免疫表型在急性髓细胞白血病中的预后价值

为探讨免疫表型在急性髓细胞白血病（ＡＭＬ）中的预后价值，分析了５７例住院成人ＡＭＬ患者的初诊免疫表型与完全缓解（ＣＲ）率和ＣＲ期的关系。结果表明，各髓系抗原的表达率依次为ＣＤ１３＞ＣＤ３３＞ＳＩ６＞ＣＤ６５＞ＣＤ１５＞ＣＤ１１ｂ＞ＣＤ１４。干／祖细胞分化抗原ＣＤ３４的表达率为４２％，以Ｍ１和Ｍ５最高（８０％和８６％），Ｍ３则几乎不表达ＣＤ３４和ＨＬＡ－ＤＲ。淋系抗原ＣＤ２、ＣＤ７、ＣＤ１０、ＣＤ１９和ＣＤ２２在部分ＡＭＬ中阳性。单参数统计分析显示，ＣＤ７＋、ＣＤ１１ｂ＋和ＣＤ３４＋的病例较阴性病例具有低ＣＲ率（Ｐ＜０．０５，＜０．０１，＜０．００５）和短ＣＲ期，表明免疫表型可以作为临床上判断ＡＭＬ预后的参考指标之一。     

ⅡCD34抗原表达与对化疗药物的敏感性

体外细胞毒法（四唑盐法）检测３６例急性髓系白血病（ＡＭＬ）细胞对阿糖胞苷（Ａｒａ－Ｃ）、高三尖杉酯碱（ＨＨｒ）、柔红霉素（ＤＮＲ）、阿克拉霉素（Ａｃｌａ）、长春新碱（ＶＣＲ）、足叶乙甙（ＶＰ－１６）的敏感性，同时用碱性磷酸酶抗碱性磷酸酶（ＡＰＡＡＰ）法检测其ＣＤ＿（３４）抗原，并与临床化疗疗效比较。发现Ａｒａ－Ｃ、ＨＨｒ、ＶＰ－１６中敏组ＣＤ＿（３４）抗原的表达较高敏组高（Ｐ＜０．０５），ＤＮＲ、Ａｃｌａ、ＶＣＲ耐药组较中敏组高，差异亦显著（Ｐ＜０．０５），六种化疗药物耐药组ＣＤ＿（３４）抗原的表达均较高敏组高（Ｐ＜０．０５）。诱导化疗第一疗程后骨髓原始细胞减少指数（ＭＢＤＩ）值＜４０组，４０～６０组及＞６０组组间ＣＤ＿（３４）抗原的表达差异显著（Ｐ＜０．０５）。ＡＭＬ化疗完全缓解，部分缓解与未缓解组组间ＣＤ＿（３４）抗原表达差异亦显著（Ｐ＜０．０５）。复发患者ＣＤ＿（３４）抗原的表达较初诊者高（Ｐ＜０．０５）。ＣＤ＿（３４）阳性白血病细胞对化疗药物具有抗药性，除因其处于静止期（Ｇ＿０期）外，可能与多药耐药基因（ＭＤＲ１）的高水平表达有关。     

CD7阳性的急性髓细胞白血病

ＣＤ７＾＋ＡＭＬ约占ＡＭＬ总数的１０％￣２０％，多同时有ＣＤ３４＾＋和ＨＬＡＤＲ＾＋，而髓系较成熟表型ＣＤ１１ｂ和ＣＤ１５阴性。染色体核型无特征性异常。ＩｇＨ和ＴＣＲ基因重排多处于胚系状态。白血病祖细胞对ＩＬ－３和ＳＣＦ有较强的刺激增殖反应。主要分布于ＦＡＢ分类中的Ｍ０、Ｍ１和Ｍ５亚型，部分Ｍ２和Ｍ４，Ｍ３未见。临床上年轻男性患者多见，肝肿大、ＤＩＣ和ＣＮＳＬ的发生率、外周血平均ＷＢＣ和原始细胞百     

突变的人DHFR肿瘤耐药基因转导脐血干细胞的体外实验研究

目的探讨突变的人二氢叶酸还原酶（ｍＤＨＦＲ）耐药基因在人造血干细胞中抗甲氨蝶呤（ＭＴＸ）的效应。方法应用免疫磁珠分选系统（ＭＡＣＳ）分离纯化脐血ＣＤ３４＋细胞后，用含ｍＤＨＦＲ的逆转录病毒上清转染脐血ＣＤ３４＋细胞，采用造血干细胞集落形成实验进行转导后细胞抗ＭＴＸ分析。结果应用ＭＡＣＳ能高度纯化人ＣＤ３４＋细胞，使分选后的脐血ＣＤ３４＋细胞的纯度平均达９０％，回收率为７１．１％。在ＭＴＸ浓度为２０ｎｍｏｌ／Ｌ的条件下培养１４天，转导ｍＤＨＦＲ耐药基因的脐血干细胞集落形成数明显高于对照组（Ｐ＜０．０１），同时对ＭＴＸ的抗性提高了约２倍。结论突变的人ＤＨＦＲ耐药基因能提高人的造血干细胞对化疗药物ＭＴＸ的抗性。     

急性非淋巴细胞白血病与HLA-DR抗原表达关系的研究

应用免疫酶标染色法检测了５７例急性非淋巴细胞白血病（ＡＮＬＬ）患者的ＨＬＡ－ＤＲ和其它细胞免疫类型，其中３８例（６６７％）表达ＨＬＡ－ＤＲ抗原，表达ＨＬＡ－ＤＲ抗原的ＡＮＬＬ常伴有ＣＤ７的表达，而较成熟的髓系细胞表面标记ＣＤ１５则不表达，ＨＬＡ－ＤＲ＋的ＡＮＬＬ与ＦＡＢ亚型Ｍ１、Ｍ５ａ有密切关系。ＨＬＡ－ＤＲ－组缓解机会大于ＨＬＡ－ＤＲ＋组（Ｐ＜００５），检测ＨＬＡ－ＤＲ抗原不仅有利于ＡＮＬＬ的诊断而且有助于判断预后。     

巨核细胞系抗原表达在急性髓系白血病中的意义

目的探讨急性髓系白血病（ＡＭＬ）巨核细胞系抗原（ＭＫ）表达与临床、生物学特征的关系。方法采用流式细胞仪间接免疫荧光法对成人初治ＡＭＬ患者２１１例进行检测。结果２７例（１２８％）表达ＭＫ;ＡＭＬ亚型中以杂合急性白血病（ＨＡＬ）和急性单核细胞白血病（Ｍ５）表达最高,分别为４５．５％和２４．１％。ＭＫ表达与ＣＤ３４抗原、外周血高白细胞数、多药耐药糖蛋白（Ｐｇｐ）高度相关（Ｐ＜０．０５）,与染色体核型无关。ＭＫ＋ＡＭＬ的完全缓解（ＣＲ）率为３３．３％,明显低于ＭＫＡＭＬ的７１９％。结论巨核细胞系抗原表达可能起源于较早期造血干细胞的恶性转化,可作为临床判断疗效及预后的参考指标之一。     

CD7抗原阳性急性髓系白血病免疫学分型及P糖蛋白检测

目的研究ＣＤ７阳性急性髓系白血病（ＣＤ７＋ＡＭＬ）的临床生物学特征。方法对３０例初治ＣＤ７＋ＡＭＬ患者进行细胞形态学、免疫表型、多药耐药Ｐ糖蛋白、细胞遗传学检测。结果３０例ＣＤ７＋ＡＭＬ在同期２６２例患者中占１１．４％,ＦＡＢ分型中以Ｍ１多见,ＣＤ７＋ＡＭＬ有较高的白细胞总数及原始细胞比例,与ＣＤ３４表达、Ｐ糖蛋白表达高度相关。完全缓解率为４３．３％,中位缓解时间为４个月。达缓解的中位时间为４８天。结论ＣＤ７＋ＡＭＬ患者缓解率低,缓解时间短,具有独特的临床生物学特征。     

免疫学表型与急性髓性白血病的预后

免疫学表型对急性髓性白血病（ＡＭＬ）有重要的预后价值。髓性抗原ＣＤ３３＾－、ＨＬＡ－ＤＲ＾－、ＣＤ１５＾＋、ＣＤ３３／ＣＤ１３〉１及ＣＤ３４＾＋／ＣＤ１３＾－预后较好，而ＣＤ１３＾＋及ＣＤ１４＾＋对预后不利，ＣＤ３４＾＋对预后仍有争议。淋巴抗原ＣＤ２１＾＋和ＴｄＴ＾＋＋对预后不利，ＣＤ５６＾＋对预后相对有利，ＣＤ２＾＋、ＣＤ７＾＋和ＣＤ１９＾＋的预后意义有争议，但大部分作者倾向于ＣＤ７＾＋对预后不     

不同来源CD_（34）~＋CD_（38）~＋和CD_（34）~＋CD_（38）~－细胞群造血性能的不均一性研究

利用ＦＡＣＳ将ＣＤ３４＋细胞分选为ＣＤ３４＋ＣＤ３８＋和ＣＤ３４＋ＣＤ３８－两个亚群，并比较了来源于人脐带血、骨髓及外周血两个亚群的分布比例和造血性能的差异。结果表明骨髓中ＣＤ３４＋及其亚群细胞所占比例最高，外周血最低；脐带血来源的亚群细胞体外形成各系造血集落及液体培养体系中维持长期造血的能力最强，外周血最弱。从而表明不同细胞亚群造血性能不均一，同一亚群不同来源的细胞也同样具有不均一性。     

急性髓系白血病细胞CD34抗原表达的研究：Ⅰ表达特点和临床意义

对５６例初发急性髓系白血病（ＡＭＬ）细胞ＣＤ＿（３４）抗原的表达作了检测，分析了ＣＤ＿（３４）抗原表达与临床表现及化疗疗效的关系。结果显示，ＡＭＬ细胞的ＣＤ＿（３４）表达率存在很大差别，从１％～８５％；５６例ＡＭＬ中ＣＤ＿（３４）阳性表达病例为２３例，占４１．１％。ＣＤ＿（３４）抗原表达与ＦＡＢ形态学分型无关，但Ｍ＿３型的表达阳性率明显低于Ｍ＿１、Ｍ＿２型。ＣＤ＿（３４）￣＋病例组与ＣＤ＿（３４）￣－病例组在年龄、性别及初发时白细胞总数、血红蛋白浓度、血小板计数等均无明显差异；在诱导化疗疗效上，ＣＤ＿（３４）￣＋组完全缓解率为４３．５％，明显低于ＣＤ＿（３４）￣－组的７２．７％。研究结果提示，ＡＭＬ细胞在ＣＤ＿（３４）抗原的表达上存在异质性；并具有一定的预后判断价值，建议对ＣＤ＿（３４）￣＋病例施行更为有效的、可能需与ＣＤ＿（３４＿￣－病例不同的化疗。     

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.