慢性心力衰竭患者血清胱抑素C的检测及临床意义

目的评估慢性心力衰竭(CHF)患者血清胱抑素C检测的临床意义。方法选取CHF患者和老年健康体检者作为研究对象,检测血清肌酐、尿素氮、胱抑素C、总胆固醇、LDL-C、血糖及左心室射血分数。统计分析CHF患者与对照组间各指标的差异及血清胱抑素C与左心室射血分数的相关性。结果心功能Ⅳ级患者肌酐水平较其他受试者显著性升高。心功能Ⅲ级和Ⅳ级CHF患者血清胱抑素C水平明显高于心功能Ⅱ级CHF患者及对照组。血清胱抑素C水平与左心室射血分数间显著相关。结论血清胱抑素C水平随心力衰竭严重程度的增加而升高。     

血清胱抑素C对1型心肾综合征患者预后的预测价值

目的研究和分析血清胱抑素C对1型心肾综合征(AKI)患者预后的预测价值。方法选择2013年1月至2015年12月接受治疗的120例1型心肾综合征患者,所有患者在入院24h内监测血清胱抑素C水平,根据血清胱抑素C水平是否在正常范围可分为胱抑素C正常组和胱抑素C升高组,并且分析两组患者的左心室射血分数(LVEF)、心功能分级(NYHA分级)以及肌酐水平是否存在差异,以及随访1年内患者的病死率和再次住院率。结果血清胱抑素C升高组患者的NYHA分级、LVEF、肌酐水平分别为(2.68±1.34)、(45.78±17.88)%、(85.49±15.18)mmol/L,血清胱抑素C正常组患者NYHA分级、LVEF、肌酐水平分别为(1.33±0.54)、(62.45±8.39)%、(44.38±11.37)mmol/L,两组差异有统计学意义(P0.05)。随访1年内,血清胱抑素C升高组患者的再住院率、病死率分别为45.45%、27.27%,血清胱抑素C正常组的再住院率、病死率分别为16.92%、1.54%,两组差异有统计学意义(P0.05)。结论血清胱抑素C水平增高的患者其病死率高于血清胱抑素C正常的患者,在1型心肾综合征患者患者中检测胱抑素C水平对患者预后有一定的预测价值。     

β2-微球蛋白、尿素氮、血肌酐、胱抑素C与糖化血红蛋白联合检测在老年2型糖尿病患者肾功能检查中的效果

目的 探讨β2-微球蛋白、尿素氮、血肌酐、胱抑素C与糖化血红蛋白联合检测在老年2型糖尿病患者肾功能检查中的应用效果。方法 选取2021年1月—2022年12月于江苏省仪征市人民医院就诊的118例老年2型糖尿病伴肾损伤患者作为研究组,65例老年单纯2型糖尿病患者作为对照组,另选取在本院接受接受健康体检的100例健康志愿者作为健康组。所有人测定糖化血红蛋白、β2-微球蛋白、尿素氮、血肌酐、胱抑素C水平。对比3组检查结果并作出深入分析。结果 研究组糖化血红蛋白、β2-微球蛋白、尿素氮、血肌酐、胱抑素C水平分别为（8.94±1.25）%、（3.95±0.63）mg/L、（9.58±1.03）mmol/L、（126.57±17.20）μmol/L、（1.79±0.41）mg/L,均高于对照组、健康组,差异有统计学意义（P<0.05）;而对照组各项指标水平均高于健康组,差异有统计学意义（P<0.05）。对于2型糖尿病伴肾损伤开展诊断时,β2-微球蛋白、尿素氮、血肌酐、胱抑素C联合检测的灵敏度、特异度、准确率、阳性预测值、阴性预测值的数值均高于各项指标单一检测,差异有统计学意义（P<...     

连续性血液滤过治疗对Ⅰ型CRS患者肾功能 及NT-proBNP的影响

目的:分析连续性血液滤过治疗Ⅰ型心肾综合征对患者肾功能及血浆N末端B型钠尿肽前体的影响。方法:随机将2018年6月～2019年6月收治的Ⅰ型心肾综合征患者60例分为观察组和对照组,各30例。对照组采用间断性血液滤过治疗,观察组采用连续性血液滤过治疗。连续治疗1周后比较两组治疗前后肾功能、血浆N末端B型钠尿肽前体、血清胱抑素C水平及白细胞介素-6、白细胞介素-8水平。结果:两组治疗后血肌酐、血尿素氮、血清胱抑素C、血浆N末端B型钠尿肽前体以及白细胞介素-6、白细胞介素-8水平均较治疗前显著下降,且观察组治疗后血肌酐、血尿素氮、血清胱抑素C、血浆N末端B型钠尿肽前体以及白细胞介素-6、白细胞介素-8水平均显著低于对照组,差异有统计学意义(P0.05)。结论:采用连续性血液滤过治疗Ⅰ型心肾综合征患者,可显著改善患者肾功能,降低患者血浆N末端B型钠尿肽前体和致炎因子水平,有利于患者病情控制和恢复。     

血胱抑素C在足月新生儿高胆红素血症的检测分析

采用比浊法检测血清胱抑素C(Cys C)的浓度,同时测定血清尿素氮(BUN)、肌酐(SCr)进行比较分析。各组新生儿的血清BUN、SCr水平比较,差异均无统计学意义(P>0.05),各组新生儿的血清Cys C水平比较,差异有统计学意义(P<0.05)。且Cys C与Tbi L呈正相关,BUN、SCr与Tbi L无相关性。血胱抑素C水平检测在足月新生儿高胆红素血症早期肾功能损害诊断中的价值优于BUN和SCr,可作为新生儿高胆红素血症早期肾功能损害的敏感指标。     

血清胱抑素C浓度变化对于慢性心力衰竭患者的临床评价意义

目的探讨血清胱抑素C(cystatin,Cys-C)对慢性心力衰竭(CHF)患者的临床评价意义。方法选择2010年7～12月在我院心内科住院的心脏病患者114例,并将其分为A、B、C 3组。A组64例为CHF患者(无原发性肾脏疾病),B组50例为无心力衰竭的心脏病患者,C组58例为健康志愿者。分别测定A、B、C 3组患者Cys-C、血清肌酐(SCr)、尿素氮(BUN)及血清β2-微球蛋白(β2-MG)水平,并进行统计分析。结果 A组与B、C组相比,血Cys-C浓度明显升高(P<0.01),其中心功能Ⅲ、Ⅳ级的血清浓度高于Ⅰ～Ⅱ级(P<0.05);不同病因心力衰竭组相互比较,血CysC浓度差异无统计学意义;血Cys-C与年龄成正相关,与左心射血分数(LVEF)、B型尿钠肽(BNP)水平呈负相关。结论血Cys-C浓度反映CHF患者的早期肾功能损害,可能是心力衰竭恶化的早期指标之一,是评估CHF风险预后的有效指标。     

胱抑素C与血肌酐在老年危重患者急性肾损伤早期诊断中的价值

通过观察ICU老年AKI患者血胱抑素C及血肌酐表达水平的不同,评价胱抑素C对老年AKI的早期诊断价值。选取2015年3月~2017年2月入住三乡医院ICU且发生AKI的老年患者68例作为观察组。随机选取同时段入我院ICU进行诊治的年龄60周岁的未患AKI患者66例作为对照组。比较两组患者一般临床资料,监测比较两组患者血胱抑素C及血肌酐的表达水平,ROC曲线评价胱抑素C和血肌酐对老年危重患者急性肾损伤早期诊断价值。观察组和对照组两组病例在基本临床资料的差异无统计学意义(均P0.05),而血清Cys C和Scr水平存在差异(均P0.05)。对照组0h、6h、12h及24h的血清Cys C和Scr水平无统计学差异(均P0.05);与对照组比较,观察组6h、12h、24h血清Cys C水平和12h、24h Scr水平存在显著性差异(均P0.05);与入院时相比,而观察组Cys C水平随时间变化呈线进行性上升,6h、12h及24h的血清Cys C水平与0h存在显著性差异(均P0.05),12h及24h的血清Scr水平显著升高。血清Cys C对老年危重患者急性肾损伤早期诊断的价值最高,血清Scr次之,两种血清标志物水平在老年危重患者急性肾损伤早期诊断具有一定参考价值(均P0.05)。老年危重且发生急性肾损伤的患者血胱抑素C及血肌酐在不同时间段的表达水平不同,胱抑素C与血肌酐在老年危重患者急性肾损伤中均存在早期诊断价值,该研究结果可能为老年危重患者急性肾损伤早期诊断提供临床依据。     

尿酸和血清胱抑素C对高血压肾损害早期诊断的预测价值

目的：探讨血尿酸和血清胱抑素C对高血压肾损害的早期诊断价值。方法前瞻性纳入原发性高血压患者151例,根据是否并发肾损害,将患者分为单纯高血压组（I组）和高血压肾损害组（Ⅱ组）,采用全自动生化分析仪同时测定血清尿酸、肌酐和尿素氮,免疫透射比浊法测定血清胱抑素C含量,并与健康体检者（对照组）相关指标作比较,并进行相关分析,评价血尿酸和血清胱抑素C对高血压肾损害早期诊断的价值。结果 I组、Ⅱ组血尿酸和血清胱抑素C的阳性率明显高于对照组（P〈0.01）。同组患者血尿酸和血清胱抑素C的阳性率明显高于其血尿素和血肌酐阳性率（P〈0.01）。此外,高血压患者血尿酸和血清胱抑素C的升高早于血尿素和血肌酐。结论血尿酸和血清胱抑素C是反映高血压早期肾功能损害的敏感指标,其敏感度高于血尿素和血肌酐,在诊断高血压早期肾损害方面有重要的临床价值。     

老年心力衰竭患者同型半胱氨酸和胱抑素C水平及意义

目的：探讨老年慢性心力衰竭（CHF）患者血清同型半胱氨酸（Hcy）、胱抑素 C的水平及意义。方法选取255例不同心功能分级的老年CHF患者,其中心功能Ⅱ级98例,心功能Ⅲ级87例,心功能Ⅳ级70例,以及同期的76例健康体检者,测定4组受试者的 Hcy、胱抑素 C 及血脂水平,记录超声心动图指标,包括左心室射血分数（LVEF）、左心室舒张末内径（LVEDD）、左心室后壁（LVPW）、室间隔厚度（IVS）等指标,评价心功能分级并进行相关分析。结果正常对照组、不同心功能水平之间 LVEF、LVEDD、LVPW、IVS、Hcy、胱抑素C、血脂水平差异均有统计学意义（P ＜0．05）;Hcy、胱抑素 C 水平与心功能分级呈正相关（r ＝0．249、0．144,P 均＜0．01）;胱抑素 C 与LVEDD、IVS、LVPW均呈正相关关系（r＝0．167,0．114、0．231,P均＜0．05）。结论 Hcy、胱抑素 C水平均与心力衰竭严重程度密切相关,胱抑素C还可能参与心室重构过程,推测 Hcy联合胱抑素C水平可作为判定老年CHF严重程度的参考指标。     

不同心功能患者血钠水平的观察

目的 观察不同心功能患者血钠水平了解心力衰竭(简称心衰)中血钠的变化.方法 对180例心血管科住院患者分为急性左心衰(A组)和非急性左心衰,后者按照纽约心脏病学会(NYNA)分级标准分为心功能Ⅰ级(B组),心功能Ⅱ级(C组),心功能Ⅲ级(D组),心功能Ⅳ级(E组),对各组间的血钠水平进行比较.结果 A、B、C、D、E各组血钠水平分别为(单位mmol/L)139.00±00.97、140.68±0.41、140.67±0.64、138.98±0.62、136.50±1.06,即血钠水平为B组＞C组＞A组＞D组＞E组,其中B组与E组间有极显著差异(P＜0.01),B组与D组、C组与E组间有显著差异(P＜0.05),其余各组间无显著差异(P＞0.05).结论 血钠水平与心功能相关,心衰越重,血钠水平越低.     

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.     

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.