快速检测甲胎蛋白的半定量金免疫渗滤法的研究

目的 建立一种伴有质控点的金免疫渗滤法(GIFA),用于半定量检测血清甲胎蛋白(AFP).方法 应用2株抗AFP单克隆抗体,其中一株包被在固相膜上,另一株与胶体金结合,组成金免疫渗滤试剂.膜上另包被2种浓度的AFP,用于测定时的定量质控.结果 本法经AFP标准液测定,结果 判定可分为＜30、30～200、＞200 μg/L 3个半定量区;119例经化学发光免疫分析系统定量测定AFP浓度的临床血清标本用于本法的对比测定,结果 符合性良好.结论 本法具有半定量和内质控的特点,结果可靠,适用于原发性肝细胞癌的早期诊断,方法 简便、快速,特别适合中、小医院和门诊部使用.     

快速检测尿微量白蛋白的半定量金免疫渗滤法的研究

目的建立一种伴有质控点的金免疫渗滤法,用于半定量检测人尿中的微量白蛋白.方法应用自制的2株抗人白蛋白单克隆抗体,其中一株包被在固相膜上,另一株与胶体金结合,组成金免疫渗滤试剂.膜上另包被2种浓度的人白蛋白,用于测定时的定量质控.结果本法经人白蛋白标准液测定,结果判定可分为<30、30～100、100～200、>200 mg/L 4个半定量区;126例经散射免疫浊度定量测定白蛋白浓度的临床尿标本用于本法的对比测定,结果符合性良好.结论本法具有半定量和质控的特点,结果可靠,适用于糖尿病、高血压等并发肾病的早期诊断,方法简便、快速,特别适合中、小医院和门诊部使用.     

快速检测尿微量白蛋白的半定量金免疫渗滤法的研究

目的　建立一种伴有质控点的金免疫渗滤法 ,用于半定量检测人尿中的微量白蛋白。方法　应用自制的 2株抗人白蛋白单克隆抗体 ,其中一株包被在固相膜上 ,另一株与胶体金结合 ,组成金免疫渗滤试剂。膜上另包被 2种浓度的人白蛋白 ,用于测定时的定量质控。结果　本法经人白蛋白标准液测定 ,结果判定可分为 <30、30～ 10 0、10 0～ 2 0 0、>2 0 0mg/L 4个半定量区 ;12 6例经散射免疫浊度定量测定白蛋白浓度的临床尿标本用于本法的对比测定 ,结果符合性良好。结论　本法具有半定量和质控的特点 ,结果可靠 ,适用于糖尿病、高血压等并发肾病的早期诊断 ,方法简便、快速 ,特别适合中、小医院和门诊部使用。     

快速检测血清HCG的半定量金免疫渗滤法的建立

目的建立一种伴有质控点的金免疫渗滤法（GIFA），用于半定量检测血清人绒毛膜促性腺激素（HCG）。方法应用2株抗HCG单克隆抗体，其中一株包被在固相膜上，另一株与胶体金结合，组成金免疫渗滤试剂。膜上另包被2种浓度的HCG，用于测定时的定量质控。结果该方法经HCG标准液测定，结果判定可分为〈50、50-300、〉300 IU／L3个半定量区；94例经化学发光免疫分析系统定量测定HCG浓度的临床血清标本用于本法的比对测定，结果符合性良好。结论该方法具有半定量和内质控的特点，结果可靠，适用于妊娠的早期诊断，方法简便、快速，特别适合中、小医院和门诊部使用。     

检测肌红蛋白的半定量金免疫层析法的研究

目的建立一种半定量检测人血清肌红蛋白的金免疫层析方法,用于急性心肌梗死的快速检测。方法一株抗人肌红蛋白单克隆抗体标记胶体金,另一株抗人肌红蛋白单克隆抗体包被膜作为检测线,兔抗鼠IgG抗体包被膜作为对照线,建立半定量金免疫层析测定方法。结果本法测定结果分为3个半定量判定区段：〈70、70-150和〉150μg/L;与化学发光免疫测定对照检测83份血清标本,符合性良好。结论金免疫层析测定法具有半定量的特点,方法简便、快速、准确,适用于急性心肌梗死的早期检测。     

尿微量白蛋白半定量金免疫层析试条的研制和临床评价

目的建立一种半定量检测人尿液中的微量白蛋白(mA lb)的金免疫层析方法。方法应用一株抗人白蛋白单克隆抗体与胶体金结合,组成胶体金结合物试剂;白蛋白包被在硝酸纤维素膜上,而制成竞争法的试剂条,同时用一定浓度的羊抗鼠IgG抗体作为参比线。结果该法经人白蛋白标准液测定,结果判定可分为<20、20~50、50~200和>200 mg/L 4个半定量区段;137例经散射免疫浊度法定量测定白蛋白浓度的临床尿标本用于该法的对比测定,结果符合性良好。结论该法具有半定量的特点,结果可靠,适用于糖尿病、高血压等并发肾病的早期诊断。方法简便、快速,特别适合中、小医院和门诊部使用。     

联合检测甲胎蛋白和癌胚抗原的胶体金免疫层析试剂的研制及性能评价

目的 建立一种新型的联合检测甲胎蛋白(AFP)和癌胚抗原(CEA)的胶体金免疫层析法(GICA).方法 G4和C2为一对抗AFP单克隆抗体(McAb),A1和C9为另一对抗CEA McAb,G4和A1分别以直线形式平行包被于固相硝酸纤维素(NC)膜上,C2和C9分别与胶体金结合后固定于结合物垫,制备成GICA试剂条.膜上另包被2 mg/mL兔抗鼠IgG抗体,用于检测有效性.结果 利用双抗体夹心原理,建立了可同时检测血清中AFP和CEA的GICA.本法经AFP和CEA标准液测定,试剂的敏感性为AFP (30 μg/L)、CEA (10 μg/L),与血红蛋白、人白蛋白、人球蛋白等无交叉反应,稳定性试验表明试剂可以在室温保存6个月以上.86份经化学发光免疫分析仪定量测定AFP、CEA浓度的临床血清标本用于本法的对比测定,符合性良好.结论 联合检测AFP和CEA的GICA试剂具有结果 可靠、方法 简便、快速等优点,与化学发光法测定结果 符合性良好.     

尿微量白蛋白半定量金免疫层析试条的研制和临床评价

目的 建立一种半定量检测人尿液中的微量白蛋白（mAlb）的金免疫层析方法。方法 应用一株抗人白蛋白单克隆抗体与胶体金结合，组成胶体金结合物试剂；白蛋白包被在硝酸纤维素膜上，而制成竞争法的试剂条，同时用一定浓度的羊抗鼠IgG抗体作为参比线。结果 该法经人白蛋白标准液测定，结果判定可分为〈20、20-50、50-200和〉200mg／L4个半定量区段；137例经散射免疫浊度法定量测定白蛋白浓度的临床尿标本用于该法的对比测定，结果符合性良好。结论 该法具有半定量的特点，结果可靠，适用于糖尿病、高血压等并发肾病的早期诊断。方法简便、快速，特别适合中、小医院和门诊部使用。     

检测粪便隐血的金免疫渗滤法的初步研究

目的建立以人白蛋白为靶抗原的检测人粪便隐血的金免疫渗滤法试剂,并作临床初步应用。方法应用自制的2株抗人白蛋白单克隆抗体,其中1株包被在硝酸纤维素膜上,另1株与胶体金结合,组成金免疫渗滤试剂,并用研制的试剂与商品化便隐血免疫层析法试剂对比检测69例临床粪便标本。结果本研究建立的方法检测范围为10～10 000 mg/L,与免疫层析法试剂条临床比对结果显示,69例标本中除1例本法为(+),而免疫层析法为(-)外,其余全部符合。结论本研究研制的金免疫渗滤法粪便隐血试验方法简便、结果可靠,进一步研究后可应用于临床。     

检测粪便隐血的金免疫渗滤法的初步研究

目的建立以人白蛋白为靶抗原的检测人粪便隐血的金免疫渗滤法试剂,并作临床初步应用。方法应用自制的2株抗人白蛋白单克隆抗体,其中1株包被在硝酸纤维素膜上,另1株与胶体金结合,组成金免疫渗滤试剂,并用研制的试剂与商品化便隐血免疫层析法试剂对比检测69例临床粪便标本。结果本研究建立的方法检测范围为10～10 000 mg/L,与免疫层析法试剂条临床比对结果显示,69例标本中除1例本法为（＋）,而免疫层析法为（-）外,其余全部符合。结论本研究研制的金免疫渗滤法粪便隐血试验方法简便、结果可靠,进一步研究后可应用于临床。     

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.     

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.     

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.     

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.