489例HSVⅡ型DNA定量检测结果分析

目的了解单纯疱疹病毒Ⅱ型定量检测的流行病学特点。方法用荧光定量PCR技术对489例患者的HSVⅡDNA进行检测，并对结果进行分析。结果489例患者中，男女患者阳性率分别为39．25％和23．21％；156例阳性结果中女性年龄（30．18±7．29）岁，男性年龄（33．23±7．35）岁，（t=2．033，P=0．04）；HSVⅡDNA拷贝对数值分别为女性6．08±1．69、男性6．46±1．61（t=1．40，P=0．17）。2002—2006年，相邻两年感染率比较其统计学结果均为P〈0．001。对病毒载量统计学分析结果：虽然病毒拷贝数逐年降低，但四年间隔时间病毒的降低才有统计学差异（P〈0．05）。结论男性患者阳性检出率高于女性；阳性患者中男性平均年龄高于女性阳性患者；两性间病毒学载量差异无统计学意义；HSVⅡ感染阳性率逐年增高；HSVⅡ阳性拷贝对数值逐年下降。     

女性系统性红斑狼疮患者血清性激素及相关细胞因子水平分析

目的了解女性系统性红斑狼疮（SLE）患者血清性激素及相关细胞因子水平,并探讨其与患者病情发生、发展的关系。方法用电化学发光法检测雌二醇（E2）、睾酮（T）、孕酮（Prog）、泌乳素（PRL）;放射免疫法检测雌三醇（E3）、白介素-2（IL-2）、白介素-6（IL-6）、白介素-8（IL-8）,ELlSA法检测白介素-4（IL-4）和γ干扰素（IFN-γ）。结果女性SLE患者E2[（53．44±32．10）μg／L]、E3[（4．98±1．60）μg／L3、Prog（（1．78±0．97）μg／L]、PRL[（18．18±13．74）μg／L]水平均明显高于健康对照组（P〈0．05）,患者活动期的E2[（67．63土33．55）μg／L]、μg/L]、Prog[（1．82土0．79）μg／L]和PRL[（23．48±16．04）μg／L]水平明显高于稳定期和健康对照组（P〈0．05）。患者IL-4水平活动期[（21．35±3．60）ng／L]和稳定期[（19．93±3．93）ng／L]均明显比健康对照组高（P％0．05）,而IFN-γ水平活动期[（12．67±0．74）ng／L]和稳定期[（13．02±1．96）ng／L]却明显比健康对照组低（P〈0．05）。结论E2、Prog、PRL水平与SLE病情活动密切相关。IL-4水平明显高于健康对照组,IFN-γ水平明显低于健康对照组（P〈0．05）,支持SLE患者体内存在Th1细胞向Th2细胞转化,表现为以Th2细胞为主的免疫应答。     

脑梗死患者总同型半胱氨酸水平变化及其相关因素分析

目的分析脑梗死（CI）患者总同型半胱氨酸（tHcy）水平变化特点,探讨与其相关的因素。方法对133例脑梗死患者（男98例,女35例）和45例健康体检者,分别测定tHcy、血清高敏C反应蛋白（hsCRP）、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL—C）含量,进行对比研究及相关性分析,并对伴有高血压、糖尿病、高血脂、冠心病的情况进行分析。结果脑梗死患者Hcy含量（15．91±7．20）μmol／L,明显高于健康对照组（8．30±2．07）μmol／L（P〈0．01）;男女组间比较tHey含量男性（16．71±7．14）μmol／L,女性（13．67±6．87）μmol／L,高同型半胱氨酸血症的发生率在男性为52．0％,女性为17．1％,男性高于女性,差异有统计学意义（P〈0．01）;tHcy水平与hsCRP呈正相关,r＝0．298,与TG、TC、HDL-C、LDL—C未见明显相关,单纯脑梗死患者tHcy水平与伴有高血压、糖尿病、高血脂和冠心病者比较,差异无统计学意义（P〉0．05）。结论tHcy增高可能是脑梗死的独立危险因素,血tHcy增高可能是男性脑梗死发生率较高的一个重要原因．     

苏北地区部分大中专院校学生对艾滋病的认知状况

目的：了解苏北地区部分大中专院校学生艾滋病相关知识、态度状况，为指导大学生预防艾滋病健康教育提供依据。 方法：使用分层抽样的方法于2006-02对徐州市4所不同专业类型大中专院校的800名一、二年级大学生，进行了艾滋病相关知识、态度及行为的问卷调查。问卷分一般情况5题、艾滋病知识18题，分值权重相同，满分为100分。对艾滋病及艾滋病患者的态度20题，分值权重相同，满分为100分。 结果：发出问卷800份，最后得到合格问卷766份。男346人，女420人，年龄16～25岁。①认知和态度得分：大学生对艾滋病的认知平均得分为62．51&;#177;15．42，对艾滋病的态度平均得分为57．23&;#177;21．96。②不同性别学生认知与态度得分：认知得分男性为61．90&;#177;15．34，女性为63．02&;#177;15．49，态度得分男性为54．49&;#177;23．49，女性为59．48&;#177;20．40，在对艾滋病的认知方面，性别间没有差异（如0．997，P=0．318），但态度得分女性优于男性（F=9．881，P=0．002）。③认知得分城市学生为63．70&;#177;15．89，农村学生为61．35&;#177;14．88，城市高于农村（F=4．441，P=0．035）。态度得分城市为57．74&;#177;22．75，农村为56．73&;#177;21．17，差异没有统计学意义（F=0．406，P=0．524）。④认知得分高年龄组（≥20岁）为70．77&;#177;14．31，低年龄组（〈20岁）为59．31&;#177;14．71，高年龄组显著高于低年龄组（F=95．69，P=0．000）。态度得分高年龄组为67．70&;#177;18．61，低年龄组为54．33&;#177;22．48，高年龄组显著高于低年龄组（F=35．95，P=0．000）。⑤不同专业层次上，认知得分由高到低分别是医学本科（72．95&;#177;12．18）、医学专科（72．45&;#177;12．04）、医药中专（61．11&;#177;13．00）、非医药中专（57．69&;#177;15．51）。认知得分总体组间有显著性差异（F=51．233，P=0．000）。态度得分由高到低分别是医学专科（70．54&;#177;15．34）、医学本科（63．68&;#177;17．55）、医药中专（60．43&;#177;18．60）、非医药中专（50．85&;#177;23．75）。态度得分总体组间有显著性差异（F=27．293，P=0．000）。⑥大学生的艾滋病知识主要来源由高到低依次为大众传播（72．7％），医疗卫生部门（49．7％），宣传栏（44．1％），学校专门教育（30．9％）等。 结论：苏北地区大学生艾滋病知识不全面，知信行不能统一，对艾滋病的态度过于敏感，应加强正规的医疗卫生部门和学校开展的健康教育，20岁以下的非医药中专类院校为健康教育的重点人群。     

起搏器治疗对左室功能尚好房室传导阻滞患者的心功能影响

目的：评价左室功能尚好的房室阻滞患者植入心脏起搏后心力衰竭和左室收缩功能，探讨起搏器术后对左室功能的影响及其预测因素。方法：对象为48例因房室传导阻滞（AVB）行永久起搏治疗的患者，对其手术前后12导联心电图、超声心动图、心功能NYHA分级进行随访评估。结果：48例患者均行右室心尖起搏，其中男性26例、女性22例，平均随访12±9月。术后随访期间，13例患者发展为充血性心力衰竭，NYHA分级较术前增高（1．64±0．7对2．27±0．8，P〈0．001），左室射血分数（LVEF）明显较术前降低（60％±6％对51％±13％，P〈0．001）。对LVEF≤40％（A组）和〉40％（B组）的患者对比分析发现，A组较B纽患者的起搏QRS时限为长（181±32ms对151±26ms，P〈0．01）．室间延迟也较长（44±29ms对27±18ms，P=0．02）；起搏QRS时限=180ms时，其检测左室功能异常的敏感性为54％，特异性为93％。结论：左室储备功能正常的房室阻滞患者，起搏后LVEF明显下降，起搏QRS时限可用以预测起搏后左室功能障碍的发生与否。     

恶性肿瘤患者治疗前后血浆纤维蛋白原含量分析

目的 观察恶性肿瘤患者治疗前后血浆纤维蛋白原（FIB）含量与抗肿瘤治疗疗效的关系。方法 采用全自动血凝分析仪测定188例恶性肿瘤患者治疗前后血浆FIB含量,115例健康体检者为对照。结果恶性肿瘤组FIB含量（5.05±1.12）g/L较健康体检组（2.91±0.87g/L）显著升高（P〈0.01）。临床Ⅲ、Ⅳ期患者FIB含量（5.13±1.48g/L）显著高于Ⅰ、Ⅱ期（4.62±1.26g/L）的患者（P〈0.05）。治疗后有效的患者FIB含量（2.92±1.33g/L）较治疗前（4.85±1.36g/L）显著下降（P〈0.01）。无效者治疗前FIB含量（5.41±1.05g/L）与治疗后（4.85±1.26g/L,）比较无显著变化（P〉0.05）。结论 血浆FIB含量在恶性肿瘤的辅助诊断、疗效判断及预后评估方面有一定临床意义。     

一种血液学检测方法对初诊系统性红斑狼疮中的诊断价值

目的探讨中性粒细胞碱性磷酸酶（NAP）在系统性红斑狼疮中的诊断价值。方法采用AS-BI法对30例初诊SLE患者（SLE组）及30例体检健康女性（健康对照组）外周血涂片进行NAP染色，观察NAP阳性率及阳性积分。结果SLE患者阳性率、阳性积分分别为（22．1±8．8）％、（22．2±8．9）分；健康对照组阳性率、阳性积分分别为（56．8±9．4）％、（58．2±9．8）分，二者比较差异有统计学意义（P〈0．001）。结论NAP的检测对初诊SLE患者有一定的诊断价值，其在SLE中活性降低的机制尚待进一步探讨。     

右心房起搏术与双心腔起搏术在病态窦房结综合征患者中的疗效比较

目的：观察右心房起搏术（AAI）与双心腔起搏术（DDD）在病态窦房结综合征（SSS）患者中的疗效。方法：74例患者分为AAI组（共36例，其中男性14例，女性22例；平均66．8±7．9岁）和DDD组（3共8例，其中男性16例，女性22例；平均65．8±9．7岁），回顾分析比较两组心功能变化、房颤、房室传导阻滞和缺血性脑卒中的发生率。结果：心动超声心功能测定，术前和随访结果比较：左室射血分数（LVEF）AAI组从（55．8±3．1％）上升至（56．5±2．4％）（P〉0．05）。DDD组LVEF从（55．5±2．8％下）降至（54．7±2．8％）（P〉0．05）。比较两组患者在心功能、房颤、房室传导阻滞和脑卒中的发生率均无统计学差异。结论：对房室传导功能正常的SSS患者，与DDD比较，安装AAI起搏器不仅手术方法简单、疗效确切、并发症少，而且价廉。     

老年慢性心力衰竭患者基质金属蛋白酶-1和层粘连蛋白水平变化的临床意义

目的 心肌细胞外基质变化是引起慢性心力衰竭左室扩大及心脏重构的主要因素之一，基质重构引起心肌纤维化和进行性心室扩大，更加重心力衰竭。本文讨论基质金属蛋白酶-1（Martix metal oproteinases，mmP-1）和层粘连蛋白（LN）在慢性心衰中的临床意义。方法 共检测冠心病心衰17例，其他原因心衰18例，男性30例，女性5例，基质金属蛋白酶测定用ELISA法，试剂由美国Orionodiagostica公司提供。结果 心衰二组患者与对照组比较均有显著差异（P〈0．01），分别为（1．60±9．8）ng／ml，（182±11．6）ng/ml，VS（119．4±10．2）ng／ml；粘连接蛋白为（74．6±6．0）mg／L，（82．7±6．4）mg/L VS（49．5±10．3）mg/L。慢性心衰患者急性发作治疗前mmP-1为（174．6±4．6）ng／ml VS治疗后（165．1±3．2）ng／ml（P〈0．05）；LN治疗前（80．2±10．7）mg/L；治疗后（71．3±5．6）mg／L。结论测定基质金属蛋白酶（mmP-1）、LN水平可以了解心衰患者心脏重构的程度，同时对患者重构的情况和病情作客观评价，对患者治疗和评估预后有一定意义。     

经面罩机械通气在重症急性左心衰竭中的应用

目的：研究经面罩机械通气（FMMV）对重症急性左心衰竭患者的治疗效果。方法：回顾分析56例重症急性左心衰竭患者FMMV后的效果（治疗组），并与传统药物治疗方法（对照组）56例比较，观察患者心率、呼吸频率、动脉血气等变化。结果：治疗组患者均能教好地耐受FMMV。2h后49例呼吸困难等临床症状明显改善，心率由（136±14）次·min^-1降至（89±10）次·min^-1（P〈0．05），呼吸频率由（38±4）次·min^-1降至（26±3）次·min^-1（P〈0．05），PaO2由（50．10±8．70）mmHg上升至（92．50±10．20）mmHg（P〈0．05），而对照组治疗前后临床症状与动脉血气变化不明显，两组比较均有统计学差异（P〈0．05）。结论：与用传统药物治疗方法相比，FMMV可迅速纠正低氧血症，改善重症急性左心衰竭患者的循环和呼吸功能。     

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.