应用改良的凝集素亲和免疫电泳自显影法检测甲胎蛋白异质体

目的解决在应用凝集素亲和免疫电泳自显影法检测甲胎蛋白异质体过程中对单一峰型的结果难以判断的问题.方法对以往建立的凝集素亲和免疫电泳自显影法略作改进,在原来两块分别含凝集素和AFP抗血清的凝胶之间加一既不含凝集素也不含抗血清的凝胶条.选择16例AFP异质体为均一型的血样本进行对照测定,并以凝集素亲和免疫电泳印迹法验证改良法的结果.结果在只含凝集素的条件下表现为1个峰的样本用改良法检测,良性肝病的样品峰型仍为1个对称峰,恶性肝病的样品峰型由原来的1个峰变为2个峰.实验表明,应用改良法结果的重复性满意,并得到凝集素亲和免疫电泳印迹法的验证.结论改良法使原本难以判断的结果清晰易辨,可应用于AFP异质体的检测.     

甲胎蛋白异质体检测在肝癌诊断中的意义

目的探讨甲胎蛋白异质体检测在肝癌诊断中的价值。方法选取1052例甲胎蛋白（AFP）≥20ng／mL的患者,取血清,采用凝集素亲和免疫电泳法检测AFP异质体。结果肝癌患者AFP—L3比值高于良性慢性肝病患者,AFP—1．3／AFP〉35％时诊断特异度较高。结论AFP异质体检测在高AFP人群中具有重要的肝癌诊断意义,但还需结合其他手段长期监测。     

凝集素捕获微量离心柱法检测甲胎蛋白异质体在原发性肝癌中的应用评价

目的探讨凝集素捕获微量离心柱法检测甲胎蛋白异质体（AFP-L3）在原发性肝癌（PLC）中的临床应用。方法采用电化学发光法（ECL）和凝集素捕获微量离心柱法分别定量检测622例甲胎蛋白（AFP）阳性PLC、24例AFP阴性PLC、17例AFP阳性良性肝脏疾病患者AFP-L3,并比较凝集素捕获微量离心柱法和凝集素亲和免疫电泳自显影法检测AFP-L3的符合率。结果 622例AFP阳性PLC患者中,AFP-L3阳性患者的γ-谷氨酰基转移酶（GGT）、总胆红素（TBil）明显高于AFP-L3阴性患者（P〈0.05）。AFP-L3与患者的丙氨酸氨基转移酶（ALT）、白蛋白（Alb）均无相关性。凝集素捕获微量离心柱法和凝集素亲和免疫电泳自显影法检测AFP-L3的阳性率分别是46%、50%,两者的符合率为92%。按AFP浓度分层分析AFP-L3阳性率后发现,随AFP浓度升高,AFP-L3阳性呈现上升趋势。AFP-L3在AFP阳性的PLC患者和AFP阳性的良性肝脏疾病患者中的检出率分别为16.67%、23.53%,显著低于AFP阳性的PLC患者（63.5%,P〈0.05）。结论凝集素捕获微量离心柱法与凝集素亲和免疫电泳自显影法具有较好的一致性;AFP-L3在AFP阳性的PLC患者中有较高的检出率,对临床具有辅助诊断和鉴别诊断价值。     

凝集素亲和电泳-免疫印迹法检测甲胎蛋白变异体

甲胎蛋白(AFP)是一个公认的肝细胞癌(HCC)标记物.然而,部分慢性肝炎、肝硬化等良性肝病亦可合成少量AFP.由于糖基化过程的差异,不同疾病状况下肝细胞分泌的AFP 在糖链结构上并不相同.为了鉴别AFP是产生于恶性肝癌细胞还是良性肝病细胞,人们已建立多种 AFP糖链变异体测定方法.新近的报告表明, AFP糖链变异体测定还有助于HCC复发转移的监测和预后的判断[1,2].我们在已建立的凝集素亲和免疫电泳自显影法[3]的基础上,又建立了操作更简便、敏感度更高的凝集素亲和电泳-免疫印迹法,并初步用于良恶性肝病的AFP糖链变异体检测.     

甲胎蛋白及其异质体检测的临床应用价值

目的探讨甲胎蛋白(AFP)异质体检测对原发性肝癌、良性肝病的临床应用价值.方法根据扁豆凝集素对AFP不同的亲和力,采用亲和免疫印迹法检测AFP-L3的百分含量.结果以AFP-L3≥15%作为原发性肝癌的诊断标准,其敏感性为90.0%,特异性为92.9%.结论 AFP及其异质体的检测对原发性肝癌,尤其是小肝癌的早期诊断和与良性肝病的鉴别诊断具有重要的临床应用价值.     

甲胎蛋白及其异质体检测的临床应用价值

目的 探讨甲胎蛋白（AFP）异质体检测对原发性肝癌、良性肝病的临床应用价值。方法 根据扁豆凝集素对AFP不同的亲和力,采用亲和免疫印迹法检测AFP－L3的百分含量。结果 以AFP－L3≥15％作为原发性肝癌的诊断标准,其敏感性为90．0％,特异性为92．9％。结论 AFP及其民 体的检测对原发性肝癌,尤其是小肝癌的早期诊断和与良性肝病的鉴别诊断具有重要的临床应用价值。     

甲胎蛋白异质体分析及其临床应用

甲胎蛋白(AFP)是一种糖蛋白。近年来国内外研究发现,由肝细胞恶变后产生的甲胎蛋白所含的糖链是含有较多岩藻糖残基,故也称岩藻糖化 AFP(FucAFP)。也就是所谓“甲胎蛋白异质体”。不同的异质体的差别在于所含糖链的不同,因而这些异质体与小扁豆凝集素(LCA)的亲和力也不同。与 LCA 亲和力强者称为 LCA 结合型 AFP(LCA-R),反之称为 LCA 非结合型 AFP(LCA-N)。LCA 结合型 AFP 总量是更具有特异性的肝癌标记物。亲和酶联免疫电泳分析法检测 AFP 异质体,具有灵敏度高,快速简便,试剂有效期长,电泳后直接染色显峰,无需特殊设备等优点,适合基层县医院检验科推广应用。     

甲胎蛋白糖链异质体检测方法的探讨

甲胎蛋白(AFP)是一种单肽链糖蛋白,其糖链主要由甘露糖、半乳糖、N-乙酰葡萄糖和唾液酸以寡聚糖形式组成。近来人们利用不同组织来源的AFP糖链结构的差异,应用植物凝集素分离AFP 异质体,对肝癌进行鉴别诊断和早期诊断。我所曾建立简便,高度敏感的亲和交叉免疫电泳放射自显影法检测AFP 糖链异质体。经过多年的实践取得一定经验,现总结如下。     

快速亲和交叉免疫电泳检测甲胎蛋白糖链异质体

我们参考国内外有关文献,改进了用亲和交叉免疫电泳(方法见中华医学检验杂志1986;3∶154,下称崔福贞法)检测甲胎蛋白糖链异质体的若干操作步骤,建立了快速、经济的检测AFP 糖链质体的亲和交叉免疫电泳法。     

AFP和AFP异质体对405例原发性肝癌的诊断价值探讨

目的探讨甲胎蛋白(AFP)和甲胎蛋白异质体(AFP Variants,AFP-V)对原发性肝癌(PHC)的诊断价值.方法用酶联免疫吸附试验(ELISA)和交叉免疫电泳、放射性自显影法分别检测AFP和小扁豆凝集素亲和性甲胎蛋白异质体(LCA-AFP-V)的血清含量.结果 405例PHC患者中,AFP阳性占75.8%,LCA-AFP-V阳性占54.3%;210例AFP低浓度阳性患者中,LCA-AFP-V阳性125例,而97例AFP高浓度阳性患者,有95例伴有异质体的升高;98例AFP阴性患者中,35例LCA-AFP-V阳性;223例非PHC中AFP阳性占42.2%,LCA-AFP-V阳性占25.6%.结论单独应用AFP或AFP-V均有一定的局限性,两者联合使用将有助于提高原发性肝癌的检出率.     

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.