三种不同检测系统钾钠氯测定结果的比对研究

目的通过方法学比较和偏倚评估,探讨不同检测系统钾钠氯检测结果的可比性。方法根据EP9-A2文件,以重复性和准确性最佳的Vitros350系统（用A表示）为目标系统,日立7600检测系统（用B表示）、上海富升Easyplus电解质检测系统（用C表示）为实验系统,检测40份患者新鲜血清的钾钠氯,以美国临床实验室修正法规（CLIA’88）规定的室间质量评价允许范围的1/2为临床可接受范围,判断不同检测系统的可比性。结果各检测系统测定钾钠氯的批内、批间变异系数均小于2%;各检测系统间的相关系数均大于0.975,B、C两系统与A系统比较：B系统的钾钠氯及C系统氯符合要求,C系统的钾部分超过及钠全部超过CLIA’88规定的1/2。结论三个检测系统测定钾钠氯的精密度符合临床要求,临床接受性能评价B系统尚可,但C系统有部分项目或全部项目不可比性。实验室应经常进行同一项目不同检测系统间的偏倚评估,判断临床接受性能,采取整改措施,保证结果的可比性。     

肇庆市三家医院不同检测系统生化指标测定结果可比性研究

目的探讨不同医疗机构检验系统间生化检验结果的可比性,为实现不同实验室检验结果互认提供实验数据。方法用同一批号室内质控分别对肇庆市第一人民医院罗氏检测系统、肇庆市第二人民医院岛津检测系统、高要市人民医院奥林巴斯检测系统进行精密度评估,根据美国临床实验室标准协会（CLSI）批准文件EP9-A2,以罗氏检测系统作为目标检测系统,岛津检测系统、奥林巴斯检测系统作为实验检测系统,对14项生化检测项目进行方法学比对和系统偏差估计。结果三家医院14项指标日间精密度都小于1/3CLIA,88允许误差范围;第二人民医院岛津检测系统与第一人民医院罗氏检测系统比较ALT、GGT、TChol存在系统偏差临床不可接受,其余项目符合临床要求;高要市人民医院奥林巴斯检测系统与第一人民医院罗氏检测系统比较,除TB外其余项目系统偏差均符合临床要求,最后对临床不可接受项目参考自建系统的量值溯源程序对其进行校准。结论要实现不同实验室检验结果互认必须对各系统间精密度与系统偏差进行比对分析并对系统偏差进行校准,以保证各系统检测结果误差在临床可按受范围内。     

数字人体系统物质组成

本文从整体到局部的思路讨论了数字人体系统物质组成.主要内容有数字人体的头部系统、颈部系统、胸部系统、腹部系统、盆部与会阴系统、背柱区系统、上肢系统、下肢系统、神经系统和感觉器官系统等,为深入研究数字人体提供物质基础.     

7种检测系统测定新鲜血浆葡萄糖的比对分析

目的通过不同检测系统测定血糖(Glu)的方法比对,探讨不同检测系统间血糖的偏倚是否符合临床质量要求。方法以可溯源的OLYMPUS AU2700检测系统1为目标检测系统,用电化学法、干式化学法、透射比色法,应用本院共7种不同检测系统对新鲜血浆标本50例的血糖进行比对检测。结果各检测系统测定Glu的变异系数均小于5.0%;各系统间的相关系数均大于0.975;7个系统间总体差异无统计学意义(P>0.05);以可溯源的检测系统1为目标检测系统进行比对,在3个医学决定水平上,检测系统3、检测系统4和检测系统7超过T±5%范围,检测系统2、检测系统5和检测系统6均未超过T±5%范围。结论部分检测系统测定Glu的结果存在偏倚,对其实施整改措施后,结果具有可比性。     

三种不同检测系统钾钠氯测定结果的比对研究

目的通过方法学比较和偏倚评估,探讨不同检测系统钾钠氯检测结果的可比性。方法根据EP9-A2文件,以重复性和准确性最佳的Vitros350系统（用A表示）为目标系统,日立7600检测系统（用B表示）、上海富升Easyplus电解质检测系统（用C表示）为实验系统,检测40份患者新鲜血清的钾钠氯,以美国临床实验室修正法规（CLIA’88）规定的室间质量评价允许范围的1/2为临床可接受范围,判断不同检测系统的可比性。结果各检测系统测定钾钠氯的批内、批间变异系数均小于2%;各检测系统间的相关系数均大于0.975,B、C两系统与A系统比较：B系统的钾钠氯及C系统氯符合要求,C系统的钾部分超过及钠全部超过CLIA’88规定的1/2。结论三个检测系统测定钾钠氯的精密度符合临床要求,临床接受性能评价B系统尚可,但C系统有部分项目或全部项目不可比性。实验室应经常进行同一项目不同检测系统间的偏倚评估,判断临床接受性能,采取整改措施,保证结果的可比性。     

全线性范围内多个定量检测系统间的偏倚评估

目的：改进 EP9-A2指南使之可用于全线性范围内多个定量检测系统间的偏倚评估。方法在4套检测系统（A、B、C、D）上检测40份患者标本的血清总胆固醇浓度,以 A 系统为参考系统,按 EP9-A2指南评估 B、C、D 系统的偏倚;在此基础上,计算两两系统间偏倚可接受距离 DD（偏倚与分析质量目标之间的距离）,以置信区间包含0为标准来识别系统间不可接受的偏倚。结果与 A 系统相比,B、C 两系统呈负向偏倚,D 系统呈正向偏倚,但 B、C、D 与 A 系统的偏倚均可接受;各系统间 DD 呈正态分布;除DD BD 置信区间包含0,B、D 两系统间偏倚不可接受外,其余系统间偏倚均可被接受;将 D 系统结果经 A 系统校正后,各系统间偏倚均可接受;作图可提供全线性范围内的偏倚评估。结论DD 均值的置信区间,可在全线性范围内有效评估3个或更多系统间的偏倚,可用于评估系统间的结果可比性。     

自建系统谷草／谷丙转氨酶量值溯源性研究

目的确保患者标本在日立自建系统与罗氏配套检测系统上谷草／谷丙转氨酶的检测结果可溯源到同一测量基准。方法通过日立自建系统与罗氏配套系统对新鲜混合血清测定结果进行对比分析,找出日立自建系统存在的系统偏差,井对日立系统校准值进行修订,修订后对日立系统进行二次校准,然后进一步进行两系统对比分析。结果第一次对比两系统偏差超过1／2CLIA’88规定的最大允许误差范围,第二次两系统偏差小于1／4CLIA’88规定的最大允许误差范围。结论通过对比分析从而对自建系统校准血清的校准值重新赋值,是实现自建系统检测结果准确性和可溯源的有效途径。     

临床实验室应用不同检测系统检测血清心肌肌钙蛋白I结果的一致性分析研究

目的　分析心肌肌钙蛋白I（cardiac troponin I, cTnI）检测结果,探讨四种不同检测系统结果间是否具有可比性,检测结果的偏倚是否在允许范围内以及同一检测系统不同实验室检测结果的差异性。方法　将20 份不同浓度的cTnI 患者血清样本在深圳迈瑞CL-2000i（A 系统）、广州万孚FS-205（B 系统）、Getein 1600（C 系统）和UniCel DxI 800（D系统）配套检测系统上进行检测,每个系统分别选择10 家实验室。参考美国临床实验室标准化协会（Clinical laboratory standardization institute, CLSI）的EP9-A2 文件,对结果进行统计学分析,评价各检测系统间cTnI 检测结果是否具有一致性;计算4 种系统及各系统的均值（x）、标准差（s）及变异系数（CV％）,分析四种不同检测系统间及同一检测系统不同实验室检测结果的差异性。结果　不同系统检测患者血清样本cTnI 结果的相关系数（r2）为0.895 3 ～ 0.989 9,A 系统与D 系统,A 系统与B 系统间相关性不佳（r2 ＜ 0.95）;分别以各系统作为参考系统,除了B 系统与C,D 系统间结果存在差异外,其他检测系统间结果具有临床可接受性。各系统CV 均较大（范围在12.36％～ 69.05％）,在低浓度处CV 明显高于高浓度处,差异有统计学意义;A,C,D 系统的s,CV％及极差（R）均较小,CV 范围基本＜ 15％,其中C 系统＜ 10％,偶有个别在检测低限处CV 较大,B 系统的s,CV％及R 均较大,CV％范围在16.14％～ 75.54％（在19,20 号标本处CV 为0.00％是由于＜ 0.01ng/ml 的值赋值为0.01ng/ml）。结论　四种检测系统间cTnI 的检测结果一致性较差,同一检测系统不同实验室检测结果间也存在一定差异。     

不同自建生化检测系统间结果的比对

目的探讨实验室内不同自建生化检测系统间检测结果的可比性,为本实验室不同生化检测系统检验结果的互认提供依据。方法参考美国临床实验室标准化委员会（NCCLS）的EP92A2文件,以日立7600检测系统为目标系统,用患者新鲜血清对实验检测系统（东芝40检测系统Y1、日立7180检测系统Y2）的常规生化结果与目标检测系统进行比对,计算实验检测系统（Y1、Y2）和目标检测系统（X）之间的相对偏差,以美国临床医学检验部门修正法规（CLIA′88）允许总误差的1/2为标准,判断检验结果的可比性。结果自建实验检测系统（Y1）的总胆红素、直接胆红素、尿素、肌酐和三酰甘油等项目与目标检测系统不具可比性;实验检测系统Y1和实验检测系统Y2的丙氨酸氨基转移酶和天门冬氨酸转移酶在低值时与目标检测系统不具可比性,因该两种酶的降低在临床上缺乏实际意义,故认为与目标检测系统具有可比性;其余项目在各医学决定水平处的SE%均小于或等于1/2CLIA′88TEa,与目标检测系统具有可比性。结论实验检测系统与目标检测系统的常规生化结果依项目不同存在不同程度的偏差;当用两个以上的检测系统检测同一检验项目时,应进行方法比对和临床可接受性评价,以实现检验结果的可比性。     

不同厂家校准品校准同一检测系统检验结果的实验研究

目的 观察不同厂家的校准品能否直接校准非配套的检测系统.方法 参考美国临床实验室标准化委员会的EP9-A2文件,以罗氏检测系统为目标检测系统(系统1),用罗氏C-fas、朗道校准品Level2和Level3分别与国内某一厂家生产的生化分析仪器、试剂和检测程序组成待评检测系统(系统2～4),然后用上述四个检测系统分别检测40份新鲜患者血清中的总胆红素(TBil)等10个项目,每个标本测定两次,结果取均值.计算待评检测系统(Y)与目标检测系统(X)之间的相对偏倚,以美国临床医学检验部门修正法规(CLIA'88)允许总误差的1/2为标准,判断检验结果的可比性.结果 系统2与系统1的TBil,DBil,ALP和CK具有可比性,其他项目不具有可比性.系统3与系统1的TBil和GGT具有可比性,其他项目不具可比性.系统4与系统1的Glu具有可比性,其他项目不具可比性.结论 不同厂家生产的校准品不能直接用于校准非配套检测系统,每一检测系统都必须具有自己的配套校准品.     

Reduction of risk factors for osteoporosis among adolescents and young adults.

Osteoporosis is the most common of all skeletal disorders. The most commonly accepted definition of osteoporosis is a decrease in the amount of calcified bone tissue to the point that fractures occur with minimal trauma. Researchers have shown that peak bone mass at skeletal maturity may be the single most important factor in the development of osteoporosis. At present, no satisfactory way to replace lost bone exists, and the ideal treatment for osteoporosis is prevention, which must begin early in life. The most promising approach in the primary prevention of osteoporosis is to help each person achieve as high a peak skeletal mass and bone density as genetically possible prior to skeletal maturity. Furthermore, identifying those adolescents and young adults at risk is of clinical value for prediction and counseling purposes. Recommendations for achieving the maximal bone mass prior to skeletal maturity, as well as methods of assessing and minimizing the risk factors for osteoporosis, will be discussed.     

Deep learning for automated skeletal bone age assessment in X-ray images

Skeletal bone age assessment is a common clinical practice to investigate endocrinology, genetic and growth disorders in children. It is generally performed by radiological examination of the left hand by using either the Greulich and Pyle (G&P) method or the Tanner–Whitehouse (TW) one. However, both clinical procedures show several limitations, from the examination effort of radiologists to (most importantly) significant intra- and inter-operator variability. To address these problems, several automated approaches (especially relying on the TW method) have been proposed; nevertheless, none of them has been proved able to generalize to different races, age ranges and genders.In this paper, we propose and test several deep learning approaches to assess skeletal bone age automatically; the results showed an average discrepancy between manual and automatic evaluation of about 0.8 years, which is state-of-the-art performance. Furthermore, this is the first automated skeletal bone age assessment work tested on a public dataset and for all age ranges, races and genders, for which the source code is available, thus representing an exhaustive baseline for future research in the field.Beside the specific application scenario, this paper aims at providing answers to more general questions about deep learning on medical images: from the comparison between deep-learned features and manually-crafted ones, to the usage of deep-learning methods trained on general imagery for medical problems, to how to train a CNN with few images.     

Automated enzymatic measurement of lecithin, sphingomyelin, and phosphatidylglycerol in amniotic fluid

We describe methods for automated enzymatic measurement of lecithin, sphingomyelin, and phosphatidylglycerol in amniotic fluid. Phospholipase C (EC 3.1.4.3) and sphingomyelin phosphodiesterase (EC 3.1.4.12) are reacted with lecithin and sphingomyelin, respectively, to liberate phosphocholine. Phosphocholine is then reacted with alkaline phosphatase, choline oxidase, peroxidase, and 4-aminoantipyrine to form a colored complex, for which the absorbance at 500 nm is measured with a centrifugal analyzer. Phosphatidylglycerol is hydrolyzed by phospholipase D (EC 3.1.4.4) to form glycerol, which is subsequently reacted with ATP and NAD+ in the presence of glycerol kinase and glycerol-3-phosphate dehydrogenase to yield NADH. The absorbance of the NADH formed is measured at 340 nm. These methods provide a simple, rapid, and accurate alternative to thin-layer chromatography for determination of phospholipids in amniotic fluid for assessment of fetal lung maturity.     

超声评估胎儿肺脏成熟度研究进展

肺发育不成熟是早产儿死亡和新生儿患病的最常见原因。评估胎肺成熟度在围生期管理中具有重要意义,产前评价胎儿肺成熟度能够提高新生儿尤其是早产儿的存活率。超声在产前评估中发挥重要作用。本文对超声评估胎儿肺成熟度的研究进展进行综述。     

评估护士长成熟度的做法及体会

目的通过评估护士长成熟度,提高护理管理的执行力度。方法将护士长根据不同成熟度进行分型,对其采取不同的管理措施,并进行考核和分析。对于支持型护士长,采用权利性影响因素。层层监督,不断考核,持续跟进,不断加强整改,养成好的习惯和工作作风;对于稳定型护士长,充分授权,适当控制,给予压力,挖掘潜力,稳定发展;对于倦怠型护士长,多采用非权力性影响因素,个别谈心交流,注重调动积极性和稳定情绪。结果年终综合考核成绩比较,支持型、稳定型、倦怠型护士长在评估管理前后差异均有统计学意义,P〈0．05。结论护理部通过评估护士长成熟度的做法,逐步构建了良好的全院护理管理体系,提高了护士长管理的质量。提高了护理管理执行力。     

产前超声评估胎儿肺成熟度研究进展

肺发育不成熟是新生儿、尤其是早产儿患病和死亡的主要原因。目前早产新生儿存活率明显提高,但其中肺脏发育不成熟引起的呼吸系统疾病发病率仍保持较高水平;产前准确评估胎儿肺成熟度对降低新生儿呼吸系统疾病发病率及优化临床治疗方案具有重要意义。随着超声技术的发展,产前超声无创评估胎儿肺成熟度已取得较大进展。本文对产前超声评估胎儿肺成熟度研究进展进行综述。     

Role of calcium in preserving the skeletal health of aging women.

During the years from adolescence through senescence, the skeleton passes through identifiable phases: consolidation, maturity, menopause, and senescence. Skeletal dynamics and calcium requirements are different during each phase. A adult woman can avoid the skeletal deterioration caused by calcium deficiency if she maintains a minimum daily calcium intake of 800 mg. Increased calcium intake will not increase skeletal mass in mature, premenopausal women and will not prevent bone loss in postmenopausal women. Because intestinal absorption decreases with age, daily calcium intake of 1000 to 1200 mg is recommended for the elderly. Women can increase their dietary calcium intake in various ways, including increasing intake of dairy products, eating calcium-rich nondairy foods, purchasing foods fortified with calcium, and, if all other methods prove inadequate, using calcium supplements. Physicians must prescribe calcium only after learning what is needed for a particular woman's skeletal health by determining that woman's stage of skeletal development and approximate calcium intake; if intake is insufficient, it should be adjusted to the level appropriate at that stage.     

剪切波弹性成像评估骨骼肌生物力学特征的应用进展

剪切波弹性成像作为一种经济、无创、精确定量的影像学方法,可以评估健康及疾病状态下的骨骼肌生物力学特征,为疾病的诊断提供可靠参考。本文就剪切波弹性成像的基本原理和其在骨骼肌力学特征的评估应用、局限性及进展进行综述。     

458例注射抑那通治疗中枢性性早熟儿童的护理

目的探讨抑那通治疗中枢性性早熟的护理方法。方法对458例中枢性性早熟患儿的护理过程进行回顾性分析,总结抑那通治疗中枢性性早熟护理方法。结果 458例患儿治疗前已有的青春期症状停止或减少,患儿迅猛的生长速度减慢,骨骼的成熟也减慢到正常速度。结论对中枢性性早熟患儿在药物治疗的基础上对患儿进行心理、睡眠、饮食、运动等方面的指导,有利于患儿康复。     

Pupil examination: validity and clinical utility of an automated pupillometer.

Pupillary size and reactivity have long been a critical component of the clinical assessment of patients with neurological disorders. The pupillary examination may provide critical information related to new or worsening intracranial pathology and facilitate prompt intervention to minimize further neuronal damage. With this in mind, intensive care nurses caring for neurologically impaired patients frequently must perform pupillary examinations in concert with assigning a Glasgow Coma Scale score. The purpose of this study was to test the accuracy and reliability of an automated pupillometer compared with the standard manual examination as a preliminary step in assessing the usefulness of automated pupillometry in the critical care setting. Twenty patients in the intensive care units of a teaching hospital were examined by two groups of three examiners using both the manual examination with a penlight or similar light source and a portable automated pupillometer capable of measuring pupil size and reaction. Measurements by a static pupillometer before and after each pupillary examination were used to determine the mean "true" size of the pupil. This study found that the automated pupillometer is more accurate and reliable than the manual examination in measuring pupil size and reactivity. For these reasons, such a device may be a beneficial addition in the clinical assessment of neurologically impaired patients.