血清甲状腺激素检测在孕期甲状腺疾病中的诊断价值

目的探讨分析血清甲状腺激素检测在孕期甲状腺疾病中的诊断价值。方法选择该院收治的妊娠期甲状腺疾病患者218例,按照患者疾病类型分为亚临床甲状腺功能减退89例(亚甲减组)、甲状腺功能减退78例(甲减组)、甲状腺功能亢进51例(甲亢组),再选择健康孕妇50例作为对照组,检测各组受试者游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4),促甲状腺素(TSH)水平,并分析各组受试者不良妊娠结局发生率。结果亚甲减组患者FT3、FT4、TT3、TT4水平与对照组比较,差异均无统计学意义(P0.05),而TSH水平显著高于对照组,且差异有统计学意义(P0.05);甲减组患者FT3、FT4、TT3、TT4水平均显著低于对照组,而TSH水平显著高于对照组,差异具有统计学意义(P0.05);甲亢组患者FT3、FT4、TT3、TT4水平显著高于对照组,而TSH水平显著低于对照组,差异具有统计学意义(P0.05);在亚甲减、甲减、甲亢诊断方面,TSH阳性率均显著高于其余各指标,且差异有统计学意义(P0.05);亚甲减组、甲减组与甲亢组不良妊娠结局发生率均显著高于对照组,且差异具有统计学意义(P0.05)。结论血清甲状腺激素水平检测对于孕期甲状腺疾病的诊断具有着重要意义,其中以TSH诊断最为敏感,能够较好地反应机体甲状腺功能的实际水平,具有着重要的临床参考价值。     

肾病综合征患者甲状腺激素水平及小剂量甲状腺素治疗临床观察

目的探讨原发性肾病综合征(PNS)患者血清游离甲状腺激素(FT3、FT4)水平及小剂量左旋甲状腺素(L-TH)治疗的疗效。方法对比分析66例PNS患者和60例健康者(健康对照组)的FT3、FT4和促甲状腺素(sTSH)水平;同时将66例肾病综合征患者随机分成两组,左旋甲状腺素组36例,一般治疗组30例,左旋甲状腺素组在常规治疗同时加L-TH 25~50μg/d。比较治疗前后甲状腺素水平及临床疗效。结果PNS组血清FT3、FT4降低,与健康者比较差异有统计学意义(P<0.01);左旋甲状腺素组与一般治疗组FT3、FT4及临床疗效治疗前后比较,均得到明显改善(P<0.01)。结论PNS患者活动期存在甲状腺功能低下,小剂量甲状腺素可作为PNS患者辅助治疗手段。     

甲状腺功能减退患者血清胰岛素样生长因子-1的变化及其意义

目的 :观察甲状腺功能减退症 (甲减 )患者血清胰岛素样生长因子 1 (IGF 1 )的变化及其与甲状腺激素(TH)、磁性甲状腺刺激激素 (m TSH)的关系。方法 :从本院门诊及住院患者中选择 36例甲减患者作为治疗组 ,从本院健康体检的人群中选择与治疗组年龄相匹配的 32例作为对照组。所有受试者均检测IGF 1及甲状腺功能 ,包括TT3 、TT4、FT3 、FT4、m TSH。治疗组患者以 1 .5～ 3μg/(kg·d)的左旋甲状腺素 (优甲乐 )口服 ,3个月复查以上检测指标 ,所得结果进行统计学处理。结果 :与对照组比较 ,甲减组血清IGF 1及TT3 、TT4、FT3 、FT4,显著降低 ,m TSH显著升高 (均P <0 .0 1 ) ,甲减组经TH替代治疗后 ,大部分患者 ( 32 /36 )血清中IGF 1及TT3 、TT4、FT3 、FT4显著升高 ,m TSH显著降低 ,均达正常人水平或以上 ,但有少数患者 ( 4/36 )以上指标未达正常人水平。结论 :甲减患者血清中IGF 1的浓度与血清中TT3 、TT4、FT3 、FT4水平呈正相关 ,与m TSH呈负相关。     

游离甲状腺素/促甲状腺素比值作为甲状腺功能评价指标的研究

目的　探索甲状腺功能紊乱者最适实验室诊断指标。方法　采用化学发光免疫技术(CLIA)测定不同人群中三碘甲状腺原氨酸 (TT3 )、甲状腺素 (TT4)、促甲状腺素 (TSH)、游离三碘甲状腺原氨酸 (FT3 )、游离甲状腺素 (FT4)浓度 ,比较受试者工作特征曲线 (ROC)下面积及频数分布散点图分离效果。结果　甲减诊断ROC值TSH :0 94± 0 0 2 ,FT3 :0 70± 0 0 7,FT4:0 92± 0 0 4 ,FT4/TSH比值 :0 95± 0 0 2 ;甲亢诊断ROC值分别为 0 86± 0 0 5 ,0 82± 0 0 3,0 83± 0 0 6 ,0 90± 0 0 5。从频数分布散点图显示 ,FT4/TSH的分离效率甲减 93% ,甲亢 85 %。结论　CLIA法测定FT4/TSH比值显示出最佳的性能与分离效果 ,可提高甲状腺功能的诊断效率 ,FT4/TSH比值应被推荐为甲状腺功能评价的首选指标。     

雅培i2000SR全自动化学发光分析仪检测甲状腺功能五项的性能验证

目的评价和验证雅培i2000SR全自动化学发光分析仪检测甲状腺功能五项[促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)]的方法学性能,并探讨甲状腺功能五项检测对甲状腺疾病的临床应用价值。方法选取该院2018年接受治疗的180例甲状腺功能异常患者,包括90例甲状腺功能亢进患者(甲亢组)和90例甲状腺功能减退患者(甲减组),同时选取健康体检者90例(健康对照组),比较不同组之间各指标检测结果的差异。根据ISO15189《医学实验室质量和能力认可准则》的要求,参照美国临床实验室标准协会(CLSI)EP系列文件和相关标准对甲状腺功能五项的精密度、正确度、分析测量范围、参考区间、不确定度进行评价分析,将结果与公认的质量目标或厂家声明的性能指标进行比较。结果甲状腺功能五项的批内精密度和批间精密度分别为1.08%～4.55%和1.08%～5.11%;正确度符合实验室要求;TSH、FT3、FT4、TT3、TT4验证的线性范围均在厂家线性范围内,二者具有良好的线性关系(R2≥0.993 2);参考区间符合率达到100%;不确定度的评定结果符合要求。与甲减组比较,甲亢组TSH水平明显降低(P0.05),FT3、FT4、TT3、TT4水平明显升高(P0.05);与健康对照组比较,甲减组TSH水平明显升高(P0.05),甲亢组FT3、FT4、TT3、TT4水平明显升高(P0.05)。结论雅培i2000SR全自动化学发光分析仪检测甲状腺功能五项的性能验证结果符合临床要求,精密度高,准确度高,线性范围宽,测定结果准确可靠,可用于大批量临床标本的检测,且TSH、FT3、FT4、TT3、TT4对甲状腺疾病的诊断具有重要的价值。     

轻微甲状腺功能减退症替代治疗的临床观察

目的　探讨甲状腺激素替代治疗轻微甲状腺功能减退 (甲减 )的临床疗效。方法　将门诊或住院并确诊为轻微甲减的 6 5例患者均采用甲状腺激素替代治疗 ,观察治疗 1、6个月后临床症状、体征的变化 ,以及血清总甲状腺素 (TT4)、游离甲状腺素 (FT4)、促甲状腺素 (TSH)、甲状腺球蛋白抗体 (TGA)、甲状腺微粒体抗体 (MCA)、总胆固醇 (TCH)、低密度脂蛋白 (LDL C)、高密度脂蛋白 (HDL C)与脂蛋白 (a) [Lp(a) ]的变化。结果　替代治疗 1个月后 ,临床症状及TSH开始改善 ,6个月后效果更为显著 (P <0 .0 1 )。治疗 6个月后TCH、LDL C平均下降 0 .3mmol/L ,但前后比较无显著性差异。TT4、FT4、TGA、MCA、HDL C、Lp(a)治疗前后均无明显变化 (P >0 .0 5 )。结论　轻微甲减早期行替代治疗可使症状、体征改善 ,胆固醇水平下降 ,可防止发展为典型甲减而造成对健康的不利影响     

小儿肾病综合征血清游离甲状腺素与血脂及血、尿蛋白的关系研究

【目的】探讨原发性肾病综合征 (PNS)患儿血清游离甲状腺素 (FT3 、FT4)的变化及其与血清总胆固醇 (TCH)、甘油三酯 (TG)、白蛋白 (ALB)及尿蛋白 (Upro)的关系。【方法】对 6 0例PNS患儿用酶联免疫法检测血清FT3 、FT4水平 ,并测定血ALB、TCH、TG ,及尿Upro水平 ,同时检测 2 5例正常儿童做对照。【结果】PNS组患儿血清FT3 、FT4降低 ,促甲状腺激素 (TSH)升高 ,与正常对照组比较差异有显著性 (P <0 .0 1) ,PNS组血FT3 、FT4与ALB呈正相关 ,与TCH、TG、Upro呈负相关。【结论】PNS患儿活动期存在甲状腺功能低下 ,检测血FT3 、FT4、TSH水平 ,可作为评估病情发展趋势和判断预后的指标之一 ,也可以为PNS患儿尤其是激素不敏感者给予小剂量甲状腺素 (TH)治疗提供重要的理论依据。     

甲状腺功能异常患者血清内脂素水平的变化及其与甲状腺激素的关系

目的:研究甲状腺功能异常(包括甲亢或甲减)患者血清内脂素水平的变化,探讨甲状腺功能异常时内脂素水平变化与甲状腺激素的相关关系及其在甲状腺功能异常患者中的临床意义。方法:选取甲状腺功能异常患者,分为甲状腺功能亢进组(甲亢组,n=30)、甲状腺功能减退组(甲减组,n=30)及甲状腺功能正常者(对照组,n=30)。取空腹血检测游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、三碘甲腺原氨酸(TT3)、甲状腺素(TT4)、空腹血糖、血脂及内脂素水平,并计算体质指数(BMI)。结果:甲亢组及甲减组内脂素水平显著高于对照组,两组间比较差异无显著性。单因素相关分析显示甲亢组血清内脂素与FT3、FT4、TT4呈正相关,与TSH、胆固醇(TC)呈负相关。甲减组血清内脂素与BMI、TSH、TC、低密度脂蛋白胆固醇(LDL-C)呈正相关,与FT3、FT4、TT3、TT4呈负相关。结论:甲状腺功能异常患者(不论是甲亢组还是甲减组)血清内脂素水平升高的改变,提示这种改变与甲亢时能量的消耗及甲减时能量的储备存在一定的关系,但作用机制复杂还有待于进一步研究。     

窒息新生儿甲状腺功能测定

目的 :探讨窒息新生儿甲状腺功能的变化。方法 :对 117例窒息新生儿 (窒息组 )及 117例同期出生的正常新生儿 (对照组 )于出生第 1天及第 8天取静脉血检测T3 、T4、FT3 、FT4和TSH。结果 :窒息新生儿T3 、T4、FT3 、FT4均显著低于对照组 (P <0 .0 1或P <0 .0 5 ) ,重度窒息新生儿T3 、T4、FT3 、FT4均显著低于轻度窒息新生儿 (P <0 0 1或P <0 0 5 ) ,TSH无显著差异 (P >0 .0 5 ) ,第 8天复查T3 、T4、FT3 、FT4和TSH窒息组与对照组无显著差异 (P >0 .0 5 )。结论 :窒息新生儿甲状腺功能损害严重 ,且与窒息程度正相关 ,恢复后甲状腺功能自行恢复 ,无需甲状腺素治疗     

甲巯咪唑联合加味知柏地黄汤治疗甲状腺功能亢进症的效果

目的 探讨甲巯咪唑联合加味知柏地黄汤治疗甲状腺功能亢进症的效果。方法 随机抽取2017年7月至2019年10月鹤壁市人民医院收治的100例甲亢患者进行分组研究,每组50例。对照组予以甲巯咪唑治疗,每日给药1次、30 mg/次,连用4周后将剂量减少至20 mg/d,共治疗12周。研究组在对照组治疗基础上加用加味知柏地黄汤加减。记录两组治疗前后血清总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、促卵泡生成素(FSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)等甲状腺功能相关实验室指标变化情况。结果 两组治疗前血清TT3、TT4、FSH、FT3、FT4水平比较,差异未见统计学意义(P 0. 05),治疗后研究组血清TT3、TT4、FT3、FT4水平降低幅度及FSH水平提高幅度均优于对照组(P 0. 05)。结论 应用甲巯咪唑联合加味知柏地黄汤对甲状腺功能亢进症患者甲状腺功能相关指标改善效果优于单用甲巯咪唑。     

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.