急性甲胺磷口服中毒与自由基损伤关系的初步研究

目的：探讨急性甲胺磷口服中毒（AMP）患者体内的一系列自由基异常反应及其对患者机体损伤程度的关系。方法：采用独立样本随机对照设计，用分光光度比色分析法检测了41例AMP患者和40例健康成人志愿者（HAV）的血浆过氧化脂质（LPO）、一氧化氮（NO）、维生素C（VitC）、维生素E（VitE）、β－胡萝卜（β-CAR）含量及红细胞超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GPX）活性，结果：与HAV组的相应生化参数均值比较，AMP组的血浆LPO和NO均值显著升高（P＜0．0001），血浆Vit、VitE、β－CAR和红细胞SOD、CAT、GPX均值显著降低（P＜0．0001），对41例AMP患者红细胞乙酰胆碱酯酶（AChE)活性与上述各生化参数的直线回归和相关分析表明，随着AChE值的降低，LPO和NO值逐渐升高（P＜0．001），而VitC、VitE、β－CAR、SOD、CAT和GPX值逐渐降低（P＜0．01），逐步回归分析表明，AChE值与GPX和LPO的相关最密切，结论：AMP患者体内的一系列自由基反应病理性加剧，其中毒程度与GPX和LPO的相关最密切。     

急性有机磷农药口服中毒与自由基变化关系的初步探讨

目的：探讨急性有机磷农药口服中毒患者体内的一系列自由基异常反应及其对患者机体损伤程度的关系。方法：采用独立样本对照设计，用分光光度比色分析法检测了58例急性有机磷农药中毒患者（AOPP）和58例健康成人志愿者（HAV）的血浆过氧化脂质（LPO）、一氧化氮（NO）、维生素C（VC）、维生素E（VE）、β－胡萝卜素（β－CAR）含量和谷胱甘肽－S－转移酶（GST）活性及红细胞超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GSH－Px）活性。结果：与HAV组各生化参数（BP）平均值（AV）比较，AOPP组血浆LPO、NO和GST的AV均升高，差异具有显著性意义（P＜0．001），血浆VC、VE、β－CAR和红细胞SOD、CAT、GSH－Px的AV均降低，差异具有显著性意义（P＜0．001）。对58例AOPP患者红细胞乙酰胆碱酯酶（AChE）活性与上述各BP的直线回归和相关分析表明，随着AChE值的降低，LPO、NO和GST值逐渐升高，均呈直线负相关（P＜0．005），而VC、VE、β－CAR、SOD、CAT和GSH－Px值逐渐降低，均呈直线正相关（P＜0．001）。对58例AOPP和58例HAV用上述BP进行判别分析的结果提示，判别正确率均为100％。结论：急性有机磷农药口服中毒患者体内的一系列自由基反应病理性加剧，采用上述参数可提高判别分析的正确率。     

延续性护理对慢性细菌性前列腺炎患者氧化应激及生活质量的影响

目的探讨延续性护理干预对慢性细菌性前列腺炎患者氧化应激及生活质量的影响。方法将2014年10月至2015年10月该院收治的162例慢性细菌性前列腺炎患者分为干预组和对照组,每组各81例。干预组离院后进行延续性护理干预,对照组只采取常规出院指导。1年后观察比较两组患者的血浆一氧化氮(NO)、维生素C(VC)、维生素E(VE)、β-胡萝卜素(β-CAR)和红细胞丙二醛(MDA)水平,红细胞超氧化物歧化酶(SOD)、过氧化氢酶(CAT)和谷胱甘肽过氧化氢酶(GPX)活性,以及患者生活质量。结果组间比较,干预组患者血浆NO、红细胞MDA水平较对照组明显下降,差异均有统计学意义(P0.05),血浆VC、VE、β-CAR水平和红细胞SOD、CAT、GPX等抗氧化酶活性及世界卫生组织生活质量测定量表(WHOQOL-BRIEF)4个维度的评分均较对照组高,差异均有统计学意义(P0.05);组内比较,干预组患者随访满1年后各项氧化应激指标及WHOQOL-BRIEF量表各维度评分均较离院时差异有统计学意义(P0.05),对照组患者随访满1年后血浆NO、VE水平和红细胞MDA、CAT、GPX水平较离院时差异也有统计学意义(P0.05)。结论延续性护理干预能改善慢性细菌性前列腺炎患者的氧化应激状态,提高其生活质量。     

急性结石性胆囊炎与一氧化氮、氧化和脂质过氧化关系的研究

目的：从自由基医学的角度探讨一氧化氮、氧化和脂质过氧化与急性结石性胆囊炎之间的关系。方法：用分光光度法检测了97例急性结石性胆囊炎患者（ALC）和100例健康志愿者（HVT）血浆中的一氧化氮（）P－NO）、维生素C（P－VC）、维生素E（PVE）、β－胡萝卜素（P- β-CAR）和过氧化脂质（P－LPO）含量及红细胞超化物歧化酶（E－SOD）、过氧化氢酶（E－CAT）、谷胱甘肽过氧化物酶（E－CSH－Px)活性和过氧化脂质（E－LPO）含量,分析比较了ALC组与HVT组各平均检测（AV）之间的差异及患者组手术前后各AV之间的差异。结果与HCT组上述各AV比较,ALC组P－NO、P－LPO和E－LPO的AV均显著增高（P＝0．001）,P－VC、P－VE、P-β-CAR、E-SOD、E-CAT和E－GSH－Px的AV均显著降低（P＝0．0001）;与ALC组手术前上述各AV比较,ALC组手后P＝NO、P－LPO和E－LPO的AV均显著降低（P＜0．001）,P－VC、E－SOD、E－CAT和E－CSH－Px的AV均显著增高（P＜0．001）,但PVE和P－β-CAR的AV在手术前后无显著性差异（P＞0．05）。结论：ALC患者体内的一氧化氮代谢严重紊乱,一系列自由基连锁反应病理性加剧,氧化抗氧化平衡严重失调。     

地塞米松对冠心病患者血液脂质过氧化物及有关抗氧化酶活性影响的临床观察

本文分组观察了地塞米松(麻醉诱导时静滴1ng/kg)对16例冠心病患者血浆LPO、红细胞SOD、CAT活性的影响。结果表明:地塞米松组麻醉诱导后血浆LPO(9.18±2.16)较麻醉前显著降低(11.05±3.6P<0.01),红细胞SOD(490.46±86.96 P<0.05)、CAT(344.94±8,P<0.001)活性较麻醉前SOD(375.78±30.6)CAT(289.73±69.22)有显著性升高,而对照组SOD.CAT却较麻醉前显著性降低,提示地塞米松对SOD.CAT活性确有抗氧化保护作用。     

美蓝对静滴普鲁卡因致红细胞过氧化损伤影响的临床观察

目的：探讨美蓝对静滴普鲁卡因（PPOC）致人体红细胞过氧化损伤的影响。方法：40例择期行上腹部手术患者根据麻醉方法不同随机分为静脉普鲁在复合麻醉（IPA）组（观察组,n=20)和芬太尼组（对照组，n=20)。分别观察麻醉诱导前，IPA120min,IPA 180min，静脉注射美蓝（1－2mg/kg)后30min患者血内一氧化氮（NO），氧自由基（OFR），超氧化物歧化酶（SOD），过氧化氢酶（CAT），高铁血红蛋白（MHb)含量变化，IPA60，120，180min血浆对氨基苯甲酸（PABA）浓度与MHb增量的关系。结果：IPA组120，180min与麻醉诱导前相比NO，OFR，MHb有显著性升高（P＜0．05，P＜0．05，P＜0．01）；SOD，CAT较麻醉前显著性降低（P＜0．05，P＜0．01）。而对照组诸指标无显著变化，IPA期间血浆PABA分别与MHb增量间自始至终呈显著正相关关系（r=0.892,0.7146,0.8517, 均P＜0．001），IPA组经美蓝治疗后诸指标均恢复至正常水平，结论：PROC在体内的代谢产物具有强氧化剂特性，可致机体NO，OFR水平升高，红细胞SOD，CAT活性受抑制及与PROC剂量相关的高铁血红蛋白血症，美蓝具有OFR清除剂特性，对PROC所致红细胞过氧化损伤可提供保护作用。     

氧化、脂质过氧化在食管癌患者中的变化

目的：探讨氧化、脂质过氧化在食管癌患中的变化。方法：检测45例食管癌患（患组）和50例健康人（对照组）血浆维生素C（P－VC）、维生素E（P－VE）、β－胡萝卜素（P－β－CAR）和过氧化脂质（P－LPO）含量及红细胞超氧化物歧化酶（E－SOD）、过氧化氢酶（E－CAT）、谷胱甘肽过氧化物酶（E－GSH－PX）活性和过氧化脂质（E－LPO）含量。结果：与对照组比较，P－VC、P－VE、P－β－CAR、E－SOD、E－CAT、E－GSH－PX值显降低（p＜0．001）P－LPO、E－LPO值显增高（p＜0．001）。结论：食管癌患氧化、脂质过氧化损伤加剧。     

清毒退热药对内毒素性发热家兔血浆LPO和红细胞SOD水平的影响

目的：观察清毒退热药对内毒素性发热家兔血浆LPO含量和红细胞SOD活力变化，并对其进行分析。材料与方法：32只新西兰家兔，随机分为4组，Ⅰ组内毒素发热模型组，Ⅱ组内毒素加清毒退热药组，Ⅲ组清毒退热药组，Ⅳ组正常对照组。以硫代巴比妥酸法测定血浆LPO含量，以邻苯三酚法测定红细胞SOD活力。结果：清毒退热药不引起正常家兔体温下降；内毒素模型组血浆LPO含量明显高于其余各组（P＜0．01），红细胞SOD活力则低于其余3组（P＜0．01）。讨论：该研究说明清毒退热药具明显解热作用。提示：自由基参与内毒素诱导的过氧化反应过程；清毒退热药具有清除自由基、抗氧化、保护细胞的作用。     

丹参对老年难治性心力衰竭患者氧化／抗氧化系统的作用

目的：探讨丹参注射液对老年人心力衰竭患者血中GSHPx、CAT、SOD酶活性及LPO含量的影响。方法：选取健康老年人36例。检测静脉血全血超氧化物歧化酶(SOD)、全血谷胱甘肽过氧化物酶(GSH—Px)和过氧化氢酶(CAT)的活性及血浆脂质过氧化物(LPO)和丙二醛(MDA)的浓度．然后与老年难治性心力衰竭组治疗前的此五项指标进行对应比较；选择78例老年难治性心力衰竭患者，随机分成两组，试验前均监测静脉血SOD、GSH—Px和CAT的活性及LPO和MDA的浓度并评价心功能。然后试验组在给予常规治疗的同时合并给予丹参注射液，16g／d，qd，疗程2周；对照组只给予常规治疗，2周后。复测上述指标，比较各组前后的变化。结果：(1)老年难治性心力衰竭患者SOD、GSH—Px和CAT的活性比健康对照组低，而LPO及MDA的浓度比健康对照组高，均P＜0．01。(2)丹参组试验前后比较，SOD、GSH—Px和CAT活性明显增高，且LPO和MDA浓度明显降低，均P＜0．05；而对照组则无显著变化，P＜0．05。(3)丹参组心力衰竭纠正的有效率显著高于对照组，P＜0．05。结论：老年难治性心力衰竭患者机体的抗氧化防御能力降低，丹参注射液可通过提高机体的抗氧化能力，消除氧自由基和脂质过氧化物起到纠正心力衰竭的作用。     

部分性脾栓塞对肝硬化患者氧化和抗氧化失衡的影响

目的　探讨部分性脾动脉栓塞术 (PSE)对肝硬化患者氧化和抗氧化系统的影响及其临床意义。方法　测定 30例肝硬化PSE后 2个月患者、30例肝硬化非PSE患者和 6 0例正常人血浆维生素C(P VitC ) ,维生素E(P VitE) ,β 胡萝卜素 (P β CAR)和一氧化氮 (P NO)含量 ,红细胞超氧化物歧化酶 (E SOD)、过氧化氢酶 (E CAT)和谷胱甘肽过氧化物酶 (E GSH Px)活力 ,血浆及红细胞过氧化脂质 (P LPO ,E LPO)水平的变化。结果　肝硬化非PSE组、PSE后 2个月组 (PSE组 )和对照组的P VitC、P VitE、P β CAR、E SOD、E CAT和E GSH Px水平依次升高 (均 P <0 .0 0 1) ;3组的P NO、P LPO和E LPO含量依次降低 (均P <0 .0 0 1) ;除了PSE组和对照组E SOD的差异无统计学意义外 ,3组之间其他检测值的两两比较差异均具有统计学意义。结论　PSE有利于纠正肝硬化患者体内一氧化氮代谢异常、氧化和抗氧化的失衡     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.