湖北省恩施侗族健康成人血脂水平调查

目的分析恩施侗族的健康成人血脂4项包括血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平。方法以2009~2013年在恩施州宣恩县人民医院健康体检的侗族人群作为研究对象进行横断研究,分别检测TG、TC、HDL-C、LDL-C 4项血脂指标,运用t检验比较该地区不同年龄组及性别的血脂水平差异。结果2009~2013年健康体检的7 632例恩施侗族人,不同年龄组TG、TC、HDL-C、LDL-C 4项指标存在明显差异,其中20~40岁年龄组TC均值为(4.59±0.82)mmol/L,TG为(1.49±0.54)mmol/L,HDL-C为(1.41±0.31)mmol/L,LDL-C为(2.49±0.72)mmol/L,均低于40~60岁及60岁及以上人群;男性4项血脂指标中TC、TG、LDL-C显著高于女性组(P0.05),而HDL-C指标低于女性(P0.05)。结论恩施侗族健康人群的血脂水平间存在明显差异,其均值与年龄和性别密切相关。     

阿坝州1231例藏族人群血脂参考值调查

目的建立阿坝州藏族健康成人血脂4项参考值，促进临床对血脂指标的科学运用。方法总胆固醇（TC）、三酰甘油（TG）采用氧化酶-终点法，高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆目醇（LDL-C）采用直接一步法，均在日立7080型全自动生化分析仪上进行测定。结果TC：男性（4．97±0．90）mmol／L，女性（4．59±0．80）mmol／L；TG：男性（1．70±0．29）mmol／L，女性（1．65±0．31）mmol／L；HDL-C：男性（1．31±0．24）mmol／L，女性（1．30±0．24）mmol／L；LDL-C：男性（2．88±0．75）mmol／L，女性（2．79±0．71）mmol／L。结论阿坝州藏族人群血脂水平明显高于其他地区，且不同年龄、性别，不同地区和民族的血脂参考值也有差异。     

石家庄市4755例公务员血脂流行病学调查

目的通过研究4 755例公务员的血脂情况,探讨我市公务员血脂异常分布及处理对策,为公务员人群冠心病的一级预防提供依据。方法选择在我院体检的公务员4 755例,采用酶法-终点法检测其血脂水平并进行分析。结果男性20~40岁年龄组的总胆固醇(TC)及甘油三酯(TG)平均值最高,分别为(5.9±6.2)mmol/L、(2.4±3.7)mmol/L,女性>60~70岁年龄组的TC、TG平均值最高,分别为(5.8±1.0)mmol/L、(1.7±1.0)mmol/L;60岁以前男性TG明显高于女性,而60岁以后女性高于男性;男性以TG升高为主(35.7%),女性以TC升高为主(36.3%)。结论我市公务员血脂异常人群主要分布在20~40岁男性,>50~70岁女性,应加强对这一人群的宣传教育,预防心血管疾病的发生。     

高校离退休职工血脂、血糖和血尿酸水平的分析

目的通过高校离退休职工血脂、血糖和血尿酸水平的分析,掌握其健康状况,为防病、治病提供重要依据。方法选择678例离退休职工,将其按年龄分55~〈65岁组、65~〈75岁组、≥75岁组进行分析。空腹抽取静脉血,使用日立7060型全自动生化分析仪检测三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血浆葡萄糖（FPG）及尿酸。结果 55~〈65岁组男性TG、FPG水平最高,分别为（1.86±1.91）mmol/L、（6.06±1.66）mmol/L;65~〈75岁组女性TC、LDL-C水平最高,分别为（6.03±1.08）mmol/L、（3.57±1.02）mmol/L;≥75岁组男性尿酸水平最高,为（306.55±87.42）μmol/L。女性TG、TC、HDL-C、LDL-C平均水平略高于男性,差异无统计学意义（P〉0.05）,男性FPG、尿酸平均水平明显高于女性（P〈0.05）。男性FPG、HDL-C异常率均明显高于女性,差异有统计学意义（P〈0.05）。女性TC、LDL-C异常率明显高于男性（P〈0.05）,男、女性TG、尿酸异常率的差异无统计学意义（P〉0.05）。结论高校离退休人员血脂、血糖水平及异常率高于其他人群,应加强该人群的健康教育和疾病干预。     

汕头市农村地区人群血脂水平调查

目的 了解汕头市农村地区人群的血脂水平及血脂异常发生率。方法 将汕头澄海区某乡村民共1333人，其中男性576人，女性757人，年龄从17～85y分为三个年龄组，每年龄组中再分为男女性两组，进行血脂四项测定，并统计人群的血脂水平及血脂异常发生率，并和其它地区进行比较。结果汕头市农村地区人群总胆固醇（TC）平均为4．86mmol／L，三酰甘油（TG）平均为1．36mmol／L，高密度脂蛋白胆固醇（HDL-C）平均为1．40mmol／L，低密度脂蛋白胆固醇（LDL-C）平均为2．89mmol／L。全体人员血脂异常比率为33％，其中（男性32％，女性34％）。血脂水平和异常比率：女性随年龄升高而升高，50y以后女性高于男性；男性到50y以后有所下降，男性高脂血症有年轻化现象，50y以前男性血脂水平高于女性，和其它农村地区人群血脂水平的对比，汕头农村地区人群血脂水平低于顺德地区高于鄣武县，和城市人群比较，人群血脂水平差异不明显。结论各地区应根据年龄、性别建立自己的参考范围，建议在农村进行广泛医疗健康教育，提高人们的保健意识，调整饮食结构，纠正不良饮食习惯。     

梧州市区2773例健康体检者血脂检测与分析

目的了解梧州市区部分健康人群血脂现状及血脂异常情况,为临床血脂异常的防治提出有效建议。方法总胆固醇（TC）、三酰甘油（TG）采用氧化酶法测定,高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）采用直接法测定。均在日立7170S型全自动生化分析仪上进行检测。结果受检人群血脂水平随年龄增加而升高。TC和LDL-C51岁以后女性高于男性;TG60岁以后女性高于男性;HDL-C各年龄组女性均高于男性。总体上血脂异常检出率从高到低依次为TG、TC、LDL-C、HDL-C。结论梧州市区人群血脂水平异常与年龄、性别有关,应建立合理的生活和饮食习惯,降低动脉粥样硬化性心脑血管疾病的发病风险。     

西安地区1 106例体检人群血脂水平分析

目的调查西安地区人群血脂水平和血脂谱现状，为血脂水平划分和血脂异常防治提供客观依据。方法选取西安地区1106例体检人群为调查对象，男性615例，女性491例，分为青年组（18～39岁）、中年组（40～49岁）、老年前期组（50～59岁）及老年组（60岁以上）共4纽。按血脂测定标准化方法测定总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDI，）和低密度脂蛋白胆固醇（LDL）4项血脂水平。结果TC升高比例较小，男女分别为1．6％、1．2％，但是TC边缘升高占有较大比例，分别为12．5％和10．0％。男性最高为中年组，女性最高为老年组。TG男性明显高于女性，男性最高为中年组，女性最高为老年前期组。HDL女性总体高于男性。LDL男性高于女性。调查结果显示，血脂谱异常以高TG和低HDL血症为主，男性分别为17．7％和24．2％，女性分别为6．5％和7．9％，男性高于女性。结论按异常发生率10％估算，西安城市居民男性TC、TG、HDL、LDL安全水平可能以〈5．34、〈2．75、〉0．92、〈3．72mmol／L为宜，女性TC、TG、HDL、LDI。安全水平可能以〈5．23、〈1．96、〉1．08、〈3．61mmol／L为宜。西安当地居民血脂异常水平在全国处于中等水平，并且有年轻化的趋势，应当引起足够的重视。     

绍兴市区9929名健康体检人群血脂水平分类及分型的统计

目的：分析绍兴市区人群血脂水平分类及分型特征。 方法：收集2004～01／2005-12在绍兴文理学院附属第一医院接受健康体检的绍兴市区人群9929名的血脂资料（男／女：5314／4615，年龄20～96岁），按年龄分为青年组（20～39岁）、中年组（40～49岁）、老年前期（50～59岁）及老年（60岁以上）4组。按中国“血脂异常防治建议”并参考美国“ATPⅢ指南”将所有数据进行血脂分类及分型并分析，具体标准：总胆固醇以5．2～5．69mmol／L为边缘性增高，〉5．7mmol／L为高总胆固醇血症；三酰甘油以1．7～2．26mmol／L为边缘性增高，〉2．26mmol／L为高三酰甘油血症；高密度脂蛋白胆固醇以〈1．03mmol／L为低水平、1．03～1．54mmol／L为合适水平，1．55mmol／L以上为高水平。 结果：①总胆固醇水平：4个年龄组中超过合适水平者基本都在30％以下，只有老年女性达到了34％。他们中约15％可以诊断为高胆固醇血症，老年女性高胆固醇血症者比例达到19．2％。（砻三酰甘油的分布：在0．56mmol／L以下者约为5％；在1．13mmol／L以下者约为35％，在1．69mmol／L以上者各组约为35％，〉2．26mmol／L者约为17％。③总胆固醇、三酰甘油都在合适范围者青年组为49％，中年组和老年前期组约为47％，老年组约为44％；从高血脂分型来说，不论是边缘性增高或明确的高血脂都是高三酰甘油略多与高总胆固醇。④高密度脂蛋白胆固醇：低水平的分布频率在各组中大致为4％，在60岁以下人群中女性（4．3％）略高于男性（3．9％），而在老年人中则相反（男性4．1％，女性3．1％）；高水平者在各组男性和女性人群中约为60％，但在老年女性中高达71．5％；高高密度脂蛋白胆固醇多见于高三酰甘油者（男性16．1％，女性15．2％），而低高密度脂蛋白胆固醇则多见于三酰甘油边缘性增高型（男性15．0％，女性13．1％）。 结论：绍兴市城区人群血脂异常处于一个较高的水平（异常者已达1／2），并且有年轻化的趋势（青年人中也达到了约50％）。     

北京地区13 336例成人空腹血脂水平分析

目的 通过检测健康查体者空腹血脂水平来了解北京地区人群血脂水平现状及其血脂异常患病率.方法 应用日立7 170全自动生化分析仪检测北京地区13 336例成人空腹血脂,血脂指标包括甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),比较不同性别和年龄组间血脂水平差别及血脂异常患病率的差异.结果 总体血脂异常患病率59.9%,男性71.6%,女性47.2%.男性TC平均(4.89±0.87)mmol/L、LDL-C平均(3.33±0.84)mmol/L、HDL-C平均(1.28±0.30)mmol/L、TG中位数1.32 mmol/L;女性TC平均(4.79±0.94)mmol/L、LDL-C平均(2.99±0.89)mmol/L、HDL-C平均(1.53±0.34)mmol/L、TG中位数0.9mmol/L.男性和女性4种血脂成分异常患病率均随年龄增加而增高(P＜0.01).TC、LDL-C、TG水平随年龄增加而增高(P＜0.01),HDL-C水平随年龄的增加有降低趋势(P＜0.01).TC在25～44岁间男性高于女性(P＜0.01),在55岁以上女性显著高于男性(P＜0.05).LDL-C在18～44岁间男性高于女性(P＜0.01),在45～74岁女性显著高于男性(P＜0.01).HDL-C水平各年龄组女性明显高于男性(P＜0.01).TG在18～54岁男性显著高于女性(P＜0.01),在55～64岁组两性间无差异,64岁以上女性高于男性(P＜0.05).结论 北京地区成人中血脂异常患病率较高,并且随年龄增大而增高,男女性别间血脂异常患病率差异有统计学意义.     

360例职工体检血脂、血糖、血尿酸、血常规结果分析

目的调查360例职工体检者血脂、血糖、血尿酸(UA)和血常规的水平,为临床制定合理的预防心脑疾病、痛风和糖尿病的措施提供参考依据。方法对360例体检者的检查结果进行整理分析,按性别、年龄分为青年组(26～40岁)、中年组(40～50岁)、中老年组(50～60岁)、老年组(≥60岁)共4组。比较各组血脂、UA、血糖的水平。按性别分组,比较男性和女性的贫血率和白细胞减少率。结果男性总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)的总体水平均高于女性,高密度脂蛋白胆固醇(LDL-C)的总体水平男性低于女性。除老年组外,各年龄组男性UA水平均高于女性。体检职工空腹血糖(FPG)水平较高,男性总均数为6.6mmol/L,女性为5.8mmol/L。男性血脂、UA和FPG异常检出率均高于女性。贫血检出率女性高于男性。结论血脂、UA和血糖的防治应以男性和更年期以后的女性为重点,干预其生活方式和饮食,对于预防心血管疾病、痛风和糖尿病有重要意义。     

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.