24例高白细胞急性白血病临床分析

目的了解高白细胞急性白血病与早期死亡(早死,ED)及疗效的关系.方法 对24例高白细胞急性白血病(HAL)及238例非高白细胞急性白血病(NHAL)进行回顾性病例对照分析.结果 ①HAL早死率(41.70%)明显高于NHAL(2.10%)(P<0.01).②HAL完全缓解率(29.17%)明显低于NHAL(50.40%).③高白细胞性急性髓性白血病(HAML)早死率(66.70%)显著高于高白细胞急性淋巴细胞白血病(HALL)(16.67%).结论 HAL早死率高,完全缓解率低,疗效差,且HAML早死率明显高于HALL早死率,应尽早减轻肿瘤负荷,防止严重并发症,以减少早死率,提高疗效.     

24例高白细胞急性白血病临床分析

目的：了解高白细胞急性白血病与早期死亡（早死，ED）及疗效的关系，方法：对24例高白细胞急性白血病（HAL）及238例非高白细胞急性白血病（NHAL）进行回顾性病例对照分析。结果：（1）HAL早死率（41．70％）明显高于NHAL（2．10％）（P＜0．01）。（2）HAL完全缓解率（29．17％）明显低于NHAL（50．40％）。（3）高白细胞性急性髓性白血病（HAML）早死率（66．70％）显著高于高白血病急性淋巴细胞白血病（HALL）（16．67％），结论：HAL早死率高，完全缓解率低，疗效差，且HAML早死率明显高于HALL早死率，应尽早减轻肿瘤负荷，防止严重并发症，以减少早死率，提高疗效。     

不同方法治疗高白细胞急性白血病的疗效分析

目的探讨用白细胞去除术加联合化疗、羟基脲 (HU)加联合化疗及单用联合化疗治疗高白细胞急性白血病(HAL)疗效的差别。方法将 5 3例HAL随机分为 3组 ,HAL 1组和HAL 2组分别先行白细胞去除和口服Hu ,显著降低白细胞后再行联合化疗 ,HAL 3组单用联合化疗 ,观察各组疗效及不良反应。 30例非高白细胞急性白血病 (NHAL)单用联合化疗作为对照组。结果HAL 1组与HAL 2组间完全缓解 (CR)率、早期病死率无显著差异 ,白细胞去除和口服HU无严重不良反应 ,其CR率均显著高于HAL 3组 (P <0 .0 5 ) ,而早期病死率低于后者。结论白细胞去除术及HU口服对降低HAL患者的白细胞是有效、安全的 ,随后行联合化疗可显著提高疗效。     

高白细胞性白血病的生物学特性研究

本研究探讨高白细胞性白血病（HAL）的生物学特点及其临床意义.采用CD45/SSC双参数散点图设门,应用三色流式细胞术,对48例HAL患者及73例NHAL患者骨髓标本进行免疫分型,并对其中74例进行核型分析.结果表明：HAL组骨髓象中红系比例明显低于NHAL组,差异具统计学显著意义（P＜0.05）;AML中HAL组CD14阳性率明显高于NHAL组,差异具统计学显著意义（P＜0.05）;ALL中HAL组CD8阳性率明显高于NHAL组,而CD22,cCD79a明显低于NHAL组,差异具统计学显著意义（P＜0.05）;HAL组与NHAL组在系列抗原专一表达及交叉表达上无统计学差异（P＞0.05）;HAL缓解率低于NHAL.结论：HAL比NHAL骨髓受抑程度更重,AML中单核细胞性白血病发生高白细胞性白血病的可能性高,ALL中HAL比NHAL更易于表达T系抗原,HAL的白血病细胞较NHAL处于更早分化阶段,同时HAL预后不佳.     

高白细胞性急性白血病50例临床研究

目的探讨高白细胞性急性白血病（HAL）的临床特征、治疗效果及预后分析。方法对50例HAL进行临床回顾性分析,同时以100例非高白细胞性急性白血病（NHAL）作对照纽。结果HAL症状重;HAL治疗有效率为58．0％,低于NHAL的76．0％;HAL组早期病死率是22．0％,高于对照组的9．0％,有统计学差异。结论HAL治疗有效率低,早期病死率高,预后差,应化疗前行白细胞单采术有效降低白细胞数,再给予足量、规范的联合化疗,预防各种并发症,才能有效地提高临床疗效,降低病死率。     

母血清白细胞介素6、C-反应蛋白与早产亚临床绒毛膜羊膜炎的关系

目的探讨母血清白细胞介素 6 (IL 6 )、C 反应蛋白 (CRP)与早产亚临床绒毛膜羊膜炎的关系。方法用酶联免疫吸附实验测定6 7例早产孕妇及 32例相同孕周正常孕妇血IL 6 ,同时测定血CPR、白细胞计数 (WBC)。结果早产组血IL 6WBC明显高于对照组(P <0 .0 5 ) ,但两组间CRP浓度无显著性差异 (P >0 .0 5 )。胎膜早破早产与胎膜完整早产血IL 6、CPR无显著性差异 (P >0 .0 5 )。组织学绒毛膜羊膜炎阳性组血清IL 6、CRP均明显高于组织学绒毛膜羊膜炎阴性组 (P<0 .0 1) ,IL 6≥ 10pg/ml、CPR >8.2 0mg/l对预测亚临床绒毛膜羊膜炎的敏感性和准确性分别为 88.89%、80 .6 0 %和 5 2 .78%、6 4.18%。结论母血IL 6CRP均是预测早产亚临床绒毛膜羊膜炎较有用的指标 ,但IL 6比CRP具有更高的敏感性和准确性。     

当归多糖对放射损伤小鼠红细胞免疫功能和造血功能的保护作用

目的进一步了解当归多糖的药用价值。方法将小鼠分为正常对照组 ,照射对照组 ,当归多糖治疗组 ,检测三组的红细胞C3b受体花环率和外周血象。结果照射对照组红细胞C3b受体花环率和外周血白细胞、血小板明显低于正常对照组 ,而当归多糖治疗组的红细胞C3b受体花环率和外周血白细胞、血小板显著高于照射对照组 ,有统计学意义 (P <0 .0 1)。结论当归多糖对放射损伤小鼠红细胞免疫功能和造血功能具有保护作用     

解脲支原体和沙眼衣原体感染与孕囊枯萎的相关研究

目的研究解脲支原体 (UU)和沙眼衣原体 (CT)感染对孕囊枯萎的影响。方法应用支原体培养和衣原体抗原免疫快速法对 10 2例囊枯萎组 (观察组 )和 86例早孕人工流产 (对照组 )宫颈分泌物进行UU和CT的检测。结果观察组宫颈分泌物UU和CT阳性检出率分别为 36 .2 %和 2 0 .6 % ,均明显高于对照组(P <0 .0 1)。观察组UU和CT复合感染率为19 .6 % ,也较对照组明显升高 (P <0 .0 1)。术后随访 2年 ,UU和CT阳性组其输卵管妊娠的发生率升高。结论UU和CT感染与孕囊枯萎密切相关。     

鼻咽癌患者谷胱甘肽S转移酶M_1基因多态性研究

目的探讨鼻咽癌 (NPC)患者的GSTM1基因多态性。方法采用内参照PCR对NPC患者的基因组DNA进行GSTM1基因型检测。结果NPC患者GSTM1空白基因型频率为 6 0 .0 % ,对照组为 4 5 .0 % ,两者差异有显著性 (P <0 .0 5 ) ,其OR =1.833,95 %CI =1.0 4 6～ 3.14 7;鳞癌的空白基因型频率为 6 0 .5 % ,明显高于腺癌的5 0 .0 % (χ2 =5 .4 0 6 ,P <0 .0 1) ;吸烟者空白基因型个体患鼻咽癌的危险性显著增加 (OR =2 .813,95 %CI=1.35 3～ 6 .0 12 ,P <0 .0 1) ,而不吸烟者的危险性增加不明显 (P >0 .0 5 )。结论GSTM1基因多态性与NPC患者的遗传易感有关 ,与NPC的病理类型也有关 ,吸烟者的GSTM1空白基因型个体更易患NPC     

55例胎盘早剥的病因及母婴预后分析

目的探讨胎盘早剥的病因及其与母婴预后的关系。方法回顾性分析本院 1993～2 0 0 0年 5 5例胎盘早剥的病因及母婴预后。结果胎盘早剥发生率 0 .4 3% ,发病原因以妊娠高血压综合征及外伤多见。新生儿窒息、低出生体重儿、围产儿死亡、剖宫产、产后出血和弥漫性血管内凝血 (DIC)分别占5 2 .7%、5 4 .5 %、4 0 .0 %、4 5 .5 %、2 3.6 %和16 .4 % ;无孕产妇死亡。重型胎盘早剥比轻型胎盘早剥对母婴影响更大 ,前者围产儿病死率、新生儿窒息及产后贫血发生率均明显高于后者 (P <0 .0 5～ 0 .0 1) ;胎盘早剥的孕龄越低 ,新生儿窒息率、围产儿病死率越高 (P<0 .0 1)。结论胎盘早剥对母婴预后影响极大 ,孕产妇剖宫产率高 ,贫血、产后出血、DIC发生率高 ;重型胎盘早剥新生儿窒息率、围产儿病死率、母体并发症明显高于轻型 ;随着孕周增加围产儿病死率、新生儿窒息发生率降低     

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.     

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.