系统性红斑狼疮抗活化的蛋白C研究

目的了解抗活化的蛋白C(APCR)在系统性红斑(SLE)患者中的发生情况,并进一步探讨SLE患者发生血栓的机制。方法采用APG-KPTT法,ELISA法和PTT-LA法分别对36例SLE患者及20例正常对照(NC)进行APCR、抗心磷脂抗体(ACA)和狼疮抗凝物(LA)检测。结果SLE患者APCR阳性率(58%)明显高于NC组(5%)(P<0.005),APCR阳性患者中血栓发生率(27.6%)明显高于APCR阴性患者(4.8%)(P<0.01),患者LA阳性率(22%)明显高于对照组(0/10)(P<0.05),患者ACA-IgG及IgM明显高于对照组(P<0.05),而IgA与对照组差异不显著(P>0.05),LA阳性组中的APCR阳性率(90.9%)明显高于LA阴性组(53.8%)(P<0.05),ACA阳性组中的APCR阳性率(64.7%)与ACA阴性组(60.6%)未发现明显相关性(P>0.05)。结论APCR在国人SLE患者中有较高的发生率且与LA有明显相关性。APCR可能是SLE患者诱发血栓的主要原因之一。     

静脉血栓的抗磷脂蛋白抗体与抗凝血、纤维蛋白溶解关系

为了探讨静脉血栓的病因病理及其与抗凝血、纤维蛋白溶解的关系 ,对 4 7例静脉血栓 (VT)患者用酶联免疫法检测抗心肌磷脂抗体 (ACA) ,用凝血法测定狼疮抗凝物 (LA)和抗活化蛋白C抗性 (APCR) ,用多聚酶链反应内切酶法鉴定因子VLeiden ,用发色底物法测定抗凝血酶Ⅲ (ATⅢ )、蛋白C(PC)、纤溶酶原 (Plg)、组织纤溶酶原激活物 (tPA)、组织纤溶酶原激活物抑制物 (tPAI)等抗凝血、纤维蛋白溶解活性。结果表明 :VT患者中 3 4 %有ACA和 (或 )LA阳性 ,其中以ACAIgG和LA为主 ;9.5 %的Plg缺乏 ,8.3 %的tPAI升高 (明显高于对照 ,P <0 0 0 5 ) ;ATⅢ、PC、tPA缺乏者依次为 4 .5 %、4 .5 %、2 .8% (与对照无差异性 ,P >0 .0 5 ) ;ATⅢ、PC、Plg联合缺乏者 1例 ;APCR未发现相应的factorVLeiden ;抗磷脂蛋白抗体 (APA)阳性和阴性组之间的各抗凝血和纤维蛋白溶解活性没有明显差异性 ;4例APCR阳性 ,3例ACA和 (或 )LA阳性 ,这 3例血浆和正常血浆混合后 2例APCR并没有完全得到纠正。结论 :抗磷脂蛋白抗体和纤维蛋白溶解异常是VT较多见的相关病理因素 ;LA和 (或 )ACA干扰蛋白C抗凝血途径 ,使之形成获得性APCR ,而此APCR可能是体内导致易栓的病因之一。     

糖尿病足患者血浆活化蛋白C抵抗、蛋白C和蛋白S活性的测定

目的探讨PC、PS活性的变化在糖尿病足形成中的作用和临床意义,以及APCR与糖尿病足形成的关系。方法采用Dahlback法对50例健康成年人(对照组)及60例糖尿病足患者(DF1、DF2组)进行APCR阳性率测定,同时测定受检者蛋白C(PC,)和蛋白S(PS)。结果糖尿病足(DF)患者血浆PC/PS活性下降与对照组有显著性差异。结论血浆PC/PS活性检测对糖尿病足患者的诊断、估计预后和疗效观察有参考价值,且APCR阳性者有动脉血栓发生的倾向。     

脑血栓患者活化蛋白C抵抗及Fg、AT-和PC的变化

本文对脑血栓患者 6 0例和健康人 30名研究其血中活化蛋白 C抵抗 (APCR)、纤维蛋白原 (Fg)、抗凝血酶 (AT- )和蛋白 C(PC)的变化。结果表明 ,患者 Fg含量、AT- 活性和 PC活性均高于对照组。而其 APCR发生率为 8.3%也高于对照组 ,表明脑血栓患者可能存在 APCR现象     

脑血栓患者活化蛋白C抵抗及Fg、AT-Ⅲ和PC的变化

本文对脑血栓患者60例和健康人30名研究其血中活化蛋白C抵抗(APCR)、纤维蛋白原(Fg)、抗凝血酶Ⅲ(AT-Ⅲ)和蛋白C(PC)的变化.结果表明,患者Fg含量、AT-Ⅲ活性和PC活性均高于对照组.而其APCR发生率为8.3%也高于对照组,表明脑血栓患者可能存在APCR现象.     

蛋白C抗凝系统与Perthes病的关系探讨

目的 探讨蛋白C抗凝系统与Perthes病的关系，论证“蛋白C抗凝系统缺陷是Perthes病的病因”。方法 采用全自动凝血分板仪检测28例Perthes病儿童及22例健康儿童的蛋白C(PC)、蛋白S(PS)、活化蛋白C抵抗(APCR)的活性。结果 Perthes病例组PC、PS、AFCR的阳性率分别为3．58％(1/28)、7．16％(2/28)、0％(0/8)，正常对照组为0％(0/22)、4．55％(1/22)、0％(0/22)，两组经统计学处理无显著性差异(P＞0．5)。结论 Perthes病与蛋白C抗凝系统无显著相关，蛋白C抗凝系统缺陷不是Perthes病的病因。     

血浆蛋白C、蛋白S在静脉血栓病人诊断及治疗中的应用

目的 检测静脉血栓形成(DVT)患者的血浆蛋白C(PC)和蛋白S(PS)活性水平，探讨它们对DVT患者诊断及治疗中的临床意义。方法 用凝固法在Coulter Acl-Futura-plus全自动血凝仪上检测30例DVT患者及24例正常对照组血浆PC、PS活性。结果 患者组治疗前与正常对照组对比较PC、PS均有极显著差异(P<0．01)。治疗后患者组与对照组比较PC、PS活性无显著差异(P>0．05)。结论 PC、PS活性测定对DVT病人的诊断及疗效观察有一定指导意义。     

下肢深静脉血栓形成患者抗凝蛋白缺陷的临床研究

目的：研究中国人群下肢深静脉血栓形成（IDVT）患者抗凝蛋白缺陷的发生率，探讨中国人群LDVT的主要发病机制。方法：应用ACLPutLlm型全自动血凝仪检测1幔）例LDVT患者（73例初发，27例复发）和100例健康人的抗凝血酶（AT）、蛋白S（PS）、蛋白C（PC）活性及活化蛋白C抵抗性（APCR）。结果：LDVT组与正常对照组相比、LDVT复发组与初发组相比，AT、PS、PC活性明显降低，APCR阳性率明显升高，均有极显著差异（P〈0．01）；本组100例LDVT患者中共有25例患者存在有抗凝蛋白缺陷，以PS缺陷的总发生率最高，为13％（13例），其次是PC缺陷，为8％（8例）；AT缺陷占5％（5例），APCR缺陷的总发生率最小，为4％（4例）。结论：先天性或获得性抗凝蛋白缺陷是中国人LDVT发病和复发的重要机制之一，因此有必要对LDVT患者进行抗凝蛋白水平的筛选。     

蛋白C抗凝系统在尿毒症维持性血液透析中的变化及意义

目的 :探讨血浆抗凝因子蛋白 C(PC)、蛋白 S(PS)及血栓调节蛋白 (TM)在尿毒症、凝血异常导致出血并发症中的作用。方法 :采用双抗夹心酶联免疫吸附法 (EL ISA)及发色底物法测定 4 5例尿毒症血液透析 (血透 )患者及正常对照组血浆 PC抗原 (PC:Ag)、PC活性 (APC)、血浆总 PS(TPS)、血浆游离 PS(FPS)及 TM含量。结果 :尿毒症患者 PC:Ag、TPS、FPS、TM和 D二聚体 (DD)含量及 APC明显高于正常对照组 (P<0 .0 5或P<0 .0 0 1) ;维持性血透患者血浆 APC、TPS、FPS及 DD血透后明显升高 (P<0 .0 5或 P<0 .0 0 1) ;TM血透后明显降低 (P<0 .0 0 1) ;有出血并发症者血浆 PC:Ag、FPS、DD含量及 APC明显升高 (P<0 .0 5或 P<0 .0 1)。结论 :尿毒症患者蛋白 C抗凝活性降低 ,与尿毒症时高凝倾向和血栓形成有关。血透可激活原本已处于高凝状态的凝血系统 ,使体内蛋白 C抗凝途径的抗凝活性增强。     

血栓病患者凝血、抗凝和纤溶活性改变的研究

目的 观察血栓病患者凝血、抗凝和纤溶指标的变化,以探讨出凝血系统机能紊乱与血栓病发生的关系,并在此基础之上为以后临床筛查、确诊血栓病提供依据。方法 应用ACL Futrua全自动凝血仪对50例静脉血栓、51例动脉血栓病患者及36例正常人进行凝血、抗凝及纤溶系统蛋白分子检测,包括凝血因子Ⅱ、Ⅶ、Ⅷ活性测定,蛋白C（PC）、蛋白S（PS）、抗凝血酶（AT）、纤溶酶原（PLG）、α2-抗纤溶酶（α2-PI）活性测定,D-二聚体、纤维蛋白原含量测定及狼疮抗凝物（LA）、活化蛋白C抵抗（APCR）的检测。结果 LA阳性者,正常组中有4例,静脉组中有总16例,动脉组中有13例。PC系统缺陷在静脉血栓病组织中,共有14例,分别为PC缺陷8例（19.0%）、PS缺陷5例（11.5%）、APCR1例;动脉血栓组中,PC系统缺陷共11例,PC缺陷2例,PS缺陷7例、APCR2例。结论 获得性因素LA阳性和PC系统缺陷是引起血栓病的主要原因,建议对于血栓患者选这两项实验进行筛查,以提高检出率。     

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.     

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.