尿肺炎链球菌抗原检测在儿童肺炎链球菌肺炎诊断中的临床意义

目的：探讨尿肺炎链球菌抗原检测在肺炎链球菌肺炎诊断中的临床意义。方法随机选择下呼吸道感染患儿300例,同时采集患儿痰标本、血标本、尿标本,对痰、血标本进行病原菌培养、鉴定,采用胶体金法检测尿肺炎链球菌抗原。结果300例患儿中,痰培养、血培养和尿肺炎链球菌抗原检测阳性率分别为10．33％（31/300）、15．67％（47/300）和19．33％（58/300）,尿肺炎链球菌抗原检测阳性率高于其他两种方法,血培养检测阳性率高于痰培养（P＜0．05）;尿肺炎球链菌抗原检测诊断肺炎链球菌肺炎的灵敏度和特异度分别为82．98％（39/47）和92．49％（234/253）。结论尿肺炎链球菌抗原检测可作为儿童肺炎链球菌肺炎的辅助诊断依据。     

尿肺炎链球菌、白细胞计数和C反应蛋白联合检测在儿童下呼吸道感染中的诊断价值

目的探讨尿肺炎链球菌检测对儿童下呼吸道感染快速诊断的临床意义。方法收集2014年9~10月在江苏省妇幼保健院的住院患儿66例,采集尿液标本用于检测尿中肺炎链球菌抗原,同时进行血液分析和C反应蛋白(CRP)检测。结果66例患儿中,尿肺炎链球菌检测、白细胞计数(WBC)和CRP的阳性率分别为4.55%、25.76%和54.55%;而对于明确的肺炎链球菌感染者,三者的阳性率类似,均达75.00%以上。结论尿肺炎链球菌快速检测技术联合WBC和CRP检测,有助于临床医生辅助快速诊断链球菌感染。     

呼吸系统感染性疾病快速诊断技术的应用

目的为临床提供快速准确的呼吸道常见感染性疾病病因诊断依据，以便尽快诊断、正确治疗、预防传播，协助临床排除SARS(严重急性呼吸综合征)及禽流感诊断。方法用酶免疫方法对呼吸道感染病人鼻咽喉分泌物、血清及尿液标本进行检测，得到A群链球菌抗原、流感病毒A型和B型抗原、呼吸道合胞病毒抗原、肺炎支原体抗体IgM、嗜肺军团菌I型抗原的定性结果。每项试验操作简单并可在30min内完成。结果一年半时间共检测来自879位病人的1152份标本，阳性结果共124个，总感染率为14．1％。A群链球菌抗原检测标本446份，阳性率为11．9％；流感病毒A型和B型抗原266份，阳性率为11．7％；呼吸道合胞病毒抗原116份，阳性率为21．6%；肺炎支原体抗体227份，阳性率为5．3％、嗜肺军团菌1型抗原97份，阳性率为3．1％。SARS流行期间这五种病原体的感染率为20．2％，阳性结果中未发现一例SARS病人。SARS流行前一年多的时间里所检测病原体感染率仅为12．0%。结论采用酶免疫法检测呼吸道病原体，结果快速可靠，为临床提供了早期诊断和正确治疗的依据，可以尽早有效地排除SARS诊断，并减少抗生素滥用现象。     

间接免疫荧光法检测肺炎支原体 IgM 的临床意义

目的：探讨肺炎支原体（MP）抗体（MP-IgM）检测在诊断呼吸道感染中的临床价值。方法采用间接免疫荧光法检测1924例呼吸道感染患者血清肺炎支原体 IgM。结果1924例患者中共检出阳性617例,阳性率32．07％,男女患者阳性率分别为26．67％和39．56％,男女阳性率差异有统计学意义（P ＜0．001）。夏季检出阳性率最高,为45．00％,春夏两季的阳性率显著高于秋冬两季。儿童组的阳性率高于成人组（P ＜0．001）。结论呼吸道感染患者中 MP 感染率较高;MP-IgM 检测有利于呼吸道感染患者的早期诊断,为临床合理用药提供帮助,避免抗生素的滥用。     

不规则管型的形态观察与临床意义

目的 检测尿沉渣涂片中的一种特殊病理管型,将其命名为不规则管型（irregular cast）,对其在不同疾病中的阳性率进行分析研究,探讨其在泌尿系感染中的诊断意义。方法 观察564例泌尿系疾病患者的尿沉渣涂片中不规则管型检出率,并通过荧光染色与瑞-姬染色方法 对管型的类别进行判定,同时对中层移行上皮、表层移行上皮、白细胞等成分阳性率作对照比较。结果 不规则管型在上泌尿系感染患者尿液中易见,特别是有1年以上感染史的患者。急性肾盂肾炎患者尿液中阳性率为63．4％,慢性肾盂肾炎患者尿液中阳性率为83．3％,肾结石患者尿液中不规则管型阳性率为8．1％,肾小球肾炎患者尿液中不规则管型阳性率为5．8％,膀胱炎、尿道炎、前列腺炎、肾囊肿患者尿液中未见。急性肾盂肾炎和慢性肾盂肾炎患者尿液中不规则管型阳性率与其他各类患者比较,差异有统计学意义（P〈0．05）。结论 不规则管型是一种特殊类型的管型,在形态上比中层移行上皮细胞更易识别,对上泌尿系感染有重要诊断意义,同时对感染性肾脏损伤有重要的临床作用。     

小儿肺炎1224例肺炎支原体抗体检测结果分析

目的探讨小儿肺炎支原体感染情况。方法采用日本富士瑞必欧株式会社肺炎支原体抗体检测试剂盒（被动凝集法）检测,回顾分析2008年6月至2008牟12月小儿血清肺炎支原体抗体检测结果。结果受检人数1224例,肺炎支原体抗体阳性率52．21％。各年龄组肺炎支原体抗体阳性率有显著性差异,6—14岁学龄期儿童肺炎支原体抗体阳性率高达65．05％。男性肺炎支原体阳性率48．14％;女性肺炎支原体阳性率58．15％,女性小儿感染肺炎支原体明显高于男性小儿（P〈0．01）。结论建议临床医师肺炎支原体感染率较高,学龄期儿童为好发年龄,女性小儿感染肺炎支原体明显高于男性小儿。对呼吸道感染的患者小儿呼吸道感染患者中进行肺炎支原体抗体测定,为临床诊断和治疗提供依据。     

尿抗原检测联合痰革兰染色诊断儿童肺炎链球菌肺炎

目的探讨尿肺炎链球菌抗原检测联合痰革兰染色诊断儿童肺炎链球菌肺炎的临床价值。方法选择2016年9月—2016年12月在我院住院的儿童肺炎链球菌肺炎427例,采集患儿的尿液及痰液标本,以痰培养作为肺炎链球菌肺炎诊断的金标准,对尿肺炎链球菌抗原检测和痰革兰染色镜检进行诊断性功能评价。结果本研究痰培养检出肺炎链球菌119例(27.9%),痰革兰染色镜检阳性168例(39.3%),尿肺炎链球菌抗原阳性112例(26.2%),且痰革兰染色镜检检出率与痰培养肺炎链球菌检出率差异有统计学意义(P0.001)。尿肺炎链球菌抗原检测与痰革兰染色镜检诊断儿童肺炎链球菌肺炎的敏感性分别为73.1%、86.5%,特异性分别为91.9%、78.9%,两种方法并联使用的敏感性与特异性分别为96.6%、72.4%,串联使用的敏感性与特异性分别为63.0%、98.1%。结论尿肺炎链球菌抗原检测与痰革兰染色镜检并联诊断的敏感性高,适合门诊患者的筛查,而上述检测方法串联特异性高,适合住院患者确诊。     

抗DNA酶B在小儿A型溶血性琏球菌感染中的诊断意义

目的：探讨抗脱氧核糖核酸酶B（抗DNA酶B）在小儿A型溶血性链球菌感染所致疾病中的诊断价值。方法：用抗DNA酶B微量法，测定126例A型溶血性链球菌感染所致疾病的小儿血清抗DNA酶B抗体，同时检测抗甸球菌溶血素O（ASO)，对两种检测方法的阳性率进行比较。结果：肾炎皮损组、咽炎痊愈及肾炎恢复组抗DNA酶B阳性率100％。0及63．3％，显示高于ASO阳性率20．0％及23．3％，两者联合检测阳性率均在70．0％以上；不典型风湿热组，肾炎上感组及咽炎组抗DNA酶B阳性率分别为100．0％、87．5％和62．0％，虽和ASO（80．0％、50．0％和72．0％）无显著性差异（P＞0．05），但两者联合检测阳性率可达100％及84．0％，提示抗DNA酶B对急性肾小球肾炎诊断有重要的临床价值。结论：ASO联合抗DNA联合抗DNA酶B检测可提高A型溶血性链球菌感染的检出率。     

慢性阻塞性肺疾病急性加重期病原学分析

目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者感染病原菌分布情况,为提高临床诊治水平提供依据。方法回顾性收集2013年6月至2014年6月在南海医院就诊并收治入院的AECOPD患者200例,其中男124例、女76例,对患者的血培养、痰培养和血清学检测结果进行分析。结果病原体检出率为68.0%(136/200),其中血培养阳性率为3.5%(7/200),以大肠埃希菌、肺炎链球菌检出为主;痰培养阳性率为37.5%(75/200),以铜绿假单胞菌、大肠埃希菌、肺炎链球菌检出为主;尿液肺炎链球菌抗原阳性率为2.5%(5/200);非典型病原体阳性率为7.5%(15/200),以肺炎支原体检出为主;呼吸道病毒血清检查阳性率17.0%(34/200),主要是乙型流感病毒和副流感病毒。结论该地区AECOPD患者感染病原体主要以革兰阴性杆菌为主,其次为病毒感染。     

检测痰中抗原快速诊断肺炎链球菌性肺炎

[目的]探索肺炎链球菌性肺炎的快速诊断法。[方法]应用Binax NOW^TM快速检测卡，从液化痰中快速检出肺炎链球菌抗原。[结果]此法较细菌培养法的阳性率明显提高。[结论]肺炎链球菌可溶性抗原检出法可快速诊断肺炎链球菌感染。     

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.     

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.