四种梅毒血清学检测方法的比较

目的评价梅毒甲苯胺红不加热血清反应素试验(TRUST)、快速血浆反应素环状卡片试验(RPR)、梅毒酶联免疫吸附试验(TP-ELISA)和梅毒螺旋体明胶凝集试验(TPPA)在梅毒检测中的应用价值。方法同时用RPR、TRUST、TP-ELISA和TPPA法检测确诊为梅毒患者的血清87份、健康查体人员血清100份及非梅毒患者的血清50份,并评价TRUST、RPR、TP-ELISA和TPPA法检测结果的敏感性和特异性等。ELISA法结合TRUST法双法筛查梅毒抗体,阳性标本再用TPPA法甄别生物学假阳性。结果TRUST、RPR和TPPA法对87份TP-ELISA法检测为阳性标本的敏感性分别为75.86%,74.71%,98.90%,特异性为98.67%,98.67%和100.00%。RPR法与TRUST法、TPPA法与ELISA法比较差异均无显著性意义(P均>0.05);TRUST法与TPPA法、RPR法与TPPA法比较差异均有显著性意义(P均<0.01)。100份健康查体人员血清,RPR、TRUST、TP-ELISA和TPPA法检测均为阴性,50份非梅毒患者血清进行RPR和TRUST法检测,2份阳性。结论TP-ELISA可替代TPPA使用;RPR法和TRUST法存在不同程度的假阳性,TP-ELISA结合TRUST双法筛查血液,用TPPA报告确证试验阳性。     

梅毒螺旋体抗体酶联免疫吸附试验作为初筛方法的梅毒逆向筛查程序的可行性分析

目的:探讨TP-ELISA作为初筛方法的梅毒逆向筛查程序的可行性分析。方法:选择2016年1月至2017年6月在大连大学附属中山医院各门诊及病房就诊的梅毒筛查者,并收集其标本15378份,采用梅毒螺旋体抗体酶联免疫吸附试验(TP-ELISA)、梅毒螺旋体明胶颗粒凝集试验(TPPA)与甲苯胺红不加热血清学试验(TRUST)筛选分析。以TPPA为标准,比较各种方法的特异性、灵敏度以及总符合率,统计TP-ELISA的S/CO值与TPPA阳性结果的相关性。结果:TPPA筛查阳性率为3. 57%,TP-ELISA筛查阳性率为3. 83%,TRUST筛查阳性率为2. 38%。TP-ELISA的灵敏度(98. 9%)明显优于TRUST(64. 3%),差异具有统计学意义(P 0. 01)。TP-ELISA与TRUST特异性与符合率差异无统计学意义(P 0. 05)。梅毒筛查时,TP-ELISA与TPPA在梅毒筛查时有较好的一致性(K=0. 945),TRUST与TPPA一致性不明显(K=0. 639)。根据梅毒抗体检测的特点以及实验室TP-ELISA的检测方法,当≤1. 0时,S/CO为阳性, 1. 0时S/CO为阳性。TP-ELISA检测结果的假阳性样本率为75. 00%(54/72),其主要是发生在S/CO值1. 0～2. 99之间。随着TP-ELISA的S/CO的数值增高,TPPA的符合率也依次增加,S/CO 5. 0时,TPPA的阳性率为100%。TRUST的检测阳性样本有13例,患者主要有妇产科正常妊娠8例,口腔科牙周炎3例,心内、呼吸2例。TP-ELISA假阴性6例,其中分布为泌尿科患者3例,骨科患者1例,妇产科患者2例,其被疑为梅毒早期。TP-ELISA假阳性患者72例。结论:TP-ELISA的灵敏度和特异性显著优于TRUST,有利于梅毒筛查效果,值得临床上大样本筛查。     

80例梅毒血清学初筛试验分析

为分析梅毒血清学初筛试验中出现疑似阳性结果的原因,以获得其准确的判断.对本科80例血清标本采用TRUST法进行初筛,同时以TP-ELISA和TPPA法确证试验作为对照.结果:80例标本中,38例TRUST可疑阳性标本中,22例阳性(57.89%)、16例阴性(42.11%);17例TRUST阳性标本中,确证阳性符合率为94.12%(16/17),1例为阴性5.82%(1/17);25例TRUST阴性标本:15例(60%)阳性,10例阴性(40%).TP-ELISA法(两种试剂盒)与TPPA结果符合率为100%.TRUST初筛试验存在着一定比例的假阳性和假阴性,临床中应结合病史及临床表现进行综合分析后作出判断.     

基层医院梅毒螺旋体抗体筛查方法比较及筛查流程探讨

目的:探讨基层医院梅毒螺旋检测的筛查方法及流程。方法:对9169份标本分别应用酶联免疫方法,胶乳凝集方法,血浆反应素卡试验进行梅毒螺旋体特异性抗体和非特异性抗体的检测,其结果与梅毒螺旋体抗体颗粒凝集试验确证方法的结果相比较。结果:9169份标本中,ELISA方法检测出的83例阳性标本经TPPA确证后79例阳性占95.18%;胶乳快速法检测出的96例阳性标本经TPPA确证76例阳性占79.17%;两种方法双阳性的77例标本经TPPA确证76例为阳性占98.70%。RPR法检测到37份阳性标本,经TPPA确证34份阳性占91.89%。初筛ELISA,胶乳快速法,RPR三种方法均阳性的34例,与经TPPA确证均为阳性为100%。结论:对于基层医院可以用ELISA方法进行筛查,用胶乳法复检,并用RPR法做传染性的检测,适当改进筛查流程确保梅毒螺旋体的检查。     

不同梅毒筛查方法效果比较

目的比较不同梅毒检测方法诊断的准确性,为梅毒筛查和诊断提供依据。方法 23 762例血清标本采用微粒子化学发光免疫分析法(CMIA)和甲苯胺红不加热血清试验(TRUST)联合检测,阳性标本再用梅毒螺旋体明胶颗粒凝集试验(TP-PA)复检,同时对CMIA法检测S/CO值0.50~0.99的阴性血清标本也用TP-PA法复检。CMIA与TP-PA法检测结果不一致的血清标本用免疫印迹法(WB)进行确认。结果 CMIA法联合TRUST法检出1 108例阳性标本(4.66%),其中TRUST法阳性者486例(2.05%),CMIA法阳性者1 074例(4.52%),CMIA法(+)并TRUST法(+)者452例,TP-PA法复检阳性率100%。CMIA法(+)/TRUST法(-)者622例,TP-PA法复检阳性率92.12%;CMIA法(-)/TRUST法(+)者34例,TP-PA法复检阳性率0。CMIA法(-)者的S/CO值0.50~0.99时TP-PA法复检阳性率23.08%,S/CO值1.00~9.99时TP-PA法复检阳性率88.14%,且S/CO值越大,TP-PA法复检阳性率越高,S/CO值≥10.00时TP-PA法复检阳性率100%。WB法对61例CMIA法和TP-PA法不一致标本确证结果显示:CMIA法阳性预测值(PPV)为57.14%,TP-PA法阳性预测值为16.67%,差异有统计学意义(P0.05)。结论血清梅毒筛查检验方法的敏感性:CMIA法TP-PA法TRUST法。CMIA法自动化程度高,结果易保留,为梅毒特异性抗体筛查的首选方法。CMIA法检测阳性的标本需进一步作TRUST及其滴度试验,而CMIA法阴性的标本不必作TRUST试验,以避免TRUST试验假阳性结果误导临床诊疗。CMIA法检测S/CO值处于临界值附近时,临床医生应结合患者临床资料进行综合诊断,对疑似病例进行随访和复检。     

梅毒非特异性抗体与特异性抗体血清学检测的临床应用评价

目的 评价梅毒血清学检测中非特异性抗体的甲苯胺红未加热血清试验(TRUST)和特异性抗体的梅毒螺旋体抗体酶联免疫吸附试验(TP-ELISA)、梅毒螺旋体颗粒凝集试验(TPPA)3种方法对梅毒诊断的临床应用.方法 对340份血清样本分别采用上述3种方法进行梅毒抗体检测,以TPPA为对照,比较TRUST、TP-ELISA对...     

临沧市无偿献血标本梅毒检测阳性情况分析

目的对临沧市无偿献血标本梅毒检测阳性情况进行分析,为制定献血者梅毒检测阳性后的屏蔽、告知和归队策略提供依据。方法对无偿献血标本分别采用2种不同厂家的TP-ELISA试剂进行检测,两次检测均为阳性的标本送市疾控中心采用TPPA和TRUST法进行检测,对不同方法的检测结果进行统计分析。结果 TP-ELISA检测阳性人群以26岁至45岁的农民和流动人口为主,在献血标本TP-ELISA法检测结果判定为阳性的标本中,有17.79%为单试剂阳性或可疑阳性标本,在TP-ELISA双试剂阳性的标本中,有17.57﹪的标本TPPA和TRUST检测均为阴性。结论梅毒抗体阳性人群在不同年龄、职业分布方面有明显的差异性,在献血者招募及梅毒防治宣传时可以此为据进行针对性的招募和宣传;不同检测试剂、方法在灵敏度、特异性方面的差异是造成血液在梅毒抗体筛查项目上淘汰的重要原因,制定科学合理的献血者筛查、归队指南是保障血液安全及避免献血者流失的必要举措。     

三种梅毒血清学检测方法的临床评价

目的评价三种梅毒血清学检测方法的临床应用价值。方法同时应用梅毒螺旋体明胶颗粒凝集试验(TPPA)、梅毒螺旋体抗体酶联免疫吸附试验(TP-ELISA)、梅毒甲苯胺红不加热血清反应素试验(TRUST)对2 561例患者血清标本进行检测(术前患者、输血前患者、产前检查孕妇、性病门诊患者)。用灵敏度、特异性、准确性、阳性预测值、阴性预测值以及Youden指数对三种方法进行评价。以TPPA为对照标准,用χ~2检验分析三种方法对同一标本检验结果的一致性。结果 TPPA,ELISA以及TRUST的阳性率分别为20.30%,20.23%和13.71%。以TPPA为标准,ELISA阳性符合率为98.26%(509/518),敏感度、特异性、准确性分别为97.88%,99.56%和99.22%,差异无统计学意义(P0.05);以TPPA为标准,TRUST阳性符合率为99.15%(348/351),灵敏度、特异性、准确性分别为66.92%,99.85%和93.17%,差异也有统计学意义(P0.05)。结论三种梅毒血清学检测方法单独使用均不能快速、准确并且经济的检出梅毒抗体,需联合检测以提高梅毒检测的临床符合率。     

54 549例住院患者梅毒血清学检测结果分析

目的：了解我院2017年住院患者梅毒血清学检测情况。方法：采用酶联免疫吸附法（ELISA-TP）筛查, 筛查阳性者用甲苯胺红不加热试验（TRUST）试验和梅毒螺旋体明胶颗粒凝集试验(TPPA)检测。结果：共收集患者54 549例，ELISA-TP阳性者1625例(检出率为3.00%)，其中1145例再用TRUST和TPPA方法检测，双阳性172例，检出率为0.32%。结论：我院住院患者梅毒感染率高，应对入院患者进行梅毒常规筛查。     

老年患者梅毒血清检测结果分析

目的:通过1 160例住院患者梅毒血清检测,分析老年梅毒血清检测阳性结果,判断假阳性的可能,避免误诊.方法:所有病例均于入院后抽血测试,采用酶联免疫吸附试验(TP-ELISA),阳性者再采用快速血浆反应素试验(RPR)、明胶颗粒凝集试验(TPPA)进行确证,得出结果.结果:TP-ELISA检测检出阳性者8例,8例均为60岁以上老人,占总受检人数的0 69%;阳性者再次RPR确证,结果阳性2例,占总受检人数的0 17%; TPPA进行确证,结果阳性2例,占总受检人数的0 17%.结论:TP-ELISA法梅毒血清检测有假阳性,假阳性率为0 34%.因此,对于老年患者的梅毒血清学诊断,应在明确病史、实验室诊断相结合的同时,结合临床症状慎重确定.     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.