Dimension Rxl Max型全自动生化分析仪性能验证

目的 为参加医学实验室认可和了解仪器性能,对Dimension Rxl Max型全自动生化分析仪进行了评估.方法 通过评估天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、谷氨酰氨基转移酶、碱性磷酸酶、总蛋白、清蛋白、糖(GLU)、肌酐(Cr)、尿酸(UA)等9个项目的 精密度、线性范围、灵敏度、正确度等,评估仪器的性能.结果 Dimension Rxl Max型全自动生化分析仪在精密度、线性范围以及正确度方面均可达到ISO15189认可所要求的仪器性能指标或仪器声明的指标等.结论 Dimension Rxl Max型生化分析仪性能稳定、准确度高,完全符合ISO15189分析质量要求.     

东芝TBA-120FR全自动生化分析仪检测系统性能证实

目的东芝TBA-120FR全自动生化分析仪检测系统分析特性进行证实。方法用上海复星长征公司的水平、水平控制血清对丙氨酸氨基转移酶(ALT)等11个项目的精密度、准确度线性范围进行验证。结果ALT,AST,TP,ALB,AKP,GGT,Glu,Urea,Cr,CH,TG项目的准确度均在厂商规定的限值内,精密度高,线性检验呈直线相关。结论东芝TBA-120FR全自动生化分析仪检测系统实验性能符合实验室的各项性能指标。     

Olympus AU400型全自动生化分析仪性能验证

目的 为参加医学实验室认可和了解仪器性能,需评估一台寿命长达12年的Olympus AU400型全自动生化分析仪.方法 通过评估天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转移酶、碱性磷酸酶、总蛋白、清蛋白、糖、尿素氮、肌酐、尿酸、乳酸脱氢酶、羟丁酸脱氢酶(α-HBDH)等12个项目的 精密度、线性范围、灵敏度、正确度等,评估仪器的性能.结果 AU400型全自动生化分析仪,在精密度、线性范围以及正确度方面,均可达到ISO15189认可所要求的仪器性能指标或者仪器声明的指标等.而AST、ALT、ALP、ALB、α-HBDH等,检测限高于仪器声明检测限,可能与仪器老化有关.结论 尽管AU400型生化分析仪使用年限较高,但除仪器灵敏度受损外,性能依然良好,完全符合ISO15189分析质量要求.     

血站实验室全自动生化分析仪ALT项目的检测性能分析

目的对全自动生化分析仪TBA-120FR检测丙氨酸氨基转移酶(ALT)的性能进行验证,以保证TBA-120FR与科华试剂盒组成的分析系统各项性能参数满足血液筛查的要求。方法对仪器进行精密度、正确度、线性范围、可报告范围、生物参考区间的验证,判定标准参照《血站技术操作规程(2015版)》及相关标准。结果低、高值质控血清批内不精密度为2.90%、1.10%,批间不精密度为3.81%、2.03%;正确度:2018年室间质评成绩合格率为100%;检测系统在20~690 U/L的线性良好,检测结果可靠;生物参考区间符合无偿献血人群的参考区间。结论TBA-120FR与科华试剂盒组成的检测系统性能验证结果能达到血站检测的要求。     

ADVIA 2400全自动生化分析仪性能验证

目的从精密度、准确性及线性范围3个方面,对ADVIA 2400全自动生化分析仪进行性能验证。方法按照美国临床实验室标准化协会(NCCLS)公布的文件标准对ADVIA 2400全自动生化分析仪进行精密度、准确性及线性范围等性能验证。结果 ADVIA 2400全自动生化分析仪检测项目钾(K)、丙氨酸氨基转移酶(ALT)、转肽酶(GGT)、三酰甘油(TG)、总胆固醇(TC)、尿素氮(BUN)、血糖(GLU)、总蛋白(TP)、肌酸激酶(CK)、淀粉酶(AMY)批内精密度和总精密度均小于厂家精密度,这些项目偏倚均小于1/2CLIA′88允许误差范围,这些项目在厂家规定的检测范围内线性良好。结论 ADVIA 2400全自动生化分析仪性能良好,满足临床检测要求。     

罗氏Cobas c701全自动生化分析仪性能评价

目的对罗氏Cobas c701全自动生化分析仪进行性能评价。方法按照美国临床和实验室标准化协会EP15-A2文件的要求,通过电解质(钾、钠、氯)和涵盖各波长的9个项目(丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、碱性磷酸酶、γ-谷氨酰转移酶、肌酐、尿素氮、葡萄糖、总蛋白、三酰甘油)对仪器的精密度、准确度、线性范围等进行验证。结果所有检测项目的重复性标准差(Sr)≤厂家声明的标准差(σr)、精密度的标准差(St)≤σt,均与厂家声明的精密度性能一致,可以接受。测定项目理论值与测定值相关性良好(回归系数为:0.999 4~1.000 0);与参加卫生部临床检验中心室间质评的检测系统比对,结果偏移均在CLIA′88规定的范围内。结论罗氏Cobas c701检测项目的重复性、精密度、准确度均达到了厂家声明检测的性能。     

罗氏Modular全自动生化分析仪测定血尿素氮、肌酐及尿酸的性能评价

目的 对罗氏Modular全自动生化分析仪测定尿素氮(BUN)、肌酐(CREA)、尿酸(UA)的性能进行初步评价.方法 根据ISO15189的要求,按美国临床与实验室协会(CLSI)指南文件EP5、EP9确立评价方案,对罗氏Modular生化分析仪检测BUN、CREA、UA的精密度、准确度、线性范围、临床可报告范围、...     

强生VITROS 5600全自动生化免疫分析仪性能验证报告

目的对强生VITROS 5600全自动生化免疫分析仪主要分析性能进行验证。方法根据实验室认可准则和美国CLIA′88性能验证文件,对强生VITROS 5600全自动生化免疫分析仪上开展的17个常规生化项目进行精密度、准确度、线性范围、临床可报告范围和生物参考区间进行验证。结果强生VITROS 5600全自动生化免疫分析仪精密度、准确度、线性范围、临床可报告范围和生物参考区间验证等均符合要求。结论强生VITROS 5600全自动生化免疫分析仪检测性能完全满足预期的临床应用要求。     

TBA-40FR全自动生化分析仪的检验质量控制

全自动生化分析仪以其高准确度、高精密度以及灵活、高效为特点,成为现代检验科必不可少的设备。正确的设置、校准、操作和保养仪器是仪器分析质量的关键。我院于2008年引进了日本东芝Ac-cute TBA-40FR全自动生化分析仪,该仪器的使用     

罗氏MODULAR P800全自动生化分析仪检测系统性能验证

目的按《医疗机构临床实验室管理办法》和《医学实验室质量和能力认可准则》ISO15189的要求对新的检测系统罗氏MODULAR P800全自动生化分析仪的分析性能进行验证。方法按美国临床实验室标准化协会CLSI的指南文件EP5-A2、EP15-A2、EP6-A2、C28-A2的要求,对罗氏MODULAR P800全自动生化分析仪进行精密度、准确度、线性范围、参考区间4个性能进行验证,并与厂商声明的性能或公认的质量标准进行比较。结果批内精密度、批间精密度均小于1/4Tea(CLIA′88);对卫生部5份室间质控品检测结果与靶值进行比对做相关性分析,相关系数r2在0.99以上,精密度、准确度、可报告范围、生物参考区间与厂商提供的性能指标相符。结论罗氏Modular生化分析仪的主要分析性能符合质量目标要求。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.