尿液干化学隐血与沉渣镜检红细胞结果分析

目的探讨分析尿液干化学隐血与沉渣镜检红细胞检测结果,为临床提高尿液检查准确率提供可靠依据,使患者病情得到及时确诊并给予积极治疗,保障患者预后及生命安全。方法该次100份尿液样本干化学隐血及沉渣镜检红细胞均由同一名具有专业知识及丰富经验的临床检验医师完成,记录检测结果,给予统计学分析,得出结论。结果尿液干化学隐血与沉渣镜检红细胞检测结果中,阴性符合率最高,为96．49％;微量符合率次之,为76．32％;阳性符合率最差,为31．25％。结论临床应对尿液干化学隐血及沉渣镜检红细胞检测结果为阳性患者进行多种实验室检测,从而确保检测结果准确可靠,尽快确诊患者病情。使其得到及时有效的治疗措施。提高患者治疗效果及预后。     

不同检测系统对总蛋白和白蛋白测定结果的偏倚评估

目的通过方法学比较和偏倚评估探讨不同检测系统对总蛋白（TP）和白蛋白（Alb）的检测结果是否具有可比性。方法根据EP-9A文件，取朗道水平2和水平3质控物以及54份不同浓度的患者新鲜血清，在3个不同的生化检测系统（系统1：日立7170生化分析仪，Roche试剂、C．f．a．s校准品和质控品；系统2：岛津CL7200生化分析仪，中生试剂、校准品，德灵质控品；系统3：日立7170生化分析仪，中生试剂、校准品，朗道质控品）上检测TP和Alb，并对数据进行统计学分析。以美国临床实验室修正法规（CLIA＇88）规定的室间质量评价允许误差范围的1／2为临床接受范围，判断不同检测系统的可比性。结果朗道质控物和新鲜血清标本中TP和Alb测定结果经随机区组设计资料的方差分析，各检测系统间的总体差异均有统计学意义（P〈0．001）。各检测系统新鲜血清标本中TP和Alb测定结果的可靠性系数α分别为0．997、0．998，各系统间的相关系数均大于0．975。各检测系统测定TP和Alb的批间精密度变异系数均小于3％，以可溯源的检测系统1为目标检测系统，TP和Alb测定结果的误差率系统2超过而系统3未超过CLIA＇88允许范围的1／2。结论3个检测系统测定TP和Alb的精密度均符合临床要求，临床接受性能评价结果显示，系统3具有可比性而系统2不具有可比性。实验室应经常进行同一项目不同检测系统间的偏倚评估，若检测结果临床不接受需采取整改措施，保证结果的可比性。     

广西医疗机构检验结果互认项目质量分析

目的对广西互认检验项目的质量情况进行分析,为推进医院间检验结果互认工作提供研究基础。方法分析2011年、2012年广西二级以上医疗机构临床化学、全血细胞计数、临床免疫学、尿液化学分析的34个互认项目室间质量评价结果,了解各项目的合格率,分析其可比性。结果（1）三级医院实验室大部分项目合格率较高,实行检验结果互认有较好的质量基础;（2）二级医院实验室各项目合格率总体上低于三级医院,其中钙离子2011年、2012年合格率分别为78．10％和74．39％,肌酐分别为75．61％和86．72％,尿液化学分析pH分别为79．28％和83．2％,HBeAb分别为65．16％和87．75％,HBcAb 分别为77．87％和86．96％。结论广西三级医院实验室互认检验项目质量较好,二级医院实验室部分项目检验质量尚需进一步提高;各实验室需通过规范开展室内质控、参加室内质控数据的实验室间比对和室间质量评价,不断提高检验质量,实现实验室间检验结果的可比互认。     

武汉地区医疗单位尿液干化学检测结果分析

目的调查不同厂家尿液分析仪器之间的差异,尽快制定出干化学法尿液分析的系统标准和行之有效的质量控制措施。方法用上海伊华出产的尿液质控品对武汉地区61家医疗单位的尿液分析仪进行室间质量评价。多台尿液分析仪按仪器所要求的方法进行检测。结果室间可比性差,存在着明显的系统误差和偶然误差。除技术因素外,仪器性能不一致和试纸带设计原理、质量、灵敏度不同是引起误差的主要原因。结论实验室之间检测结果差异过大的现象,不容忽视。建议国内有关部门尽快研制出尿液化学成分的定量质控品(含临界值的质控品),以便随时监测仪器的性能和试纸带的质量。     

尿液分析仪法与尿沉渣镜检法检测尿红、白细胞的分析与探讨

目的：通过对尿液中红、白细胞进行尿液分析仪法和尿沉渣镜检法两种方法的检测与分析,探讨尿液分析的最佳方法。方法：抽取笔者所在医院门诊和住院患者1500份尿液标本,同时进行尿液分析仪法和尿沉渣镜检法进行分析比较其结果。结果：尿液分析仪法和尿沉渣镜检法检测白细胞均阳性占25．7％,均阴性占63％,二者符合率为88．7％,尿液分析仪阳性而尿沉渣镜检法阴性的占3％,尿液分析依法阴性而尿沉渣镜检法阳性的占8．3％,二者不符合率为11．3％。尿液分析仪法和尿沉渣镜检法检测红细胞均阳性的占27．7％,均阴性占57．3％,二者符合率为85％,尿液分析仪法阳性而尿沉渣镜检法阴性占10％,尿液分析依法阴性而尿沉渣镜检法阳性占5％,二者不符合率为15％。结论：尿液分析检查中必须将尿液分析仪法和尿沉渣镜检法结合起来才能为临床提供更准确的检验结果。     

浅谈血尿的检验方法与诊断标准之间的关系

目的:探讨分析血尿的检验方法与诊断标准之间的关系,旨在为提高临床诊断的准确率提供可靠的理论依据.方法:选取2009年8月～2012年8月间我院收治的需要接受血尿检查的患者865例作为研究对象,分别采用干化学尿液分析仪检验法、UF-100流式尿沉渣分析仪检验法及光学显微镜离心沉渣镜检法对其尿液标本进行检验,并将检验结果及患者的临床资料进行回顾性的分析.结果:经统计,应用UF-100流式尿沉渣分析仪检验法对尿液标本进行检验的血尿检出率为57.57％,用干化学尿液分析仪检验法对尿液标本进行检验的血尿检出率为35.49％,用光学显微镜离心沉渣镜检法对尿液标本进行检验的血尿检出率为39.65％.UF-100流式尿沉渣分析仪检验法与光学显微镜离心沉渣镜检法对同一标本的检验结果符合率为80.69％,用UF-100流式尿沉渣分析仪检验法与干化学尿液分析仪检验法对同一标本进行检测结果的符合率为71.21％,用光学显微镜离心沉渣镜检法与干化学尿液分析仪检验法对同一标本进行检测结果的符合率为75.49％°结论:光学显微镜离心沉渣镜检法是检查尿液有形成分的金标准.将上述3种检验方法结合起来对尿液进行尿检,能有效提高血尿检验的准确率.     

女性尿液白细胞干化学法与沉渣镜检检测结果比较分析

随着尿液分析仪的普遍使用,尿液干化学分析已成为医院的常规尿检项目。但在女性尿液分析时,作者发现干化学法与沉渣镜检白细胞结果有一定差异。所以女性尿液检查时干化学检查只作为筛查,对干化学分析阳性的标准,必须沉渣镜检。因此,显微镜检查仍是尿液有形成分检测的金标准。     

尿干化学分析仪测定与显微镜镜检结果分析

目的:通过比较尿液干化学分析与显微镜镜检两种方法的检测结果,联系临床合理解析实验结果。方法:运用干化学分析法和沉渣镜检测定患者尿液白细胞、尿血红蛋白、红细胞,对两种方法的检测结果进行分析比较。结果:实验数据显示化学法分析结果与镜检结果有不相符的情形存在,两者阴、阳性结果间有交叉现象。结论:尿干化学法检查与沉渣镜检法的联合使用能提高临床应用价值。     

尿干化学法与镜检尿沉渣对比分析

目的：探讨用两种显微镜检查法与干化学试纸条检测尿中有形成分的应用价值。方法：按MCCLS GP-16A（（尿沉渣检查标准化的建议》要求收集926份临床尿液标本，分别用尿液沉渣镜检离心法、过筛法与干化学试纸条进行分析。结果：两种镜检法与干化学法检出红细胞阳性符合率83．82％～84．08％，阴性符合率76．76％～78．62％，白细胞阳性符合率62．72％～63．47％，阴性符合率93．46％～95．51％。结论：干化学试纸法不能替代镜检法检测尿中的有形成分。     

不同检测系统钙、磷、镁测定结果的偏倚评估

目的 探讨不同检测系统钙、磷、镁测定结果的可比性。方法 根据EP-9A文件，取朗道水平2和水平3质控物。以及41例不同浓度的患者新鲜血清，在3个不同的生化检测系统（检测系统：日立7170A生化分析仪、Roche校准物、试剂及质控品；捡测系统：强生Vitros250干式生化分析仪及其配套的校准物、试剂，德灵质控品；检测系统：日立7170A生化分析仪、Randox校准物、试剂及质控品）上进行钙、磷、镁检测，并对数据进行相关的统计学分析。以美国临床实验室修正法规（CLIA＇88）或澳大利亚室间质量评价标准规定的室间质量评价允许误差范围的1／2为临床接受范围。判断不同检测系统的可比性。结果朗道质控物和新鲜血清标本钙、磷、镁测定结果经随机区组设计资料的方差分析，除检测系统Ⅲ的磷、镁外，其余各检测系统测定结果差异均有显著性（P〈0．001）。各检测系统新鲜血清标本钙、磷、镁测定可靠性系数α分别为0．9928、0．9908、0．9277，各系统间的相关系数均〉0．975。各检测系统测定钙、磷的批间精密度变异系数均〈5％，镁的批间精密度变异系数均〈8．3％，以可溯源的检测系统Ⅰ为目标检测系统，钙、磷、镁均有超过CLIA88允许范围1／2的待评捡测系统。结论检测系统2与目标检测系统间有明显偏倚，主要与方法学差异有关。实验室应经常进行同一项目不同检测系统间的偏倚评估，判断临床接受性能，采取整改措施，保证结果的可比性。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.