降钙素原、C反应蛋白及白细胞计数在呼吸道感染性疾病中的诊断价值

目的探讨血清降钙素原(PCT)、C反应蛋白(CRP)及白细胞计数(WBC)在呼吸道感染性疾病中的诊断价值。方法随机选取呼吸道感染性疾病患者142例,测定其PCT、CRP及WBC水平,分析三者在呼吸道感染性疾病中的诊断价值。结果细菌感染组的PCT、CRP及WBC水平显著高于支原体感染组和病毒感染组,差异有统计学意义(P0.05),PCT、CRP及WBC对呼吸道感染性疾病的诊断效率分别为95.07%、56.34%、66.90%,革兰阴性菌组患者的PCT水平显著高于革兰阳性菌组患者,差异有统计学意义(P0.05),革兰阴性菌组患者和革兰阳性菌组患者的CRP及WBC水平差异无统计学意义(P0.05)。结论血清PCT、CRP及WBC的检测对细菌性感染性疾病的早期诊断具有重要的应用价值,作为较为理想的感染性疾病标志物,PCT检测更具有特异性。     

降钙素原、C反应蛋白及白细胞计数在诊断新生儿感染中的应用价值

目的探讨降钙素原(PCT)、C反应蛋白(CRP)及白细胞计数(WBC)联合检测在鉴别诊断新生儿感染中的应用价值。方法选择感染性疾病新生儿115例,按照感染类型的不同分为细菌感染组65例和病毒感染组50例,选择同期50例非感染性疾病新生儿作为对照组。比较3组新生儿治疗前及治疗后的血PCT、CRP及WBC水平。结果治疗前,细菌感染组、病毒感染组新生儿PCT、CRP及WBC水平显著高于对照组(P 0. 05),细菌感染组新生儿PCT、CRP及WBC水平又显著高于病毒感染组(P 0. 05)。治疗后,细菌感染组和病毒感染组新生儿PCT、CRP及WBC水平均显著下降(P 0. 05)。3种指标联合检测与降钙素原单项检测比较,差异有统计学意义(P 0. 05)。结论 PCT、CRP及WBC水平均可以作为临床判断新生儿感染性疾病的有效检测指标,且3项指标联合检测诊断的阳性率更高。     

探讨降钙素原在细菌感染性疾病中的临床应用价值

目的通过检测降钙素原（PCT）、C反应蛋白（CRP）、白细胞计数（WBC）,探讨它们在细菌感染性疾病中的临床应用价值。方法以该院近年来收住的疑为细菌感染的患者70例,非细菌感染患者25例,检测其血清中的PCT、CRP和血液中的WBC,用统计学方法进行分析比较。结果细菌感染组中PCT显著升高,为（17.61±1.39）ng/mL,高于非细菌感染组和对照组（P〈0.01）,具有统计学意义;而细菌感染组CRP与非细菌感染组比较差异无统计学意义（P〉0.05）;但细菌感染组WBC高于非细菌感染组和对照组（P〈0.05）。结论 PCT、CRP、WBC均对细感染性疾病的鉴别具有一定的诊断价值,而且相比CRP、WBC,PCT能早期、灵敏地反应全身性感染,可作为全身细菌感染早期诊断的指标,并具有较高的临床诊断价值。     

3项指标检测在细菌感染诊断中的价值探讨

目的探讨炎性指标中性粒细胞表面CD64、单核细胞HLA-DR、降钙素原(PCT)检测在细菌感染性疾病诊断中的价值。方法选取2013年10月至2014年3月福建省立医院临床初步诊断为感染性疾病的住院患者90例,按出院时回顾性分析,将患者分为细菌感染组、非细菌感染组(包括真菌或支原体感染);另选取同期健康体检者30例作为对照组。比较各组之间CD64、HLA-DR、PCT、C反应蛋白(CRP)、中性粒细胞碱性磷酸酶(NAP)积分、白细胞计数(WBC)的检测结果。结果细菌感染组CD64、PCT、CRP明显高于非细菌感染组与对照组,差异有统计学意义(P0.01),NAP、WBC明显高于对照组,差异有统计学意义(P0.01),HLA-DR明显低于非细菌感染组与对照组,差异有统计学意义(P0.01);非细菌感染组CD64、CRP、NAP积分(P0.01)与WBC计数(P0.05)明显高于对照组,而PCT及单核细胞HLA-DR与对照组相比较,差异无统计学意义(P0.05)。细菌感染组各炎性指标相关性分析表明:CD64与HLA-DR呈负相关(r=-0.36,P0.01);PCT与CRP呈正相关(r=0.43,P0.01);HLA-DR除与CD64呈负相关外,还与CRP、WBC呈负相关(P0.01)。按PCT水平对感染程度分级,结果显示PCT各水平组的HLA-DR水平均明显低于对照组(P0.05,P0.01),并呈现明显递减趋势;除0.05~0.5ng/mL组外,其他PCT水平组的CD64水平均明显高于对照组(P0.05,P0.01),并呈现明显的递增趋势。结论 PCT、CD64、HLA-DR是较好的细菌感染指标,3者联合检测对细菌感染的诊断、评估与监测有着重要的意义。     

降钙素原在感染性发热诊断中的意义

目的分析感染性发热患者中细菌感染和病毒感染血清降钙素原(PCT)水平的差别,探讨血清PCT在感染性发热诊断中的意义。方法采用半定量固相免疫测定法测定48例细菌感染性发热患者、40例病毒感染性发热患者以及30例健康对照组血清中的PCT,将检测结果分成4个水平,PCT<0.5 ng/mL,0.5 ng/mL≤PCT<2.0 ng/mL,2.0 ng/mL≤PCT<10.0 ng/mL和PCT≥10.0 ng/mL,分析PCT水平与细菌病毒感染之间的关系。以PCT≥0.5 ng/mL为阳性诊断标准。结果细菌感染组患者血清PCT水平高于病毒感染组和对照组,差异有统计学意义(P≤0.05),病毒感染组与对照组之间差异无统计学意义(P>0.05)。结论检测PCT能有效地鉴别细菌性和非细菌性感染性发热,有利于早期正确治疗。     

联合检测PCT、CRP及WBC在临床感染性疾病诊疗中的价值

目的探讨联合动态检测降钙素原(PCT)、C反应蛋白(CRP)及白细胞计数(WBC)在临床感染性疾病中的应用价值。方法将95例感染性疾病患者分为细菌感染组58例,非细菌感染组37例,另选同期健康体检者50例作为对照组,检测并比较各组PCT、CRP、WBC水平。细菌感染组分别于使用抗菌药物前,使用抗菌药物1、3、7d,停用抗菌药物后检测PCT、CRP及WBC。结果细菌感染组治疗前PCT、CRP及WBC与非细菌感染组治疗前及对照组比较,差异均有统计学意义(P0.05)。非细菌感染组PCT、CRP及WBC与对照组比较,差异无统计学意义(P0.05)。细菌感染组治疗前,治疗1、3d后PCT、CRP及WBC与对照组比较,差异有统计学意义(P0.05)。细菌感染组各项指标联合及单独检测阳性率均明显高于非细菌感染组,差异均有统计学意义(P0.05)。细菌感染组与非细菌感染组联合检出率均明显高于单项检测阳性率,差异均有统计学意义(P0.05)。结论 PCT、CRP及WBC联合检测可广泛用于感染性疾病的鉴别诊断及疗效监测。     

4项指标检测在感染性疾病中的诊断价值

目的探讨降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)和中性粒细胞百分率(NEU%)在感染性疾病中的诊断价值。方法选取2016年8月至2018年8月该院收治的110例感染性疾病患者,根据细菌培养或病原体IgM抗体检测结果分为细菌感染组(56例)与非细菌感染组(54例),同时从健康体检者中设立对照组(60例),于用药前抽取各组人员的静脉血进行PCT、CRP、WBC和NEU%测定。结果细菌感染组的PCT、CRP、WBC和NEU%水平明显高于非细菌感染组及对照组,差异均有统计学意义(P0.05)。非细菌感染组的PCT、WBC和NEU%水平与对照组比较,差异无统计学意义(P0.05);非细菌感染组的CRP水平与对照组比较,差异有统计学意义(P0.05)。对于细菌感染,CRP敏感度最高,PCT的特异度、约登指数、阳性预测值和阴性预测值均高于CRP、WBC和NEU%。结论 PCT、CRP、WBC和NEU%检测在感染性疾病的鉴别诊断中都有各自的应用价值,其中PCT对于细菌感染的诊断效能优于其他3项。     

血清降钙素原与C反应蛋白联合检测在肺部感染性疾病中的诊断价值

目的分析研究血清降钙素原(PCT)与C反应蛋白(CRP)检测在肺部感染性疾病诊断中的临床应用价值。方法选取2013年1月~2014年12月我院收治的90例肺部感染性疾病患者,根据病原学结果,其中细菌感染组48例,非细菌感染组42例(真菌感染20例、病毒感染22例),选取同期在我院就诊的健康体检者50例设立为对照组。对比细菌感染组与非细菌感染组之间以及两组与对照组之间PCT与CRP水平的差异。比较组间PCT检测、CRP检测和联合检测的阳性率;并对细菌感染组PCT检测、CRP检测和联合检测的阳性率进行比较。结果三组治疗前的血清PCT和CRP水平差异有统计学意义(P0.05),细菌感染组血清PCT与CRP水平显著高于非细菌感染组患者与健康对照组检测者,均差异有统计学意义(P0.05)。治疗后细菌感染组患者的PCT与CRP水平较治疗前显著下降,差异有统计学意义(P0.05);治疗后非细菌感染组患者的PCT与CRP水平较治疗前无显著差别,差异无统计学意义(P0.05);结果显示,细菌感染组PCT、CRP检测和联合检测阳性率均高于非细菌感染组(P0.05),细菌感染组联合检测阳性率均PCT、CRP单组检测,差异均有统计学意义(P0.05)。结论血清PCT与CRP检测与肺部细菌性感染密切相关,联合检测血清PCT与CRP水平能显著提高肺部疾病的诊断与鉴别诊断的可靠性,可明确指导肺部感染性疾病患者选择合理的抗菌药物展开治疗,值得临床推广应用。     

血清PCT对急性发热患者菌血症的诊断效果探讨

目的探讨血清降钙素原(PCT)水平对急性发热患者菌血症的诊断价值。方法选取386例急性发热患者为研究对象,并分为菌血症组(n=52)、局部感染组(n=276)和非感染组(n=58)。比较各组的血清PCT、C反应蛋白(CRP)水平及白细胞(WBC)计数,通过受试者工作特征(ROC)曲线的曲线下的面积(AUC)评价其诊断价值,并确定最佳临界值及其灵敏度、特异度、阳性预测值、阴性预测值和Youden指数。结果菌血症组血清PCT水平明显高于局部感染组和非感染组,差异有统计学意义(P0.05)。菌血症组CRP和WBC明显高于非感染组,差异有统计学意义(P0.05)。菌血症组血清PCT0.5ng/ml的比例明显低于局部感染组和非感染组,差异有统计学意义(P0.05),而0.5~2.0ng/mL、2.0~10.0ng/mL的比例均明显高于局部感染组和非感染组,差异有统计学意义(P0.05)。革兰阳性菌感染患者血清PCT水平明显高于革兰阴性菌,差异有统计学意义(P0.05)。PCT、CRP和WBC的AUC分别为0.858、0.723、0.710,差异有统计学意义(P0.05)。对于菌血症,血清PCT水平的最佳阳性阈值为0.4ng/mL,其灵敏度、特异度、阳性预测值、阴性预测值及Youden指数分别为90.4%、64.2%、49.5%、94.5%及0.546。结论在诊断菌血症方面,血清PCT水平具有较高的灵敏度和特异度,可作为一个快速且可靠指标。     

血清降钙素原联合C反应蛋白和白细胞计数检测在呼吸道感染中的应用

探究血清降钙素原(PCT)联合C反应蛋白(CRP)和白细胞计数(WBC)检测在呼吸道感染中的应用价值。选取我院2015年3月~2016年5月收治的84例呼吸道感染患者,依据是否存在细菌感染分为细菌感染组(n=31)与非细菌感染组(n=53),并选取同期28例健康体检者作为对照组,检测并对比各组血清PCT、CRP及WBC水平,并比较其诊断结果。细菌感染组血清PCT、CRP及WBC各指标水平均高于对照组和非细菌感染组,差异具有统计学意义(P0.05);非细菌感染组血清PCT、CRP水平均高于对照组,差异具有统计学意义(P0.05);各指标联合检测诊断敏感性、准确性均高于应用血清PCT、CRP及WBC单一检测,特异性高于CRP及WBC,差异具有统计学意义(P0.05)。对呼吸道感染患者应用血清降钙素原联合C反应蛋白和白细胞计数检测,可显著提高临床诊断呼吸道感染的准确率,有效鉴别细菌性与非细菌性呼吸道感染。     

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.     

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.     

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.