

原发性肾病综合征患者外周血T细胞亚群分析

目的：探讨原发性肾病综合征患者外周血T淋巴细胞亚群的变化。方法：采用间接免疫荧光法检测40例原发性肾病综合征患者外周血T淋巴细胞亚群（CD^3＋、CD^4＋、CD4^＋/CD^8＋）并与30例正常人对照组进行对比。结果：原发性肾病综合征组CD^3＋、CD^4＋和CD^4＋/CD^8＋的比值均显著低于正常对照组（P〈0.001）。结论：原发性肾病综合征患者存在T淋巴细胞免疫功能紊乱,表现在T淋巴细胞亚群失衡。     

子痫前期患者及正常孕妇外周血T淋巴细胞亚群的变化

目的：研究外周血T淋巴细胞亚群在子痫前期患者及正常孕妇中的变化。方法：采用流式细胞技术检测子痫前期患者及正常孕妇外周血CD3^＋、CD4^＋、CD8^＋T淋巴细胞并与未孕妇女进行对照，探讨T淋巴细胞亚群及CD4^＋／CD8^＋T细胞比值在子痫前期及正常孕妇中的变化。结果：子痫前期与正常妊娠妇女相比，子痫前期患者总T淋巴细胞无显著变化，CD^4＋T淋巴细胞升高，差异非常显著（P〈0．001）；CD8^＋T淋巴细胞下降，差异非常显著（P〈0．001）：CD4^＋／CD8^＋T淋巴细胞比值升高．差异非常显著（P〈0．001）。与未孕妇女相比差异无显著性（P〉0．05）。子痫前期患者中CD^4＋／CD^8＋T淋巴细胞比值与平均动脉压呈正相关（r=0．569，P〈0．01）。结论：T淋巴细胞亚群的数量变化及相互间的平衡失调在子痫前期发病机制中发挥重要作用：     

休克期大面积切痂对烫伤大鼠NK细胞活性的影响

目的：探讨休克期大面积切痂对烫伤大鼠外周血NK细胞活性的影响，了解严重烧伤机体免疫状况，为临床治疗提供理论依据。方法：健康wistar大鼠70只，随机分为3组。正常对照组（10只）：不麻醉，不造成烧伤，于实验第1天活杀取血，检测NK细胞活性；休克期切痂组（30只）：造成背部30％TBSAⅢ度烧伤，依照Parkland公式腹腔内注射乳酸林格氏液复苏，于伤后第6小时将焦痂完全切除，辐照氟银猪皮覆盖，四周缝合打包固定，分笼喂养，分别于伤后第1、5、9天各活杀10只取血检测NK细胞活性；常规治疗组（30只）：动物模型制作同休克期切痂组，伤后创面外涂碘酊，2次／d．至伤后第4天手术将焦痂完全切除，辐照氟银猪皮覆盖，四周逢合打包固定，分笼饲养，于伤后第1、5、9天各活杀10只取血检测NK细胞活性。结果：（1）休克期切痂组、常规治疗组两组大鼠烫伤后其外周血NK细胞活性均较正常对照组低，且差异有显著性（P〈0．01或P〈0．05）；（2）休克期切痂组伤后第5、9天两时相点外周血NK细胞活性与常规治疗组比较明显提高，差异有显著性，至第9天基本接近正常。结论：烫伤后大鼠外周血NK细胞活性明显降低；休克期切痂有助于烫伤大鼠外周血NK细胞活性的恢复。     

原发性胆汁性肝硬化患者外周血T淋巴细胞亚群检测的意义

目的 探讨原发性胆汁性肝硬化（PBC）患者外周血T淋巴细胞亚群及细胞因子的特点及意义。方法 以35倒健康人作为对照组,用流式细胞术分析了35例确诊的PBC患者外周血T淋巴细胞亚群及其分泌IL-4和IFN-γ情况。结果 PBC患者组CD^4＋T细胞升高,CD8^＋T细胞下降,CD4^＋T／CD8^＋T比值上升（P〈0．05）;PBC患者CD4^＋T细胞IFN-1表达显著升高（P〈0．05）,而IL-4水平与对照组比较无显著性差异（P〉0．05）。结论 在PBC发病机制中,CD4^＋T细胞和TH1亚群细胞超重要作用。     

联合检测外周血T淋巴细胞亚群及血清CEA在大肠癌患者中的表达意义

目的研究大肠癌患者血清癌胚抗原（CEA）水平及其免疫功能状态及其在诊断预后等方面的临床意义。方法应用流式细胞仪检测35例大肠癌患者外周血T淋巴细胞亚群及血清CEA的表达水平。结果大肠癌患者的CD^＋4细胞值、CD^＋4／CD^＋8比值下降,CD^＋8细胞值CEA血清水平显著高于对照组。结论大肠癌患者的免疫功能低下,CEA的阳性率高,有利于临床医生的诊断及对患者免疫功能的评估,以便制定合理的治疗方案。     

流式细胞术测肺癌患者外周血T细胞亚群及其与临床病理的关系

目的：探讨应用流式细胞术检测肺癌患者细胞免疫功能的方法及其与临床病理的关系。方法：应用三色免疫荧光流式细胞仪测定105例肺癌患者及18例正常对照者外周血T细胞亚群CD3^＋、CD4^＋、CD8^＋、NK细胞、CD4^＋／CD8^＋比值。结果：全组肺癌患者外周血中各T淋巴细胞亚群比例较正常对照组无显著性差异；Ⅰ期、Ⅱ期肺癌患者和健康对照组之间T细胞各亚群相比没有统计学差异；Ⅲ期、Ⅳ期肺癌患者和健康对照组相比：CD4^＋明显降低（P=0．04）；CD8^＋则明显升高（P=0．02）；CD4^＋／CD8^＋较正常有所下降，但没有显著性差异。结论：外周血T细胞亚群的检测有助于对肺癌患者的病情、临床分期以及机体免疫状态的判断，晚期肺癌患者机体免疫状态成紊乱型改变。     

严重烧伤患者T淋巴细胞功能观察及临床意义

目的：观察严重烧伤患者伤后T淋巴细胞亚群及增殖活性的动态变化，了解患者伤后免疫信息，为临床免疫治疗提供理论依据。方法：动态观察35例严重烧伤患者伤后1、2、3周T淋巴细胞亚群及T淋巴细胞转化率的变化，并与10例健康献血员作对照分析。结果：与正常对照组比较，严重烧伤患者伤后T淋巴细胞亚群发生了明显变化：CD3细胞下降，CD4细胞比例下降，CD8细胞比例升高，CD4／CD8比值下降，T淋巴细胞转化活性降低。差异均有显著性（P〈0.01或P〈0．05），至伤后第3周仍无恢复。     

休克期切痂对烫伤大鼠肝HMGB1表达及肝功能的影响

目的　探讨休克期切痂对烫伤大鼠肝组织高迁移率族蛋白B1(HMGBl)表达及肝脏功能影响。方法　 30 %Ⅲ度烫伤Wistar大鼠随机分为 2 4h和 72h切痂植皮组。RT PCR和免疫组化染色法检测肝脏HMGBlmRNA/蛋白表达 ,同时检测血浆AST、ALT含量。结果　大鼠烫伤后肝组织HMGB1mRNA表达量增加 1～ 2 5倍 ,2 4h切痂组伤后 8d其水平较烫伤对照和 72h切痂组显著减少 (P <0 0 5 )。烫伤后大鼠肝细胞和枯否细胞HMGB1表达阳性率较正常大鼠均显著升高 (P <0 0 1) ,2 4h切痂组 4、 8dHMGB1表达阳性细胞数较烫伤对照和 72h切痂组均显著减少 (P <0 0 1)。同时 ,烫伤大鼠血浆AST和ALT水平升高 (P<0 0 5 ) ,而 2 4h切痂组伤后 4、 8d较烫伤对照组和 72h切痂组显著降低 (P <0 0 1)。结论　烫伤大鼠休克期切痂能够下调肝组织HMGB1表达 ,局部HMGB1诱生参与了肝损伤的病理生理过程。     

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.