急性淋巴细胞白血病流式细胞术免疫分型中抗原异常表达的意义

目的研究急性淋巴细胞白血病免疫分型中抗原的异常表达.方法用多参数流式细胞仪对76例初诊的急性淋巴细胞性白血病(ALL)患者进行免疫分型.结果76例ALL中B系ALL70例占92.1%,T-ALL占6例.70例B系ALL中CD45-或CD45±表达占75.5%,显示该白血病细胞具有异质性;CD38弱表达占60%,CD10强表达占40%;B系ALL表达髓系抗原以CD33最高达25.7%,CD13次之达24.2%,CD15和CD11b较少见,分别占5.7%和1.4%.结论急性淋巴细胞白血病流式细胞术免疫分型中抗原异常表达,不但在初诊时有助于白血病克隆的识别、门的设定、白血病细胞数的定量,而且能在形态学缓解后作MRD检测,为白血病复发监测提供重要手段.     

三色流式细胞术分析急性淋巴细胞白血病免疫分型

本研究探讨急性淋巴细胞白血病（ALL）各亚型免疫分型的特点及其临床意义。利用CD45／SSC双参数散点图设门方法,对40例ALL进行三色流式细胞术免疫表型分析。结果显示：采用CD45／SSC双参数散点图设门法能清楚地区分骨髓或外周血中的淋巴细胞、单核细胞、粒细胞、有核红细胞和原始细胞群。40例ALL中B—ALL26例,T-ALL11例,HAL3例。26例B—ALL中CD19全部（100％）阳性表达,而11例T-ALL中CD7表达的阳性率最高（100％）。伴髓系抗原表达的ALL（My＋ALL）比较常见,本实验中共有12例,约达到30．0％,经常累及B淋巴系统（占My＋ALL的75．0％）;在髓系抗原中以CD13表达阳性率最高;有3例患者为急性杂合性白血病（HAL）,发病率为7．5％,且全部为髓系、B系共同表达,其中有2例患者CD34阳性表达,占66．67％。结论：在流式细胞仪上采用CD45／SSC双参数散点图设门方法进行三色流式细胞术分析,能排除正常细胞的干扰,使免疫分型的结果更为准确、可靠。     

儿童急性白血病免疫分型及其临床意义

目的 探讨儿童急性白血病（AL）抗原表达规律及其临床意义。方法 采用流式细胞术检测46例儿童AL的免疫表型。结果 46例AL中,急性淋巴细胞白血病（ALL）30例,急性髓细胞白血病（AML）10例,杂合型6例。30例ALL中,T系ALL 4例（13.3%）,B系ALL 26例（86.7%）。ALL中3例（10%）有髓系抗原表达,以CD33阳性最常见;AML中4例（40%）有淋系抗原表达,以CD7阳性率最高。儿童AML淋系抗原表达阳性率高于儿童ALL髓系抗原表达（χ^2=4.32,P〈0.05）。B系ALL中CD34阳性率为56.5%。AML中CD34的表达频率为40.0%,其中M2的CD34阳性率为66.6%,高于其他AML病儿的CD34阳性率（χ^2=5.42,P〈0.05）。结论 应用免疫分型可以较好地分析每例白血病病儿,尤其是对于混合型白血病及抗原交叉表达者更有意义。     

67例儿童急性白血病流式细胞术免疫分型的研究

目的探讨儿童急性白血病流式细胞术（flow cytometry）免疫分型的特点。方法选择67例儿童急性白血病，采用CD45／SSC双参数散点图设门法流式细胞术进行急性白血病免疫表型检测，分析儿童急性白血病细胞的抗原表达规律。结果①FAB分型与免疫分型相符率为92．5％（62／67）。②B细胞系列急性淋巴细胞白血病（B-ALL）中CDl9敏感性最高，HLA-DR、cCD79a特异性强。T细胞系列急性淋巴细胞白血病（T-ALL）中cCD3、CD7敏感性最高，cCD3特异性强。③急性髓细胞自血病（AML）中CD117、CDl3、CD33敏感性高，CDll7、cMPO的髓系特异性强。④急性淋巴细胞白血病（ALL）中伴髓系抗原表达（My^＋-ALL）占50．0％，主要表达的髓系抗原为CD33、CDl3。AML中伴淋系抗原表达（Ly^＋-AML）占35．0％，主要表达的淋系抗原为CD7。结论①免疫学分型弥补了FAB分型的不足，更能反映白血病细胞的异质性，提高了诊断的准确性。②儿童降ALL最具有诊断价值的抗原是CDl9、HLA-DR、cCD79a，T-ALL最具有诊断价值的抗原是cCD3、CD7。My^＋-ALL主要表达的髓系抗原为CD33、CDl3。③儿童AML最具有诊断价值的抗原为CDll7、CDl3、CD33，而CDll7的髓系特异性优于CDl3、CD33，是鉴别ALL、AML的重要标志，Ly^＋-AML主要表达的淋系抗原为CD7。     

201例成人急性白血病免疫分型特点

目的探讨成人急性白血病(AL)三色流式细胞术免疫分型的特点。方法采用CD45/SSC双参数散点图设门方法进行三色流式细胞术免疫表型分析。结果156例急性髓细胞系白血病(AML)主要表达CD117(90.38%)、CD13(87.18%)、CD33(71.79%)、CD34(67.74%)、HLA DR(60.90%)。33.98%的AML患者伴有淋系抗原表达,最常见为CD7(24.36%)。B细胞系急性淋巴细胞白血病(ALL)35例(17.4%),主要表达CD19(100.00%)、HLA DR(100.00%)、CD10(74.29%)、CD34(60.00%)、CD20(31.40%)。T细胞系ALL10例(4.98%),主要表达CD7(80.00%)、CD2(60.00%)。24.5%的ALL表达髓系相关抗原,主要是CD13(17.80%)及CD33(11.10%)。结论流式细胞仪三色荧光标记法进行AL免疫分型,对白血病的准确诊断和分型有重要的指导意义。     

86例儿童急性淋巴细胞白血病三色流式细胞术免疫分型研究

目的 探讨儿童急性淋巴细胞白血病（ALL）三色流式细胞术免疫分型的特点。方法 采用CD45/SSC双参数散点图设门方法进行三色流式细胞术免疫表型分析。结果 CD45/SSC双参数散点图设门方法与FSC/SSC双参数散点图设门方法比较能将骨髓中的原始细胞与正常淋巴细胞、单核细胞及粒细胞明显分开，所得原始细胞经例与形态学分类接近，原始细胞免疫表型假阳性发生率低。86例儿童ALL标本中，B-ALL占95.3%，T-ALL占2.3%。Common-ALL和Pro-B-ALL分别占B-ALL的76.8%和6.1%。57.0%和34.9%的儿童ALL表达CD34和髓系抗原，其中以Pro-B-ALL分别占B-ALL的76.8%和6.1%。57.0%和34.9%的儿童ALL表达CD13和CD33的表达差异无显著性。结论 CD45/SSC双参数散点图设门方法排除了骨髓中正常细胞的干扰，免疫分型结果更可靠。儿童ALL有较高的CD34和髓系抗原表达。     

462例白血病分型回顾性分析

目的探讨白血病FAB分型与免疫分型的关系,以指导临床分析与治疗。方法回顾性分析2011~2013年该院收治462例初诊为各种类型白血病患者的临床资料,统计FAB分型及组化染色结果,部分患者进行流式细胞术(FCM)免疫分型,并对两种检查结果进行分析比较。结果 462例白血病患者中FAB初诊急性髓细胞白血病(AML)171例,急性淋巴细胞白血病(ALL)50例,慢性白血病76例,少见类型3例,分型不明确56例,分型不符27例。FAB分型与临床诊断符合率82.03%;34例白血病行免疫分型,单表型29例,双表型4例,未表型1例,免疫分型与临床诊断符合率达到97.06%。髓系抗原CD13,CD33阳性表达率高;CD34及HLA-DR在M3中未表达;CD7为髓系常伴随的淋巴系统表面抗原。结论免疫分型诊断准确率高于FAB分型,二者结合可提高诊断准确率,免疫分型在鉴别AML各亚型具有重要作用。     

急性白血病流式细胞术免疫分型的特点及临床意义

目的探讨急性白血病流式细胞术免疫分型的特点及临床意义。方法 100例急性白血病,采用流式细胞术进行急性白血病免疫表型检测。结果①用特异性抗体将急性淋巴系白血病分为T细胞系列急性淋巴细胞白血病(T-ALL)和B细胞系急性淋巴细胞白血病(B-ALL)。②用特异性抗体使急性髓细胞白血病(AML)的分型更明确。③发现急性淋巴细胞白血病(ALL)中伴髓系抗原表达(My-ALL)、AML中伴淋系抗原表达(Ly AML)和混合型白血病。结论免疫学分型能反映白血病细胞的特征,提高了诊断的准确性。     

多参数流式细胞术在白血病免疫分型中的应用探讨

目的 探讨多参数流式细胞术(FCM)在白血病免疫分型中的应用.方法 利用CD45/SSC 设门的四色荧光FCM检测339例白血病患者骨髓细胞表面标记.结果 339例白血病中急性髓系白血病(AML)150例,占44.2%,髓系抗原表达率以CD33(86.7%)最高,其余从高到低依次为CD117、CD3、cMPO、CD15.淋巴细胞性白血病183例,占54.0%,其中急性B淋巴细胞白血病(ALL-B)110例、急性T淋巴细胞白血病(ALL-T)27例、慢性淋巴细胞白血病(CLL)46例.ALL-B淋巴系抗原表达率以CD19最高,其余由高到低依次为cCD79a、CD10、CD22、CD20,ALL-T淋巴系抗原表达率以CD7最高,其余由高到低依次为CD2、CD5、CD3.髓系白血病中常见交叉表达淋巴系抗原CD56、CD7、CD9.ALL中常见交叉表达髓系抗原CD13、CD33,CD14的表达与单核细胞白血病相关.结论 应用多参数FCM能对白血病进行分型,对于白血病的诊断治疗和预后判断均有重要价值.     

急性白血病跨系列抗原表达特点分析

目的探讨急性白血病跨系抗原表达的特点和临床意义。方法采用三色流式细胞术和CD45/SSC双参数散点图设门方法,对临床初诊的白血病患者幼稚细胞分化抗原进行分析,用EGIL（白血病分型欧洲协作组）积分系统,以得分〉和≤2进行分组,对病人的分型特征和临床特征进行分析。结果在99例具有淋系和髓系抗原表达的白血病中,髓系优势组占53.5%,淋系优势占11.1%,双高表达组占15.2%,双低表达组占20.2%。淋系优势和髓系优势组免疫分型与FAB分型基本一致,而免疫分型双高组和双低组的FAB细胞形态分布各有特点;跨系列抗原表达可见T与髓系、B与髓系、T B髓三系共表达的形式,以B与髓系共表达为多见,未见T与B共表达的形式;CD7、CD19、CD33是跨系列白血病常表达的抗原;CD7阳性在髓系优势组具有较高的表达率;双低下组外周血白细胞计数值和外周血计数〉50×109/L的发生率均高于其他组。结论髓系优势为跨系列白血病的主要构成;免疫分型较FAB分型更客观和详细的反映了白血病细胞的分化状态;髓系优势组中CD7阳性可能是干细胞的一个标志;淋髓双低表达组的病人幼稚细胞数高,其恶性程度可能高。     

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.