血清肌钙蛋白Ⅰ对小儿病毒性心肌炎的诊断价值探讨

【目的】探讨血清肌钙蛋白I(CTnI)在小儿病毒性心肌炎诊断中的价值。【方法】将 1 998年 1月至2 0 0 2年 1 2月间临床诊断为病毒性心肌炎的住院患儿 6 8例 ,在同一时段 ,同一份血清分别测试CTnI、血清肌酸激酶心肌型 (CK MB)值。【结果】CTnI对诊断小儿病毒性心肌炎敏感性高于CK MB(P <0 .0 1 ) ;CTnIT诊断窗口时间明显长于CK MB(P <0 .0 1 )。【结论】CTnI有助于病毒性心肌炎的诊断 ,且操作简便 ,无需昂贵仪器 ,便于基层使用     

尿液上皮细胞中巨细胞病毒载量预测婴儿巨细胞病毒激活感染的价值

目的 探讨尿液上皮细胞(EC)中人巨细胞病毒(HCMV)DNA载量预测婴儿活动性HCMV感染的应用价值.方法 分别收集82例HCMV潜伏感染组和84例活动性感染组婴儿外周血和尿液标本,采用实时荧光定量聚合酶链反应(FQ-PCB)和化学发光免疫分析检测血浆HCMV DNA载量和HCMV IgM/IgG抗体;间接免疫荧光法检测外周血多形核白细胞(PMNLs)中HCMV pp65抗原;UF-100尿沉渣全自动分析仪和FQ-PCR分别做尿液EC计数和HCMV DNA载量检测,并计算尿液EC中HCMV DNA载量.同时,用受试者工作特征曲线(ROC)评价尿液上皮细胞中HCMV DNA载量在婴儿HCMV激活感染诊断中的敏感度和特异度.结果 166例HCMV感染婴儿尿液上皮细胞中HCMV DNA阳性检出率最高,为94.58%(157/166),病毒载量范围为5.67×102-1.31×107拷贝/103EC;不同时段尿液EC中HCMV DNA载量差异无统计学意义(F=0.19,P>0.05);活动性感染组尿液EC中HCMV DNA载量[5.13±0.99(拷贝/103EC,lg)]显著高于潜伏感染组[3.92±0.82(拷贝/103EC,lg),t=8.52,P<0.01];根据ROC曲线,当cut-off值为4.55时,尿液EC中HCMV DNA载量对活动性感染诊断的敏感度和特异度分别为71.4%和75.2%;活动性感染患儿更昔洛韦治疗后尿液EC中HCMV DNA载量显著低于治疗前(t=5.44,P<0.01).结论 尿液EC中HCMV DNA载量用于预测婴儿HCMV活动性感染是一种简便、有效的方法,并能用于治疗监测.     

人巨细胞病毒性心肌炎与柯萨奇病毒性心肌炎的对比研究

【目的】探讨人巨细胞病毒性心肌炎的临床特点。【方法】对 2 9例人巨细胞病毒性心肌炎与 5 2例柯萨奇病毒性心肌炎在发病年龄、心电图、心肌酶谱、心功能等方面临床对比。【结果】人巨细胞病毒性心肌炎以小婴儿居多 ,经统计学处理 ,差异有显著性 ,学龄前期发病例数接近。人巨细胞病毒性心肌炎患儿血清心肌酶CK MB、CTnT明显高于柯萨奇病毒性心肌炎 ,差异有显著性 (P <0 .0 1 )。心电图变化人巨细胞病毒性心肌炎以传导阻滞为主 ,与柯萨奇病毒性心肌炎比较差异有显著性 (P <0 .0 5 ) ,在ST T及早搏方面差异无显著性 (P >0 .0 5 )。在心功能方面 ,人巨细胞病毒性心肌炎心室收缩功能、左室射血分数 (LVEF)、左室短轴缩短率 (LVFS)、心脏指数 (CI)与柯萨奇病毒性心肌炎比较差异有显著性 (P <0 .0 1 ) ,心室舒张功能 (E/A)无明显差异。【结论】人巨细胞病毒性心肌炎对心肌的损害程度重于柯萨奇病毒性心肌炎。     

巨细胞病毒肝炎患儿血浆白细胞介素-12 p40水平测定及意义

目的探讨巨细胞病毒(CMV)肝炎患儿血浆白细胞介素(IL)-12亚基p40的水平及意义。方法采用双抗体夹心酶联免疫吸附试验(ELISA)测定52例CMV肝炎患儿更昔洛韦抗病毒治疗前后及36例健康儿童血浆IL-12p40水平,采用速率法和实时荧光定量聚合酶链反应(FQ-PCR)分别测定CMV肝炎患儿血浆ALT活性和尿液HCMV DNA载量。结果 CMV肝炎组血浆IL-12p40水平(pg/ml)(M=536.5,P5=123.5,P95=1061.1)低于正常对照组(M=632.2,P5=226.7,P95=1829.3),经检验差异有统计学意义(Z=-2.721,P0.01)。CMV肝炎患儿血浆IL-12p40水平与其ALT活性(U/I)、尿液HCMV DNA载量(拷贝/ml,lg)呈显著负相关(r=-0.433、-0.491,均P0.01)。治疗有效组血浆IL-12p40水平与入院时比较差异有统计学意义(Z=-5.004,P0.01),而无效组患儿治疗前后血浆IL-12p40水平差异无统计学意义(Z=-1.449,P0.05)。结论 CMV肝炎患儿存在血浆IL-12p40水平低下,其水平变化在一定程度上可反应患儿体内CMV病毒载量及肝脏损害程度,并对预测更昔洛韦抗病毒疗效有一定价值。     

对急性呼吸系统感染患儿血清CK-MB增高的再认识

目的　探讨急性呼吸系统感染患儿血清CK MB增高而无心肌炎临床症状和心电图改变的原因。方法　对急性呼吸系感染患儿于病程的 1～ 5天内采静脉血同时测定CK MB(采用免疫抑制法 )和CTnⅠ (采用夹心ELISA法 ) ,并动态观察病人临床症状、心电图改变以判断是否合并心肌炎。结果　 13 0例急性呼吸系感染患儿中血清CK MB增高 5 8例 ,血清CTnⅠ增高 3例 ,其阳性率为 10 0 % ,经卡方检验P <0 .0 5 ,差异有显著性。 12 7例临床无心肌炎的病例中 ,血清CK MB增高 5 5例 ,正常 72例 ,12 7例患儿中血清CK MB增高组、CK MB正常组与正常儿童对照组三组间CTnⅠ值经方差分析P >0 .0 5 ,差异无显著性。结论　应用免疫法测定的血清CK MB值不能作为判断呼吸系感染时有无心肌损伤的“金指标” ,应改用质量法测定血清CK MB ,或测定血清CTnⅠ来补充。     

更昔洛韦抗病毒治疗巨细胞病毒肝炎患儿的临床疗效分析

【目的】探讨更昔洛韦抗病毒治疗巨细胞病毒(CMV)肝炎患儿的临床疗效。【方法】回顾性分析2019年3月至2021年3月本院收治的88例巨细胞病毒肝炎患儿的临床资料,根据抗病毒治疗药物的不同将其分为观察组和对照组,每组44例。对照组患儿给予还原型谷胱甘肽治疗,观察组在对照组的基础上另给予更昔洛韦治疗。比较两组患儿黄疸消退时间、肝脏回缩时间、脾脏回缩时间,治疗前后血清总胆红素(TBIL)、谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(GGT)水平,并比较两组患儿临床疗效及不良反应发生情况。【结果】观察组黄疸消退、肝脏回缩及脾脏回缩时间显著少于对照组,差异均有统计学意义(均P<0.05)。治疗后,两组患者血清TBIL、ALT、GGT水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组临床总有效率为93.18%(41/44),高于对照组的77.27%(34/44),差异有统计学意义(χ^(2)=4.423,P=0.036)。两组不良反应发生率比较,差异无统计学意义(χ^(2)=1.048,P=0.310)。【结论】更昔洛韦抗病毒治疗巨细胞病毒肝炎患儿能够缩短临床症状消失时间,促进肝功能恢复,且安全可靠。     

更昔洛韦治疗婴儿肝炎综合征的临床研究

目的了解婴儿肝炎综合征的人巨细胞病毒 (CMV)感染情况 ;探讨更昔洛韦治疗CMV肝炎的临床效果。方法对 117例临床诊断婴儿肝炎综合征患儿进行血清HCMV IgM和CMV DNA(PCR法 )检测 ;将HCMV IgM或CMV DNA阳性的患儿随机分成两组 ,对照组给予病毒唑 [10～ 15mg/(kg·d) ,静滴 ,10～ 14天 ],治疗组给予更昔洛韦 [5～7.5mg/(kg·d) ,静滴 ,10～ 14天 ],其余对症治疗相同 ;观察患儿CMV感染转阴率及临床症状缓解情况。 结果①婴儿肝炎综合征患儿CMV感染率是 4 1.88% ;②治疗组CMV感染总转阴率 (85 .71% )明显高于对照组 (30 .4 3% ) ;③治疗组总有效率 (85 .19% )明显高于对照组 (31.82 % ) ;④治疗组血清胆红素恢复正常时间是 (13.4 8± 11.0 3)天 ,对照组是(2 4 .0 8± 7.34)天 ,丙氨酸氨基转移酶恢复正常时间是 (34.4 8± 11.0 3)天 ,对照组是 (48.6 7± 9.11)天 ,治疗组临床症状恢复正常时间明显短于对照组 ;⑤治疗组不良反应率 (33.33% )与对照组 (2 7.2 7% )比较无显著性差异。结论更昔洛韦治疗婴儿肝炎综合征安全、有效。     

手足口病患儿联合检测肌酸激酶同工酶MB、心肌肌钙蛋白Ⅰ在合并病毒性心肌炎诊断中的价值

目的探讨手足口病患儿联合检测血清中肌酸激酶同工酶MB（CK—MB）、心肌肌钙蛋白Ⅰ（cTnI）水平对诊断合并病毒性心肌炎的价值。方法将188倒HFMD患儿分为确诊合并精毒性心肌炎组、疑似舍并病毒性心肌炎组、无合并病毒性心肌灸组。所有惠儿清晨空腹采集静脉血,检测血清中的肌酸激酶同工酶MB（CK—MB）、心肌肌钙蛋白Ⅰ（cTnI）水平,对结果进行统计分析。结果确诊合并病毒性心肌炎组与疑似合并病毒性心肌炎组血清中CK—MB、cTnI均高于无合并病毒性心肌炎组,差异有统计学意义（P〈0．05）;确诊合并病毒性心肌炎组血清中CK—MB、cTnI与疑似合并病毒性心肌炎组比较差异无统计学意义（P〉0．05）。确诊组与疑似组两项检测中的总异常率均分别高于两纽中CK—MB、cTnI单独检测异常率（P〈0．05,P〈0．05）。结论CK—MB、cTnI在HFMD中诊断合并病毒性心肌炎有重要意义;HFMD患儿同时检测血清中CK—MB、cTrI水平,可以提高合并病毒性心肌炎的捡出率。     

人巨细胞病毒在免疫力低下人群中耐药研究新进展

随着抗人巨细胞病毒（HCMV）药物的进展,更昔洛韦（ganciclovir,GCV）等抗病毒药物对HCMV感染引起的相关疾病有较好的疗效,其他多种新型抗病毒药物也着手于体内外的各项试验。抗病毒药物治疗HCMV病外,更大用途是预防感染症状的发作。因为人群中HCMV感染是普遍的,且又呈现潜伏感染状态,一旦宿主免疫功能受损失控,潜伏-激活感染的危害是严重的。目前临床上针对移植特殊群体预防HCMV潜伏．激活主要的策略有：（1）普遍给药预防：对所有可能HCMV感染或激活的危险人群在开始移植时或移植术后立即进行抗病毒治疗;     

更昔洛韦治疗婴儿淤胆型巨细胞病毒性肝炎的疗效研究

目的:探讨婴儿淤胆型巨细胞病毒性肝炎应用更昔洛韦治疗的反应.方法:共有67例患儿纳入研究,根据初诊时血清总胆红素(TB)高低分组,TB≤171μmol/L为组Ⅰ(32例),TB＞171μmol/L为组Ⅱ(35例).确诊后予更昔洛韦[5 mg/(kg·次),静脉点滴,每12h 1次,连用21d]抗病毒治疗,同时给予护肝、利胆、退黄等对症处理.观察临床表现、肝脏生化指标、血常规变化.结果:治疗前患儿的总胆汁酸(TBA)水平在两组间比较差异有显著性(P＜0.05),而γ-谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)在两组间比较,差异无统计学意义(P＞0.05).治疗后两组患儿的TB、直接胆红素(DB)、TBA均显著下降(P＜0.05),而GGT及ALP水平的下降无统计学意义(P＞0.05).更昔洛韦治疗过程中有12例患儿(18%)出现一过性粒细胞减少症,无一例患儿出现粒细胞缺乏,未观察到明显神经系统副作用.结论:婴儿淤胆型巨细胞病毒性肝炎中,更昔洛韦抗病毒治疗安全有效.     

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.