可博利-2号在中老年男性雄激素部分缺乏症中的应用

【目的】探讨可博利-2号在中老年男性雄激素部分缺乏症中的疗效。【方法】中老年男性雄激素部分缺乏症60例（观察组）,中青年男性健康者60例（对照组）,两组均用可博利-2号口服液,每次10 ml,每日3次,疗程2~3个月,观察症状改善情况,检测血睾酮、一氧化氮、雌二醇和经腹B超测前列腺大小综合分析。【结果】观察组49例患者症状明显改善,血睾酮、一氧化氮均上升,雌二醇无明显变化,前列腺体积增大;对照组血睾酮、一氧化氮、雌二醇和前列腺大小均无变化。【结论】可博利-2号治疗中老年男性雄激素部分缺乏症效果良好、使用安全,值得更进一步研究和开发应用。     

中年男性秃顶人群代谢综合征发生率与心血管病及糖尿病危险因素的相关性

目的:探讨中年男性秃顶人群中代谢综合征(metabolicsyndrome,MS)的发生率以及与心血管病和糖尿病危险因素间的关系。方法:调查于2002-10/2004-09在江苏省东海县人民医院内分泌科完成。选择江苏省东海县内城镇企事业机关等单位体检人员中的35～59岁汉族符合Ebling秃顶分类Ⅱ级以上的头顶部脱发男性239例为秃顶组,以自愿参加研究的无秃顶男性体检人员236例为对照组。测定两组的腰臀围、体质量指数(bodymassindex,BMI)、血压、总胆固醇、三酰甘油、高密度脂蛋白胆固醇highdensitylipoproteincholesterol,HDL-C、()血糖、胰岛素、胰岛素抵抗指数(homeostasismodelassessmentinsulinre-sistance,HOMA-IR、睾酮水平,通过比较两组上述指标的差异,分析男)性秃顶人群MS、心血管病和糖尿病危险因素的发生率及聚集性;胰岛素抵抗与心血管病和糖尿病危险因素聚集性的关系;秃顶群体中的MS与心血管病和糖尿病危险因素的指标变化、聚集程度及其间的相关性。结果:两组被调查475例均进入结果分析。①秃顶组的BMI犤(27.30±3.20)kg/m犦、腰围犤(93.10±5.90)cm犦、臀围犤(97.2±6.10)cm犦、2腰/臀比值(0.96±0.10)、收缩压犤(139.30±11.00)mmHg,1mmHg=0.133kPa犦、舒张压犤(92.20±8.90)mmHg犦、总胆固醇犤(6.25±0.83)mmo     

MMP-1血清水平升高与前降支肌桥患者肌桥临近血管动脉粥样硬化的相关性研究

【目的】探讨MMP-1血清水平与前降支心肌桥（MB）临近血管动脉粥样硬化（As）的相关性,为了解MMP-1在MB临近血管AS中的作用提供依据。【方法】检测前降支（LAD）MB伴临近血管AS（组别1）和不伴AS（组别2）患者血清MMP-1水平并比较两组患者的临床资料。【结果】两组患者临床特征与血清CRP水平差异无显著性（P〉0．05）,伴临近血管As组患者MMP-1血清水平显著高于不伴AS组[（25．7±6．1）ng／mLVS（12．6±5．8）ng／mL,P〈0．001],Logistic回归分析结果表明：LADMB伴AS与MMP-1血清水平独立相关。【结论】MMP-1血清水平升高可能参与了LADMB临近血管As。     

睾酮补充治疗对中老年男性糖脂代谢的影响

目的观察睾酮(T)补充治疗对中老年男性糖脂代谢的影响。方法收集睾酮水平低下的中老年男性对照组(C组)42例,非肥胖治疗组(A组)31例和肥胖治疗组(B组)35例,观察1年,检测治疗前后睾酮及糖脂代谢变化。结果治疗前3组睾酮及代谢指标无明显差异,1年后,A、B组随着睾酮增加,三酰甘油(TG)、空腹胰岛素(FIns)、胰岛素抵抗指数(HOMA-IR)水平降低,高密度脂蛋白胆固醇(HDL)升高,C组实验前后指标无明显差异;B组较A组更早出现TG水平差异,且HOMA-IR较A组下降趋势更明显。结论睾酮补充治疗可改善糖脂代谢,为中老年男性带来心血管方面的获益。     

利钠肽前体水平对预防血液透析患者心血管并发症的作用

【目的】探讨对血利钠肽前体（NT-proBNP）浓度异常的血液透析患者进行干预治疗,对预防心血管并发症的作用研究。【方法】收集血液透析患者,利钠肽前体超过450ng／L 115例。分为两组,对照组50例,常规血液透析治疗;干预组65例,在对照组基础上加抗心衰治疗。观察两组首次严重心血管事件。【结果】干预组经抗心衰治疗后NT-proBNP浓度较干预前明显下降,也低于对照组,差异有显著性（P〈0．05）。共有37例患者因心血管原因死亡（32．2％）,死亡患者的血浆NT—proBNP水平较非致死性心血管事件患者的高,差异有显著性（P〈0．05）。非致死心血管事件发生率干预组26例（40％,26／65）,对照组35例（70％,35／50）,两组间差异有显著性（P〈0．01）,但死亡率差异无显著性（P〉0．05）。发生首次严重心血管事件的患者的血浆NT—proBNP水平相比,差异无显著性（P〉0．05）。【结论】对血液透析患者利钠肽前体异常者予以抗心衰治疗,能降低心血管事件的发生。     

唑来膦酸治疗老年男性原发性骨质疏松的临床效果评估

【目的】评估唑来膦酸治疗老年男性原发性骨质疏松患者的临床效果。【方法】将76名年龄≥70岁的男性原发性骨质疏松患者随机分为两组。对照组（n＝39）每日补充钙剂和维生素D,治疗组（n＝37）在对照组的基础上给予一次静脉滴注唑来膦酸5 mg。随访12个月后观察所有研究对象骨密度和骨代谢标记物水平变化。【结果】治疗组的椎骨、全髋骨和股骨颈骨密度均显著高于对照组（P＜0．05）;血液骨代谢标记物β-CTx、PINP和BSAP水平则显著低于对照组（P ＜0．05）,两组严重不良反应发生率分别为24．32％和23．08％,差异无统计学意义（P＞0．05）。【结论】唑来膦酸治疗一年后可以显著提高患者骨密度和降低骨代谢标记物水平,降低老年男性原发性骨质疏松患者的骨折危险。     

急性多发性后循环脑梗死的危险因素及病因学分析

【目的】探讨急性多发性后循环脑梗死的发病危险因素及病因。【方法】纳入急性多发性后循环脑梗死患者463例,根据磁共振弥散加权成像（DWI）病灶特点将患者分为急性多发性脑梗死组（AMBI）以及急性单发脑梗死组（ASBI）,按改良TOAST分型标准对其进行病因分类。对其可能的危险因素分别行单因素分析和多因素Logistic回归分析,同时将其按年龄分为中青年组、老年组和高龄组,对可能危险因素行单因素分析。【结果】AM—BI组与ASBI组相比,饮酒史、高脂血症及下肢血管斑块在两组间差异有统计学意义（P〈0．05）。多因素Logistic回归分析显示男性、高脂血症为AMBI组独立危险因素。在病因学上两组间差异无统计学意义。在AMBI组内各年龄段的比较中,中青年饮酒、吸烟较多见（P〈0．05）,老年人群以心脏疾病多见（P〈0．05）。【结论】高脂血症及性别（男性）是急性多发性后循环脑梗死AMBI的独立危险因素,中青年急性多发性后循环脑梗死AMBI患者以吸烟及饮酒史较常见,而心脏疾病更多见于老年及高龄后循环AMBI患者。     

2260例成年男性骨质疏松症危险因素分析

【目的】了解本地区成年男性各年龄段骨密度（BMD）的变化情况和骨质疏松症（OP）的发生率及其相关危险因素。【方法】采用美国L unar公司的双能X线骨密度仪对2260例成年男性进行腰椎L 2～4和髋部BMD测定。【结果】男性BMD峰值在25～29岁,30岁后随年龄增加而降低;超重组和肥胖组的BMD显著高于正常体质量组（ P ＜0．05）。消瘦组各部位BMD显著低于正常体质量组（ P＜0．05）。年龄、高钙饮食、体质量指数及锻炼作为OP的风险因子,OR值分别为1．07,0．945,0．849,0．494。OP发生率随着年龄的增长而增高（ P ＜0．05）。【结论】成年男性BMD随年龄增长而降低,OP的发生率也随之增加;高钙饮食、体质量指数及锻炼是OP的保护性因素,而年龄是OP的危险因素。     

2型糖尿病患者糖尿病外周血管病变检出率及其相关危险因素分析

【目的】探讨2型糖尿病患者糖尿病外周血管病变（PAD）的检出率及相关危险因素。【方法】520例45岁以上的住院2型糖尿病患者,根据踝肱指数（ABI）比值大小分别为ABI〈0．9的PAD组101例、ABI≥0．9非PAD组419例,比较可能诱发PAD的危险因素。【结果】患者合并PAD占总数的19．4％。年龄、糖尿病病程、收缩压（SBP）、尿素氮（BUN）、肌酐（Cr）、尿微量白蛋白、低密度脂蛋白胆固醇（LDL—C）及高血压、冠心病、脑梗死、糖尿病肾病等因素差异均有显著性（P〈0．01～〈0．05）。Logistic回归显示年龄、收缩压、血肌酐水平是PAD发生的独立危险因素。【结论】年龄大于45岁的2型糖尿病患者中19．4％合并PAD,年龄、收缩压、血肌酐水平是DR独立的危险因素。     

青少年肥胖与Ghrelin相关性分析

【目的】探讨青少年肥胖与生长激素释放肽（Ghrelin）的关系。【方法】158名13～15岁青少年,根据体重指数（BMI）分为对照组80例,超重组44例和肥胖组34例。测量身高、体重及腰围（WC）。空腹静脉采血,应用酶联免疫吸附法检测血清真胰岛素（TI）和Ghrelin水平。【结果】①超重组BMI、WC和空腹血糖（FPG）高于对照组（P〈0．05）,肥胖组BMI和wc高于超重组（P〈0．05）,超重组和肥胖组TI和胰岛素抵抗指数（HOMA-IR）均高于对照组（P〈0．01）,三组间Ghrelin水平比较差异无显著性（P〉0．05）。②Ghre-1in与FPG和ln（HOM站IR）存在单变量相关。多元线性回归显示以Ghrelin为因变量,在校正年龄、性别和BMI后,FPG和ln（HOMA—IR）为独立危险因素。③三组分别进行多元线性回归分析显示,对照组FPG、超重组ln（HOMA-IR）和FPG、肥胖组ln（HOMA—IR）分别为Ghrelin独立危险因素。【结论】FPG水平和胰岛素抵抗（insulin resistance,IR）是导致青少年血Ghrelin水平变化的独立危险因素,在肥胖青少年IR,而非FPG,可能是Ghrelin水平变化的独立预测因素。。     

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.