复方甘草酸苷治疗婴儿肝炎综合征疗效观察

目的观察复方甘草酸苷治疗婴儿肝炎综合征的疗效及不良反应。方法 86例婴儿肝炎综合征患儿随机分为治疗组与对照组,均常规给予保肝治疗,退黄、补充维生素处理,治疗组在此基础上给予静脉滴注复方甘草酸苷注射液,剂量为3m l/kg,1天1次,连用14天。比较其疗效。结果治疗后治疗组的肝功能指标明显好于对照组(P<0.01);治疗组与对照组的住院时间分别为17.4±3.1天、19.7±3.5天(P<0.01),治愈率分别为79.4%、58.8%(P<0.05);治疗组患儿血钾浓度在治疗前后分别为4.0±0.3mmol/L、4.0±0.2mmol/L(P>0.05),血钠浓度分别为141.4±4.1mmol/L、142.3±4.0mmol/L(P>0.05)。结论复方甘草酸苷治疗婴儿肝炎综合征疗效好,且无不良反应,为一较理想药物。     

熊去氧胆酸治疗乙型肝炎病毒感染相关婴儿肝炎综合征疗效观察

目的探讨熊去氧胆酸(UDCA)在乙型肝炎病毒感染相关婴儿肝炎综合征中的疗效。方法将35例乙肝感染相关婴儿肝炎综合征患儿随机分为治疗组(20例)和对照组(15例)。对照组予以常规治疗。治疗组在此基础上分别加用UDCA,观察和记录临床体征、肝功能恢复情况。结果 UDCA治疗组的临床疗效和肝功能均优于对照组,统计学分析有显著差异(P<0.05)。结论 UDCA对乙肝感染相关婴儿肝炎综合征患儿有改善临床症状、缩短病程,提高治愈率的作用。     

TLR4、SAA水平在新生儿败血症中的变化及与心肌、肝功能受损的关系

目的探讨败血症患儿血清中Toll样受体4(TLR4)、淀粉酶A蛋白(SAA)的变化特点及与患儿心肌、肝功能受损的关系。方法选取我院2016年6月-2017年12月确诊的败血症新生儿90例(病例组)、90例健康新生儿(对照组),检测两组的血清TLR4mRNA、SAA水平,并分析二者与肝功能指标、心肌损伤指标的关系。结果病例组患儿的血清SAA、TLR4mRNA水平显著的高于对照组(P0.05);病例组患儿的血清ALT、AST、TBIL、GGT水平显著的高于对照组(P0.05);病例组患儿的血清cTnI、c TnT、CK-MB、H-FABP水平显著的高于对照组(P0.05);病例组患儿的血清SAA、TLR4mRNA与血清ALT、AST、TBIL、GGT呈显著的正相关关系(P0.05);病例组患儿的血清SAA与血清ALT、AST、TBIL、GGT呈显著的正相关关系(P0.05),TLR4mRNA水平ALT、AST、TBIL、GGT的相关性无统计学意义(P0.05)。结论 TLR4mRNA、SAA水平在新生儿败血症血清中升高显著,可能与患儿肝功能损害、心肌受损具有一定的相关性。     

B细胞活化因子与小儿自身免疫性脑炎严重程度的相关性分析

目的 分析B细胞活化因子(BAFF)与小儿自身免疫性脑炎严重程度的相关性,为临床诊治小儿自身免疫性脑炎提供思路。方法 该研究采用病例-对照的研究方法,将该院2020年1月至2022年6月收治的45例自身免疫性脑炎患儿作为病例组,另将该院同期收治的45例病毒性脑炎患儿作为对照组;查阅两组患儿电子病历档案,收集性别、年龄、临床特征、脑脊液BAFF、血清BAFF等临床资料;应用改良Rankin量表(mRS)评估自身免疫性脑炎患儿的病情严重程度,比较轻度组、中重度组患儿实验室资料及影像学资料,分析BAFF与小儿自身免疫性脑炎严重程度的关系。结果 病例组临床特征为精神行为异常、认知障碍、癫痫发作、语言障碍、意识障碍占比高于对照组,临床特征为发热、恶心占比低于对照组,差异有统计学意义(P<0.05);病例组脑脊液BAFF及血清BAFF水平低于对照组,差异有统计学意义(P<0.05);病例组与对照组其他资料对比,差异无统计学意义(P>0.05);45例自身免疫性脑炎患儿经评估,病情程度为轻度28例,中重度17例;轻度组白细胞计数、中性粒细胞计数、mRS评分低于中重度组,白蛋白、脑脊...     

幽门螺杆菌对乙肝后肝硬化患者血氨的影响

目的:探讨乙肝后肝硬化患者幽门螺杆菌(Helicobacterpylori,Hp)感染与血氨的关系。方法:选择160例Hp阳性的乙型肝炎后肝硬化患者为阳性组,48例Hp阴性的乙型肝炎后肝硬化患者为阴性组,83例Hp阴性的健康检查者为对照组。分别检测各组的空腹血氨。阳性组病例治疗1周,停药4周后复查Hp,根除Hp后复查血氨。根据肝功能Child分级进行分组,比较各组血氨水平。结果:阳性组血氨浓度显著高于阴性组(P<0.01);阴性组血氨浓度亦显著高于对照组(P<0.01);Hp根除后血氨浓度显著下降(P<0.01);阳性组中不同肝功能分级组血氨浓度之间有显著差异(P<0.05),而阴性组中不同肝功能分级组血氨浓度之间无显著差异(P>0.05)。结论:Hp感染与乙肝后肝硬化的血氨浓度升高密切相关,易并发肝性脑病,根除Hp可使血氨水平显著降低,有利于防治肝性脑病。     

阻塞性睡眠呼吸暂停低通气综合征患儿肺功能的变化观察

目的:观察与探究阻塞性睡眠呼吸暂停低通气综合征患儿肺功能的变化情况。方法:选取2015年9月至2018年11月曲靖市第一人民医院收治的阻塞性睡眠呼吸暂停低通气综合征患儿68例为观察组,同时期的健康儿童68名为对照组。比较2组的肺功能指标,比较观察组中不同严重程度者的肺功能指标。结果:观察组的肺功能指标均差于对照组,观察组中重度患儿的肺功能指标均低于轻度及中度患儿,中度患儿的检测结果则低于轻度患儿,差异有统计学意义(P 0. 05)。结论:阻塞性睡眠呼吸暂停低通气综合征患儿肺功能相对较差,且不同严重程度患者的差异明显,因此应注意对予阻塞性睡眠呼吸暂停低通气综合征患儿进行肺功能的监测与调控。     

总胆汁酸测定对婴幼儿肝炎综合征诊断价值的探讨

目的 探讨血清总胆汁酸(TBA)在婴幼儿肝炎综合征中的诊断价值.方法 采用全自动酶循环法分析技术对52例婴幼儿肝炎综合征及60例健康对照组的婴幼儿进行空腹血清TBA及其他肝功能6项指标测定.结果 健康对照组血清TBA值频数呈正偏态分布,经对数转换后,正态性D检验呈对数正态分布,参考值范围:0～11.6 μmol/L.患儿组血清TBA值范围:1.1～239.6 μmol/L,异常率达90.4%,与健康对照组比较,差异有统计学意义(P＜0.05);患儿组TBA与血清碱性磷酸酶、直接胆红素、γ-谷氨酰转移酶水平有良好的相关性,且TBA的灵敏度和特异性均优于常规指标.结论 血清TBA测定对婴幼儿肝炎综合征的诊断、疗效观察及预后判断均有重要意义.     

肝硬化患者鸟氨酸循环能力的研究

目的分析肝硬化患者血清氨甲酰磷酸合成酶I（CPS-I）、鸟氨酸氨基甲酰转移酶（OCT）水平,探讨肝硬化患者鸟氨酸循环能力。方法肝硬化组为我院2008年1月-2009年12月120例肝硬化患者,正常对照组为2009年3月我院体检健康者60例。收集研究对象的血清和血浆,测定血清CPS-I、OCT、肝功能指标（TB、DB、ALT、AST、GGT、TP、Alb）和血氨。分析肝硬化组和正常对照组CPS-I和OCT水平;分析肝硬化组CPS-I、OCT与肝功能指标、血氨的相关性;分析单纯性肝硬化组CPS-I、OCT与血氨的相关性。结果肝功能和血氨指标显示：肝硬化组血氨、TB、DB、ALT、AST、ALP、GGT高于正常对照组（P〈0.05）,TP、Alb低于正常对照组（P〈0.05）。肝硬化组血清CPS-I、OCT水平分别为174.6（125.2,206.4）IU/L和365.0（235.9,426.4）×10 IU/L,低于正常对照组（199.4（179.3,320.8）IU/L和408.8（344.0,611.9）×10 IU/L）（P〈0.05）。肝硬化组CPS-I与OCT相关性好,相关系数r=0.946（P〈0.05）;CPS-I、OCT与ALT、AST呈负相关（P〈0.05）。单纯性肝硬化组CPS-I和OCT与血氨呈负相关（P〈0.05）。结论肝硬化患者血清CPS-I、OCT水平降低,表明其鸟氨酸循环能力降低,氨转化不足导致血氨升高。     

5’-NT和γ—GT在婴儿肝炎综合征与胆道闭锁鉴别诊断中的价值

目的观察血清5’-核苷酸酶（5’-NT）、γ-谷氨酰转肽酶（γ-GT）活性的变化在淤胆型婴儿肝炎综合征与胆道闭锁鉴别诊断中的价值。方法采用法国梅里埃公司5’-NT诊断试剂盒,同时采用全自动生化分析仪测定60例阻塞性黄疸（28例胆道闲锁和32侧婴儿肝炎）患儿及20侧正常对照组婴儿血清5’-NT,γ-GT,血清总胆红素（TBILT）,直接胆红素（DBILT）水平。结果在28例胆道闭锁和32例婴儿肝炎病例中,5’-NT和γ-GT均数较20例正常对照组升高（P〈0．05）,5’-NT和γ-GT均数在胆道闭锁组明显高于淤胆型婴儿肝炎综合征组（P〈0．05）,在胆道闭锁病例中,5’-NT与γ-GT、TBILT和DBILT呈正相关（P〈0．05）。结论血清5’-NT及γ-GT的测定有助于淤胆型婴儿肝炎综合征和胆道闭锁的鉴别诊断。     

熊去氧胆酸对减轻婴儿肝炎综合征全身炎症反应的效果分析

探讨熊去氧胆酸治疗婴儿肝炎综合征的临床疗效,并分析其对机体炎症反应效果。选择我院小婴儿科收治婴儿肝炎综合征168例,根据治疗方式不同分为常规组(82例)与试验组(86例),两组患儿均进行常规护肝抗炎治疗,试验组在常规治疗基础上加用熊去氧胆酸,治疗3w后比较两组治疗前后的炎症因子,包括血清肿瘤坏死因子(TNF-ɑ)和白细胞介素-6(IL-6),并比较两组肝功能变化,检测指标有总胆红素(TBIL)、谷丙转氨酶(ALT)、谷氨酰转氨酶(GGT)以及总胆汁酸(TBA)。经治疗,常规组炎症因子TNF-ɑ及IL-6依次是(285.84±34.65)ng/L、(38.62±3.15)ng/L,试验组(204.58±46.62)ng/L、(28.36±3.47)ng/L,较治疗前均显著下降,且试验组下降幅度显著高于常规组(P0.05);肝功能指标比较,两组TBIL、DBIL、GGT及TBA较治疗前均显著下降,且试验组下降幅度明显高于常规组(P0.05);两组患儿均未出现较为严重的不良反应,仅常规组出现1例病情反复需手术治疗者。在保肝治疗基础上加用熊去氧胆酸治疗婴儿肝炎综合征,可有效减少机体炎性反应,促进肝功能恢复,增强临床疗效,无明显不良反应,安全性较高,临床可予以考虑。     

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.     

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.