3个项目联合检测胸腔积液的临床应用价值

目的通过检测胸腔积液组织多肽抗原（TPA）、癌胚抗原（CEA）、神经元烯醇化酶（NSE），以探讨TPA同CEA、NSE联合检测在鉴别良恶性胸腔积液的临床价值。方法应用化学发光免疫分析法检测56例良性疾患组患者和72例恶性肿瘤组患者胸腔积液及血清TPA、CEA、NSE含量，并进行比较分析。结果恶性肿瘤组胸腔积液中TPA、CEA、NSE含量分别为（4175±2696．9）U／L，（198．7±237．9）ng／mL，（28．03±30．7）ng／mL均高于良性疾患组的（1123±656．2）U／L，（1．23±0．90）ng／mL，（8．10±8．36）ng／mL。良恶性胸腔积液之间三项肿瘤标志物差异具有统计学意义。并且恶性疾患组胸腔积液中三项标志物水平及诊断敏感性均显著高于三项肿瘤标志物血清。结论胸腔积液TPA、CEA、NSE检测有利于良恶性胸腔积液的鉴别，胸水三项肿瘤标志物比血清三项肿瘤标志物具有更重要的意义，三项标志物联合检测可以提高对肺癌诊断的灵敏度和特异性。     

胸水与血清CYFRA21-1、CEA、NSE测定对肺癌的诊断价值

目的　探讨胸水和血清肿瘤标志物癌胚抗原 (CEA)、神经元特异性烯醇化酶 (NSE)、细胞角蛋白 19片段(CYFRA2 1- 1)在肺癌诊断中的临床价值。方法　采用电化学发光法测定 6 4例肺癌、36例良性肺病 (BLD)患者胸水和血清中CEAA、NSE、CYFRA2 1- 1水平。结果　肺癌患者血清中CEA、CYFRA2 1- 1、NSE的测定值分别为 34.99± 70 .5 2ng/ml、2 0 .5 7±2 8.8ng/ml、36 .2 1± 4 9.19ng/ml;而胸水中分别为 2 2 5 .36± 4 0 7.4 9ng/ml、134.38± 2 6 3.0 0ng/ml、74 .2 2± 119.0 5ng/ml,各项指标的统计学检验均有显著差异 (p <0 .0 1)。三者联合检测在胸水与血清中的阳性率分别为 98.4 4 %和 81.2 5 %。胸水中CEA、CYFRA2 1- 1和NSE在腺癌、鳞癌及非小细胞性肺癌的阳性率 (分别为 83.14 %、95 %、10 0 % )高于血清 (分别为 6 4 .2 9%、80 %、75 % )。结论　胸水CEA、NSE、CYFRA2 1- 1检测对肺癌的诊断价值优于血清     

血管内皮生长因子(VEGF)在恶性胸腔积液中的诊断价值

目的 :检测胸水中血管内皮生长因子 (VEGF)和癌胚抗原 (CEA)在恶性和结核性胸腔积液中的含量 ,探讨VEGF在良恶性胸水中的鉴别诊断价值。方法 :收集未经治疗且诊断明确的胸腔积液患者胸水 2 5例 ,用酶联免疫吸附法 (ELISA)检测胸水中VEGF和CEA的含量。结果 :恶性胸水 13例 ,VEGF含量为 ( 5 73 .62± 40 1.98) pg/ml ,结核性胸水 12例 ,VEGF的含量为 ( 2 3 1.41±15 8.0 6) pg/ml,二者比较差异有显著性 ( P <0 0 5 ) ,13例恶性胸水CEA的含量为 ( 4 9.90± 63 .3 2 ) μg/L ,12例结核性胸水CEA的含量为 ( 2 11± 2 11) μg/L ,二者比较差异有显著性 ( P <0 0 5 ) ,恶性胸水VEGF和CEA的含量均明显高于结核性胸水。 13例恶性胸水中 ,7例VEGF >5 0 0 pg/ml,5例CEA >2 0 μg/L ;2例VEGF <5 0 0 pg/ml同时CEA <2 0 μg/L ,在 12例结核性胸水中VEGF <5 0 0pg/ml同时CEA <2 0 μg/L。结论 :胸水中VEGF的升高有助于恶性胸水的诊断 ;联合检测胸水中VEGF和CEA ,诊断恶性胸水的敏感性提高     

VEGF、sFas、CEA联合检测对胸腔积液的鉴别诊断价值

目的 通过测定胸腔积液患者胸液中VEGF (Vascular endothelial growth factor,血管内皮生长因子)、sFas(可溶性Fas) 、CEA(癌胚抗原)的水平来探讨三者对胸腔积液鉴别诊断的价值.方法 应用EILSA方法及电化学发光免疫分析技术检测33例肺癌恶性胸液、33例结核性胸液及24例漏出液中VEGF、sFas和CEA的浓度.结果 肺癌恶性胸液组VEGF、sFas、CEA的浓度分别为(393.407±183.125 pg/ml,202.952±82.304 pg/ml,95.012±167.686 ng/ml)明显高于结核性胸液组(250.658±143.074 pg/ml,117.094±70.474 pg/ml, 2.485±1.186 ng/ml);漏出液组(158.896±114.736 pg/ml,59.571±12.573 pg/ml,1.983±0.885 ng/ml),差异具有显著性(P＜0.05).结核性胸液组中VEGF、sFas 明显高于漏出液组(P＜0.05),而两组之间CEA无显著性差异(P＞0.05).VEGF、sFas和CEA联合检测优于单项检测,其中联合方式以sFas+CEA的诊断效能较好.结论 恶性胸液组中VEGF、sFas、CEA水平明显高于良性胸液组.联合检测VEGF、sFas及CEA对胸水良、恶性的鉴别诊断有较高的临床价值.VEGF、sFas和CEA联合检测优于单项检测,其中联合方式以sFas+CEA的诊断效能较好.     

胸水中可溶性CD44V6的检测及意义

目的 探讨可溶性CD44V6(sCD44V6)在良恶性胸水中的诊断价值.方法 用酶联免疫吸附试验(ELISA)检测67份恶性胸水(其中肺癌56例、食管癌7例、胃癌4例)、76份良性胸水(其中非特异性疾病64例、结核性12例)的sCD44V6水平,并绘制受试者工作特征(ROC)曲线,评价此项指标在胸水定性诊断中的临床价值.结果 肺癌、食管癌、胃癌的组sCD44V6水平分别为97.9±15.5ng/ml、95.5±25.7 ng/ml及97.3±35.6ng/ml,明显高于良性非特异性疾病组及结核组44.7±18.9ng/ml和47.5±20.3ng/ml,良恶性组比差异有显著意义(P＜0.01).以59.4ng/ml为诊断界点,诊断恶性胸水的敏感度为82.1%,特异性为87.5%.结论 sCD44V6对于良、恶性胸水的鉴别诊断有重要价值.     

检测胸水和血清中CEA、CA125、CA153、CA199、铁蛋白对良恶性胸水鉴别诊断的意义

目的：探讨检测胸水和血清中CEA、CA125、CA153、CA199、铁蛋白在良恶性胸水鉴别诊断中的价值。方法：检测良性组和恶性组患者胸水和血清中五项肿瘤标志物的浓度，应用统计学方法分析判断其诊断价值。结果：恶性组血清中CEA、CA125平均水平显著高于良性组，胸水中五项肿瘤标志物水平均显著高于良性组。恶性组胸水中的水平显著高于血清中。结论：检测胸水中五项肿瘤标志物的水平对胸水良恶性的诊断有重要意义。     

胸水CEA、CA125、CA153、CA199、铁蛋白检测在良恶性胸水鉴别诊断中的价值

目的：探讨胸水肿瘤标志物的检测在良恶性胸水鉴别诊断中的价值。方法：检测51例恶性胸水，42例良性胸水患者胸水中CEA、CA125、CA153、CA199、铁蛋白的浓度，应用统计学方法分析判断其在胸水良恶性诊断中的价值。结果：恶性组胸水中五项肿瘤标志物平均水平均显著高于良性组，差异有显著性。结论：胸水CEA、CA125、CA153、CA199、铁蛋白检测在良恶性胸水鉴别诊断中有重要意义。     

VEGF，CEA，CA125联合检测在鉴别良恶性胸腹腔积液中的临床价值

目的 通过联合检测患者胸腹腔积液中血管内皮生长因子(vascular endothelial growth factor,VEGF) 、癌胚抗原(CEA)、肿瘤相关抗原125(CA125)的水平,探讨三者对胸腹腔积液鉴别诊断的临床价值.方法 应用ELISA方法及电化学发光免疫分析技术,检测81例患者胸腹腔积液中VEGF,CEA和CA125的浓度.结果 恶性胸腹腔积液组VEGF浓度为321.41±295.91 pg/ml,与良性胸腹腔积液组(31.00±92.87 pg/ml)比较,差异有统计学显著性意义(P<0.01);恶性胸腹腔积液组CEA浓度为227.46±738.08 ng/ml,与良性胸腹腔积液组(1.10 ± 1.12 ng/ml)比较,浓度明显高于良性组(P<0.05);恶性胸腹腔积液组CA125的浓度为1051.11±745.39 U/ml,与良性胸腹腔积液组(475.21±407.75 U/ml)比较,差异有统计学显著性意义(P<0.01);VEGF,CEA和CA125在恶性胸腹腔积液中检测的敏感度分别为58%,47%和86%,特异度为96%,98%和49%;在区分良恶性胸腹腔积液时,VEGF和CEA联合检测优于单项检测.结论 恶性胸腹腔积液组中VEGF,CEA和CA125水平明显高于良性组.VEGF,CEA及CA125联合检测可区分良恶性胸腹腔积液的性质,对于良恶性胸腹腔积液的鉴别诊断具有较高的临床价值.     

胸水CYFRA21-1、CEA及NSE联合测定对肺癌的诊断价值

目的　通过胸水CYFRA2 1 1(细胞角蛋白片段 )、CEA(癌胚抗原 )及NSE(神经烯醇化酶 )的检测 ,探讨各指标对肺癌诊断特异性及联合分析对肺癌的诊断价值和临床意义。方法　对 12 3例肺良性疾病组患者和 15 6例肺癌组患者胸水进行上述肿瘤标志物测定。将肺癌患者又根据病理类型分成腺癌组 (81例 )、鳞癌组 (5 0例 )、小细胞癌组 (12例 )和未定性癌组 (13例 )对各指标分别进行对照分析。结果　肺癌组胸水CYFRA2 1 1、CEA及NSE含量 (ng/ml)分别为 5 5 34± 37 44、5 7 11± 5 2 6 5及 16 99± 2 9 2 2 ,而肺良性疾病组的含量则分别为 9 0 8± 7 5 4、9 92± 6 2 8和 7 30±6 2 9,各指标的统计学检验均有极显著差异 (P <0 0 0 1)。CYFRA2 1 1在肺鳞癌组最高 ,与小细胞肺癌组相比有显著差异 (P <0 0 5 ) ,而与腺癌组和未定型癌组相比无显著差异 (P <0 0 5 ) ;CEA主要在腺癌组的含量均比其他肺癌组有极明显增高 (P <0 0 0 1) ;NSE则在小细胞癌组最高 ,其含量与其他肺癌组相比有极明显增加 (P <0 0 0 1)。结论　胸水CYFRA2 1 1,CEA及NSE在不同组织类型肺癌中的含量明显不同 ;三者联合测定对肺癌的诊断有重要的临床参考价值     

神经元特异性烯醇化酶、细胞角质蛋白19片断、癌胚抗原联合LDH、ADA检测对良、恶性胸腔积液鉴别的意义

目的探讨血清、胸水中神经元特异性烯醇化酶（NSE）、细胞角质蛋白19片断（CYFRA21—1）、癌胚抗原（CEA）对良、恶性胸腔积液的鉴别价值。方法对40例经病理确诊的胸腔积液患者按胸水的性质分为恶性胸水组（23例）和良性胸水组（17例）。2组患者均采用电化学发光法检测血清及胸腔积液中NSE、CYFRA21—1、CEA的含量．生化检测胸腔积液中乳酸脱氢酶（LDH）和腺苷脱氨酶（ADA）。结果恶性胸水组的血清NSE、CYFRA21—1及CEA均显著高于良性胸水组（P=O,02、0．02及0．01）;胸水CYFRA21—1及CEA均明显高于良性胸水组（严如．01或P=0．04）,ADA显著低于良性胸水组（P=0．01）。2组胸水NSE、LDH比较差异无统计学意义（均P〉O．05）。结论血清、胸腔积液中NSE、CYFRA21—1、CEA和ADA联合检测,对良、恶性胸腔积液的鉴别诊断有重要价值,能提高准确率。     

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.