抗-HCV IgM、抗-HCV IgG与HCV RNA的相关性及临床意义

[目的]研究丙型肝炎病毒（HCV）抗-HCV IgM、抗-HCV IgG与HCV RNA的相关性。[方法]收集236例HCV患者标本，用酶联免疫吸附法检测抗-HCV IgM、抗-HCV IgG、同时用逆转录-聚合酶链反应（RT-PCR）检测HCV RNA。[结果]168例HCV RNA（＋）标本中，抗-HCV IgM阳性率为72．0％（121／168）；抗-HCV IgG阳性率为85．1％（143／168），抗-HCV IgM、抗-HCV IgG与HCV RNA的关联系数均为r=1。抗-HCV IgM、抗-HCV IgG与HCV RNA的检出符合率分别为69．1％（163／236）、75．4％（178／236）。随着抗-HCV IgG抗体光密度值（OD值）的增大，HCV RNA的检出率亦增加（X^2=27.5 P〈0．001）。提示两者间存在相互关联性（r=0．93）。[结论]HCV感染者血清抗-HCV抗体与HCV RNA的阳性检出率呈正相关，血清中抗-HCV的含量越高，HCV RNA的含量越多，其传染性越强。抗-HCV IgM与HCV病毒复制亦密切相关，可以做为HCV复制的补充指标。     

HCV胶体金试剂在急诊患者手术输血前的快速检测

目的应用HCV胶体金试剂对急诊手术患者输血前进行检测,并与抗-HCV ELISA法进行比较。方法对本医院2008年1～10月的3216例急诊手术患者,先应用HCV胶体金试剂检测抗体,再分别用试剂①、②两种抗-HCV试剂进行ELISA法检测。对HCV胶体金试剂、试剂①、②检测为阳性的标本,再进行HCV RNA RT—PCR荧光定量检测。结果3216份标本中HCV胶体金试剂检测阳性25份,抗-HCV试剂①ELISA法检测阳性33份,试剂②检测阳性34份（两种试剂均阳性26份,仅试剂①、②阳性的分别为7和8份）。HCV RNA RT—PCR荧光定量检测阳性28份。结论HCV胶体金法与抗-HCV ELISA法结果符合率为92．59％,与HCV RNA RT—PCR荧光定量法结果符合率89．29％,HCV胶体金试纸法假阳性率低,操作简便、快速,适合急诊患者手术前输血的筛选。     

两种试剂检测抗-HCV在丙型肝炎诊断中的意义

目的提高丙型肝炎病毒抗体（抗-HCV）检出率和检测结果的准确率。方法应用两个厂家抗-HCV ELISA试剂（试剂①、②）检测本院2006年1～12月间2516份输血、手术前住院患者血清标本。再将试剂①、②均阳性的血清标本28份、仅试剂①阳性的15份和仅试剂②阳性的17份血清标本进行HCV RNA RT—PCR荧光定量检测。结果试剂①、②抗-HCV均阳性28份标本的RT—PCR结果均阳性,仅试剂①抗-HCV阳性的15份标本中2份阳性,试剂②抗-HCV阳性的17份标本中3份阳性;仅试剂①或②抗-HCV阳性的32份血清标本中,HCV RNA RT—PCR检测阳性率为15．63％。结论采用双试剂检测能提高抗-HCV的检出率和结果的准确率。     

丙型肝炎患者血清HCV—RNA载量与抗-HCV及丙氨酸氨基转移酶联合检测的意义

目的：探讨丙型肝炎患者血清HCV—RNA载量与抗-HCV及丙氨酸氨基转移酶（ALT）浓度的关系。方法：采用实时荧光定量PCR法检测HCV—RNA载量,酶联免疫吸附法（ELISA）检测抗-HCV,全自动生化分析仪连续监测法测定ALT活性浓度。结果：289例丙型肝炎患者的血清标本中,抗-HCV均为阳性,282份标本HCV—RNA均高于检测上限（1000IU／mL）,两种检测方法的符合率为97．6％。ALT异常率随着HCV—RNA载量的增高而升高。HCVRNA载量与ALT异常率呈正相关（r=0．968,P％0．05）。而ALT浓度变化与HCV—RNA载量并无相关性（r=0．028,P〉0．05）。结论：HCV—RNA载量与抗-HCV检测是诊断HCV感染的重要指标,HCV—RNA载量是反映HCV复制的可靠指标,结合丙氨酸氨基转移酶测定,可以帮助临床了解HCV在体内复制的状况及肝脏的损伤情况,为临床诊断HCV感染和评价抗HCV治疗效果提供可靠依据。     

丙肝患者血清抗-HCV和HCVRNA检测效果分析

目的比较ELISA法检测抗-HCV和荧光PCR法检测HCV RNA的效果,分析荧光PCR法在血站开展的必要性,为临床输血安全提供可靠依据。方法对2013年5月1日~2014年4月31日采集的149 200份无偿献血者标本进行HCV的检测。结果 ELISA法检测抗-HCV阳性标本610例,阴性标本148590例,610例阳性标本中用荧光PCR检测出HCV RNA阳性490例,占80.32%,148 590份抗-HCV阴性标本中HCV RNA阳性298例,占0.2%。结论用ELISA法检测抗-HCV,去除抗-HCV阳性血液,在此基础上对抗-HCV阴性血液加做HCV RNA核酸检测可以确保输血安全。     

定量PCR与传统RT-PCR检测HCV RNA的比较研究

目的用荧光定量PCR（FQ-PCR）和逆转录PCR（RT-PCR）法检测抗-HCV阳性血清中的HCVRNA，探讨两种方法检测结果的临床意义。方法抗-HCV阳性血清样本1062份，其中481份用RT-PCR法检测，465份用FQ-PCR法检测，另有116份同时用两种PCR法检测。结果RT-PCR法检测HCV RNA的阳性率为49．90％（240／481），FQ-PCR法的阳性率为62．58％（291／465），两种方法的阳性率有显著性差异（P〈0．001）。同时用两种方法检测116份，RT-PCR法阳性率为49．14％（57／116），FQ-PCR法阳性率为65．52％（76／116），也有显著性差异（P〈0.05）。FQ-PCR法检测的40份阴性中RT-PCR法检测出4例HCVRNA阳性。结论FQ-PCR检测HCVRNA比RT-PCR特异性高．但RT-PCR的敏感性较FQ-PCR高，部分FQ-PCR检测的阴性结果不能排除HCV RNA阳性的可能性。     

HCV胶体金与ELISA法在献血者体检中的应用比较

目的应用丙型肝炎病毒（HCV）胶体金法检测无偿献血者,并与抗-HCV ELISA法比较。方法对2008年1月～2009年12月的5830例无偿献血者,先应用HCV胶体金试纸条检测,再分别用试剂1、试剂2两种抗-HCV ELISA试剂进行常规初检、复检。对HCV胶体金法阳性的标本、试剂1初检、试剂2复检阳性的标本,再进行HCV RNA RT-PCR荧光定量检测。结果在被检测的5830份标本中,HCV胶体金法阳性有11份,抗-HCV ELISA试剂1初检阳性12份、试剂2复检阳性13份;其中初检、复检均阳性的11份,仅初检阳性1份和仅复检阳性2份,HCV RNA RT-PCR荧光定量检测阳性11份。结论本组检验HCV胶体金法与HCV RNA RT-PCR荧光定量法结果符合率为100.0%,HCV胶体金试纸法假阳性率低,操作简便、快速,适合无偿献血者抗-HCV筛选。     

丙型肝炎病毒抗体酶联免疫吸附试验阳性判断值在献血员血液筛检中的意义

目的探讨丙型肝炎病毒(HCV)抗体酶联免疫吸附试验(ELISA)测定阳性判断值(Cut-off)“灰区”在献血员血液筛检中的应用价值。方法采用逆转录-聚合酶链反应(RT-PCR)方法检测了503份抗-HCV ELISA测定为阴性的献血员血清(浆)标本的HCV RNA。如HCV RNA检测为阳性，则使用重组免疫印迹(RIBA)方法进一步检测抗HCV。结果在503份抗-HCV ELISA阴性献血员血清(浆)标本中，发现有5份HCV RNA阳性，其中2份标本抗HCV ELISA测定S/CO比值小于0．5，RIBA结果均为阴性。另外3份抗HCV阴性(ELISA检测的S/CO值在0．8-0．9之间)但HCV RNA为阳性的献血员血标本，进一步进行RIBA检测，发现其中2份为抗核心区(C22)单独阳性，另外1份为抗NS3单独阳性。阳性标本HCV RNA的含量测定均约为10^4拷贝/ml。结论为尽可能减少输血后HCV感染的发生，有必要将抗-HCV ELISA测定的Cut-off值下移20％，因为S/CO比值接近Cut-off值的血液有很大可能为HCV感染者。     

抗-HCV、HCV-RNA及ALT检测138例结果分析

目的：探讨丙型肝炎病毒（HCV）RNA与丙型肝炎抗体（抗-HCV）及丙氨酸氨基转移酶（ALT）之间的关系。方法：采用荧光定量聚合酶链反应（FQ-PCR）测定138例疑似HCV感染者血清HCV RNA,ELISA法检测抗-HCV,全自动生化分析仪测定ALT。结果：138例标本中HCV RNA和抗-HCV均阳性者108例,HCV RNA阳性而抗-HCV阴性者3例,HCV RNA阴性而抗-HCV阳性者27例。ALT水平与HCV RNA含量无显著相关性。结论：同时检测HCVRNA和抗-HCV可提高丙型肝炎患者的检出率;HCV RNA含量不能反映肝脏损伤的程度。     

抗-HCV阳性献血者血清HCV RNA水平与ALT活性的关系

目的 分析抗-HCV阳性献血者血清HCV RNA含量与ALT活性的关系。方法 采用ELISA法检测抗-HCV，阳性标本用荧光PCR试剂盒测定HCV RNA，分析标本ALT活性与HCV RNA水平的关系。结果 60份抗-HCV阳性标本经PCR检测后有27份标本含有HCV RNA，HCV RNA拷贝量与ALT活性呈正相关，且标本的HCV RNA含量越多，ALT活性也越高(P＜0．01)。结论 献血者中筛查ALT并结合PCR技术，能减少HCV经血传播的危险。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.