国产邻苯三酚红试剂检测尿蛋白的性能验证

目的 评估国产邻苯三酚红试剂测定尿蛋白的分析性能.方法 收集不同尿液蛋白浓度的新鲜尿液标本,采用不精密度、回收率、最低检出限、线性范围以及临床可报告范围进行验证.结果 高、低2个浓度水平尿液样本总蛋白测定的批内CV值分别为2.34%及1.11%,批间CV值分别为3.21%及1.65%;平均回收率为97.5%,最低检出限为0.367 mg/dL,在11～298 mg/dL的浓度范围内线性良好,最大稀释倍数为20倍,临床可报告范围为11～5 960 mg/dL.结论 不精密度、回收率指标可满足临床要求,最低检出限、线性范围、最大稀释倍数及临床可报告范围可提供更好的质量保证,但高浓度标本需稀释处理.     

反相高效液相色谱法测定消毒剂中聚六亚甲基双胍和醋酸氯己定含量

目的 建立一种同时测定复方消毒剂中聚六亚甲基双胍(PHMB)和醋酸氯己定(CHA)含量的高效液相色谱方法。方法 采用氰基色谱柱反相高效液相色谱法，通过梯度洗脱，对复方消毒剂中PHMB和CHA进行测定。结果 本方法能将不同聚合度的PHMB合并为一个峰，并与CHA分离，在2.0～10.0 mg/L范围内峰面积与质量浓度的线性关系良好(r>0.999);定量限分别为1.0和0.5 mg/L,检出限分别为0.3和0.15 mg/L;PHMB加标回收率为99.6%～107.8%,CHA加标回收率为95.6%～104.8%。结论 本研究建立的测定复方消毒剂中PHMB和CHA含量的反相高效液相色谱法操作简单、准确可靠，具有实际应用价值。     

高效液相色谱法测定复方消毒剂中聚六亚甲基双胍准确性研究

目的建立复方消毒剂中聚六亚甲基双胍测定方法。方法采用气体熏蒸载体杀菌试验方法,对机器发生二氧化氯气体杀灭枯草芽孢杆菌黑色变种芽孢高效液相色谱法,对复方消毒剂中聚六亚甲基胍含量测定的准确性和稳定性进行评价。结果用高效液相色谱法检测聚六亚甲基胍含量在5~100 mg/L范围内线性良好。相关系数r=0.9997,回收率为97.8%~100.1%,RSD=1.0%~1.3%,检出限为0.15 mg/L,定量限为0.5 mg/L。结论用高效液相色谱法检测复方消毒剂中聚六亚甲基双胍含量,操作简便、快速准确,可满足日常检测。     

液相色谱串联质谱法分析血清中脂溶性维生素的性能评价及临床应用

目的 建立液相色谱串联质谱法定量分析血清中脂溶性维生素的方法,并进行性能分析评价以及初步临床应用。方法 采用液相色谱串联质谱法定量检测血清中脂溶性维生素含量,并检测2022年11月至2023年11月在苏州大学附属第一医院产科门诊产检的1 113例孕妇血清中的脂溶性维生素。参照《液相色谱串联质谱临床检测方法的开发与验证》进行血清中脂溶性维生素高效液相色谱串联质谱检测方法的方法学验证。结果 液相色谱串联质谱法定量检测血清中脂溶性维生素,包括维生素A、维生素E、维生素D2、维生素D3、维生素K1,线性范围分别为40～4 000 ng/mL、0.5～50μg/mL、2～200 ng/mL、5～250 ng/mL、0.1～10 ng/mL,检出限分别为2.50 ng/mL、0.10 ng/mL、0.40 ng/mL、1.00 ng/mL、0.02 ng/mL,定量下限分别为10.00 ng/mL、0.50 ng/mL、1.00 ng/mL、5.00 ng/mL、0.10 ng/mL,批内变异系数(CV)和批间CV均小于15%,回收率分别为91.25%～107.18%、90.00%～105.51%...     

酶法测定尿液草酸和枸橼酸的方法学性能验证及分析前影响因素研究

目的为了保证检测结果的可比性并规范尿液前处理过程,对酶法检测尿液草酸和枸橼酸的试剂盒进行性能验证及分析前影响因素研究。方法参考相关行业标准,对草酸和枸橼酸酶法试剂盒进行精密度、正确度、线性范围及干扰的性能验证。分析前影响因素研究包括:不加防腐剂,比较在室温、4℃和-20℃条件下放置不同时间的草酸和枸橼酸浓度;按照不同比例(100∶1,50∶1)、在不同时间(收样即刻,收样24 h后,冻存标本检测前)加入6 mol/L HCl酸化尿液对草酸和枸橼酸浓度的影响。结果在低浓度下,草酸和枸橼酸的重复性(以CV表示)为0.92%和1.41%,实验室内不精密度为1.79%和1.75%,偏倚为-1.77%和-2.68%;在高浓度下,草酸和枸橼酸的重复性(以CV表示)为0.32%和0.91%,实验室内不精密度为1.20%和3.14%,偏倚为-0.81%和-4.62%。草酸在1.65～210.71 mg/L范围内线性良好(Y=0.993X-0.216,R~2=0.999);枸橼酸在0.19～17.85 mmol/L范围内线性良好(Y=0.953X+0.044,R~2=0.999)。血红蛋白对草酸检测干扰较大,1 g/L以下时无干扰,2 g/L以上有明显负干扰;总蛋白低于1.5 g/L时对草酸和枸橼酸均没有干扰。不加任何防腐剂,尿液在室温、4℃及-20℃保存后,草酸浓度显著降低,枸橼酸浓度保持稳定。在尿液收集即刻和收集后24 h,按照50∶1的比例加入6 mol/L HCl,草酸和枸橼酸浓度无显著变化(P0.05)。尿液标本-20℃冻存,检测前按50∶1的比例加入6 mol/L HCl酸化,草酸和枸橼酸稳定性良好,至少可稳定30 d。结论酶法尿液草酸和枸橼酸试剂盒可用于结石代谢评估,检测结果具有可比性。尿液酸化可保持草酸和枸橼酸稳定,酸化时间无特殊要求。     

免疫比浊法测定尿液游离血红蛋白的方法学研究

目的在全自动生化分析仪上建立胶乳增强免疫比浊法测定尿液游离血红蛋白的方法学,并进行方法性能评价。方法使用抗人血红蛋白HBA0抗体(8.5mg/ml),80nm聚苯乙烯羧基胶乳微球(estapor,纳米微球)等材料制备检测试剂;在东芝TBA120全自动生化仪上设置项目参数并进行校准;方法学性能评价包括准确度、精密度、线性范围、灵敏度、特异度等性能指标;建立该地区健康人群尿液游离血红蛋白的生物参考区间并验证。结果项目参数建立后定标通过,各测定点与拟合的校准曲线未呈现明显偏离,定标液浓度值与吸光度值经相关性分析,r=0.980 7,r~2=0.961 8;回收试验中低值样本S_低加入浓度为100mg/L和500mg/L的标准液后回收率分别为95.3%和102.7%,高值样本S_高加入浓度为100mg/L和500mg/L的标准液后回收率分别为104.2%和103.5%;精密度试验中低值样本S_低和高值样本S_高的总不精密度CV分别的6.52%和4.18%;线性范围为0~1 100mg/L;分析灵敏度为2.8mg/L;干扰试验显示当样本中游离胆红素、结合胆红素、维生素C、动物血红蛋白分别小于342μmol/L,342μmol/L,0.03g/L和500mg/L时对该试验结果无明显干扰,当乳糜浓度870FTU时对该试验结果有显著干扰;该研究建立的健康人群生物参考区间男性为0~13.3mg/L、女性为0~17.1mg/L,两组参考区间经t检验无显著性差异(P0.05)。结论研究表明该方法学性能具备检测临床尿液标本,解决了化学法潜血试验特异性不够的问题,并实现了数值化检测,该研究也为其他类型临床标本的检测提供了思路。     

罗氏Modular P800型生化分析仪测量总胆红素的方法学性能评价及参考区间的建立

目的 通过对罗氏ModularP800生化分析仪检测血清总胆红素(TBIL)的方法学性能评价和建立参考区间的研究,探讨临床化学定量检测的方法学性能评价方案和实验方法.方法 取罗氏正常水平质控和病理水平质控物,分别进行批内20次和连续20 d总胆红素的检测,统计分析批内变异(CV)和日间CV;将高、低值血清按一定比例混合,检测TBIL,回归分析确定分析测量范围(AMR);将中值血清按一定比例稀释后检测TBIL,分析稀释后样本测量值和预期结果的符合程度,得出临床可报告范围(CRR);回顾分析376名健康人群血清样本TBIL的检测结果,统计分析建立参考区间.结果 正常水平、病理水平质控批内CV分别为0.63%,0.58%;日间CV分别为2.46%,1.68%;AMR为0.5～741.0μmol/L;CRR为0.5～59 280μmol/L;TBIL的参考区间为2.1～22.3μmol/L.结论 Modular系统检测性能能满足临床要求,评价方案简单易行;参考区间与厂家提供的参数不同,说明厂家提供的参考区间不可直接引用.     

噁唑烷酮类新药MRX-Ⅰ在人血浆、尿液浓度超高效液相色谱串联质谱测定方法的建立及验证

目的建立及验证超高效液相色谱串联质谱（UPLC-MS,/MS）的方法用于测定人血浆和尿液中恶唑烷酮类新药MRX-I药物浓度。方法 UPLC-MS/MS液相条件为色谱柱Waters ACQUITY UPLC BEH C8;流动相为乙腈：水（40：60,v/v）。质谱采用ESI源正离子多反应监测（MRM）。内标为利奈唑胺,以乙酸乙酯液-液萃取法清除血浆及尿液样本中杂质。方法学验证包括基质效应、绝对回收率、精密度和准确度及MRX-I在人血浆及尿液样本中放置稳定性。结果 UPLC-MS/MS法检测MRX-I在人血浆和尿液中的线性范围均为（0.005 00～1.00）mg/L,最低检测浓度均为0.005 00 mg/L。MRX-I与内标在血浆和尿液中的保留时间小于1.5 min。本方法学验证结果显示MRX-I在人血浆和尿液基质效应因子分别为90.4%±8.2%和82.7%±7.9%;血浆和尿液中MRX-I提取回收率分别为112.8%±13.4%和105.6%±13.4%。MRX-I血浆样本的测定方法日内、日间准确度分别为98.9%～105.0%和96.5%～102.6%;尿液样本的测定方法日内、日间准确度分别为92.7%～98.6%和95.1%～105.7%。MRX-I在人血浆和尿液样本室温放置24 h、预处理后自动进样器放置48 h、-40℃冰箱冻融3次、-40℃冰箱分别放置8个月和6个月仍然保持稳定。结论本研究建立的UPLC-MS/MS检测人血浆及尿液中MRX-I浓度方法的灵敏度高,专属性强。其方法学验证结果均符合生物样品分析的要求。     

尿液和脑脊液蛋白测定自动比浊法的评价

目的评估和证实尿液和脑脊液蛋白测定自动比浊法的性能.方法用罗氏公司的苯索氯铵试剂,以比浊法进行尿液和脑脊液蛋白测定,并对方法的检测限、病人结果可报告范围、精密度和准确度等作了实验观察.结果方法的检测低限为0.04 g/L,可定量报告的检测限为0.08 g/L,病人结果可报告范围为0.08～2.0 g/L,批内CV为1.5%,此间CV为2.2%;传统磺柳酸蛋白测定与之比较,二法间尿液Y1=0.85X+0.068,r=0.972;脑脊液Y2=0.86X+0.056,r=0.980.结论本法简便、快速、准确且样本用量少(5～15 μl),适合临床实验室推广应用.     

国产尿液干化学试纸法检测尿微量清蛋白的可靠性评价

目的 评价一种国产尿液干化学试纸法检测尿液微量清蛋白(urine microalbuminuria,U-mALB)的临床应用可靠性.方法 筛选激光散色比浊法定量检测U-mALB在< 30 mg/L,30～80 mg/L,80～150 mg/L和>150 mg/L四个不同取值范围组的新鲜尿液标本268例,对比国产尿液干化学试纸法检测U-mALB以及尿液常规蛋白检测结果,评价两种方法特异度及在不同取值范围内U-mALB检测结果灵敏度,并进行了3种浓度不同的尿液标本该试纸法检测U-mALB结果重现性的评价.结果 与激光散色比浊法定量检测U-mALB比较,国产尿干化学试纸法检测U-mALB及尿液常规蛋白检测的特异度均为97.5%;检测U-mALB在30～80 mg/L,80～150 mg/L和>150 mg/L取值范围组的灵敏度分别为22.5%,91.2%和100%;尿液干化学试纸法检测U-mALB与尿液常规蛋白检测在U-mALB取值范围组的灵敏度比较,差异均无统计学意义(P>0.05);3种不同浓度尿液标本试纸法检测U-mALB结果的重现性为100%.结论 该国产尿液干化学试纸法检测U-mALB在30～80 mg/L定量取值范围组灵敏度较低;尿液干化学试纸法检测U-mALB对临床mALB尿的诊断筛查与尿液常规蛋白检测不具有明显优势.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.