高通量透析对中分子物质和细胞因子的影响

目的研究高通量透析对维持性血液透析患者中分子物质和细胞因子水平的影响.方法55例患者随机分组后分别进行高通量透析(n＝30例)和常规血液透析(n＝25),每周透析2～3次.于透析前,透析后即刻,透析12个月后检测两组患者血浆BUN,Cr,P3-,β2微球蛋白(β2-MG),甲状旁腺激素(PTH)、IL-1β、IL-6、IL-8和TNFα水平,并于透析20 min 后检测透析液中的IL-1β、IL-6、IL-8和TNFα水平,对两组的指标进行了比较.结果对P3-,β2-MG,PTH的清除率高通量透析组优于常规血液透析组(P＜0.05),对BUN,Cr的清除率两组相比较无显著差异;首次高通量透析后IL-8和TNFα与透析前比较显著升高(P＜0.05),透析1年后血浆IL-1β、IL-6、IL-8和TNFα呈下降趋势,但与透析前和常规血液透析1年后比较无显著差异;高通量透析组透析液中IL-1β、IL-6、IL-8、TNFα和β2-MG水平高于常规血液透析组(P＜0.05).结论高通量透析对中分子物质和磷离子的清除率优于常规血液透析,对细胞因子的影响近似于常规血液透析.     

高通量透析对中分子物质和细胞因子的影响

〖目的〗研究高通量透析对维持性血液透析患者中分子物质和细胞因子水平的影响.〖方法〗 55例患者随机分组后分别进行高通量透析(n＝30例)和常规血液透析(n＝25),每周透析2～3次.于透析前,透析后即刻,透析12个月后检测两组患者血浆BUN,Cr,P3-,β2微球蛋白(β2-MG),甲状旁腺激素(PTH)、IL-1β、IL-6、IL-8和TNFα水平,并于透析20 min后检测透析液中的IL-1β、IL-6、IL-8和TNFa水平,对两组的指标进行了比较.〖结果〗对P3-,β2-MG,PTH的清除率高通量透析组优于常规血液透析组(P＜0.05),对BUN,Cr的清除率两组相比较无显著差异;首次高通量透析后IL-8和TNFa与透析前比较显著升高(P＜0.05),透析1年后血浆IL-1β、IL-6、IL-8和TNFa呈下降趋势,但与透析前和常规血液透析1年后比较无显著差异;高通量透析组透析液中IL-1β、IL-6、IL-8、TNFα和β2-MG水平高于常规血液透析组(P＜0.05).〖结论〗高通量透析对中分子物质和磷离子的清除率优于常规血液透析,对细胞因子的影响近似于常规血液透析.     

急性胰腺炎早期患者IL-6,TNF,CD_4~ /CD_8~ 的变化及意义

目的揭示重型胰腺炎发病机制和早期监测指标。方法对 12例重型胰腺炎 (SAP) ,15例轻型胰腺炎 (MAP)病人和 13例正常人 (N )的外周血用ELISA法测定IL -6及TNF ;用间接免疫荧光法测定CD4 、CD8 细胞。结果SAP组IL-6水平明显高于MAP组及N组 (P <0 .0 1) ,但MAP组与N组比较无差异 (P >0 .0 5 )。IL -6大于 10 0 pg/ml时预测SAP的敏感性为83 .33 % ,特异性 93 .33 % ;三组间TNF检出率无差异 ;CD4 百分率在SAP组明显下降 (P <0 .0 1)。SAP组IL -6与CD4 百分率呈明显负相关 (r =-0 .6 196 ,P <0 .0 5 )。结论SAP早期IL -6升高和细胞免疫功能抑制可能属其早期反应 ,测定IL -6有助于轻、重型胰腺炎的鉴别     

儿童结核病周围血单个核细胞分泌的TNF-α与PPD皮试的关系

目的探讨儿童结核病周围血单个核细胞(PBMC)分泌的肿瘤坏死因子 α(TNF α)与PPD皮试反应之间的关系。方法按常规方法PPD皮试 ,根据其硬结大小分为A组 (直径≥ 2 0mm)、B组 (15～ 19mm )和C组 (≤ 9mm )。分离PBMC ,用卡介苗提取素作刺激物、体外孵育附壁的PBMC ,收取上清 ,用ELISA方法测定TNF α含量。结果A组 ,B组和C组之间 ,PBMC分泌的TNF α有显著性差异 (P <0 .0 1)。结论结核病患儿PBMC分泌的TNF α检测与PPD皮试反应强度密切相关     

高通量血液透析与常规透析的临床效果观察与比较

目的：探讨应用高通量透析器进行血液透析与常规血液透析效果比较；了解其对尿毒症患者中、小分子毒素的清除与营养状况的评估。方法：将33例维持性血液透析患者随机分为高通量组和常规组。常规组使用Fresenius聚砜膜17R血滤器，常规组使用F6透析器，均每周透析3次，每次4—4．5h，均采用碳酸氢盐透析液，AK95S透析机，血流量为220-250ml／min，透析液流量500ml／min，透析前后分别采血，测血中尿素氮，肌酐，磷，β2-微球蛋白及甲状旁腺素，观察治疗前后的效果。结果：高通量透析与每周透析相同时间的低通量透析相比，小分子物质尿素氧，肌酐的下降率相近，差异无统计学意义（P〉0．05）；高通量透析治疗后即刻血β2-微球蛋白和甲状旁腺素水平下降较低通量透析显著（P〈0．05）；低通量透析对β2-微球蛋白和甲状旁腺素几乎没有清除作用，高通量透析对血磷的清除率也明显提高。结论：高通量血液透析可减轻中分子中毒素所致的症状，改善患者的生活质量。     

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。     

高低通量透析中患者血浆细胞因子及内毒素水平的研究

目的研究高、低通量透析患者透析中血浆细胞因子水平变化及其与内毒素的关系。方法选择采用聚砜膜行高、低通量透析患者各9例,测定其透析开始(0分钟)及透析后60、90和240分钟时血浆白介素1β(IL1β)、IL6、肿瘤坏死因子α(TNFα)和内毒素水平。结果2组患者透析至60分钟时血浆IL1β水平最高（与0分钟相比,低通量组P>0.05,高通量组P<0.05）,透析至240分钟时水平最低(与0时相比,低通量组P<0.01,高通量组P>0.05)。2组患者透析中TNFα水平都呈上升趋势,内毒素水平都呈下降趋势,但无显著差异。大部分患者透析中IL6水平很低,只有5例患者表现为升高。2组患者在细胞因子、内毒素水平上并无差异;透析中细胞因子水平变化与内毒素水平无相关性。结论高通量透析与低通量透析相比,并不会增加患者透析中细胞因子产生异常及内毒素污染的可能。透析中细胞因子的变化与内毒素并无明显相关性。     

常用血液净化方法对维持性血液透析患者血清甲状旁腺素的清除效果

目的　比较 3种常用血液净化方法对维持性血液透析患者血清甲状旁腺素 (PTH)的清除效果。方法　将 90例维持性血液透析患者随机分为 3组 :血液灌流 +血液透析组 (HD +HP)、血液透析滤过组 (HDF)、血液透析组 (HD) ,HD +HP组接受树脂吸附联合血液透析治疗 ,HDF组接受血液透析滤过治疗 ,HD组接受血液透析治疗 ,放射免疫法测定血清PTH水平。结果　 (1)HD +HP治疗后患者血PTH从(2 91 7± 2 37 5 )pg/ml降至 (12 2 2± 114 5 )pg/ml,平均单次清除率为 4 8 6 % ,治疗前后比较差异有显著性(P <0 0 5 ) ;(2 )HDF治疗后患者血PTH从 (32 5 9± 4 2 3 1)pg/ml降至 (90 9± 93 7)pg/ml,平均单次清除率为 5 9 5 % ,治疗前后比较差异有显著性 (P <0 0 5 ) ;(3)HD治疗后血PTH从 (2 97 7± 2 11 3)pg/ml降至(2 4 8 1± 10 5 5 )pg/ml,平均单次清除率为 13 1% ,治疗前后比较差异无显著性 (P >0 0 5 )。结论　血液灌流联合血液透析和血液透析滤过能有效地清除PTH ,两者清除率差异无显著性 ;而血液透析不能有效地清除PTH。     

2型糖尿病合并冠心病25例冠脉造影分析

目的探讨 2型糖尿病合并冠心病时冠脉造影情况 ,进一步认识糖尿病对心血管的危害及其严重性。方法选择 2 5例 2型糖尿病合并冠心病的患者为观察组 ,糖尿病病史 1～ 15年 ;对同期随机抽出 32例无糖尿病的冠心病患者为对照组。采用Judkins法行选择性冠脉造影 ,对两组患者冠脉造影结果进行对比分析。结果C型病变观察组占 72 % ,对照组占 6 % (P <0 .0 1) ;A型病变观察组占 8% ,对照组占 75 % (P <0 .0 1) ;B型病变两组分别为 2 0 %、19% ,差异无显著性 (P >0 .0 5 )。结论2型糖尿病患者合并冠心病冠脉病变多为严重、弥漫、多支、多处病变 ,应积极预防和控制糖尿病的发生发展 ,以减少冠心病的发生。     

窒息新生儿尿中炎症细胞因子改变与肾小管损伤的关系

目的 :探讨炎症细胞因子在新生儿窒息后肾损伤中的作用。方法 :采用酶联免疫吸附 (EL ISA)法检测窒息患儿尿中白介素 8(IL 8)、IL 6、肿瘤坏死因子 α(TNFα)水平 ,并同时测定尿中反应肾小管损伤的指标 β2 微球蛋白 (β2 MG)、N 乙酰 β D 氨基葡萄糖苷酶 (NAG)和 γ 谷胺酰转肽酶 (γ GT)水平。结果 :IL 8、IL 6、TNFα、β2 MG、NAG、γ GT在轻度窒息组和重度窒息组较正常对照组以及重度窒息组较轻度窒息组均显著升高 (P均 <0 .0 5 ) ;在窒息组内 ,尿中各炎症因子水平与肾小管各损伤指标之间均呈显著正相关关系 (P均 <0 .0 5 )。结论 :窒息可诱导机体发生全身炎症反应综合征 ,进而导致窒息后肾损伤的发生。尿中炎症细胞因子水平的测定是判断窒息程度及肾损伤的重要指标。     

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.