子宫腺肌症和子宫肌瘤患者血清CA125测定的临床意义

目的探讨血清CA125测定在子宫腺肌症中的意义及在子宫腺肌症与子宫肌瘤鉴别诊断中的价值。方法用化学发光免疫分析法检测112例子宫腺肌症、166例子宫肌瘤患者及200例健康对照者血清CA125的水平。其中60例子宫腺肌症患者治疗后复检。结果子宫腺肌症组CA125值（82．3±70．5）IU／ml,阳性率为75．0％;子宫肌瘤组CA125值（33．2±21．3）IU／ml,阳性率为10．2％;健康对照组CA125值（25．1±17．6）IU／ml,阳性率为8．0％。子宫腺肌症组的CA125均值及阳性率较子宫肌瘤组和健康对照组为显著增高,差异有统计学意义（P〈0．01）;子宫肌瘤组患者血清CA125水平与健康对照组差异无统计学意义（P〉0．05）;子宫腺肌症患者治疗后血清CA125水平均较治疗前明显下降（P〈0．01）。结论结合其他检查手段,血清CA125可以作为子宫腺肌症与子宫肌瘤鉴别诊断及疗效评价的一个指标。     

子宫肌腺症和子宫内膜异位症患者血清CA125检测的临床意义

目的探讨血清糖类抗原（CA）125在子宫肌腺症和子宫内膜异位症中的临床价值。方法用化学发光免疫分析法检测子宫肌腺症、子宫内膜异位症、子宫肌瘤、卵巢囊肿患者及健康对照者血清CA125的水平，部分子宫肌腺症和子宫内膜异位症患者治疗后复测。结果子宫肌腺症和子宫内膜异位症组血清CA125水平[（69．5±32．0）IU／mL和（52．3±8．4）IU／mL]较子宫肌瘤组[（38．2±27．1）IU／mL]、卵巢囊肿组[（29．8±21．0）IU／mL]及健康对照组[（26．0±8．1）IU／mL]显著增高，差异均有统计学意义（P均〈0．01）；子宫肌瘤或卵巢囊肿患者血清CA125水平与健康对照组差异均无统计学意义（P〉0．05）。子宫肌腺症和子宫内膜异位症组治疗后血清CA125水平均较治疗前明显下降（P均〈0．01）。结论结合患者体征及影像学检查，血清CA125可作为子宫肌腺症与子宫肌瘤、子宫内膜异位症与卵巢囊肿鉴别诊断以及疗效评价的指标。     

子宫腺肌病病灶范围及微囊腔大小与血清CA125的关系

【目的】探讨子宫腺肌病病灶范围及微囊腔大小与血清CA125颅的关系。【方法】采用放射免疫法（RIA）检测及比较76例子宫腺肌病患者（观察组）及76例子宫肌瘤患者（对照组）的血清CA125颅值。采用Jone Rosal描述方法测量观察组患者子宫腺肌病病变范围及病灶微囊腔大小。【结果】观察组患者血清CA125颅值（93．37±39．3μ／mL）明显高于对照组血清CA125颅（16．32±4．86μ／mL）差异有显著性（P〈0．05）,且观察组随子宫腺肌病病灶范围增大,病灶内微囊腔的增大,血清CA125颅值升高。【结论】血清CA125颅检测有助于子宫腺肌病的诊断。根据血清CA125颅值可粗略评估子宫腺肌症病灶情况。     

宫瘤消胶囊联合醋酸亮丙瑞林治疗子宫腺肌症的效果

目的：探讨宫瘤消胶囊联合醋酸亮丙瑞林治疗子宫腺肌症的效果。方法：选取2018年5月~2019年11月收治的98例子宫腺肌症患者，随机分为观察组和对照组，各49例。两组患者均接受醋酸亮丙瑞林治疗，对照组联合左炔诺孕酮治疗，观察组联合宫瘤消胶囊治疗。比较两组子宫体积、血清癌胚抗原125（CA125）、痛经程度及不良反应发生情况。结果：治疗3个疗程后，与对照组比较，观察组子宫体积更小，血清CA125水平、痛经程度评分及不良反应发生率均更低，差异均有统计学意义（P＜0.05）。结论：宫瘤消胶囊联合醋酸亮丙瑞林治疗子宫腺肌症，可缩小患者子宫体积，抑制CA125表达，缓解痛经症状，且安全性较高。     

腹腔镜子宫腺肌病病灶切除术联合孕三烯酮治疗的临床研究

目的探讨腹腔镜下子宫腺肌病病灶切除术联合孕三烯酮治疗子宫腺肌病的临床疗效及安全性。方法回顾性分析2008年1月一2011年4月,诊断为子宫腺肌病并接受治疗的82例患者的临床资料。根据患者对治疗方法的不同选择分成3组,腹腔镜子宫腺肌病病灶切除术联合孕三烯酮治疗27例,作为联合组;单独应用腹腔镜病灶切除术治疗25例,作为手术组;单独应用孕三烯酮治疗30例,作为药物组。手术或用药前后分别记录患者的痛经程度、月经量、子宫体积、血清癌抗原125（CA125）、贫血及并发症等情况。结果3组患者治疗后痛经程度均得到缓解,联合组与手术组治疗后相比,痛经程度、月经量、子宫体积差异无统计学意义（P〉0．05）;联合组与药物组相比,痛经程度差异有统计学意义（P〈0．05）;联合组治疗后12个月血清CA125水平、血红蛋白水平与手术组相比,差异有统计学意义（P=-0．019,P=-0．049）。结论腹腔镜子宫腺肌病病灶切除术联合孕三烯酮药物治疗,能缓解患者的临床症状,近期疗效显著,但远期疗效有待进一步观察。     

曼月乐治疗子宫腺肌病的疗效和对CA125表达的影响

目的：观察曼月乐治疗子宫腺肌病的临床疗效和对血浆CA125表达的影响。方法对132例子宫腺肌病患者宫腔内放置曼月乐。观察比较患者治疗前后的临床疗效如痛经的程度、月经量、子宫体积、子宫内膜厚度、血清CA125的变化。结果放置后脱落2例,其余130例放置曼月乐治疗子宫腺肌病患者6个月后痛经明显缓解,月经量明显减少,子宫内膜变薄（P〈0.01）,子宫体积缩小,血清CA125下降（P〈0.01）。结论曼月乐对子宫腺肌病的治疗安全有效,是一种较好的保守性治疗手段。     

止痛化症胶囊联合米非司酮治疗子宫腺肌症的临床疗效

目的探讨止痛化症胶囊联合米非司酮治疗子宫腺肌症的临床疗效。方法选取2016年11月～2017年11月本院收治的68例子宫腺肌症患者,采用随机数字表法将所有患者分为观察组和对照组各34例,对照组采用米非司酮进行治疗,观察组采用止痛化症胶囊联合米非司酮进行治疗,比较两组患者子宫体积变化情况、血清CA125变化、痛经评分、症状评分、治疗效果和生活质量评分。结果治疗后,观察组子宫体积变化情况、血清CA125变化优于对照组,差异有统计学意义(P0.05),观察组痛经评分和症状评分低于对照组,差异有统计学意义(P0.05),观察组治疗效果和生活质量评分高于对照组,差异有统计学意义(P0.05)。结论应用止痛化症胶囊联合米非司酮治疗子宫腺肌症患者,可有效改善患者子宫体积和血清CA125变化情况,提高患者治疗效果和生活质量,并降低患者痛经评分和症状评分,安全性高,值得应用。     

左炔诺孕酮宫内缓释系统治疗子宫腺肌症患者月经过多的疗效及对血清CA125的影响分析

选取我院2014年10月~2015年10月期间子宫腺肌症患者30例,全部患者月经结束后3~5d采用左炔诺孕酮宫内缓释系统(曼月乐)宫内置入术。比较子宫腺肌症患者曼月乐放置前后月经量、痛经评分、子宫大小、血清癌抗原125(CA125)、卵泡刺激素(FSH)、促黄体生成素(LH)与雌二醇(E2)等水平的差异。曼月乐放置后6个月,子宫腺肌症患者月经量明显少于曼月乐放置前,子宫腺肌症患者痛经评分明显低于曼月乐放置前,曼月乐放置前后比较差异具有统计学意义(P<0.05);曼月乐放置前后子宫大小比较差异无统计学意义(P>0.05)。曼月乐放置后6个月,子宫腺肌症患者血清CA125明显低于曼月乐放置前,曼月乐放置前后比较差异具有统计学意义(P<0.05);曼月乐放置前后血清FSH、LH、E2水平比较差异无统计学意义(P>0.05),全部患者均无明显严重不良反应。左炔诺孕酮宫内缓释系统治疗子宫腺肌症患者月经过多的疗效显著,可能通过降低血清CA125水平,有效改善月经量与痛经症状,降低血清CA125水平,延缓疾病发展。     

子宫腺肌症111例临床分析

目的：分析子宫腺肌症的发病相关因素，临床表现及临床诊断准确率。方法：对111例病理确诊为子宫腺肌症患者的相关临床资料进行回顾性分析。结果：111例平均年龄为43．2岁，30～50岁占81．9％，经产妇占91．0％，其主要临床表现是痛经(70．2％)、月经异常(63．0％)、子宫增大(95．5％)，术前诊断符合率55．9％，B超诊断符合率53．2％，血清CA125检测阳性率70．4％，MRI检测阳性率90．9％。结论：子宫腺肌症的发病与分娩、宫腔操作等造成子宫内膜侵入子宫基层生长有关，其临床表现以痛经、月经异常为主，单靠临床表现诊断该症准确率低，综合临床表现、B超及血清CA125的联合检测能提高子宫腺肌症的术前诊断率，MRI诊断子宫腺肌症灵敏度高。     

腹腔镜下单极法电消融术治疗子宫腺肌病术后血清CA125水平、EMAb阳性率及性激素水平的变化

目的 探讨腹腔镜下单极法电消融术治疗子宫腺肌病术后血清CA125水平、EMAb阳性率及性激素水平的变化。 方法 对26例子宫腺肌病患者行腹腔镜下单极法电消融术治疗，测定手术前后血癌抗原（CA125）、抗子宫内膜抗体（EMAb）及性激素水平。 结果 术后患者血清CA125水平及EMAb阳性率均较术前显著降低（P〈0．01），手术前后促卵泡生成素（FSH）、促黄体生成素（LH）和雌二醇（E2）差异无显著性（P〉0．05）；所有患者未出现围绝经期症状。 结论 腹腔镜下单极法电消融术可降低血清CA125水平及EMAb阳性率、对性激素影响不大。     

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.