利用溶血指数纠正溶血标本乳酸脱氢酶活力

目的　利用HITACHI 7170全自动生化分析仪的溶血指数对溶血标本乳酸脱氢酶 (LDH)活力作数学纠正 ,求得接近实际值的纠正值。方法　测定 9份LDH活力不等的无溶血混合血清LDH活力 (Y)及其对应人工溶血血清LDH活力 (Z)、溶血指数 (X)作多元回归分析 ,得多元回归式Y =- 38.16 - 2 4 .38X 1.0 98Z ,用于临床溶血标本的LDH测定值作数学纠正。结果　临床轻度溶血标本 (溶血指数≤ 10 )的LDH值经数学纠正后与无溶血原血清LDH值间的偏倚除个别外均在± 2 0 %范围内 ,符合美国CLIA’88能力比对检验分析的质量要求。结论　运用该法可纠正溶血对LDH测定的干扰 ,符合临床要求     

利用溶血指数纠正溶血标本乳酸脱氢酶活力

目的利用HITACHI 7170全自动生化分析仪的溶血指数对溶血标本乳酸脱氢酶(LDH)活力作数学纠正,求得接近实际值的纠正值.方法测定9份LDH活力不等的无溶血混合血清LDH活力(Y)及其对应人工溶血血清LDH活力(Z)、溶血指数(X)作多元回归分析,得多元回归式Y＝-38.16-24.38X+1.098Z,用于临床溶血标本的LDH测定值作数学纠正.结果临床轻度溶血标本(溶血指数≤10)的LDH值经数学纠正后与无溶血原血清LDH值间的偏倚除个别外均在±20%范围内,符合美国CLIA'88能力比对检验分析的质量要求.结论运用该法可纠正溶血对LDH测定的干扰,符合临床要求.     

应用多元回归分析建立纠正高胆红素干扰酶法测定血清总胆固醇结果的校正公式及验证

目的 评价不同浓度胆红素对酶法测定总胆固醇(total cholesterol, TC)的影响,应用多元回归分析建立校正公式并验证其校正效果。方法 收集100 例来自于南京医科大学第一附属医院2020 年12 月门诊或住院患者的新鲜无黄疸血清标本。配制一系列浓度梯度的胆红素溶液,分别加入其中50 例患者的血清标本中,检测各标本总胆红素(total bilirubin,TB)和TC 浓度,分析胆红素水平对TC 检测结果的影响及二者的相关性。应用多元回归分析建立校正公式,并利用另外50 例患者标本验证该校正公式的性能。结果 黄疸实验组与生理盐水对照组间差异具有统计学意义(F=3.947,P<0.01),标本TC 浓度与TB 浓度呈负相关(r2=0.989 4);在胆红素加入浓度分别为100,200,300,400,500 和600 μmol/L 的实验组中,TC 浓度的平均偏倚依次为:-6.65%±4.89%,-14.21%±8.89%,-29.00%±13.43%,-31.07%±14.62%,-38.21%±13.95% 和-43.51%±12.69%,且初始浓度TC ＜ 3 mmol/L 的标本产生的平均偏倚均明显高于TC ≥ 3 mmol/L 的标本,差异具有统计学意义(t=9.192 ～ 14.836,均P ＜ 0.01);设无黄疸血清标本的TC 浓度为Y,其对应人工黄疸标本的TC 实测浓度为Z,TB 浓度为X,经多元回归分析,校正公式为Y =0.002 353·X + 0.973·Z+ 0.000 337·X·Z － 0.013 34;经公式校正后92.67% 的黄疸标本TC 浓度偏倚小于±10%。结论 黄疸患者血清标本中高胆红素水平可导致其TC 的检测结果偏低,偏倚大小与TB 浓度以及初始TC 浓度相关,运用校正公式可有效校正高胆红素对TC 测定的干扰,符合临床要求。     

新生儿血液样本溶血对血清NSE检测结果的影响及其校正公式的建立

目的探讨新生儿溶血对血清神经元特异性烯醇化酶(NSE)检测的影响,并建立校正公式。方法在24 h内收集72份新生儿血清样本,用化学发光法检测加入前后血清NSE浓度的变化。采用氰化蓝(HiCN)法检测加入前后血清血红蛋白(Hb)浓度的变化,建立新生儿溶血样本的NSE校正公式,通过Hb变化对NSE结果的影响获得变化常数。将变分常数的修正NSE结果与HiCN方法的修正NSE结果进行比较,以评估改进的HiCN方法的可行性。采用HiB法和仪器法对Hb的检测结果进行分析,建立了仪器方法的NSE校正公式。结果72例新生儿溶血样本中NSE浓度变化常数为(23.70±3.62)mg/gHb。分析血清游离度ΔY,ΔHbHiCNX,并分析血清Hb浓度浓度和Hb浓度变化之间的相关方程Y=23.17X(r^2=0.8122,P<0.001)从不断变化NSE校正和相关方程的NSE校正(P=0.541)。无统计学差异HiCN方法和仪器Hb结果高度相关(r^2=0.9924,P<0.001)。新生儿血清NSE检测结果通过NSE校正得到纠正=NSE减去23.17HbHiCN,NSE校正=NSE减去23.60Hb加13.22。结论溶血对血清NSE检测有重要影响,新生儿溶血标本的NSE浓度可通过校准公式计算,以协助临床评估新生儿缺氧的严重程度。     

新生儿血液样本溶血对血清NSE检测结果的影响及其校正公式的建立

目的探讨新生儿血液样本溶血对血清神经元特异性烯醇化酶(NSE)检测结果的影响,并建立其校正公式。方法在72份出生24 h内的新生儿血清样本中添加对应的冻融红细胞。采用化学发光法检测添加前后血清NSE浓度的变化,氰化高铁血红蛋白(HiCN)法检测添加前后血清血红蛋白(Hb)浓度的变化,从而建立新生儿溶血样本的NSE校正公式。根据自身Hb变化对NSE结果的影响推算出变化常数。将变化常数校正的NSE结果与HiCN法校正公式校正的NSE结果进行比较,评价HiCN法校正公式的可行性。对HiCN法与仪器法的Hb检测结果进行相关性分析,以建立针对仪器法的NSE校正公式。结果 72份新生儿溶血样本NSE浓度结果变化常数为(23.70±3.62)mg/g Hb。以ΔNSE_(血清)为Y、ΔHb_(HiCN)为X,血清NSE浓度变化与Hb浓度变化之间的相关方程为Y=23.17X(r~2=0.8122,P0.001)。采用自身变化常数获得的NSE校正值和采用相关方程获得的NSE校正值之间差异无统计学意义(P=0.541)。HiCN法与仪器法的Hb结果高度相关(r~2=0.992 4,P0.001)。HiCN法和仪器法新生儿血清NSE检测结果的校正公式分别为NSE_(校正)=NSE_(测定)-23.17Hb_(HiCN)和NSE_(校正)=NSE_(测定)-23.60Hb_(仪器)+13.22。结论溶血对血清NSE检测影响较大。可以通过校正公式计算新生儿溶血样本NSE浓度,以帮助临床评价新生儿缺氧缺血性脑病(HIE)的严重程度。     

1种新的血红蛋白推算公式及其在高脂血标本检测中的应用

目的寻求不同体积红细胞中血红蛋白推算公式,探讨其在高脂血干扰标本检测中的应用。方法采用Sysmex XE-5000血细胞分析仪对患者血液进行常规分析,随机收集无脂血、黄疸、溶血及白细胞增多等标本1 500例,根据红细胞平均体积分为3组(大红细胞组、正常红细胞组、小红细胞组),通过Pearson相关对其血红蛋白浓度、红细胞计数、红细胞平均体积值进行分析,获得推算方程。收集不同红细胞平均体积的高脂血标本各50例,共计150例,将相应检测数据分别代入推算方程求得血红蛋白推算值,采用血浆置换法校正血红蛋白浓度,通过方差分析对各组血红蛋白实测值、血红蛋白推算值、血红蛋白校正值进行分析,评价推算公式。结果由趋势散点图看出血红蛋白测定值与红细胞计数×所测红细胞平均体积值呈明显线性关系,相关性较好(r=0.984、0.978、0.963),回归方程(Y=0.351 X-7.012;Y=0.364 X-11.250;Y=0.405 X-31.484;Y为血红蛋白浓度,X为红细胞计数×红细胞平均体积值)成立;高脂血标本血红蛋白实测值组明显高于血红蛋白推算值组和血红蛋白校正值组(F=8.192、19.204、15.766,P0.05),血红蛋白推算值组与血红蛋白校正值组差异无统计学意义(P0.05)。结论不同体积大小红细胞中,血红蛋白测定值与红细胞计数×所测红细胞平均体积值有较好的线性关系,其相应回归方程为1种简单、有效的血红蛋白推算公式,血红蛋白推算值可为高脂血情况下血红蛋白检测结果准确性提供帮助。     

C反应蛋白测定两种检测系统间结果的比较

目的 对两种不同检测系统测定C反应蛋白(C-reactive protein,CRP)的结果进行比对和偏倚分析,以评价不同检测系统CRP测定结果的可比性。方法 参照美国临床实验室标准研究所(CLSI)EP9-A2文件要求,收集长海医院急诊患者乙二胺四乙酸二钾(EDTA-K₂)抗凝血50例,同时使用全自动免疫分析仪(Beckman Immage 800)和免疫荧光分析仪(i-CHROMA^TM Reader)检测待测样本中的CRP浓度,评价两种方法检测结果的相关性。结果 使用血浆标本时,两方法相关性良好,回归方程为Y=1.076 5X-3.031 5,R²=0.986。全血测定的回归方程为Y=0.882 6X-1.180 8,R²=0.931 1。对于红细胞压积(HCT)较低的标本(<30.45%)使用纠正公式:全血CRP(纠正后)=全血CRP结果(纠正前)/(1-HCT)。Y(纠正后)=1.006 8X-3.612 2,R²=0.950 9。结论 两种检测系统血浆CRP的测定结果具有可比性,适合临床应用。遇HCT较低的标本时,通过校正公式校正,可提高全血结果的可比性。     

探讨溶血标本血清钾离子测定的纠正方法

在临床检验工作中经常遇到标本溶血 ,就血清钾离子 (简称血钾 )检测来说 ,标本溶血使测定结果偏高。这样的结果易给临床带来误诊。到目前为止 ,未见有关溶血标本血钾检测纠正办法的报道 ,现就此问题的研究体会作一介绍。一、材料和方法1.标本　选用本院作电解质分析的血清标本。2 .方法　 (1)验证实验方法 :①测若干例未溶血标本血清吸光度 (A) (4 5 0nm ) ,取均值C(作为常量 ) ;②测血清标本未溶血时钾离子浓度为K0 ;③将标本溶血测钾离子浓度为K1,溶血血清A值为HB1;④加剧溶血标本 ,测钾离子浓度为K2 ,溶血血清A为HB2 ;⑤利用公式计…     

红细胞压积对床旁检测全血C反应蛋白的影响

目的探讨不同红细胞压积(HCT)对床旁检测(POCT)全血C反应蛋白(CRP)结果的影响。方法速率散射比浊法检测血清CRP作为比较方法(IMMAGE 800),免疫比浊法检测全血CRP作为试验方法进行POCT。分别检测正常HCT、低HCT、高HCT全血标本的CRP和配对标本的血清CRP,利用HCT的校正公式,对全血CRP检测结果进行校正,统计两种方法检测CRP的一致性。结果正常HCT标本,两种方法检测CRP的结果一致(t=1.34,P>0.05),相关性良好(Y=0.996 X+0.063,r=0.992)。POCT在测定异常HCT标本时,校正前全血CRP与血清CRP测定结果差异有统计学意义(低HCT组:t=3.25,P<0.05;高HCT组:t=3.56,P<0.05),但对所得值进行换算校正后,其结果与IMMAGE 800所得结果一致(低HCT组t=1.53,P>0.05;高HCT组t=1.78,P>0.05)。结论 HCT超出正常范围的标本做全血CRP检测时,结果经校正处理后,结果可靠。     

溶血对心肌酶学指标的干扰评估

目的:研究不同程度溶血对心肌酶学的影响及纠正.方法:选择心肌酶为正常值、异常中值、异常高值各一份标本,分离血清,红细胞部分冰冻处理造成溶血,紫外法测定血红蛋白(HGB)浓度;日立7600全自动生化分析仪测定心肌酶学的5个指标.结果:溶血导致心肌酶指标AST、CK、CK-MB、LDH、α-HBDH显著增高,通过HGB浓度可以适当纠正.结论:溶血对心肌酶产生严重干扰,通过纠正可尽可能地得到临床真实值.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.