酶偶联法测定肌酐与苦味酸法的比较

目的：评价肌酐酶－氧化酶偶联法测定肌酐（以下简称酶法）。方法：同时用ROCHE公司和LABO公司的两种酶法试剂盒测定肌酐并与苦味酸法进行比较。结果：LABO酶法测定肌酐的线性范围为25μmol/L-2210μmol/L，ROCHE为49μmol/L－4420μmol/L，苦味酸法为92μmol/L－520μmol/L。LABO试剂的批内CV＜0．54％，批间CV＜2．06％，回收率为95％；ROCHE试剂的批内CV＜0．88％，批间CV＜2．30％，回收率为99％；苦味酸法批内CV＜1．13％，批间CV＜3．23％，回收率为93％。溶血、黄疸对两种酶法测定肌酐的干扰率＜4％；抗坏血酸对苦味酸法产生正干扰，当其＞0．625g/L时，干扰率≥11．2％，抗坏血酸≥1．25g/L时，对ROCHE试剂测定结果的干扰率≥5．58％；药物头孢曲松钠≥1．00g/L时，对苦味酸法产生正干扰，干扰率≥7．11％，对其它两种试剂无干扰。结论：酶法测定肌酐优于苦味酸法，可作为临床常规测定方法。同时，临床实验室需根据自己的实际情况选择合适的酶法试剂盒。     

偶氮氯膦I测定血清钙

目的：建立灵敏度高、选择性好、试剂稳定的血清钙测定方法。方法：在pH9.6的2－氨基－2－甲基－1，3－丙二醇（AMP）缓冲介质中，以偶氮氯膦I作显色剂，8－羟基喹啉－5－磺酸为掩蔽剂，分光光度法测定血清钙。对反应条件和方法性能进行系统研究。结果：该方法显色络合物最大吸收波长为580nm，线性血清钙。对反应条件和方法性能进行系统研究。结果：该方法显色络 的最大吸收波长为580nm，线性范围达5．0mmol/L，回收率为98．8％－99．1％，平均99．0％。批内变异系数（CV）和批间变异系数（CV）分别为0．95％和1．74％。与邻甲酚酞络合酮（OCPC）（X1）比较：Y＝1．003X1－0．036，r=0.996;与偶氮肿Ⅲ（X2）比较：Y＝1.001X2-0.030,r=0.997；与酶速率（X3）法比较：Y＝0.999X3-0.045,r=0.998。在血清胆红素高达412μmol/L,血红蛋白7g/L，镁2．59mmol/L及Intralipid高达8g/L时均对该法无显著干扰。结论：该法具有简便、快速、试剂稳定和灵敏可靠的优点，适合血清钙的手工测定和自动分析。     

固蓝B单一试剂显色法测定血清总胆红素的探讨

用固蓝B、HCl、尿素已制单一试剂测定血清总胆红素。方法学评价结果：线性范围0～342．0μmol／L，批内CV1．52％，批间CV2．10％，回收率98．2％～102．9％，表观摩尔消光因数K630＝1．0007×105cm2／mol，Hb≤2．5g／L，NaN3≤2．0g／L基本不影响胆红素测定，与改良J－G法比较，γ＝0.999，Y（本法）＝0．99X＋0．15。     

尿素酰基裂解酶酶偶联法测定血清总钙

目的 介绍尿素酰基裂解酶酶偶联测定血清总钙的方法。方法 双试剂两点法；缓冲液为三乙醇胺（TEA，pH8.0,200mmol/L）；试剂I：含NaHCO326.0mmol/L,NADPH 0.4mmol/L,α－酮戊二酸8.0mmol/L，尿素酰基裂解酶115U／L，GLDH43．0kU/L；试剂Ⅱ：含NaCO3 26.0mmol/L,ATP6.2mmol/L。结果 方法线性范围为0．5－5．0mmol/L，批内和批间平均变异系数分别为2．13％和2．69％。平均回收率为102．7％ 。本法（Y）与邻甲酚酞络合酮法（OCPC法，X1）比较：r＝0．981，Y1＝1．02X1－0．021，与偶氮胂Ⅲ法（X2）比较：r＝0．978，Y＝0．99X2＋0．03。血清胆红素高达300μmol/L，血红蛋白4g/L，镁2.5mmol/L，NH4^ 2.0mmol/L,Trig 8.0mmol/L对本法无明显干扰。结论 本法具有简便、准确、快速，适用于自动分析等特点。     

用HBHBA作色原测定血浆游离血红蛋白

目的 测定血浆中游离血红蛋白。方法 用2，4，6－三溴－三羟基苯甲酸(HBHBA)做色原剂和4－AAP（4－氨基氨替吡啉）形成红色醌类物质，用比色法测定其浓度。结果 该法线性范围0－0.8g/L。重复性试验，低值血清批内CV＝2．8％，批间CV＝5％；高值批内CV＝1．7％，批间CV＝3．7％。平均回收率98．6％（96％－102％）。对照实验r=0.9860(Y=0.99x 0.2)。正常参考值0.013-0.073g/L。结论 所用试剂无毒性，不致癌，显色稳定，灵敏度高，重复性好，结果准确可靠，是一种理想的测定方法。     

尿液和脑脊液蛋白测定自动比浊法的评价

目的：评估和证实尿液和脑脊液蛋白测定自动比浊法的性能，方法：用罗氏公司的苯索氯铵试剂，以比浊法进行尿液和脑脊液蛋白测定，并对方法的检测限，病人结果可报告范围，精密度和准确度等作了实验观察，结果：方法的检测低限为0．04g/L，可定量报告的检测限为0．08g/L，病人结果可报告范围为0．08－2．0g/L，批内CV为1．5％，批间CV为2．2％，传统磺柳酸蛋白测定与之比较，二法间尿液Y1＝0．85X＋0．068，r=0.972,脑脊液Y2＝0．86X＋0．056，r=0.980。结论：本法简便，快速，准确且样本用量少（5－15ul)，适合临床实验室推广应用。     

人巨细胞病毒被膜磷蛋白pp65重组抗原酶联免疫吸附法的建立与两种方法的比较分析

目的用我们研制的一种新人巨细胞病毒(HCMV)重组被膜磷蛋白pp65为抗原，建立快速、简便和特异的检测HCMVIgM的间接酶联免疫吸附法(REC—EL．ISA)。方法用自行设计、表达的新的HCMV pp65重组抗原，建立REC—ELISA，并检测100份临床疑似为HCMV感染者血清中HCMV—IgM，同时与全病毒为抗原的间接ELISA法(简称全病毒一ELISA法)和美国BioCheck试剂盒(简称BioCheck法)检测结果进行比较。结果REC—ELISA法重组抗原最适量为3．5μg／孔，HRP标记二抗为1：800，血清稀释度为1：100；稳定性试验阳性变异系数(CV)为9．5％，重复性试验平均CV值：批内CV 4．5％，批间CV 9．6％。REC—ELISA法、全病毒-ELISA法和BioCheck法检测HCMV IgM的阳性率分别为44％、50％和45％；REC—ELISA法的敏感性为95．6％，其特异性(98．2％)高于全病毒-ELISA法(90．9％)；正确指数为92．8％，与BioCheck法一致性为97．0％。结论用pp65重组抗原建立的REC—ELISA法具有高度特异性与敏感性，且操作简单、快速，重复性好；与全病毒抗原相比，重组抗原可规模化、标准化生产，且更安全、经济，具有良好的临床应用前景。     

血清肌红蛋白比浊法测定试剂的评价及其初步临床应用

目的 通过评价肌红蛋白测定试剂的性能,建立一种用全自动生化分析仪检测肌红蛋白的免疫比浊法。 方法 利用标记抗体检测抗原的比浊法原理,进行精密度、线性、回收率、干扰试验。 结果 本法标准曲线y＝7．3635＋0．9739x,r＝0．9997。正常人血清肌红蛋白浓度的批内CV％为0．25％,批CV％为1．49％。心肌梗塞病者的则分别人1．3％与2．23％,回收率为97．1％～104．7％。血清TG＞5．0mmol／L或Hb＞500mg／L对肌红蛋白的检测才有干扰。测定100例健康体检者血清肌红蛋白（SMb）含量为20．7～58．9μg／L。33例急性心肌梗塞（AMI）患者的SMb的含量为542±178μg／L。 结论 该法具有快速、灵敏、简便、准确的优点,对AMI的诊断有较高的应用价值。     

人甲状腺球蛋白测定酶联免疫吸附试验方法的建立及应用

目的 建立一种简便、快速、灵敏、可靠的测定甲状腺球蛋白的酶联免疫吸附试验方法。方法 在纯化甲状腺球蛋白（TG）的基础上，制备出TG单克隆抗体，并用纯化的TG多抗包被，酶标记单克隆抗体，建立双抗体夹心ELISA。结果 经临床50例健康人测定，其范围在9－16μg/L。方法的批内变异为7．76％－9．69％，批间变异为12．3％－12．6％。检测低限为0．13μg/L，可定量报告低限为1．0μg/L。结论 人甲状腺球蛋白ELISA方法的建立为甲状腺疾病的检测提供了一种新的方法。     

EIA定量检测甲状腺球蛋白抗体和甲状腺微粒体抗体在临床中的应用

目的 探讨酶免疫法定量检测血清抗甲状腺球蛋白抗体（TG—Ab）和抗甲状腺微粒体抗体（TM—Ab）在临床应用价值。方法 采用酶免疫法（EtA）定量检测血清TG—Ab和TM—Ab．并对检测条件、干扰因素、精密度和准确度进行试验探讨。结果 EIA定量测定血清TG—Ab和TM—Ab分别在880IU／ml和665IU／ml以下线性良好．TG—Ab批内和批间CV分别为3．2％和7．1％，TM—Ab批内和批间CV分别为3．9％和7．6％。测得平均回收率为TG—Ab：92．4％、TM—Ab：101．2％．血清标本4℃存放一周内．对测定结果无影响。胆红素、血红蛋白在0．5g／L对测定无干扰．Hb浓度〉0．5g／L对TM-Ab产生正干扰．结论 EIA定量检测能较准确检测血清甲状腺自身抗体水平，操作简便．结果准确．符台临床常规使用要求．对自身免疫性甲状腺疾病的诊断、疗效观察及预后具有临床应用价值。     

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.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.