三联疗法根除幽门螺杆菌临床观察

目的：探讨枸橼酸铋雷尼替丁加左氧氟沙星加呋喃唑酮三联1周疗法根除幽门螺杆菌的疗效及安全性。方法：选择110例符合条件的幽门螺杆菌阳性慢性胃炎和消化性溃疡患者，随机分为两组。治疗组采用枸橼酸铋雷尼替丁（350mg，2次／d）加左氧氟沙星（200mg，2次／d）加呋喃唑酮（100mg，2次／d），治疗7d；溃疡患者继用枸橼酸铋雷尼替丁350mg，2次／d，3周。对照组采用奥美拉唑（20mg，2次／d）加阿莫西林（1．0g，2次／d）加甲硝唑（400mg，2次／d），治疗7d；溃疡患者继用奥美拉唑20mg，1次／d，3周。疗程结束后4周及8周复查Hp，观察幽门螺杆菌根除率、症状缓解率、溃疡愈合率及不良反应等。结果：治疗组和对照组的症状缓解率、幽门螺杆菌根除率、溃疡治愈率、不良反应发生率分别为91．8％、81．6％、90，5％、32．7％和94．0％、86．0％、95．0％、28．0％，差异无统计学意义（P〉0．05）。治疗组与对照组每例根除幽门螺杆菌费用分别为100．10元、274．68元，治疗组根除幽门螺杆菌期望成本比对照组低196．77元。结论：幽门螺杆菌加左氧氟沙星加呋喃唑酮三联1周疗法是根除幽门螺杆菌的理想方案，可作为根除幽门螺杆菌一线治疗的选择。     

雷贝拉唑及雷尼替丁枸橼酸铋的短程四联疗法根除幽门螺杆菌感染

目的观察雷贝拉唑与雷尼替丁枸橼酸铋（Ranitidine bismath citrate，RBC）联合的五天四联疗法根除幽门螺杆菌（Helicobacter pylori，Hp）的疗效及安全性。方法选择Hp感染的活动期溃疡或慢性糜烂性胃窦炎患者，随机分为A、B、C、D四组。分别用雷贝拉唑三联七天疗法、RBC三联七天疗法、雷贝拉唑与三甲二枸橼酸铋联合四联七天疗法和雷贝拉唑与RBC联合四联五天疗法根除Hp治疗，活动期溃疡病例抗Hp治疗后继续服雷贝拉唑10mg，1次／d，疗程2周。观察Hp的根除率、活动期溃疡和糜烂性胃窦炎的愈合率以及副作用的发生率。结果雷贝拉唑与RBC联合五天四联组Hp根除率（97．7％）显著高于雷贝拉唑三联组（72．7％）或RBC三联组（75．6％）（P〈0．05），亦高于雷贝拉唑与三甲二枸橼酸铋联合四联组（88．4％），但差异无统计学意义（P〉0．05）。雷贝拉唑与RBC联合的五天四联组与其他三组对活动期溃疡愈合率较接近；高于其他三组对糜烂性胃窦炎的愈合率，但差异无统计学意义（P〉0．05）。不良反应发生率，雷贝拉唑三联组（8．9％）、RBC三联组（6．7％）和雷贝拉唑与RBC联合四联组（8．9％）较类似。均低于雷贝拉唑与三甲二枸橼酸铋联合四联组（20．0％），但差异无统计学意义（P〉0．05）。结论雷贝拉唑与RBC联合四联疗法可获得高Hp根除率，不良反应少、疗程短，值得进一步试用。     

奥美拉唑三联疗法根除幽门螺杆菌疗效观察

目的探讨奥美拉唑＋克拉霉素＋阿莫西林三联疗法根除幽门螺杆菌（Hp）感染的疗效。方法选择86例Hp阳性消化性溃疡患者，将其分为治疗组和对照组，均给予奥美拉唑加两种抗生素1周三联治疗。治疗组：口服奥关拉唑（20mg／次）＋克拉霉素（500mg／次）＋阿莫西林1000mg／次）；对照组：口服奥美拉唑（20mg／次）＋甲硝唑片（400mg／次）＋阿莫西林（1000mg／次），均为2次／d，疗程为1周，一月后进行Hp检测。结果治疗组Hp根除率90．7％，对照组Hp根除率86．0％，两组根除率无统计学差异（P〉0．05）；治疗组不良反应发生率为14．0％，对照组为16．3％，两组比较无显著性差异（P〉0．05）。结论两组方案均能有效缓解消化性溃疡症状和根除Hp，但奥美拉唑＋克拉霉素＋阿莫西林三联疗法对Hp根除率相对较高，且不良反应相对较轻，值得临床推广应用。     

含铋剂四联疗法作为一线方案根治幽门螺杆菌感染的临床研究

目的探讨含铋剂的四联疗法作为一线方案对幽门螺杆菌感染的有效性和安全性。方法选择2008年9月一2010年9月间137例确诊幽门螺杆菌感染的初治患者,随机分为RAC组（雷贝拉唑、阿莫西林和克拉霉素）和RBAC组（雷贝拉唑、阿莫西林、克拉霉素和枸橼酸铋钾）。经治疗7d后比较两组根除率和不良反应发牛率。结果RAC组和RBAC组的按方案分析根除率分别为77．6％和90．3％,意向性治疗分析根除率分别为72．6％和86．7％。RBAC组的按方案分析和意向性治疗分析根除率均高于RAC组（P〈O．05）。不良反应发生率分别为1．6％和1．3％（P〉O．05）。结论以雷贝拉唑、阿莫西林、克拉霉素和枸橼酸铋钾为组合的四联疗法能显著提高幽门螺杆菌感染的初治成功率,不良反应少,安全有效。     

三联疗法根除幽门螺杆菌感染临床观察

目的 探讨枸橼酸铋雷尼替丁、左氧氟沙星、阿莫西林三联一周疗法,根除幽门螺杆菌(Hp)的疗效及安全性.方法 选择100例Hp阳性的慢性胃炎和消化性溃疡患者,随机分为两组,治疗组采用枸橼酸铋雷尼替丁350mg、左氧氟沙星200mg、阿莫西林1000mg,均为每日2次(早、晚),疗程1周.对照组采用奥美拉唑20mg、克拉霉唑500mg、阿莫西林1000mg,均为每日2次(早、晚),疗程1周,4周后复查Hp.结果 治疗组Hp根除率92%,对照组Hp根除率82%,差异无统计学意义(P＞0.05).结论 枸橼酸铋雷尼替丁、左氧氟沙星、阿莫西林三联疗法Hp根除率高,副作用少而轻,患者依从性好,值得临床推广使用.     

莫西沙星、埃索拉唑和呋喃唑酮三联根除幽门螺杆菌的疗效观察

目的比较莫西沙星、埃索拉唑和呋喃唑酮三联疗法与经典铋剂四联疗法作为初次治疗方案根除幽门螺杆菌（Hp）感染的疗效与安全性。方法选取126例经胃镜检查证实为Hp感染上消化道疾病患者,随机分为两组：治疗组（n=66）,给予埃索拉唑、莫西沙星、呋喃唑酮三联10d治疗;对照组（n=60）,给予经典铋剂四联14d治疗,疗程结束4周后复查Hp,观察疗效和不良反应。结果治疗组Hp根除率为89．4％,对照组为88．3％,差异无统计学意义（P〉0．05）;治疗组不良反应发生率（16．7%）明显低于对照组（36．7％）,差异有统计学意义（P〈0．05）。结论莫西沙星、埃索拉唑和呋喃唑酮三联Hp根除率与经典铋剂四联疗法相同,但不良反应少,患者耐受好,安全。     

序贯疗法根除初治失败幽门螺杆菌疗效观察

目的分析总结雷贝拉唑、阿莫西林、克拉霉素、替硝唑组成的10日序贯疗法根除初治失败幽门螺杆菌（Helicobacter pylori,Hp）的疗效。方法将2009年5月一2011年5月在消化科门诊及住院经胃镜确诊的胃、十二指肠溃疡患者65例,经标准三联疗法治疗4周后Hp仍阳性的患者随机分为两组,治疗组33例前5d用雷贝拉唑i0mg、阿莫西林1．0,每日2次口服,后5d用雷贝拉唑10mg、克拉霉素500mg、替硝唑500mg,每日2次口服;对照组32例用雷贝拉唑10mg、枸橼酸铋钾600mg、呋喃唑酮0．1g、阿莫西林1．0g,每日2次,疗程10d。停药4周后复查Hp。结果治疗组Hp根除率81．8％,对照组75．0％,两组比较无统计学意义（P〉O．05）。不良反应率分别为12．1％和34．3％,两组比较有统计学意义（P〈O．05）。结论序贯疗法对初治失败Hp根除率高于四联疗法但无统计学意义,不良反应率低于对照组,可作为根除初治失败Hp的一种有效方案。     

左氧氟沙星对幽门螺杆菌感染的治疗作用

目的观察左氧氟沙星治疗幽门螺杆菌感染的有效性和安全性，旨在探索新的根除幽门螺杆菌感染的治疗方案。方法66例Hp阳性胃、十二指肠溃疡患者，随机分为观察组和对照组各33例，观察组给予质子泵抑制剂（标准剂量）＋枸橼酸铋钾（0.22g）＋左氧氟沙星（0.2g）＋阿莫西林（1．0g），每日2次，口服；对照组给予质子泵抑制剂（标准剂量）＋枸橼酸铋钾（0.22g）＋甲硝唑（0.2g）＋阿莫西林（1．0g），每日2次，疗程7天，观察两组Hp根除率的差异，并记录副作用。结果观察组Hp根除率为84．84％；溃疡愈合率为93．93％。对照组Hp根除率为66．67％；溃疡愈合率为93．75％。两组比较，溃疡愈合率差异无统计学意义（P〉0．05），但Hp根除率观察组较对照组高（P〈0．05）。结论左氧氟沙星治疗Hp感染根除率高，症状缓解快，不良反应少，值得临床推广应用。     

抗幽门螺杆菌感染治疗功能性消化不良的临床观察

目的探讨根除幽门螺杆菌（Hp）对Hp阳性功能性消化不良（FD）症状的作用,为临床治疗功能性消化不良提供依据。方法Hp阳性FD患者110例随机分为两组：治疗组给予法莫替丁20mg、胶体次枸橼酸铋240mg、阿莫西林1g,甲硝唑400mg四联疗法,均2次／d;对照组给予法莫替丁20mg,2次／d和莫沙必利10mg,3次／d,疗程均为1周。治疗后1个月行^14C-尿素呼气试验（^14C—UBT）,并进行症状评分和疗效评定;随访1年再行^14C—UBT试验并进行症状评分。结果治疗组Hp根除率92％,其中Hp根除组1个月末和1年后的症状积分显著低于对照组（P〈0．01）,未根除组症状积分与对照组差异无统计学意义（P〉0．05）。治疗组症状改善的总有效率为81．2％,与对照组65．5％相比,差异有统计学意义（P〈0．05）。结论根除Hp可以在较长时间内改善FD症状,是治疗Hp阳性FD的必要措施。     

艾普拉唑联合铋剂标准四联与序贯方案治疗幽门螺杆菌感染性慢性胃炎的疗效比较

【目的】观察艾普拉唑联合铋剂14 d标准四联方案及序贯方案治疗幽门螺杆菌（H ．pylor ,Hp）感染性慢性胃炎患者的临床疗效。【方法】经胃镜、快速尿素酶试验确诊的 H p阳性患者160例,按区组随机化分组法分为两组,每组80例,分别接受艾普拉唑＋枸橼酸铋钾＋阿莫西林克拉维酸钾＋左氧氟沙星的14 d的标准四联方案（标准组）或艾普拉唑＋阿莫西林克拉维酸钾＋左氧氟沙星＋呋喃唑酮14 d序贯疗法方案（序贯组）治疗。疗程结束后4～6周内行14 C尿素呼吸试验检测并观察比较两组患者症状改善及不良反应发生情况。【结果】标准组和序贯组H p根除率的符合方案数据分析分别为87％（67／77）和87．17％（68／78）;意向性分析分别为82．5％（66／80）和81．2％（65／80）。标准组和序贯组对上腹痛、反酸、烧心感等临床症状缓解有效率分别达94．8％（73／77）和94．87％（74／78）;不良反应轻微,发生率分别为5．19％和6．41％。两组患者在上述3个方面相比较差异均无显著性（均 P ＞0．05）。【结论】艾普拉唑联合铋剂14 d标准四联方案或14 d序贯疗法方案治疗 Hp阳性慢性胃炎患者均可获得临床症状改善率高、不良反应轻、Hp根除率高的疗效。     

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.     

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.