白念珠菌烯醇化酶双抗体夹心ELISA检测方法的建立

摘要：目的：建立检测白念珠菌烯醇化酶（enolase, Eno）的双抗体夹心ELISA法,并试用于几种真菌培养上清液的检测。 方法：将抗白念珠菌Eno单抗作为包被抗体,辣根过氧化物酶标记的羊抗Eno抗体作为检测抗体,用方阵滴定法确定包被抗体和酶标抗体浓度,建立检测Eno的ELISA法,对方法的精密度、特异性、最低检测限等指标进行评价。用该法检测白念珠菌、热带念珠菌、光滑念珠菌、近平滑念珠菌、季也蒙念珠菌、新生隐球菌和酿酒酵母等不同真菌培养上清中Eno水平。 结果：Eno浓度为20 ng/mL和5 ng/mL时,批内和批间变异系数(CV)分别为6.61%、9.19%和6.98%、13.81%;最低检测限为1.25 ng/mL。本法可从白念珠菌37 ℃培养24 h后的上清中检出Eno,Eno含量与白念珠菌菌丝含量呈正相关。本法对近平滑念珠菌有微弱交叉反应,与热带念珠菌、光滑念珠菌、季也蒙念珠菌、新生隐球菌和酿酒酵母均无交叉反应。 结论：建立的检测白念珠菌Eno的双抗体夹心ELISA方法有较好的特异性,可用于评价Eno检测在侵袭性白念珠菌感染中的诊断价值。     

用免疫磁珠法检测抗白念珠菌烯醇化酶抗体

摘要：目的：建立检测人血清抗白念珠菌烯醇化酶(Eno)IgG类抗体的免疫磁珠法,并评估其在念珠菌血症诊断中的价值。 方法：将Eno重组蛋白耦联至磁性微珠上,以辣根过氧化物酶（HRP）标记的羊抗人IgG为二抗,优化免疫磁珠法的反应条件,考察其精密度和特异性。收集经血培养确诊的念珠菌血症患者（n=113）、念珠菌定植者（n=50）、细菌菌血症患者（n=30）和健康人对照者（n=100）血清,用免疫磁珠法测定抗Eno抗体,并与ELISA法结果进行比较。 结果：免疫磁珠法测定抗Eno抗体的批内、批间变异系数（CV）分别为8.2%和14.2%,重组Eno抗原对相应抗体的阻断率为91.6%。以吸光度（A）值0.29为cut off值时,诊断念珠菌血症的敏感性、特异性、阳性预测值和阴性预测值分别为80.5%、92.3%、90.1%和84.5%。免疫磁珠法的敏感性和特异性与ELISA法比较无统计学差异,但检测流程从37 ℃ 2.5 h缩短至常温1 h。 结论：免疫磁珠法检测抗Eno IgG类抗体简便、快捷、可靠,在侵袭性念珠菌感染研究中具有潜在的应用价值。     

检测3种侵袭性真菌感染相关抗体的蛋白质芯片法

摘要：目的：用念珠菌烯醇化酶（Eno）、果糖二磷酸醛缩酶（Fba1）及烟曲霉硫氧还蛋白还原酶（TR）3种基因重组蛋白质,建立检测这3种蛋白质特异性抗体的蛋白质芯片法,并进行临床应用评价。 方法：用重组Eno、Fba1和TR作为固相抗原构建蛋白质芯片。对芯片制备及血清中相应抗体测定的反应条件进行优化。对方法的重复性、稳定性及特异性进行考察,并测定临床确诊的侵袭性念珠菌病（IC）、侵袭性曲霉病（IA）患者血清中的相应抗体。 结果：蛋白质芯片以硝酸纤维素膜为固相载体,以Tris-HCl为载样液,重组Eno、Fba1、TR最适点阵浓度分别为0.5 mg/mL、0.04 mg/mL和1.0 mg/mL,用含50 g/L脱脂奶粉的PBS溶液封闭,待测血清稀释度为1∶10。抗Eno抗体和抗Fba1抗体诊断IC的敏感性和特异性分别为67.6%（71/105）和96.5%（299/310）,64.8%（68/105）和90.3%（280/310）;联合检测抗Eno抗体和抗Fba1抗体,可将敏感性提高至81.0%。抗TR抗体诊断IA的敏感性为71.4%（30/42）,特异性为98.1%（366/373）。 结论：建立了同时检测两种真菌的3种不同抗体的蛋白质芯片方法,敏感性尚可,可用于高危人群的筛查。     

双抗原夹心ELISA检测抗HCV总抗体

目的建立检测抗HCV抗体的双抗原夹心ELISA法,评价其可行性。方法将与His或GST融合表达的HCV基因工程抗原,分别用作ELISA的包被和酶标记抗原,建立用于抗HCV总抗体检测的双抗原夹心ELISA。用此方法检测1 968份临床血清标本,并以间接ELISA(北京万泰试剂)与之对照;此外,用套式RT-PCR检测部分血清的HCV RNA。结果有1 761份血清2种ELISA检测均为阴性,有190份血清均为阳性,两种方法符合率为99.1%;有17份血清的检测结果不相符,间接法阳性而本法阴性的14份,其中HCV RT-PCR阳性1份;本法阳性而间接ELISA阴性的3份,其中RT-PCR阳性2份。双抗原夹心ELISA与间接ELISA的敏感性分别为99.48%、98.96%,特异性分别为99.94%、99.27%。结论新研制的检测抗HCV总抗体的双抗原夹心ELISA具有较高的敏感性和特异性,值得作进一步的深入研究。     

侵袭性念珠菌病患者抗烯醇化酶抗体水平升降及影响因素

目的评估抗念珠菌烯醇化酶(enolase,Eno)抗体(抗Eno)对侵袭性念珠菌病(invasive candidiasis,IC)的诊断价值,分析IC患者体内抗Eno水平变化趋势及影响因素。方法连续收集外科重症监护病房(ICU)IC易感患者从入住ICU当天到转出ICU或死亡的血清样本,3~5 d 1份(共收集血清1 200份,每例患者1~26份不等)。用ELISA法测定抗Eno抗体。结合念珠菌培养结果,观察抗体水平首次升高、下降的时间及影响因素。结果 307例临床显示脓毒症患者中,68例抗Eno阳性,34例念珠菌培养阳性。抗体与念珠菌培养共同阳性者21例,其中半数以上患者的抗Eno水平升高出现在培养结果阳性前;高水平抗Eno在30~60 d下降至临界值以下。47例抗体阳性但培养阴性患者中,预防用抗真菌药22例(46.8%);13例抗体阴性的确诊病例中,11例使用糖皮质激素。结论抗Eno诊断IC的敏感性高于念珠菌培养,特别是对于预防性用抗真菌药的患者;抗体水平首次升高出现在IC早期,随后下降,使用免疫抑制剂可干扰抗体检出。     

双抗原夹心酶联免疫吸附试验对丙型肝炎病毒抗体检测灵敏度及特异性的影响

目的:探究双抗原夹心酶联免疫吸附试验对丙型肝炎病毒抗体(抗-HCV)检测灵敏度及特异性的影响。方法:选取2016年5月~2017年4月我院进行手术和血液透析前抗-HCV检测的患者270例,经血液筛查(荧光定量PCR法)抗-HCV阳性12例,抗-HCV阴性258例,采用双抗原夹心酶联免疫吸附法(ELISA)和间接ELISA分别对270例患者血清进行抗-HCV检测,比较两种检测方法的特异性、灵敏度。结果:双抗原夹心ELISA法灵敏度、特异性均高于间接ELISA法(P<0.05)。结论:双抗原夹心酶联免疫吸附试验可提高丙型肝炎病毒抗体检测灵敏度及特异性,可作为临床血液标本筛查首选方法。     

抗烯醇化酶抗体检测对侵袭性念珠菌病的诊断价值

目的 利用白念珠菌烯醇化酶重组蛋白质为抗原,建立测定人血清中抗白念珠菌烯醇化酶IgG类抗体的ELISA法,评估其在侵袭性念珠菌病(IC)诊断中的应用价值.方法 收集各类确诊IC患者(66例)和白念珠菌定植者(32例)血清,用重组白念珠菌烯醉化酶包被ELISA微孔板,测定血清中的抗烯醇化酶抗体,确定cut off值并对方...     

双抗体夹心ELISA检测肺炎支原体抗原方法的建立

目的　建立检测肺炎支原体(MP)抗原的双抗体夹心酶联免疫吸附试验(ELISA),并探讨其临床应用的可行性。方法　采用不同株MP单抗,用双抗体夹心ELISA检测MP抗原,优化该方法检测MP抗原的最佳实验条件。对MP标准株及147份临床标本进行测定,观察双抗体夹心ELISA的敏感性和特异性及该方法与聚合酶链反应(PCR)检测的符合率。结果　包被单抗量为20μg/ml,酶标记单抗1∶200稀释时,阳性对照与阴性对照吸光度之比(P/N值)最大,检测MP抗原敏感度达2μg/ml,和其他支原体没有交叉反应; 147份临床标本PCR检测阳性率13. 6% (20 /147),双抗体夹心ELISA检测阳性率12. 2% ( 18 /147 ),两者符合率达95. 9%。结论　建立的双抗体夹心ELISA检测MP抗原具有快速、简便、灵敏度高、特异性强等优点。     

两种方法检测梅毒抗体临床分析

目的研究酶联免疫吸附试验双抗原夹心法与甲苯胺红不加热血清试验（TRUST）法检测梅毒抗体的特异性和敏感性。方法采用酶联免疫吸附试验双抗原夹心法和TRUST法对梅毒抗体进行检测。结果酶联免疫吸附试验双抗原夹心法比TRUST法特异性和敏感性高。结论 TRUST法只适合作为初筛试验,酶联免疫吸附试验双抗原夹心法特异性和敏感性高,对临床诊断具有重要意义。     

双抗体夹心ELISA检测肺炎支原体抗原方法的建立

目的建立检测肺炎支原体(MP)抗原的双抗体夹心酶联免疫吸附试验(ELISA),并探讨其临床应用的可行性。方法采用不同株MP单抗,用双抗体夹心ELISA检测MP抗原,优化该方法检测MP抗原的最佳实验条件。对MP标准株及147份临床标本进行测定,观察双抗体夹心ELISA的敏感性和特异性及该方法与聚合酶链反应(PCR)检测的符合率。结果包被单抗量为20μg／ml,酶标记单抗1：200稀释时,阳性对照与阴性对照吸光度之比(P／N值)最大,检测MP抗原敏感度达2μg／ml,和其他支原体没有交叉反应;147份临床标本PCR检测阳性率13．6％(20／147),双抗体夹心ELISA检测阳性率12．2％(18／147),两者符合率达95．9％。结论建立的双抗体夹心ELISA检测MP抗原具有快速、简便、灵敏度高、特异性强等优点。     

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.     

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.     

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.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."