住院患者血乳酸和血氨的检测流程优化及质量提升

目的 探讨同济大学附属同济医院住院患者乳酸和血氨项目检测结果阳性率高的原因,并制定改进措施,提高乳酸和血氨检测的准确性.方法 以乳酸>2.2 mmol/L或血氨>30μmol/L为阳性,分别统计同济大学附属同济医院2019年1—6月门诊、急诊、住院和住院急诊患者样本乳酸及血氨项目的总检测数、检测结果阳性率以及检验流程各...     

Comparison of six anthropometric measures in discriminating diabetes: A cross‐sectional study from the National Health and Nutrition Examination Survey

BackgroundTraditional anthropometric measures, including body mass index (BMI), are insufficient for evaluating the risk of diabetes. This study aimed to evaluate the performance of new anthropometric measures and a combination of anthropometric measures for identifying diabetes.MethodsA total of 46 979 participants in the National Health and Nutrition Examination Survey program were included in this study. Anthropometric measures, including weight, BMI, waist circumference (WC), waist‐to‐height ratio (WtHR), conicity index (CI), and A Body Shape Index (ABSI), were calculated. Logistic regression analysis and restricted cubic splines were used to evaluate the association between the anthropometric indices and diabetes. The receiver operating characteristic (ROC) curve analysis was performed to compare the discrimination of different anthropometric measures.ResultsAll anthropometric measures were positively and independently associated with the risk of diabetes. After adjusting for covariates, the per SD increment in WC, WtHR, and CI increased the risk of diabetes by 81%, 83%, and 81%, respectively. In the ROC analysis, CI showed superior discriminative ability for diabetes (area under the curve 0.714), and its optimum cutoff value was 1.31. Results of the combined use of BMI and other anthropometric measures showed that among participants with BMI <30 kg/m², an elevated level of another metric increased the risk of having diabetes (P < .001). Similarly, at low levels of weight, CI, and ABSI, an elevated BMI increased diabetes risk (P < .001).ConclusionsWtHR and CI had the best ability to identify diabetes when applied to the US noninstitutionalized population. Anthropometric measures containing WC information could improve the discrimination ability.     

Structure Characterization and Impact Effect of Al-Cu Graded Materials Prepared by Tape Casting

With the need of developing new materials, exploring new phenomenon, and discovering new mechanisms under extreme conditions, the response of materials to high-pressure compression attract more attention. However, the high-pressure state deviating from the Hugoniot line is difficult to realize by conventional experiments. Gas gun launching graded materials could reach the state. In our work, the corresponding Al-Cu composites and graded materials are prepared by tape casting and hot-pressing sintering. The microstructure and the acoustic impedance of the corresponding Al-Cu composites are analyzed to explain the impact behavior of Al-Cu graded materials. Computed tomographic testing and three-dimension surface profilometry machine results demonstrated well-graded structure and parallelism of the graded material. Al-Cu GMs with good parallelism are used to impact the Al-LiF target at 2.3 km/s using a two-stage light-gas gun, with an initial shock impact of 20.6 GPa and ramping until 27.2 GPa, deviating from the Hugoniot line.     

参芪清毒胶囊对血液透析患者营养指标、氧化应激、炎性因子、残余肾功能的影响

目的:研究参芪清毒胶囊对血液透析患者营养指标、氧化应激和炎性因子、残余肾功能(RRF)的影响.方法:将181例血液透析患者采用投掷法随机分为对照组、观察组.对照组予以常规基础药物,观察组在对照组基础上予参芪清毒胶囊,对比两组治疗效果及营养指标、丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px...     

MRI平扫在肾脏嗜酸细胞瘤与嫌色细胞癌鉴别诊断中的价值

目的:评估MRI平扫量化参数在肾脏嗜酸细胞瘤与嫌色细胞癌鉴别诊断中的价值.方法:本研究回顾性分析42例经病理证实患者的MRI平扫数据,其中嗜酸细胞瘤18例,嫌色细胞癌24例.由两名医生采用盲法测量肿瘤实性成分的T1WI及T2WI标准化信号值(SSI)、表观弥散系数(ADC).应用组内相关系数(ICC)评估测量的可靠性,...     

Patient‐centred care – preanalytical factors demand attention: A questionnaire study of venous blood sampling and specimen handling

Objective. Most mistakes in laboratory medicine are the result of human error occurring before the blood sample reaches the laboratory. This survey of preanalytical procedures was designed to identify sources of error and potential targets for quality improvement strategies. Material and methods. The staff in a highly specialized surgical ward at a university hospital completed a questionnaire addressing the collection and handling of venous blood samples in plastic vacuum test‐tubes for general clinical chemistry testing. Results. The results suggest that venous blood sampling instructions are not always followed. When uncertain about how a sample should be collected, the majority of respondents rely on potentially poor sources of information, such as out‐of‐date printed instructions or the advice of a colleague, rather than consult up‐to‐date electronic instructions. Furthermore, they do not always report errors and the referrals are not always handled according to sampling instructions. The respondents were highly motivated, however, and had a strong interest in receiving further education in, and assuming increased responsibility for, venous blood sampling procedures in the ward. Conclusions. We believe that the introduction of standardized routines and regular staff training, combined with an exchange of the existing paper‐based referral management system with an electronic system for managing referrals, could increase safety in the preanalytical process, with positive effects on patient safety. Given the importance of venous blood samples in patient care, a more extensive study covering other hospital wards and primary health‐care centres is needed.     

多普勒超声定量血流量准确性的实验研究

目的：本文探讨几种常用多普勒血流参数定量血流量的准确性。方法：在离体模型上准确模拟出不同的血流量,用频谱多普勒测量几种血流数（TAmean、TApeak和VTI）,分别计算每分血流量Q,并与实际血流量进行比较。结果：Q(TAmean）与实际血流量接近,测量比较准确（回收率RR＝98．0％）,其次是Q（TApeak)（RR＝91．6％）,而Q(VTI)准确性较差（RR＝159．9％）,高估实际血流量约60％;而各方法的变异系数无明显差别。结论：应用TAmean计算每分血流量较其它血流参数相对比较准确。     

两种不同采血标本法对血清钾离子的影响

目的：通过对两种不同采血标本法的比较,探讨采血标本时不取下针头将血液缓慢注入干试管会不会导致溶血,方法：采用随机配对的方法将受试者分为实验组和对照组,在其它条件相同的情况下,实验组抽血后不取下针头,对照组抽血后取下针头将血缓慢沿试管壁注入干试管内观察两组血清钾离子均值有无差异性,结果：两种不同采血标本法采得血液所测得血清钾离子均值差异无显著意义（P＞0．05）,用实验组方法采血标本不会导致溶血,结论：采血标本时,不取下针头将血缓慢沿试管壁注入干试管内不会导致溶血,并可以减轻护士因职业暴露而感染经血液传播疾病的危险。     

创伤严重程度与住院不同时间营养不良的关系

目的 探讨创伤病人损伤严重程度与其住院不同时间营养不良的关系.方法 对外伤后24 h内入院的120例创伤病人,入院首日依据创伤严重程度评分（ISS）分为轻度损伤、中度损伤及重度损伤,各40例.入院次日对病人进行营养不良风险筛查（NRS）,住院期间每周进行NRS评分,共4次.并对评分结果进行统计分析.结果 ISS与住院期间第1～3周NRS评分呈正相关（r=0.408～0.752,P〈0.01）.重度损伤组第1～3周NRS评分明显高于其他两组,差异有显著性（F=11.16～121.28,q=2.15～21.15,P〈0.001）.结论 创伤病人营养不良风险与创伤严重程度有关.对创伤病人进行ISS测定可预测病人住院期间不同时间存在营养不良的风险.     

单检及16份混样检测模式对献血者核酸检测效果的比较研究

目的 探讨单份及16份混合标本2种检测模式对献血者血液病毒核酸检测(nucleic acid test,NAT)效果的影响.方法 2009年2至6月顺序留取北京无偿献血者标本,用诺华Procleix ULTRIO Assay进行单份(ID)或16份混合标本(P16)乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)和人类免疫缺陷病毒-1( HIV-1)三项联合核酸检测.单份NAT反应性同时HBsAg、抗-HCV或抗-HIV血清学不合格的标本,血清学合格的单份NAT反应性经双孔NAT复检阳性的标本,以及混合NAT反应性/拆分NAT为阳性的标本,进一步用诺华Procleix HBV、HCV和HIV-1鉴别试剂进行鉴别试验.血清学合格、HBV NAT单独阳性标本进一步用Roche HBV定量实验加以验证和进行病毒含量测定、血清学分析、并进行稀释以模拟是否能被P16-NAT检出.阳性检出率进行四格表连续校正的x2检验.结果 (1)在7613份单份NAT (ID-NAT)标本中,检出NAT阳性26份,ID-NAT阳性率0.34％(26/7613);(2)在16 064份共1004份P16混合标本NAT(P16-NAT)中,检出NAT阳性27份,P16-NAT阳性率为0.17％ (27/16 064);(3)在血清学合格标本中,单份检测的NAT单独阳性检出率为0.12％ (9/7438),高于16份混样检测的NAT单独阳性检出率0.01％ (2/15 750)(x2=11.880,P＜0.05).9份ID-NAT及2份P16-NAT单独阳性标本经鉴别均为HBV NAT阳性,未检出 HCV NAT单独阳性或HIV NAT单独阳性;(4)9份ID-NAT HBV单独阳性血样模拟P16-NAT,仅有2份可被检出;(5)对8份ID-NAT及2份P16-NAT单独阳性标本进行Roche HBV定量测定,均可确证其核酸检测结果,但病毒含量很低.其中2份HBV病毒含量为472 IU/ml及15 IU/ml,6份含量＜12 IU/ml,另2份原倍不能定量经10倍浓缩处理后测得含量为＜ 12 IU/ml和14.3 IU/ml;(6)11份HBV NAT单独阳性标本中,3份(27.3％)为潜在的窗口期感染,其余8份(72.7％)抗-HBc阳性或抗-HBe阳性,但抗-HBc-IgM均为阴性,为隐匿性感染;(7) P16-NAT初检呈反应性需要进行拆分试验的混合样本比率为2.49％ (25/1004),其中由血清学合格标本所致初检反应性的混合样本比率为0.20％ (2/1004).结论 ID-NAT单独阳性检出率高于P16-NAT单独阳性检出率.为避免低病毒含量HBV的漏检,应选用灵敏度高的核酸检测试剂,并尽量采用小标本量混合检测,甚至采用单份检测方式.