三种梅毒螺旋体抗体检测方法的比较分析

目的比较化学发光法（TP-CLIA）、酶联免疫吸附试验（TP-ELlSA）和梅毒螺旋体明胶颗粒凝聚试验（TPPA）对梅毒螺旋体特异性抗体（TP-Ab）检测的意义。方法分别用CLIA、ELISA和TPPA检测患者的1797份血清样本,收集CLIA／ELISA／TPPA／法检测均阳性但临床未明确诊断的标本及结果不一致标本以重组免疫印迹法（RIBA）最终确认。结果三种方法共筛选69例阳性及可疑血清标本。CIIA／EIISA／TPPA法均阳性标本63例,其中52例有临床明确诊断。另11例3种方法检测均阳性但未明确诊断标本和6例检测结果不一致标本用RIBA确证。CLIA法确认阳性66例,阳性率3．67;ELISA法确认阳性65例,阳性率3．62;TPPA法法确认阳性61例,阳性率3．39;CLIA、ELISA及TPPA法敏感性分别为98．51％、97．02％和91．05％;特异性均为99．88;诊断效率分别99．83％、99．78和99．66％。结论CLIA法和ELISA法敏感性均高于TPPA法,不管用何种方法检测对于临床诊断不符的标本均应慎重,必要时用RIBA法补充确认,以排除假阳性。     

胶体金试纸法和化学发光免疫法检测全分子HCG的观察

目的观察胶体金试纸法和化学发光免疫法检测全分子人绒毛膜促性腺激素（HCG）的异同。方法采用胶体金试纸法和化学发光免疫法检测187例血清标本中全分子HCG。结果187例血清标本用胶体金试纸法检测阴性64例（其中假阴性例10例），弱阳性24例，阳性37例，强阳性62例。化学发光免疫法检测〈5IU／L者54例、〉15～1830271 IU／L者133例。两种方法经配对X^2检验差异具有显著性（X^2=8．1，P〈0．005）。结论①胶体金试纸法较化学发光免疫法简便快速，但有假阴性。化学发光免疫法灵敏度、精密度较胶体金试纸法高，但线性范围稍窄。②胶体金试纸法测定结果结合临床可用于估计化学发光免疫法血清稀释倍数。     

ELISA法和化学发光法在感染性免疫检查中的比较分析

目的深入分析并比较酶联免疫吸附法(ELISA)与化学发光法对血清中HIV-1/HIV-2抗体、梅毒抗体及丙肝抗体的检测结果。方法分别采用ELISA法和化学发光法对患者血清和标准物质进行HIV-1/HIV-2抗体、梅毒抗体和丙肝抗体的检测,然后对检测结果进行资料整合并分析。结果相同公司生产的3种抗体标准物质,用化学发光法丙肝抗体检测结果为阳性,HIV-1/HIV-2及梅毒抗体为阴性,ELISA法检测均为阳性;化学发光法检测HIV-1/HIV-2抗体为阴性标本的测定数据会出现一定的波动;化学发光法测定结果为测定值较低的阳性标本,ELISA法测定有一定可能会显示为阴性。结论临床上采用化学发光法对HIV-1/HIV-2抗体、梅毒抗体及丙肝抗体检测的灵敏度高于ELISA法,因此在实际检测过程中,关于检测方法的选择更多的应倾向于化学发光法。     

化学发光免疫分析检测丙型肝炎病毒抗体与重组免疫印迹试验确证阳性的关联研究

目的：探讨化学发光免疫分析（CLIA）检测丙型肝炎病毒抗体（抗-HCV）与重组免疫印迹试验（RI-BA）确证结果的关系。方法对10309例在山东大学附属省立医院就诊的门诊及住院患者采用 CLIA 法进行抗-HCV 检测，对检测为有反应性的标本通过 RIBA 作进一步确证。结果CLIA 初筛抗-HCV 抗体有反应性的标本共计106例，采用 RIBA 试剂对106例反应性标本进行检测，确认阳性37例、不确定28例、阴性41例，确认阳性比例为34．91％，且确认阳性标本比例与 S/CO 比值呈正相关。确证阳性标本条带检出率有差别，Core 检出率最高，其次依次为 NS3、NS4、NS5。结论确证结果与确证的条带分布有关，可根据 CLIA 法 S/CO 比值预测确证结果，有利于对结果进行正确和合理解释。     

两种方法检测戊型肝炎病毒IgM抗体的临床验证

目的：对MP生物医学亚太私人有限公司（简称MP公司）生产的戊型肝炎病毒IgM抗体快速检测试剂（胶体金法）和戊型肝炎病毒IgM抗体检测试剂（酶联免疫吸附试验,ELISA）进行临床验证,评价其与参比试剂的等效性。方法采用SFDA注册的试剂（北京万泰生物药业股份有限公司生产,ELISA）为参比试剂,与MP公司生产的上述两种试剂,同时对250例标本进行比对试验;如MP公司试剂与万泰试剂检测结果不一致,用SFDA注册的第3方试剂（上海科华生物工程股份有限公司生产,戊型肝炎病毒IgM抗体,ELISA）进行复核。结果MP公司的胶体金法和ELISA试剂与万泰ELISA试剂检测戊型肝炎病毒IgM抗体阴性符合率分别为96．9％和94．9％,阳性符合率分别为94．5％和92．7％,总符合率分别为96．4％和94．4％。两公司试剂检测结果比较,差异无统计学意义（P＞0．05）。结论MP公司胶体金法和ELISA检测戊型肝炎病毒IgM抗体试剂,与参比试剂（万泰试剂）具有等效性,可以在临床诊断中应用。     

丙型肝炎病毒抗体两种检测方法的比较

目的为探讨金标法检测丙型肝炎(简称丙肝)病毒抗体的敏感性和特异性。方法采用酶联免疫吸附试验(ELISA)法和胶体金法对200例血清进行丙型肝炎病毒抗体检测。结果200例血清中ELISA法检测丙肝病毒抗体阳性40例,胶体金法丙肝病毒抗体检测阳性34例,符合率为85.%。两法结果经统计学检验结果差异无统计学意义。结论金标法检测丙肝病毒抗体敏感性比ELISA法略低,但与ELISA法相比仍然能满足临床要求。适合在标本量不大的基层医院使用。     

三种方法检测丙型肝炎病毒抗体结果一致性比较

目的探讨采用不同方法检测丙型肝炎病毒抗体结果的一致性。方法随机留取临床患者ELISA法检测丙型肝炎病毒抗体值为1≤S/C.O.4和S/C.O.4的标本各100份。随机留取内镜患者胶体金法检测丙型肝炎病毒抗体阴性、阳性标本各100份。采用胶体金法、ELISA、化学发光法三种方法对标本进行复检。结果临床患者ELISA检测结果为1S/C.O.4时,胶体金法的阳性检出率仅为38%;当ELISA法检测结果 S/C.O4时,三种方法检测的阳性率均为100%。对内镜检查患者胶体金法检测留取的阴、阳性标本各100份,胶体金法复检全部符合,ELISA、化学发光法检测有4~6份标本的结果不符合。结论胶体金法作为丙型肝炎病毒抗体检测方法敏感性低,应谨慎采用此方法用于内镜检查患者的检测。     

心肌标志物三合一胶体金免疫层析法与全自动化学发光法对比评价

目的对比评价国产心肌标志物三合一胶体全免疫层析法与全自动化学发光法的临床检测性能。方法血清样本来自246例心血管疾病住院患者，用上述两种方法测定血清肌红蛋白（Mb）、肌酸激酶同工酶（CK—MB）和肌钙蛋白I（cTnI）浓度，并以化学发光法为相对标准，评价胶体金免疫层析法的临床诊断效能。结果与化学发光法比较，胶体金免疫层析法所测Mb，CK—MB和cTnI的相对敏感度分别为30．0％，61．5％和66．6％，相对特异度分别为99．O％，82．7％和64．0％，相对准确度分别为87．8％，80．5％和64．2％。结论心肌标志物三合一胶体金免疫层析法的特异度相对较好，但敏感度偏低。作为心肌标志物的POCT检测方法，国产试剂有必要进一步提高其敏感度。     

丙肝病毒抗体化学发光酶免疫分析方法的建立和应用

【目的】建立丙肝病毒抗体化学发光酶免疫分析方法（CUA）并应用于临床检测。【方法】以辣根过氧化物酶（HRP）为酶标记物,以鲁米诺为发光底物,采用双抗原夹心法检测血样中的抗丙肝病毒（HCV）,建立抗HCV化学发光酶免疫分析方法;并与常规使用的抗HCV酶联免疫分析方法（ELISA）同时检测500例血浆标本中的抗HCV,以荧光定量PCR为金标准,探讨其临床应用价值。【结果]CLIA方法敏感度为0．2ng／mL,变异系数〈10％,稳定性好。CLIA和ELISA同时检测500例血浆标本,ELISA检测出7例阳性,CLIA检测出8例阳性,经PCR检测最终确定结果与CLIA相符。【结论]CLIA法检测HCV敏感、准确、稳定性好,适合临床推广应用。     

酶联免疫法和胶体金法对比检测病毒性丙型肝炎

目的探讨酶联免疫法和胶体金法检测病毒性丙型肝炎的效果。方法选取344例血清标本并分别采用胶体金法与酶联免疫法进行丙型肝炎病毒阳性检测,随后以化学发光法进行确证。对两种方法的敏感性与特异性进行对照比较。结果两种检验方法共筛选出48例阳性及可疑血清标本。其中胶体金法筛选45例阳性,化学检验法确证43例,3例可疑标本经确证为阴性;酶联免疫法筛选46例阳性,化学检验法确证42例,2例可疑标本,1例经确证为阳性,1例经确证为阴性。胶体金法与酶联免疫法的敏感性分别为100.00%、97.72%;特异性分别为71.43%、55.56%。结论胶体金法与酶联免疫法相比更为灵敏,能够有效减少漏检现象,并具有操作便捷、价格低廉、检测时间短等优势;值得注意的是在对S/CO较低的标本进行检测应慎重,如有必要可采用化学发光法进行确证,对假阳性进行排除。     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.