比浊法在细菌药物敏感试验中的评价

目的 :探讨药敏试验传统试管稀释法 (试管法 )中肉眼观察结果改良为比浊仪比浊 (简称比浊法 )后 ,其准确性和临床应用意义。方法 :将 10 0株临床菌株对注射用青霉素钠、硫酸阿米卡星、环丙沙星、硫酸庆大霉素的敏感性用比浊法作出判断 ,然后与试管法的药敏结果进行比较。用质控菌确定比浊培养法的准确度。结果 :比浊法检测细菌对 4种抗生素敏感性与试管法药敏检测结果在 3、5、8h时 10 0株中完全相吻合的有 5 0、98、99株 ,通过 u检验 ,在 5 h后 P>0 .0 5 ,无显著性差异。结论 :比浊法缩短了药敏结果时间 ,量化了药敏结果的判断标准。     

Paracoagulation tests in laboratory verification of intravascular coagulation. Comparative clinical evaluation of the SDPS test and of the ethanol test with serial dilution (SD ethanol test)]

The AA. remark that laboratory diagnosis of intravascular coagulation is a still alive methodological problem. The presence in the flowing blood of certain molecules (fdp) that derive from that alteration of fibrinogen metabolism, that is at the basis of any intravascular coagulation syndrome, can be detected by immunological methods. Paracoagulation tests allow on the contrary to detect fibrin monomers and fibrin degradation products (fdp) that are still clottable (nonenzymatic coagulation). The positivity of these ones constitutes therefore an indirect evidence of the effects of thrombin on fibrinogen and keeps us nearer to the pathogenetic moment which is the real basis of any I.C. syndrome. The AA. make here a parallel between the two principal paracoagulation tests that are S.D.P.S. test according to GUREWICH (1971 [7]) and Ethanol Gelation test according to GODAL (1966 [6]) whose details are given. These two tests were performed in parallel in 589 cases which showed clinical evidence or suspicion of I.C. mostly supported by the further clinical courses of the patients. The two tests are both positive only in 164 cases (27,8%); both non-positive in 109 cases (18,6%); S.D.P.S. test is positive alone in 306 cases (51,9%); Godal's test is positive alone in 10 cases (1,7%). These data, supported by clinical course, allow the AA. to think that S.D.P.S. test is more sensitive than Godal's test. Although the AA. make the hypothesis that S.D.P.S. test may be more sensitive owing to its serial diluitions method that allows it to achieve an optimal ratio between the paracoagulant agent and the molecules which are capable to be clotted (paracoagulated). So they modify Godal's test applying to it too the principle of serial diluitions. The details are given. This new Serial Diluition Ethanol Gelation test is therefore performed in parallel with S.D.P.S. test in 314 cases which showed clinical evidence or suspicion of I.C. mostly supported by further clinical courses of the patients. In this second series of 314 patients the two tests are both positive in 138 cases (43,9%); both non-positive in 33 cases (10,5%); S.D.P.S. test was positive alone in 108 cases (34,3%); S.D.E.G. test was positive alone in 35 cases (11,3%). As we can see in this second series S.D.P.S. test remains more sensitive showing positivities in 246 cases (78,2%) whereas S.D.E.G. test is positive in 173 cases (55,2%). In conclusion the application of serial diluitions also to Ethanol Gelation test increase its sensitivity (from 29,5% to 55,2%), but it does not reach S.D.P.S. test's one. S.D.E.G. test may be really useful in clinics because it gives informations within 10 min but its non-positivity must be supported by the results of S.D.P.S. test which on the contrary gives sure informations only after 24 hours.     

OBSERVATIONS UPON THE NOGUCHI MODIFICATION OF THE WASSERMANN COMPLEMENT FIXATION TEST IN THE DIAGNOSIS OF LUES IN THE MILITARY SERVICE

In the vast majority of cases examined in this laboratory the result of the Wassermann test was simply confirmatory of the clinical findings, but there were numerous suspicious cases, or cases in which symptoms were present and the patient denied a specific history, in which the test was of the greatest value, and it is in such instances, perhaps, that it may be regarded as "the court of last resort " in arriving at a conclusion regarding the nature of the condition present. Certainly if there is any value in experience and statistics, we are justified in regarding this test as the most valuable means we possess of diagnosing lues, and our experience with the Noguchi modification of the test has justified all that has been claimed for that method. We believe that our results have proven that by the use of the complement fixation test in the military service it is possible to prevent the enlistment of men suffering from latent lues who would otherwise be enlisted; to control specific treatment by using it as an index of the efficiency of such treatment; to clear up the diagnosis of obscure or suspicious cases; and to enable the surgeon to avoid mistakes in discharges for disability in cases suspected of this disease. Owing to the facility with which clinical observations can be made in armies, and the control that is possible of tested individuals, it is to be hoped that the Noguchi modification of the complement fixation test will be more widely used than it has been in the military services, for which we believe it is especially adapted. So far as we are aware the Medical Department of our army is the first to adopt this test as a routine diagnostic procedure and to apply it in the case of applicants for enlistment.     

骨髓单个核细胞Coomb's试验在淋巴瘤合并贫血患者诊断中的意义

目的探讨ML(淋巴瘤)合并贫血(外周血红细胞悬液Coomb,s试验阴性)患者对骨髓的单个核细胞进行Coomb,s试验的临床价值。方法抽取我院自2008年11月至2011年11月以来,于我科治疗的血液病患者临床资料进行回顾性分析,其中A组AIHA(自身免疫性的溶血性贫血)患者10例(阳性对照组),均系外周血红细胞悬液Coomb's试验呈阳性者;B组4名正常人与46例各类型(再障,PNH,IDA等)贫血患者共50例(阴性对照组),均已明确诊断;C组ML合并贫血患者100例(实验组)均系外周血红细胞悬液Coomb,s试验呈阴性者;对3组患者骨髓的单个核细胞进行Coomb,s试验,并予以对比分析。结果对A组骨髓的单个核细胞进行Coomb,s试验,10例均提示为阳性,而B组中50例均提示为阴性,C组23例结果呈阳性,而67例结果呈阴性,A组患者骨髓单个核细胞Coomb,s试验阳性率为100.0%(10/10),C组患者阳性率为23.0%(23/100),两组差异呈显著性(P<0.05)。结论 ML合并贫血(外周血红细胞悬液Coomb,s试验阴性)患者对骨髓的单个核细胞进行Coomb,s试验检查,能够对其诊断以及鉴别诊断均提供有效的实验依据,从而避免误诊情况的发生,同时也能够对患者进行有效并且及时的治疗,应予推广。     

旋转试验与冷热水试验检查前庭功能的结果比较

背景判断前庭功能的方法有冷热试验及旋转试验,两种方法检测结果相关性如何?目的观察旋转试验与冷热水试验检查前庭功能结果的一致性.设计以患者为观察对象,评估方法学优异性的对比实验.单位解放军总医院耳鼻咽喉科.对象选择1990-04/1996-12在解放军总医院耳鼻咽喉科因眩晕、耳聋耳鸣就诊的门诊及病房患者为观察对象,所有患者均经用Hallpike冷热水试验检查结果均显示前庭功能异常,且知情同意.其中男68例,女32例;年龄16～74岁,平均(37±3)岁.单侧异常91例,双侧异常9例.前庭功能异常判定标准为[建侧眼震慢相角速度(slow phase velocity,SPV)-患侧SPV/健侧SPV-患侧SPVX100%]≥15%,上述比值＜15%判定为正常.方法对患者进行旋转试验,分别采用正弦摆动和旋转骤停两种刺激方式,其中正弦摆动试验刺激幅度为90°,频率为0.167Hz;骤停旋转试验,1°～2°/s2加速度达峰速90°/s,恒速旋转至眼震消失后骤停进行测试.主要观察指标骤停旋转试验及正弦摆动试验结果. 结果按实际处理分析.双侧异常者9例,8例诱发出眼震,1例双侧听神经瘤旋转试验未诱发出眼震.其他患者旋转试验均诱发出眼震.冷热水试验单侧异常的91例患者中有2例由于不愿接受骤停旋转试验而未做.正弦摆动试验检查64%(58/91)患者前庭功能异常,骤停旋转试验检查61%(54/91)患者前庭功能异常.结论旋转试验中的正弦摆动试验和骤停旋转试验可检查出前庭功能异常,但与冷热水试验结果不完全相符.     

低年龄段患儿对皮试仪法皮试的依从性研究

目的调查低年龄段(0~6岁)患儿对皮试仪法皮试的依从性,分析其影响因素,以期为进一步采取干预措施提高患儿的依从性提供依据。方法 2015年10月至2016年1月,便利抽样法选取潍坊市某三级甲等医院门急诊注射室进行皮试仪法皮试的低年龄段患儿1450例为研究对象,统计其对皮试仪法皮试的依从程度,并分析其影响因素。结果在1450例患儿中,完全不依从的患儿为226例(占15.6%)、较不依从的患儿为413例(占28.5%)、较为依从的患儿为489例(占33.7%)、完全依从的患儿为322例(占22.2%)。不同年龄、距上次创伤性操作时间、是否为首次使用皮试仪、是否进行过皮内注射法皮试的患儿的依从性差异均有统计学意义(均P0.05)。且上述4项因素是影响低年龄段患儿对皮试仪法皮试依从性的主要因素(均P0.05)。结论低年龄段患儿在皮试仪法皮试中的依从程度较低,多种因素影响患儿依从性,护理人员和家属应进行适当的干预以提高患儿的依从性。     

血清免疫固定电泳、蛋白电泳、免疫球蛋白及轻链定量对多发性骨髓瘤临床诊断价值探讨

目的探讨血清蛋白电泳、总蛋白、免疫球蛋白及轻链、蛋白电泳、免疫固定电泳测定对多发性骨髓瘤(MM)的诊断价值。方法对89例多发性骨髓瘤患者的血清总蛋白、免疫球蛋白及轻链、蛋白电泳、免疫固定电泳和尿轻链κ、λ的检测结果进行统计分析。结果 89例MM患者38例患者血清总蛋白含量升高;55例免疫球蛋白及轻链定量显著升高;血清蛋白电泳56例检出M带,而免疫固定电泳中89例均为阳性结果。结论免疫固定电泳检是MM诊断的敏感方法 ,应作为MM的常规检测方法 。     

运用护理干预降低青霉素皮试假阳性率

目的探讨护理干预对青霉素皮试结果的影响。方法将2 000例患者随机分为两组,对照组1 000例,按常规对患者进行青霉素皮试,干预组1 000例,运用护理干预对患者进行青霉素皮试。结果对照组阴性866例,假阳性98例,阳性36例;干预组阴性945例,假阳性21例,阳性34例。经统计学处理,两组差异有统计学意义(P<0.01)。结论运用护理干预能明显降低青霉素皮试的假阳性率。     

False positive results in severe acute respiratory coronavirus 2 (SARS-CoV-2) rapid antigen tests for inpatients

Severe acute respiratory syndrome coronavirus 2 rapid antigen detection (RAD) test kits are widely used as primary screening test in Japan because rapid diagnosis of coronavirus disease 2019 (COVID-19) is critical for infection control. We report cases with RAD test false-positive results in a ward for patients with disabilities. RAD tests potentially evoke hospital operational risk. It is desirable that performing PCR test appropriately when patients admitted to a medical treatment ward with COVID-19 symptoms instead of RAD test.     

一起特殊群体结核病暴发疫情流行病学调查

目的了解劳动教养人员结核病暴发疫情的流行病学特征。方法采用结核菌素试验、胸透、结核分支杆菌检查以及流行病学调查。结果查出结核病例26例,罹患率达3.43%,其中肺结核涂阳3例、涂阴17例,肺外结核6例。结论引起本次疫情的原因复杂,可能与新劳教人员未进行体检、首例病例未得到及时规范的治疗以及劳教场所人群集居等因素有关。     

标准化皮试与特异性IgE测定在检测特异性过敏原中的比较

目的：比较标准化皮试和特异性IgE测定对过敏性哮喘患检测特异性过敏原的作用和意义。方法：对52例哮喘患分别作以下检测；采用国际标准化的Allergopharma过敏原皮试液（共12种）作点刺试验；采用UniCAP过敏原检测系统作混合吸入物过敏筛选试验（Phadiatop试验）。结果：52例哮喘患中标准化皮试阳性45例（占86.5%)。其中粉尘螨阳性42例（占93.3%)。52例哮喘患中Phadiatop试验阳性47例（90.4%)。其中44例（93.6%)标准化皮试同时为阳性；5例Phadiatop阴性中4例皮试呈阴性，标准化皮试与Phadiatop试验的总符合率为92.3%(48/52)。结论：采用国际标准化的皮试液作点刺试验同时辅以Phadiatop试验阳性或阴性对照判断结果。可作为吸入性过敏原特异性诊断较为可靠的标准化手段。     

两种不同放散试验在新生儿ABO溶血病检测中的比较

目的观察比较酸放散和传统热放散在新生儿AB0溶血病检测中的应用效果。方法共收集344例新生儿血标本,同时进行酸放散和热放散试验,比较两者的差异及其与临床诊断的吻合度。结果酸放散阳性112例,阴性232例：热放散阳性112例,阴性232例。酸放散与热放散试验间差异无统计学意义（P〉0．05）。结论对于新生儿ABO溶血病的诊断,酸放散与传统热放散试验的检测效果并无差别,且酸放散试验不受主观因素影响,缩短试验时间,不需要特殊的加热振荡水浴箱,值得推广。     

临床护理路径应用于全子宫切除术效果分析

目的探讨临床路径(CP)应用于全子宫切除术的实施效果。方法62例病例分为实验组和对照组,实验组30例实施CP,对照组32例实施传统的治疗护理,将2组的治疗护理效果进行对比。结果术后首次下床时间对照组(27.78±15.61)h,实验组(17.53±8.99)h(t值=3.19,P<0.01);首次排气时间对照组(58.20±10.73)h,实验组(52.24±9.54)h(t值=2.46,P<0.05);术后腹胀发生例数对照组22例,实验组9例(P<0.01);住院天数实验组明显减少(P<0.01);住院费用对照组(5005.63±147.68)元,实验组(4432.21±126.45)元。术后使用镇痛剂和残端出血无统计学意义。结论CP应用于子宫切除术能提高治疗与护理质量,缩短住院时间,减少住院费用,适合在基层医院开展。     

乙型肝炎病毒表面抗原弱反应性样本的确认与分析

目的对酶联免疫吸附试验（ELISA）定性的乙型肝炎病毒表面抗原（HBsAg）弱反应性样本进行确认及分析。方法收集经ELISA检测HBsAg的S／CO值为0．7～3．0的样本共613例,以中和试验确认,同时进行微粒子酶免疫方法（MEIA）检测,不确定病例继续随访。结果经确认共41例与ELISA判定结果不符,假阳性率4．9％,假阴性率10．7％;其中S／CO值0．9～1．2范围产生的假阴性率或假阳性率最高。中和试验和MEIA法检测结果基本一致,仅4例不符。结论ELISA检测HBsAg呈弱反应性,尤其是“灰区”结果应予以确认,中和试验和MEIA都是有效的方法,个别病例还需参考病史长期随访。     

干化学法与沉渣镜检法对比检测尿中红细胞和白细胞

目的探讨迪瑞H-300尿液分析仪干化学法与尿沉渣镜法检测红细胞和白细胞的一致性。方法对3678例尿液分析仪干化学测定全部为阴性、619例测定为隐血±至＋＋同时白细胞阴性的尿液标本做尿沉渣镜检。结果3678例阴性标本尿沉渣镜检检出白细胞每高倍视野5～30个以上206例,假阴性率占5．6％;红细胞每高倍视野3～15个115例,假阴性率为3．1％。在619例隐血阳性同时白细胞阴性的尿标本中,红细胞假阳性率为3．1％,白细胞假阴性率为5．5％。结论临床上使用干化学法做尿常规出现全阴性时,为了避免漏、误诊,必须进行显微镜沉渣检查。     

新生儿血型抗体892例探讨

目的 分析新生儿血型抗体,探讨新生儿血型抗体在新生儿输血配合试验中的应用。方法 对892例新生儿血清作盐水介质,间接抗人球蛋白血型血清学试验。结果 892例新生儿血清在盐水介质中检出ABO血型抗体725例,阳性率占81.3％;在抗人球蛋白介质中检出ABO血型抗体845例,阳性率占94.7％。结论 新生儿大部分产生ABO血型抗体,而且抗体性质大部分为IgM,少部分为IgG。抗人球蛋白试验较盐水试验灵敏,血型抗体检出率高。新生儿交叉配血不容忽视血型抗体。     

凝聚胺法与微柱凝聚法检测不规则抗体的对比分析

目的探讨凝聚胺法与微柱凝聚法在不规则抗体筛选中的价值对比。方法对2010～2011年江门市新会区人民医院6 720例预约输血患者,用凝聚胺法与微柱凝聚法分别进行不规则抗体筛查,阳性结果再用谱细胞通过抗人球蛋白方法进行特异性检测。结果用微柱凝聚法筛查出不规则抗体阳性28例,阳性率为0.42%,而凝聚胺检测阳性26例,阳性率仅为0.39%,两种方法比较差异无统计学意义（P〉0.05）。其中Rh系统占总不规则抗体比例为57.1%,分别为抗-D 5例,抗-E 7例,抗-C 2例,抗-Ec 2例。结论凝聚胺法与微柱凝聚法都适用于临床筛查不规则抗体,微柱凝聚法比凝聚胺法更有利于大规模自动化筛查,对于有条件的大医院更适合临床输血前的应用和相关疾病的诊断,而凝聚胺法在基层或者临床急诊上也可合理开展。     

测定抗-HBs的两种方法在不同温育时间的结果比较

目的探讨检测乙型肝炎（下称乙肝）病毒表面抗体（抗-HBs）两种方法在不同温育时间的结果差异。方法采用免疫酶法（EIA）一步法、时间分辨荧光（TRF）法检测抗-HBs,OD值在0．056-0．380之间标本温育时间变化而造成的结果值的差异。结果用30min EIA一步法检测抗-HBs,结果37例弱阳性和59例阴性,再用60min EIA一步法抗-HBs检测,结果41例呈弱阳性和55例阴性。用TRF两步法抗-HBs测定出42例弱阳性和54例阴性,发现有6例标本不同于温育30min的EIA一步法抗-HBs检测的结果。结论酶联免疫吸附试验作为一种固相免疫测定,抗原抗体的结合反应在固相上进行,要使液相中的抗原或抗体与固相上的特异抗体或抗原完全结合,必须在一定的温度、时间条件下反应。温育所需时间与温度成反比,尤其在冬天,标本从室温到恒温箱这一过程很容易造成实际测定温育时间不够,也是造成灰区误差的原因之一。     

Quick's time and derived times in the study of the extrinsic course of the coagulation process. The PIVKA (protein induced by vitamin K absence or antagonists) in states of chronic disseminated intravascular coagulation

After reviewing the available methods for the clinical study of the extrinsec way of the coagulative process (Quick's time, Owren's Thrombotest and Normotest), the AA. explain what is the significance that the most of hte researchers ascribe to time-value discrepancies between Thrombotest and Normotest. The AA. remember that while the former is sensitive to the presence of certain inhibitors called PIVKA (Protein Induced by Vitamin K Absence or Antagonists), just as Quick's original time; the latter is on the contrary insensitive to them. Then it provides more significant data about the real rate of factors II, VII, and X. Such inhibitors have been found also in subjects that did not undergo any anti-vitamin K therapy and peculiarly in cases in which a Intravascular Coagulation occurred. Therefore the AA. thought to verify the hypothesis that the detection of a discrepancy between TT and NT could be useful in the clinical diagnosis of I.C. which is a serious and often hardly detectable disorder of haemostasis. The AA. have therefore tested 72 patients, 65 of which showed the evidence of I.C. and 7 with I.C. probabilities. The discrepancy values that were obtained are showed in Table I. The first group (65 cases) was furtherly divided into four subgroups, according to the positivities obtained from SDPS test, as shown in Table II. The AA. can therefore come to the following conclusions: a) In human Intravascular Coagulation, the discrepancy between NT/TT may occur with a frequency of 57 per cent but it is not a constant event. b) The discrepancy rate is generally of low degree, being of high degree only in twelve cases (18.5 per cent. c) Analyzing the discrepancy presence and rate in relation to the number of SDPS test positivities, we can notice that the values are remarkably scattered and it is not possible, only on the basis of these data to make a statistical evaluation of their significativity because the groups are not comparable among them, being in exc3ss the cases in which paracoagulation occurs in a low degree. We can only state that the absence of discrepancy predominates in the cases in which a low number of positivities of SDPS test occurs, and on the contrary the discrepancy is a constant event in the cases in which SDPS test shows a large number of positivities. In consitive test to detect Intravascular Coagulation, but we think the positivity of this test may be a support in doubtful cases.     

脑血管病患者BIT检查项目间相关性研究

目的通过对脑血管病患者进行BIT检查 ,了解BIT检查中通常检查和行动检查间的相关性。方法对 2 2例脑血管病患者进行BIT检查 ,分析BIT各个项目间的相关性 ,以及共同因子。结果通常检查和行动检查各合计得分在正常界限分以上或以下的患者右半球损伤的 16例中有 14例 ,左半球损伤的患者 6例中有 5例 ,少数病例有分离现象 .对BIT检查中 15个项目两变数间的相关系数进行比较 ,结果有显著性差异 (P <0 .0 5 ) ,但因子分析因病例数少 ,抽出的主因子不显著。结论脑血管病患者BIT检查各个项目间的相关性很强 ,在临床上有实际应用价值。