VEGF、sFas、CEA联合检测对胸腔积液的鉴别诊断价值

目的 通过测定胸腔积液患者胸液中VEGF (Vascular endothelial growth factor,血管内皮生长因子)、sFas(可溶性Fas) 、CEA(癌胚抗原)的水平来探讨三者对胸腔积液鉴别诊断的价值.方法 应用EILSA方法及电化学发光免疫分析技术检测33例肺癌恶性胸液、33例结核性胸液及24例漏出液中VEGF、sFas和CEA的浓度.结果 肺癌恶性胸液组VEGF、sFas、CEA的浓度分别为(393.407±183.125 pg/ml,202.952±82.304 pg/ml,95.012±167.686 ng/ml)明显高于结核性胸液组(250.658±143.074 pg/ml,117.094±70.474 pg/ml, 2.485±1.186 ng/ml);漏出液组(158.896±114.736 pg/ml,59.571±12.573 pg/ml,1.983±0.885 ng/ml),差异具有显著性(P＜0.05).结核性胸液组中VEGF、sFas 明显高于漏出液组(P＜0.05),而两组之间CEA无显著性差异(P＞0.05).VEGF、sFas和CEA联合检测优于单项检测,其中联合方式以sFas+CEA的诊断效能较好.结论 恶性胸液组中VEGF、sFas、CEA水平明显高于良性胸液组.联合检测VEGF、sFas及CEA对胸水良、恶性的鉴别诊断有较高的临床价值.VEGF、sFas和CEA联合检测优于单项检测,其中联合方式以sFas+CEA的诊断效能较好.     

CEA、CA125、LDH联合检测对良恶性胸、腹腔积液鉴别的临床应用

目的探讨测定癌胚抗原(CEA)、糖类抗原125(CA125)和乳酸脱氢酶(LDH)在胸、腹腔积液良恶性鉴别诊断中的临床应用价值。方法应用Beckmancoulter ACCESS2全自动微粒子化学发光免疫分析仪测定胸、腹腔积液中CEA、CA125的水平,应用罗氏C501全自动生化分析仪测定胸、腹腔积液中LDH的水平,评价3项指标对胸、腹腔积液良恶性判断的临床应用价值。结果 CEA、CA125、LDH在良恶性胸、腹腔积液中的表达水平差异有统计学意义(P<0.05);CEA、CA125、LDH在恶性胸、腹腔积液中的阳性率分别为84.21%,92.98%,75.44%。结论联合检测CEA、CA125、LDH对良恶性胸、腹腔积液鉴别诊断有重要价值。     

血管内皮生长因子(VEGF)在恶性胸腔积液中的诊断价值

目的 :检测胸水中血管内皮生长因子 (VEGF)和癌胚抗原 (CEA)在恶性和结核性胸腔积液中的含量 ,探讨VEGF在良恶性胸水中的鉴别诊断价值。方法 :收集未经治疗且诊断明确的胸腔积液患者胸水 2 5例 ,用酶联免疫吸附法 (ELISA)检测胸水中VEGF和CEA的含量。结果 :恶性胸水 13例 ,VEGF含量为 ( 5 73 .62± 40 1.98) pg/ml ,结核性胸水 12例 ,VEGF的含量为 ( 2 3 1.41±15 8.0 6) pg/ml,二者比较差异有显著性 ( P <0 0 5 ) ,13例恶性胸水CEA的含量为 ( 4 9.90± 63 .3 2 ) μg/L ,12例结核性胸水CEA的含量为 ( 2 11± 2 11) μg/L ,二者比较差异有显著性 ( P <0 0 5 ) ,恶性胸水VEGF和CEA的含量均明显高于结核性胸水。 13例恶性胸水中 ,7例VEGF >5 0 0 pg/ml,5例CEA >2 0 μg/L ;2例VEGF <5 0 0 pg/ml同时CEA <2 0 μg/L ,在 12例结核性胸水中VEGF <5 0 0pg/ml同时CEA <2 0 μg/L。结论 :胸水中VEGF的升高有助于恶性胸水的诊断 ;联合检测胸水中VEGF和CEA ,诊断恶性胸水的敏感性提高     

胸水TPA、CEA、NSE联合检测的临床应用价值

目的　通过检测胸水组织多肽抗原(TPA)、癌胚抗原(CEA)、神经元烯醇化酶(NSE)含量,探讨TPA以及同CEA、NSE联合检测对良恶性胸水的临床诊断价值。方法　应用化学发光免疫分析法检测5 6例良性疾患组患者和72例恶性肿瘤组患者胸水及血清TPA、CEA、NSE含量,并进行比较分析。结果　良性胸水TPA、CEA、NSE含量分别为112 .3±6 5 6. 2u/L ,1. 2 3±0 .90ng/ml,8. 10±8 36ng/ml,而恶性胸水组含量分别为4 .175±2 6 .96 9u/L ,198. 7±2 37. 9ng/ml,2 8 .0 3±30 . 7ng/ml,经统计学分析,良恶性胸水之间三项肿瘤标志物具有极显著性差异(P <0 .0 0 1)。结论　胸水TPA、CEA、NSE检测有利于良恶性胸水的鉴别诊断,胸水三项肿瘤标志物检测比血清具有更重要的意义,三项标志物联合检测可以提高对肺癌诊断的灵敏度和特异性。     

探讨肿瘤标记物CEA、CA15—3、CA19—9、CA125及AFP在胸腔积液中的诊断价值

目的 探讨检测胸水和血清中的5种肿瘤标记物:CEA、CA15-3、CA19-9、CA125及AFP在良恶性胸腔积液鉴别诊断的应用价值.方法 采用电化学发光法对42例恶性肿瘤患者的胸水、血清及40例非恶性肿瘤患者的胸水进行免疫蛋白定量检测.并加以分析. 结果 CEA、CA15-3、CA19-9及CA125在恶性胸水中的含量均明显高于良性胸水(P<0.01或P<0.05).在恶性组中其胸水的水平也明显高于血清水平(P<0.01或P<0.05).但AFP水平不论胸水还是血清中,恶性组和良性组均无明显差异(P>0.05).CEA、CA15-3、CA19-9、CA125及AFP对恶性胸水诊断的敏感性分别为66.7%、69%、47.6%、95.2%、9.5%;特异性为90%、85%、92.5%、7.5%、97.5%;准确性为78%、76.8%、69.5%、52.4%、52.4%.CEA与CAl53联合检测其敏感性和特异性高达85.7%和85%,准确性为85.4%.结论 检测胸水中的CEA、CA15-3、CA19-9及CA125有利于良恶性胸腔积液的鉴别诊断,其中CEA和CA15-3的联合检测为最佳组合,可显著提高对恶性胸水的诊断阳性率.     

多肿瘤标志物联合检测在鉴别良恶性腹水中的诊断价值

目的探讨肿瘤标志物甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原153(CA153)、糖类抗原199(CA199)联合检测在良恶性腹水中的鉴别诊断价值。方法对83例良性腹水(良性组)和47例恶性腹水(恶性组)患者分别采用化学发光微粒子免疫分析法检测腹水AFP、CEA、CA125、CA153、CA199,并对结果进行统计分析。结果恶性组的腹水AFP、CEA、CA125、CA153、CA199浓度明显高于良性组,两组各项目浓度比较差异有统计学意义(P0.01);AFP和CA125在良、恶性组均有较高的阳性率,两组阳性率差异无统计学意义(P0.05);联合检测肿瘤标志物提高了检测的敏感性而不降低特异性。结论联合检测腹水中的AFP、CEA、CA125、CA153、CA199浓度水平可提高良性和恶性腹水鉴别诊断的准确性和灵敏性。     

联检CEA、CA125在肺癌并胸腔积液中的诊断价值

目的探讨CEA、CA125在良、恶性胸腔积液鉴别诊断中的价值。方法对46例恶性胸腔积液、44例良性胸腔积液患者于治疗前分别抽取血清及第1次胸腔积液标本进行CA125、CEA测定。结果恶性胸腔积液组血清和胸腔积液CA125、CEA测定值高于良性胸腔积液组(P<0.01)。在胸腔积液中,CA125假阴性56.5%(26/46),假阳性86.4%(38/44);CEA假阴性67.4%(31/46),假阳性81.8%(36/44);CEA和CA125联合检测假阴性69.6%,假阳性90.9%。结论胸腔积液CA125和CEA联合检测有利于良恶性胸腔积液的鉴别,且比血清中更具有临床价值。     

联合检测胸腹腔积液sCD44V6,CEA,CYFRA21-1,CA199，NSE,CA125 对良恶性疾病鉴别诊断价值研究

目的　探讨可溶性CD44V6（sCD44V6）、血清肿瘤标志物癌胚抗原（CEA）、非小细胞肺癌相关抗原细胞角蛋白19（CYFRA21-1）、糖链抗原199（CA199）、神经原特异烯醇化酶（NSE）和糖链抗原（CA125）联合检测在诊断恶性胸腹腔积液中的应用价值。方法　选择2015 ~ 2018 年结核性胸腹腔积液93 例，炎性胸腹腔积液44 例, 肝硬化腹腔积液39 例，共176 例（良性胸腹腔积液组），恶性肿瘤患者157 例（恶性胸腹腔积液组），应用酶联免疫吸附试验（ELISA）通过标准品绘制标准曲线检测sCD44V6 的浓度，采用化学发光法检测胸腹腔积液中CEA，CA199，CA125，CYFRA21-1 和NSE 水平，绘制ROC 曲线并计算曲线下面积（area under curve，AUC）来评价各指标的诊断价值。结果　恶性胸腹腔积液中sCD44V6，CEA，CA199，CYFRA21-1 和NSE 水平明显高于良性胸腹腔积液, 两者之间在统计学上有显著性差异（t=12.06 ~ 29.33, 均P<0.05）。恶性胸腹腔积液异常检出率高于良性胸腹腔积液组, 分别为81.53% vs 12.50%，67.28% vs 14.77%，55.41% vs 13.07%，94.90% vs 54.55%，79.62% vs 47.73%，64.33% vs 25.00%，差异均有统计学意义（χ2=36.11~159.73, 均P<0.05）；ROC 曲线分析sCD44V6，CEA，CA199，CA125，CYFRA21-1，NSE 曲线下面积分别为0.816，0.755，0.719，0.784，0.735 和0.789，联合检测为0.958；各种检测项目单独检测评价以sCD44V6 最好，敏感度为79.61％，特异度为82.92％，联合检测指标敏感度为85.09％，特异度为93.58％。结论　sCD44V6，CEA，CA199，CA125，CYFRA21-1 和NSE 联合检测对胸腹腔积液良恶性鉴别诊断有重要价值。     

肺癌患者血清、胸水血管内皮生长因子的表达及其意义

目的 研究血管内皮生长因子在肺癌患者血清、胸水中的表达水平对肺癌的诊断及良恶性胸水鉴别诊断的价值.方法 采用酶联免疫吸附法(ELISA法)检测23例肺癌患者血清与胸水VEGF含量.结果 肺癌组血清VEGF表达水平[(108±83.51)ng/L]与良性渗出液组[(42.83±21.78)ng/L],与健康对照组[(31.59±17.29)ng/L]比较,差异均有显著性.肺癌组胸水中VEGF表达水平[(313±175.75)ng/L]明显高于良性胸水[(101±50.16)ng/L](P<0.01).肺癌组的胸液/血清比值[(4.86±2.75)]显著高于良性渗出液组[(2.3±1.81)](P<0.01).肺癌患者血清VEGF表达水平与组织学类型、原发病灶大小、淋巴结转移无密切关系.结论 血清与胸水VEGF检测有助于肺癌的临床诊断和良恶性胸水的鉴别诊断.血清VEGF有可能与恶性胸水的形成有关.     

血清CA125、CA199及CEA联合检测在卵巢肿瘤诊断中的价值

目的探讨血清癌抗原125(CA125)、糖链抗原199(CA199)及癌胚抗原(CEA)联合检测在卵巢肿瘤诊断中的价值.方法采用电化学发光法测定卵巢肿瘤患者术前空腹血清中的CA125、CA199、CEA的含量.结果卵巢恶性肿瘤患者血清中的CA125均值为(210±242.5)U/ml,阳性率72.4%,CA199均值为(39.7±40.7)U/ml,阳性率为44.8%,明显高于卵巢良性肿瘤患者,差异有显著性(P＜0.01和P＜0.05);CEA的均值及阳性率较良性肿瘤患者组高,但差异无显著性(P＞0.05).CA125和CA199两项联合检测及CA125、CA199、CEA三项联合检测敏感性均为89.7%,较单项测定CA125高,差异有显著性(P＜0.05).结论 CA125、CA199联合检测可提高卵巢恶性肿瘤诊断的敏感性,在鉴别诊断卵巢肿瘤的良恶性方面有一定的价值,而增加CEA检测并不能提高卵巢恶性肿瘤的检出率.     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

骨脂肪瘤及血管脂肪瘤的CT及MRI表现:9例报告并文献复习

目的探讨骨脂肪瘤及血管脂肪瘤的CT及MRI表现。方法收集手术病理证实的9例骨脂肪瘤及血管脂肪瘤的临床及影像学资料,9例术前8例接受CT扫描,3例接受MRI检查。结果9例中骨脂肪瘤6例,骨血管脂肪瘤3例。6例骨脂肪瘤发生于骨内4例,骨旁2例。骨内脂肪瘤跟骨1例,距骨1例,眶骨1例,肱骨1例。骨旁脂肪瘤颅骨1例,股骨1例。骨血管脂肪瘤发生于肋骨1例,颅骨1例,椎骨1例。骨内脂肪瘤CT显示病变骨质呈轻度膨胀性改变,边缘见轻度硬化环,病灶内见脂肪密度及条弧形、结节状钙化,MRI显示病灶T1WI呈高信号,PDWI及T2WI抑脂序列呈低信号。骨旁脂肪瘤CT呈不均匀高密度团块,MRI显示病灶T1WI呈高信号,T1WI及T2WI抑脂序列呈低信号。3例骨血管脂肪瘤CT显示病变骨质呈显著膨胀性改变,骨破坏边缘及内部见多发骨嵴及粗大骨小梁,高密度骨针呈放射状、簇状或不规则排列。结论骨内脂肪瘤及血管脂肪瘤CT及MRI表现均以脂肪成分为主要特征,骨旁脂肪瘤CT以骨化性团块为特征,骨血管脂肪瘤骨质膨胀性改变较骨内脂肪瘤显著,病灶边缘及中心以多发骨嵴及粗大骨小梁为特征。      

城乡居民高血压与饮食习惯的调查分析

心血管疾病是我国的多发病和人群的主要死亡原因之一,而高血压已成为中老年人的常见病,是冠心病、脑卒中最主要的危险因素,已成为世界性公共卫生问题。随着我国经济的发展及人们生活水平的日益提高,我国在1958年、1979年、1991年分别进行了全国性的高血压普查,结果表明,我国高血压患病率在持续上升,且上升速度逐年加快。由于文化程度、生活习惯以及信息来源不足的差异也是导致城居民高血压患病率持续上升的重要原因,因此指导城乡居民进行合理的饮食,对预防高血压的发生、发展有着重要的意义。     

糖尿病视网膜病变筛查与防治中存在的问题及对策

目的探讨糖尿病视网膜病变(diabetic retinopathy,DR)患者筛查和防治中存在的问题及对策。方法以76例糖尿病DR患者为对象,调查未能早期接受眼科诊治的原因。结果存在问题主要是患者对DR防治知识不了解、血糖控制不理想、内科医生未建议进行专科检查等。结论眼科医护人员应密切与糖尿病专科的联系,尽早对DM患者进行DR健康教育,并开展社区DR防治工作。