UF-100尿沉渣分析仪及干化学分析在筛检尿路感染中的应用

目的 用中段尿定量细菌培养作为金标准，比较UF-100尿沉渣分析仪(简称UF-100)及干化学分析试验在筛检尿路感染(UTI)中的可靠性。方法 对369份中段尿标本做细菌培养菌落计数和UF-100及干化学分析，并比较结果。结果 91例培养出细菌，占24．7％；在UF-100细菌计量≥2750μl，白细胞≥20μl，且干化学分析中自细胞酯酶和亚硝酸盐试验为阳性时，待检标本的特异性和阳性预示值最大，分别为99．3％、92．0％；但此时敏感性较低，仅为25．3％，且假阴性例数较高达68例，占18．4％。结论 UF-100、干化学分析单独或联合运用均不能准确预见尿培养结果，诊断UTI仍须做细菌培养。     

尿干化学分析和涂片镜检在筛选尿路感染中的应用

目的　比较尿干化学分析中白细胞酯酶、亚硝酸盐试验和涂片染色镜检在筛选泌尿系统感染中的可靠性。方法　收集 4 0 0份合格中段尿标本 ,先取 10 μl做细菌培养及菌落计数 ,剩余标本做干化学分析及涂片染色镜检。结果　有 4 1例培养出有意义细菌 (菌落计数≥ 10 5cfu/ml) ,占 10 .3%。白细胞酯酶和亚硝酸盐试验的敏感性分别为 73.2 %、4 6 .3% ,特异性分别为 86 .6 %、98.1% ,两者合并敏感性、特异性分别为 90 .2 %、85 .2 %。另外有 4例 (9.5 % )标本培养阳性但干化学分析阴性。镜检共有 30例阳性 ,敏感性 6 1.36 % (2 7/ 4 1) ,其中 3例镜检阳性但培养阴性。若以菌落计数≥ 10 4cfu/ml为标准 ,则阳性例数达到 5 5例 (占 13.8% ) ,干化学分析的敏感性、特异性及阴性预示值 (NPV)变化不大 ,但阳性预示值 (PPV)却显著提高 ;涂片染色镜检的特异性稍有降低 ,但镜检PPV却不变。结论　尿试条干化学分析、涂片染色镜检在筛选泌尿系统感染时敏感性不足 ,诊断泌尿系统感染须做细菌培养     

尿有形成分、尿干化学和尿培养联合检测对于尿路感染的意义

目的分析尿有形成分分析、尿干化学和尿培养之间的关系,以探讨尿常规检查对于尿路感染(UTI)的意义。方法分别采用iQ200尿液有形成分分析仪(简称iQ200)、COMBI500尿11项干化学分析仪及VITECK32细菌鉴定仪对309例临床中段尿标本同时进行尿有形成分、尿干化学分析及细菌培养,分析尿培养鉴定、白细胞定量、细菌定量、白细胞酯酶(LE)和亚硝酸盐(NIT)之间的关系。比较这5项指标对UTI筛查和诊断的意义。结果有效统计标本271例,其中尿培养阳性74例,阳性率为27.3%。当细菌定量阳性(白细胞≥20个/μL)、且LE和NIT为阳性时,待检标本UTI的特异性和阳性预测值最大,分别为98.1%(52/53)和96.0%(24/25),但此时敏感性较低,仅为32.4%(24/74)。当以细菌定量、白细胞、LE中的任一阳性结果作为阳性筛选时,敏感性可达94.6%(70/74),阴性预测值达0.778(14/18)。尿常规4个检测单项以白细胞的诊断效率最高,约登指数为0.420,且其检测结果与细菌培养结果具有一致性。iQ200对革兰阴性杆菌的检测能力优于阳性球菌。结论尿常规检查中干化学和iQ200的4个尿路感染的相关指标可快速拟诊或排除UTI;4个关键指标均为阳性时,可临床诊断UTI,但确诊仍需尿培养结果。iQ200诊断UTI的效能优于尿干化学检测。     

尿干化学分析和涂片镜检在筛选尿路感染中的应用

目的 比较尿干化学分析中白细胞酯酶、亚硝酸盐试验和涂片染色镜检在筛选泌尿系统感染中的可靠性。方法 收集400份合格中段尿标本，先取10μl做细菌培养及菌落计数，剩余标本做干化学分析及涂片染色镜检。结果 有41例培养出有意义细菌(菌落计数≥10^5cfu／ml)，占10．3％。白细胞酯酶和亚硝酸盐试验的敏感性分别为73．2％、46．3％，特异性分别为86．6％、98．1％，两者合并敏感性、特异性分别为90．2％、85．2％。另外有4例(9．5％)标本培养阳性但干化学分析阴性。镜检共有30例阳性，敏感性61．36％(27／41)，其中3例镜检阳性但培养阴性。若以菌落计数≥10^4cfu／ml为标准，则阳性例数达到55例(占13．8％)，干化学分析的敏感性、特异性及阴性预示值(NPV)变化不大，但阳性预示值(PPV)却显著提高；涂片染色镜检的特异性稍有降低，但镜检PPV却不变。结论 尿试条干化学分析、涂片染色镜检在筛选泌尿系统感染时敏感性不足，诊断泌尿系统感染须做细菌培养。     

尿液不同检测方法对泌尿系统感染的诊断价值

目的:观察尿有形成分分析及干化学分析筛查泌尿系统感染的价值.方法:留取130例尿路感染患者中段尿标本,应用培养法进行细菌计数和鉴定,应用UF-1000i尿有形成分分析仪检测细菌计数和WBC,应用H-100MA尿干化学分析仪测定白细胞酯酶和亚硝酸盐.以中段尿定量细菌培养结果为标准,比较尿有形成分分析及干化学分析诊断尿路感染的准确率.结果:培养法检出细菌阳性标本954份(73.1%),分离出细菌102株.尿干化学分析和尿有形成分分析检测结果中分别有49份和83份为阳性,阳性率分别为37.7%和63.8%.结论:诊断尿路感染需做细菌培养,尿有形成分分析和干化学分析参数不能作为诊断尿路感染的依据,可用于尿路感染治疗时动态监洲.     

UF-100流式尿分析仪在筛检妊娠早期妇女无症状尿路感染中的应用

目的用UF-100检测妊娠早期妇女中段尿,以中段尿定量细菌培养作为金标准,比较UF-100在筛选妊娠早期妇女无症状尿路感染(AUTI)中的可靠性。方法对667份妊娠早期妇女中段尿标本,做细菌培养菌落计数与UF-100流式尿分析仪结果进行比较。结果51例培养出细菌占7.7%;通过对UF-100不同的Cut off值比较,实验认为:在UF-100细菌计量为≥2 750/μl,白细胞≥20/μl为阳性时,待检标本的特异性(Sp)和阴性预示值(NPV)最大,分别为99.4%,99.5%,同时检测的敏感性(Se)和阳性预示值(PPV)也较高,分别为94.0%,92.2%。结论快速筛检妊娠早期妇女无症状尿路感染,用UF-100是可行的;诊断妊娠早期妇女无症状尿路感染,仍须做细菌培养。     

UF-100尿液分析仪在筛检妊娠早期妇女无症状尿路感染中的应用

目的用UF-100尿液分析仪检测妊娠早期妇女中段尿,以中段尿定量细菌培养作为金标准,比较UF-100尿液分析仪在筛检妊娠早期妇女无症状尿路感染(AUTI)中的可靠性。方法对897例妊娠早期妇女中段尿标本做细菌培养菌落计数和UF-100尿液分析仪检测并比较结果。结果74例培养出细菌,占8.2%;以UF-100尿液分析仪细菌计数≥2 750/μL、白细胞≥20/μL为阳性时,待检标本的特异性和阴性预测值最大,分别为97.3%、99.0%。结论用UF-100尿液分析仪快速筛检妊娠早期妇女AUTI是可行的;但诊断妊娠早期妇女AUTI,仍须做细菌培养。     

3种检测方法在尿路感染中的应用探讨

目的探讨UF-1000i尿沉渣分析、AX-4030尿干化学分析、尿液离心镜检3种检测方法在尿路感染中的应用。方法随机选择385份门诊或住院患者的中段尿标本,同时进行3种方法的检测,以定量细菌培养为金标准,比较不同方法的结果与定量细菌培养结果的一致性。结果385份尿液样本中有68例细菌培养为阳性,占17.7%(按照尿中革兰阳性菌≥104CFU/mL,革兰阴性菌≥10~5 CFU/mL时诊断为尿路感染标准)。在UF-1000i尿沉渣分析中,细菌计量≥2 750/μL,白细胞数≥20/μL为尿路感染标准,同为阳性时灵敏度最低为60.2%,阳性预测值达最高为63.0%。在AX-4030尿干化学分析中白细胞酯酶(LEU)和亚硝酸盐试验同时为阳性,灵敏度最低为45.6%,阳性预测值最高为68.0%。在尿液离心镜检中灵敏度有所提高,其灵敏度为63.2%,但阳性预测值仅为48.9%。结论 UF-1000i尿沉渣自动分析、AX-4030尿干化学分析、尿沉渣离心镜检阴性预测值较高,在筛选泌尿系统感染时灵敏度不足,因此,在诊断泌尿系统感染时以上3种检测方法均不能替代尿定量细菌培养。     

社区与院内妇女妊娠早期无症状尿路感染的筛选与分析

目的用UF-100流式尿液分析仪筛栓社区与院内妊娠早期妇女无症状尿路感染，以中段尿定量细菌培养作为金标准，同时探讨社区与院内妊娠早期妇女无症状尿路感染病原学构成特点及抗生素耐药情况。方法对897份妇科门诊（551份，占61．4％）与住院（346份，占38．6％）妊娠早期患者中段尿标本，做细菌培养菌落计数、药敏试验，同时与UF-100流式尿分析仪做比较。结果总计74例培养出细菌，占8．3％；其中社区标本检出49例，占66．22％，院内标本检出25例，占33．78％，社区与院内尿路感染的病原学分布以大肠埃希菌、肠球菌为主，但两菌所占比例不同；药敏试验也存在差异。同时在UF—100上检测细菌计量≥2750／μl，白细胞≥20／μl为阳性时，待检标本的特异度（Sp）和阴性预示值（NPV）最大，分别为97．3％，99．0％，且假阴性例数较低为8例，仅占0．89％。结论筛检社区与院内妊娠早期妇女无症状尿路感染，用UF-100是可行的；认识社区与院内尿路感染病原菌分布及细菌耐药规律，对指导临床正确用药十分有益。     

尿流式有形成分及干化学分析在尿路感染诊断中的应用评价

目的 评价尿干化学分析及UF-1000i流式尿有形成分分析单独及联合应用时在尿路感染诊断中的应用价值.方法 留取148例尿路感染(UTI)患者、284例非尿路感染患者的中段尿标本,分别用培养法做尿细菌计数和鉴定,用UF-1000i流式尿有形成分分析仪做细菌计数(BACT)、酵母样菌(YEC)、WBC检测,用URISYS 2400尿干化学分析仪做自细胞酯酶(LEU)、亚硝酸盐(NIT)检测.评价尿干化学分析、UF-1000i流式尿有形成分分析仪以及UF-1000i联合尿干化学分析与定量尿细菌培养对诊断UTI的一致程度,并评价其对UTI诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度.结果 在148例尿路感染患者中,定量尿细菌培养的检出率为73.6%(109/148),尿干化学分析LEU和NIT同时为阳性的检出率为26.4%(39/148),两种方法的检出率之间差异有统计学意义(χ2=55.68,P<0.05).UF-1000i流式尿有形成分分析BACT和WBC任意1项为阳性诊断UTI的检出率为91.2%(135/148),高于定量尿细菌培养的检出率,差异有统计学意义(χ2=14.70,P<0.05).UF-1000i流式尿有形成分分析和尿干化学分析仪联合参数BACT、WBC、LEU和NIT任意1项为阳性诊断UTI的检出率为94.6%(140/148),高于定量尿细菌培养的检出率,差异有统计学意义(χ2=20.45,P<0.05).尿干化学分析敏感度较低,为26.4%(39/148),特异度较高,为99.3%(282/284);应用UF-1000i流式尿有形成分分析BACT作为尿路感染诊断依据时的敏感度为92.6%(137/148),特异度为39.8%(113/284),阳性预测值为44.5%(137/308),阴性预测值为91.1%(113/124);尿干化学分析与UF-1000i流式尿有形成分分析联合应用时,敏感度为98.O%(145/148),阴性预测值97.1%(100/103),特异度为35.2%(100/284),阳性预测值为44.1%(145/329),准确度为56.7%(245/432).结论 联合UF-1000i流式尿有形成分分析及尿干化学分析可在早期尿路感染筛查诊断中发挥重要作用;同时对尿细菌培养为阴性的UTI患者的明确诊断具有重要价值.     

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.     

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.