D-二聚体检测对急性脑梗死诊断的意义

[目的]探讨血浆D-二聚体检测对急性脑梗死的诊断意义。[方法]采用酶免疫分析方法应用ELFA技术（酶联荧光分析）检测150例急性脑梗死患者和60例健康对照组D-二聚体水平。[结果]急性脑梗死患者D-二聚体水平明显高于健康对照组,比较差异具有显著性（P〈0．01）,病情重者升高更明显。[结论]血浆D-二聚体水平变化可作为判断急性脑梗死患者病情及评估预后的敏感标志物。     

急性脑梗死患者血液流变学指标、D-二聚体及纤维蛋白原联合检测的临床意义

目的探讨急性脑梗死患者血液流变学指标、D-二聚体及纤维蛋白原联合检测的临床意义。方法对56例急性脑梗死患者的血液流变学指标、D-二聚体及纤维蛋白原进行检测分析,30名健康体检者作为对照组。结果急性脑梗死患者血液流变学指标明显高于对照组（P〈0．01）,两组的D-二聚体和纤维蛋白原指标差异有显著意义（P〈0．01）。结论联合检测血液流变学指标、D-二聚体及纤维蛋白原有助于急性脑梗死的预防,治疗及预后判断。     

急性脑梗死继发癫痫患者血浆一氧化氮和D-二聚体水平的变化

目的：观察急性脑梗死后继发癫痫患者的血浆因子一氧化氮和纤溶指标D-二聚体水平的变化及两者的相关性。方法：以2001-01／2003-12广东省江门市人民医院收治的急性脑梗死继发癫痫发作患者36例为癫痫组，同期体检和献血者41例为对照组。采用硝酸酶还原法测定被试者的血浆一氧化氮浓度，酶双抗体夹心法测定血D-二聚体的水平，癫痫组患者在癫痫发作时采血检测。同时将癫痫患者的血浆一氧化氮和D-二聚体水平作直线相关分析。结果：按意向处理分析，77例均进入结果分析。①血浆一氮化氮浓度：癫痫组明显高于对照组[（102．73&;#177;30．51），（83．32&;#177;25．32）μmol／L，t=3．05，P〈0．01]。②血浆D-二聚体质量浓度：癫痫组明显高于对照组[（1．09&;#177;0．97），（0．61&;#177;0．59）mg／L，t=2．6588，P〈0．01]。，③癫痫组患者血浆一氮化氮和血浆D-二聚体之间没有直线相关性厂=0．037，P〉0．05）。结论：急性脑梗死后继发癫痫患者存在高水平的血浆一氧化氮浓度和纤溶活性升高。一氧化氮和D-二聚体可能参与了急性脑梗死后继发癫痫的病理过程，但两者之间无直线相关性。     

D-二聚体和糖化血红蛋白对脑梗死和脑出血的临床意义

目的探讨D-二聚体和糖化血红蛋白含量变化对脑梗死和脑出血的关系和意义。方法选择在本院住院的脑梗死和脑出血的患者，将其分为脑梗死组、脑出血组、一般疾病组和健康对照组，所有受试者均测试糖化血红蛋白和D-二聚体，进行统计学分析。结果与健康对照组比较，脑梗死组的D-二聚体和糖化血红蛋白均明显升高（P〈0．01），与脑出血组的D-二聚体差异无统计学意义，糖化血红蛋白差异有统计学意义（P〈0．01）；脑出血组和脑梗死组比较，D-二聚体和糖化血红蛋白差异有统计学意义（P〈0．01、P〈0．05）。结论通过测定D-二聚体和糖化血红蛋白，能够对临床表现易混淆的脑梗死和脑出血两种疾病区别开来，指导临床治疗。     

急性脑梗死患者血浆D-二聚体水平的临床研究

目的探讨血浆D-二聚体在急性脑梗死发病过程中的变化。方法采用免疫比浊法检测30例健康对照者及46例急性脑梗死患者（入院后第1、7、14天）血浆D-二聚体的变化，分析其与梗死体积大小、神经功能缺损程度的相关性。结果急性脑梗死组患者血浆中D-二聚体含量与健康对照组相比明显增高（P〈0．01），大、中体积梗死组及神经功能缺损重、中型组的D-二聚体水平明显高于小体积梗死组及神经功能缺损轻型组（P〈0．01）。结论急性脑梗死患者血浆D-二聚体水平可作为判断病情的客观指标。     

胰腺癌患者凝血功能的变化及其临床意义

[目的]了解胰腺癌五项凝血指标的变化并探讨其临床意义。[方法]使用凝固点检测法检测46例正常人、32例胰腺良性肿瘤患者、106例胰腺癌病人和43例胰腺癌肝转移患者血浆凝血酶原时间（Frr）、活化部分凝血活酶时间（APT）、凝血酶时间（TT）、纤维蛋白原（Fib）含量和D-二聚体水平。[结果]胰腺癌、胰腺癌肝转移患者血浆中的Fib和D-二聚体与正常人、胰腺良性肿瘤患者相比明显升高（P〈0．05），且肝转移组的Fib和D一二聚体与未转移组相比也有统计学意义（P〈0．05）；但FT、APTT和TT与对照组相比没有统计学意义（P〉0．05）；不同的组织学分级，Fib没有统计学意义（P〉0．05）而D-二聚体有统计学意义（P〈0．05）。[结论]胰腺癌及胰腺癌肝转移患者血浆Fib和D-二聚体含量均升高。     

D-二聚体／FDP比值在急性与陈旧性脑梗死诊断中的意义

目的研究急性与陈旧性脑梗死时患者血浆凝血、纤溶活性的变化,探讨D-二聚体／FDP比值在急性与陈旧性脑梗死时的应用价值。方法比较40例急性脑死塞患者与40例陈旧性脑梗死患者血浆凝血、纤溶活性。检测血浆中的纤维蛋白原（Fbg）、D-二聚体（D-dimer）、纤维蛋白（原）降解产物（FDP）三个参数。对三个参数分别进行组合分析：评价不同组合在鉴别急性与陈旧性脑梗死时的应用价值。结果急性脑梗死组血浆D-二聚体／FDP比值明显高于陈旧性脑梗死组（P〈0．05）;而单独Fbg、FDP比较两组差别无显著性（P〉0．05）;两组单独D-dimer结果均与正常参考值有差别（P〈0．05）,但两组相比较,D-dimer值差别无显著性（P〉0．05）。结论急性脑梗死的发生存在血液高凝状态大于纤溶状态,D-二聚体／FDP比值可以作为诊断急性与陈旧性脑梗死的快速简便实验室指标。     

急性脑梗死患者血浆D-二聚体及血清C-反应蛋白检测及意义

[目的]探讨急性脑梗死患者血浆D-二聚体（D—Dimer）,及血清CRP的变化及其临床意义。[方法]选自2008年10月～2009年3月在我院脑系科收治的急性脑梗死患者28例,并与46例正常对照组进行上述两个项目的检测分析。[结果]急性脑梗死患者血浆D—D含量明显高于对照组（P〈0．01）CRP;数明显高于对照组（P〈0．05）。[结论]监测血浆D—D,CRP升高,对急性脑梗死的诊断,治疗有重要意义。     

脑梗死患者抗凝血酶-Ⅲ、D-二聚体及血小板活化指标的变化

目的 探讨急性脑梗死患者抗凝纤溶系统指标及血小板活化指标的变化规律。方法以同期健康体检者为对照组，对急性脑梗死患者进行抗凝血酶-Ⅲ（AT-Ⅲ）、D-二聚体（D—D）含量及活化血小板膜糖蛋白CD62p、血小板平均体积的测定。结果 与对照组比较，脑梗死组AT-Ⅲ活性明显降低，D-二聚体显著升高（P〈0．01），活化血小板膜糖蛋白CD62p及血小板平均体积显著升高（P〈0．01和0．05）。结论 抗凝纤溶系统及血小板活化指标与脑梗死的发生发展密切相关，检测抗凝纤溶系统及血小板活化指标对脑梗死的诊断及治疗有一定的临床意义。     

急性胰腺炎患者血浆D-二聚体含量及外周血淋巴细胞蛋白激酶C活性的变化及意义

目的通过对急性胰腺炎患者血浆D-二聚体含量及淋巴细胞蛋白激酶C（PKC）活性的检测，探讨其在急性胰腺炎病程演变中的作用，从而为急性胰腺炎的早期抗纤溶治疗及选择特异性的PKC拮抗剂提供理论依据。方法采用双抗体夹心Elisa法和同位素γ—32P—ATP催化活性测定法分别对实验组和对照组进行血浆D-二聚体含量及淋巴细胞PKC活性的检测。结果急性轻型胰腺炎组血浆D-二聚体水平及淋巴细胞PKC活性较对照组均有所增高（P〈0．05），急性重症胰腺炎组血浆D-二聚体水平及淋巴细胞PKC活性较正常对照组明显增高（P〈0．01）。而血浆D-二聚体及淋巴细胞PKC活性比较。重症胰腺炎组显著高于轻型组（P〈0．01）。结论血浆D-二聚体含量及淋巴细胞PKC活性变化与急性胰腺炎的病程演变关系密切，血浆中D-二聚体含量可作为急性胰腺炎的辅助诊断、预后监测及疗效追踪的一项有用的检测指标。在急性胰腺炎早期行抗纤溶治疗及选择特异性的PKC拮抗剂具有重要意义。     

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.     

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.