调节激活正常T细胞表达及分泌因子和单核细胞趋化蛋白-1在急性冠状动脉综合征中的作用及诊断价值

目的探讨单核细胞趋化蛋白-1(MCP-1)、调节激活正常T细胞表达及分泌因子(RANTES)在急性冠状动脉综合征(ACS)中的作用及诊断价值.方法对临床确诊的48例ACS患者及32名正常对照采用酶联免疫吸附试验(ELISA)检测血清MCP-1和RANTES的含量.结果 ACS患者组血清RANTES的含量[(37.97±24.89)ng/ml]明显高于正常对照组[(29.28±15.68)ng/ml,P＜0.05].ACS患者血清MCP-1含量为(175.28±144.82)pg/ml,正常对照组为(199.08±112.66)pg/ml,两组间差异无显著性(P＞0.05).结论 MCP-1及RANTES都不是理想的心肌损伤标志物.     

单核细胞趋化蛋白-1与急性冠状动脉综合征的相关性

目的通过研究急性冠脉综合征(ACS)患者单核细胞趋化蛋白-1(MCP-1)的变化,探讨其与冠脉病变的相关性。方法选取60例ACS患者,包括急性心肌梗死(AMI)患者28例,不稳定型心绞痛(UA)患者32例,心电图无缺血性改变并经冠状动脉造影排除冠心病的胸痛患者为对照组30例,采用酶联免疫法法测定MCP-1,所有ACS患者进行冠状动脉造影对冠脉血管进行损害程度评分,研究MCP-1与冠状动脉狭窄范围及程度的关系。结果①ACS组MCP-1组明显高于对照组[(152.27±34.24)pg/ml vs(113.45±21.98)pg/ml,P<0.01]。②ACS组内血清MCP-1水平在AMI组与UA组间差异无统计学意义[(153.46±18.67)pg/ml vs(150.16±22.45)pg/ml,P>0.05]③冠状动脉狭窄程度积分在ACS组内UA组与AMI组比较差异无统计学意义(P>0.05),两组内冠状动脉狭窄程度与外周血MCP-1水平均无相关性(P>0.05)。结论外周血MCP-1水平可以判断ACS的严重程度,但与冠状动脉的病变狭窄程度无明显关系。     

支气管哮喘患者治疗前后血清IL-2和IL-8水平的动态变化

目的探讨支气管哮喘患者血清白细胞介素-2(IL-2)和白细胞介素-8(IL-8)水平的动态变化和检测的临床意义.方法对30例患者经中药治疗前后及26名正常对照者,采用酶联免疫吸附试验(ELISA)检测血清中上述2种细胞因子的含量.结果血清IL-2水平在急性发作期患者为(9.2±3.2)ng/ml,明显低于正常对照组[(22.8±11.5)ng/ml,P<0.01],缓解期增至(19.9±5.4)ng/ml,与正常对照组差异无显著性(P>0.05);血清IL-8水平在急性发作期患者为(1 055±506) ng/ml,明显高于正常对照组[(196±72)ng/ml,P<0.01],缓解期降至(214±119)ng/ml,与正常对照组差异无显著性(P>0.05).结论动态测定IL-2、IL-8是判断支气管哮喘病情变化的有益指标.     

血清白介素-6 C反应蛋白水平和急性冠状动脉综合征的关系--附30例检测报告

目的研究急性冠状动脉综合征(acute coronary syndrome,ACS)患者血清白介素-6和C反应蛋白水平的变化,为ACS的早期预防及临床干预治疗提供参考.方法用酶联免疫吸附法测定30例ACS患者和18例稳定型心绞痛(stable angina pectoris,SAP)患者和26名正常人(对照组)的白介素-6、C反应蛋白水平,比较ACS组和SAP组入院时和住院3周后的白介素-6、C反应蛋白水平变化情况.结果ACS组入院时和住院3周后白介素-6[(254±70)ng/L,(239±67)ng/L]、C反应蛋白水平[(38±18)ng/L,(35±17)ng/L]分别与SAP组[(113±41)ng/L、(109±40)ng/L、(4.9±1.8)ng/L、(4.7±2.0)ng/L]、对照组[(93±39)ng/L、(3.7±1.5)ng/L]比较差异均有统计学意义,均为P＜0.01,ACS组入院时与住院治疗3周后的白介素-6、C反应蛋白水平比较差异均无统计学意义(均为P＞0.05).而SAP组入院时和住院3周后的白介素-6、C反应蛋白水平与对照组比较差异亦无统计学意义,均为P＞0.05.结论ACS患者血清白介素-6、C反应蛋白水平显著升高,提示炎症反应可能参与了ACS的发生、发展过程,白介素-6、C反应蛋白可作为监测ACS病情的临床生化指标.     

HTLV-Ⅰ相关性HAM/TSP患者血清及脑脊液IL-6的测定及其意义

【目的】探讨白细胞介素6(IL-6)在人嗜T淋巴细胞病毒Ⅰ型相关性脊髓病/热带痉挛性瘫痪(HAM/TSP)发病中的作用。【方法】应用免疫放射方法检测8例HAM/TSP患者血清及脑脊液中IL-6水平。【结果】HAM/TSP患者血清及脑脊液中IL-6含量分别为(194.76±30.01)pg/ml;(184.12±36.39)pg/ml,而其他神经系统疾病(OIND)组血清及脑脊液中IL-6含量分别为(132.61±21.76)pg/ml;(124.95±15.39)pg/ml,正常对照组(NC)组血清IL-6含量为(127.08±22.05)pg/mL。HAM/TSP患者血清及脑脊液IL-6水平均明显高于正常对照组(P<0.01);但HAM/TSP患者血清中IL-6含量与脑脊液中IL-6含量水平不呈线性相关。【结论】IL-6在HAM/TSP发病的免疫机制中可能起到重要作用。     

糖尿病患者血IL-1,IL-6,IFNγ测定及临床意义

目的 :探讨IL 1,IL 6 ,IFNγ与糖尿病的关系。方法 :用免疫放射法对 15例 1型糖尿病、6 3例 2型糖尿病患者及 2 0例正常人的血IL 1,IL 6及IFNγ进行测定。 6 3例 2型糖尿病中有 30例合并早期肾病及眼底病变。结果 :1型糖尿病组血IL 1高于正常组及 2型糖尿病组 [(31 14± 14 36 )pg/ml对 (2 1 37± 8 2 4)pg/ml及(2 3 15± 8 5 3)pg/ml,两者均P <0 0 5 ];血IL 6明显低于正常组及 2型糖尿病组 [(0 45± 0 2 1)ng/ml对 (0 95± 0 47)ng/ml及 (1 5 3± 0 0 7)ng/ml,P <0 0 5 ,P <0 0 1];1,2型糖尿病组血IFNγ均低于正常组 [(0 94± 0 6 5 )IU/ml及 (1 0 1± 0 6 1)IU/ml对 (1 6 4± 0 49)IU/ml,均P <0 0 1]。结论 :1型糖尿病胰岛 β细胞损伤与血IL 1,IL 6密切相关 ;1,2型糖尿病IFNγ水平均降低 ,其临床意义有待进一步探讨     

急性冠脉综合征患者血浆可溶性低密度脂蛋白受体相关蛋白1、调解活化正常T细胞表达和分泌趋化因子浓度的变化及意义

目的探讨急性冠脉综合征(acute coronary syndrome,ACS)患者血浆可溶性低密度脂蛋白受体相关蛋白1(soluble low-density lipoprotein receptor-related protein-1,sLRP-1)浓度、调解活化正常T细胞表达和分泌趋化因子(regulated upon activation normal T cell expressed and secreted,RANTES)浓度的变化及其与冠状动脉病变严重程度的相关性及其临床意义。方法连续选取2019年1月至2019年7月承德医学院附属医院心内科接受冠脉造影的250例住院患者进行前瞻性研究,包括ACS患者158例、稳定型心绞痛(stable angina pectoris,SAP)42例、对照组50例。其中ACS患者包括急性心肌梗死(acute myocardial infarction,AMI)组92例、不稳定型心绞痛(unstable angina pectoris,UAP)组66例,冠状动脉病变程度根据Gensini积分进行评估,对照组为同期行冠状动脉造影检查排除冠状动脉粥样硬化的患者。酶联免疫吸附测定(enzyme linked immunosorbent assay,ELISA)法测血浆sLRP-1、RANTES浓度。结果AMI组患者血浆lg sLRP-1和RANTES浓度[(0.69±0.20)mg/L与(125.17±34.87)ng/L]和UAP组[(0.62±0.19)mg/L与(118.51±21.46)ng/L]高于SAP组[(0.42±0.11)mg/L与(99.56±21.46)ng/L]和对照组[(0.27±0.08)mg/L与(98.39±19.37)ng/L](P均<0.05),而血浆lg sLRP-1和RNATES在AMI组与UAP组之间、SAP与对照组之间比较差异无统计学意义(P均>0.05)。ACS患者经PCI治疗后血浆lg sLRP-1和RANTES浓度较术前下降(P均<0.05);ACS患者血浆lg sLRP-1和RANTES浓度与Gensini积分无相关性(r值分别为0.12、0.22,P均>0.05)。结论ACS患者血浆sLRP-1和RANTES参与ACS的进展过程,并存在一定的相关性;心肌灌注治疗改善冠状动脉的炎症反应。     

急性冠状动脉综合征患者血浆五聚素3与脂蛋白相关磷脂酶A2水平及临床意义

目的探讨血浆五聚素3(PTX3)与脂蛋白相关磷脂酶A2(LP-PLA2)水平对急性冠状动脉综合征早期的预测价值以及冠状动脉支架置入术(PCI)前后其血浆水平的变化。方法选择冠状动脉造影检查明确无冠状动脉狭窄患者(对照组)20例,急性冠状动脉综合征(ACS)患者20例,稳定型心绞痛(SAP)患者20例。所有研究对象入院后即刻采集血液标本集中测定PTX3及LP-PLA2含量。ACS患者于PCI术后1个月复测上述指标血浆水平值。结果 (1)ACS组血浆PTX3水平[(3.58±0.43)ng/ml]显著高于SAP组[(1.95±0.24)ng/ml]及对照组[(1.54±0.21)ng/ml](P<0.001),同样ACS组LP-PLA2水平[(604.00±145.51)ng/ml]显著高于SAP组[(403.75±44.38)ng/ml]及对照组[(235.62±83.66)ng/ml](P<0.001);(2)PCI术后1个月患者血浆PTX3水平[(2.15±0.14)ng/ml]和LP-PLA2水平[(314.00±20.35)ng/ml]较术前显著降低(P<0.001)。结论血浆PTX3及LP-PLA2水平可作为ACS早期生物标记物;血浆PTX3及LP-PLA2水平可以反映冠状动脉病变斑块的稳定性。     

应用血清RANTES诊断严重脓毒症及预后判断的价值评价

目的检测严重脓毒症患者血清中受激活调节正常T细胞表达和分泌因子(RANTES)水平,并评价其对严重脓毒症的诊断和预后价值。方法选取严重脓毒症患者40例为严重脓毒症组(SS组),同期门诊体检者20例为对照组,收集临床及实验室参数,计算APACHEⅡ评分和DIC评分,采用酶联免疫吸附测定(ELISA)方法检测血清RANTES的水平。结果 SS组患者血清RANTES水平[(3 175.91±1 341.78)pg/ml]较对照组[(5 374.27±927.87)pg/ml]下降(P<0.05)。相关分析显示RANTES与WBC、PLT、AST、TBIL、Cr、PT、APTT、PCT、APACHEⅡ评分和DIC评分均呈显著负相关(P<0.05),显示RANTES诊断严重脓毒症的AUCSS=0.917,95%CI 0.817⁰.993(P<0.05),判断严重脓毒症死亡的AUCdeath=0.786,95%CI 0.6500.993(P<0.05),判断严重脓毒症死亡的AUCdeath=0.786,95%CI 0.650⁰.922(P<0.05)。结论严重脓毒症患者的血清RANTES水平明显降低,并死亡率升高,对严重脓毒症的诊断和预后判断有较好的价值。     

支气管哮喘患儿血清中ECP和IL-5的测定及其临床意义

目的探讨支气管哮喘患儿不同病期血清中嗜酸粒细胞阳离子蛋白(ECP)和白细胞介素-5(IL-5)浓度变化及其临床意义.方法用荧光酶联免疫法测定40例哮喘发作组、25例缓解组和15名正常对照组儿童血清ECP,用酶联免疫吸附试验(ELISA)测定IL-5水平.结果哮喘发作组血清ECP浓度[(10.21±1.9)μg/L]与正常对照组[(1.94±0.5)μg/L]比较差异有显著性(P<0.01),而缓解组[(2.23±0.45)μg/L]与正常对照组比较差异无显著性(P>0.05).哮喘发作组、缓解组血清中IL-5水平分别[(90.02±2.4)ng/L、(25.96±1.7)ng/L]与正常对照组[(9.94±1.2)ng/L]比较差异有显著性(P<0.01).结论 ECP和IL-5是参与哮喘发作过程的重要炎症介质,是判断哮喘变应性炎症的重要参考指标.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.