依达拉奉对脑出血患者S-100B、MMP-9和脑水肿的影响

目的观察脑出血患者静脉血S-100B、基质金属蛋白酶-9（MMP-9）和脑水肿的动态变化及依达拉奉对其的影响。方法检测80例脑出血患者第1、7、14天及20例健康人静脉血S-100B和MMP-9的含量,同时计算脑出血患者第1、7、14天继发性脑水肿的体积;另外将脑出血患者随机分为普通治疗组和依达拉奉治疗组,观察两组治疗前后S-100B、MMP-9和脑水肿的变化。结果急性脑出血患者血S-100B和MMP-9的含量明显升高,与对照组比较差异有统计学意义（P〈0.01）;S-100B在入院第1天最高,然后逐渐降低,在第14天恢复至正常水平,与对照组比较差异无统计学意义（P〉0.05）;MMP-9在入院第7天最高,第14天时较入院时降低,但仍明显高于对照组,与对照组比较差异有统计学意义（P〈0.01）。同时MMP-9的动态变化与脑水肿体积变化一致,而S-100B的变化与脑水肿体积的变化不一致。脑出血患者治疗后依达拉奉组第7天和第14天时MMP-9和脑水肿体积均低于普通治疗组,差异有统计学意义（P〈0.01）。依达拉奉组S-100B亦低于普通治疗组,差异有统计学意义（P〈0.01）。结论脑出血患者静脉血S-100B和MMP-9均明显增高,MMP-9含量的变化与脑出血后脑水肿变化密切相关,依达拉奉可以降低脑出血患者血S-100B、MMP-9和脑水肿的水平。     

依达拉奉对老年髋关节置换术后血清MMP-9和S-100β蛋白质量浓度及认知功能障碍的影响

目的评价依达拉奉对老年患者人工髋关节置换术后血清基质金属蛋白酶-9(MMP-9)、S-100β蛋白质量浓度及术后认知功能障碍(POCD)的影响。方法将80例65~93岁接受人工髋关节置换术患者采用随机双盲法分为依达拉奉组(E组,n=40)和对照组(C组,n=40)。2组均采用脊椎-硬膜外联合阻滞麻醉,E组于术前30min静脉注射依达拉奉60mg,C组给予等量生理盐水。分别于术前24h及术后6、24、48和72h用简易精神状态检查量表(MMSE)评估所有患者的认知功能,并采集空腹静脉血测定血清MMP-9及S-100β蛋白质量浓度。结果 2组患者术后各时点血清MMP-9与S-100β蛋白质量浓度均较术前显著升高(P<0.05),而E组术后各时点血清MMP-9与S-100β蛋白质量浓度均较C组明显降低(P<0.05)。2组术后6、24、48h MMSE评分均较术前24h显著降低(P<0.05),E组术后6、24、48h MMSE评分均显著高于对照组(P<0.05);E组POCD发生率较C组显著降低(15.0%比27.5%,P<0.05)。结论老年患者人工髋关节置换术后血清MMP-9及S-100β蛋白质量浓度升高;依达拉奉能明显降低患者血清MMP-9及S-100β蛋白质量浓度,并减轻患者术后早期认知功能损害。     

依达拉奉对脑梗死患者的疗效及血清中MMP-9、IL-6影响的临床研究

目的观察依达拉奉对脑梗死患者的疗效及血清中基质金属蛋白酶-9（MMP-9）和白细胞介素-6（IL-6）的影响。方法收集我院确诊为脑梗死的患者共140例,分为观察组（70例）和对照组（70例）,观察组在常规治疗的基础上加用依达拉奉治疗,对照组单纯应用常规治疗,应用酶联免疫吸附实验（ELISA）检测治疗前、后患者血清中MMP-9和IL-6水平。结果观察组治疗的疗效明显优于对照组,两组在治疗前MMP-9和IL-6水平差异无统计学意义,治疗后观察组中MMP-9和IL-6的减少值明显高于对照组。结论脑梗死患者加用依达拉奉治疗,效果明显,且能显著降低血清中MMP-9和IL-6的含量,临床意义明显。     

脑梗死血管介入后应用依达拉奉右莰醇药物的临床疗效

目的 探讨脑梗死患者在基础治疗血管介入术后,应用药物依达拉奉右莰醇注射液治疗的临床效果及意义。方法 选取2021年8月—2023年4月菏泽市成武县人民医院收治的80例脑梗死患者作为研究对象,根据治疗药物的不同分为研究组（n=40）和对照组（n=40）。两组患者均接受血管介入术治疗,对照组在术后使用依达拉奉,研究组在术后使用依达拉奉右莰醇注射液,比较两组患者的国立卫生研究院卒中量表评分、改良Rankin量表（Modified Rankin Scale, mRS）评分及血清指标（一氧化氮、超氧化物歧化酶、活性氧簇）水平。结果治疗15 d后,研究组国立卫生研究院卒中量表评分为（4.59±0.77）分,低于对照组的（5.17±0.91）分,差异有统计学意义（t=3.077,P<0.05）;治疗15 d,研究组一氧化氮、超氧化物歧化酶水平低于对照组,差异有统计学意义（P均<0.05）;治疗15 d,研究组活性氧簇水平低于对照组,差异有统计学意义（t=6.138,P<0.05）。结论脑梗死患者在血管介入术基础上再配合应用依达拉奉右莰醇注射液治疗临床效果十分显著,这种综合治疗方案显...     

依达拉奉对急性脑梗死患者血清炎症因子水平的影响

目的观察依达拉奉对急性脑梗死患者血清炎症因子白细胞介素-6（IL-6）、肿瘤坏死因子（TNF-α）和超敏C反应蛋白（hs—CRP）水平的影响。方法选择急性脑梗死患者120例,随机分为依达拉奉组60例和常规治疗组60例,选择门诊健康体检者60例作为正常对照组。所有脑梗死患者均于入院时、治疗后3d、7d、14d分别抽静脉血3mI检测血清中IL-6、TNF-α、hs-CRP含量各1次,门诊健康体检者仅测定1次血清IL-6、TNF-α、hs-CRP含量。结果脑梗死患者血清IL-6、TNF-α及hs-CRP浓度水平较健康体检组明显升高（P〈0．01）。依达拉奉组和常规治疗组治疗前血清IL-6、TNF-α及hs-CRP含量测定无明显差异（P〉0．05）,治疗后依达拉奉组血清IL-6、TNF-α浓度治疗后3d、7d和14d逐步下降,较常规治疗组有显著差异（P〈0．01）。依达拉奉组治疗后7d和14d血清hs-CRP浓度含量测定明显降低（P〈0．05和P〈0．01）;常规治疗第14天血清hs-CRP浓度才明显降低（P〈0．05）;两组间治疗第7天和第14天有显著差异（P〈0．05）。依达拉奉对于中重度病情患者的血清IL-6、TNF-α、hs—CRP水平的影响比轻度病情患者影响更大。结论急性脑梗死患者血清IL-6、TNF-α和hs—CRP含量明显增加,依达拉奉能显著降低急性脑梗死患者血清炎症因子IL-6、TNF—α和hs—CRP的水平,且对病情重者影响更明显。     

依达拉奉治疗急性脑出血后颅内压的临床观察

目的：研究自由基清除剂依达拉奉在急性脑出血后颅内压的临床治疗应用。方法：97例确诊为急性脑出血的患者被随机分为依达拉奉组52例和常规治疗组45例，同时设正常对照组30例。依达拉奉组是在常规治疗基础上加用依达拉奉静脉滴注，14天为一个疗程。结果：治疗前依达拉奉组、常规治疗组与正常对照组比较血清NO、LPO平均值均升高（P〈0．05），SOD、GSH-Px平均值均减低（P〈0．05）：而依达拉奉组与常规治疗组各指标未见统计学差异（p〉0．05）。治疗后3天、7天，依达拉奉组NO、LPO低于常规治疗组，SOD、GSH-Px高于常规治疗组，两组差异有统计学意义（P〈0．05）。治疗后14天，两组差异无统计学意义（P〉0．05）。治疗前依达拉奉组、常规治疗组颅内压无统计学差异（p〉0．05），治疗后3天、7天颅内压依达拉奉组较常规治疗组降低，有统计学意义（P〈0．05）。结论：依达拉奉能有效清除脑出血后体内产生的大量自由基，降低脑出血后颅内压。     

依达拉奉右莰醇注射液对急性缺血性脑卒中患者的临床疗效及神经功能保护作用分析

摘要：目的：探讨急性缺血性脑卒中（AIS）患者给予依达拉奉右莰醇注射液的临床疗效及神经功能保护作用。方法：选取2021年2月至2022年12月在南城县人民医院接受治疗的共计76例AIS患者，以随机数字表法分成研究组（38例）与对照组（38例），对照组给予依达拉奉注射液治疗，研究组给予依达拉奉右莰醇注射液治疗，比较两组临床疗效、神经功能、日常生活功能、生存质量、不良反应。结果：研究组（97.37%）治疗总有效率较对照组（78.35%）更高（P<0.05）；治疗后两组美国国立卫生研究院卒中量表（NIHSS）评分降低（P<0.05），改良Barthel指数量表（MBI）评分提高（P<0.05），与对照组相比，研究组NIHSS评分更低（P<0.05），MBI评分更高（P<0.05）；治疗后两组简明健康调查问卷（SF-36）评分提高（P<0.05），研究组较对照组更高（P<0.05）；研究组不良反应发生率为7.89%（3/38），与对照组的26.32%（10/38）更低（P<0.05）。结论：AIS患者给予依达拉奉右莰醇注射液治疗能够提升临床疗效，改善神经功能，增强日常生活功能及生存质量，安全性较高。     

依达拉奉联合乌司他丁对胸腔镜手术患者肺功能及肺表面活性蛋白A表达的影响

目的依达拉奉联合乌司他丁对胸腔镜手术患者肺功能及肺表面活性蛋白A表达的影响。 方法选取择期行胸腔镜肺部肿瘤切除手术患者72例,随机分为4组：生理盐水对照组（对照组）、依达拉奉组、乌司他丁组和依达拉奉联合乌司他丁组（联合组）。每组分别在麻醉诱导前（T₀）、单肺通气前即刻（T₁）、手术结束时（T₂）及术后24 h（T₃）行动脉血气分析,计算氧合指数（OI）和呼吸指数（RI）;采用全血自动分析仪测定多形核中性粒细胞（PMN）的数量;采用ELISA法检测血浆SP-A的浓度;记录血流动力学指标。随访患者术后住院时间及有无肺水肿、肺部感染等肺部并发症。 结果4组患者血流动力学指标差异无统计学意义。T₂时点,联合组、依达拉奉组及乌司他丁组OI较对照组均明显增高（P<0.05）,联合组OI又显著高于依达拉奉组及乌司他丁组（P<0.05）;RI和PMN则呈相反趋势（P<0.05）。T₃时点,联合组SP-A的表达显著高于对照组、依达拉奉组及乌司他丁组（P<0.05）,而对照组、依达拉奉组及乌司他丁组间差异无统计学意义。 结论联合应用依达拉奉和乌司他丁较单一用药方案更能改善胸腔镜手术患者术后肺功能,可能与抑制PMN的聚集和上调血SP-A的表达有关。     

依达拉奉对急性脑出血患者ET、NO和SOD的影响

目的：探讨依达拉奉对急性脑出血（ACH）患者开颅术后ET、NO含量和SOD活力的影响。方法：测定40例ACH患者手术前后ET、NO含量及SOD活力。结果：ACH患者术前ET及NO明显高于正常对照组；开颅手术后较术前有显著性升高。A组给予依达拉奉后，ET及NO较治疗前显著性降低，而SOD活力较治疗前升高，与B组组间比较差异有显著性。结论：临床治疗剂量的依达拉奉可明显提高ACH患者体内SOD活力，降低ET及NO而具有脑保护作用。     

依达拉奉右莰醇注射液对急性缺血性脑卒中的疗效分析

目的：探讨给予急性缺血性脑卒中（AIS）患者依达拉奉右莰醇注射液的临床疗效。方法：选取2021年2月至2022年1月在南城县人民医院接受治疗的76例AIS患者,按随机数字表法分成研究组与对照组,各38例。对照组给予依达拉奉注射液治疗,研究组给予依达拉奉右莰醇注射液治疗。比较两组临床疗效、神经功能、日常生活活动能力、生存质量及不良反应。结果：研究组治疗总有效率（97.37%）较对照组（78.95%）高（P<0.05）;治疗后两组美国国立卫生研究院卒中量表（NIHSS）评分降低（P<0.05）,改良Barthel指数量表（MBI）评分提高（P<0.05）,且研究组NIHSS评分低于对照组（P<0.05）,MBI评分高于对照组（P<0.05）;治疗后两组简明健康调查问卷（SF-36）评分提高（P<0.05）,且研究组高于对照组（P<0.05）;研究组不良反应发生率为7.89%,低于对照组的26.32%(P<0.05);随访1年,研究组脑血管事件累计发生率为2.63%,低于对照组的21.05%(P<0.05)。结论：AIS患者给予依达拉奉右...     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.