PLT-F计数低值血小板的准确性评价

目的探讨Sysmex XN-9000全自动血细胞分析仪PLT-F通道在低值血小板测定中的临床意义。方法采用Sysmex XN-9000全自动血细胞分析仪的3种方法电阻抗法(PLT-I)、光学法(PLT-O)、荧光核酸染色法(PLT-F)进行血小板计数,从精密度、低值血小板及红细胞碎片干扰评价,并与使用抗CD61抗体的流式细胞术检测结果进行比较。结果与电阻抗法(PLT-I)、光学法(PLT-O)相比,荧光核酸染色法(PLT-F)的重复性最好,精确度较高;在红细胞碎片干扰实验中,PLT-F具有较强的抗干扰能力(高、低浓度组P0.05),PLT-O次之(高浓度组P0.01,低浓度组P0.05);低值血小板相关分析结果显示3种方法都得到良好的相关性,PLT-F法的准确性较高,尤其在低值血小板计数中。结论临床常规标本可以使用Sysmex XN-9000全自动血液分析仪的PLT-I法检测,当标本血小板数目异常或溶血时,建议使用PLT-O法或PLT-F法复查,必要时采用镜检法或流式细胞术。     

4种检测方法在低值血小板计数中的应用比较

目的探讨电阻法(PLT-I)、光学法测定(PLT-O)、荧光法(PLT-F)、显微镜法计数在低值血小板计数(PLT)中的应用。方法从2014年1月至2016年7月住院的1 200例患者中,分别采集乙二胺四乙酸二钾(EDTA-K2)静脉血,经Sysmex XN-1000全自动型血细胞分析仪检测出PLT50×10~9/L的血液标本为研究标本,并根据PLT数据的差异对血液标本进行分类,即PLT为20×10~9/L~50×10~9/L、PLT为10×10~9/L~20×10~9/L和PLT10×10~9/L 3个组;继而分别通过对PLT-I、PLT-O、PLT-F、显微镜法对上述EDTA-K2标本PLT进行检测,其中以显微镜法计数结果作为金标准,使用统计学软件SPSS19.0对所有检查结果进行分析。结果经Sysmex XN-1000全自动型血细胞分析仪检测出PLT50×10~9/L的血液标本共计600例;当PLT为20×10~9/L~50×10~9/L和PLT10×10~9/L时,PLT-I、PLT-O、PLT-F检测结果与显微镜法PLT检测结果比较,差异均无统计学意义(P0.05);当PLT为10×10~9/L~20×109/L时,PLT-I、PLT-F与显微镜法PLT检测结果比较,差异均无统计学意义(P0.05),然而PLT-O同显微镜法PLT检测结果比较,差异有统计学意义(P0.05);根据相关性分析,PLT-I、PLT-O、PLT-F与显微镜法均有相关性(P0.05),且PLT-F与显微镜法相关性极强。结论当PLT为20×10~9/L~50×109/L和PLT10×109/L时,PLT-I、PLT-O、PLT-F和显微镜法均能较准确地计数低值血小板数量;当PLT为10×10~9/L~20×10~9/L时,因误差导致,PLT-O检测低值血小板数目明显偏低,应进行复检;在PLT50×10~9/L的情况下,PLT-F检测法表现出极强的再现性,因此其对判断是否进行血小板输注更为有利。     

XN-2000全血细胞分析仪对低值血小板检测的分析探讨

目的通过对XN-2000血细胞分析仪的阻抗模式(PLT-I)和低值模式(PLT-F)的低值血小板(PLT)检测结果比较分析,为其低值PLT复检规则的制定提供依据。方法收集PLT-I模式检测PLT80×109/L 264例,分别使用PLT-F法和手工法检测并涂片镜检,根据镜检结果分为无聚集组和聚集组,无聚集组根据MCV大小和镜下PLT形态T分为MCV80 f L组、70 flMCV80 f L组和MCV70 f L组以及大PLT组并采用相关性分析,聚集组结合仪器报警分析。结果仪器PLT聚集报警中,PLI-I法假阳性率91.4%,假阴性率50%,PLT-F法假阳性和假阴性均为0;MCV80 f L、70 flMCV80 f L和MCV70 f L时PLT-I法的r值分别为0.866、0.958、0.244,PLT-F法分别为0.896、0.976、0.988;大PLT组中PLT-I法和PLT-F法r值分别为0.895和0.951;当出现聚集、大PLT及小红细胞干扰时,其直方图或散点图会出现特殊改变。结论 XN-2000的PLT-F干扰较小,特异性高,当PLT-I法出现MCV70 f L或聚集报警时,应结合直方图和散点图观察,采用PLT-F法复检,以降低人工镜检率,提高工作效率。     

XN-9000血液分析仪“低值血小板”检测通道的临床应用评价

目的探讨Sysmex XN-9000(简称XN9000)全自动血液分析仪计数低值血小板的临床应用价值。方法 1、选用3份病人低值血小板(PLT:50-80x109/L)标本,分别用仪器的PLT-F、PLT-I通道与手工相差显微镜连续检测10次,计算其变异系数;2、选取200例低血小板标本,根据血小板报警信息分为无血小板报警组(130例)和血小板直方图异常报警组(70例)二组,用PLT-F、PLT-I和手工相差显微镜镜检三种方法同时检测,分别计算PLT-F法、PLT-I法与手工相差显微镜镜检结果的相关系数及偏差。结果 1、三份样本的变异系数PLT-F法最小(均小于1.47%),其次为PLT-I法(均小于3.12%),手工相差显微镜镜检法最大,但变异系数均小于4.07%;2、无血小板报警组和血小板直方图异常报警组PLT-F法、PLT-I法与手工显微镜镜检的相关系数R2分别为:PLT-F法:0.9761、0.8051;PLT-I法:0.9567、0.6672;相对偏差分别为:PLT-F法:1.74%、6.97%;PLT-I法:2.68%、8.43%。结论当无血小板报警时,XN-9000低值血小板通道(PLT-F)计数低值血小板比PLT-I法更准确,能替代手工显微镜计数;当有血小板直方图报警时应进行手工显微镜计数确认。     

MCV对不同方法血小板计数结果的影响

目的探讨红细胞平均体积(MCV)对XN-2000血液分析仪电阻抗法(PLT-I)和荧光染色法(PLT-F)计数患者血小板结果的影响。方法采用Sysmex XN-2000血液分析仪对286例患者抗凝血分别用PLT-I和PLT-F进行血小板计数,计数结果根据MCV大小分为3组,A组:MCV<72 fL,B组:72 fL≤MCV≤82 fL,C组:MCV>82 fL;将两种方法检测的血小板结果进行统计学分析。结果A组PLT-I和PLT-F两种方法计数结果差异有统计学意义(P<0.05),B组和C组这两种方法计数结果差异均无统计学意义(P<0.05)。结论临床进行血常规血小板计数检测时,MCV越大,PLT-I和PLT-F二者计数结果差异越不明显,MCV<72 fL时,PLT-I和PLT-F血小板计数结果有明显差异,提示MCV<72 fL时采用PLT-F对血小板计数结果进行复检,可有效避免小红细胞导致的血小板计数假性增高。     

血小板计数准确性研究及对策

目的：探讨临床常规血小板（PLT）计数不准确的原因,并提出纠正措施。方法收集PLT计数异常标本180例,分为4组,分别为低值 PLT 组（PLT≤20×109/L）72例,小红细胞组54例,大 PLT 组33例,PLT 聚集组21例,分别采用光学法（PLT-O）、阻抗法（PLT-I）、手工镜检法（PLT-M）3种方法同时计数 PLT,用配对 t 检验进行分析。结果低值 PLT 组、小红细胞组、大 PLT 组光学法与 PLT 计数 PLT-M 法比较差异无统计学意义（P ＞0．05）,而 PLT-I 法与 PLT-M 法 PLT 计数比较差异有统计学意义（P ＜0．05）。PLT 聚集组的标本,PLT-I 法和 PLT-O 法计数结果比较,PLT-O 法结果更接近真实值。结论PLT-I法 PLT 计数的影响因素很多,主要有小红细胞干扰导致计数偏高,大 PLT 漏检导致 PLT 结果偏低,PLT 聚集等,当 PLT 计数结果异常时应根据复检规则复检,采用手工 PLT-M 法或者 PLT-O 法纠正,必要时重新采血测定。     

PLT-F通道在异常血小板计数检测中的价值

目的通过荧光血小板(PLT-F)通道对异常血小板(PLT)计数样本进行检测,分析PLT-F通道在异常PLT计数检测中的价值。方法采集空腹静脉血样本158例,将样本分为低值PLT组、小红细胞干扰组、大PLT组和PLT聚集组。采用电阻抗法(PLT-I)、荧光法(PLT-F)检测PLT计数,并将其检测结果与人工镜检法(PLT-M)结果进行比较。结果低值PLT组、大PLT组及小红细胞干扰组PLT-F通道检测PLT计数及幼稚血小板分数(IPF)的批内重复性[变异系数(CV)]分别为4.94%、1.70%、0.80%与4.81%、1.30%、2.74%。低值PLT组、小红细胞干扰组及大PLT组PLT-F与PLT-M的决定系数(r2)值分别为0.856 8、0.822 3与0.771 0;PLT-I与PLT-M的r2值分别为0.679 1、0.775 4与0.592 6。结论 PLT-F通道批内重复性好,可通过PLT-F通道对异常PLT计数样本进行快速复检。     

迈瑞BC6800-PLUS血液分析仪8倍光学模式在低值血小板计数检测中的临床应用价值

目的?探讨迈瑞BC6800-PLUS血液分析仪8倍光学模式在解决低值血小板计数（PLT）检测准确性问题上的临床应用价值。方法?选取电阻抗模式下PLT＜50×109／L 的标本335 例,其中5 例用电阻抗法（PLT-I）、光学法（PLT-O）、8 倍光学法（PLT-O8）检测PLT 11次,进行重复性评价;另外330例用光学法和8倍光学法检测,以手工计数（PLT-M）作为参考并与其比较。结果?PLT-O8的重复性优于PLT-I、PLT-O的重复性;当PLT无干扰时,PLT-I、PLT-O、PLT-O8与手工法检测结果差异无统计学意义（P＞0.05）;当PLT 有小红细胞和细胞碎片干扰且PLT＜10×109／L 时,PLT-O 与PLT-M 差异有统计学意义（P＜0.05）,PLT-O8与PLT-M差异无统计学意义（P＞0.05）。结论?当镜检血小板有红细胞碎片和小红细胞干扰且PLT＜10×109／L时,迈瑞BC6800-PLUS血液分析仪的8倍光学模式检测PLT的准确性较好,有一定的临床应用价值。     

未成熟血小板比率、平均血小板体积与血小板计数方法比较研究

目的 探讨未成熟血小板比率(IPF)与平均血小板体积(MPV)对血小板计数方法影响,XE-5000全自动血细胞分析仪激光染色法(PLT-O)和电阻抗法(PLT-I)计数血小板与显微镜计数血小板比较研究.方法 根据IPF与MPV选择XE-5000分析仪测试的高、中、低值血小板标本各1份,首先比较PLT-I与PLT-O测试计数血小板的精密度;其次用室间质评结果分析XE-5000仪两种测试的准确度.结果 XE-5000计数血小板低、中、高值具有较好的精密度,变异系数(CV)小于4.0%.血小板计数正常或高值且IPF<20%时用PLT-O与PLT-I差异无统计学意义(P<0.05);血小板计数减少且IPF>25%时,PLT-I法与显微镜法比较,差异有统计学意义(P<0.05),而PLT-O法与显微镜法比较,差异无统计学意义(P<0.05).结论 一般情况下,血常规采用XE-5000 PLT-I法计数血小板,当血小板减少且被复检软件程序拦截制片镜检发现有大血小板时,可用显微镜计数法或PLT-O法复查血小板数.     

XE-2100血液分析仪两种血小板计数方法的准确性在血液疾病中的观察

目的观察XE-2100血液分析仪电阻抗法(PLT-I)和光学法(PLT-O)计数血小板的准确性以及与某些血液疾病的关系。方法检测XE-2100血液分析仪计数血小板的精密度并采用50名正常人和150例血液病患者的样本,用PLT-I法、PLT-O法和手工显微镜法同时计数血小板,以手工显微镜法结果为参考。结果XE-2100血液分析仪PLT-I法和PLT-O法计数血小板(低、中、高值)有较好的重复性,变异系数(CV)均<4.0%。健康者在XE-2100上用PLT-I法和PLT-O法计数血小板与显微镜法比较差异无统计学意义(P>0.05)。血液性疾病患者PLT-O法计数血小板与显微镜法比较差异无统计学意义(P>0.05),但PLT-I法计数血小板与显微镜法比较差异有统计学意义(P<0.05)。结论Sysmex XE-2100血液分析仪在分析血液病患者的血小板时,应以PLT-O法测定结果为好,但在仪器报警时还须用显微镜法复核。     

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.     

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.     

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.     

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.