急性甲胺磷口服中毒与自由基损伤关系的初步研究

目的：探讨急性甲胺磷口服中毒（AMP）患者体内的一系列自由基异常反应及其对患者机体损伤程度的关系。方法：采用独立样本随机对照设计，用分光光度比色分析法检测了41例AMP患者和40例健康成人志愿者（HAV）的血浆过氧化脂质（LPO）、一氧化氮（NO）、维生素C（VitC）、维生素E（VitE）、β－胡萝卜（β-CAR）含量及红细胞超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GPX）活性，结果：与HAV组的相应生化参数均值比较，AMP组的血浆LPO和NO均值显著升高（P＜0．0001），血浆Vit、VitE、β－CAR和红细胞SOD、CAT、GPX均值显著降低（P＜0．0001），对41例AMP患者红细胞乙酰胆碱酯酶（AChE)活性与上述各生化参数的直线回归和相关分析表明，随着AChE值的降低，LPO和NO值逐渐升高（P＜0．001），而VitC、VitE、β－CAR、SOD、CAT和GPX值逐渐降低（P＜0．01），逐步回归分析表明，AChE值与GPX和LPO的相关最密切，结论：AMP患者体内的一系列自由基反应病理性加剧，其中毒程度与GPX和LPO的相关最密切。     

急性有机磷农药口服中毒与自由基变化关系的初步探讨

目的：探讨急性有机磷农药口服中毒患者体内的一系列自由基异常反应及其对患者机体损伤程度的关系。方法：采用独立样本对照设计，用分光光度比色分析法检测了58例急性有机磷农药中毒患者（AOPP）和58例健康成人志愿者（HAV）的血浆过氧化脂质（LPO）、一氧化氮（NO）、维生素C（VC）、维生素E（VE）、β－胡萝卜素（β－CAR）含量和谷胱甘肽－S－转移酶（GST）活性及红细胞超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GSH－Px）活性。结果：与HAV组各生化参数（BP）平均值（AV）比较，AOPP组血浆LPO、NO和GST的AV均升高，差异具有显著性意义（P＜0．001），血浆VC、VE、β－CAR和红细胞SOD、CAT、GSH－Px的AV均降低，差异具有显著性意义（P＜0．001）。对58例AOPP患者红细胞乙酰胆碱酯酶（AChE）活性与上述各BP的直线回归和相关分析表明，随着AChE值的降低，LPO、NO和GST值逐渐升高，均呈直线负相关（P＜0．005），而VC、VE、β－CAR、SOD、CAT和GSH－Px值逐渐降低，均呈直线正相关（P＜0．001）。对58例AOPP和58例HAV用上述BP进行判别分析的结果提示，判别正确率均为100％。结论：急性有机磷农药口服中毒患者体内的一系列自由基反应病理性加剧，采用上述参数可提高判别分析的正确率。     

急性结石性胆囊炎与一氧化氮、氧化和脂质过氧化关系的研究

目的：从自由基医学的角度探讨一氧化氮、氧化和脂质过氧化与急性结石性胆囊炎之间的关系。方法：用分光光度法检测了97例急性结石性胆囊炎患者（ALC）和100例健康志愿者（HVT）血浆中的一氧化氮（）P－NO）、维生素C（P－VC）、维生素E（PVE）、β－胡萝卜素（P- β-CAR）和过氧化脂质（P－LPO）含量及红细胞超化物歧化酶（E－SOD）、过氧化氢酶（E－CAT）、谷胱甘肽过氧化物酶（E－CSH－Px)活性和过氧化脂质（E－LPO）含量,分析比较了ALC组与HVT组各平均检测（AV）之间的差异及患者组手术前后各AV之间的差异。结果与HCT组上述各AV比较,ALC组P－NO、P－LPO和E－LPO的AV均显著增高（P＝0．001）,P－VC、P－VE、P-β-CAR、E-SOD、E-CAT和E－GSH－Px的AV均显著降低（P＝0．0001）;与ALC组手术前上述各AV比较,ALC组手后P＝NO、P－LPO和E－LPO的AV均显著降低（P＜0．001）,P－VC、E－SOD、E－CAT和E－CSH－Px的AV均显著增高（P＜0．001）,但PVE和P－β-CAR的AV在手术前后无显著性差异（P＞0．05）。结论：ALC患者体内的一氧化氮代谢严重紊乱,一系列自由基连锁反应病理性加剧,氧化抗氧化平衡严重失调。     

老年人红细胞抗氧化酶活性与血浆过氧化脂质含量的变化

目的　探讨老年人体内红细胞抗氧化酶活性及过氧化脂质含量的变化。方法　测定 82例 61岁健康男性老年人 (老年健康组 )的红细胞超氧化物歧化酶 (E—SOD)、红细胞过氧化氢酶 (E—CAT)、红细胞谷胱甘肽过氧化物酶 (E—GSH—Px)活性及血浆过氧化脂质 (P—LPO)含量 ,并与 65例 4 0岁健康男性的测定值进行对照 (年轻健康组 )。结果　老年健康组E—SOD、E—GSH—Px活性显著低于年轻健康组 (P值 <0 .0 0 1～P值 <0 .0 1 ) ,E—CAT活性两组间无显著差异 (P值 >0 .0 5)、P—LPO含量显著高于年轻健康组 (P值 <0 .0 1 )。结论　健康老年人的氧化状态显著高于年轻成人的氧化状态。     

氧化、脂质过氧化在食管癌患者中的变化

目的：探讨氧化、脂质过氧化在食管癌患中的变化。方法：检测45例食管癌患（患组）和50例健康人（对照组）血浆维生素C（P－VC）、维生素E（P－VE）、β－胡萝卜素（P－β－CAR）和过氧化脂质（P－LPO）含量及红细胞超氧化物歧化酶（E－SOD）、过氧化氢酶（E－CAT）、谷胱甘肽过氧化物酶（E－GSH－PX）活性和过氧化脂质（E－LPO）含量。结果：与对照组比较，P－VC、P－VE、P－β－CAR、E－SOD、E－CAT、E－GSH－PX值显降低（p＜0．001）P－LPO、E－LPO值显增高（p＜0．001）。结论：食管癌患氧化、脂质过氧化损伤加剧。     

丹参对老年难治性心力衰竭患者氧化／抗氧化系统的作用

目的：探讨丹参注射液对老年人心力衰竭患者血中GSHPx、CAT、SOD酶活性及LPO含量的影响。方法：选取健康老年人36例。检测静脉血全血超氧化物歧化酶(SOD)、全血谷胱甘肽过氧化物酶(GSH—Px)和过氧化氢酶(CAT)的活性及血浆脂质过氧化物(LPO)和丙二醛(MDA)的浓度．然后与老年难治性心力衰竭组治疗前的此五项指标进行对应比较；选择78例老年难治性心力衰竭患者，随机分成两组，试验前均监测静脉血SOD、GSH—Px和CAT的活性及LPO和MDA的浓度并评价心功能。然后试验组在给予常规治疗的同时合并给予丹参注射液，16g／d，qd，疗程2周；对照组只给予常规治疗，2周后。复测上述指标，比较各组前后的变化。结果：(1)老年难治性心力衰竭患者SOD、GSH—Px和CAT的活性比健康对照组低，而LPO及MDA的浓度比健康对照组高，均P＜0．01。(2)丹参组试验前后比较，SOD、GSH—Px和CAT活性明显增高，且LPO和MDA浓度明显降低，均P＜0．05；而对照组则无显著变化，P＜0．05。(3)丹参组心力衰竭纠正的有效率显著高于对照组，P＜0．05。结论：老年难治性心力衰竭患者机体的抗氧化防御能力降低，丹参注射液可通过提高机体的抗氧化能力，消除氧自由基和脂质过氧化物起到纠正心力衰竭的作用。     

联合维生素E和维生素C对维持性血液透析患者脂联素和氧化应激的影响

【目的】研究联合维生素E（VitE）和和维生素C（VitC）对维持性血液透析（MDH）患者脂联素（ADPN）和氧化应激的影响。【方法】MHD患者64例,分为对照组（C组）和联合治疗组（T组,给予VitE200mg／d和VitC200mg／d口服,治疗3个月）,并以正常人20例为正常对照组（N组）。比较三组各项临床指标。【结果】与N组比较,MHD患者血清丙二醛（MDA）水平升高,谷胱甘肽过氧化物酶（GSHPx）、超氧化物歧化酶（SOD）水平降低;同时ADPN升高。给予VitE和VitC治疗后,患者血清MDA水平降低,GSH—Px、SOD水平升高,同时ADPN进一步升高,ADPN与GSHPx、SOD呈正相关,与MDA呈负相关。【结论】口服VitE和VitC可能通过抑制MHD患者体内氧化应激状态,上调ADPN的水平,发挥心血管保护作用。     

急性肾功能衰竭与氧化损伤

目的测定急性肾功能衰竭患者体内自由基异常反应诱导的氧化损伤。方法采用随机对照研究设计,选择50例急性肾功能衰竭患者(ARF)和50例健康成人志愿者(HAV)。用分光光度测量法分别检测血浆一氧化氮(NO),维生素C(V_C),维生素E(V_E),β-胡萝卜素(β-CAR),血浆和红细胞过氧化脂质(LPO)以及红细胞超氧化物歧化酶(SOD)、过氧化氢酶(CAT)和谷胱甘肽过氧化物酶(GPX)的活性。结果与HAV比较,ARF的血浆NO浓度、血浆和红细胞LPO浓度明显增高(P＜0．01),而血浆V_C、V_E、β-CAR浓度和红细胞SOD、CAT、GPX活性明显下降(P＜0．01)。直线相关分析显示,ARF随着血浆NO水平、血浆和红细胞LPO水平增高,以及血浆V_C、V_E、β-CAR水平和红细胞SOD、CAT和GPX活性下降,血清尿素氮和肌酐水平逐渐增高(P＜0．01)。判别分析显示,ARF的判别正确率为75．3%～93%,HAV为70%～91．3%,逐步判别分析显示,ARF的判别正确率提高到99．2%,HAV提高到100%。可靠性分析显示,ARF的可靠系数(α)为0．816,标准系数α为0．972,P＜0．01。结论在ARF体内,一系列自由基连锁反应呈现严重病理变化,其结果导致氧化损伤,加速肾功能恶化。因此,在ARF的治疗上,加用抗氧化剂非常必要。     

单纯性高甘油三酯血症辨证分型与自由基代谢及凝血-纤溶活性关系的研究

目的 :研究单纯性高甘油三酯血症辨证分型与自由基代谢及凝血纤溶活性的关系。方法 :选择血清甘油三酯 >1.8mm ol/ L患者 ,按中医辨证分为气虚证组 (2 5例 )、阴虚证组 (2 6例 )、阳虚证组 (2 0例 )、痰湿证组 (2 4例 )和血瘀证组 (2 5例 ) ,并设立对照组 (2 5例 ) ,比较各组血浆丙二醛 (MDA)、超氧化物歧化酶 (SOD)、谷胱甘肽过氧化物酶 (GSH Px)、内皮素 (ET)、一氧化氮 (NO)、血小板α颗粒膜蛋白 (GMP 14 0 )、组织型纤溶酶原激活剂 (t PA)及其抑制剂 (PAI)等指标的差异。结果 :高甘油三酯血症各证型 ET、MDA、PAI、GMP 14 0均高于对照组 ,而 NO、SOD、GSH Px、t PA均较之为低 (P均 <0 .0 1) ;痰湿证组、血瘀证组 ET、MDA、PAI、GMP 14 0、SOD、GSH Px均高于气虚证组、阴虚证组与阳虚证组 ,而 NO、t PA则较低 (P均 <0 .0 1) ;阳虚证组 SOD、GSH Px则较气虚证组与阴虚证组显著降低 (P均 <0 .0 1)。结论 :各证型均存在不同程度的自由基代谢紊乱及凝血纤溶系统的改变 ,痰湿证及血瘀证存在较明显脂质过氧化反应增强、血管内皮细胞功能障碍、血小板活化、纤溶活性降低等改变 ,阳虚证组抗氧化酶活性降低。     

缺血性脑血管病患者VitC VitE SOD MDA测定的临床意义

目的 :对缺血性脑血管病患者血清VitC、VitE、超氧化物歧化酶 (SOD)、丙二醛 (MDA)进行测定 ,以了解VitC、VitE的抗氧化剂作用。方法 :缺血性脑血管病患者 5 8例 ,采用 75 1紫外分光光度计测其吸光度 ,根据所测得的吸光度在标准曲线上查出相对应的浓度值。结果 :脑供血不足组 (脑缺血组 1)与对照组比较 ,VitC、VitE、SOD略降低 ,MDA略增高 ,但差异无显著性 (P >0 .0 5 ) ;脑梗死急性期组 (脑缺血组 2 )与对照组比较 ,MDA明显增高 ,VitC、VitE、SOD明显降低 ,并均与MDA呈负相关 (均P <0 .0 1) ;恢复期 4项测定值均恢复至接近对照组水平。结论 :缺血性脑血管病患者体内存在自由基代谢紊乱的特点 ,应及早补充外源性抗氧化剂VitC及VitE。     

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.