凝血5项试验室内质控血浆的制备及应用评价

目的自制凝血试验多项目质控血浆用于常规凝血4项及D-二聚体的室内质量控制并对其进行评价。方法选择符合条件的健康人血浆,经充分混合后分装、低温保存,并对其进行精密度和稳定性评价。结果质控血浆制备方法简便,精密度与稳定性俱佳,至少稳定保存6个月,与试剂配套质控血浆具有相似的效果。结论自制血凝多项目质控血浆具有良好精密度、稳定性,可替代进口质控品用于血凝仪室内质控。     

自制凝血质控品用于室内质控的研究

常用的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)组成的凝血常规检查,在临床诊断、手术、治疗及预后中起到了非常重要的作用[1].目前全自动或半自动的凝血仪与传统的手工法操作来比提高了分析的准确性和精密性.但是因凝血质控品主要依赖进口,价格昂贵且供应时间周期长的问题影响了其进一步推广与应用,国产的凝血质控品鲜见有售[1,2].鉴于此情况,本文研究了自制凝血质控品及其性能,以自制质控品应用于凝血常规测定室内质量控制工作,并购买了德国DADE BEHRING公司商品质控品进行了同步比较测试,探讨与评价自制质控品在凝血常规检测室内质量控制体系中的应用,为进一步进行凝血常规检测的标准化研究奠定基础.     

ELISA试验室内质控“双质控点法”的应用分析

目的探讨“双质控点法”在ELISA试验室内质控的有效性及应用价值。方法当更换质控血清批号时，将新批号质控血清在旧批号质控血清结束前与旧批号质控血清一起测定3～4次，新批号质控结果按“即刻法”分析。结果采用“双质控点法”对前3次实验结果进行质控均在控。结论“双质控点法”对ELISA试验室内质控是有效、及时、可靠的，可作为常规ELISA试验室内质控方法的补充。     

自制凝血质控血浆的研制及评估

目的 自制凝血质控血浆替代凝血三项(PT、APTT、FIB)质控参比血浆,并对其进行评估.方法 选择凝血三项均正常的外科术前筛查患者血浆,经混合、冷藏、离心等处理后进行定值、分装及贮存,并从质控图评估其质控效果及稳定性.结果 自制凝血质控血浆三个项目的SD均较小,提示检测的精密度较好;可以满足检测需要,能及时发现可能引起的失控原因;自制质控血浆的凝血三项平均值均在较小的范围内,变异系数分别为PT 3.16％、APTT 5.06％、FIB 4.19％,稳定性较好.结论 自制凝血质控血浆可以起到室内质控的效果,并具有有一定的稳定性,可以替代进口室内质控血浆用作凝血试验的质控物.     

四川省175家医院PT、APTT、Fg质量控制调查结果分析

目的通过凝血试验室间质量评价活动，发现试验检测中存在的问题，提出改进意见，提高检测的精密性、准确性和可靠性。方法省检验中心组织1年1次的室间质量评价(EQA)活动；现场调查实验室现状、试验的规范化、室内质控(IQC)的开展情况。结果参加室间质控的单位逐次增加，凝血酶原时间(PT)、活化的部分凝血酶原时间(APTT)和纤维蛋白原(Fg)成绩有所提高；全自动仪器测定的成绩明显优于半自动仪器；配套试剂明显优于非配套试剂；室内质控开展较差。结论加强人员培训，加强试验的规范化和室内质控，建立标准化操作规程和建立实验室各仪器的正常值范围是一项重要工作。     

基层医院室内质控品的自制及应用

目的自制室内质控品作为测定凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）参比血浆，评价自制室内质控品是否符合临床要求，降低检验成本。方法收集日常工作中PT、APTT均正常且常见传染病检测均为阴性的临床样本，混合后分装，置-20℃冷冻备用。结果自制室内质控品（冷冻混合血浆）在60d内与新鲜混合血浆的PT、APTT比较，差异无统计学意义（P〉0．05）。结论自制室内质控品符合室内质控要求，此分装方法可用于自制室内质控品，可降低检验成本。     

Sysmex-CA7000与SFS000凝血分析仪室内质控结果对比

目的：探讨Sysmex—CA7000与SF8000两款凝血分析仪对正常值质控及异常质控标本检测结果的差异。方法：以广东省室内质控（包含正常质控及异常质控标本）作为检测对象,以Sysmex—CAT000与SF8000两款凝血分析仪同时进行1个月的常规质控检测,包括凝血酶原时间（PT）,活化部分凝血活酶时间（APTT）和纤维蛋白原含量（Fbg）,并对其各个相对应的指标的结果进行统计分析。结果：Sysmex—CA7000与SF8000两款凝血仪对凝血参数PT,APTT的检测,正常值质控标本及异常值质控标本结果差异有统计学意义（P〈0．01）;Fbg的检测,正常值质控标本及异常值质控标本结果差异无统计学意义（P〉0．05）。结论：如果科室内同时使用Sysmex—CA7000与SF8000两款凝血分析仪,应区分并注明其正常参考值范围。     

凝血检验室内质控血浆的制备与评估

目的自制凝血检验室内质控血浆并对其进行评估。方法选择符合条件的正常人血浆,经过混合、离心、防腐等处理后定值、分装和保存。从质控效果和稳定性两方面对其进行评估。结果自制凝血检验室内质控血浆方法简便,在室内质控方面和B iopool定值质控血浆具有相似的效果,当血凝仪报告结果发生失控时能及时反映出来。稳定期半年。结论摸索出了凝血检验室内质控血浆的配制方法,从质控效果和稳定性两方面评估表明完全可以用于凝血检验的室内质控。     

凝血常规试验在血凝分析仪上的比对分析

目的评价成都中医药大学附属医院检验科两台血凝分析仪(法国Stago公司Stago CT型和StagoRE型)检测凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)的准确性和一致性。方法对两台血凝分析仪用配套校准物进行校准;用配套质控物常规室内质控评价凝血常规的稳定性;使用比对试验评价两台仪器检测凝血常规的准确性和一致性。结果 PT、INR、APTT、Fib 4项试验比对结果的变异百分率(CV)符合卫生部临床检验中心凝血室间质量评价标准。两台血凝分析仪的检测结果有较好的相关性,除Fib相关系数r值为0.959 8,其余检测项目相关系数均大于0.975 0。结论通过不同血凝分析仪检测PT、APTT、Fib的比对试验,有效提高了本科室不同血凝分析仪器间的可比性,有效地保证了检验结果的准确性和精密度,提高了检验的质量。     

新鲜冰冻血浆用于凝血功能检验室内质控的探讨

目的探讨用新鲜冰冻血浆进行凝血检验室内质控的可行性。方法选用中心血站提供的新鲜冰冻血浆,经过快速解冻处理后进行定值、分装、保存。结果自制凝血质控血浆与德国DADE公司的冻干质控血浆具有相似的效果,自制质控血浆稳定性部分良好。结论通过自制凝血室内质控血浆的研制,大大节约了试剂成本的支出,从稳定性和质控效果上看,可以用于凝血检验项目的室内质量控制。     

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.     

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.     

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.     

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.     

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.