包头地区8000例育龄妇女TORCH监测数据分析

目的了解包头地区育龄妇女TORCH感染情况及其流行特点。方法采用酶联免疫吸附试验(ELISA)对包头医学院第一附属医院2013-01—2014-12 8 000例育龄妇女血清进行TORCH(TOX、RV、CMV、HSVⅠ和HSVⅡ)IgM和IgG检测。结果育龄妇女TORCH感染率为7.4%,感染率最高为RV,其次是CMW和HSV。TORCH检测感染率分别为RV占3.11%,CMV占0.91%,HSVⅠ和Ⅱ分别占0.17%和0.24%,TOX的感染率最低占0.03%,除TOX和HSV IgG阳性率较低,其余的阳性率均高于90%。在≤30岁年龄段的育龄妇女中,TORCH各病原体的IgM抗体阳性率普遍较高,RV IgM、TOX、CMV和HSV IgM的阳性率存在年龄差异。TORCH IgG阳性率普遍存在着随其年龄的增长呈现升高趋势,TOX和RV IgG阳性率的年龄段间存在显著性差异。TORCH的感染类型中单项感染357例,复合感染190例。结论包头市育龄妇女人群中存在一定比例的TORCH感染现状及较低RV IgG阳性率,建议育龄妇女孕前应进行TORCH筛查,以便尽早采取相应措施,避免由TORCH感染导致出生缺陷婴儿的发生。     

深圳市罗湖区育龄男女优生十项(TORCH)筛查结果分析

目的分析本地区育龄男女优生十项(TORCH)的筛查结果,了解TORCH感染现状,为提高生育质量提供参考。方法以2015年5月至2018年7月在深圳市罗湖区人民医院进行TORCH筛查的19 973例育龄男女为研究对象,采用化学发光免疫法(CLIA)检测血清TORCH特异性抗体IgG及IgM并统计分析。结果所调查育龄人群的弓形虫(TOX)、风疹病毒(RV)、单纯疱疹病毒Ⅰ/Ⅱ(HSVⅠ/Ⅱ)、巨细胞病毒(CMV),细小病毒B19(PV B19)IgG抗体阳性率分别为1.58%、75.66%、98.10%、91.03%和18.17%;TOX、RV、CMV、HSVⅠ/Ⅱ、PV B19IgM抗体阳性率分别为0.41%、1.24%、0.31%、8.26%和0.54%;育龄女性CMV-IgG、HSVⅠ/Ⅱ-IgG和HSVⅠ/Ⅱ-IgM的阳性率均高于育龄男性,差异具有统计学意义(P0.05);将调查人群分为低龄组(18～30岁)和高龄组(31～45岁),CMV-IgG、HSVⅠ/Ⅱ-IgG、PV B19-IgG和PV B19-IgM在高龄组阳性检出率均高于低龄组,差异具有统计学意义(P0.05)。结论本地区有一定比例的育龄男女感染TORCH,而CMV-IgG和HSVⅠ/Ⅱ-IgG阳性率最高,应加强育龄期男女产前筛查TORCH力度,降低先天性TORCH感染风险,提高人口素质。     

苏州地区32,986例孕妇TORCH感染情况调查

目的 调查苏州地区孕妇TORCH感染情况.方法 采用酶联免疫吸附法,检测32,986例孕早期妇女TORCH-IgM.结果 TORCH-IgM总阳性率3.99%.弓形体（TOXO）阳性率0.74%,风疹病毒（RV）0.50%.巨细胞病毒（CMV）1.37%,单纯疱疹病毒（HSV）1.53%,各阳性率差异无显著性（P〉0.05）.HSV、TOXO、RV阳性率逐年升高,CMV阳性率逐年下降.TORCH-IgM总阳性率逐年升高.结论 苏州地区孕妇TORCH感染率上升,孕前妇女应重视TORCH筛查.     

新生儿及婴儿TORCH感染血清学检测分析

目的了解青岛地区新生儿及婴儿TORCH感染状况和感染特点。方法应用间接化学发光免疫分析法(CLIA)检测1 196例新生儿和婴儿血清中的TORCH特异性抗体,并进行统计分析。结果受检患儿中TORCH-IgM阳性率为1.67%,其中以CMV和HSV感染为主;患儿中TORCH-IgG抗体阳性率为99.16%,其中以CMV感染最常见,阳性率为94.31%;患儿混合感染率达到93.31%,以HSV和CMV混合感染为最多,阳性率达85.45%;新生儿及婴儿IgG抗体检测均以CMV-IgG抗体阳性率最高,分别为96.28%、82.76%;男性和女性患儿CMV-IgG阳性率均为最高,分别为94.36%、94.27%。结论青岛地区TORCH感染以CMV、HSV感染及二者混合感染为主,既往感染阳性率较高,新近感染阳性率较低,新近感染患儿并发症主要是呼吸系统和消化系统疾病,因此,加强新生儿和婴儿TORCH抗体检测筛查,对辅助临床鉴别和治疗具有重要的意义。     

南京地区18759例住院新生儿TORCH检测结果分析

目的了解南京地区住院新生儿TORCH感染情况,为相关疾病诊疗提供参考依据。方法采用化学发光免疫分析法对该院2014-2017年18 759例住院新生儿进行弓形虫(TOX)、风疹病毒(RV)、巨细胞病毒(CMV)、单纯疱疹病毒(HSVⅠ+Ⅱ)IgM进行血清学检测。结果新生儿TORCH-IgM总阳性率为0.51%,CMV-IgM阳性率最高(0.23%),其次为HSV-IgM(Ⅰ+Ⅱ)0.17%,RV-IgM 0.10%,TOX-IgM0.02%,差异有统计学意义(P0.05)。RV-IgM阳性患儿中,男性新生儿阳性率为0.14%,女性新生儿阳性率为0.05%,差异有统计学意义(P0.05);TORCH-IgM阳性患儿中,早产儿39例,非早产儿56例,早产患儿少于非早产患儿,且早产患儿中HSV感染人数最多;CMV-IgM阳性率呈现逐年上升的趋势,2014-2017年CMV-IgM阳性率分别为0.15%、0.19%、0.24%、0.38%。结论南京地区住院新生儿TORCH-IgM阳性率较低,以CMV感染为主,但CMV-IgM阳性率有逐年上升的趋势,防治形势仍然不可轻视。     

ELISA法检测TORCH系列特异性抗体的临床应用研究

[目的]探讨ELISA法检测TORCH系列特异性抗体的临床应用价值.[方法]用ELISA捕获方法对2400例门诊孕妇血清进行TORCH系列IgM抗体的检测,并与免疫印迹(Western-blotting,WB)法对比.[结果]2400份血清标本中,ELISA法检出阳性率分别为TOXO-IgM 1.29%(31/2400)、RV-IgM 2.54%(61/2400)、CMV-IgM 4.25%(102/2400)和HSV-IgM 2.83 %(68/2400);与WB法阳性检出率比较,ELISA法检出每单项抗体阳性率均高于WB法,两者检测TORCH四项抗体阳性率差异无显著性(P>0.05).ELISA法检测CMV-IgM阳性率最高,TOXO-IgM阳性率最低.其中有不良孕史孕妇血清TORCH-IgM阳性率均高于正常孕妇血清阳性率,分别为4.5%(TOXO)、15.3%(CMV)、10.0%(HSVⅡ)和8.7%(RV).[结论]ELISA法检测血清TORCH-IgM抗体具有简便、快速、特异的优点,适合于临床TORCH感染的辅助诊断和早期TORCH感染的大规模筛查.     

孕产妇6种病原体感染的血清标志物检测及其临床意义

目的 了解该地区孕产妇乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)及TORCH(弓形虫(TOX)、风疹病毒(RV)、巨细胞病毒(CMV)和单纯疱疹病毒(HSV))的感染情况,并探讨孕产妇感染性血清标志物检测的临床意义.方法 对2011年1~12月该院门诊和住院的2 535例孕产妇进行产前乙型肝炎表面抗原(HBsAg)、HCV抗体(抗-HCV)及TORCH 特异性抗体IgM检测.结果 2 535例孕产妇中,HBsAg、抗-HCV、TOX-IgM、RV-IgM、CMV-IgM及HSVⅡ-IgM阳性率分别为12.5%、0.67%、1.74%、2.68%、0.55%及0.16%.结论 本地区孕产妇以HBV感染为主,此6种病原体可垂直传播导致新生儿先天缺陷,通过对孕产妇进行感染性血清标志物检测,是及早发现传染病和防止母婴垂直传播的有效防治措施之一,对减少新生儿传染病的发生,提高优生优育和人口素质尤为重要.     

1005例育龄女性优生五项IgM抗体检测结果分析

目的探讨和分析育龄女性优生五项(TORCH)IgM抗体检测对优生优育的意义。方法采用磁微粒化学发光法(CLIA)检测育龄女性的血清IgM抗体。结果 1005例育龄女性TORCH-IgM总阳性率为4.18%,其中弓形虫病毒(TOX)IgM,风疹病毒(RV)IgM,巨细胞病毒(CMV)IgM,单纯疱疹病毒Ⅰ(HSVⅠ)和单纯疱疹病毒Ⅱ(HSVⅡ)IgM的阳性率分别为0.1%、0.90%、1.90%、0.10%和1.19%,阳性率从高到低依次为CMV-IgM、HSVⅡ-IgM、RV-IgM、TOX-IgM和HSVⅠ-IgM。TORCH-IgM的检出年龄主要集中在20～29岁,其检出率高达71.43%。结论通过对育龄女性进行TORCH五项筛查检测,可早发现、早诊断、早预防TORCH的感染,有利于临床制定相应处理方案,从而提高优生优育质量,降低不良妊娠的发生率。     

皖北地区育龄妇女TORCH感染状况分析

目的分析皖北地区育龄妇女感染弓形虫(TOX)、风疹病毒(RV)、巨细胞(CMV)、单纯疱疹病毒(HSV)感染状况。方法应用酶联免疫吸附试验对137例育龄妇女进行血清TORCH-IgM和TORCH-IgG检测。结果 137例育龄妇女中TORCH-IgM阳性14例,总阳性率为10.22%。其中TOX、RV、CMV和HSV-Ⅰ、Ⅱ型的IgM阳性率分别为2.22%(3/135)、0.00%(0/137)、0.73%(1/137)、12.64%(11/87)和0.75%(1/133);IgG阳性率分别为10.53%(4/38)、82.50%(33/40)、90.00%(36/40)、91.67%(33/36)和18.92%(7/37)。结论皖北地区育龄期妇女RV、CMV、HSV感染率较高,针对目前育龄期妇女感染TORCH后无特效治疗状况,应加强TORCH知识普及,加强孕前期检测,做好优生优育工作,提高人口素质。     

山东地区儿童TORCH感染情况的调查及分析

目的探讨山东地区儿童TORCH病原体感染情况及分布模式,为预防和诊断提供临床依据。方法收集2014年12月至2016年8月该院1 010例0~15岁儿童外周血标本,并根据年龄分组,利用化学发光法进行TORCH抗体免疫球蛋白M(IgM)和TORCH抗体免疫球蛋白G(IgG)检测,统计阳性率。结果 1 010例儿童血清TORCH(CMV、HSV、RV、TOX)IgM抗体阳性率分别为17.82%、9.00%、1.98%、0.20%,合并感染率为4.55%;TORCH[巨细胞病毒(CMV)、单纯疱疹病毒(HSV)、风疹病毒(RV)、弓形虫(TOX)]IgG抗体阳性率分别为90.00%、83.07%、58.12%、0.79%;CMV和HSV感染者所占比例较高,TOX感染率最低。结论山东地区0~15岁儿童TORCH感染较普遍,且以CMV感染为主,TOX少见,同时存在合并感染。TORCH检测对预防和治疗病原体感染具有提高人口素质的重要意义。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.