去白细胞输血对急性白血病患者细胞免疫功能的影响

目的　观察去白细胞输血对急性白血病患者细胞免疫功能的影响。方法　将 6 1名化疗期间需要接受输血的急性白血病患者随机分为两组 :观察组 30例 ,接受去白细胞输血 ;对照组 31例接受常规输血 ,两组患者的化疗方案基本相同。对两组治疗前后的T细胞亚群、NK细胞活性及红细胞C3b受体花环率 (RBC C3bR)检测并作统计学处理。结果　两组患者的细胞免疫功能在治疗前无显著性差异 ,治疗后观察组患者的细胞免疫功能 (T4、T4 /T8、NK细胞活性、红细胞C3b受体花环率 )均明显高于对照组 (P <0 .0 5或P <0 .0 1 )。结论　与常规的输血方法相比 ,去白细胞输血可以改善急性白血病患者机体的细胞免疫功能     

去白细胞血小板对恶性淋巴瘤患者细胞免疫功能的影响

目的观察去白细胞血小板对恶性淋巴瘤患者细胞免疫功能的影响。方法将60名化疗期间需要输注血小板的恶性淋巴瘤患者随机分为两组,输注去白细胞血小板的观察组30例,输注常规血小板的对照组30例,两组患者的化疗方案基本相同。对两组治疗前后的T细胞亚群,NK细胞活性检测进行统计、对比及分析。结果两组患者的细胞免疫功能在治疗前无明显差异,治疗后观察组患者的细胞免疫功能(T3、T4、T4/T8、NK细胞活性)均明显高于对照组(P0.05或P0.01)。结论与常规血小板的输注相比,去白细胞血小板输注能够有效改善恶性淋巴瘤患者的细胞免疫功能。     

去白细胞输血对地中海贫血患儿细胞免疫功能的影响

目的:探讨滤出白细胞的红细胞(滤白)输注对预防重型地中海贫血患者非溶血性发热性输血反应(FNHTR)的意义及其对患者细胞免疫功能的影响.方法:68例重型β地中海贫血患者根据患者自己的要求以及患者的经济情况等分为如下两种治疗:32人输注悬浮红细胞,36人输注滤出白细胞的红细胞.对治疗后的FNHTR发生率进行统计学分析,同时对两组患者治疗前后的T细胞亚群、NK细胞活性及红细胞C3b受体(RBC-C3bR)花环率进行检测及统计学处理.结果:滤白治疗组FNHTR的发生率明显低于悬红治疗组患者(P＜0.001);两组患者的细胞免疫功能在治疗前差异无显著性,滤白组治疗后细胞免疫功能(T4、T4/T8、NK细胞活性、RBC-C3bR花环率)均明显高于对照组(P＜0.01或P＜0.05).结论:去白细胞输血可降低同种异体输血反应的发生率,改善机体的细胞免疫功能,在一定程度上降低机体免疫功能的破坏,对于有条件的地中海贫血患者是重要的输血治疗措施.     

黄芪注射液对非小细胞肺癌患者辅助化疗后免疫状态的改善作用

目的:探讨黄芪注射液对肺癌术后辅助化疗患者免疫状态的影响。方法:选取我院2010年9月²013年9月接受肺癌根治术的ⅢA期非小细胞肺癌患者200例,随机分为实验组和对照组各100例,观察并记录两组患者辅助化疗后的免疫状态。免疫状态通过测定T细胞亚群、NK细胞及免疫球蛋白水平进行评估。结果:辅助化疗结束时两组肺癌患者的CD3+T细胞、CD4+T细胞和CD4+/CD8+比值均明显下降,而CD8+T细胞明显增加,NK细胞活性明显弱于正常人,说明肺癌患者辅助化疗后的细胞免疫处于较低水平。在辅助化疗后1周,患者CD3+T细胞、CD4+T细胞以及CD4+/CD8+比值进一步下降;实验组患者辅助化疗后1个月,CD3+T细胞、CD4+T细胞及NK细胞活性首先恢复正常;对照组患者以上三种细胞比例虽然有所上升,但速度较为缓慢,直到化疗结束后3个月时仅CD4+T细胞达到正常水平。在化疗后第1周至第3个月的各观察时间内,实验组CD8+T细胞和CD4+T细胞百分比均显著高于对照组。两组患者的体液免疫状态变化趋势与细胞免疫类似。结论:黄芪注射液可显著提高肺癌术后辅助化疗患者的免疫功能。     

去白细胞输血对白血病患者细胞免疫功能的影响

目的 探讨去白细胞输血对白血病患者细胞免疫功能的影响。方法 选取2017年8月至2019年7月在河南科技大学第一附属医院治疗的60例急性白血病患者,根据随机数字表法分为两组。对照组30例采取普通血液成分输血,观察组30例应用去白细胞输血。比较两组的治疗总有效率与CD4+、CD4+/CD8+水平,不良反应发生情况。结果 治疗后,观察组患者的治疗总有效率为90. 00%(27/30),对照组为66. 67%(20/30),差异有统计学意义(P 0. 05);输血后,观察组CD4+、CD4+/CD8+水平均明显高于对照组(P 0. 05);输血期间,观察组患者出现不良反应率为3. 33%(1/30),对照组为23. 33%(7/30),差异有统计学意义(P 0. 05)。结论 对白血病患者应用去白细胞输血可改善患者机体细胞免疫功能,减少不良反应发生,应用效果良好。     

恶性血液病患者化疗后口腔溃疡的护理干预

目的 探讨恶性血液病患者化疗后减少口腔溃疡发生的护理干预措施.方法 将121例恶性血液病化疗患者随机分为干预组和对照组,其中60例对照组患者采取常规护理方法,61例干预组患者在常规护理的基础上采取预防口腔溃疡的干预护理措施.干预6周后观察2组患者口腔溃疡的发生情况.结果 干预组患者口腔溃疡的发生情况显著低于对照组(P<0.05).结论 积极的护理干预措施可有效地预防和减少恶性血液病患者化疗后口腔溃疡的发生.     

白细胞介素-Ⅱ和LAK细胞对放疗后鼻咽癌患者细胞免疫功能的影响

目的探讨白细胞介素 Ⅱ (IL 2 )和LAK细胞对鼻咽癌 (NPC)放疗后患者细胞免疫功能的影响。方法2 7例放疗后获CR的患者分成2组 :A组 (治疗组 ) ,17例接受IL 2和LAK细胞治疗 ;B组 (对照组 ) ,10例仅予一般治疗。检测两组治疗前后NK活性和CD 4/CD 8值的变化。结果A组治疗后NK活性和CD 4/CD 8比值均明显提高 (P <0 .0 5 ) ,B组则无明显变化。结论IL 2和LAK细胞治疗可增加NPC放疗后患者的NK活性 ,对T细胞亚群有调节作用。     

白血病患者免疫功能的临床研究

已有许多动物实验和临床观察的结果表明:细胞免疫功能在肿瘤的发生、发展上有着重要意义。为了解白血病患者细胞免疫功能的变化,我们对30例白血病患者进行了白细胞介素-2(IL-2)、NK细胞活性及T细胞亚群的检测,就其检测结果及临床意义进行初步探     

恶性血液病患者癌因性疲乏的护理干预

目的探讨恶性血液病患者癌因性疲乏(CRF)的护理干预方法及效果.方法将住院接受化疗的恶性血液病患者70例,随机分为观察组和对照组各35例.对照组接受常规护理,观察组除接受常规护理外,由专职护士对癌因性疲乏进行护理干预.分别在干预前、后对两组患者进行癌因性疲乏和生存质量评估.结果干预后两组患者的疲乏程度和生存质量比较差异有显著性(P＜0.05,P＜0.01).结论护理干预可缓解或消除恶性血液病患者癌因性疲乏,提高患者的生存质量.     

香菇多糖联合GP方案对晚期非小细胞肺癌的疗效观察

目的:香菇多糖作为一种生物免试调节剂目前受到临床的广泛重视,本研究旨在观察香菇多糖联合化疗治疗晚期非小细胞肺癌的疗效.方法:将62例晚期非小细胞肺癌患者随机分为实验组和对照组,实验组采用香菇多糖加化疗,对照组采用单纯化疗.两组患者在治疗前后测定外周血T淋巴细胞亚群和NK细胞活性,对患者疗效、免疫功能、生活质量及不良反应进行评价.结果:治疗后实验组和对照两组的有效率分别为64.5%和38.7%(P＜0.05);实验组的T淋巴细胞亚群和NK细胞活性明显高于对照组(P(0.05),免疫功能明显改善;实验组的Karnofsky评分上升率(51.6%)高于对照组(25.8%)(P＜0.05).结论:香菇多糖联合化疗治疗晚期非小细胞肺癌的疗效优于单纯化疗.     

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.