胶体金法血清β-HCG检测结果对发光免疫分析仪检测程序选择的价值

目的 探讨胶体金法β-HCG检测结果 应用于微粒子全自动发光免疫分析仪检测程序选择中的价值.方法 分别用胶体金法试纸条和微粒子全自动发光免疫分析仪对血清标本进行β-HCG检测.结果 胶体金法检测阴性标本126例,定量检测结果 为(0.00~22.8) mIU/mL;弱阳性标本98例,97例定量检测结果 为(12.6~982.4) mIU/mL,1例为525 312 mIU/mL;阳性标本3例,定量检测结果 为(991.5~1 080.6) mIU/mL;强阳性标本51例,定量检测结果 为(1 120.8~182 826.7) mIU/mL.结论 98%的临床标本可根据胶体金法试纸条检测结果 选择微粒子全自动发光免疫分析仪常规或稀释检测程序.     

CK-MB免疫抑制法和免疫沉淀法的比较

CK-MB的测定已广泛用于心肌损伤的诊断,目前实验室常用的测定方法多为免疫抑制法和免疫沉淀法。免疫抑制法检测CK-MB的活性浓度(U/L),因其操作简单,可在生化仪上检测而得到广泛应用。但有时由于非典型CK成份存在会导致测定CK-MB时出现错误的结果。近几年随着全自动免疫分析仪发展,免疫沉淀法测定CK-MB得到广泛普及,它检测其定量浓度,不受非典型CK成分影响,能更好地反映心肌损伤的程度。本文收集一组标本用两种方法检测并比较分析两者的优缺点及临床应用价值。     

罗氏Cobas8000全自动生化分析仪检测心肌酶谱的性能评价

目的对在罗氏公司Cobas8000型全自动生化分析仪上检测的心肌酶谱:天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)的分析性能进行评价。方法参考美国临床和实验室标准化协会性能评价方法和相关报道,并根据临床需求和实际要求,对罗氏公司Cobas8000型全自动生化分析仪测定血清心肌酶谱的准确度、精密度、线性范围、生物参考区间和最大稀释倍数5项分析性能进行验证和评价,并与强生公司Vitro5600型分析仪进行方法学比对。结果罗氏Cobas8000分析仪对心肌酶谱的检测准确度较好,各项指标的相对偏倚均小于允许总误差的1/2,符合美国临床实验室改进修正法案(CLIA′88)的指标要求。精密度验证结果显示批内变异系数和不同批次之间的检测标本变异系数分别小于允许总误差的1/4和1/3。线性回归方程的斜率在0.998~1.017,r 2均≥0.995。AST、LDH、CK、CK-MB的临床可报告范围分别为2~700 U/L、10~1000 U/L、7~2000 U/L、3~2000 U/L。参考范围验证除LDH有一个值超出该参考区间外,其他结果均在参考范围内。高浓度的标本可经稀释后再行测定,测定结果表明4项测定指标的相对偏差在允许误差范围内,具有较高的临床参考价值。实验室内结果比对,4个项目比对结果均符合CLIA′881/2允许偏倚,与Vitro5600型分析仪具有良好的一致性。结论罗氏Cobas8000型全自动生化分析仪检测心肌酶谱的主要分析性能均符合厂商声明的性能和有关的质量要求,检测结果准确性较高、可靠性较好,临床参考价值较高,故可满足临床需求。     

胶乳免疫比浊法检测肌酸激酶同工酶的性能评价

目的采用胶乳免疫比浊法对肌酸激酶同工酶(CK-MB)进行测定,以验证其性能是否满足厂家声明和临床诊断的要求。方法依据美国临床实验室标准化协会文件和卫生行业标准要求,对CK-MB的功能灵敏度、精密度、分析测量范围、临床可报告范围、生物参考区间和抗干扰能力进行验证评价,并与传统的化学发光法结果进行比较。结果验证后CK-MB功能灵敏度为1.30ng/mL。高、低浓度质控品的批内不精密度分别为1.05%、2.24%,日间不精密度分别为1.41%、2.88%。分析CK-MB检测范围为3.07～185.67ng/mL,临床可报告范围为1.30～1 485.36ng/mL,生物参考区间为0～5ng/mL。当标本血红蛋白≤15g/L,三酰甘油≤11.4mmol/L,胆红素≤684μmol/L时,对CK-MB检测结果无明显干扰。胶乳免疫比浊法与化学发光法总体符合率为88.0%,线性回归方程为Y=0.882 5 X-0.397 4,r2=0.985,相关性良好。结论在贝克曼库尔特AU5800全自动生化分析仪上采用胶乳免疫比浊法检测CK-MB的性能达到厂家声明,并且可满足临床需求。     

应用EP6-A文件评价MP1干式生化分析仪淀粉酶检测的线性

目的应用CLSI EP6-A文件对MP1全自动干式生化分析仪定量测定淀粉酶(AMY)的线性进行评价。方法配制6个AMY浓度为等间距的血清标本,用MP1全自动干式生化分析仪进行测定,每个标本重复测定2次,对数据进行多项式回归分析,得出线性范围。结果重复测定的不精密度CV为2.47%,小于5%的设定误差目标,最适拟合模型为一次多项式,AMY在4.7~1 015U/L范围内呈线性。结论 MP1全自动干式生化分析仪定量测定AMY在4.7~1 015U/L范围内呈线性。     

应用全自动生化分析仪测定缺血修饰白蛋白

目的建立白蛋白钴结合（ACB）试验检测缺血修饰白蛋白（IMA）。方法应用日立7600型全自动生化分析仪,采用ACB法测定IMA,并测定血清中不同白蛋白浓度,以观察白蛋白对其影响。结果ACB方法批内变异系数（CV）为5.0%,批间CV为1.6%。不同浓度的人血清白蛋白ACB法测定结果是线性的,回归方程为Y=0.029＋1.57X,r=0.995,P=0.000。黄疸对测定无明显影响;溶血（5 g/dL）和脂血（0.4%）对测定有干扰。健康人群参考范围为79.6 U/mL。结论IMA是评价心肌缺血的有效诊断工具,采用全自动生化分析仪建立测定IMA的方法方便、简单,可以大批量测定。     

应用全自动生化分析仪测定缺血修饰白蛋白

目的建立白蛋白钴结合(ACB)试验检测缺血修饰白蛋白(IMA)。方法应用日立7600型全自动生化分析仪,采用ACB法测定IMA,并测定血清中不同白蛋白浓度,以观察白蛋白对其影响。结果ACB方法批内变异系数(CV)为5.0%,批间CV为1.6%。不同浓度的人血清白蛋白ACB法测定结果是线性的,回归方程为Y=0.029 1.57X,r=0.995,P=0.000。黄疸对测定无明显影响;溶血(5 g/dL)和脂血(0.4%)对测定有干扰。健康人群参考范围为79.6 U/mL。结论IMA是评价心肌缺血的有效诊断工具,采用全自动生化分析仪建立测定IMA的方法方便、简单,可以大批量测定。     

全自动微粒子化学发光免疫分析仪监测地高辛血药浓度

采用全自动微粒子化学发光免疫分析仪对服用了地高辛的120例成年患者进行血药浓度监测分析。地高辛血药浓度＜0.5ng/ml 共22例次（7.69%）、0.5-2.0ng/ml 有效范围内242例次（84.62%）、2.0-3.0ng/ml 范围内18例次（6.29%）、≥3.0 ng/ml共4例次（1.40%）。根据监测结果适当调整患者地高辛药物服用剂量之后,120例患者均在7d内接受多次全自动微粒子化学发光免疫分析仪监测并显示血清标本中地高辛浓度在有效范围0.5-2.0ng/ml之内,未见死亡病例。使用全自动微粒子化学发光免疫分析仪可准确测定患者服用地高辛后的血清药物浓度,及时调整用药量,保证疗效、避免意外。     

强生VITROS5.1FS生化分析仪6个血清酶项目的可报告范围验证

目的验证丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)、α-淀粉酶(AMY)和γ-谷氨酰转移酶(GGT)6个血清酶项目在强生VITROS 5.1FS生化分析仪上的可报告范围。方法根据CLSI的EP6-A文件的方法并参照美国强生公司提供的验证方案对ALT、AST、ALP、LDH、AMY和GGT可报告范围进行验证。选择高浓度、低浓度血清混合,用生理盐水作为稀释液,将高值血清按1∶2、1∶4、1∶8、1∶16、1∶32进行稀释,每个稀释浓度平行检测2次,取其均值作为检测值,计算检测值与预期值间偏倚,采用行业标准作为判断标准,以小于可接受最大偏倚的最大稀释倍数的结果为可报告范围。结果 ALT、AST、ALP、LDH、AMY和GGT最大稀释倍数均为1∶8。可报告范围:ALT为6.0~921.6U/L,AST为3.0~687.2U/L,ALP为20.0~1 094.4U/L,LDH为100.0~2 067.6U/L,AMY为30.0~863.0U/L,GGT为10.0~1 289.2U/L。结论强生VITROS 5.1FS生化分析仪检测的ALT、AST、ALP、LDH、AMY、GGT可报告范围基本符合质量目标要求和厂商说明要求,满足临床检验的需求。     

免疫抑制法测定深圳地区13岁以下健康儿童CK-MB水平及分析

目的了解免疫抑制法测定深圳地区5个月~13岁不同年龄健康儿童血清肌酸激酶MB同工酶(CK-MB)的含量水平,并分析其与方法学提供的参考区间的差异性,为本地区建立健康儿童CK-MB参考区间提供依据。方法收集2016年3~6月来医院保健科体检的健康儿童1 062例,依据年龄分为3组:5个月~3岁的学龄前组、4~6岁的幼儿组和7~13岁的小学组,并选择同期健康成人390例,采用免疫抑制法检测血清CK-MB含量,与方法学提供的参考区间比较,对含量超出范围的标本同时进行肌钙蛋白I(cTnI)、肌红蛋白(MYO)和心电图检测,并对结果进行统计分析。结果 1 062例健康儿童检出CK-MB含量异常率为66.20%(703/1 062),其中学龄前组、幼儿组和小学组CK-MB含量异常率分别为81.02%(239/295)、66.23%(251/379)和54.90%(213/388),各组CK-MB含量异常率的差异有统计学意义(χ~2=3.71~15.95,P0.01~0.05),而390例健康成人血清CK-MB含量均24 U/L;703例CK-MB含量异常标本中c Tn I含量均0.034 ng/ml,有3例标本MYO结果稍有增高61.5 ng/ml,但随后的心电图跟踪检查均未见异常;学龄前组、幼儿组及小学组儿童血清CK-MB含量(U/L)分别为41.52±19.38、35.09±14.37及28.15±7.86,不同年龄段儿童血清CK-MB含量的差异有统计学意义(t=2.60~4.13,P0.05);健康儿童血清CK-MB含量为34.97±10.64 U/L,与健康成人血清CK-MB含量(16.05±7.13 U/L)的差异有统计学意义(t=13.93,P0.01)。结论免疫抑制法检测深圳地区5个月~13岁健康儿童血清CK-MB含量异常率较高,临床上不能直接引用方法学提供的参考区间,应及时建立本地区健康儿童CK-MB免疫抑制法的正常参考区间,以便更好地为临床服务,降低误诊和不必要的确诊项目检查。     

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."