尿红细胞MCV和RDW检测对鉴别血尿来源的诊断价值

目的 利用SYSMEX XS-1000i血液分析仪对尿中的红细胞进行尿红细胞平均体积(MCV)及其分布宽度(RDW)的测定,评价鉴别血尿来源的诊断价值.方法 本文采用血球分析仪测定166例血尿患者尿红细胞平均体积(MCV)及其分布宽度(RDW),其中肾小球性血尿(G-HMT)69例,非肾小球性血尿(NG-HMT)97例.结果 G-HMT的MCV明显小于NG-HMT的MCV,以73fl为界,尿MCV≥73fl提示NG-HMT,＜73fl提示G-HMT,RDW间差异有统计学意义(P＜0.01),其诊断准确性高,是简单无创伤性的检查.结论 测定尿中红细胞MCV和RDW诊断血尿来源具有较高的临床诊断价值.     

尿红细胞形态检测三种方法的比较与分析

目的:为临床鉴别肾性血尿和非肾性血尿提供简便、准确、客观的检查方法.方法:用UF-100全自动尿沉渣分析仪、尿红细胞平均体积(MCV)测定和尿沉渣镜检3种方法分别对90例血尿患者进行尿红细胞形态检测,将三者结果进行分析比较.结果:UF-100对肾性血尿诊断符合率92.7%,非肾性血尿诊断符合率85.7%.MCV对肾性血尿诊断符合率98.2%,非肾性血尿诊断符合率94.2%.镜检对肾性血尿诊断符合率78.2%,非肾性血尿诊断符合率71.4%.结论:MCV和UF-100鉴别血尿来源具有客观、准确、重复性好的特点,有重要临床应用价值,尤以MCV测定准确性最佳,3种方法各有优缺点,联合应用能明显提高诊断的符合率.     

外周血和尿液红细胞平均体积差值在血尿定位诊断中的应用

目的探讨采用血、尿中红细胞平均体积差值(ΔMCV)鉴别肾性和非肾性血尿的诊断价值。方法采用BAY-120血细胞分析仪检测100例肾小球性疾病和非肾小球性疾病患者外周血和尿中ΔMCV,计算二者之间的差值,利用受试者工作曲线(ROC曲线)确定临界值;同时应用相差显微镜观察尿液异常红细胞情况。结果肾性与非肾性血尿患者自身血和尿中ΔMCV差异有统计学意义(P<0.01),ROC曲线下面积为0.978,以ΔMCV≥10fL鉴别肾性、非肾性血尿约登指数为0.82,敏感度为92%,特异性为90%。相差显微镜法的敏感度为94%,特异性为92%,两种方法诊断血尿来源差异无统计学意义(P>0.05)。结论采用血、尿中ΔMCV鉴别肾性和非肾性血尿具有较高的敏感度和特异性,可以作为筛查血尿来源较好的诊断指标。     

尿液有形成分分析仪的红细胞研究参数及其信息对血尿来源诊断的应用

目的探讨尿液有形成分分析仪的红细胞研究参数及红细胞信息(RBC-Info)在诊断血尿来源的应用价值。方法 295例血尿标本,其中130例为肾性血尿,165例为非肾性血尿,用sysmex UF-500i尿液有形成分分析仪进行红细胞研究参数测定,并将结果与人工镜检结果进行比较。结果肾性血尿组与非肾性血尿组对比,70%红细胞前向散射光(RBC-P70Fsc)分别为64.0ch(60.0～67.0)ch和117.0ch(113.0～119.0)ch,红细胞前向散射光分布宽度(RBC-Fsc-DW)分别为36.0ch(30.0～42.0)ch和18.0ch(16.0～24.0)ch,大红细胞(Large-RBC)与小红细胞(Small-RBC)之比分别为1.0∶4.4和25.0∶1.0,未溶解红细胞(Non-Lysed-RBC#)与溶解红细胞(Lysed-RBC)之比分别为1.9∶1.0和35.4∶1.0,未溶解红细胞百分率(Non-Lysed-RBC%)分别为66.0%(60.1%～76.5%)和97.7%(93.0%～99.2%),二者差异有统计学意义(P<0.01)。仪器RBC-Info提示与人工镜检的临床符合率:肾性血尿组分别为91.5%和81.5%,差异有统计学意义(P<0.01)、非肾性血尿标本分别为80.0%与86.1%,差异有统计学意义(P<0.05)。结论 Large-RBC与Small-RBC及Non-Lysed-RBC#与Lysed-RBC的比值是血尿来源有价值的参考指标。RBC-Info敏感性高、客观可靠、快速高效,是提示血尿来源的直观参考信息。     

尿沉渣检测分析仪联合血细胞分析仪在鉴别血尿来源中的应用

目的探讨尿沉渣检测分析仪和血细胞分析仪联合检测在鉴定肾小球性血尿和非肾小球性血尿中的应用价值。方法利用US-2020尿沉渣检测分析仪和血细胞分析仪对81例不同来源血尿标本进行检测。结果 42例肾小球性血尿中红细胞畸形率为(81.70±9.29)%,39例非肾小球性血尿中红细胞畸形率为(19.0±12.0)%,利用红细胞形态鉴别血尿来源敏感性71.4%,特异性94.8%,诊断符合率82.7%,血细胞分析仪测定肾源性和非肾性血尿中红细胞平均体积和红细胞体积分布宽度分别为(64.00±7.98)fL,(24.90±3.98)%和(89.00±11.89)fL,(14.90±2.45)%,二者差异有统计学意义(P0.05)。结论利用尿沉渣检测分析仪对尿中有形成分的测定和红细胞形态观察,利用血细胞分析仪测定尿红细胞相关参数等对血尿的诊断均有指导意义,二者联合应用提高了诊断符合率,可更加客观准确的鉴别血尿来源,为基层医院提供了很好的鉴别诊断策略。     

UF-1000i尿有形成分分析仪研究性参数在血尿来源鉴别中的应用

目的：探讨UF-1000i尿有形成分分析仪研究参数在鉴别肾性及非肾性血尿中的应用价值。方法回顾性分析血尿患者449例,其中肾性血尿患者259例,非肾性血尿患者190例。尿液标本用UF-1000i尿有形成分分析仪测定后记录各项参数测试结果,将红细胞研究性参数与患者临床诊断的符合情况进行统计分析。结果肾小球性血尿组与非肾小球性血尿组的RBC数值、RBC-P70Fsc、RBC-Fsc-DW、电导率及pH值等研究参数均存在明显差异,P〈0.01。两组数据的RBC-Info （红细胞形态信息）临床诊断符合率均较高,且非肾小球性血尿组的临床符合率随红细胞数量增多而升高,但肾小球性血尿组未有明显变化。结论 UF-1000i尿有形成分分析仪的研究参数对肾性及非肾性血尿的鉴别有较好的临床参考价值。     

尿红细胞形态和MCV在判断血尿来源中的应用价值

目的通过对尿中红细胞形态和红细胞平均体积(MCV)值的检查,帮助鉴别诊断肾性血尿和非肾性血尿。方法用Gen iuss-SEAC五分群血液分析仪和相差显微镜,检查肾性和非肾性患者血尿中的红细胞形态和MCV值。结果肾性和非肾性血尿中MCV值差异有统计学意义(P<0.05),肾性血尿中MCV值≤75 fL,畸形红细胞2种以上,畸形率≥75%。结论通过对尿中红细胞形态分析和MCV值测定,可协助肾性血尿和非肾性血尿的鉴别诊断。     

尿红细胞形态及平均体积在在血尿定位应用分析

目的探讨尿红细胞形态及尿红细胞平均体积(MCV)检查在判定血尿来源定位应用价值。方法选取100例血尿的标本作为考察对象,Sysmex XN-1000全自动血球分析仪检测尿红细胞平均体积(MCV),并用相差显微镜检查尿红细胞形态学,观察和分析肾小球性血尿组(glomerular hematuria,GH)和非肾小球血尿组(non glomerular hematuria,NGH)尿红细胞形态及尿红细胞平均体积的差异。结果肾小球性血尿(GH)组尿MCV值(63.71±6.03)fl明显低于非肾小球性血尿(NGH)组MCV值(92.37±12.11)fl(P0.05)且尿MCV不高于72.0fl,变形红细胞80%呈多形型。结论尿中红细胞形态及红细胞平均体积特征分析可作为血尿定位诊断和鉴别诊断的方法之一,有助于判断血尿的来源提供临床参考依据。     

血MCV与尿MCV比值在血尿来源鉴别中的应用

目的探讨血红细胞平均体积(MCV)与尿MCV比值在血尿来源鉴别中的应用价值。方法用血细胞分析仪同时检测62例肾性血尿组及50例非肾性血尿组患者尿MCV及血MCV,分析两组患者血MCV与尿MCV比值。结果肾性血尿组与非肾性血尿组间患者血MCV与尿MCV比值经t检验差异有统计学意义,经ROC曲线分析在比值大于或等于1.25时其灵敏度为93.5%、特异性为98.5%、准确性95.5%,有较高的的诊断效率。结论使用血MCV与尿MCV比值来鉴别血尿来源方便、简单、可靠,适于推广应用。     

相差显微镜及尿沉渣分析仪鉴别血尿来源分析

目的 利用相差显微镜及尿沉渣分析仪鉴别血尿来源.方法 采用相差显微镜计算尿异形红细胞率,结合尿沉渣分析仪对临床确诊的103例血尿患者进行尿液分析.结果 相差显微镜下异形红细胞率及尿流式细胞技术分析RBC-P70Fsc,肾性血尿与非肾性血尿结果 差异显著;以异形红细胞率≥75%为cutoff值好.结论 利用相差显微镜及尿沉渣分析仪可鉴别血尿来源.     

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.     

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.