301例B—ALL细胞表面抗原检测结果分析

目的 探讨Ｂ淋巴细胞相关抗原在急性Ｂ细胞型淋巴细胞白血病（Ｂ－ＡＬＬ）细胞表面的表达及其与细胞形态和治疗的关系。方法 采用ＡＢＣ－ＡＰ免疫组化法结合选用多种Ｂ淋巴细胞相关抗原的克隆性抗体对３０１例初发（Ｂ－ＡＬＬ）患者的白血病细胞进行细胞表面抗原检测。结果 Ｂ－ＡＬＬ患者的白血病细胞ＣＤ１９、ＨＬＡ－ＤＲ呈高阳性率表达；而ＣＤ２０的阳性表达率较低。阳性表达率与ＦＡＢ分类分型有一定关系。其中Ｌ１型Ｃ     

CD7抗原阳性急性髓系白血病免疫学分型及P糖蛋白检测

目的研究ＣＤ７阳性急性髓系白血病（ＣＤ７＋ＡＭＬ）的临床生物学特征。方法对３０例初治ＣＤ７＋ＡＭＬ患者进行细胞形态学、免疫表型、多药耐药Ｐ糖蛋白、细胞遗传学检测。结果３０例ＣＤ７＋ＡＭＬ在同期２６２例患者中占１１．４％,ＦＡＢ分型中以Ｍ１多见,ＣＤ７＋ＡＭＬ有较高的白细胞总数及原始细胞比例,与ＣＤ３４表达、Ｐ糖蛋白表达高度相关。完全缓解率为４３．３％,中位缓解时间为４个月。达缓解的中位时间为４８天。结论ＣＤ７＋ＡＭＬ患者缓解率低,缓解时间短,具有独特的临床生物学特征。     

间质性肺病支气管肺泡灌洗液中TNF和IL—2的临床研究

同步检测了３０例间质肺病（ＩＬＤ）患者和９例正常对照者的支气管肺泡灌洗液（ＢＡＬＦ）中肿瘤坏死因子（ＴＮＦ）和白细胞介素－Ⅱ（ＬＩ－２）含量，并探讨其意义，结果显示ＩＬＤ病人ＢＡＬＦ中ＴＮＦ含量明显高于正常对照者（Ｐ〈０．０５），ＢＡＬＦ中ＩＬ－２测定值亦以ＩＬＤ病人显著增高（Ｐ〈０．０５或Ｐ〈０．０１），且与结节病缚ＢＡＬＦ淋巴细胞百分化，ＣＤ４／ＣＤ８比值之间有高度相关性。作者认为，ＢＡＬＦ中     

骨髓增生异常综合征骨髓原始细胞祖细胞体外培养

以植物血凝素－白细胞条件培养液（ＰＨＡ－ＬＣＭ）作为刺激源，研究确定了白血病原始细胞祖细胞（ＢＣＰ）体外培养方法的一些细节。用此方法观察了骨髓增生异常综合征（ＭＤＳ）患者去除Ｔ细胞和粘附细胞的骨髓单个核细胞中ＢＣＰ体外生长情况。２７例ＭＤＳ中１０例（３７％）有原始细胞集落（ＢＣＣ）生长。ＢＣＣ阳性率和产率与ＦＡＢ亚型之间有一定的相关性；阳性率并与姐妹染色单体分化（ＳＣＤ）显著相关。对照组中无一例有ＢＣＣ生长。本文结果表明ＢＣＰ能够反映ＭＤＳ的恶性细胞克隆；ＢＣＣ是评估ＭＤＳ病期的重要生物学指标。     

脐血血浆增强阿糖胞苷抗白血病效应的实验研究

目的研究脐血血浆（ＣＢＰ）对２８例急性髓系白血病（ＡＭＬ）细胞体外对阿糖胞苷（ＡｒａＣ）敏感性的影响。方法以基因重组人粒巨噬细胞集落刺激因子（ｒｈＧＭＣＳＦ）和空白组作对照,采用ＭＴＴ法检测ＡｒａＣ的细胞毒作用。结果ＡＭＬ细胞对ＡｒａＣ的敏感性表现出异质性,但使用ＣＢＰ及ｒｈＧＭＣＳＦ均可显著增强ＡｒａＣ对耐药ＡＭＬ细胞的毒性,与空白对照组相比,差异有显著性（Ｐ＜００５）,尤以ＣＢＰ为优。结论ＣＢＰ与ｒｈＧＭＣＳＦ类似,可能通过促进耐药ＡＭＬ细胞进入增殖周期,从而增强ＡＭＬ细胞对ＡｒａＣ的敏感性,预示ＣＢＰ与ＡｒａＣ联合运用治疗耐药ＡＭＬ的潜在价值。     

四川地区间变性大细胞淋巴瘤的临床病理与免疫组化研究

目的 观察四川地区间变性大细胞淋巴瘤（ａｎａｐｌａｓｔｉｃ ｌａｒｇｅ ｃｅｌｌ ｌｙｍｈｏｍａ,ＡＬＣＬ）的临床病理和免疫组化特征。方法 搜集临床资料并随访,应用免疫组化（ＡＢＣ法）,对１９例ＡＬＣＬ的临床病理和免疫组化进行研究。结果 记均阳性）。１１例为ＣＤ４５阳性,１０例ＥＭＡ阳性,１４例ＴＩＡ１阳性。ＣＤ１５及ＣＤ６８均为阴性。形态学上瘤组织表现为窦、滤泡间侵犯,瘤细胞形态多样,可见胚胎样     

T淋巴细胞识别自体慢性粒细胞白血病肿瘤细胞抗原的研究

目的：验证慢性粒细胞白血病（ＣＭＬ）患者体内是否存在细胞毒Ｔ淋巴细胞前体细胞，并鉴定其表型和功能特征。方法：用混合淋巴瘤细胞培养技术，用自体瘤细胞和细胞因子刺激扩增ＣＭＬ患者骨髓和外周血单个核细胞（ＭＮＣ）。结果：ＣＭＬ缓解期和慢性期均存在对自体和异体ＣＭＬ细胞杀伤活性的Ｔ淋巴细胞，这些细胞对自体和异体正常ＭＮＣ没有杀伤活性，对正常ＣＦＵ－ＧＭ无抑制作用。而ＬＡＫ细胞对自体ＣＭＬ细胞无杀伤活性（＜１０％），只对异体ＣＭＬ细胞有杀伤活性。上述Ｔ细胞包括ＣＤ３＋ＣＤ５６＋非主要组织相容性抗原（ＭＨＣ）限制性Ｔ细胞，和ＣＤ３＋ＣＤ６－ＭＨＣ限制性Ｔ细胞。用自体ＣＭＬ细胞刺激可增加Ｔ细胞激活抗原ＣＤ２５和ＨＬＡ－ＤＲ的表达。上述Ｔ细胞对自体ＣＭＬ细胞呈较弱的增殖反应，对异体ＣＭＬ细胞几乎无增殖反应，对载有ＢＣＲ－ＡＢＬ肽的自体缓解期ＥＢ病毒转染Ｂ细胞也无增殖反应。结论：ＣＭＬ细胞可能有共同的肿瘤抗原，后者可以被Ｔ细胞识别，但尚无证据表明是ｐ２１０的融合区序列。     

骨髓增生异常综合征血清降钙素和降钙素基因相关肽测定及其意义

目的寻找一个早期预测骨髓增生异常综合征（ＭＤＳ）向急性髓系白血病（ＡＭＬ）转化的指标。方法对ＭＤＳ患者４５例,ＡＭＬ患者４０例,对照组５０例,利用放射免疫法（ＲＩＡ）检测其血清中的人降钙素（ｈＣＴ）、降钙素基因相关肽（ＣＧＲＰ）水平,并对ＭＤＳＲＡ组、ＲＡＥＢ组中部分患者进行随访,观察其临床转归及与ｈＣＴ、ＣＧＲＰ血清水平的关系。结果ＭＤＳ各型及ＡＭＬ初发组患者ｈＣＴ、ＣＧＲＰ血清水平均有升高,与对照组相比差异均有显著性（Ｐ＜０．０１）,ＲＡＥＢ组高于ＲＡ组（Ｐ＜０．０５）,在ＲＡ向ＲＡＥＢ、ＲＡＥＢ向ＡＭＬ转化过程中ｈＣＴ、ＣＧＲＰ均逐渐升高。结论ｈＣＴ、ＣＧＲＰ血清水平检测可以作为早期预测ＭＤＳ向ＡＭＬ转化的指标     

急性髓系白血病细胞CD34抗原表达的研究：Ⅰ表达特点和临床意义

对５６例初发急性髓系白血病（ＡＭＬ）细胞ＣＤ＿（３４）抗原的表达作了检测，分析了ＣＤ＿（３４）抗原表达与临床表现及化疗疗效的关系。结果显示，ＡＭＬ细胞的ＣＤ＿（３４）表达率存在很大差别，从１％～８５％；５６例ＡＭＬ中ＣＤ＿（３４）阳性表达病例为２３例，占４１．１％。ＣＤ＿（３４）抗原表达与ＦＡＢ形态学分型无关，但Ｍ＿３型的表达阳性率明显低于Ｍ＿１、Ｍ＿２型。ＣＤ＿（３４）￣＋病例组与ＣＤ＿（３４）￣－病例组在年龄、性别及初发时白细胞总数、血红蛋白浓度、血小板计数等均无明显差异；在诱导化疗疗效上，ＣＤ＿（３４）￣＋组完全缓解率为４３．５％，明显低于ＣＤ＿（３４）￣－组的７２．７％。研究结果提示，ＡＭＬ细胞在ＣＤ＿（３４）抗原的表达上存在异质性；并具有一定的预后判断价值，建议对ＣＤ＿（３４）￣＋病例施行更为有效的、可能需与ＣＤ＿（３４＿￣－病例不同的化疗。     

人FⅧ基因高效表达质粒的构建及其在Cos-7细胞中的表达

目的：构建人ＦⅧ真核表达质粒——ｐＡｄＣＭＶＬｉｎｋＦⅧＤＢ并观察其在Ｃｏｓ－７细胞中的表达活性。方法：采用缺失大部分Ｂ结构域的人凝血因子ⅧｃＤＮＡ（ＦⅧＤＢ），长度为４．６ｋｂ，将其插入含腺病毒序列表达质粒——ｐＡｄＣＭＶＬｉｎｋ１，构建了ＦⅧ真核表达质粒——ｐＡｄＣＭＶＬｉｎｋＦⅧＤＢ，用脂质体介导法将其转染Ｃｏｓ－７细胞，转染后２４，４８，７２小时分别用逆转录－聚合酶链反应（ＲＴ－ＰＣＲ）、ＥＬＩＳＡ法及一期法测定培养细胞中ＦⅧＤＢｍＲＮＡ及ＦⅧ的含量与活性。结果：ＲＴ－ＰＣＲ法可检测到ＦⅧＤＢｃＤＮＡ转录的ｍＲＮＡ，ＥＬＩＳＡ法测得７２小时后ＦⅧ的含量为每２４小时１８ｎｇ／１０６细胞，一期法测得活性为每２４小时０．６Ｕ／１０６细胞，相当于正常人血浆中１００μｇ／ＬＦⅧ所产生的凝血活性的６０％。结论：所构建的ＦⅧ真核表达质粒在Ｃｏｓ－７细胞中具有一定的表达活性。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.