对比液态氟碳脂质纳米粒与全氟丙烷脂质微泡体外显影及耐声压性

目的 与全氟丙烷（C₃F₈）脂质微泡造影剂比较,分析自制液态氟碳（PFOB）脂质纳米粒体外显影及耐声压性的优劣。方法 分别制备生物素化PFOB脂质纳米粒及生物素化C₃F₈脂质微泡,评估其稳定性,并观察其加入亲和素前后的体外显影效果。对2种造影剂在低声压（MI=0.28）及高声压（MI=0.56）环境下进行超声辐照,于辐照前及辐照10、20、30 s后观察显影情况及其差异。结果 2种造影剂加入亲和素后均发生聚集现象,粒径均较加入亲和素前明显增大（P均<0.05）;且加入亲和素前（t=16.225,P<0.001）、后2种造影剂间粒径差异均有统计学意义（t=-5.046,P<0.001）。稳定性观察期间PFOB脂质微粒内浓度无明显改变,而C₃F₈脂质微泡随放置时间延长浓度呈减低趋势。加入亲和素后,PFOB脂质纳米粒回声明显增强;C₃F₈脂质微泡加入亲和素前后显影效果均较好。低声压（MI=0.28）及高声压（MI=0.56）环境下,PFOB脂质纳米粒造影剂显影强度无明显改变,而C₃F₈脂质微泡显影强度随辐照时间延长呈减低趋势。结论 相较于C₃F₈脂质微泡,PFOB纳米脂质纳米粒造影剂粒径小、耐声压性好,更符合靶向超声造影剂的要求。     

载10-羟基喜树碱液态氟碳纳米粒制备及其表征、体外增强超声显像效果观察

目的 研制一种包裹液态氟碳（PFP）的新型载药纳米级超声造影剂,考察其基本特性并观察其体外增强超声显像效果。方法 采用旋转蒸发和探头超声法制备载10-羟基喜树碱（10-HCPT）的液态氟碳（PFP）纳米粒,在光学显微镜和透射电镜下观察纳米粒形态,采用马尔文仪测量纳米粒粒径和电荷。采用紫外分光光度计测定纳米粒包封率,并应用低强度聚焦超声（LIFU）辐照载药液态氟碳纳米粒溶液,观察纳米粒相变情况及其增强超声显像效果。结果 制备的载药脂质纳米粒外观为乳白色混悬液,在油镜及透射电镜下观察,载药纳米粒形态规则,分布均一,平均粒径约（500.82±25.97）nm,表面平均电位为（-47.77±3.09）mV;在体外经LIFU辐照后,可见纳米粒发生液气相变形成微泡,在基波模式和谐波模式下,均可显著增强超声显影。结论 成功研制了包裹液态氟碳的载药脂质纳米粒,可望成为一种新型的多功能超声造影剂。     

心肌特异性导向肽靶向诊疗造影剂增强心肌分子显影及其在大鼠体内的分布

目的 制备心肌特异性靶向肽（PCM）修饰的载药纳米诊疗探针,探讨其心肌靶向显影能力及其在大鼠体内的分布情况。方法 采用双乳化法及碳二亚胺法制备PCM靶向载卡维地洛纳米诊疗探针（PCM/C-PFPs）,检测其基本性质、大鼠体内显影及体内分布情况。结果 PCM/C-PFPs纳米探针呈球形,平均粒径为（415.00±6.24） nm,电位为（-20.27±1.55） mV;包封率为（78.23±3.45）%;C-PFPs与多肽PCM连接率为（98.98±1.02）%。加热至约60℃时,该探针发生明显相变,并产生大量微气泡。声诺维组和PCM/C-PFPs+低频聚焦超声（LIFU）组大鼠心脏超声显影效果明显,但声诺维组显影仅维持数分钟,而PCM/C-PFPs+LIFU组心脏超声信号可持续至1 h,且心脏显影的声强度高于其他各组（P均<0.05）。PCM/C-PFPs+LIFU组大鼠心脏切片中可见大量聚集的红色探针,明显多于C-PFPs+LIFU组和单纯PCM/C-PFPs组,且多于该组其他组织（肝、肾、肺、脾）。结论 本研究成功制备的心肌靶向诊疗造影剂,具有良好的靶向心脏超声显影和大鼠体内分布特性。     

一种产气超声/光声双模态纳米粒的制备及性质检测

目的 研制一种包碳酸氢铵溶液的脂质纳米粒,并观察其超声/光声成像效果。方法 采用薄膜水化法加挤出法制备脂质包裹碳酸氢铵溶液的纳米粒,光镜、电镜、激光粒径仪和电位检测仪检测纳米粒一般物理特性,并通过光声成像仪观察其超声/光声成像效果。结果 制备的纳米粒呈圆球形,形态规则,大小分布均匀,无明显聚集,平均粒径为(230.90±54.58)nm,电位为(-22.81±5.75)mV。碳酸氢铵纳米粒有超声/光声信号,双蒸水纳米粒无超声/光声信号。结论 成功制备包碳酸氢铵溶液脂质纳米粒,可用于超声及光声成像,为进一步体外、体内成像实验奠定了基础。     

载黑色素脂质纳泡的制备及体外多模态显像实验研究

目的 制备一种包载黑色素的多模态脂质纳泡（MNBs）造影剂,观察其体外超声、光声、MR显影效果。方法 采用三氯甲烷注入—冷冻干燥—全氟丙烷充气法制备MNBs和普通脂质纳泡（NBs）,检测MNBs的一般特性（形态、粒径、黑色素装载量、稳定性）,对不同浓度MNBs进行体外超声、光声、MR成像并进行定量对比分析。结果 MNBs形态规则,粒径分布均匀,透射电镜显示MNBs成功包裹黑色素颗粒。黑色素的载药量为90.53 μg/mg。体外显影实验示随MNBs和NBs浓度的增加,超声造影效果明显增强,MNBs和NBs的超声造影表现无明显差异,相对信号强度差异无统计学意义（P > 0.05）;随MNBs浓度的增加,光声和MRI显影效果增强,NBs无光声和MRI显影效果。结论 成功制备出一种包载黑色素的多模态脂质纳泡造影剂,可明显增强超声、光声、MR显影效果。     

超声微泡连接特异性抗体的制备方法及靶向化处理因素对超声微泡物理性质的影响

目的 探讨超声微泡连接特异性抗体的制备方法及靶向化处理因素对超声微泡物理性质的影响.方法 应用生物素-链霉亲和素连接系统,使注射用六氟化硫微泡(SonoVue)与特异性抗血管细胞黏附分子-1(VCAM-1)抗体相连接,用间接免疫荧光法检测抗体与微泡的连接,用马尔文激光粒径分析仪分别测定生物素化处理前后微泡的粒径,采用超声诊断仪评价微泡靶向化构建前后的显像效果.结果 SonoVue与特异性抗体成功连接,间接免疫荧光检测呈阳性.生物素修饰后的微泡粒径分布变窄,与普通微泡的超声显像效果略有差异.结论 通过生物素-链霉亲和素系统可以成功靶向化构建超声微泡,靶向化处理因素对微泡的粒径有一定影响,对微泡的超声显影效果略有影响.     

Integrin αvβ3靶向超声微泡的制备及体外寻靶实验

目的 制备Integrin α_vβ₃靶向超声微泡,对其一般理化性质及体外寻靶能力进行检测。方法 采用巯基-马来酰亚胺连接法制备携FITC标记iRGD肽的Integrin α_vβ₃靶向微泡(MB_{Integrin αvβ3}),并制备空白微泡(MB_control)。检测两组微泡的一般理化性质,在荧光显微镜下观察两组微泡荧光显像,流式细胞仪检测两组微泡FITC荧光含量。于光学显微镜及荧光显微镜下观察两组微泡与小鼠脑微血管内皮细胞(bEnd.3)的黏附情况。结果 ①MB_{Integrin αvβ3}粒径为(0.84±0.26)μm,与MB_control粒径(0.79±0.19)μm差异无统计学意义(P>0.05);②荧光显微镜下观察,MB_control组微泡无荧光显示,MB_{Integrin αvβ3}组微泡表面显示绿色荧光;③流式细胞仪测得MB_{Integrin αvβ3}组微泡FITC荧光含量为98.4%,MB_control组微泡FITC荧光含量为2.5%;④体外寻靶实验显示,MB_{Integrin αvβ3}组微泡能聚集结合于bEnd.3细胞表面。结论 成功制备了携iRGD肽的Integrin α_vβ₃靶向微泡,其具有良好的体外寻靶能力。     

自制高分子微泡超声造影机械指数与频率和峰值强度的相关性

目的 探讨兔体内自制高分子微泡CEUS机械指数和频率与峰值强度的相关性。方法 采用单乳化法制备包裹全氟戊烷的嵌段共聚物微泡造影剂,固定其他超声扫描条件,对6只新西兰大白兔于机械指数0.04、0.09、0.17、0.34和超声频率3.5、5.0、6.5、8.0 MHz下进行肾脏CEUS,分析机械指数和频率与峰值强度的相关性;静脉注射10倍造影剂量微泡,观察毒性反应。结果 自制微泡平均粒径为（3.92±1.43）μm。兔体内峰值强度与机械指数呈正相关（r=0.99,P<0.05）,与超声频率呈负相关（r=-0.93,P<0.05）;静脉注射大剂量微泡后,未见明显毒性反应。结论 采用自制高分子微泡作为造影剂对兔进行CEUS时,峰值强度与机械指数呈正相关,与超声频率呈负相关;微泡安全性良好。     

超声介导正己酰羧甲基壳聚糖载药纳米液滴对卵巢癌细胞的抑制作用

目的 评价采用正己酰羧甲基壳聚糖制备相变型载阿霉素（DOX）纳米液滴的体外超声显像效果及抑制卵巢癌细胞生长的作用。方法 将羧甲基壳聚糖与正己酸酐发生酰化反应合成正己酰羧甲基壳聚糖,采用声振乳化法制备正己酰羧甲基壳聚糖载药纳米液滴,表征其表面形态、粒径、电位;评价其体外超声显像效果,以紫外分光光度计测定药物包封率,采用CCK-8法检测卵巢癌细胞存活率,并进行统计学分析。结果 成功制备正己酰羧甲基壳聚糖载药纳米液滴,镜下为大小均匀的球状物,平均粒径为（458.33±43.50）nm,包封率为（52.06±10.14）%。纳米液滴可增强超声显影效果。超声联合载药纳米液滴组的卵巢癌细胞存活率[（62.54±3.60）%]低于DOX组[（75.55±7.21）%]、载药纳米液滴组[（76.18±4.94）%]和超声组[（89.90±0.83）%],差异有统计学意义（P均<0.05）。结论 超声联合正己酰羧甲基壳聚糖载药纳米液滴可有效抑制卵巢癌细胞生长,在临床诊疗中具有潜在应用价值。     

超声激励荧光微泡对兔乳腺癌转移淋巴结的释放作用

目的 观察超声激励荧光微泡空化对兔乳腺癌转移淋巴结的荧光释放作用。 方法 使用二甲基亚砜(DMSO)溶解绿色细胞膜荧光分子探针(DiO),抽取少量溶解液与脂质微泡混和,通过高速机械振荡制成荧光微泡。选取16只荷VX2乳腺癌的新西兰大白兔随机分成荧光微泡联合超声空化组和单纯荧光微泡组。荧光微泡联合超声空化组经瘤周皮下注射1 ml荧光微泡并按摩,待瘤周引流淋巴结超声显影后,采用脉冲式治疗超声间歇辐照淋巴结5次,共30 min;单纯荧光微泡组同样经瘤周皮下注射荧光微泡并按摩,但给予治疗超声假照。剖取淋巴结标本行冰冻组织切片,于激光共聚焦显微镜下观察淋巴结内的荧光分布情况,并定量分析荧光面积、累积光密度(IOD)及平均光密度(AOD)。 结果 荧光微泡联合超声空化组淋巴结的荧光面积、IOD和AOD均高于单纯荧光微泡组(P均<0.05)。 结论 荧光脂质微泡经瘤周注射不仅可进入兔乳腺癌模型的淋巴管使淋巴结显影,且可在治疗超声的激励作用下实现荧光物质在局部淋巴结高浓度释放。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.