广东省凝血酶原时间测定的室间质量评价

目的 探讨广东省临床实验室监测凝血酶原时间（PT）的检测状况及影响PT测定室间可比性的因素.方法 通过每年两次定期向全省参评实验室寄发质控样品（每次5个样品）,然后对其回报的数据进行统计分析,作出实验室检验水平的评价.结果 近年来全省实验室间PT（INR）测定结果的CV值尽管有逐渐下降的趋势,但室间变异仍然相当高.同一凝血活酶试剂的测定结果,PT（INR）的CV明显大于PT（sec）的CV,特别是对异常水平质评物的测定.结论 凝血活酶试剂敏感度指数（ISI）值标定的不准确性和INR计算不正确的是引起广东省临床实验室间凝血酶原时间测定变异大的主要原因.     

广东省凝血酶原时间测定的室间质量评价

目的探讨广东省临床实验室监测凝血酶原时间(PT)的检测状况及影响PT测定室间可比性的因素.方法通过每年两次定期向全省参评实验室寄发质控样品(每次5个样品),然后对其回报的数据进行统计分析,作出实验室检验水平的评价.结果近年来全省实验室间PT(INR)测定结果的CV值尽管有逐渐下降的趋势,但室间变异仍然相当高.同一凝血活酶试剂的测定结果,¨(INR)的CV明显大于PT(sec)的CV,特别是对异常水平质评物的测定.结论凝血活酶试剂敏感度指数(ISI)值标定的不准确性和INR计算不正确的是引起广东省临床实验室间凝血酶原时间测定变异大的主要原因.     

应用六西格玛评价河北省17家三甲医院凝血项目的检验性能

目的应用六西格玛(6σ)评价参加河北省室内质控室间比对的17家三甲医院的凝血实验项目数据的检验质量现状。方法收集该省17家三甲医院室内质控室间比对凝血实验项目室内质控数据,项目包括血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB),统计各实验室室内质控均值()、变异系数(CV)、偏移(bias),西格玛(σ)度量和质量目标指数(QGI)。结果 PT、APTT、FIB大于3σ的性能优良实验室分别占58.82%、41.18%、52.94%;PT、APTT、FIB为2σ～3σ的中等质量实验室分别占17.65%、58.82%、35.29%;PT、APTT、FIB小于2σ性能较差的实验室分别占23.53%、0.00%、11.76%。需优先改进PT、APTT、FIB精密度的实验室占91.12%、82.35%、88.24%。结论参加比对的17家三甲医院凝血实验项目检验性能有待提高。6σ评价方法统一而简单,用于室内质控室间比对更加简便直观。     

参加全省凝血试验室间质量评价结果分析

目的通过分析2009～2011年度参加的全省凝血试验室间质量评价结果,总结经验发现问题,以便采取相应措施提高检验质量,更好地服务于临床和患者。方法按照卫生部临检中心的要求,对全省组织的凝血质控样本进行检测,并对其结果作统计分析。结果全年度总评成绩理想,合格率较高。其中2009年上半年和2011年下半年各有一个批号的PT不合格,2009年上半年和2010年下半年各有一个批号的PT-INR不合格,全年度PT和PT-INR均分均为88.9,APTT和FIB均分均为100.0;正常水平的合格率较高,为100.0%,而异常水平的合格率较低,仅为83.3%。结论要做好凝血试验室间质量评价活动,应加强实验室操作人员的专业素质和工作责任心,重视仪器的日常维护保养,优选试剂厂家,保证试剂质量,认真做好室内质量控制,以保证检验质量的持续改进。     

凝血分析仪的初步临床应用

用欧加农凝血分析仪,自动检测凝血酶原时间(PT),活化部分凝血活酶时间(APTT),纤维蛋白原(FIB),操作简便,测试快捷,具有手工操作不可比拟的精密度与准确度.测试123例病人的PT,APTT,FIB,结果与临床相吻合,并以国际标准化比率(INR表示PT的结果,既避免了组织凝血活酶敏感性差异的影响,又使各实验室间的PT结果有了可比性,为PT室间质控的开展奠定了基础.     

混合血浆制备异常凝血质控物及其稳定性的探讨

目的 探讨采集检测后的混合血浆制备异常质控血浆的稳定性和精密度,能否作为日常凝血室内质控物.方法 采集40人份以上血浆混合封盖,置于37 ℃水浴箱中,连续进行凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)检测,当PT、APTT值分别比正常对照相差约2～3倍的值时,立即将混合血浆分装于塑料小离心管,每支约0.3 ml,置-80 ℃超低温冰箱速冻备用.每天从冷冻冰箱取出1支置于37 ℃水浴中速溶后,随同当日凝血标本检测,连续观察5个月.结果 分别计算出 5个月的PT、APTT、FIB均值、标准差,以第一个月的均值、标准差为靶值作t检验比较得出:5个月PT、APTT、FIB比较差异均无统计学意义(P＞0.05),CV值＜5%.结论 自制异常质控血浆保存在-80 ℃时,PT、APTT、FIB可稳定5个月以上,可用于日常凝血室内质控.     

全自动血凝仪CA-7000性能及生物参考区间的验证与评价

目的了解攀钢集团总医院检验科实验室新购SYSMEX全自动血凝仪CA-7000的性能指标是否符合相关要求以及上海太阳试剂厂商提供的参考区间能否直接应用于临床。方法(1)批内不精密度:取新鲜混合血浆[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)为3个浓度水平,凝血酶时间(TT)、D-二聚体、纤维蛋白原降解产物(FDP)为正常浓度水平]连续测定各20次,计算标准偏差(SD)、变异系数(CV)。(2)日间不精密度:采用两个水平的质控品,每天测定1次,连续20 d,计算SD、CV。(3)携带污染率:测定稀释的血浆3次后,测定原浓度血浆3次,再测定稀释的血浆3次,计算携带污染率。(4)线性范围:测定5个浓度的样本,与理论值作比较,计算y=ax+b。(5)准确性:重复测定蒸馏水复溶后的FIB定值血浆、D-二聚体、FDP质控品(低值、高值)10次,计算均值和FIB的相对偏差。(6)正确度评价:选用国家卫生和计划生育委员会凝血5个批次室间质控品为正确度评价物,计算偏倚率。(7)生物参考区间的验证:选择20个健康体检人群进行生物参考区间转移的验证,计算R值。结果(1)批内不精密度:不同水平PT、APTT、FIB的CV分别为0.46%~1.06%、0.47%~2.66%、1.99%~3.92%,正常水平TT、D-二聚体、FDP的CV分别为0.71%、4.24%、7.05%。(2)日间不精密度:正常水平PT、APTT、FIB、TT的CV分别为2.62%、2.1%、8.9%、2.0%,异常水平PT、APTT的CV分别为2.85%、3.1%。(3)携带污染率:FIB为0.42%,D-二聚体为3.58%,FDP为1.96%。(4)检测线性范围:FIB为0.8~5.7 g/L,D-二聚体为0.50~30.00 mg/L,FDP为12.50~110.00 mg/L。(5)准确性:FIB相对偏差为7.15%,CV15%,D-二聚体/FDP均在质控范围内。(6)生物参考区间的验证:总样本R值为0.96。(7)正确度评价结果:除一个批号的APTT偏倚处在上限外(15.28%),其余各指标均合格。结论本实验室新购的全自动血凝仪SYSMEX CA-7000各项性能指标基本符合要求,太阳试剂厂商提供的参考区间可以使用。     

滴宝凝血因子筛选试剂临床应用评价

目的 评价滴宝凝血筛选试剂临床应用价值.方法 通过检测校正血浆、正常范围质控血浆、异常范围质控血浆和正常混合血浆(如病人血浆)测定滴宝凝血试剂(APTT、PT、FIB)的准确性、重复性和线性范围,并与同类型试剂(梅里埃、德灵试剂)作比较.结果 准确度:APTT测定值与靶值偏差2.3～2.4%,PT测定值与靶值偏差0～1.1%,FIB测定值与靶值偏差6.4～8.6%;重复性:APTT CV值0.53～1.77%;PT CV值1.8%;FIB CV值3.0～4.7%,线性范围0.92～6.36 g/L;与梅里埃试剂、德灵试剂比较,有良好相关性γ=0.9190～0.9289;t检验P＞0.05.结论 滴宝凝血因子筛选试剂各项指标完全符合临床检测APTT、PT、FIB要求,值得推荐使用.     

凝血常规试验在血凝分析仪上的比对分析

目的评价成都中医药大学附属医院检验科两台血凝分析仪(法国Stago公司Stago CT型和StagoRE型)检测凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)的准确性和一致性。方法对两台血凝分析仪用配套校准物进行校准;用配套质控物常规室内质控评价凝血常规的稳定性;使用比对试验评价两台仪器检测凝血常规的准确性和一致性。结果 PT、INR、APTT、Fib 4项试验比对结果的变异百分率(CV)符合卫生部临床检验中心凝血室间质量评价标准。两台血凝分析仪的检测结果有较好的相关性,除Fib相关系数r值为0.959 8,其余检测项目相关系数均大于0.975 0。结论通过不同血凝分析仪检测PT、APTT、Fib的比对试验,有效提高了本科室不同血凝分析仪器间的可比性,有效地保证了检验结果的准确性和精密度,提高了检验的质量。     

GLP体系下全自动血凝分析仪的3Q验证

目的以Sysmex CA7000全自动血凝分析仪为例,探究良好实验室规范(GLP)体系下全自动血凝分析仪3Q验证过程。方法选择凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)4项检验指标,对仪器的批内精密度、日间精密度、准确性、线性、携带污染率进行性能验证。结果 PT、APTT、TT、FIB的批内精密度CV值分别为1.33%、1.57%、1.47%、1.90%;日间精密度CV值分别为1.73%、1.52%、1.55%、2.14%;在准确度方面,PT、APTT、TT、FIB的正常质控CV值分别为7.45%、3.88%、-4.98%、4.36%,PT、APTT的异常质控CV值分别为8.11%、8.77%;FIB的线性相关系数(r)值为0.999 3,a值为1.02;标本携带污染率最高CV值为2.15%;所测结果均符合行业通用标准和仪器厂家要求。结论通过GLP体系下的3Q验证,Sysmex CA7000血凝分析仪各方面性能优良,可以用于临床检验部的检验工作。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."