A型行为与脑血管疾病的相关性

目的 通过探讨A型行为与脑血管疾病的关系，为临床脑血管病患者心理行为的干预提供依据。方法 应用“A型行为问卷”对150例脑血管疾病患者(脑出血65例，脑梗死85例)及50例健康体检者进行了测试。结果(1)脑出血组A型行为52例占80%，脑梗死组A型行为54例占64％，对照组A型行为为17例占34％。脑出血组与脑梗死组均以A型行为占优势(χ2=21．88，15．24，P&;lt;0．01)，但脑出血组占绝对优势。(2)脑出血组(39．1&;#177;5．2)及脑梗死组(35．2&;#177;7．2)A型行为问卷平均得分均明显优于对照组(29．8&;#177;1．5)(t＝7．46、6．91，P均＜0．01)。(3)脑出血组(194&;#177;19)／(102&;#177;11)mmHg及脑梗死组(188&;#177;29)／(115&;#177;8)mmHgA型行为的平均血压均高于对照组(t＝7．46、6．91，P均＜0．01)。结论 A型行为与患者高血压、脑出血的发生正相关，可能是脑血管疾病的发病因素之一。     

高敏C反应蛋白检测在脑血管疾病中的意义

目的:探讨血清高敏C反应蛋白(hight-sensitive C-reactive protein,hs-C R P)与脑血管疾病的关系。方法:采用免疫散射速率比浊法,检测60例脑血管疾病患者和25例健康体检对照者血清hs-C R P水平。结果:18例短暂脑缺血发作(TIA)组hs-C R P为(1.94±1.40)m g/L,25例脑梗死组为(15.51±6.91)m g/L,17例脑出血组为(11.95±4.88)m g/L,20例正常对照组为(1.09±0.66)m g/L,脑梗死组、脑出血组与对照组比较血清hs-C R P水平升高,差异均具有显著性(P<0.001);TIA组与对照组比较差异无显著性(P>0.05)。结论:血清hs-C R P水平与脑血管疾病密切相关,可预测脑血管疾病的危险性,并可作为监测病情和预后判断的指标。     

血管性痴呆患者颅脑CT及经颅多普勒改变的定量研究

目的:探讨血管性痴呆(vasculardementia,VD)患者颅脑CT和经颅多普勒改变,促进对于VD临床特点的认识。方法:对同期同一医院收集的30例VD患者、30例无明显认知功能障碍的脑梗死患者通过颅脑CT检查了解梗死病灶和脑萎缩值情况,通过经颅多普勒检查了解脑血供情况。结果:①VD组患者多发性脑梗死病例数显著多于脑梗死对照组(χ2=4.63,P<0.05)。②VD组患者脑梗死灶体积(26.3±37.8)cm3明显高于脑梗死组(7.8±15.5)cm3(t=2.49,P=0.016)。VD组三脑室宽度犤(0.84±0.14)cm犦和哈氏犤(5.76±0.71)cm犦明显高于脑梗死组犤(0.62±0.15),(5.19±0.63)cm,t=3.75,P=0.001;t=3.35,P=0.002犦。③VD组患者各脑血管的阻力指数均大于脑梗死组(t=2.07～3.09,P<0.05～0.01)。结论:VD患者有明显颅脑CT及经颅多普勒改变,普遍存在脑萎缩,存在广泛的脑血管弹性减退。     

慢性乙型肝炎患者行为特征中的神经质、情绪及人格稳定性

目的:探讨慢性乙型肝炎患者的精神、行为和个性特征,寻求进行干预的可能性。 方法:68例慢性乙型肝炎患者按年龄、性别、职业、文化程度和婚姻状态与正常人(对照组)1:1配对,对两组对象进行临床精神卫生症状自评量表(SCL-90)、艾森克个性问卷(EPQ)和A型行为问卷测试。 结果:SCL-90量表评估中,慢性乙型肝炎患者的躯体化(1.66±0.48)、人际关系(1.89±0.56)、抑郁(1.91±0.49)、焦虑(1.83±0.46)、偏执(1.71±0.52)和精神病性(1.63±0.45)等因子评分均明显高于对照组t=2.178～2.309,P均<0.05)。EPQ问卷测评中,慢性乙型肝炎患者的精神病性、神经质或情绪和人格稳定性等维度评分均明显高于对照组(t=2.137～2.232,P均<0.05)。A型行为问卷调查中,慢性乙型肝炎患者的时间紧迫感特征、争强好胜和时间紧迫感特征+争强好胜因子得分明显高于对照组(t=2.132～2.348,P均<0.05)。 结论:慢性乙型肝炎患者存在明显的精神心理、行为和个性方面的异常。     

脑梗死患者不同时期血浆蛋白S水平与梗死范围的关系

目的:通过观察脑梗死患者外周血不同时期血浆蛋白S水平的变化,探讨蛋白S水平与脑梗死范围的关系。方法:选择2002-07/2003-01上海第二医科大学附属仁济医院神经内科住院或急诊留院观察急性脑梗死患者38例(脑梗死组)。对照组为来本院体检的健康者38例,性别、年龄均与脑梗死组相匹配(P>0.05)。脑梗死组在入院时(发病5d以内)、发病后20d采静脉血2mL(对照组与脑梗死组同时间点采血)。总蛋白S和游离蛋白S含量均采用双抗体夹心酶联免疫吸附法测定。结果:参加实验脑梗死组39例,对照组38例,均采样至实验结束。①不同病程阶段蛋白S水平的变化:脑梗死组急性期(5d内)、亚急性期(20d)总蛋白S水平均较对照组明显下降[(13.80±2.83),(14.69±2.66),(16.91±4.04)mg/L,(t=-3.888,-2.828,P<0.01)]。脑梗死组急性期、亚急性期游离蛋白S水平均较对照组明显下降[(6.36±2.02),(6.88±1.60),(8.80±2.41)mg/L,(t=-4.782,-4.095,P<0.01)]。②不同梗死范围蛋白S水平的变化:根据入院1周时MRI的检查结果分为腔隙性脑梗死组11例和非腔隙性脑梗死组27例。急性期、亚急性期非腔隙性脑梗死组患者总蛋白S水平低于腔隙性梗死组患者[急性期:(13.22±2.79),(15.22±2.50)mg/L;亚急性期:(13.88±2.16),(16.68±2.83)mg/L,(t=-2.062,-3.313,P<0.05)];明显低于对照组[(16.91±4.04)mg/L(t=-4.098,-3.906,P<0.01)]。急性期、亚急性期非腔隙性脑梗死组患者游离蛋白S水平低于腔隙性梗死组患者[(5.78±1.69),(7.79±2.14)mg/L;(6.41±1.40),(8.03±1.52)mg/L,(t=-3.077,-3.151,P<0.05)];明显低于对照组[(8.80±2.41)mg/L,(t=-5.944,-5.031,P<0.01)]。结论:脑梗死患者蛋白S水平在急性期、亚急性期均明显下降,其下降的水平与病灶大小有一定关系。     

老年2型糖尿病合并脑梗死患者的脑功能障碍及其智力、记忆力特点

目的:探讨老年2型糖尿病合并脑梗死患者的脑功能及其智力、记忆力特点。方法:采用成人成套神经心理测验犤HRB(A)-RC〗及龚耀先修订的韦氏成人智力测验(WAIS-RC)及韦氏记忆测验(WMS-RC)对42例老年2型糖尿病合并脑梗死患者(DI组)及相匹配的60例非糖尿病性脑梗死患者(I组)以及43例无脑梗死正常人(对照组)进行测定及比较分析,同时就脑梗死灶的大小、数目、部位对脑功能的影响进行分析。结果:HRB(A)-RC结果:DI组连线测验2.22±0.43,触摸时间33.62±3.61,脑功能成绩和总智商FIQ(75.64±8.59)及记忆商M(65.40±10.27均明显低于I组(1.75±0.14,29.72±3.23,96.67±9.61,86.20±7.59)和对照组(1.55±0.11,20.38±3.19,104.49±5.68,97.33±6.29),差异有显著性意义(P<0.01);大片脑梗死(FIQ≤79占46.9%,MQ≤79,62.5%)比小片脑梗死(22.9%比35.7%)、皮质下脑梗死(40.1%比57.9%)特别是基底核、脑室旁、丘脑处脑梗死比皮质脑梗死(16.3%比25.6%)更易产生脑功能障碍(χ2=5.9882～10.3864,P<0.05～0.01),多灶脑梗死与单灶脑梗死功能障差异无显著性意义(P>0.05);DI组中大片脑梗死及皮质下脑梗死较I组多(χ2=11.5069～18.2021,P<0.01)。结论:老年2型糖尿病合并脑梗死可引起明显的脑功能障碍。     

超声波治疗对急性脑梗死患者神经功能及血液流变学的影响

目的:观察超声扫描脑血管治疗仪对脑梗死患者的治疗效果,探讨超声波治疗脑梗死的可能机制。方法:将260例脑梗死患者分为治疗组和对照组各130例。两组均进行常规治疗,治疗组在此基础上应用超声扫描脑血管治疗仪治疗,1次/d,20min/次,治疗20d。治疗前后两组均评估神经功能缺损评分、Barthel指数,同时进行血液流变学检测。结果:治疗后神经功能缺损评分治疗组为(11.42±5.64)分,对照组为(14.73±6.01)分,两组比较差异有显著性意义(t=6.105,P<0.05)。Barthel指数治疗组治疗后为(56.72±13.68)分,高于对照组(53.22±13.98)分,差异有显著性意义(t=4.975,P<0.05)。血液流变学两组均有好转,但差异无显著性意义(P>0.05)。结论:超声辅助治疗脑梗死疗效确切,有助于患者功能恢复。     

内皮素、降钙素基因相关肽参与糖尿病合并脑梗死发病过程中的作用

目的观察糖尿病(DM)合并脑梗死(CI)患者血浆内皮素(ET)和降钙素基因相关肽(CGRP)水平变化,探讨内皮素及降钙素基因相关肽与糖尿病合并脑梗死之间的相互关系。方法2000-03/2001-12在广东医学院附属医院内分泌科住院的DM患者86例,根据有无脑梗死及脑动脉硬化将患者分为DM合并脑梗死(DM+CI)组36例、无脑梗死的DM合并脑动脉硬化(DM+CA)组22例、DM无并发症(SDM)组28例,DM+CI组根据病情程度有分为轻型组、中型组和重型组,选择18例正常人作为正常对照组。采用放射免疫法检测各组患者及对照组血浆ET和CGRP水平并进行比较。结果DM+CI组病程3d内血浆ET犤(99±26)ng/L犦高于病程15～20d者犤(64±19)ng/L犦、DM+CA组犤(64±15)ng/L犦及SDM组犤(56±14)ng/L犦和正常对照组犤(46±13)ng/L犦(t=3.77～10.08,P均<0.01);DM+CI组病程15～20d者与DM+CA组血浆ET比较无显著性差异,但均高于SDM组及正常对照组(t=2.07～4.58,P<0.05或P<0.01);SDM组血浆ET亦较正常对照组升高(t=2.72,P<0.01)。DM+CI组病程3d内、DM+CI组病程15～20d、DM+CA组和SDM组血浆CGRP(ng/L)分别为(99±34),(71±20),(69±22),(76±18),均低于正常对照组(123±26)(t=2.69～8.35,P均<0.01);DM+CI组病程3d内血浆CGRP高于病程15～20d者及DM+CA组和SDM组(t=3.32     

胃癌及结直肠癌患者行为和个性特征的对照分析

目的:探讨个体行为和个性特征与胃癌和结直肠癌发病的关系,寻求进行干预的可能性。方法:经临床、影像学(或内镜)和病理学确诊的胃癌和结直肠癌患者168例(癌症组)按年龄、性别、职业、文化程度、婚姻状况与正常对照组(113例)1:1配对,并选用C型行为特征问卷(typeCbehaviorqueation-aire,TCBQ)和艾森克人格问卷(Eysenckpersonalityquestionaire,EPQ)对两组对象进行了测评。结果:共配成了56对,癌症组C型行为问卷调查结果中的焦虑、抑郁、愤怒、愤怒向内和愤怒向外等项评分明显高于对照组(t=2.059～2.339;P均<0.05),而后者中的理智和乐观评分显著高于前者(t=2.148和2.262;P均<0.05),两组患者的EPQ评分比较中,癌症组的神经质或情绪、神经病性、人格稳定性评分分别为11.3±4.9,8.9±2.4和,13.6±4.3,3个维度评分均显著高于对照组(6.7±3.1,5.6±2.7,6.2±2.5)(t=2.215～2.337,P均<0.05),但后者中的内外向性(E,12.1±5.5)则明显高于前者(4.5±1.8)(t=2.469,P<0.05)。结论:人们个体行为和个性特征与胃肠和结直肠癌发病有密切联系。     

维持性血液透析患者脑血管意外的危险因素及转归

目的:了解维持性血液透析患者发生脑血管意外的相关危险因素及影响脑血管意外患者转归的主要因素。方法:回顾性分析17例脑血管意外的血液透析患者的临床资料。12例同期住院的维持性血液透析患者作为对照组。结果:脑血管意外组低密度脂蛋白(LDL)明显高于对照组(2.99±1.27mmol/L vs 2.01±0.52mmol/L,P<0.05)。两组在年龄、性别、透析龄、糖尿病病史、心血管疾病史、高血压及其控制情况、透析情况、血红蛋白、其它血脂指标、肾功能、钙磷乘积、ECG幅值等方面均无显著差异。脑出血组发病距末次透析时间短于脑梗死组,分别为17.7 h和60.0 h。脑出血组的病死率明显高于脑梗死组(88.9%和12.5%,P<0.01)。结论:LDL是尿毒症患者脑血管意外的可能危险因素,脑出血的病死率明显高于脑梗死组。     

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.