肿瘤标志物的联合检测在肺癌诊断中的临床价值

目的探讨血清中CEA、CA125、NSE和CYFRA21-1四种肿瘤标志物联合检测在不同组织类型肺癌中的临床诊断价值。方法采用电化学发光免疫分析技术测定116例肺癌患者及65例健康人血清中的CEA、CA125、NSE利CYFRA21-1水平。结果CYFRA21-1、NSE、CEA、CA125四项肿瘤标志物肺癌组检测水平均显著高于对照组（P〈0．01）,肿瘤标志物测定水平与病理组织类型有关。其中CYFRA21-1在鳞癌及腺癌的阳性率分别为73．21％、63．64％;NSE在小细胞肺癌的阳性率为62．50％;CEA和CA125检测的阳性率及血清水平以腺癌最高;四项联合检测的阳性率为82．76％。结论血清CEA、CA125、NSE和CYFRA21-1的联合检测有助于提高肺癌的诊断效率,并对组织分型有较高的参考价值。     

多肿瘤标志物蛋白芯片检测系统对消化道肿瘤诊断的价值评价

目的探讨多肿瘤标志物蛋白芯片检测系统在诊断消化系统肿瘤的应用价值。方法使用多肿瘤标志物蛋白芯片检测系统（C-12）检测173例消化道恶性肿瘤患者及其中60例肿瘤术后患者、225例消化道良性疾病患者、82例健康体检者血清中12项肿瘤标志物表达水平。结果消化道恶性肿瘤组肿瘤标志物C-12检测阳性率明显高于良性疾病组及健康体检组,有显著性差异（P〈0.01）;除胰腺癌外,12项联合检测阳性率明显高于单项标志物阳性率（P〈0.05）;60例肿瘤患者6项肿瘤标志物（CA19-9、CEA、CA242、AFP、CA125、CA15-3）血清水平术后均低于术前,并有显著性差异（P〈0.05）。结论运用蛋白芯片技术检测多肿瘤标志物可以明显提高恶性肿瘤诊断的灵敏度,可用于高危人群的早期消化系统肿瘤筛查,以及肿瘤治疗后的疗效观察。     

多肿瘤标志物蛋白芯片检测系统在消化道恶性肿瘤的临床应用价值

目的研究多肿瘤标志物蛋白芯片检测系统在消化道恶性肿瘤的普查、诊断及预后判断的临床价值。方法采用C-12蛋白芯片技术检测96例常见消化道恶性肿瘤患者组,87例消化道良性疾病患者组,120例健康查体者组血清中12项肿瘤标志物表达水平及阳性率,及51例消化道恶性肿瘤患者术后12项肿瘤标志物表达水平。结果消化道恶性肿瘤组肿瘤标志物C-12检测结果及阳性率明显高于良性疾病组及健康查体组,差异有显著性（P〈0.05）;12项联合检测阳性率（61.1%-82.3%）明显高于单项检测阳性率（27.72%-70.5%）;消化道恶性肿瘤患者术前及部分患者术后C-12检测结果比较,差异也有显著性（P〈0.05）;C-12中CA199、CEA、CA242、FER、AFP、CA125、CA153等7项在恶性消化道肿瘤中表达明显高于其余几项肿瘤标志物（P〈0.05）。结论多肿瘤标志物蛋白芯片检测系统用于恶性消化道肿瘤的普查、早期诊断及术后疗效观察,有一定的临床价值。     

外周血肿瘤标志物联合检测对肺癌诊断的价值

目的探讨血清肿瘤标志物癌胚抗原（CEA）、细胞角蛋白19（CYFRA21-1）、神经元烯醇化酶（NSE）、鳞状细胞癌抗原（SCCAg）单栓及联合检测在原发性支气管肺癌中的诊断价值。方法应用电化学发光免疫法（ECLIA）检测156例支气管肺癌患者和39例肺部良性疾病患者血清中CEA、CYFRA21-1、NSE、SCCAg 4种标志物的水平。结果肺癌组4种血清肿瘤标志物阳性率均明显高于肺部良性疾病组（P〈0．01）。CEA在腺癌中的阳性率为47．0％，高于鳞癌和小细胞癌（P〈0．05）。CYFRA21-1在腺鳞癌、鳞癌中的阳性率分别为73．3％、71．7％，NSE在小细胞肺癌中的阳性率为83．3％。血清CE、CYFRA21-1、SCCAg在Ⅳ期肺癌患者阳性率显著高于Ⅰ、Ⅱ期（P〈0．05，P〈0．01）。血清NSE在早期和晚期肺癌中的阳性率无显著性差异（P〉0．05）。4种标志物单栓敏感性以NSE、CYFRA21-1较高（58．3％，53．2％），4种标志物联合检测和3种任意组合联舍检测的敏感性均高于单检的敏感性（P〈0．05），以CEA＋NSE＋CYFRA21-1组合敏感性最高（82．7％）。结论4种血清肿瘤标志物对于肺癌的辅助诊断有一定的临床价值。3项或4项血清肿瘤标志物联合检测可提高肺癌的诊断率。     

肿瘤标志物蛋白芯片法与电化学发光法检测结果的比较以及蛋白芯片法对肺癌的辅助诊断研究

目的 了解多肿瘤标志物蛋白芯片法与电化学发光法所测肿瘤标志物结果的符合性以及蛋白芯片法对肺癌的辅助诊断价值.方法 蛋白芯片法与电化学发光法测相同标本的四项肿瘤标志物,对比两种方法的符合性.同时分析蛋白芯片法对肺癌的辅助诊断价值.结果 CA19-9、CEA、NSE、CA125 四项指标,两种方法间差异无统计学意义（P〉0.05）;蛋白芯片法辅助诊断肺癌的敏感度为55.26%,电化学发光法四项单指标辅助诊断肺癌的敏感度分别为CA19-9 17.76%、CEA 33.88%、NSE 4.61%、CA125 37.5%.结论 蛋白芯片法与电化学发光法检测CA19-9、CEA、NSE、CA125的特异性和灵敏度相近,同时,多肿瘤标志物蛋白芯片检测方法对肺癌辅助诊断的阳性率较高,体现了蛋白芯片法多指标联合检测的优势.     

6种肿瘤标志物联合检查对肺癌的诊断价值

目的：探讨肿瘤标志物神经特异性烯醇化酶（NSE）、细胞角蛋白（CYFRA21-1）、癌胚抗原（CEA）、糖类抗原125（CA125）、糖类抗原153（CA153）和铁蛋白（Ferritin）对肺癌的诊断价值。方法采用电化学发光法分别检测151例肺癌（肺癌组）、100例肺良性疾病患者（肺良性疾病组）及50例健康对照组的血清 NSE、CYFRA21-1、CEA、CA125、CA153、Ferritin 水平并进行分析。结果肺癌组患者6种肿瘤标志物水平明显高于肺良性疾病组和健康对照组,差异有统计学意义（P ＜0．05）。小细胞肺癌的 NSE 水平高于鳞癌和腺癌,差异有统计学意义（P ＜0．05）,而鳞癌和腺癌 CYFRA21-1水平高于小细胞肺癌,差异有统计学意义（P ＜0．05）。6种肿瘤标志物中 NSE 的灵敏度最高,为82．8％。6项肿瘤标志物中3项阳性时,肺癌组阳性率较高,假阳性显著降低。结论血清肿瘤标志物的水平和阳性率与肺癌的病理类型有关。联合检测血清肿瘤标志物可提高早期诊断肺癌的灵敏度和特异度,首选 CEA、NSE 和 CYFRA21-13种肿瘤标志物联合检测。     

多肿瘤标志物蛋白芯片检测在肺癌诊断中的价值

目的 探讨多种肿瘤标志物蛋白芯片检测系统在肺癌诊断中临床应用价值方法 应用化学发光法多种肿瘤标志物蛋白芯片检测系统，测定并分析254例病理或细胞学首次确诊肺癌患者，以及276例健康体检者血清中12种肿瘤标志物（CA19-9、NSE、CEA、CA242、CA125、CA153、AFP、Ferritin、f-PSA、PSA、β-HCG及HGH）的表达水平。结果 肺癌组的阳性率显著高于健康体检组(68.90% vs 17.03%，χ2= 152.95, P <0.01) ;肺癌组中Ferritin CA-125 CEA CA19-9的阳性率分别为41.07% 35.86% 33.47%和13.15%。结论 多肿瘤标志物蛋白芯片检测系统在肺部恶性病变的诊断中有较高的临床应用价值。     

血清肿瘤标志物CA125、CA199、CEA、NSE联合检测在肺癌诊断中的应用

目的探讨血清肿瘤标志物CA125、CA199、CEA、NSE联合检测在肺癌诊断中的应用价值。方法选择本院2009年1月至2010年2月住院的肺癌患者220例肺癌病例组,选取同期我院健康体检人员为正常对照组250例,进行肿瘤标志物CA125、CA199、CEA、NSE进行联合检测。结果经统计学分析肺癌病例组CA125、CEA、NSE血清水平明显高于正常对照组,差异有显著性意义（P〈0．01）,CA199在两组的表达水平比较无显著性差异（P〉0．05）。经统计学分析CA125、CEA、NSE与联合检测三项肿瘤标志物之间的敏感性、特异性比较有显著型差异（P〈0．01）。结论单项肿瘤标志物检测,可以对临床有一定的指导性,但在敏感性、特异性均方面各有欠缺,很多肿瘤标志物与其他相应的疾病有一定的交叉性,对单项肿瘤标志物检测指导临床诊断价值有限,同时选用多项肿瘤标志物进行检测,可以达到单项检测在敏感性和特异性上的不足,能够有效的为临床提供有价值的佐证资料,以能够达到初筛和早期诊断的目的。     

多肿瘤标志物蛋白芯片检测系统在肝、肺恶性肿瘤早期诊断中的应用观察

[目的]探讨多肿瘤标志物蛋白芯片检测系统(简称C—12检测系统)在肝、肺恶性肿瘤早期诊断方面的应用价值。[方法]收集52例健康体检者、18例肝良性疾病、加例治疗前肝癌、加例肺良性疾病和26例治疗前肺癌患者的空腹血清，应用C-12检测系统测定十二种肿瘤标志物：AFP、CEA、CA199、NSE、CA242、FER、HCG、f—PSA、PSA、CA125、HGH、CA153。[结果]健康体检组阳性率1．9％，肝良性疾病组阳性率55．6％，肝癌组阳性率85％；肺良性疾病组阳性率40％，肺癌组阳性率84．6％。肝癌组以AFP阳性率最高(70％)，CA199次之(60％)，CA125第三(50％)。肺癌组以CEA阳性率最高(80．8％)，CA125次之(65．4％)，CA242第三(38．5％)。[结论]C12检测系统将十二种肿瘤标志物联合测定，优于单项指标的测定，提高了阳性检出率，降低了假阳性的干扰，能为肝、肺恶性肿瘤的早期诊断提供更好的帮助，有望成为临床常用而有效的检查项目。     

多肿瘤标志物蛋白芯片检测在肺癌诊断中的价值

目的:探讨多种肿瘤标志物蛋白芯片检测系统在肺癌诊断中临床应用价值。方法:应用化学发光法多种肿瘤标志物蛋白芯片检测系统,测定并分析254例病理或细胞学首次确诊的肺癌患者,以及276例健康体检者血清中12种肿瘤标志物(CA19-9、NSE、CEA、CA242、CA125、CA153、AFP、ferritin、f-PSA、PSA、β-HCG及HGH)的表达水平。结果:肺癌组的C-12芯片检测阳性率显著高于健康体检组(68.90%vs17.03%,χ2=152.95,P<0.01),敏感性和特异性分别为68.9%和82.9%;肺癌组中ferritin、CA125、CEA及CA19-9的阳性率分别为41.04%、35.86%、33.47%和13.15%。结论:多肿瘤标志物蛋白芯片检测系统在肺部恶性病变的诊断中有较高的临床应用价值。     

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.     

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.     

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.     

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.