银杏叶片对高原人体运动血液流变学的影响

目的 探讨银杏叶片、红景天和酪氨酸对高原人体力竭运动血液流变学的影响。方法 对进驻海拔3700m高原半年的30名健康青年随机分为银杏叶片组、红景天组和酪氨酸组，每组10人。在服药前、服药第15天分别进行运动至力竭，分别检测血中红细胞压积(HCT)、血液粘度(ηb)、血浆粘度(ηp)、还原粘度(ηr)、红细胞刚性指数(IR)、红细胞变形系数(TK)、红细胞聚集系数(VAI)及血栓形成系数(TFL)。结果 服药前力竭运动后较安静时HCT、ηb、ηp、ηr、IR、TK、VAL、TFL均升高(P＜0．05或P＜0．01)。服药后力竭运动后较安静时银杏叶片组和酪氨酸组ηr、Tk增高(P＜0．05或0．01)；红景天组ηp、ηr、TK增高(P＜0．05)，其余均无统计学差异(P＞0．05)。服药后较服药前银杏叶片组HCT、ηb、ηp、ηr、IR、TK、VAI、TEL均降低(P＜0．05或0．01)；红景天组和酪氨酸组ηb、ηp、ηr、IR、TK、VAI、TFL降低(P＜0．05或0．01)，HCT无统计学差异(P＞0．05)。银杏叶片组、酪氨酸组和红景：天组之间比较血液流变学指标均无统计学差异(P＞0．05)。结论 三种药物均具有改善组织微循环及血液流变性的作用，使红细胞变形能力增强，血液粘度下降，血流速度增加。     

乙酰唑胺和高原维康片对高原人体运动时血液流变学指标的影响

目的　探讨3种药物对高原人体运动时血液流变学的影响。方法　对进驻海拔370 0m高原6个月的4 0名健康青年随机分为高原维康片组、乙酰唑胺组、红牛饮料组和安慰剂组,每组10名。在安静时、服药前、服药第10d及停药第10d分别采用功率自行车进行渐增负荷运动至力竭,测定红细胞压积(HCT)、血液粘度(ηb)、血浆粘度(ηp)、还原粘度(ηr)、红细胞刚性指数(IR)、红细胞变形系数(TK)、红细胞聚集系数(VAI)及血栓形成系数(TFL)。结果　①力竭运动后较安静时HCT、ηb、ηp、ηr、IR、TK、VAI、TFL均升高(P <0 .0 5或0 .0 1)。②给予乙酰唑胺、高原维康片及红牛饮料后能明显降低血液粘滞度,提高红细胞变形能力,且乙酰唑胺效果更好。结论　乙酰唑胺、高原维康片及红牛饮料均具有改善组织微循环及血液流变性的作用,使红细胞变形能力增强,血液粘度下降,血流速度增加。     

富氧对海拔3 700m高原人体血液流变学的影响

目的探讨在高原建立富氧室对机体血液流变学的影响.方法在海拔3 700m高原室内充氧,使氧浓度提高为24%～25%.12名受试者在富氧条件下睡眠10h,出富氧室4h后,检测红细胞压积(HCT)、血液粘度(ηb)、血浆粘度(ηp)、还原粘度(ηr)、红细胞刚性指数(IR)、红细胞变形系数(TK)和血细胞聚集系数(VAl).结果富氧后较富氧前ηb、ηp、IR、TK和VAI均降低,有显著性差异(P<0.05),HCT、ηr无统计学意义(P>0.05).结论富氧10h可改善高原机体缺氧,并且增强机体的氧储备可持续4h以上.     

无锡春光医学仪器厂产品介绍

BRC──51全自动血液流变仪 该仪器能检测并打印ηb(血液粘度)、HCT(红细胞压积)、ηr(血液还原粘度)、ηp(血浆粘度)、Fibg(纤维蛋白原)、IR(红细胞刚性指数)、TK(红细胞变形性 TK值)、VAI(血细胞聚集系数)、MST(微循环滞留时间)、TFL(血栓形成系数)等 10项血液流变学结果。 其特点是:用血量少(50微升)、操作方便、灵敏度高、重复性好;不仅适用于临床检测,也适用于健康普查;特别是在心脑血管疾病、糖尿病、肿瘤等疾病的诊断与预防中具有很高的实用价值。 CG── PC中风预测仪 CG──PC系列中风预测仪的硬件为普及型计算机,采用…     

西藏高原移居昆明藏族青年血液流变学检测分析

目的了解从西藏高原(海拔3 000～4 600m)进入昆明(1 880m)6个月后的67例藏族青年血液流变学指标状况.方法用R80A全自动血液流变分析仪检测藏族青年血液流变学指标并与对照组(昆明汉族健康青年)血液流变学指标结果进行比较.结果藏族组5项指标高于对照组,6项指标低于对照组,1项指标两组无显著差异.高于指标是:低剪切率全血粘度(ηb1s-1)、红细胞压积(HCT)、全血低切还原粘度(Lηr)、全血低切相对粘度(VIP)、红细胞聚集指数(VAI),P均<0.05;低于指标是:高剪切率全血粘度(ηb200s-1)、中剪切率全血粘度(ηb65s-1)、高切还原粘度(Hηr)、高切相对粘度(VIb)、红细胞刚性指数(IR)、红细胞变形指数TK,6项中除红细胞刚性指数(IR)P<0.01外,其它P<0.05; 无显著差异指标是血浆粘度(ηp),P>0.05.结论藏族青年其血液流变指标与当地汉族青年相比存在明显异常,西藏高原环境对世居藏族青年的血液流变学影响进入平原生活短期内不易改变;藏族青年血液流变学存在的主要问题是红细胞聚集性过强而变形性较弱.     

100例晚期癌症患者24小时血液流变学变化的观察

目的 探讨晚期癌症患者24小时血液流变学变化的规律及在指导临床治疗和判断预后的临床意义。方法 对100例晚期癌症患者在24小时内分别于3：30、7：30、11：30、15：30、19：30、23：30采手指血6次，测定全血粘度(1ηb)、血浆粘度(ηp)、红细胞压积(HCT)、纤维蛋白原(PFC)、红细胞刚性指数(IR)、红细胞聚集系数(VAJ)、血栓形成系数(TFL)和红细胞变形系数(TK)，并作显著性t检验。结果 100例患者的八项血液流变学指标24小时中都有不同程度的变化，其中HCT、ηb、IR、VAI、TK等五项指标的变化较为明显，其高峰值均在23：30—3：；30，低峰值在15：30，最高值与最低值之间有显著性差异(P＜0．05和P＜0．01)。呈现出的“一高三低”(ηp、PFC、TFL降低，IR增高)趋势中Ⅲ期患者占90．9％(40／44)、Ⅳ期占66．1％(37／56)。结论 微循环功能紊乱是导致癌细胞转移的首要条件。血液流变学改变随着病情的加重而增加，肿瘤病期越晚血浆粘度越高，提示血液流变学异常在恶性肿瘤转移时可能有促进作用。恶性肿瘤的血液流变学变化是以“高凝高粘血症”为主，其次为“高凝低粘血症”为特点。肿瘤昼夜血液流变学改变与时辰有一定的关系，因此可针对血液流变紊乱的时辰变化定时活血化淤治疗或化疗，同时检测的血液流变学结果还可作为判断病情和预后、判断手术治疗效果的参考指标。     

BRC-51B型血液流变仪的临床应用

我们将无锡春光医学仪器厂生产的BRC-51B型全自动血液流变仪应用于临床.检测了50例心脑血管疾病患者及40名健康人.效果很好。 检测结果显示:27例脑血栓患者血液流变学检测的十项指标.阳性率普遍较高。其中TFL、HCT及ηb等三项,全部是异常结果.阳性率100%,其它几项血液流变学指标的阳性率,也普遍较高(ηr 96.3%,ηp,74.1%,PFC62.3%,IR88.9%,TK85.6%.VAI74.1%,mst81.5%)。结果表明,用BRC-51B型血液流变仪检测,对脑血栓的诊断有很高的参考价值。其中最主要的项目是TFL、HCT和ηb等三个项目。但是;由于HCT和ηb两项,在其它病种中…     

雾化吸入L-精氨酸治疗高原肺水肿对血液流变性的影响

目的：探讨左旋精氨酸（L－Arg）对高原肺水肿（HAPE）患者血液流变学的影响。方法：在海拔3700米采用氧气驱动雾化吸入L－Arg治疗高原肺水肿患者9例为L－Arg组，并与吸入低浓度NO混合气8列高原肺水肿患者为NO组作对照，分别测定HCT、ηb、ηp、ηr、IR、TK、VAI和TEL等血液流变学指标。结果：NO组和L－Arg组治疗前较治后的ηb,ηp,ηr、VAI、TEL均增高非常显著（P＜0．01）。HCT、TK、IR无统计学差异（P＞0．05）。NO组和L－Arg组比较，各指标均无统计学指标（P＞0．05）。结论：L－Arg治疗对HAPE有效，通过调节提高NO水平而改善血液循环，比较经济简便，易于推广应用。     

硬膜外麻醉对高血压病人围手术期血液流变性影响的临床研究

目的探讨硬膜外麻醉对高血压病人围麻醉期间血液流变性的影响。方法选择ASAⅠ～Ⅱ,拟在硬膜外麻醉下行择期腹部手术的成年高血压病人15例,在麻醉前、麻醉后30min、术毕时、术后24h、48h、72h分别采集肘静脉血5mL,用FASCO-3010型全自动血流变快测仪检测高切全血粘度(Hnb)、低切全血粘度(Lηb)、全血还原粘度(ηr)、血浆粘度(ηp)、红细胞聚集指数(EAI)、红细胞变形指数(TK)、红细胞刚性指数(ERI)等指标。结果麻醉前患者静脉血各项指标均高于正常值;麻醉后30min各项指标与麻醉前比较无明显变化;术毕时,Hηb、Lηb、ηr、ηp、EAI较麻醉前均明显降低,TK明显升高(P<0.05);术后24h时,ηp仍维持低水平,其余各指标呈升高趋势;72h时,Hηb、Lηb、ηr、ηp、EAI、ERI等指标高于术前。结论高血压患者在硬膜外麻醉期间血液粘度明显降低,是高血压患者实施手术治疗可选用的麻醉技术之一。     

全身麻醉对高血压病人围麻醉期血液流变性影响的临床研究

目的探讨全身麻醉对高血压病人围麻醉期间血液流变性的影响。方法选择ASA Ⅰ-Ⅱ级,拟在气管插管全身麻醉下行腹部择期手术的成年高血压病人15例,在麻醉前、麻醉后30min、术毕麻醉苏醒时、术后24h、48h和72h分别采集肘静脉血5mL,用FASCO-3010型全自动血流变快测仪检测其高切全血粘度(Hηb)、低切全血粘度(Lηb),全血还原粘度 (ηr)、血浆粘度(ηp)、红细胞聚集指数(EAI)、红细胞变形指数(TK)、红细胞刚性指数(ERI)等指标。结果麻醉前患者静脉血各项指标均明显高于正常值范围;麻醉后30min时,Hηb、Lηb、ηr、ηp、EAI及TK值明显降低(P<0．05);术毕麻醉苏醒时Hηh、Lηh、ηr、EAI及TK开始升高,与麻醉前比较升高无显著性差异。结论高血压病人在全身麻醉期间血液粘度明显降低,有利于高粘滞血症并发症的预防。     

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.