流式细胞仪计数网织红细胞方法评价

目的建立流式细胞仪计数网织红细胞的方法并应用于临床.方法 5 μl全血加入噻唑橙(TO)染色液中,流式细胞仪计数10万个红细胞,分析其中的网织红细胞百分数(Ret%),并与手工法进行比较.结果流式细胞仪法与手工法计数网织红细胞结果差异无显著性,该法批内变异系数(CV)<3.23%,批间CV<4.86%.结论流式细胞仪计数网织红细胞快速、客观、结果准确、重复性好,适合临床常规检测网织红细胞.     

流式细胞仪与镜检法计数网织红细胞的比较

目的建立流式细胞仪计数网织红细胞的方法并应用于临床。方法5ul全血加入噻唑橙染液中，流式细胞仪计数10万个红细胞，分析其中的网织红细胞数并与镜检法比较。结果流式细胞仪法与镜检法计数网织红细胞结果差异无显著性。结论流式细胞仪计数网织红细胞快速．结果准确．且重复性好，适合临床常规检测网织红细胞。     

流式细胞仪检测网织红细胞及抗凝血不同时间的网织红细胞计数

目的 评价流式细胞仪（FCM）检测网织红细胞与人工显微镜法计数差异;抗凝血不同时间的网织红细胞计数与非抗凝血活体染色网织红细胞计数差异。方法 采集34例健康体检者和32例贫血患者标本,分别进行FCM法和人工法计数网织红细胞;采集55例健康体检者抗凝血标本分别在即时、1h、2h、3h、4h不同时间网织红细胞计数,并与非抗凝血活体染色网织红细胞计数比较。结果 FCM法与手工法网织红细胞计数,两者比较无显著差异,P＞0．05,正常组r=0.93,贫血组r=0.94;抗凝血不同时间与非抗凝血网织红细胞计数,两者比较无显著差异,P＞0．05,r=0.95。结论 FCM测定网织红细胞是一种快速、准确的方法;抗凝血网织红细胞计数可以替代非抗凝血活体染色网织红细胞计数。     

高白细胞标本对仪器法网织红细胞计数的干扰

目的观察高白细胞标本对仪器法网织红细胞计数(%)及未成熟网织红细胞组份计数(IRF%)测定的干扰。方法使用血液分析仪对30例高白细胞标本(300×109/L)进行网织红细胞计数,然后以稀释液对标本进行不同浓度的稀释后再进行网织红细胞计数,同时将不同浓度标本进行手工法网织红细胞计数。结果 30例标本中有11例标本仪器网织红细胞计数结果及未成熟网织红细胞组份计数结果与手工法结果相比偏高,在稀释到一定浓度(100×109/L左右或更低)后网织红细胞浓度与未成熟网织红细胞组份比例明显下降,计数结果与手工法结果相符。结论高白细胞血样进行网织红细胞计数时会受到白细胞的干扰,通过对标本进行稀释后再进行测定可得到正确的网织红细胞结果及未成熟网织红细胞组份比例。     

XE-2100血液分析仪测定网织红细胞的评估

目的 对XE-2100血液分析仪测定网织红细胞的性能进行评估。方法 通过正常及异常网织红细胞标本来测定其重复性、线性范围、携带污染率,并与流式细胞仪测10名体检者和20例贫血患者的网织红细胞进行比较。结果 XE-2100血液分析仪测定网织红细胞的重复性较好、线性范围能满足临床的要求、携带污染率较低;与流式细胞仪测定比较两者的相关性较好。结论 XE-2100血液分析仪测定网织红细胞能替代手工法。     

XE-2100血液分析仪测定网织红细胞的评估

目的对XE2100血液分析仪测定网织红细胞的性能进行评估。方法通过正常及异常网织红细胞标本来测定其重复性、线性范围、携带污染率,并与流式细胞仪测10名体检者和20例贫血患者的网织红细胞进行比较。结果XE2100血液分析仪测定网织红细胞的重复性较好、线性范围能满足临床的要求、携带污染率较低;与流式细胞仪测定比较两者的相关性较好。结论XE2100血液分析仪测定网织红细胞能替代手工法。     

流式细胞术同时检测网织红细胞与网织血小板

目的 :探讨流式细胞术同时检测网织红细胞与网织血小板的可行性 ,建立网织红细胞与网织血小板在流式细胞仪检测中的正常参考值。方法 :采用荧光染料噻唑橙 (TO)标记的方法 ,用流式细胞仪分析人体血细胞中网织红细胞与网织血小板的表达情况。结果 :流式细胞仪图谱可明显区分红细胞与血小板两群细胞群体 ,可同时进行网织红细胞与网织血小板的分析 ,网织红细胞在人体外周血中表达的百分含量为 1 14± 0 2 3,网织血小板为 1 5 9± 0 73。提示 :利用流式细胞仪可同时进行网织红细胞与网织血小板的百分数检测 ,快速、客观、准确 ,可做为临床检验指标之一 ,广为推展     

目视窥盘法计数网织红细胞（Ret）探讨

随着临床检验事业的快速发展，目前在国外一些发达的国家及国内一些较大的医院都采用了流式细胞仪及全自动网织红细胞计数仪及五分类组合式的全自动细胞计数仪计数网织红细胞。其结果有准确性及稳定性的一面，亦有仪器经常出现故障，不能及时的报告结果。为此，仍然摆脱不了传统的手工目视法计数网织红细胞。目视窥盘法计数网织红细胞（Ret）是上世纪末90年代初，卫生部临床检验中心推广的一种快速、简单、实用、成本低的新方法。     

网织红细胞计数方法评价

网织红细胞计数对各类贫血的诊断和疗效观察均具有重要意义。传统方法为显微镜下计数经活体染色的网织红细胞占成熟红细胞的比例，此法费时、重复性较差，随着分析仪器的发展，使网织红细胞计数成为现实。本文通过对流式细胞仪(FCM)检测网织红细胞与传统方法的比较，得出的结果如下：……     

CellaVision DM96血细胞数字图像分析仪计数网织红细胞的性能评价

目的评价Cella Vision DM96血细胞数字图像分析仪(简称"DM96")计数网织红细胞的性能。方法随机选取116例EDTA-K2抗凝全血标本,用DM96、手工法、Sysmex XE-2100(简称"XE-2100")和Beckman Coulter LH750(简称"LH750")计数网织红细胞并比较。结果用DM96红细胞分析模块计数网织红细胞,与XE2100、LH750、手工法差异无统计学意义(P0.05)。结论用DM96红细胞分析模块计数网织红细胞性能良好。     

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.