14C-尿素呼气试验与组织学诊断幽门螺杆菌感染在慢性胃炎中的对比研究

目的 评价14C尿素呼气试验对慢性胃炎患者幽门螺杆菌感染的诊断价值.方法 取180例因上腹部症状而行胃镜检查的患者胃窦粘膜活检,分别行Wartin-Stany（WS）银染色、快速尿素酶实验（RUT）、14C尿素呼气试验（14C UBT）,并同时行病理组织学诊断;将WS和RUT结果相一致且病理结果为慢性胃炎的病例入选,分析14C尿素呼气试验（14C UBT）诊断慢性胃炎幽门螺杆菌感染的特异性、敏感性、准确性.结果 14C尿素呼气试验（14C UBT）的特异性为：93.8%;敏感性为：90.9%;准确性为：92.2%.结论 14C尿素呼气试验（14C UBT）是一项敏感的、特异的、安全、可靠的非侵入性Hp的检测方法.     

~(13)C-尿素呼气试验诊断儿童幽门螺杆菌感染的临床评估

目的　评估13C 尿素呼气试验(13C UBT)诊断幽门螺杆菌(HP)感染的准确性。方法　对23例有消化 道症状的患儿进行病理组织学、快速尿素酶试验,以决定是否感染HP。结果　以内镜检查结果作为诊断HP感 染的金标准。13C UBT的敏感性是92.85%,特异性100%,阳性预测值100%,阴性预测值90%,诊断准确率 95.56%。结论　13C UBT有较高的敏感性和特异性,是一种测定小儿HP感染可靠易行的非侵入性诊断方法。     

唾液测试板检测幽门螺杆菌感染的临床价值

目的 探讨唾液测试板检测幽门螺杆菌(Hp)感染的临床价值.方法 采用唾液测试板检测患者唾液中的尿素酶,同时用快速尿素酶试验(RUT)、胃黏膜组织学检查(改良Giemsa染色)、14C-尿素呼气试验(14C-UBT)及细菌培养联合检测来判断胃黏膜Hp感染情况.结果 80例患者行Hp联合检测栓出阳性患者51例,阳性率为63.75%,其中唾液测试板检出38例,阳性率47.50%,RUT检出45例,阳性率56.25%,组织学检查检出47例,阳性率58.75%,14C-UBT检出47例,阳性率58.75%,细菌培养检出38例,阳性率47.50%.唾液测试板、RUT、组织学检查、14C-UBT及细菌培养诊断Hp感染的敏感性分别为72.55%、80.39%、88.24%、80.39%、74.51%;特异性分别为96.55%、86.21%、93.10%、79.31%、100.00%;准确性分别为81.25%、82.50%、90.00%、80.00%、83.75%;阳性预测值分别为:97.37%、91.11%、95.74%、87.23%、100.00%;阴性预测值分别为66.67%、71.43%、81.82%、69.70%、69.05%,结果进行X2检验,差异无显著性.结论 唾液测试板检测唾液中Hp感染的阳性率及准确性、敏感性、特异性与RUT等相近,且此法为非侵入性、快速、简便,价格不高,不需要任何其他仪器,是值得临床进一步验证的一种新的非侵入性Hp感染诊断方法.     

14碳呼气试验诊断幽门螺旋杆菌感染临床价值

目的:比较、评价14碳呼气试验(01C urea breath test,14C-UBT)与组织学和快速尿素酶试验(rapid urease test,RUT)诊断幽门螺旋杆茵(Helicobacter pylori,HP)感染的价值.方法:经胃镜检查有功能性消化不良症状107例患者纳入本研究,依据怠者临床特点分为上腹痛综合征组和餐后不适综合征组.胃镜检查后吞服14C尿素胶囊后进行14C-UBT.通过对比组织学方法和RUT计算14C-UBT的灵敏度、特异度和精确度.结果:上腹痛综合征组HP阳性率高于餐后不适综合征组(P<0.05);与组织学方法相比14C-UBT的精确度为93%,阳性预测值99%,阴性预洲值86%;与RUT相比14C-UBT精确度为93%,阳性预测值92%.阴性预测值97%(Knppa值=0.867),精确度具有一致性.结论:14C-UBT是一种快速、可靠、安全、经济的诊断现症HP感染的最佳方法.     

14碳呼气试验诊断幽门螺旋杆菌感染临床价值

目的:比较、评价14碳呼气试验(14C urea breath test,14C-UBT)与组织学和快速尿素酶试验(rapid urease test,RUT)诊断幽门螺旋杆菌(Helicobacter pylori,HP)感染的价值。方法:经胃镜检查有功能性消化不良症状107例患者纳入本研究,依据患者临床特点分为上腹痛综合征组和餐后不适综合征组。胃镜检查后吞服14C尿素胶囊后进行14C-UBT。通过对比组织学方法和RUT计算14C-UBT的灵敏度、特异度和精确度。结果:上腹痛综合征组HP阳性率高于餐后不适综合征组(P<0.05);与组织学方法相比14C-UBT的精确度为93%,阳性预测值99%,阴性预测值86%;与RUT相比14C-UBT精确度为93%,阳性预测值92%,阴性预测值97%(Kappa值=0.867),精确度具有一致性。结论:14C-UBT是一种快速、可靠、安全、经济的诊断现症HP感染的最佳方法。     

幽门螺旋杆菌感染几种检测方法比较

目的本文回顾分析间接固相免疫层析法、14C—尿素呼吸试验、组织学病理染色对Hp感染诊断的应用价值。方法对170例因上腹部不适就诊者行14C-尿素呼气试验、间接固相免疫层析法Hp检测,其中120例胃镜检查进行组织学Giemsa染色。结果间接固相免疫层析法、14C—尿素呼吸试验及纲织病理染色的敏感性分别为90.8%、95.2%、96.2%;特异性分别为83 4%、97.7%、100%。结论间接固相免疫层析法可用于Hp感染的筛杳,而不能作为疗效判断的指标,14 CR乎气试验是较可靠的Hp检测方法,组织病理灵敏性和特异性最高,但不能用作流行病学调查。HP阳性者易患慢性胃炎和十二指肠溃疡(P值均<0.01)。     

14C呼气试验与快速尿素酶试验诊断幽门螺杆菌的对比研究

目的:比较14 C呼气试验(carbon-14-urea breath test,14 C-UBT)和快速尿素酶试验(rapid urease test,RUT)两种检测方法在诊断幽门螺杆菌(Helicobacter pylori,HP)感染中的价值。方法:将胃镜检查确诊为消化性溃疡的1 722例患者纳入本研究。先行RUT检测,30min后行14 C-UBT检测。比较两种方法的阳性率、敏感性、特异性和正确性。结果:RUT检测HP的阳性率、敏感性、特异性和正确性分别为61.87%(1 035/1 722)、90.80%(1 086/1 196)、89.73%(472/526)、90.48%(1 558/1722);14 C-UBT检测HP的阳性率、敏感性、特异性和正确性分别为69.45%(1 196/1 722)、93.91%(972/1 035)、97.08%(665/687)、95.06%(1637/1 722)。两种方法无显著差异。结论:14 C-UBT与RUT检测HP感染均有较高的敏感性、特异性及正确性,它们都是临床上用于诊断HP感染的简单、安全、可靠的方法。     

幽门螺杆菌唾液测试板与14C-尿素呼气试验检测幽门螺杆菌感染的比较

目的:比较幽门螺杆菌唾液测试板(HPS)与14C-尿素呼气试验(14C-UBT)检测幽门螺杆菌(Hp)感染的临床价值。方法:用HPS检测唾液中的尿素酶,同时行14C-UBT及胃镜检查行快速尿素酶试验(rapidurease test,RUT)、胃黏膜组织学检查(改良Giemsa染色)及细菌培养联合检测来判断胃黏膜Hp感染情况,并比较HPS与14C-UBT诊断Hp感染的阳性率、敏感性、特异性、准确性、阳性预测值及阴性预测值。结果:160例患者行Hp联合检测检出阳性患者102例,阳性率为63.75%,其中HPS检出76例,阳性率47.50%,14C-UBT检出94例,阳性率58.75%。HPS、14C-UBT诊断Hp感染的敏感性分别为72.55%、80.39%;特异性分别为96.55%、79.31%;准确性分别为81.25%、80.00%;阳性预测值分别为97.37%、87.23%;阴性预测值分别为66.67%、69.70%。对以上结果进行χ2检验,差异均无统计学意义。结论:HPS检测Hp感染的阳性率及准确性、敏感性、特异性与14C-UBT相近,且此法快速、简便,价格低廉,不需要任何其他仪器,是值得临床进一步验证的一种新的非侵入性Hp感染诊断方法。     

13C-尿素呼气试验与快速尿素酶试验诊断幽门螺杆菌感染的比较

目的:探讨13C-尿素呼气试验(13C-UBT)与快速尿素酶试验(RUT)诊断幽门螺杆菌(HP)感染的价值。方法:86例因消化道症状就诊的患者行13C-UBT试验及RUT试验,同时行胃镜检查,用活检钳钳取胃窦黏膜组织行病理学检查。比较13C-UBT及RUT试验与病理组织学检测的符合率,并比较13C-UBT试验及RUT试验诊断幽门螺杆菌感染的敏感性、特异性、准确性、阳性预测值及阴性预测值。结果:13C-UBT试验检测HP感染的敏感性及准确性分别为98.7%及97.7%明显高于RUT试验的88.8%及87.2%(χ2分别为6.83、6.74,P均<0.01)。结论:13C-UBT具有高效、特异性强、准确性较高、迅速、安全等优点,是一种较好的检测方法。     

儿童粪便幽门螺杆菌抗原检测的临床应用

目的：对粪便幽门螺杆茵抗原(Hpsa)检测诊断儿童HP感染的应用和价值进行探讨。方法：选择有消化道症状的82例儿童为研究对象，以快速尿素酶试验(RUT)，组织学切片(改良Giemsa)联合检测为诊断标准，采用ELISA法检测患儿的Hpsa。结果：在82例患儿中HPSA检测诊断HP感染敏感性、特异性和准确性分别为94．74％，90．91％，92．68％。结论：Hpsa检测是一种简便、准确的诊断儿童HP感染的方法。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.