抗凝剂血浆和血清对血无机磷测定的相关性探讨

目的了解4种抗凝剂血浆和对应血清测定血无机磷的相关性。方法以血浆为候选法及对应血清为标准方法 ,采用全自动生化分析仪直接测定。结果 4种抗凝剂抗凝血浆及对应血清平行测定结果为:肝素、草酸钾、EDTA-K2抗凝血浆及对应血清均有较好的相关性(r=0.890、0.818、0.848);回归系数假设检验,肝素、草酸钾、EDTA-K2抗凝血浆和对应血清回归方程比较差异有统计学意义(P0.05),呈直线回归关系。枸橼酸钠抗凝血浆及对应血清呈中度相关(r=0.762);回归系数假设检验,血浆和血清回归方程比较差异有统计学意义(P0.05),呈直线回归关系。结论肝素、草酸钾、EDTA-K2抗凝血浆能快速、准确地提供检测结果 ,与参考方法结果有可比性,而枸橼酸钠抗凝血浆检测结果与参考方法结果的可比性不如前者。     

肝素锂、EDTA-K_2抗凝剂对生化检测影响的调查与分析

目的探讨肝素锂与EDTA-K2抗凝血浆对生化检测指标的影响,以期在临床上采用血浆代替血清进行生化检测。方法将同一血液样品放置于无抗凝剂的采血管、肝素锂抗凝管和EDTA-K2抗凝管,在同一时间内用全自动生化分析仪进行检测,并对检测结果进比较分析。结果 16项肝素锂、EDTA-K2抗凝血浆与血清样品比较差异无统计学意义（r2〉0.800、P〉0.05）;11项肝素锂抗凝血浆与血清比较差异无统计学意义（r2〉0.800、P〉0.05）;4项肝素锂抗凝血浆与血清比较差异有统计学意义（r2〉0.800、P〈0.05）,检测以上指标时可用肝素锂抗凝血浆代替血清。3项肝素锂与EDTA-K2抗凝血浆与血清相关性差（r2〈0.800）。结论大多数指标可以用肝素锂抗凝血浆代替血清,部分亦可用EDTA-K2抗凝血浆代替血清,但是需要建立相应的回归关系或者血浆参考体系,少数样品不宜用血浆代替血清或者只能采用血浆进行检测。临床检测用血浆代替血清,在提高检测效率以及避免患者多次多量采血等方面具有重要意义。     

普通促凝管与EDTA-K2抗凝管在血糖测定中差异的探讨

目的 探寻一种快速、准确的血糖检测方法,并且适用于乙二胺四乙酸二钾(EDTA-K2)抗凝血浆.方法 将同一份标本分别抽取于不含抗凝剂的促凝管中和含EDTA-K2的抗凝管中,分别对血清、血浆用HITACHI7600全自动生化分析仪检测血糖,观察抗凝剂EDTA-K2的使用对检测结果的影响.结果 EDTA-K2抗凝组血糖检测结果与血清对照组比较,差异无统计学意义(P=0.269 7).结论 EDTA-K2抗凝剂抗凝血浆较适用于葡萄糖含量的测定,不仅在急诊检验中可大大缩短报告时间,而且在糖尿病的普查、监控和疗效观察中,特别是在婴幼儿手足口病筛查中均有重要意义.     

不同标本类型间髓过氧化物酶水平的检测分析

目的探讨不同标本类型间髓过氧化物酶(MPO)检测结果的差异性、抗凝剂的选择及检测结果的比对。方法同时采集165例健康体检人群含乙二胺四乙酸二钾(EDTA-K2)、肝素钠两种抗凝剂的血浆标本及不含抗凝剂的普通生化管的血清标本,分别检测3种标本类型中MPO水平,并对各组检测结果进行统计学分析。结果同一例体检者不同抗凝剂的血浆标本间及与不含抗凝剂的血清标本间MPO检测结果差异有统计学意义(P0.05)。结论不同标本类型对血液标本中MPO水平检测结果差异较大,建议各个实验室检测时根据不同抗凝剂制订相应的参考区间;由于EDTA-K2抗凝血浆不受体外白细胞中MPO释放的影响,推荐采用EDTA-K2抗凝血作为检测MPO水平的首选。     

乙二胺四乙酸二钾抗凝血浆与血清肝功能8项检测结果比较

目的探讨乙二胺四乙酸二钾(EDTA-K2)抗凝血浆与血清在检测总胆红素(TBIL)、直接胆红素(DBIL)、总蛋白(TP)、清蛋白(ALB)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)等8项肝功能指标结果的差异。方法在全自动生化分析仪上对EDTA-K2抗凝血浆和血清分别进行上述8项生化检测,并对结果进行比较和评价。结果 EDTA-K2抗凝血浆与血清比较,TBIL、TP、ALB、ALT、AST结果差异无统计学意义(P>0.05),EDTA-K2抗凝血浆ALP明显低于血清,差异有统计学意义(P<0.01),GGT略低于血清,差异有统计学意义(P<0.01),DBIL明显高于血清,差异有统计学意义(P<0.01)。结论 EDTA-K2抗凝血浆可用于TBIL、TP、ALB、ALT、AST检测,不宜用于DBIL、ALP检测,对GGT检测结果应制订EDTA-K2血浆参考范围或乘以校正系数。     

干化学法与速率法在不同血液样本ALT检测中的应用简

目的 探讨无偿献血者不同血液样本在干化学法与速率法丙氨酸氨基转移酶（ALT）检测中的应用,找出适合两法检测的血液样本,提高检测的可靠性.方法 采用干化学法对不抗凝全血、血清、EDTA-K2抗凝血浆、EDTA-K2抗凝血袋辫血浆样本检测ALT,同时采用速率法对血清、EDTA-K2抗凝血浆、EDTA-K2抗凝血袋辫血浆样本检测ALT,将干化学法检测的不同血液样本与不抗凝全血样本,速率法检测的不同血液样本与血清样本ALT检测结果相比较,分析其-致性.结果 不同血液样本对干化学法与速率法ALT结果的差异有统计学意义（F=19.43,P＜0.01;F=11.48,P＜0.01）.干化学法不抗凝全血样本与速率法EDTA-K2抗凝血浆样本ALT检测结果具有良好的一致性（F=2.81,P＞0.05）,回归方程为Y=1.044X-4.280,相关系数R＝0.993 7,R2=0.987 4,表明两种方法的相关性良好.结论 不抗凝全血、血清样本适合干化学法ALT检测,EDTA-K2抗凝的血液样本不适合干化学法检测.血清、EDTA-K2抗凝血浆样本适合速率法ALT检测,血袋辫血样本因含有ACD保养液会影响干化学法与速率法ALT检测结果,使结果变低.可以采用干化学法不抗凝全血样本初筛,EDTA-K2抗凝血浆样本速率法复检.     

常规生化检测项目血清与血浆的对比分析

目的通过实验对比常规生化检测中血清和血浆的差异。方法在全自动生化分析仪上,对血清和乙二胺四乙酸二钾（EDTA-K2）抗凝血浆的13项常规生化指标进行检测,并将测定结果进行比较和分析。结果13项常规生化指标中,血清和EDTA-K2抗凝血浆有10项有统计学差异。结论为了保证常规生化检验的质量,为临床提供准确的检测数据,EDTA-K2抗凝血浆不能应用于常规生化检测中。     

不同血液样本在生化项目检测中的结果比较

目的比较血清样本、不同抗凝血浆在常规生化项目检测中的结果差异。方法对50例体检者的5种不同血液样本(血清、肝素锂血浆、枸橼酸钠血浆、乙二胺四乙酸二钾(EDTA-K2)血浆、HMF血浆)在相同测量条件下测定15项生化指标。结果与血清组比较:肝素锂血浆组碱性磷酸酶(ALP)、清蛋白(ALB)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(HDL-C)的检测结果差异有统计学意义(P<0.05),天门冬氨酸氨基转移酶(AST)的检测结果差异有统计学意义(P<0.01);EDTA-K2血浆组除高密度脂蛋白胆固醇(HDL-C)、肌酐(Cr),5-羟甲基糖酫(HMF)血浆组除LDH-C的检测结果差异无统计学意义(P>0.05),其余各抗凝血浆组生化项目的检测结果均与血清组差异有统计学意义(P<0.05)。结论不同的血液标本对常规生化项目的检测几乎都具有显著性的差异,应根据WHO建议选用适宜的标本类型进行分别检测。     

采用离子选择性电极间接法检测血浆钾离子正常参考区间的建立与评价

目的 建立惠州地区人群采用离子选择性电极间接法检测肝素钠抗凝血浆钾离子的正常参考区间及评价其必要性.方法 用离子选择性电极间接法检测惠州地区1710例不同性别、年龄正常人群的肝素钠抗凝血浆钾离子浓度,用统计学方法分析制定正常参考区间;并用离子选择性电极间接法同比检测比较不同水平钾离子浓度的肝素钠抗凝血浆和血清两种标本类型,分析两者之间的差异.结果 正常人群不同性别组间差异无统计学意义(P=0.743),成年组与未成年组和老年组相比差异均有统计学意义(P=0.004,0.003),成年组血浆钾离子平均浓度(3.69±0.28)mmol/L,未成年组和老年组合并血浆钾离子平均浓度(3.76±0.36)mmol/L,肝素钠抗凝血浆与血清两种标本类型在高中低三种水平检测中,差异均有统计学意义(均P=0.000).结论 本研究对惠州地区正常人群采用离子选择性电极间接法检测肝素钠抗凝血浆钾离子建立了正常参考区间,为临床准确诊治疾病提供了科学依据,同时为相关实验室制定正常参考区间提供参考数据.     

EDTA-K2抗凝血浆与血清中心脏标志物检测结果的一致性验证

目的 确定肌红蛋白(Myo)、肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)在乙二胺四乙酸二钾(EDTA-K2)抗凝血浆与血清标本中的检测结果是否存在明显差异.方法 采用亚辉龙iFlash 3000-H化学发光测定仪检测133例患者EDTA-K2抗凝血浆与血清中Myo、cTnI和CK-MB水平.结果 血清和血浆M...     

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.     

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.