胰弹力蛋白酶I和核糖核酸酶检测的临床价值

目的　探讨人胰弹力蛋白酶Ⅰ (Humanpancreaticelastase 1 ,HPE1 )放射免疫测定 (Radioimmunoassay ,RIA)和核糖核酸酶(Ribonuclease ,RNase)活性检测的临床价值。方法　参照Satake等建立的改良HPE1RIA和Thomas等的改良酸溶性产物法检测 82例正常成年人和 2 2 2例各类患者血清并分析结果。结果　 82例健康成人HPE1值为 2 3.8( 3.4ng L) ,RNase活性为 5 7.0 3( 1 2 .1 6 μ ml) ;急性胰腺炎和胰腺癌HPE1 值明显高于其他疾病 (P <0 .0 1 )。联合检测HPE1 、RNase活性可提高胰腺癌的检出率 ( 92 .47% )。结论　HPE1 RIA对急性胰腺炎有诊断价值 ,联合检测HPE1 、RNase活性检测对胰腺癌诊断有一定的临床价值     

口服莫沙必利治疗功能性消化不良的随机对照试验

目的　观察新型促胃肠动力药莫沙必利 (胃 5 HT4受体促进剂 )对功能性消化不良 (FD)的随机对照试验。方法　FD患者 42例 ,随机分为试验组 (2 1例 ,服枸橼酸莫沙必利片 )和对照组 (2 1例 ,服吗叮啉片 )。采用GCP标准 ,双盲法观察 ,在实验开始前、服药第 1 4、2 8天记录症状变化及副作用发生情况。随机抽取部分患者于实验开始前和结束时做99MTc胃排空试验。结果　莫沙必利对FD症状的疗效与吗叮啉组相当 (P >0 .0 5 )。99MTc胃排空测定发现莫沙必利组治疗后的半排时间 (45 .0 5± 1 2 .2 1 )min缩短 ,1 2 0min残留率 (2 9.73%± 8.5 1 % )减少 (P <0 .0 5 ) ,两组病例未发现毒副反应。结论　莫沙必利对于FD疗效良好 ,对胃排空延迟有良好疗效 ,安全度高。     

关于建立非隶属关系附属医院的实践与思考

本文从医学人才培养的高度,论述高校与附属医院建立非隶属关系的附属医院的过程、体会和思考,指出目前存在的问题和解决途径.对进一步深化临床教育教学改革具有重要意义.     

Trading places. Two hospitals adjust to a sponsorship swap

On December 31, 1993, the Carondelet Health System transferred sponsorship of St. Joseph Hospital, Kirkwood, MO, to SSM Health Care System in exchange for SSMHCS's St. Mary's Hospital in Blue Springs, MO. Even though both systems and hospitals involved in the deal were Catholic, the hospitals' staffs had to adjust to cultural changes. After the letter of intent was signed at St. Joseph, the lines of communication were kept open throughout the transition. Assurances and explanations of the benefit program alleviated major tension and removed fears. Information on benefits became the essence of an employee newsletter that the hospital put out every few weeks. St. Mary's Hospital chief executive officer also placed a high value on communications. At St. Mary's, in answering employees' questions, administrators found uncertainty gave way to relief when they learned the hospital would remain Catholic and not-for-profit. Still, employees experienced a period of anxiety. Employees at both hospitals were more concerned about losing their jobs than they were about the transfer of sponsorship. Despite this uncertainty, employees at both hospitals feel the recent trade to another system has strengthened their position.     

Evaluation of [methyl-3H]L655,708 and [ethyl-3H]RY80 as putative PET ligands for central GABA(A) receptors containing alpha5 subunit

Two selective radioligands of gamma aminobutyric acid (GABA)A receptors containing the alpha5 subunit, [3H]L655,708 and [3H]RY80, were evaluated in rats as potential in vivo tracers for positron emission tomography (PET). Brain uptake index (BUI), a measure of first pass extraction, was moderate for [3H]L655,708 (BUI of 59%) and good for [3H]RY80 (BUI of 96%). This finding was consistent with their in vitro binding to plasma proteins of approximately 76% and 50%, respectively. Following intravenous injection of either radioligand, radioactivity in plasma was measured and uptake characteristics were assessed in brain within a time period relevant to PET scanning (up to 90 min). Discrete brain regions, such as frontal cortex, striatum, hypothalamus, thalamus, hippocampus, colliculi, medulla, and cerebellum, were sampled and the temporal distribution of radioactivity analysed. Despite the reasonable delivery to the brain, neither of the radioligands had sufficient retention in the tissues rich in alpha5-containing GABA(A) receptors to achieve a good selective signal. For both radioligands, a maximal tissue:cerebellum ratio of 1.5 was seen in hippocampus at 10 min after injection. Thus, neither of the compounds studied shows potential for further development as an in vivo PET ligand.     

MRI in patients with intraspinal bullets

The purpose of this study was to determine whether neurologic sequelae occur in patients with intraspinal bullets or bullet fragments who undergo magnetic resonance imaging (MRI). Nineteen patients with bullets or bullet fragments adjacent to the cord or nerve roots underwent clinical MRI studies at 1.5 T. Sequences included conventional spin echo, fast spin echo, gradient-recalled echo, and inversion recovery. Patients were queried during scanning for symptoms of discomfort, pain, or change in neurologic status. Detailed neurologic examinations were performed prior to MRI (baseline), post MRI, and at the patients' discharge. Sixteen patients were completely paralyzed (ASIA-A), and three were not paralyzed. The length of time from injury was 2-24 months. No patients experienced pain or discomfort during the procedure. No change in neurologic status occurred. Follow-up radiographic studies showed no bullet movement following the scanning. We conclude that in patients with complete spinal cord injury, MRI in patients with intraspinal bullets may be performed.