慢性重型肝炎相关检测指标改变与预后的分析

目的总结凝血酶原活动度（PTA）、凝血酶原时间的国际标准化比值（INR）、白蛋白（ALB）、总胆红素（TB）、丙氨酸氨基转移酶（ALT）、胆碱酯酶（CHE）、总胆固醇（TC）、总胆汁酸（TBA）、血清谷草转氨酶与血清谷丙转氨酶的比值（AST/ALT）与慢性重型肝炎（CSH）预后的关系。方法选择2007年1月2010年3月收治的56例CSH患者,依据病情转归,分为存活组（35例）和死亡组（21例）。比较两组PTA、INR、ALB、Tb、ALT、CHE、TCH、TBA、AST/ALT。结果死亡组PTA、INR、CHE、TC较存活组降低（P值均〈0.05）,TB、TBA、AST/ALT较存活组升高（P值均〈0.05）,ALT、ALB较存活组差异无统计学意义（P〉0.05）。结论 PTA、INR、CHE、TC、TB、TBA、AST/ALT水平可作为CSH预后的判定指标,ALT、ALB与CSH预后无明显关联。     

深圳市学龄前期健康儿童干式化学血清胆红素参考区间调查

目的 调查深圳市学龄前期(3～6岁)健康儿童干式化学血清总胆红素(TBIL)、未结合胆红素(BU)、结合胆红素(BC)、δ-胆红素(Bδ)的参考区间.方法 通过随机抽样调查学龄前期体检儿童,筛选出839例健康儿童抽取静脉血,用VITROS 350干式化学分析仪进行血清胆红素项目检测并分析结果.结果 该地区学龄前期健康儿童不同性别和年龄组间血清TBIL、BU、BC、Bδ结果无显著性差异,建立的TBIL、BU、BC、Bδ参考区间分别为8～18 μmol/L、5～17 μmol/L、0～4 μmol/L、0～2 μmol/L.结论 建立起深圳市学龄前期健康儿童干式化学胆红素参考区间,为其他实验室转移和建立健康儿童干式化学胆红素参考区间提供实验依据.     

结合胆红素和非结合胆红素的直接测定在高胆红素血症中的应用

目的评价结合胆红素（CBil）和非结合胆红素（UBil）的直接测定在胆汁瘀积性黄疸（CJ）、肝细胞性黄疸（HJ）和新生儿溶血性黄疽（NHJ）中的价值以及δ胆红素／总胆红素（δBil／TBil）比值对CJ患者手术疗效判断的意义。方法用Vitros 250型干式生化仪及配套干片测定18例CJ患者和20例HJ患者血浆TBil、CBil和UBil，计算δBil；13例CJ患者在行胆总管切开引流术后3d、5d、7d复测。同法测定22例NHJ患儿血浆CBil和UBil，计算新生儿总胆红素（NBil）。结果CJ组CBil／TBil比值与HJ组比较差异有统计学意义（P=0．000），而UBil／TBil比值、δBil和δBil／TBil比值2组间差异均无统计学意义（P=0．241、0．067、0．090）。6例经胆总管切开引流术治疗后排泄良好的CJ患者的TBil、CBil和UBil在术后第3d起逐渐下降，δBil缓慢下降，δBil／TBil比值由术前的0．16～0．44升至0．52～0．78。7例治疗后排泄不良的CJ患者其TBil、CBil和UBil在术后5d～7d缓慢减低，δBil变化甚微，δBil／TBil在0．20～0．46范围内波动。NHJ患儿血浆NBil、UBil及UBil／NBil比值均明显增高。结论CBil和UBil的直接测定及δBil／TBil比值对CJ、HJ和NHJ的诊断和／或鉴别诊断以及CJ患者手术疗效的判断均有很好的应用价值。     

良性梗阻性黄疸患者减黄术后δ胆红素测定的意义

目的 :通过对 42例良性梗阻性黄疸病人围减黄手术期血清总胆红素 (TBil)、直接胆红素 (DBil)、结合胆红素 (Bc)、非结合胆红素 (Bu)、δ胆红素 (δ Bil)的测定 ,了解其变化规律 ,确定其临床意义。方法 :分别于手术前 1d ,手术后 1、3、7、10、14、18、2 1d采集血标本 ,使用美国干式生化分析仪测定其中TBil、DBil、Bc、Bu和δ Bil的含量。结果 :减黄效果良好组在减黄术后TBil、Bc、Bu迅速下降 ,δ Bil/TBil不断升高 ,7d后绝大多数病例 >0 6;减黄效果不良组中不少病例在术后TBil不但不消退 ,反而有一定的升高 ,原因不明 ,之后缓慢减低 ,在减黄过程中无明显消退阶段 ,Bc、Bu下降缓慢 ,δ Bil/TBil始终 <0 6。结论 :δ -Bil/TBil是预测减黄效果的最佳指标。     

Vitros 250干生化分析仪总胆红素测定的结果及其临床意义

目的对干生化分析仪测定胆红素时出现总胆红素(TBIL)与游离胆红素(Bu)+结合胆红素(Bc)之和不相符的现象进行分析,探讨如何正确认识Vitros 250干生化分析仪的TBIL测定结果及其临床意义。方法收集住院患者血清标本230例,在Vitros 250干生化分析仪上进行TBIL、Bc和Bu的测定(TBIL=Bu+Bc+δ-胆红素),分析不同TBIL浓度范围下TBIL与Bu+Bc之间的关系。结果 TBILBu+Bc现象在TBIL≤30μmol/L时出现的比率分别为76.7%(115/150)和0.0%(0/150),在TBIL>30μmol/L时出现的比率分别为10.0%(8/80)和83.8%(67/80)。结论 Vitros 250干生化分析仪测定胆红素存在普遍的TBIL与Bu+Bc不相符现象,在TBIL浓度正常或略偏高时(≤30 mol/L)主要表现为TBIL30μmol/L)因δ-胆红素的出现而主要表现为TBIL>Bu+Bc,对此应以实测结果报告TBIL并报告检出δ-胆红素。     

各型胆红素检测在肾综合征出血热诊治中的意义

目的 探讨肾综合征出血热患者各病期各型胆红素的动态变化规律及临床意义。方法 使用美国EKTACHE 750XRC Analyzer生化分析仪对肾综合征出血热患者各病期丙氨酸氨基转移酶(ALT)、总胆红素（TBil)、直接胆红素(DBil)、非结合胆红素(Bu)、结合胆红素(Bc)、δ胆红素(δ—Bil)进行测定。结果 与对照组相比，发热期除δ—Bil外．其他指标均相差显著，少尿期ALT、TBil、BM、Bc、DBil变化最大，多尿期患者血清δ—Bil含量最高，恢复期Bu、Bc趋于正常，而ALT和TBil相差显著，δ—Bil和DBil相差极为显著。Bc/Bil全病程呈逐渐下降趋势，Bc／TBil开始逐渐上升在少尿期达到高峰，之后逐渐下降，而δ—Bil/TBil和DBil/TBil在全病程始终呈逐渐上升趋势。结论 对肾综合征出血热患者各病期各型胆红素的动态监测有助于肾综合征出血热的诊断、分期及预后判断。     

婴幼儿肝炎δ胆红素变化与疾病转归的关系

目的:探讨不同类型的婴幼儿肝炎病程中δ胆红素（Bδ）的变化规律与肝炎病情转归的关系。方法:在疾病的不同时期,多次测定不同类型的婴幼儿肝炎病人血清中δ胆红素及其他胆红素组份,分析不同类型的婴幼儿肝炎病人δ胆红素的变化规律与肝炎病情转归的关系。结果:68例肝炎病人共测定胆红素组份187次,Bδ平均值=27.94μmol/L（0～307.6）,Bδ/TBIL平均值=36.7％（0.0～98.33％）;不同类型的肝炎病人血清δ胆红素的结果差异无显著意义,Bδ/TBIL各组间差异有显著意义,巨细胞肝炎组高于婴儿肝炎综合征组;不同类型的肝炎病程中Bδ/TBIL随病情变化有2种类型,愈后各不相同,各种肝炎出现2种变化的机率与肝炎类型无关。结论:不同类型的肝炎δ胆红素的结果无差异,出现第一种变化类型的婴幼儿肝炎愈后最好,第二种变化类型病情出现迁延,病程相对较长,当Bδ/TBIL升高到（45.10±4.78）％,TBIL下降到（44.86±5.18）μmol/L时,Bδ/TBIL曲线会与TBIL曲线出现交叉点,愈后较好。若Bδ/TBIL一直在较低水平排徊,无法升到（45.10±4.78）％时,两曲线不会出现交叉点,愈后较差。     

δ-胆红素ADA,ALP与γ-GT在梗阻性黄疸诊断中的作用

目的 探讨δ-胆红素,ADA,γ-GT和ALP在肝细胞性黄疸和阻塞性黄疸鉴别诊断中的价值.方法 对大庆市第二医院88例健康人群、67例急性黄疸型肝炎和29例阻塞性黄疸病人的血清进行了δ-胆红素,ADA,γ-GT,ALP和ALT酶活性平行检测,用SPSS10.0系统对数据进行统计分析.结果 δ-胆红素和γ-GT结果在肝细胞性黄疸、梗阻性黄疸组中差异均有统计学显著性意义(P＜0.05),且其阳性率均为100%.而ADA在急性黄疸型肝炎组中虽只有88%阳性率,但其在梗阻性黄疸组中有非常低的阳性率,在两病例组中差异有统计学非常显著性意义(P＜0.05).结论 δ-胆红素,ADA,γ-GT和ALP的联合检测是诊断梗阻性黄疸的良好指标,若4项指标均增高,则为肝细胞性黄疸;δ-胆红素,γ-GT和ALP显著增高,而ADA正常则为梗阻性黄疸.     

血清GGT及GGT与CHE、ALT比值的实验室诊断价值探讨

目的 观察谷氨酰胺转肽酶(GGT)、谷氨酰胺转肽酶与胆碱脂酶比值(GGT/CHE)及谷氨酰胺转肽酶与丙酸转移酶比值(GGT/ALT)实验室的诊断价值。方法本文用速率法测定110例肝胆疾病患者及50例健康人血清GGT、CHE、ALT的酶活力,同时计算出GGT/CHE,GGT/ALT比值。结果肝癌及肝转移癌患者GGT、GGT/CHE、GGT/ALT较对照组及非癌症组差异有显著意义(P<0.01)。肝硬化及重症肝病组较正常对照组亦差异有显著意义(P<0.05),急性性肝炎,胆石症者与对照组比对,其GGT/CHE、GGT/ALT差异无显著意义(P>0.05)。结论GGT、GGT/CHE、GGT/ALT三值的实验室结果对鉴别肝癌及肝胆良性疾病具有一定参考价值。     

总胆红素与白蛋白比值对新生儿胆红素脑病的早期诊断价值

目的 探究总胆红素与白蛋白比值(B/A比值)对新生儿胆红素脑病的早期诊断价值.方法 将云南省第三人民医院2019年1月至2019年12月收治的21例胆红素脑病患儿设为观察组,同时期未发生胆红素脑病的89例高胆红素血症患儿设为对照组.比较两组患儿的总胆红素(TBIL)、间接胆红素(IBIL)、白蛋白(ALB)水平及B/A...     

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.     

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.