血细胞形态学室间质量评价体系的建立及运行

目的 建立血细胞形态学室间质量评价(EQA)体系,对基层医院检验人员细胞形态识别能力进行评价。方法 新疆生产建设兵团临床检验中心采用图文摄像系统挑选外周血涂片中具有代表性的细胞或物质图片建立血细胞形态学图谱库,结合EQA管理网络平台构建血细胞形态学EQA体系,并开展2023年160余家基层医院血细胞形态学两次共20幅质量评价(质评)图片的EQA工作。结果 构建的图谱库涵盖78类各种血细胞,共1 520幅图片,包括红细胞系、粒细胞系、淋巴细胞和浆细胞、单核细胞系、巨核细胞和血小板系。2023年血细胞形态学EQA工作通过EQA管理网络平台进行了数据上报、质评成绩发布及汇总分析等。两次EQA均取得满分成绩的实验室数为27家(16.67%),第1次和第2次合格实验室数分别为123家(75.46%)和138家(85.18%),两次合格率比较,差异有统计学意义(P<0.05)。结论 该研究构建了较完善的血细胞形态学EQA体系,并在基层医院检验人员细胞形态识别能力的评价中得到了较好的运行,同时也反映出基层医院检验人员血细胞形态识别能力亟待提升。     

骨髓涂片细胞形态学室间质量评价体系的建立与应用

目的研究骨髓涂片细胞形态学室间质量评价(EQA)方法、标准,探讨其临床应用价值。方法用已确诊的骨髓涂片附临床资料及实验室有关检查结果,定期发放至参评单位进行细胞形态学室间质量评价。结果诊断完全符合率逐年提高,1988年50%,2005年85.8%(P<0.005)。其中急性髓细胞白血病首次28.3%,历年总体均值提高到56.6%,亚型符合率也从39.6%提高到70.0%(P<0.005)。其他血液病的诊断符合率均有显著提高。结论以细胞形态学检查为主,结合临床资料,全面综合分析作出实验室诊断的骨髓涂片EQA体系,能有效提高血液病细胞形态学检查技术与诊断水平。     

骨髓涂片细胞形态学室间质量评价体系的建立与应用

目的研究骨髓涂片细胞形态学室间质量评价（EQA）方法、标准，探讨其临床应用价值。方法用已确诊的骨髓涂片附临床资料及实验室有关检查结果，定期发放至参评单位进行细胞形态学室间质量评价。结果诊断完全符合率逐年提高，1988年50％，2005年提高到85．8％（P〈0．01）。其中急性髓细胞白血病首次28．3％，历年总体均值提高到56．6％，亚型符合率也从39．6％提高到70．0％（P〈0．01）。其他血液病的诊断符合率均有显著提高。结论以细胞形态学检查为主，结合临床资料，全面综合分析作出实验室诊断的骨髓涂片EQA体系，能有效提高血液病细胞形态学检查技术与诊断水平。     

上海地区表皮生长因子受体基因突变检测室间质量评价

目的分析上海地区临床实验室表皮生长因子受体(EGFR)基因突变检测项目室间质量评价(EQA)的总体情况,对存在问题进行分析,以确保检测质量。方法 2016年2次EQA样本盘各包含5份样本,要求各参评实验室在规定时间内将检测结果上传至上海市临床检验中心数据库。依据回报结果计算各实验室的EQA成绩和样本符合率,并汇总阳性样本和阴性样本的总体符合率。结果 2016年2次EQA分别收到25和30份有效回报结果,分别有20(80%)和26(87%)家实验室检测结果完全正确,分别有0(0%)和1(3%)家实验室EQA成绩80分;10份样本的符合率最高为100%,最低为88%;阳性样本和阴性样本的总体符合率分别为95.76%和97.27%;复合突变漏检是样本不符合的主要原因,达50%(5/10)。结论上海地区临床实验室EGFR基因突变检测总体符合率较高,但仍存在问题,复合突变漏检是主要原因;临床实验室应加强质量控制以保证检测结果的准确性。     

乙型肝炎病毒YMDD突变室间质量评价调查品制备及应用

目的制备乙型肝炎病毒(HBV)YMDD突变室间质量评价(EQA)调查品,评估上海地区临床实验室检测HBV YMDD突变的能力。方法筛选HBV DNA5×104 IU/ML的临床样本,经稀释制成含HBV YMDD不同突变类型的样本盘。采用实时荧光聚合酶链反应(PCR)、高温连接酶反应(LDR)和测序法筛选EQA候选样本,并采用PCR评估样本均匀性和稳定性。2017年2次EQA各制备5份样本,要求参评实验室在规定时间内检测样本并上报检测结果。对回报结果进行分析。结果 2017年2次EQA分别收到12份和10份有效回报结果,66.67%的实验室检测结果完全正确。HBV YIDD、YVDD、YIDD+YVDD和YMDD不同突变样本的检测符合率分别为90.63%、86.36%、77.27%和88.24%。结论制备的调查品均匀、稳定,可用于EQA;部分临床实验室HBV YMDD突变检测能力尚需提高,应加强质量控制以保证检测结果的准确性。     

某院近3年临床分离细菌分布及耐药性检测

目的 了解该院临床分离细菌分布及对抗菌剂的耐药性,为临床用药提供依据.方法 对该院2008～2010年所有分离菌株进行回顾性分析,药敏试验使用纸片扩散法和VITEK2微生物分析仪检测,按照美国临床实验室标准化协会(CLSI)的标准进行.结果革兰阳性菌感染呈上升趋势,其中以金黄色葡萄球菌和肠球菌为主;肠球菌对所检测的药物...     

湖南省肿瘤标志物项目(体液类)检测质量现状分析

[目的]通过对湖南省各级临床实验室肿瘤标志物(TM)项目(体液类)检测室间质量评价情况与室内质控的数据分析,评估全省实验室该项目分析性能,提高检测结果的准确性、可重复性和可比性,促进实验室质量改进.[方法]对2008年至2012年肿瘤标志物项目(体液类)检测的室间质量评价(EQA)回报数据和室内质控(IQC)回报的相关情况进行分析.[结果]TM项目EQA参评实验室合格率逐年上升;各项目检测试剂分组数据和方法学分组数据经无重复双因素方差分析,不同方法分组各项目统计结果合格率及变异系数(CV)值的组间差异有统计学意义(P＜0.05),不同试剂分组的CV值差异亦有统计学意义(P＜0.05).IQC图回报率均值12.75％,呈逐年上升趋势.[结论]本省TM EQA参评实验室过少,EQA样本的靶值代表性待提高;TM项目EQA的能力验证(proficiency testing,PT)得分和CV均值与实验室选择的检测系统有关;分组测定EQA结果以电化学发光组准确度最好,试剂分组以进口试剂EQA结果精密度较好.全省各实验室应加强室内质量控制工作.     

实验室质量评价分析系统在国家免费孕前优生健康检查项目中的应用

该研究旨在建立"免费孕前优生健康检查项目"临床实验室室间质量评价(EQA)网络结果上报分析系统,高效、快捷、安全地实施EQA计划,确保这项国家免费惠民项目的顺利实施。基于Web方式和统计学基础,依据美国临床实验室改进修正法案(CLIA′88)能力验证(PT)成绩计算方法,利用省级计划生育信息平台的已有设施和技术力量,增加功能模块,开发统计软件,根据国家免费孕前优生健康检查项目的检测内容,搭建项目单位实验室检验质量评价的网络平台。自2012年国家免费孕前优生健康检查项目在山东省全覆盖以来,免费孕前优生健康检查实验室EQA网络上报分析系统,是高效、便捷的数字化EQA应用平台。系统平台由省级项目主管部门、地市级项目主管部门、省级检验质量监测指导中心、参评实验室、卫生和计划生育委员会信息中心远程管理五级平台组成。较经典的基于Web方式临床检验实验室EQA信息管理系统所包含的EQA组织者、参评实验室、第三方管理的服务器等三级平台增加了省、市两级项目主管部门平台。实验室EQA网络平台在国家免费孕前优生健康检查项目中应用,体现了操作简便、技术构架严谨、安全机制严密等特性。五级平台的建立,能够高效、及时为参评单位和项目管理者反馈参评单位EQA成绩,及时采取有效监管措施,确保项目临床检验质量。     

美国CLSI M52和CNAS指南关于商品化微生物鉴定系统及药敏试验系统验证方法的比较

美国临床和实验室标准化协会(CLSI)在2015年发布了文件M52-商品化微生物鉴定及药敏试验系统的验证研究,旨在为执行验证研究的实验室提供指导性建议。在实验室将商品化微生物鉴定系统和药敏试验系统应用到常规检测之前,应对未加修改而使用的已确认的检验程序进行独立验证。该文将CLSI文件M52和中国合格评定国家认可委员会(CNAS)指南中关于商品化微生物鉴定系统及药敏试验系统的验证方法进行比较,结合国内临床微生物实验室的部分情况,分析对比两者之间的差异,以供国内临床微生物实验室制定符合自身情况的验证方案。     

PBL教学法在临床微生物学检验实习教学中应用的体会

正近些年来,随着国家卫计委对临床抗菌药物使用的规范化治理工作推进,临床抗感染治疗越发依靠参照实验室的病原微生物诊断报告。随着病原微生物耐药特点的不断变化,新抗菌药物的研发及投入使用,临床抗感染治疗方案也在不断发展更新,美国临床实验室标准化协会(CLSI)发布的针对实验室检测方案的标准也每年随之不断更新。可以说临床微生物学科的动态发展变化非常迅速,而这一现状对临床微生物检验人员     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。