幽门螺杆菌与不典型增生相关性的初步研究

目的：初步探讨幽门螺杆菌与不典型增生的相关性。方法：应用ＣＬＯ－ｔｅｓｔ、组织学和分子生物学该当联合检测６５例胃粘膜活检标本中ＨＰ感染。结果：不典型增生中ＨＰ的检出率显著高于正常组,ＨＰ感染与患者年龄、性别无关。结论：ＨＰ可能在从浅表性胃炎→肠化生→不典型增生→胃癌的发生过程中起一定作用。     

幽门螺杆菌对胃癌发生的影响

目的：探讨幽门螺杆菌感染与胃癌患者之间的关系。方法：对６１３例胃镜检查患者的结果和幽门螺杆菌（ＨＰ）感染情况进行回顾性研究。结果：慢性胃炎、萎缩性胃炎,、肠化生、不典型增生及胃癌的ＨＰ感染率不同,ＨＰ感染率在慢性胃炎－萎缩性胃炎－肠化生－胃癌这一模式中呈逐渐增高的趋势。说明ＨＰ感染与胃癌的发生密切相关。     

幽门螺杆菌感染与胃癌前病变的关系

目的：研究幽门螺杆菌（ＨＰ）感染与胃癌前病变的关系。方法：回顾性分析了５２１６例因上消化道症状做胃镜患者的ＨＰ检测及胃粘膜病理学检查结果。结果：ＨＰ总检出率为４５．８％,萎缩性胃炎、肠化生及异型增生的ＨＰ检出率显著高于ＨＰ总检出率（Ｐ＜０．０５）,上述３种胃癌前病变之间ＨＰ检出率无显著差异,ＨＰ阳性患者３种癌前病变的发生率显著高于ＨＰ阴性患者（Ｐ＜０．０１）,萎缩性胃炎和肠化生的发生年龄亦显著提早;ＨＰ阳性患者在３种癌前病变的程度上与ＨＰ阴性患者无显著差异（Ｐ＞０．０５）,随着病变程度的加重,ＨＰ检出率逐渐下降;ＨＰ阳性患者的肠化类型与ＨＰ阴性患者无显著性差异（Ｐ＞０．０５）。结论：ＨＰ感染与胃癌前病变密切相关,ＨＰ感染主要作用于癌前病变的起始阶段。     

幽门螺杆菌感染与胃粘膜病变的关系

幽门螺杆菌 (ＨＰ)感染与胃粘膜病变的关系已引起人们的重视。我们对本院近年来胃镜检查病人 ,按胃粘膜病变情况分为 :浅表性胃炎 (ＣＳＧ)组、萎缩性胃炎 (ＣＡＧ)组、肠化生组、不典型增生组、胃癌组。回顾分析比较各组ＨＰ感染率 ,探讨ＨＰ感染对胃粘膜病变发展直至胃癌过程的影响及临床意义。1　对象方法4 99例病人均经胃镜及病理学检查确诊。ＣＳＧ组 2 30例 ,男性 12 6例 ,女性 10 4例 ,年龄 16～ 69岁 ,平均 4 3.7岁 ;ＣＡＧ组 92例 ,男性 4 2例 ,女性 50例 ,年龄 2 5～ 75岁 ,平均 4 1.3岁 ;肠化生组 35例 ,男性 16例 ,女性 19例 ,…     

幽门螺杆菌感染与胃癌前病变的关系研究

目的：探讨由门螺杆菌(HP)感染与胃癌的相关性。方法：全部病例做胃镜检查时钳取胃粘膜组织，送病理组织检查有无肠化生、胃粘膜萎缩和不典型增生。同时在胃窦部距幽门5cm内取活检1块，作快速尿素酶试验，判断有无幽门螺杆菌(IIP感染。结果：其中由门螺杆菌(HP)感染组有310例发生癌前病变，发生率为21．8％；而无由门螺杆菌(HP)感染组发生癌前病变206例，发牛率为18．0％，两者比较有显著性差异(t＝2.39，P＜0.05).     

幽门螺杆菌感染与胃癌癌前病变的关系初探——附2563例检测结果

目的：探讨幽门螺杆菌（Ｈｐ）与胃癌癌前病变的关系。方法：分析了２５６３例做胃镜检查患者的胃粘膜病理组织检查和尿素酶试验结果。结果：共检出Ｈｐ阳性１４１９例（５５．４％），Ｈｐ感染时肠化生、胃粘膜萎缩和不典型增生的胃癌癌前病变发生率分别为１７．５％、８．２％和４．４％，显著高于无Ｈｐ感染１１４４例的１４．２％、４．８％和３．０％（Ｐ＜０．０１，＜０．０１，＜０．０５）。Ｈｐ感染组癌前病变发生的年龄为（４１±１０）岁，小于无Ｈｐ感染组的（４３±１２）岁（Ｐ＜０．０１）。结论：早年感染Ｈｐ使肠化生、胃粘膜萎缩和不典型增生的发生率升高，Ｈｐ感染可能是胃癌的发病原因之一。     

幽门螺杆菌感染与肠上皮化生的关系

对５２５例胃疾病患者行病理及幽门螺杆菌（ＨＰ）检查，ＨＰ阳性者３１０例，占５９．１％，有肠化生者１２７，占２４２％，二者的发生率随增龄而增加（Ｐ＜０；００５）。ＨＰ阳性组肠化生比阴性组更常见，分别为２８．４％和１８．１％（Ｐ＜０．０１），ＨＰ阳性的肠化生患者平均年龄明显低于ＨＰ阴性者。提示ＨＰ感染是肠化生发生的一个重要危险因素；肠化生与肠型胃癌有密切关系     

胃粘膜病变患者幽门螺杆菌感染与癌基因表达的关系

探讨幽门螺杆菌感染ｒａｓ原癌基因产物ｐ；２１蛋白和ｐ５３癌基因产物突变型ｐ５３蛋白表达的关系。方法：应用免疫组织化学方法，检测慢性浅表性胃炎３０例，胃粘膜不全结肠型肠化生２５例，异型增生２９例，胃癌３７例的活检标本。     

萎缩性胃炎与幽门螺杆菌感染的组织病理学研究

为了探讨慢性胃炎从浅表到萎缩的演变过程中幽门螺杆菌（ＨＰ）感染的作用，本文对２８０例内镜诊断为慢性胃炎的胃窦粘膜活检标本进行了病理组织学和ＨＰ检测（培养、病理染色和快速尿素酶试验）结果的分析。结果显示，ＨＰ总检出率为６３２％（１７７例），其中正常粘膜、慢性浅表性胃炎（ＣＳＧ）、慢性萎缩性胃炎（ＣＡＧ）的阳性率分别为２６６％（４例），６０８％（１１５例）和７６３％（５８例），三组间比较差异有显著性（均Ｐ＜００１）。ＨＰ阳性率随增龄而增加，ＣＡＧ的比例及病变分级也随增龄而增大，年轻的ＣＡＧ患者伴ＨＰ感染较多。在ＨＰ感染的胃粘膜中，检出活动性胃炎１２１例（６８３％）、淋巴滤泡７８例（４４０％）、肠化生及不典型增生２９例（１６３％），三种病变与胃粘膜萎缩的关系非常密切。提示ＨＰ感染可促进ＣＡＧ的形成。     

幽门螺杆菌感染及PCNA表达与胃腺癌的相关性研究

目的 :探讨幽门螺杆菌感染及PCNA表达与胃癌发生的关系。方法 :对 183例手术切除或胃镜活检标本采用简易快速尿素酶反应检测HP感染情况 ,免疫组化采用SP法检测PCNA的表达强度。结果 :慢性浅表性胃炎 ,慢性萎缩性胃炎伴肠上皮化生、中重度不典型增生及胃癌的HP感染与PCNA表达的强度不同 ,均呈递增趋势 ,同时在慢性萎缩性胃炎伴肠上皮化生及中重度不典型增生组中 ,HP阳性患者PCNA表达显著高于HP阴性患者 ,两者比较差异有显著性(P <0 .0 5 )。结论 :HP感染的胃粘膜处于高增殖状态 ,可能具有较高的癌变易感性     

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.