乳胶增强免疫比浊法测定血清Lp(a)

目的 了解乳胶增强免疫比浊法检测血清Lp(a)的优越性和临床应用前景.方法 对检测血清Lp(a)的乳胶增强免疫比浊法和免疫比浊法进行重复性试验、线性范围试验和回收试验的比较,采用两种方法平行检测48例冠状动脉心脏病患者血清Lp(a)的含量,进行相关性分析,并用乳胶增强免疫比浊法检测42例正常人血清Lp(a)含量.结果 两种方法都有较好的重复性,但乳胶增强免疫比浊法稍优于免疫比浊法;两种方法具有较好的相关性(r=0.988,P＜0.001),相关方程Y=1.087X+10.8;回收率均在95%以上,乳胶增强免疫比浊法略高于免疫比浊法;乳胶增强免疫比浊法的线性范围(5～1200 mg/L)较免疫比浊法(10～900 mg/L)要宽;乳胶增强免疫比浊法检测血清Lp(a)的参考范围为18.4～292 mg/L.结论 乳胶增强免疫比浊法检测血清Lp(a)的准确性和精确度都优于免疫比浊法;具有敏感性高、稳定性好、方便快速的优点,适宜在有自动化生化分析仪的医院推广使用.     

乳胶增强免疫比浊法测定血清Lp（a）

目的了解乳胶增强免疫比浊法检测血清Lp(a)的优越性和临床应用前景。方法对检测血清Lp(a)的乳胶增强免疫比浊法和免疫比浊法进行重复性试验、线性范围试验和回收试验的比较,采用两种方法平行检测48例冠状动脉心脏病患者血清Lp(a)的含量,进行相关性分析,并用乳胶增强免疫比浊法检测42例正常人血清Lp(a)含量。结果两种方法都有较好的重复性,但乳胶增强免疫比浊法稍优于免疫比浊法;两种方法具有较好的相关性(r=0.988,P<0.001),相关方程Y=1.087X 10.8;回收率均在95%以上,乳胶增强免疫比浊法略高于免疫比浊法;乳胶增强免疫比浊法的线性范围(5～1200mg/L)较免疫比浊法(10～900mg/L)要宽;乳胶增强免疫比浊法检测血清Lp(a)的参考范围为18.4～292mg/L。结论乳胶增强免疫比浊法检测血清Lp(a)的准确性和精确度都优于免疫比浊法;具有敏感性高、稳定性好、方便快速的优点,适宜在有自动化生化分析仪的医院推广使用。     

斑点免疫金渗滤法定量测定血清淀粉样蛋白A方法的建立及性能评估

目的建立斑点免疫金渗滤法（DIGFA）定量测定血清淀粉样蛋白A（SAA）并评估其分析性能。方法选用2株商品化抗SAA单克隆抗体，分别结合于硝酸纤维素膜和胶体金，制备免疫金渗滤试剂板条（SAA—DOT）以定量检测SAA。按照EP文件，评估SAA—DOT的分析性能（检测限、精密度、准确性、线性范围等）。结果SAA—DOT最低检测限为5mg／L；10和100mg／L的批内变异系数（CV）分别为9．07％和10．21％，天间CV分别为11．33％和11．53％；线性范围为5—230mg／L；SAA—DOT的测定结果与商品化乳胶增强速率散射比浊法（LERN）试剂具有良好的相关性（r=0．995，P〈0．05）。表观健康者血清SAA浓度中位数为5．7mg／L，95％可信区间为0—9．6mg／L。结论基于DIGFA的SAA-DOT简便、快速，能在5min内完成检测，各项分析性能指标达到国家食品药品监督管理局（SFDA）对体外诊断试剂的要求，可用于临床患者血清标本的检测。     

胱抑素C测定试剂盒的分析性能评估

目的 评价胱抑素C测定试剂盒(免疫比浊法)的各项分析性能,了解其是否满足临床要求.方法 评价胱抑素C测定试剂盒(免疫比浊法)的精密度、灵敏度、特异性、线性范围,并进行方法 学比对.结果 四川新成生物公司的胱抑素C测定试剂盒(免疫比浊法)的批内不精密度CV≤3.73%,批间不精密度CV≤4.05%;测定范围0.20～10.00mg/L;灵敏度LLD=0.20mg/L;试剂特异性好;与日本生研株式会社试剂盒比对相关性良好,y=1.0191x+0.022,R2=0.9969.结论 四川新成生物公司的胱抑素C测定试剂盒(免疫比浊法)精密度好、灵敏度高、特异性强、可测定范围广,能够满足临床实验室的需要.     

乳胶增强免疫比浊法测定血清胱抑素C

目的建立乳胶增强免疫比浊测定血清胱抑素C(Cystatin C)的全自动分析方法。方法采用乳胶增强免疫比浊法测定Cystatin C,根据美国临床实验室标准化协会相关文件,对方法进行精密度、线性、准确性等评价及临床初步应用。结果此方法批内CV<4.0%,批间CV<5.0%。抗干扰性强,血红蛋白小于或等于4.0g/L、胆红素小于或等于420μmol/L、类风湿因子小于或等于2 200 U/L、三酰甘油小于或等于10 mmol/L对测定无影响;与进口试剂相比,Y=1.007 5X+0.002 9,r=0.999 5,二者相关性良好。试剂开瓶稳定性良好。结论乳胶增强免疫比浊法测定血清Cystatin C,具有方法简便、快速、灵敏的优点,且结果准确,可用自动分析仪测试,适合临床检验应用。     

颗粒增强免疫比浊法测定血清同型半胱氨酸的方法学评价

目的：对胶乳颗粒免疫比浊法测定血清同型半胱氨酸（HCY）的方法学进行初步评价。方法：应用胶乳颗粒免疫比浊法测定HCY的精密度、标准曲线、干扰实验、稳定性实验、并与循环酶法测定血清HCY的结果进行相关性分析。结果：颗粒增强免疫比浊法测定HCY的精密度（批内CV为1.87%、0.75%,批间CV为2.29%、5.35%）较高;HCY浓度在0μmol/L～50μmol/L范围内线性良好;当抗坏血酸浓度1107mg/L、胆红素浓度445 umol/L、血红蛋白浓度6.7 g/L;甘油三酯浓度14.6 mmol/L、氨离子浓度75 umol/L时均未对测定结果产生干扰;试剂开瓶后稳定周期也可达到25天;颗粒增强免疫比浊法和循环酶法测定HCY相关性良好（y =0.9904x ＋0.0813,r=0.9981）。结论：颗粒增强免疫比浊法测定血清HCY具有较高的精密度,结果准确可靠,适合临床实验室推广。     

参照CLSI EP文件评价两种类风湿因子测定试剂的优劣

目的参照美国临床实验室标准化协会EP文件评价两种类风湿因子(RF)测定试剂的优劣,建立实验室可用的同类试剂评价方案,便于择优选用。方法针对两种不同方法的血清RF测定试剂进行初步评价。分析两种方法测定血清RF的精密度、功能灵敏度、测定范围和干扰因素。结果胶乳增强免疫比浊和免疫比浊测定RF的精密度分别为4.58%(低值)、2.83%(高值)和7.19%(低值)、2.90%(高值);功能灵敏度为2 U/mL和9U/mL,测定范围分别为:2～140U/mL和0～300U/mL;抗干扰能力分别为胆红素:≤342μmol/L和≤500μmol/L,血红蛋白:≤10g/L和≤5g/L,三酰甘油:≤11.3mmol/L和≤6.75mmol/L;试剂开瓶后多批次反复测定CV分别为:4.35%(高值)、4.89%(低值)和4.45%(高值)和7.39%(低值)。结论胶乳增强免疫比浊法是测定血清RF较好的方法,快速、准确、灵敏度和精密度高,且结果准确,相对免疫比浊法在功能灵敏度、精密度、抗干扰能力方面更佳,但测定范围低于免疫比浊法。     

乳胶增强免疫比浊法检测D-二聚体水平的方法学评价

目的对乳胶增强免疫比浊法检测D-二聚体水平进行方法学评价.方法系统研究了乳胶增强免疫比浊法检测D-二聚体水平的精密度、灵敏度、稀释线形、校准曲线的稳定性及干扰性,并分析其对血浆与血清水平测定的相关性.结果乳胶增强免疫比浊法检测D-二聚体水平的精密度为1.84～3.89%,分析灵敏度为50μg/L,校准曲线至少稳定六个月,稀释标本的回收率为89.8～106.8%,平均回收率为99.1%,血清测定结果略高于血浆值,但两者差异无显著意义(P＞0.05).血清与血浆之间具有良好的相关性(r=0.9816).结论乳胶增强免疫比浊法检测D-二聚体水平具有全自动、适合门急诊检测、稳定、定量和快速等优点,值得临床推广应用.     

免疫比浊法D二聚体测定在全自动生化分析仪上的使用

目的对胶乳增强免疫比浊法D二聚体试剂定量测定血浆D二聚体的方法进行临床实验评价。方法实验评价包括精密度、线性测定、前带试验、相关性、回收实验以及干扰实验。结果胶乳增强免疫比浊法测定血清D二聚体批内精密度测定变异系数(CV)为1.8%~3.9%,批间精密度测定CV为3.6%~4.5%,回收率在95.2%~99.3%。线性测定良好,可达60μg/mL,回归方程为Y=1.007X-0.2536,不同浓度的标准品检测相关性r2=0.9997,Y=1.0048X-0.045 4。对胆红素、血红蛋白、三酰甘油、纤维蛋白原及相关联物质可溶性纤维蛋白、D单体均具有很好的抗干扰能力。结论利用胶乳增强免疫比浊法在全自动生化仪上测定D二聚体的结果符合临床使用的要求。     

乳胶增强免疫比浊法测定髓过氧化物酶试剂盒性能验证评价

目的：评价血浆髓过氧化物酶（MPO）乳胶增强免疫比浊法试剂盒在AU2700全自动生化分析仪使用的性能验证。方法根据美国临床实验室标准化委员会（NCCLS）的评价方案对北京九强公司生产的乳胶增强免疫比浊法髓过氧化物酶测定试剂盒进行了回收试验、干扰试验、临床可报告范围及精密度验证。结果北京九强生产的MPO乳胶增强免疫比浊法试剂盒的两个浓度水平质控品的实验室精密度CV为8．9％;回收率95．7％～108．3％。线性评价的相关系数r＝0．997,线性回归方程为Y＝1．033X-25．092;干扰试验中不同程度的标本溶血均对测定MPO造成严重干扰。抗坏血酸6．3～100mg/L,三酰甘油小于7．8mmol/L内无明显干扰,相对偏差小于10％,三酰甘油浓度大于7．8mmol/L对试验有明显干扰,相对偏差为11．5％～11．9％。结论九强公司在国内首次推出的髓过氧化物酶（MPO）乳胶增强免疫比浊法试剂盒在抗干扰、线性、正确度及精密度等方面的性能达到临床需求,值得在临床心脑血管危险因子检测中推广应用。     

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.     

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.     

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.