血清中尿酸和胆红素与冠心病的关系

目的：探讨冠心病患者血清中尿酸、胆红素、低密度脂蛋白胆固醇浓度与冠心病的关系。方法：选取156例冠心病患者，检测血清中尿酸、总胆红素、间接胆红素和低密度脂蛋白胆固醇浓度，并选取138例健康体检者作对照组进行比较。结果：冠心病组血清总胆红素、间接胆红素明显低于对照组（P〈0．01）。低密度脂蛋白胆固醇、尿酸明显高于对照组（P〈0．01）。结论：低血清胆红素水平和高尿酸水平与冠心病密切相关。     

血清胆红素测定在冠心病中的临床意义

目的探讨冠心病（CHD）患者血清胆红素测定的意义。方法测定144例冠心病患者和100例健康对照组血清胆红素的含量并进行对比分析。结果冠心病患者组血清总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）浓度均低于健康对照组,差异有统计学意义（P〈0.05）。结论血清胆红素是防止冠心病的有效物质,检测胆红素水平对冠心病患者有重要意义。     

血清胆红素浓度与冠心病的关系探讨

目的探讨血清胆红素浓度变化与冠心病之间的关系。方法采用全自动生化分析仪,检测经选择性冠状动脉造影确诊的120例冠心病患者及经体检证实健康者100例(为对照组)的空腹血清总胆红素、直接胆红素浓度。结果血清胆红素浓度明显低于对照组(P<0.01)。结论血清胆红素浓度下降可能在冠心病的发病中具有一定的作用,血清胆红素浓度与冠心病发生的危险性呈显著负相关。     

冠心病与血清胆红素相关分析

目的：探讨冠心病患者血清胆红素指标的变化特征。方法：选取100例经临床确诊的冠心病患者为观察组,100例健康体检者为对照组,采用全自动生化仪检测血清胆红素浓度。结果：观察组总胆红素、直接胆红素、间接胆红素水平明显低于对照组（P〈0.01）。结论：血清胆红素浓度降低是冠心病发病的重要危险因素之一,测定血清胆红素水平对预防冠心病的发生有一定的临床价值。     

冠心病患者血清尿酸和胆红素测定结果分析

[目的]探讨血清尿酸（UA）、胆红素（BIL）与冠心病（CHD）的关系。[方法]选择206例冠心病患者（冠心病组），其他疾病组203例、104例健康体检者（对照组），测定血清尿酸和胆红素浓度并做结果分析。[结果]冠心病组血尿酸水平显著高于对照组（P〈0．01），总胆红素显著低于对照组（P〈0．01），差异有统计学意义。[结论]高水平UA、低血清BIL水平可能是CHD的危险因素之一，通过血清UA、BIL的综合测定，可间接评估患者冠状动脉病变的严重程度。     

血清胆红素浓度与冠心病相关性研究

目的：探讨血清胆红素（Bil）浓度水平与冠心病（CHD）的关系。方法：检测90例CHD患者和90例正常人血清总胆红素（TBil）及直接胆红素（DBil）并计算间接胆红素（IBil），并对两组结果进行比较。结果：CHD组血清TBil、DBil、IBil（TBil-DBil）水平均降低与正常对照组，二者比较差异均有统计学意义（P〈0．05）。血清胆红素（Bil）浓度水平与冠心病（CHD）呈显著负相关。结论：血清低Bil水平与动脉粥样硬化（AS）密切相关可能是导致CHD的重要因素。     

冠心病患者超敏C反应蛋白及总胆红素检测的临床意义

目的探讨冠心病（CHD）患者血清总胆红素及超敏C反应蛋白（hs-CRP）测定的临床意义。方法 60例冠心病患者及健康对照60例,用钒酸盐氧化法测定总胆红素,用透射比浊法测定hs-CRP浓度并做结果分析。结果冠心病患者血清总胆红素水平与健康对照组相比降低（P〈0.05）,hs-CRP水平与健康对照组相比增高（P〈0.01）。结论血清总胆红素与冠心病的发生率呈负相关;血清C-反应蛋白与冠心病的发生率呈正相关。     

血清总胆红素与冠心病相关性研究

目的：研究血清总胆红素水平与冠状动脉粥样硬化的关系。方法：选择住院冠心病患者90例（病例组）及同期来我院体检的96例（对照组）进行血清总胆红素的测定,并进行统计学分析。结果：与对照组比较,病例组血清总胆红素水平低（P〈0.01）,两组在不同血清总胆红素浓度的构成比不同,病例组低浓度比例高于对照组（P〈0.01）,高浓度比例低于对照组（P〈0.01）。结论：低浓度血清总胆红素水平与冠心病的发病有密切相关。     

老年冠心病患者血清胆红素水平的变化

目的：探讨老年人群血清胆红素水平与冠状动咏病变程度的关系。方法：对163例经选择性冠状动脉造影（CAG）明确诊断为冠心病的患者（冠心病组）和 105例经CAG证实无冠状动脉狭窄的患者f对照组）测定血清总胆红素（Bill—T）、直接胆红素（Bili—D）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL—C），并计算间接胆红素（Bili-I）水平。结果：冠心病组血清Bili- T、Bili—I水平及HDL—C明显低于对照组（P〈0．05或P〈0．01），而LDL．C水平在冠心病组明显高于对照组（P〈0．01），但冠脉狭窄范围和程度与胆红素水平无明显关联（P〉0．05）。急性冠脉综合征时胆红素水平显著升高（P〈0．05）。结论：血清胆红素水平降低可能在冠心病发病中具有一定的作用。[著者文摘]     

冠心病患者各类血清脂质和血胆红素检测指标分析

目的：分析冠心病患者的各类血清脂质与血胆红素指标变化特征。方法：选择近期在我院就诊冠心病患者81例,45例同龄、同性别健康体检者为对照组,两组对象分别接受了血清脂质和各类血胆红素浓度检测。结果：冠心病患者的血清总胆红素、直接总胆红素、间接总胆红素和高密度脂蛋白浓度均明显低于对照组,而血总胆固醇、甘油三酯和低密度脂蛋白浓度均明显高于后者（P均〈0.01~0.05）。结论：冠心病患者存在着明确的血清脂质与血胆红素各项指标异常。     

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.