血清糖类抗原（CA－50）测定在喉癌诊断中的初步应用

本文应用ＩＲＭＡ法测定了２０例喉鳞状细胞癌患者和２０例正常成人血清ＣＡ－５０值，并对其中１６例喉癌患者进行了术前、术后自身对照观察，结果发现：喉癌患者血清ＣＡ－５０值明显高于正常对照（Ｐ＜０．０１），异常阳性率为５０％；喉癌组术前、术后ＣＡ－５０比较无显著差异。初步研究可示，血清ＣＡ－５０作为肿瘤标志在喉癌辅助诊断中具有一定的研究价值。     

血清糖类抗原（CA—50）测定在喉癌诊断中的初步应用

本文应用ＩＲＭＡ法测定了２０例喉鳞状细胞癌患者和２０例正常成人血清ＣＡ－５０值，并对其中１６例喉癌者进行了术前，术后自身对照观察，结果发现：喉癌患者血清ＣＡ－５０值明显高于正常对照（Ｐ＜０．０１），异常阳性率为５０％；喉癌组术前，术后ＣＡ－５０比较无显著差异，初步研究可示，血清ＣＡ－５０作为肿瘤标志在喉癌辅助诊断中具有一定的研究价值。     

血清CA72—4测定鉴别胃良,恶性病变的价值

该文测定４３例胃良、恶性病变患者的血清ＣＡ７２－４值,并与ＣＡ１９－４９、ＣＡ５０、ＣＥＡ进行比较,结果表明：ＣＡ７２－４对胃癌的诊断率（５７．１４％）明显高于ＣＡ１９－９（４２．８６％）、ＣＡ５０（２３．８１％）及ＣＥＡ（９．２５％）,均Ｐ＜０．０５,不仅敏感度高,而且特异度达９５．４５％;ＣＡ７２－４与ＣＡ１９－９或ＣＡ５０联合测定,优于单测ＣＡ７２－４,其诊断率分别达７１．４３％、６１．９０％。认为ＣＡ７２－４可作为胃癌诊断及随访的一种有价值的血清肿瘤标志物。     

化学发光免疫分析法测定血清CA—125的临床应用

为了探讨血清ＣＡ－１２５在临床肿瘤中的诊断价值。用化学发光免疫分析法测定盆腔良性肿瘤和各类恶性肿瘤以及正常对照者血清ＣＡ－１２５。结果显示：以６８Ｕ／ｍｌ为阳性预期值,各类肿瘤ＣＡ－１２５的阳性率分别为：盆腔良肿瘤５．４％,肝癌３８．８％,肺癌３５．２％,结直肠癌３１．８,乳腺癌３０．０％,子宫内膜癌５０．０％,卵巢癌７９．２％。以卵巢良性肿瘤与恶性肿瘤相比较,ＣＡ－１２５诊断卵巢癌的灵敏度为７９     

血甭MG7—Ag和TAG—72在胃癌诊断中的应用

目的：探讨血清ＭＧ７－Ａｇ和ＴＡＧ＿７２检测对胃癌的诊断价值。方法：采用放射免疫分析法对９４例患者血清癌单抗ＭＧ７相关抗原（ＭＧ７－Ａｇ）和单抗Ｂ７２相关抗原即肿瘤相关糖蛋白抗原ＴＡＧ－７２）水平进行检测。结果：血清ＭＧ７－Ａｇ和ＴＡＧ－７２测定诊断胃癌的敏感性分别为５２．８％和６９．４％,特异性分别为８６．２％和８４．５％,两者联合检测可提高胃癌的阳性检出率达８６．１％。胃癌切除后血清ＭＧ７－Ａ     

免疫斑点法测抗钙调素自身抗体及其与其他8种自身抗体的关系

目的 探讨抗钙调素（ＣａＭ）自身抗体与自身免疫病及其他自身抗体的相互关系。方法 采用ＳＰＡ－免疫斑点法（ＳＰＡ－ＩＤＡ）对３４０例自身免疫病患者,４８例肿瘤患者,５２例正常人血清进行抗ＣａＭ抗体测定,并随机取自身免疫病患者血清同时检测其他８种自身抗体。结果 各类延寿央免疫病患者体内不同程度地存在着抗ＣａＭ自身抗体,４８例肿瘤患者血清中仅１例阳性,５２例正常人血清中无１例阳性。经统计学分析,抗ＣａＭ     

血液透析对慢性肾功能衰竭患者血清SIL2R、IL6和TNFα的影响

目的：探讨慢性肾功能不全（ＣＲＦ）患者细胞免疫功能状况,以及血液透析（血透）的影响。方法：应用酶联免疫吸附（ＥＬＩＳＡ）双抗体夹心法检测３０例ＣＲＦ未透析患者和６２例血透患者血透前后及对照组血清可溶性白介素－α受体（ＳＩＬ－２Ｒ）、白介素－６（ＩＬ－６）和肿瘤坏死因子－α（ＴＮＦ－α）水平。结果：与对照组相比,ＣＲＦ未透析患者和血透患者血清ＳＩＬ－２Ｒ、ＩＬ－６和ＴＮＦ－α水平无显著差异。血清ＳＩＬ－２Ｒ较透前显著增高。结论：ＣＲＦ患者均存在显著的细胞免疫功能紊乱,单次透析对细胞免疫功能无显著影响。     

miRNA-21在结直肠癌中的表达研究

目的 检测MicroRNA-21（miRNA-21）在正常人和结直肠癌患者血清,以及结直肠癌患者癌组织和癌旁组织中的表达,探讨其与结直肠癌临床病理参数的关系.方法 采用实时荧光定量PCR（RT-qPCR）技术检测正常人和结直肠癌患者血清,以及结直肠癌患者癌组织和癌旁组织中的表达,分析miRNA-21的表达与结直肠癌临床病理参数的关系.结果 miRNA-21在结直肠癌患者血清中表达水平显著高于正常人血清（P＜0.05）;结直肠癌组织中miRNA-21表达水平明显高于癌旁组织;中晚期（Ⅲ期和Ⅳ期）结直肠癌组织中miRNA-21表达水平明显高于早期（Ⅰ期和Ⅱ期）结直肠癌（P＜0.05）;低分化肿瘤组织中miRNA-21表达水平明显高于中高分化者;有淋巴结转移的结直肠癌组织中miRNA-21表达水平明显高于无淋巴结转移者.结论 miRNA-21在结直肠癌患者血清及肿瘤组织中呈高表达,可能与结直肠癌的发生发展有关.     

α—L—岩藻糖苷酶在肝细胞癌诊断的应用与评价

研究发现肝细胞癌（ＨＣＣ）患者平均血清α－Ｌ－岩藻糖苷酶（ａ－Ｌ－ｆｕｃｏｓｉｄａｓｅ，ＡＦＵ）水平明显升高，邦联ＡＦＵ可作为诊断ＨＣＣ的肿瘤标志物。     

结直肠癌p53基因点突变和蛋白表达的研究

目的了解中国人结直肠癌ｐ５３基因的突变谱，探讨聚合酶链反应－单链构象多态（ＰＣＲ－ＳＳＣＰ）银染技术用于研究结直肠癌中ｐ５３基因突变的可行性。方法应用ＰＣＲ－ＳＳＣＰ银染技术检测４１例结直肠癌ｐ５３基因突变，以ＡＢＣ免疫组织化学染色检测结直肠癌Ｐ５３蛋白的表达。结果３４％（１４／４１）的病例显示有ｐ５３基因突变，其中外显子５，６，７和８各有４，１，５和４例突变。２０例有Ｐ５３蛋白异常表达，阳性率为４９％。结论导致Ｐ５３蛋白异常堆积的ｐ５３基因突变是结直肠癌的一种常见的分子结构改变，可能在结直肠癌的发生和发展中起着重要的作用。ＰＣＲ－ＳＳＣＰ银染技术是一简便、快速、有效的检测基因点突变的方法     

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.     

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.     

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.     

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.