白介素—8水平的检测及其在评价腹透液生物相容性中的意义

为探讨持续性非卧床腹膜透析（ＣＡＰＤ）患者腹腔局部白细胞介素－８（ＩＬ－８）的基因表达及蛋白水平以及其在评价腹透液生物相容性中的临床意义。采用细胞原位杂交、逆转录－ＰＣＲ和酶联免疫吸附法（ＥＬＩＳＡ）检测６例非腹膜炎ＣＡＰＤ患者腹腔内巨噬细胞（ＭＰ）的表达和透出液中ＩＬ－８产生水平，以外周血清和外周淋巴细胞作自身对照。基因表达结果用计算机图象分析系统处理。结果显示腹腔内透析液ＩＬ－８水平明显高于血清（３９．２９±１６．３ｐｇ／ｍｌｖｓ２４．３２±１２．４ｐｇ／ｍｌＰ＜０．０５），腹腔巨噬细胞表达ＩＬ－８的信号也明显强于外周血淋巴细胞（３．２６±１．２１ｐｇ／ｍｌｖｓ１．３４±０．５８ｐｇ／ｍｌＰ＜０．０５）。结果表明在ＣＡＰＤ患者中，由于非生理性腹透液的长期刺激使腹腔巨噬细胞处于一种慢性激活状态并表达、释放ＩＬ－８，如监测透出液中ＩＬ－８水平可作为评价腹透液生物相容性的重要手段     

过敏性紫癜患儿急性期免疫功能变化

本文检测了过敏性紫癜患儿急性期外周血免疫球蛋白血清ＩｇＧ,ＩｇＡ,ＩｇＭ,ＩｇＤ,Ｔ细胞亚群ＣＤ３,ＣＤ４,ＣＤ８,ＣＤ４／ＣＤ８水平,结果显示,血清ＩｇＡ、ＩｇＤ较对照组升高,有显著性差异（Ｐ〈０．０１）。而血清ＩｇＭ较对照组显著增高（Ｐ〈０．０５）,ＩｇＧ则较对照组降低（Ｐ〈０．０５）。ＣＤ３低于对照组,有显著性差异（Ｐ〈０．０１）,ＣＤ４高于对照组,有极显著性差异（Ｐ〈０．０１）,ＣＤ８低于     

胰岛素依赖型糖尿病患者外周T淋巴细胞亚群及血清SIL—2R变化

检测胰岛素依赖型糖尿病（ＩＤＤＭ）患者１４例、非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者２３例和正常对照组３０例血清可溶性白介素２受体（ＳＩＬ－２Ｒ）水平以及Ｔ淋巴细胞亚群的变化，结果发现，ＩＤＤＭ患者ＳＩＬ－２Ｒ水平显著低于正常对照组和ＮＩＤＤＭ组（Ｐ〈０．０１；Ｐ〈０．０５）。ＣＤ８显著低于正常对照组和ＮＩＤＤＭ组（Ｐ均〈０．０１），ＣＤ４／ＣＤ８比值明显升高，与正常对照组和ＮＩＤＤＭ组比较有显著     

老年男性血清CT和BGP变化研究

应用放射免疫分析方法测定了５４例不同年龄健康男性血清ＣＴ及ＢＧＰ。老年有ＣＴ含量为１４．６６ｐｇ／ｍＬ±１３．９６ｐｇ／ｍＬ，与对照组８．８９ｐｇ／ｍＬy ７．６３ｐｇ／ｍＬ比较明显增高，差异显著（Ｐ〈０．０５）；血ＢＧＰ各组含量无差异（Ｐ〉０．０５）。提示老年男性ＣＴ含汨随增龄增高。     

血清试餐胃泌素监测十二指肠溃疡患者幽门螺杆菌根除效果的研究

为探讨十二指肠溃疡（ＤＵ）患者血清试餐胃泌素（ＭＳＧ）对幽门螺杆菌（ＨＰ）感染的反应，评估抗ＨＰ治疗后ＭＳＧ的降低水平及其用于判定ＨＰ根除效果的可靠性，对５２例ＨＰ阳性ＤＵ患者治疗前后分别进行胃镜检查，取胃粘膜ＨＰ培养、病检及快速尿素酶试验，并测定其血清ＭＳＧ浓度。结果发现，ＤＵ患者血清ＭＳＧ浓度（１５４８±６３８ｐｇ／ｍｌ）较对照组（６０９±２５８ｐｇ／ｍｌ）明显升高（Ｐ＜０００１），但经治疗后，ＨＰ被根除者ＭＳＧ明显下降（５６５±１７７ｐｇ／ｍｌ），与治疗前比较差异有非常显著性（Ｐ＜０００１）。ＨＰ未根除者ＭＳＧ下降不明显（１２８２±２３５ｐｇ／ｍｌ），与治疗前比较差异无显著性（Ｐ＞００５）。如果以ＭＳＧ下降率≥３０％视为ＨＰ根除，与ＨＰ培养、病检及尿素酶方法比较，其敏感性为８７０％，特异性为８３３％，阳性预测值９７５％，阴性预测值４５５％，准确性８６５％。提示ＨＰ感染可引起ＤＵ患者血清ＭＳＧ升高，ＨＰ根除后则迅速下降，其一定范围的降低幅度可能对判定ＨＰ根除是一可靠的，无创伤性的较好指标     

心肺复苏家兔血浆ET、CGRP含量变化的研究

目的 研究血浆内皮素（ＥＴ）与降钙素基因相关肽（ＣＧＲＰ）在心脏骤停缺血／再灌注损伤前后含量变化规律及意义。方法 制作家兔心脏骤停缺血／再灌注模型。观察心肺复苏后各时相血浆ＥＴ、ＣＧＲＰ、血压及心电变化。结果 动物在心脏骤停及复苏即刻血浆ＥＴ含量明显变化（Ｐ〈０．０５），而血浆ＣＧＲＰ水平降低（Ｐ〈０．０５），复苏后０．５小时血浆ＥＴ明显升高（Ｐ〈０．０１），复苏后２小时血浆ＥＴ、ＣＧＲＰ均较复苏前有明显上升（Ｐ〈０．０５）。结论 在心脏骤停缺血／再灌注损伤过程中ＥＴ、ＣＧＲＰ水平变化及相关关系可能是一种调节机制并在病理生理过程中起重要作用。     

原发性肝癌患者多头自控射频仪治疗前后免疫功能的变化

实验采用流式细胞仪和单向琼脂扩散法,检测３０例原发性肝癌（ＨＣＣ）患者经间砂自动控制射频治疗仪治疗前后,其细胞免疫和体液免疫功能,结果显示ＨＣＣ患者ＣＤ４＾＋细胞降低（Ｐ〈０．０５）,ＣＤ８＾＋细胞升高（Ｐ〈０．０５）;ＩｇＧ、ＩｇＡ、ＩｇＭ含量与正常对照组相比地明显变化,治疗后,ＣＤ４＾＋细胞升高（Ｐ〈０．０１）,ＣＤ８＾＋细胞降低（Ｐ〈０．０５）,ＩｇＧ,ＩｇＡ,ＩｇＭ的含量稍微升高,与治疗前相比无显著性差异（Ｐ〉０．０５）,说明ＨＣＣ患者经自动控制射频治疗仪治疗后细胞免疫指标有所改善。     

黄芪对肝硬化患者血清前白蛋白的影响

目的：探讨黄芪对肝硬化患者血清前白蛋白的影响。方法：观察两组患者治疗前后血清前白蛋白升高程度及临床症状、体征改善情况。结果：两组治疗后血清前白蛋白均升高,尤以治疗组较对照组升高更显著（Ｐ〈０．００１）,且治疗组治疗前后比较白蛋白（ＡＬＢ）升高,谷丙转氨酶（ＡＬＴ）下降均较明显（Ｐ＝０．０５,Ｐ〈０．０５）;同时临床纳差、腹胀、腹水改善情况治疗组与对照组比较差异有显著性意义（Ｐ〈０．０５）。结论：黄     

儿童脑白质营养不良的氢质子磁共振波谱学研究

目的 探讨儿童脑白质营养不良的氢质子磁共振波谱学（＾１Ｈ ＭＲＳ）表现及其临床意义,为临床早期诊断和治疗提供帮助。方法 对８例脑白质营养不良患儿和６例对照组儿童进行了＾１Ｈ ＭＲＳ检查,对两组间各代谢产物峰下面积比的均值进行ｔ检验。结果 病例组ＮＡＡ／Ｃｒ比值明显低于对照组（Ｐ〈０．０１）,而Ｃｈｏ／Ｃｒ比值较对照组升高（Ｐ〈０．０５）,ｍＩ／Ｃｒ和ｍＩ／ＮＡＡ比值与对照组相比也明显升高（Ｐ〈０．０１）;ｍＩ／Ｃｒ比值升高是ＭＬＤ的显著特征;ＣＤ的ＮＡＡ浓度较对照组升高,Ｃｈｏ浓度减低。在ＭＲＩ表现正常的病例和ＭＲＩ未受 部位亦可探及明显的ＭＲＳ改变。结论 ＾１Ｈ ＭＲＳ可以无创地观察脑白质营养不良脑内异常的生化代谢改变,且它具有很高的敏感性,可先于ＭＲＩ发现脑内病变,有助于病变的确诊和鉴别诊断。     

白血病患者自体骨髓移植后性腺内分泌功能的变化

为了解ＭＡＣ预处理方案的相关毒性──对性腺内分泌功能的影响，观察了１９例白血病患者用ＭＡＣ方案预处理行自体骨髓移植前后的垂体－性腺内分泌功能。所有患者移植前血清卵泡刺激素（ＦＳＨ）、黄体生成素（ＬＨ）、催乳素（ＰＲＬ）、睾酮（Ｔ）和雌二醇（Ｅ２）水平与正常对照组无明显差异（Ｐ＞０．０５）。女性在移植后１～１２个月血清ＦＳＨ和ＬＨ较移植前明显升高（Ｐ＜０．０１），血清Ｅ２水平较移植前明显降低（Ｐ＜０．０１），移植后１年内均有不同程度的闭经；男性在移植后１～１２个月血清ＦＳＨ较移植前明显增高（Ｐ＜０．０１），血清ＬＨ和Ｔ虽在正常值范围，但与移植前比较仍有统计学差异（Ｐ＜０．０５）。所有患者移植后１个月后血清ＰＲＬ水平与移植前均无显著差异（Ｐ＞０．０５）。６３．６％男性血清ＦＳＨ水平和６６．７％女性血清ＦＳＨ、ＬＨ及Ｅ２水平在移植后１年内逐渐恢复正常。研究结果表明，ＭＡＣ方案预处理自体骨髓移植后，患者性腺受到了一定程度损害，但多数患者可在近期内恢复，不影响长期存活者的生活质量。     

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.