尿毒症和肾移植患者血清透明质酸的变化

目的　测定血浆中透明质酸 (HA)与尿毒症和肾移植患者病情变化的关系。方法　采用竞争性酶联免疫吸附试验测定尿毒症组 (A组 )、肾移植组 (B组 )、正常对照组 (C组 )血浆HA水平 ,同时测定血清肌酐 (SCr)。结果　血清HA水平A组 ( 414 2 5± 2 0 8 6 5ng/ml)高于B组 [( 6 9 5 7±46 2 8)ng/ml]和C组 [( 6 0 85± 2 5 5 5 )ng/ml](P <0 0 5 ) ;B组和C组比较差异无显著意义 (P >0 0 5 ) ,与血肌酐呈正相关 (r=0 87)。同时A组患者血肌酐透析前后比较差异有显著意义 [分别是透前 ( 810 48± 2 14 72 ) μmol/L透后 ( 2 2 5 2 8± 16 6 32 ) μmol/L ,(P <0 0 5 ) ];而血浆HA透析前后无变化[分别是透前 ( 414 2 5± 15 7 83)ng/ml]透后 ( 40 2 34± 12 5 6 7)ng/ml,(P >0 0 5 ) ]。结论　血HA可作为评估尿毒症和肾移植患者病情变化的一个指标。     

糖尿病患者血IL-1,IL-6,IFNγ测定及临床意义

目的 :探讨IL 1,IL 6 ,IFNγ与糖尿病的关系。方法 :用免疫放射法对 15例 1型糖尿病、6 3例 2型糖尿病患者及 2 0例正常人的血IL 1,IL 6及IFNγ进行测定。 6 3例 2型糖尿病中有 30例合并早期肾病及眼底病变。结果 :1型糖尿病组血IL 1高于正常组及 2型糖尿病组 [(31 14± 14 36 )pg/ml对 (2 1 37± 8 2 4)pg/ml及(2 3 15± 8 5 3)pg/ml,两者均P <0 0 5 ];血IL 6明显低于正常组及 2型糖尿病组 [(0 45± 0 2 1)ng/ml对 (0 95± 0 47)ng/ml及 (1 5 3± 0 0 7)ng/ml,P <0 0 5 ,P <0 0 1];1,2型糖尿病组血IFNγ均低于正常组 [(0 94± 0 6 5 )IU/ml及 (1 0 1± 0 6 1)IU/ml对 (1 6 4± 0 49)IU/ml,均P <0 0 1]。结论 :1型糖尿病胰岛 β细胞损伤与血IL 1,IL 6密切相关 ;1,2型糖尿病IFNγ水平均降低 ,其临床意义有待进一步探讨     

降钙素原测定在感染性疾病中的临床意义

目的　评价血清降钙素原 (PCT)对细菌感染诊断的临床价值。方法　回顾分析细菌感染和病毒感染患者血清降钙素原水平。结果　病毒感染者与轻症或局限性细菌感染患者血清降钙素原 <0 .5ng/ml,中度细菌性感染患者 >0 .5ng/ml,重症细菌性感染患者 >2 .0ng/ml,重度脓毒症或感染性休克患者 >10 .0ng/ml。病毒感染组和轻症或局限性细菌感染组与中度以上细菌性感染组PCT有显著性差异 (P <0 .0 1)。PCT对细菌感染诊断的敏感性为 93 .3 3 % ,特异性为 95 .0 0 %。结论　血清降钙素原可以作为细菌感染诊断的有效指标之一。     

恶性腹水中可溶性CD44v6的检测及意义

目的　探讨可溶性CD44v6(sCD44v6)对恶性腹水的诊断价值。方法　用酶联免疫吸附试验 (ELISA)检测 10份良性疾病患者腹腔液 (不伴腹水 ) ,14份恶性疾病患者腹腔液 (不伴腹水 ) ,36份肝硬化腹水、8份结核性腹水、2 3份恶性腹水中sCD44v6水平。结果　恶性腹水组sCD44v6水平为 (89 2±38 2 )ng/ml,明显高于肝硬化腹水组 (44 8± 18 0 )ng/ml、结核性腹水组 (5 0 3± 12 6 )ng/ml及良、恶性疾病不伴腹水患者腹腔液组 [(5 1 1± 2 0 3)ng/ml和 (38 4± 12 4 )ng/ml,P <0 0 1];后 4组间比较 ,sCD44v6水平差异无显著意义 (P >0 0 5 )。恶性腹水中卵巢癌腹水组sCD44v6水平 [(89 4± 2 5 7)ng/ml]高于胃癌腹水组 [(83 9± 32 6 )ng/ml]和结肠癌腹水组 [(80 1± 10 0 )ng/ml],但差异无显著意义 (P >0 0 5 )。以 6 2 8ng/ml为阳性界值 ,腹水sCD44v6诊断恶性腹水的敏感性为 73 9% ,特异性为 91 7%。结论　sCD44v6对于良、恶性腹水的鉴别诊断有重要价值。     

老年高血压妇女炎症相关蛋白表达水平的研究

目的探讨老年高血压妇女控制血压后炎症相关蛋白的表达水平及与健康妇女间的差异。方法采用免疫浊度法、放射免疫分析法、酶联免疫吸附双抗体夹心法 (ELISA法 )测定 4 1例已接受降压治疗的老年妇女及 2 4例健康妇女循环中C反应蛋白 (CRP)、白细胞介素 6 (IL 6 )、可溶性细胞间粘附分子 1(sICAM 1)、E 选择素 (E se lectin)等炎症相关蛋白的表达水平。结果老年高血压组妇女CRP、IL 6、sICAM 1、E selectin水平分别为 (1.4 2± 0 .30 )mg/L ,(0 .2 9± 0 .0 5 )ng/ml,(2 5 1.79± 30 .34)ng/ml,(39.0 7± 6 .39)ng/ml较正常对照组上述指标的水平 [(1.13± 0 .19)mg/L ,(0 .2 4± 0 .0 3)ng/ml,(2 19.2 0± 2 2 .73)ng/ml,(2 9.82± 5 .30 )ng/ml]明显增高 ,差异均有统计学意义 (P <0 .0 5 )。结论老年高血压妇女积极控制血压后其炎症相关蛋白的表达水平仍存在明显异常 ,应寻求降压治疗之外的抗炎、抗粘附新途径     

高血压病患者福辛普利治疗前后血浆肾上腺髓质素水平的变化

目的 :探讨高血压病患者抗高血压治疗前后血浆肾上腺髓质素 (AM )水平的变化。方法 :用特异性的放射免疫分析法测定 3 3例高血压病患者福辛普利治疗前和治疗 3个月后及 3 0例正常对照组的血浆AM水平。结果 :高血压病患者的基础血浆AM水平明显高于对照组 [( 5 5 .78± 15 .0 8)ng/L比 ( 9.90± 6.93 )ng/L ,P <0 .0 1]。Ⅱ期患者的平均血浆AM水平显著高于Ⅰ期患者 [( 61.87± 13 .48)ng/L比 ( 4 8.64± 14 .62 )ng/L ,P <0 .0 1] ;伴有左心室肥厚 (LVH )者高于无LVH者 [( 66.49± 14 .11)ng/L比 ( 5 3 .2 9± 9.62 )ng/L ,P <0 .0 2 ] ;有肾功能损害者也高于无肾功能损害者 [( 67.3 2±15 .92 )ng/L比 ( 5 3 .0 9± 11.47)ng/L ,P <0 .0 2 ]。福辛普利治疗 3个月后 ,高血压病患者的血浆AM水平降至 ( 4 5 .91±10 .2 5 )ng/L( P <0 .0 1) ,但LVH或肾功能损害者仍高于无相应病变者 (均P <0 .0 5 )。结论 :本研究结果显示高血压病患者的血浆AM水平升高 ,尤其是伴LVH和肾功能损害的患者 ,福辛普利治疗后其水平显著下降 ,说明AM可能对血压的调节和肾功能的保护有重要作用。     

新生儿细菌感染患者的血降钙素原测定

目的：评价血清降钙素原（PCT）对新生儿细菌感染诊断的诊断价值。方法：用半定量固相免疫层析测定法检测39例足月健康新生儿及39例细菌感染新生儿血清降钙素原水平。结果：39例细菌感染组新生儿中血清PCT有26例〉0．5n ng/ml，7例〉2．0ng/ml，3例〉10ng／ml，3例〈0．5ng／ml，阳性率达92．3％。39例足月健康新生儿血清PET仅有1例〉0．5ng／ml，阳性率2．5％。细菌感染组与足月健康新生儿血清PCT有显著性差异（P〈0．01）。结论：血清降钙素原测定可以作为新生儿细菌感染快速诊断的有效指标。     

高能聚焦超声治疗前、后胰腺癌患者血清CEA、CA199的变化

目的探讨高能聚焦超声治疗(HIFU)对胰腺癌患者血清癌胚抗原(CEA)、糖类抗原199(CA199)的影响。方法采外周血用电化学发光法测定31例HIFU治疗前、后胰腺癌患者和30例健康人血清中CEA、CA199的含量。结果治疗前胰腺癌患者血清CEA、CA199含量[分别为(50．65±43．11)ng／ml,(126．08±77．21) U／ml]较健康人[(4．44±5．34)ng／ml,(37．32±19．39)U／ml]明显升高,差异有统计学意义(P<0．001)。治疗后胰腺癌患者血清CEA、CA199含量[(18．91±33．00)ng／ml,(52．92±55．61)U／ml]较治疗前明显下降,差异有统计学意义(P<0．01),其中CEA较健康人比较差异有统计学意义(P<0．05);CA199接近健康人,差异无统计学意义(P>0．05)。治疗后完全缓解及部分缓解胰腺癌患者血清中CEA和CA199的含量[(4．14±3．29)ng／ml,(23．43±18．23)U／ml]明显低于稳定及进步的胰腺癌患者[(28．24±39．63)ng／ml,(71．55±63．28)U／ml],差异有统计学意义(P<0．05),生存期≥1年的胰腺癌患者血清中CEA和CA199的含量[(6．11±7．49)ng／ml,(32．66±25．06)U／ml]明显低于生存期<1年的患者[(32．57±43．42)ng／ml,(74．54±70．60)U／ml],差异有统计学意义(P <0．05)。结论血清CEA和CA199可作为胰腺癌诊断、疗效观察和预后判断的辅助指标,HIFU能明显下调胰腺癌血清CEA和CA199水平。     

慢性心力衰竭32例的血清甲状腺素变化

目的　探讨慢性心力衰竭 (CHF)患者血清三碘甲状腺原氨酸 (T3 )值的变化。方法　对比分析32例CHF患者的血清T3 值和 30例健康对照组的血清T3 值。结果　Ⅱ级CHF患者血清T3 值为 (1 0±0 5 2 )ng/ml,Ⅲ级CHF患者血清T3 值为 (0 81± 0 4 7)ng/ml,Ⅳ级CHF患者血清T3 值为 (0 6 3± 0 5 7)ng/ml,健康对照组血清T3 值为 (2 0 3± 0 4 5 )ng/ml,各级CHF血清T3 值均有下降 ,与健康对照组比较 ,差异有显著意义 (P <0 0 5 )。结论　CHF患者的血清T3 水平有降低。     

血清降钙素原水平在脓毒症患者中表达的意义

目的 研究血清降钙素原(PCT)在脓毒症诊断、鉴别诊断及病情严重程度评价中的价值.方法 将2005年11月至2008年11月入住我院儿科的脓毒症患儿76例分为细菌性脓毒症组48例和病毒性脓毒症组28例.比较2组PCT、CRP、WBC计数、中性粒细胞比例(N)、危重评分的差别;用ROC曲线评价其诊断价值;计算PCT与危重评分的相关性.结果 细菌性脓毒症组的PCT值明显高于病毒性脓毒症组,差异有统计学意义[(3.25±1.14)μg/L与(0.383±0.26)μg/L,t=13.02,P<0.01].但2组CRP[(10.90±4.53)mg/L与(9.79±2.45)mg/L]、WBC计数[(11.50±5.69)109/L与(10.43±4.03)109/L]、N[(77.15±6.31)%与(74.11±7.47)%]、危重评分[(81.75±6.81)分与(84.39±6.58)分]比较差异均无统计学意义(P均>0.05);当PCT≥2.0 μg/L时诊断细菌性脓毒症的敏感性、特异性分别为97%和95%,ROC曲线下面积为0.847;血清PCT水平与小儿危重病例评分呈显著负相关(r=-0.832,P<0.05).结论 PCT是诊断细菌性脓毒症灵敏的指标.     

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.