肥胖型多囊卵巢综合征患者不同治疗方式对内分泌改善的比较

目的：探讨肥胖型多囊卵巢综合征（PCOS）患者不同治疗方式对内分泌的影响。方法：将78例肥胖型PCOS患者分为两组。第一组45例口服达应-35治疗6个月．第二组33例减轻体重治疗6个月：治疗前后测定体重指数（BMI）、血清生殖激素、口服糖耐量及胰岛素释放试验。结果：第一组治疗前后黄体生成素（LH）、雌二醇（E2）、睾酮（T）明显改善，差异有显著性（P〈0．01）；第二组治疗前后卵泡刺激素、LH、T、E2、BMI及糖耐量和胰岛素释放均有明显改善，差异有显著性（P〈0．05）。结论：对肥胖型PCOS患者，降低体重可明显改善其生殖内分泌状态．糖耐量及胰岛素释放也有明显改善，疗效较达应-35治疗明显     

二甲双胍对多囊卵巢综合征患者内分泌及代谢的影响

目的 探讨二甲双胍对多囊卵巢综合征(PCOS)患者内分泌及代谢的影响,并评估二甲双胍在PCOS患者治疗中的作用.方法 选择PCOS患者36例,予二甲双胍治疗12周(治疗前为A组,治疗后为B组),同期选择月经周期规律的正常妇女26例为对照组(C组),测定各组体重指数(BMI)、性激素、血脂、空腹血糖、空腹胰岛素(FINS),计算胰岛素敏感指数(ISI).结果 ①与C组相比,A组BMI、甘油三酯(TG)、低密度脂蛋白-胆固醇(LDL-C)、FINS、黄体生成素(LH)、LH/卵泡刺激素(FSH)、睾酮(T)升高(P＜0.05);ISI降低(P＜0.01);②与A组相比,B组BMI、TG、LDL-C、FINS、LH、LH/FSH、T降低(P＜0.05);ISI升高(P＜0.01).结论 二甲双胍能纠正PCOS患者的内分泌及代谢异常,是治疗PCOS的重要手段.     

育龄期多囊卵巢综合征患者的糖代谢异常和胰岛素抵抗

目的探讨育龄期多囊卵巢综合征（PCOS）患者的糖代谢异常和胰岛素抵抗。方法选择育龄期PCOS患者168例,分为肥胖PCOS组78例和非肥胖PCOS组90例,正常对照组100例,对比临床表现及检测内分泌激素、空腹血糖、空腹胰岛素、服糖后2h血糖及2h胰岛素。结果育龄期PCOS患者的月经周期、多毛、痤疮、B超提示卵巢增大、卵巢多囊性改变、有不孕史与对照组比较,差异均有显著性（P〈0．05）,育龄期PCOS组的血清LH、T与对照组比较,差异有显著性（P〈0．05）。育龄期肥胖P-COS组的空腹血糖、服糖后2h血糖、空腹胰岛素、服糖后2h胰岛素与对照组比较,差异均有显著性（P〈0．05）。结论早期出现月经稀发、BMI升高的患者是否存在PCOS,值得重视。育龄期PCOS患者尤其肥胖型要高度重视糖代谢异常及胰岛素抵抗,以决定是否采取干预措施,避免出现远期并发症而对PCOS患者造成健康威胁。     

二甲双胍治疗多囊卵巢综合征合并胰岛素抵抗对改善内分泌、代谢及排卵功能的疗效观察

目的：探讨二甲双胍对多囊卵巢综合征（PCOS）合并胰岛素抵抗患者内分泌、代谢及排卵功能的影响。方法：PCOS合并胰岛素抵抗患者40例于自然月经或撤退性出血第5天服用二甲双胍12周，观察治疗前后血清生殖激素、胰岛素水平、血糖、血脂水平及排卵功能的变化。结果：治疗后，患者各时相胰岛素（INS）水平显著下降（P〈0．01）。高密度脂蛋白胆固醇（HDL—C）显著升高（P〈0．01），低密度脂蛋白胆固醇（LDL—C）显著降低（P〈0.05）。患者血清黄体生成素（LH）、黄体生成素／促卵泡生成素比值（LH／FSH）、睾酮（T）和雄烯二酮（A）水平均显著下降（P〈0.01）；性激素结合蛋白（SHBG）水平显著升高（P〈0.01）；治疗后克罗米芬促排卵成功率为70％，明显高于治疗前25％（P〈0.01）。结论：二甲双胍通过改善胰岛素抵抗，降低胰岛素水平，使PCOS患者异常的血激素相、血脂相及排卵功能得到明显改善。     

瘦素受体Gln223Arg基因多态性与多囊卵巢综合征胰岛素抵抗及脂质代谢的关系

目的：探讨瘦素受体Gln223Arg基因多态性与多囊卵巢综合征（PCOS）患者的胰岛素抵抗及脂质代谢的关系。方法：PCOS患者56例（PCOS组）及健康志愿者32例（对照组）,应用聚合酶链反应～限制性酶切片段长度多态性（PCR—RELP）测定瘦素受体Gln223Arg基因变异频率。分析Gln223Arg基因变异与腰臀比例（WHR）、体重指数（BMI）、胰岛素抵抗指数（HOMA—IR）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL—C）及低密度脂蛋白胆固醇（LDL—C）之间的相关性。结果：瘦素受体Gln223Arg共存在AA,AG及GG三种基因型。PCOS组和对照组基因型分布比较差异无统计学意义（P〉0．05）。PCOS组中,与GG基因型相比,AA＋AG基因型的wHR,BMI及TG显著升高（P〈0．05）,HOMA—IR有升高趋势,但差异无统计学意义（P〉0．05）,其他各项检测指标差异均无统计学意义（P〉0．05）。无论PCOS组还是对照组,各变量均与瘦素受体Gln223Arg基因多态性无相关性（P〉0．05）。结论：瘦素受体Gln223Arg基因多态性可能通过调节胰岛素敏感性、影响机体局部体脂分布和脂质代谢等参与PCOS的发生。     

高血压并左心室肥厚与体重指数、胰岛素敏感性的关系

目的：探讨高血压患者胰岛素敏感性，体重指数与左室肥厚的关系。方法：检测70例高血压患者和66例对照者胰岛素敏感性指数（ISI），左室重量指数（LVMI），体重指数（BMI）。结果：高血压组ISI降低（P〈0．05），LVMI升高（P〈0．05）。影响LVMI因素为ISI、SBP、BMI和DBP（P〈0．05）。高血压并左心室肥厚组ISI降低（P〈0．05）。结论：肥胖和胰岛素抵抗是高血压发生左心室肥厚的影响因素。     

38例2型糖尿病并胆石症患者的胰岛素、血脂水平及其相关关系

目的：探讨2型糖尿病并胆石症患者的胰岛素、血脂水平及其相关关系。方法：测定38例2型糖尿病并胆石症患者的空腹胰岛素、血清脂质及载脂蛋白水平，计算胰岛素敏感指数（ISI），分析其相互关系，并与38例不伴胆石症的2例糖尿病患者相比较。结果：2型糖尿病并胆石症组与不伴胆石症组相比较，前者的ISI明显降低（P＜0．01），空腹胰岛素，甘油三酯，总胆固醇和载脂蛋白A1（ApoA1)，明显升高（P＜0．01，P＜0．05），高密度脂蛋白－胆固醇（HDL－C），载脂蛋白AⅡ（ApoAⅡ)则无显著变化（P＞0．05），ISI与甘油三酯，总胆固醇呈负相关，与HDL－C呈正相关，多元回归分析显示胆石症与ISI呈负相关。结论：胰岛素抵抗可能是2型糖尿病患者胆石形成的危险因素。     

不同干预措施对青春期肥胖型PCOS患者性激素及其临床表现的影响

【目的】探讨不同干预措施对青春期肥胖型多囊卵巢综合征（PCOS ）患者性激素及其临床表现的影响。【方法】收集13～20岁青春期肥胖型PCOS患者127例,根据干预措施不同分为3组：A组（44例）,生活方式调整＋炔雌醇环丙孕酮（达英‐35）＋盐酸二甲双胍治疗;B组（42例）,仅用生活方式调整;C组（41例）,达英‐35＋盐酸二甲双胍治疗,均干预3个月,比较各组干预后性激素水平和临床指标。【结果】三组治疗后体质量指数（BMI）均有显著性下降（ P ＜0．05）,且A组BMI显著低于B组、C组（ P ＜0．05）,但B组与C组比较差异无统计学意义（ P ＞0．05）。A组与C组治疗后的黄体生成素／卵泡刺激素（LH／FSH）、睾酮（T）均有显著下降（ P ＜0．05）,B组治疗后LH／FSH、T 虽亦呈下降趋势,但与治疗前比较无显著性差异（ P ＞0．05）。三组治疗后月经异常改善明显,痤疮、多毛等改善不明显。【结论】生活方式调整联合达英‐35和盐酸二甲双胍通过降低PCOS患者BM I、L H／FS H及T水平,有效恢复月经,且其作用优于达英‐35和盐酸二甲双胍,但对多毛、痤疮等症状改善不明显。     

黄芪多糖联合达英-35对多囊卵巢综合征患者胰岛素抵抗、雄激素及脂代谢的影响

目的：探讨黄芪多糖和达英-35联合应用对多囊卵巢综合征（PCOS）胰岛素抵抗、雄激素水平及脂代谢的影响。方法：对32例PCOS患者联合应用黄芪多糖和达英-35共3个月,观察治疗前后血性激素、胰岛素敏感性及血脂的改变。结果：治疗后患者血清空腹胰岛素水平、LH／FsH比值、T、A、DHEAS均显著降低（P〈0．01）,胰岛素敏感指数显著升高,血T—CHO、Lp（a）降低（P〈0．01）,HDL—C显著升高,TG也有轻度降低,差异具有统计学意义（P〈0．05）。结论：黄芪多糖联合达英-35可有效改善PCOS患者胰岛素抵抗和高雄激素状态及血脂代谢,可为PCOS治疗的又一选择。     

绞股蓝对高脂饲料饲养致兔高脂血症、C反应蛋白升高的干预研究

目的：探讨绞股蓝对高脂饲料饲养致兔高脂血症、C反应蛋白升高的影响。方法：40只雄性日本大耳白兔分为A、B、C、D组，分别喂饲高脂饲料（92．5％标准饲料＋2％胆固醇＋2％蛋黄＋3．5％猪油）＋绞股蓝5g／kg、高脂饲料＋辛伐他汀5mg／kg、高脂饲料、标准饲料。饲养前和饲养后3周、6周检测三酰甘油、胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、C反应蛋白。结果：①A组、B组、C组三酰甘油、胆固醇、低密度脂蛋白胆固醇渐升，与饲养前比较差异有统计学意义（P〈0．05），A组、B组高密度脂蛋白胆固醇渐升，与饲养前比较差异有统计学意义（P〈0．01），A组三酰甘油、胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇与C组比较差异有显著性（P〈0．05）；②A组、B组、C组C反应蛋白渐升，与饲养前比较差异有统计学意义（P〈0．01），饲养后A组与C组比较差异有统计学意义（P〈0．01）。结论：绞股蓝有预防高胆固醇饵料饲养兔发生高脂血症、c反应蛋白升高的作用。     

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.