新生儿脐带血红细胞指标在新生儿地中海贫血筛查中的价值

目的:探讨新生儿脐带血红细胞指标与地中海贫血的相关性,揭示其在新生儿地中海贫血筛查中的临床价值。方法:收集2017年7月至2018年12月在南方医科大学附属中山市博爱医院出生的2919例新生儿脐带血,进行血常规检测,另采集外周血检测地中海贫血基因,确定各指标中的cut-off值,并计算灵敏度、特异度等评价指标。结果:2919例新生儿脐带血共检出地中海贫血314例,阳性检出率为10.76%。2605例非地中海贫血患儿的RBC、RDW的平均水平低于314例地中海贫血患儿;非地中海贫血患儿的Hb、MCV、MCH、MCHC、HCT、Hb/RBC、MCV/RBC水平高于地中海贫血患儿,两组间各指标的比较均有显著性差异。其中α地中海贫血组的RBC和RDW水平高于非地中海贫血组,而Hb、MCV、MCH、MCHC、HCT、Hb/RBC和MCV/RBC水平均低于非地中海贫血组;β地中海贫血组的MCV、MCH、Hb/RBC水平均低于非地中海贫血组;α,β复合地中海贫血组的MCV、MCH、Hb/RBC和MCV/RBC水平均低于非地中海贫血组。MCV的cut-off值设为106.05fl时,灵敏度为0.548,特异度为0.907,特异度在各指标中最高。MCH+MCV/RBC联合诊断的ROC曲线下面积最大,为0.807,其中灵敏度为0.710,特异度为0.841,阳性预测值为0.348,阴性预测值为0.960。结论:单一脐带血红细胞指标对于地中海贫血的筛查各有优缺点,而联合MCH+MCV/RBC可以提高其对地中海贫血筛查或诊断的准确性,对于降低重型地中海贫血患儿的出生率有积极的作用,在基层医院具有很高的普及价值。     

红细胞及网织红细胞多参数分析在地中海贫血患者中的变化

目的：探讨红细胞及网织红细胞参数在地中海贫血患者中的变化。方法：应用XE-2100全自动血细胞分析仪检测31例正常人（对照组）和46例地中海贫血患者（观察组）RBC、Hb、HCT、MCH、MCHC、MCV和网织红细胞百分比（RET％）、网织红细胞绝对值（RET#）、未成熟网织红细胞比率（IRF％）、低荧光强度网织红细胞比率（LFR％）、中荧光强度网织红细胞比率（MFR％）、高荧光强度网织红细胞比率（HFR％）等六项网织红细胞参数，并对检测结果进行分析。结果：地中海贫血患者红细胞和网织红细胞各参数与对照组相比差异具有显著性（P〈0．05），其中网织红细胞百分比、网织红细胞绝对值、未成熟网织红细胞比率、中荧光强度网织红细胞比率、高荧光强度网织红细胞比率显著性增高（P〈0．05），RBC、Hb、HCT、MCH、MCHC、MCV、LFR％明显下降（P〈0．05）。结论：网织红细胞参数为反映骨髓造血功能较好的指标。     

关于血液分析仪测定Hb、RBC、HCT的评价

血红蛋白（Hb），红细胞计数（RBC），红细胞压积比（HCT）是贫血的诊断和分类的重要指标。在临床上应用非常广泛，一般多采取手工测定，操作繁琐。随着医学科学技术的发展，近年来血液分析仪在我国得到较广泛的应用，不仅大大提高了工作效率，而且检测Hb、RBC、HCT的同时，还给出某些红细胞参数（MCV、MDV、MCH、MCHC）对贫血的早期发现及鉴别诊断具有重要意义，对传统分类方法具有补充作用。为此，笔者对我院应用的日本sysmexF－800型血液分析仪Hb、RBC、HCT结果进行了分析，同手工检测方法进行了对照比较，作出如下评价。1…     

轻型β-地中海贫血的红细胞参数分析

目的:探讨红细胞参数分析在筛查轻型β-地中海贫血中的价值。方法:用全自动血细胞分析仪对326例轻型β-地贫患者和420例正常对照者检测血常规,比较红细胞参数中RBC、Hb、MCV、MCH、RBC/Hb、RBC/MCV、RDW等指标。结果:轻型β-地贫患者的RBC、RBC/Hb、RBC/MCV、RDW均明显高于正常对照组(P<0.01),Hb、MCV和MCH均明显低于正常组(P<0.01)。结论:检测RBC、Hb、MCV、MCH、RBC/Hb、RBC/MCV、RDW等指标是大规模筛查轻型β-地贫最经济有效的方法。     

上海市血液分析仪地区性质量控制

目的研究血液分析仪地区性质量控制的方法和程序。方法制备全血室内质控品,观察其精度和稳定性,使用质控品进行室内质控,统计分析医院各仪器组的质控参数。结果室内质控品稳定期为90 d,分装变异系数（CV）最小为0.36%[血红蛋白（Hb）],最大为2.98%[血小板（PLT）]。90 d内白细胞（WBC）、红细胞（RBC）、Hb、红细胞比积（HCT）、PLT的变化偏倚分别为-1.5%、-0.2%、1.5%、2.3%和-2.1%。各医院将每个工作日检测的室内质控品结果输入计算机形成质控图,并从地区性质控汇总表中得到相关质控参数进行自我评价。结论血液分析仪地区性质量控制方式切实可行,为提高上海地区内血液分析仪的结果准确性和可靠性提供了保证。     

血细胞分析仪的质控与结果比对

目的 对不同血细胞分析仪进行结果比对和质量控制。方法 每天随机选取高、中、低值患者标本至少8例，共分析5d。以XT-1800i评价本室其他2台血细胞分析仪结果[白细胞（WBC）、血小板（PLT）、红细胞（RBC）、血红蛋白（Hb）、红细胞比积（HCT）、红细胞平均体积（MCV）]，同时还用全血质控品对各台血细胞分析仪进行质控（WBC、RBC、Hb、HCT、PLT、MCV）。结果 XT-1800i与KX-21和PENTRA60分析结果的偏差均在可接受范围内，而XT-1800i与KX-21和PENTRA60分析结果的相关性很好，r〉0．975或r^2〉0．95。结论 XT-1800i、KX-21和PENTRA60在临床应用中可以相互替换使用。     

甲亢患者贫血有关指标检测分析

目的：探讨甲状腺功能亢进患者（简称甲亢）贫血有关各项指标的变化及临床意义。方法：用Symex SF-3000全自动血细胞分析仪检测81例甲亢患者RBC、Hb、MCV、MCH、MCHC,血涂片检查细胞形态,同时检测120例正常人并与之比较。结果：甲亢患者RBC、Hb、MCV、MCH、MCHC结果异常。81例甲亢患者中48例红细胞体积小。结论：甲亢可能引起小细胞低色素性贫血。     

三种红细胞指标在地中海贫血出生干预筛查中的价值

目的:探讨平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)、红细胞计数与平均红细胞体积比值(RBC/MCV)在地中海贫血出生干预筛查中的应用价值,探求更准确的地中海贫血出生干预的初筛指标.方法:选择经分子生物学技术确诊的426例地中海贫血携带者,56例非地中海贫血携带者以及464例健康对照者进行MCV、MCH和RBC/MCV检测,并对实验结果进行单个指标、两者联合和三者联合共7种筛查方法的分析.结果:取MCV<82fL、MCH<26pg、RBC/MCV>5.9为截断值,MCV、MCH和RBC/MCV单项检测的敏感度和特异度分别为95.77%、91.78%、97.42%和80.38%、83.27%、82.88%;MCV与MCH、RBC/MCV两者联合检测的敏感度和特异度分别为95.77%、98.59%、98.12%和80.38%、80.19%、81.15%;MCV、MCH和RBC/MCV三项联合检测的敏感度和特异度分别为100%和80%.结论:单项检测中以RBC/MCv的阳性率最高,RBC/MCV在地中海贫血的筛查评价中优于MCv和MCH:MCV+MCH+RBC/MCV联合检测是地中海贫血出生干预筛查中更为准确的指标.     

铁剂治疗缺铁性贫血早期红细胞指标分析

目的：探讨缺铁性贫血铁剂治疗有效的早期指标。方法：对2003-07／2006-06住院3周以上的36例缺铁性贫血患者进行前瞻性研究。口服硫酸亚铁治疗前及治疗后第4、7、11、14、18及21天分别用Abbott细胞计数仪检测外周血红细胞计数（RBC）、血红蛋白质量浓度（Hb）、红细胞平衡体积（MCV）和红细胞平均血红蛋白（MCH）。结果：RBC、Hb、MCV及MCH平均值在第4天即见升高，以后继续逐步升高。第7天与治疗前测定的平均值相比，Hb（P=0．001）、MCV（P=0．008）升高有极显著意义，MCH升高有显著意义（P=0．015），第7天时全部患者的Hb、MCV及MCH均比治疗前升高。结论：Hb、MCV、MCH可作为观察补铁疗效的方便、敏感指标。     

MCV和RBC脆性及血红蛋白电泳在产前筛查地中海贫血的价值

目的评价平均红细胞体积（MCV）、红细胞（RBC）脆性试验、血红蛋白（Hb）电泳在产前筛查地中海贫血中的价值。方法选取来我院产前检查的经基因诊断确诊的地中海贫血患者140例,正常对照100例,分别进行MCV测定,RBC脆性试验和血红蛋白电泳试验,分析各单项试验及三项试验联合检测地中海贫血的灵敏度、特异度等评价指标。结果MCV、RBC脆性试验、Hb电泳单项检测对地中海贫血诊断的灵敏度及特异度分别为93.6%、89.3%、82.1%及78.0%、92%、97%;MCV与红细胞脆性及Hb电泳3项平行联合检测的灵敏度及特异度为100%、80.0%;系列联合检测的灵敏度及特异度为71.1%、100%。与各单项试验比较,平行联合检测的灵敏度高（P〈0.05）、系列联合检测的特异度高（P〈0.05）。结论MCV、RBC脆性试验及Hb电泳对产前地中海贫血筛查有较高价值,三项联合检测能更有效地筛查出地中海贫血携带者。     

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.     

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.     

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.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.