氧化低密度脂蛋白与脑梗死血液流变关系的临床研究

目的　探讨脑梗死患者血浆氧化修饰低密度脂蛋白 (ox LDL)和血液流变学指标的变化及其相关关系。方法　用ELISA法检测 30例脑梗死患者和 30例健康对照者血浆ox LDL ;同时测定血液流变学指标 ,并对ox LDL与血液流变指标进行两者的相关分析。结果　脑梗死患者血浆ox LDL浓度明显高于对照组 (P <0 .0 0 1) ;血液流变学指标与正常对照组比较 ,高切全血黏度、低切全血黏度、血细胞比容和红细胞变形指数均有显著差异性 (P <0 .0 5 ,P <0 .0 1或P <0 .0 0 1) ;脑梗死患者血浆ox LDL浓度与血流变异常指标呈正相关 (P <0 .0 5或P <0 .0 0 1)。结论　血浆ox LDL与血液流变学检测对脑梗死的诊断和治疗效果的估计均有意义     

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。     

脑血栓形成患者血液流变学分析

目的　探讨湛江市男女脑血栓形成患者血液流变学的特点。方法　常规检测脑血栓形成患者各项血液流变学指标 ,并设正常对照组。结果　男性脑血栓形成患者血液流变学指标 :EPT、K值、ESR、ηb、ηp、FAD、L、MW、DW与对照组比较差异非常显著 (P <0 .0 1) ;女性脑血栓形成患者血液流变学指标 :FIB、FAD、L、MW、DW与对照组比较差异非常显著 (P <0 .0 1)。结论　湛江市男女脑血栓形成患者血液流变学异常特征基本一致 ,但引起的原因不完全相同。     

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.     

平均血小板容积、纤维蛋白原含量及血液流变学在青年脑梗死患者外周血中的变化

本研究旨在探讨平均血小板容积(MPV)、纤维蛋白原(FIB)含量及血液流变学改变与青年脑梗死患者梗死体积的相关性,为其临床早期诊断和治疗提供依据。根据头部CT或MRI病灶大小及神经功能受损程度将我院109例脑梗死患者(18-45岁)分为大梗死组(梗死体积>10 cm3)、中梗死组(梗死体积4-10 cm3)、小梗死组(梗死体积<4 cm3),30例健康查体正常人作为对照组,进行MPV、FIB及血液流变学指标检查,包括:全血黏度低切(Lηb)、全血黏度中切(Mηb)、全血黏度高切(Hηb)、血浆黏度值(ηP)、全血还原黏度低切(Lηr)、全血还原黏度中切(Mηr)、全血还原黏度高切(Hηr)、血沉方程K值(KVE)、红细胞积聚指数(EAI)、红细胞刚性指数(ERI)、红细胞变形指数(EDI)、红细胞电泳指数(EEI)、红细胞比容、血沉,共计16项指标。结果表明:各组脑梗死患者MPV、FIB含量和血液流变学指标均高于健康对照组(P<0.05);大梗死组MPV、FIB含量和血液流变学指标均高于小梗死组(P<0.05);各组脑梗死患者在病程恢复期MPV、FIB含量和血液流变学指标均有明显下降,但未达到健康对照组水平(P<0.05)。脑梗死体积与MPV、FIB含量及血液流变学水平呈正相关(r=0.36,0.29,0.48)。结论:青年脑梗死病情的严重程度与MPV、FIB及血液流变学水平密切相关,定期检查上述指标对预防青年脑梗死很有价值。     

吸入液氧对海拔3 700m高原人体力竭运动后血液流变学的影响

目的观察吸入液氧对高原人体力竭运动血液流变学的影响.方法对进驻海拔3 700m高原3个月的10名健康青年在吸入液氧(吸氧组,4L/min)和不吸液氧(对照组)的条件下,采用功率自行车进行递增负荷运动,并在安静时,运动后测定红细胞压积(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)和血栓形成系数(TFL)等血液流变学指标.结果运动后吸氧组较对照组HCT、ηb、ηp、ηr、TK、IR、VAI、TFL均降低(P<0.01).结论吸入液氧能延长供氧时间,加快运动机体血液流变学各指标的恢复,可能是运动后疲劳消除的重要方法之一.     

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.     

氢化考地松对脂肪栓塞综合征血液流变性影响的实验研究

目的　探讨氢化考地松对脂肪栓塞综合征血液流变性的影响。方法　应用血液流变学检测技术,测定了治疗组、未治疗组和对照组的全血粘度(ηb)、血浆粘度(ηp)、红细胞压积(Ht)、校正全血粘度(ηb′)、红细胞聚集指数(EAI)、及血小板和纤维蛋白原等各项指标,并对三者进行比较。结果　(1)治疗组血小板、纤维蛋白原指标保持比较稳定的水平,而未治疗组则表现为血小板减少和纤维蛋白原增高。未治疗组血小板计数与对照组比较有显著差别(P <0 .0 1) ,未治疗组与治疗组比较有显著性差异(P <0 .0 1)。未治疗组纤维蛋白原指标与对照组比较有显著性差异(P <0 .0 5 ) ,未治疗组与治疗组比较有显著性差异(P <0 .0 1)。(2 )治疗组、未治疗组及对照组三组间ηb无显著差异(P >0 .0 5 )。经校正后,治疗组与对照组间ηb′仍无显著性差异(P >0 .0 5 ) ,而未治疗组与治疗组、对照组比较:未治疗组ηb′显著增高(P <0 .0 5或P <0 .0 1)。(3)治疗组与对照组比较,ηp、Ht、EAI均无显著差异(P >0 .0 5 )。未治疗组与对照组、治疗组比较,ηp、EAI显著增高,Ht显著下降(P <0 .0 5或P <0 .0 1)。结论　FES血液多呈高粘滞状态,其原因是纤维蛋白原含量增高和血小板的聚集破坏所致     

术后早期自控镇痛对老年髋关节置换患者血液流变性的影响

目的探讨术后48小时内患者自控镇痛(Patient-controlled analgesia,PCA)对老年髋关节置换患者血液流变性的影响。方法选择65～75岁、ASAⅠ-Ⅱ级、腰麻下行髋关节置换患者120例,采用随机数字表法分为PCA组和对照组(C组),每组60例。PCA组患者术毕实施48 h PCA。于腰麻前(T1)、术毕(T2)、术后6 h(T3)、术后24 h(T4)、术后48 h(T5)采集静脉血液,检测高切变率全血黏度(Hηb)、低切变率全血黏度(Lηb)、血浆黏度(ηp)、全血还原黏度(ηr)、红细胞聚集指数(EAI)、红细胞刚性指数(ERI);记录T1-5无创血压、心率,T2-5VAS评分。结果最终纳入85例患者。与T1比较,PCA组中Hηb、Lηb、ηp、ηr在T3～5时点明显降低,EAI及ERI在T5时点明显降低(P 0. 05)。与C组比较,PCA组Hηb、Lηb、ηp、ηr、EAI及ERI在T5明显降低,Lηb在T4时也明显降低(P 0. 05)。PCA组收缩压(SBP)、舒张压(DBP)在T3～5时点低于T1(P 0. 05); PCA组SBP、DBP在T3、T4时点低于C组(P 0. 05)。C组心率(HR)在T3～5时点高于T1,在T3、T4高于PCA组(P 0. 05)。PCA组T3～5时点VAS评分低于C组(P 0. 05)。结论术后早期PCA可改善髋关节置换老年患者血液流变性,降低血液黏度。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.