静脉血与末梢血常规生化检测结果的比较分析

目的：探讨CelercareM1分析仪检测静脉血与末梢血常规生化项目的结果可比性。方法取受试者的静脉血与末梢血在CelercareM1分析仪上平行测定Mg2＋、Cl－、tCO2、K＋、Na＋、Ca2＋、α‐HBDH、LDH、AST、CK、CK‐MB、TP、ALB、TBIL、ALT、GGT、ALP、UREA、GLU、UA、CHOL、HDL‐C等项目,并对结果进行比较。结果静脉血tCO2检测结果高于末梢血,差异有统计学意义（P＜0．05）。末梢血的α‐HBDH、LDH、CK、CK‐MB检测结果均高于静脉血,差异有统计学意义（P＜0．05）。结论除了电解质和α‐HBDH、LDH、CK以及CK‐MB项目外,末梢血可以替代静脉血在CelercareM1分析仪上进行常规生化项目的检测。     

日立7600生化分析仪交叉污染及防范措施的探讨

目的 研究日立7600生化分析仪使用中的交叉污染及其防范措施.方法 选用丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、镁(Mg)、钙(Ca)、磷(P)、淀粉酶(Amy)、肌酸激酶(CK)、总蛋白(TP)、清蛋白(Alb)、乳酸脱氢酶(LDH)、γ-谷氨酰转移酶(GGT)、肌酐(Crea)、尿酸(UA)、总胆红素(TB)、总胆固醇(TC)、甘油三酯(TG)、葡萄糖(Glu)共18个检测项目为观察对象,项目互相组合,观察不同的组合对检测结果的影响.对有影响的项目设定清洗程序,观察清洗后的效果.结果 Alb、Amy、CK、ALP对Mg;Ca、TB对P;TC对Ca;TP对CK的测定存在交叉污染,加设水清洗程序可以去除Alb对Mg、TP对CK的交叉污染;设定碱性清洗液清洗后可以去除其余的试剂交叉污染.结论 生化分析仪使用中存在交叉污染,检测项目间选择设置合适的清洗程序可以有效的避免交叉污染.     

日立7600生化分析仪交叉污染及防范措施的探讨

目的研究日立7600生化分析仪使用中的交叉污染及其防范措施。方法选用丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、镁(Mg)、钙(Ca)、磷(P)、淀粉酶(Amy)、肌酸激酶(CK)、总蛋白(TP)、清蛋白(Alb)、乳酸脱氢酶(LDH)、γ-谷氨酰转移酶(GGT)、肌酐(Crea)、尿酸(UA)、总胆红素(TB)、总胆固醇(TC)、甘油三酯(TG)、葡萄糖(Glu)共18个检测项目为观察对象,项目互相组合,观察不同的组合对检测结果的影响。对有影响的项目设定清洗程序,观察清洗后的效果。结果Alb、Amy、CK、ALP对Mg;Ca、TB对P;TC对Ca;TP对CK的测定存在交叉污染,加设水清洗程序可以去除Alb对Mg、TP对CK的交叉污染;设定碱性清洗液清洗后可以去除其余的试剂交叉污染。结论生化分析仪使用中存在交叉污染,检测项目间选择设置合适的清洗程序可以有效的避免交叉污染。     

全自动生化分析仪使用中项目交叉污染的观察

目的探讨HITACHI7180A全自动生化分析仪标本间交叉污染的情况及解决办法。方法选择测试项目，逐一配对测试，观察污染情况。结果确认乳酸脱氢酶（LDH）对无机磷（IP）、肌酸激酶（CK）对血清镁（Mg）、淀粉酶（AMY）对总钙（Ca）的测定有影响。结论通过设定HITACHI7180A全自动生化分析仪的项目测定顺序（通道号）和对干扰项目进行特殊清洗，基本降低了交叉污染，得到较理想的结果。     

血清Mg^2＋测定中的交叉污染及排除方法

目的了解全自动生化分析中血清Mg2 的交叉污染,探讨采取相应的方法加以排除。方法通过初步实验和确定试验分析对Mg2 的测定存在交叉污染的项目,应用仪器自带的清洗程序和合理安排仪器通道的方法加以排除。结果对Mg2 存在污染的项目有TG、GLU、TP、HDL、AKP、CK、CK-MB、CO2和AMY,通过清洗程序能明显减低AKP、CK以及CK-MB的干扰,通过合理安排仪器通道的方法能有效消除上述项目对Mg2 测定的影响。结论要充分重视交叉污染现象,在熟悉仪器和试剂性能的基础上可以采取相应的对策来加以排除。     

血清Mg2+测定中的交叉污染及排除方法

目的 了解全自动生化分析中血清Mg2+的交叉污染,探讨采取相应的方法加以排除.方法 通过初步实验和确定试验分析对Mg2+的测定存在交叉污染的项目,应用仪器自带的清洗程序和合理安排仪器通道的方法加以排除.结果 对Mg2+存在污染的项目有TG、GLU、TP、HDL、AKP、CK、CK-MB、CO2和AMY,通过清洗程序能明显减低AKP、CK以及CK-MB的干扰,通过合理安排仪器通道的方法能有效消除上述项目对Mg2+测定的影响.结论 要充分重视交叉污染现象,在熟悉仪器和试剂性能的基础上可以采取相应的对策来加以排除.     

迈瑞BS-300全自动生化分析仪的使用评价

[目的]评价迈瑞BS-300全自动生化分析仪的主要性能。[方法]按终点法、固定时间两点法和连续监测法选定7个项目[尿素（UREA）、总蛋白（TP）、白蛋白（ALB）、碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）、谷草转氨酶（AST）、谷丙转氨酶（ALT）。对迈瑞BS-300全自动生化分析仪进行精密度、准确度和交叉污染试验。[结果]交叉污染率在0％-1．639％，所测定指标的精密度和准确度，变异系数在0．54％～1．60％。[结论]BS-300全自动生化分析仪主要性能指标达到了国家标准，接近或达到国外同类产品要求，结果可靠，适合中小型医院使用。     

日立7600生化分析仪检测血清镁中的试剂交叉污染及其消除措施

目的研究日立7600生化分析仪检测血清镁中的试剂交叉污染及其消除措施。方法选用生化试剂中含有镁离子（Mg2＋）的总蛋白（TP）、碱性磷酸酶（ALP）、二氧化碳（CO2）、血糖（Glu）、淀粉酶（Amy）、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）10个项目作为污染观察对象,以质控血清为样本,分别研究这10个项目对Mg2＋检测中的试剂针、比色杯的交叉污染情况;对于Mg2＋检测的试剂针及比色杯交叉污染问题,分别采取设置其相应的清洗程序、分放不同模块检测,观察效果。结果对Mg2＋存在试剂针交叉污染的项目有CO2、Amy、TC 3个项目;对Mg2＋存在比色杯交叉污染的项目有CO2、Amy、TC、HDL-C、CK、CK-MB 6个项目,且试剂针污染程度不及比色杯污染严重。设置以去离子水作为清洗剂时的试剂针或比色杯清洗程序,或者上述施污染项目与Mg2＋分置于不同的模块上检测均可有效地消除其交叉污染。结论全自动生化仪测定血清Mg2＋中存在着试剂的交叉污染,可采取有效措施加以消除。     

OLYMPUS AU2700全自动生化分析仪携带污染检出及解决措施

目的:探讨OLYMPUS AU2700全自动生化分析仪标本检测时可能存在的携带污染及其处理措施.方法:收集健康正常人混合血清,对31项常用分析项目各测试10次,取其平均值作为对照值.其后对各项目按比色杯内外圈分成两组逐一配对检测,以超过对照值5％或3个标准差为标准筛选出疑似污染项目.最后对疑似污染项目进行确认,并制订相应措施避免携带污染.结果:除Ca外的所有项目重复性均较好,Ca的10次检测结果以高低值相间规律出现,经分析后发现低值组检测所使用的比色杯前一次均是检测TP所用,初步认定TP测定对Ca测定有比色杯携带污染,最后选用高值组的均值作为Ca的对照值.外圈组14项及内圈组17项测试项目逐一配对进行425项测试,其中有37项次结果超过对照值5％或3个标准差,判定为疑似污染.经过确认实验,认定7项次(1.89％)结果存在试剂针或搅拌棒携带污染.但TP测定并未对Ca测定有试剂针或搅拌棒携带污染,故再次确认存在比色杯携带污染.将TP和Ca分别设在内圈和外圈,并增设纯水清洗程序,有效消除了上述携带污染.结论:OLYMPUS AU2700全自动生化分析仪携带污染率较低,合理设置项目的比色杯内外国及增设纯水清洗程序可以消除携带污染.     

肌酸激酶及其同工酶试剂对三酰甘油自动分析的影响

目的研究对三酰甘油(TG)自动分析产生交叉污染的项目及避免交叉污染的方法。方法将疑似对TG测定有交叉污染的项目的试剂加入混合血清中作为实验管测定TG,并与加入同比例生理盐水的对照管相比较,初筛出对TG测定结果存在交叉污染的项目;先测定初筛实验中对TG测定存在交叉污染的项目CK和CK-M B,再连续测定TG 9次,观察自动分析顺序对TG测定结果的影响,同时观察CK和CK-M B试剂对TG测定结果影响的持续程度。结果CK和CK-M B试剂对TG测定结果存在明显的交叉污染;先测CK和CK-M B后测TG的分析顺序对TG的测定结果有明显影响,CK及CK-M B试剂对TG测定结果的影响均持续到第2管。结论CK和CK-M B试剂对TG测定结果存在明显的交叉污染。生化自动分析中应注意分析顺序对实验结果的影响。     

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.     

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.