Ten highly sensitive thyrotropin assays compared by receiver-operating characteristic curves analysis: results of a prospective multicenter study

We report a prospective multicenter study, undertaken to compare the efficacy of 10 highly sensitive thyrotropin assay kits for the diagnosis of hyperthyroidism. Performances of the kits were compared with a reference diagnosis based on clinical examination, pertinent biological tests, and determination by an independent laboratory of the concentrations in serum of free triiodothyronine and free thyroxin. No thyrotropin determination was used in establishing this reference diagnosis. Receiver-operating characteristic curves were obtained for results from 600 patients (217 hyperthyroid and 383 euthyroid) by each kit. Even though analyses were performed out of the working range of most kits, the clinical correlation was nevertheless excellent. The best results corresponded to a sensitivity of 97.5% associated with a specificity of 96.1% and were significantly better than those obtained with all other kits. Results of this comparison depended greatly on the heterogeneity of the "normal"/"abnormal" categories. When only diffuse hyperthyroidism was considered, sensitivity and specificity were improved for all kits, and there was no significant difference among the five best kits.     

超声心动图及B型脑钠肽与左心室舒张期压力的相关性及受试者工作特征曲线评价

目的应用受试者工作特征（ROC）曲线分析左心室舒张末期压力（LVEDP）及舒张早期经二尖瓣口血流速度与舒张早期二尖瓣环的运动速度比值（E/Ea）、B型脑钠肽（BNP）的关系。方法收集疑有冠心病行选择性冠状动脉造影检查104例患者进行LVEDP测定,并行多普勒超声心动图检查和BNP测定。分析上述指标的相关性及ROC曲线特征。根据美国纽约心脏病协会（NYHA）的标准对心脏的患者进行心功能分级。结果 104例患者中,86例有器质性心脏病（心功能Ⅰ级及Ⅱ级各18例,心功能Ⅲ级21例,心功能Ⅳ级29例）,另18例无明显的心脏病证据。随着心功能分级的增加,LVEDP、BNP及E/Ea比值呈不同程度进行性的恶化。LVEDP与BNP和E/Ea呈正相关（r=0.786,0.651,均P〈0.01）,与E/A和Ea/Aa呈负相关（r=-0.231,-0.652,P〈0.05或〈0.01）。E/Ea及BNP的ROC曲线下面积分别为0.830及0.951（均P〈0.01）。结论 E/Ea比值及BNP能较好地无创性评估LVEDP,但BNP的准确度更高。     

ROC曲线分析及诊断分界点确定程序

目的介绍一种新开发的ROC分析软件.方法①依据非参数法和参数法ROC分析理论建立算法.②对文献中3套数据分别用本软件、SPSS及Analyse-it软件进行ROC分析验证.③应用:肺部良性39,恶性87例的PET FDG图像的SUV最大值及平均值鉴别良恶性效能评估.结果①软件主要功能:提供非参数和参数法两种ROC分析;确定3个典型诊断分界点;计算诊断符合率评价指标.②软件验证:3个软件对3套数据的分析结果完全相同.③应用实例:SUV平均值的诊断效能稍好,但差异无显著性.结论该软件不仅具有较完整的ROC分析功能,而且还具有确定诊断分界点,提供多种诊断符合率指标的功能,是目前性能较完整的软件.     

Evaluating audio-visual and computer programs for classroom use

Appropriate faculty decisions regarding adoption of audiovisual and computer programs are critical to the classroom use of these learning materials. The author describes the decision-making process in one college of nursing and the adaptation of an evaluation tool for use by faculty in reviewing audiovisual and computer programs.     

计算机辅助精子分析与常规精液分析的比较研究

目的研究计算机辅助精子分析（CASA）和常规精液分析（SRA）各项参数是否具有可比性。方法对213例精液标本同时行CASA和SRA分析。CASA采用西班牙SCA精液质量分析仪进行检测,SRA按世界卫生组织（WHO）推荐的标准化方法进行检测。结果当精子密度介于（5-80）×10^6/mL时,CASA和SRA分析的平均精子密度、精子活动力的差异无统计学意义（P〉0.05）;当精子密度〈5×10^6/mL时,CASA分析的平均精子密度高于SRA（P〈0.05）,精子活动力的差异无统计学意义（P〉0.05）;当精子密度〉80×10^6/mL时,CASA分析的平均精子密度高于SRA（P〈0.05）,且CASA检测a级精子比例偏高,d级精子比例偏低（P〈0.05）;用生理盐水按一定比例将精液稀释后分别进行CASA和SRA,平均精子密度、精子活动力的差异均无统计学意义（P〉0.05）。结论当精子密度介于（5-80）×10^6/mL时,CASA和SRA对精子密度和活动力的分析具有可比性;当精子密度〈5×10^6/mL时,CASA的误差较大,需进行SRA;当精子密度〉80×10^6/mL时,需用生理盐水稀释精液后行CASA或SRA分析,两者结果具有可比性。因此,当用CASA进行精液分析时,应同时结合显微镜镜检。     

Comparison of eight commercial on-site screening devices for drugs-of-abuse testing

Eight commercially available on-site drugs-of-abuse testing devices for detecting cannabinoids (THC-COOH), opiates (OPI), cocaine (COC), amphetamines (AMP), metamphetamines (MET) and benzodiazepines (BZO) were evaluated. The used urine specimens suspected of being drug positive were all confirmed by gas chromatographic/mass spectrometry (GC/MS). For AMP and MET, sensitivities varied between 83 and 95% and specificities between 98 and 100%. Correspondingly, sensitivities between 88 and 98% and specificities between 95 and 100% were observed for THC-COOH. For BZO, sensitivities varied between 91 and 97% and specificities between 97 and 100%. Only a few confirmed positive samples were available for OPI and COC, the sensitivities being between 83 and 100% and 100%, respectively. On-site devices did not always find extremely high drug concentrations. False-negative results were found with AMP in particular. Pholcodine, commonly used as medicine, was observed to give false-positive results with most of the devices and was not, however, included in given cross-reactivity tables. It was found that the devices differed markedly with respect to interpretation of test results and to ease of test performance, leading to the suggestion that different criteria for selecting on-site devices for either emergency laboratories in hospitals or for police stations and prisons should be used. Since the overall specificity of any of the devices was not 100% and false positives were identified, we found it important to confirm any positive screening test result.     

Comparison of eight commercial on-site screening devices for drugs-of-abuse testing

Eight commercially available on-site drugs-of-abuse testing devices for detecting cannabinoids (THC-COOH), opiates (OPI ), cocaine (COC), amphetamines (AMP), metamphetamines (MET) and benzodiazepines (BZO) were evaluated. The used urine specimens suspected of being drug positive were all confirmed by gas chromatographic/mass spectrometry (GC/MS). For AMP and MET, sensitivities varied between 83 and 95% and specificities between 98 and 100%. Correspondingly, sensitivities between 88 and 98% and specificities between 95 and 100% were observed for THC-COOH. For BZO, sensitivities varied between 91 and 97% and specificities between 97 and 100%. Only a few confirmed positive samples were available for OPI and COC, the sensitivities being between 83 and 100% and 100%, respectively. On-site devices did not always find extremely high drug concentrations. False-negative results were found with AMP in particular. Pholcodine, commonly used as medicine, was observed to give false-positive results with most of the devices and was not, however, included in given crossreactivity tables. It was found that the devices differed markedly with respect to interpretation of test results and to ease of test performance, leading to the suggestion that different criteria for selecting on-site devices for either emergency laboratories in hospitals or for police stations and prisons should be used. Since the overall specificity of any of the devices was not 100% and false positives were identified, we found it important to confirm any positive screening test result.     

顽固高血压病三组治疗方案的比较

目的：对联合用药治疗顽固高血压病三组方案疗效进行比较。方法：采用前瞻、随机、双盲研究，经洗脱期(2周～4周)后，随机分为三组：尼群地平 卡托普利 双氢克尿塞(尼卡双组，85例)，尼群地平 氨酰心安 双氢克尿塞(尼氨双组，87例)，卡托普利 氨酰心安 双氢克尿塞(卡氨双组，85例)。平均每日各药用量：尼群地平313mg，氨酰心安38mg，卡托普利56mg，双氢克尿塞12．5mg。随访12个月，观察各组疗效、副作用及对生活质量的影响。结论：三组联合用药均可有效降压，尤其对较顽固的高血压，但以尼氨双组降压效果最佳，卡氨双组最差，而尼卡双组的累计药物副作用、生活质量改善及依从性相对更好。     

Comparison between eight poisons information centers in Europe

AIM: To map and compare organization and activities of eight poisons information centers in Europe in order to learn and discuss future development. MATERIAL AND METHODS: In 2004, the following eight centers in six countries were visited and studied: Brussels, Lille, Munich, Cardiff, London, Utrecht, Stockholm and Zurich. Each center was visited for 1 or 2 days. All centers filled in the same questionnaire. RESULTS AND CONLUSION: Although all centers had the same functions, they showed great differences in organization and activities. Several of the centers seemed to be understaffed for an optimum utilization of poisons information centers by the society. In order to increase harmonization and prepare the European poisons information centers for the future not only continuous voluntary collaboration, but also regulation by the European Union (EU), is proposed. It is advocated that the European Association of Poisons Centers and Clinical Toxicologists (EAPCCT) should take an active role, also towards EU.     

原发性甲状旁腺功能亢进症八例临床误诊分析

原发性甲状旁腺功能亢进症(甲旁亢)在我国曾被认为是罕见病,1978年前国内共报道48例,而近18年来90余篇文献已报道760余例,故不能再视为罕见病.国内外报道其发病率为0.1%,在我国一些大医院中误诊率竟高达40%～80%,被误诊时间往往达数年之久[1].我院1976～1999年共收治8例,现对其误诊情况进行分析.