濮阳地区无偿献血人群梅毒抗体检测结果及流行情况分析

目的了解濮阳地区无偿献血人群不同年龄、学历、职业、性别的梅毒抗体检测及流行情况。方法选取2015年至2016年18～55岁的无偿献血者标本34029例进行梅毒抗体检测。结果 2016年濮阳地区献血人群梅毒感染率较2015年有所上升,差异有统计学意义(P0.05);女性献血者梅毒感染率高于男性献血者,差异有统计学意义(P0.05);不同年龄段中以40～50岁献血者梅毒感染阳性率最高,小于20岁的献血者梅毒感染阳性率最低,各年龄段间梅毒感染阳性率差异有统计学意义(P0.05);已婚献血者梅毒抗体阳性感染率高于未婚献血者,差异有统计学意义(P0.05);学历越高的献血者梅毒感染率越低,学历越低的献血者梅毒感染率越高,差异有统计学意义(P0.05);不同职业人群中梅毒感染率差异有统计学意义(P0.05)。结论濮阳地区目前的梅毒感染形式比较严峻,还需要对高风险人群加强梅毒和安全献血知识的宣传,我站要把控献血安全质量,增加梅毒筛查力度,保证献血安全、用血安全。     

输血前患者4项感染指标检测结果与流行趋势

目的分析输血前患者4项感染指标检测结果与流行趋势。方法选择该院2010~2012年输血前患者25 068例,采用ELISA法进行乙型肝炎病毒表面抗原(HBsAg)、丙型肝炎病毒抗体(抗-HCV)、人类免疫缺陷病毒抗体(抗-HIV)和梅毒螺旋体抗体(抗-TP)检测。结果 2010~2012年输血前患者HBsAg、抗-HCV、抗-HIV和抗-TP阳性率分别为12.78%、1.06%、0.05%和0.95%,其中抗-HIV和抗-TP阳性率具有逐年上升趋势,差异均有统计学意义(P0.05),不同性别和年龄HBsAg阳性率比较差异均有统计学意义(P0.01);男性抗-HIV阳性率高于女性,差异有统计学意义(P0.05);抗-TP阳性率具有随年龄增长而增高的趋势,差异有统计学意义(P0.01)。结论输血前患者具有一定的感染率并有增高的趋势。进行输血前检查,对于了解输血前患者感染状况、减少医疗纠纷和提高输血安全性具有重要意义。     

深圳宝安地区血液筛查不合格献血人群特征分析

目的了解深圳宝安地区血液筛查不合格献血人群的结构,为制订降低输血风险策略提供科学依据。方法分析2008~2015年输血管理信息系统中血液筛查不合格献血人群的性别、年龄、教育程度和职业情况,并对以上人群丙氨酸氨基转移酶(ALT)、乙型肝炎表面抗原(HBsAg)、丙型肝炎病毒抗体(抗-HCV)、人免疫缺陷病毒抗体(抗-HIV)、梅毒抗体(抗-TP)进行检测。结果 5 545例不合格献血人群中,血液检测总阳性率为2.47%(ALT为0.16%、HBsAg为0.70%、抗-HCV为0.39%、抗-HIV为0.24%、抗-TP为0.56%、灰色区为0.45%),总阳性率呈逐年下降趋势(P0.01),但抗-TP阳性率有逐年升高趋势(P0.05)。不合格献血人群的性别比较,差异无统计学意义(P0.05),但在不同年龄段、学历、职业方面差异有统计学意义(P0.01)。结论为降低输血风险,加强献血前的健康咨询,壮大固定献血队伍,在低危人群中招募献血者至关重要。     

1200例输血前患者HBsAg、抗-HCV、抗-HIV及梅毒抗体检测的调查研究

目的回顾性分析肇庆市第一人民医院1 200例输血前患者乙肝表面抗原(HBsAg)、丙型肝炎病毒抗体(抗-HCV)、艾滋病病毒抗体(抗-HIV)及抗梅毒螺旋体抗体(抗-TP)检测的结果 ,旨在寻找该院输血前患者传染性标志物的分布特点,为提高医院医疗水平提供一定的数据支持。方法选取2010年1月至2016年6月于该院进行治疗且需要输血的1 200例患者作为调查对象。使用酶联免疫吸附测定(ELISA)检测试剂盒测定患者的血HBsAg、抗-HCV、抗-HIV及抗-TP水平,分析不同科室各指标阳性率的特点,并根据患者基本病历资料分析不同因素对患者传染病阳性率的影响。结果 1 200例输血者4项感染指标的结果表明HBsAg的阳性率最高(9.08%),显著高于其他血清检测指标,差异有统计学意义(P0.05),其次抗-TP的阳性率也很高。157例阳性感染指标在各科室的分布结果表明,在妇产科、大内科以及血透中心中阳性例数占比较高,均在15%左右,显著高于儿科和血液病科。根据患者的基本病历资料数据对患者的血清学阳性检查数据进行比较,并通过χ2检验分析不同因素下患者阳性率的差异,结果显示,不同性别和年龄患者在阳性率上比较差异无统计学意义(P0.05),而在文化水平、收入水平、户籍以及遗传因素均与患者血清检查阳性率上有显著性影响,差异有统计学意义(P0.05)。结论 1 200例输血前患者血HBsAg、抗-HCV、抗-HIV及抗-TP检测结果表明,HBsAg的阳性率最高,不同文化水平、收入水平及户籍性质的人群的阳性率不同,有一定的分布规律,值得临床重点关注。     

某地区戒毒人群HBV、HCV、HIV和TP标志物检测结果分析

目的分析山东济宁地区戒毒人群乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、人类免疫缺陷病毒(HIV)和梅毒(TP)的感染现状。方法对2014-2016年该院收治的1 003例戒毒人员传染病标志物乙型肝炎5项指标、HCV抗体(HCV-Ab)、HIV抗体(HIV-Ab)和TP抗体(TP-Ab)进行检测和结果分析。结果戒毒人群HBs-Ag阳性率7.38%,HCV-Ab阳性率0.40%,TP-Ab阳性率8.87%,HIV-Ab阳性未检出,总阳性率15.75%。不同年龄组间HBs-Ag阳性率和TP-Ab阳性率差异均有统计学意义(P0.01),40岁年龄组有较高的HBs-Ag阳性率和TP-Ab阳性率;不同性别间TP-Ab阳性率差异有统计学意义(P0.01),女性高于男性;不同职业HCV-Ab阳性率差异有统计学意义(P0.05);农民组HCV-Ab阳性率较高;强制/自愿戒毒组间TP-Ab阳性率差异有统计学意义(P0.05),强制戒毒人群TP-Ab阳性率高于自愿戒毒人群。结论该地区内吸毒人群HBV、HCV和HIV感染率较低,TP感染率较高;不同的年龄、性别、职业、地市是HBV、HCV和TP感染的影响因素。     

梧州市无偿献血者梅毒血清学检测结果分析

目的 了解梧州市无偿献血者梅毒感染情况,为保证临床输血安全提供依据。方法 对梧州市2010年1月至2012年12月无偿献血者的血液检测标本108 879份,进行梅毒传染性标志检测,统计梅毒抗体的阳性数和感染率并进行统计学分析。结果 2010年1月至2012年12月无偿献血者梅毒抗体阳性率为0.59%(643/108 879),其中男性412例、女性231例,不同年龄、性别无偿献血者梅毒血清学阳性率结果比较,差异无统计学意义(P>0.05)。结论 加大无偿献血宣传力度,做好献血前的咨询和体检筛查工作,选择低危行为献血者,对保证血液质量,降低输血传播梅毒风险有重要意义。     

输血患者在输血前传染病检测结果分析及意义

目的 了解该院输血患者在输血前相关传染病感染情况,以避免医源性感染及医疗纠纷的发生并提醒医务人员加强自我保护意识.方法 采用酶联免疫吸附试验(ELISA)对2 182例输血患者在输血前进行人类免疫缺陷病毒抗体(抗-HIV1/2)、梅毒螺旋体抗体(抗-TP)检测,用时间分辨荧光法对其进行乙型肝炎表面抗原(HBsAg)及丙型肝炎病毒抗体(抗-HCV)检测.结果 检测指标中HBsAg感染率居首,阳性率为10.08%,其次为抗-TP感染,阳性率为1.60%,抗-HCV感染率为0.55%,HIV感染率为0%.其中男性HBsAg感染率高于女性,差异有统计学意义(P<0.05),其他3项检测结果差异均无统计学意义(P>0.05).结论 对输血患者进行输血前相关传染病标志物检测非常重要,是避免和预防医院感染和医疗纠纷发生的重要手段,也对提高医护人员的自我保护意识具有十分重要的意义.     

甘肃省无偿献血者梅毒筛查反应性人群结构分析

目的通过分析甘肃省无偿献血者梅毒抗体筛查反应性人群的结构,为招募安全血源的策略提供依据,为制定甘肃省梅毒反应性的献血者归队策略提供基础性数据。方法收集兰州市2011年1月至2016年8月无偿献血者梅毒检测结果,并收集兰州市与省内3家血站(东部、西部、中部各抽取1家)2015年1月至2016年8月无偿献血者梅毒检测结果,进行统计学分析。结果兰州市299 969位无偿献血者梅毒抗体筛查阳性率为0.59%,不同文化程度、年龄、性别、职业、婚姻、民族的不合格率差异有统计学意义(P0.05);兰州市与省内3家中心血站的无偿献血人群相比,不同文化程度、年龄、职业、民族的不合格率的差异无统计学意义(P0.05)。结论甘肃省无偿献血者中,学历较高的、18~30岁、学生、医务人员、汉族人群是全省招募安全固定献血者的重点对象;开展梅毒抗体联合筛查策略,拟定甘肃省梅毒反应性的献血者归队策略。     

广东省惠州地区HBV、HCV、TP和HIV感染情况分析

目的检测并分析广东省惠州地区乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、梅毒螺旋体(TP)和人类免疫缺陷病毒(HIV)的感染情况,为疾病防控提供临床依据。方法对2014-2017年共103229例、65770例、55667例和63201例体检人群或患者分别进行HBV、HCV、TP、HIV的检测,对性别、年龄、人群和年份分布进行分析。结果广东惠州地区的HBV、HCV、TP和HIV的阳性率分别为16.81%、1.02%、1.85%和0.11%。男性在HBV、HCV、HIV感染率均高于女性,差异有统计学意义(P0.05)。HBV、HCV、TP感染的成年组均高于未成年组(P0.05)。而HIV的18～60岁组阳性率较高(0.13%),但各年龄组差异无统计学意义(P0.05)。门诊病人的四种疾病阳性率明显高于体检人员和住院患者(P0.05)。不同年份间HBV、HCV、TP感染率差异有统计学意义,其中HBV阳性率逐年降低,而HCV则升高。结论该地区HBV、HCV、TP和HIV感染率仍较高,尤其要关注门诊病人,做好疾病防控,减少职业暴露。     

浙江省湖州市婚检人群艾滋病、梅毒、乙型病毒性肝炎检测分析

目的 了解浙江省湖州市婚检人群中艾滋病、梅毒和乙型病毒性肝炎(乙肝)的感染情况并作必要性探讨。 方法 对2008年5月至2010年12月到浙江省湖州市妇幼保健院进行婚前医学检查人群进行乙肝病毒表面抗原(HBsAg)、梅毒抗体及人类免疫缺陷病毒抗体(抗-HIV)检测。 结果 21 831名婚检人群中,HBsAg阳性居首位,占4.65%;其次是梅毒抗体阳性,占0.30%;再次是抗-HIV阳性,占0.009%。男、女性HBsAg阳性率差异有统计学意义,男性高于女性(2=46.63,P0.05);男、女性梅毒阳性率差异无统计学意义(2=0.38,P0.05)。2008 - 2010年HBsAg阳性率有逐渐下降趋势,各年间差异无统计学意义(2=3.93,P0.05);梅毒抗体阳性率有逐渐上升趋势,各年间差异有统计学意义(2=10.44,P0.05);从乙肝三系检测结果看,HBeAg阳性占20.95%,主要为HBsAg+HBeAg+抗-HBc和HBsAg+抗-HBe+抗-HBc两种模式,占83.82%。 结论 湖州市婚检人群HBsAg、梅毒、HIV感染率不高,但婚检人群作为特殊人群,应引起特别关注;婚前医学检查对疾病控制、普及传染病预防知识、提高生活质量、保障家庭幸福及提高出生人口素质有重要意义。     

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.     

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.     

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.     

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.     

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.