Sysmex CS5100与Sysmex CA7000血凝仪测定结果的可比性分析

目的验证Sysmex CS5100和Sysmex CA7000两台全自动血凝仪检测结果的一致性和可靠性。方法利用血凝仪配套的校准品Standard Human Plasma对Sysmex CS5100和Sysmex CA7000进行校准。校准合格后,随机选取20例临床患者标本对凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D-二聚体(DD)5个参数进行两次平行试验并将两组数据的平均值进行对比。所选标本的测定值要尽量覆盖各个项目仪器检测的线性范围,把通过卫生部临床检验中心室间质评测定的Sysmex CA7000作为参考仪器,Sysmex CS5100作为对比仪器,计算出两者的检测结果偏差,对其进行对比分析。结果两台仪器在校准后,对选定标本所测得的各项检测结果经对比所得偏差均在允许范围内。结论实验室检测系统的定期校准和对比,有利于检测结果的质量控制,可以确保同一检验项目在不同应用程序和设备间的检验结果的一致性和可靠性,从而更好地为临床提供优质的服务。     

Sysmex CS5100全自动凝血分析仪性能评价与比对研究

目的对Sysmex CS5100全自动凝血分析仪(以下简称CS5100)的性能进行评价,并与Sysmex CA7000全自动凝血分析仪(以下简称CA7000)比对,分析系统准确性及可靠性。方法对CS5100进行正确度、精密度、纤维蛋白原(Fib)线性、携带污染率和参考区间进行评价,同时将CS5100与CA7000进行比对试验。检测指标包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、Fib。结果 CS5100检测PT、APTT、Fib等主要参数的准确性、批内不精密度、日间不精密度均符合ISO15189相关文件要求,Fib线性良好(r=0.994),最高携带污染率为-2.81%,参考区间符合95%的要求,参与室间质评成绩优秀,与CA7000比对结果合格。结论 CS5100各方面性能良好,可用于临床标本的检测,检测结果可用于临床的诊断和治疗。     

Sysmex CA7000及CS5100全自动凝血分析仪性能评价

目的验证Sysmex CA7000和CS5100全自动凝血分析仪系统性能。方法参考美国临床和实验室标准化协会(NCCLS)相关文件,并对照全国临床检验操作规程(第4版)及卫生行业标准的有关规定,对Sysmex CA7000和CS5100不精密度、准确度、携带污染率、线性、检测限、参考区间进行系统评价。结果批内精密度、日间精密度正常样本和异常样本变异系数(CV)均在规定范围内。准确度验证各项目符合卫生部室间质评定值范围,携带污染率、线性评价、检测限、参考范围验证均符合本室质量管理要求。结论 CA7000及CS5100凝血分析仪不精密度、准确度、携带污染率、线性、检测限、参考区间验证评价通过,该系列仪器性能良好,有效保证凝血检测结果的可靠性及可比性。     

Sysmex CA 7000和CA 1500全自动血凝仪性能评价及实验室比对

目的通过对Sysmex CA 7000和CA 1500全自动血凝仪进行性能评价,以及仪器间实验室比对,确定2套检测系统是否稳定、可靠。方法分别在Sysmex CA 7000和CA 1500全自动血凝仪上进行批内精密度、日间精密度、线性验证、临床可报告范围、准确性验证、正确度验证,并对2套检测系统进行仪器间实验室比对。结果Sysmex CA 7000和CA 1500全自动血凝仪检测各项指标的变异系数及相关系数均满足CLIA′88检测要求。结论Sysmex CA 7000和CA 1500全自动血凝仪2套检测系统精密度好、线性良好、临床可报告范围宽、准确性高、正确度良好,2套检测系统实验室比对数据具有良好的可比性。     

Sysmex CA 7000全自动凝血仪性能评价

目的对Sysmex CA7000全自动凝血仪进行性能评价。方法对Sysmex CA 7000凝血仪上的准确性、不精密度、线性、检测限、携带污染率进行评价。检测189名健康体检者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)并建立95%参考区间。结果准确性试验测定结果在厂家给定范围或标定靶值的±8%范围内,仪器的准确性良好。批内和天间最大变异系数(CV)为6.05%,符合厂家要求(CV<10%),仪器的不精密度良好。线性验证试验结果显示FIB相关系数(r)为0.999 1、FⅧ∶C为0.999 5、AT∶A为0.998 5、D-二聚体(D-D)为0.996 7,均符合厂家要求(r≥0.975),仪器线性范围良好。检测限最大CV为10.45%,符合厂家要求(CV<20%),对低值样本有较好的检测能力。样本及试剂携带污染率最高CV为5.44%,均符合厂家要求(≤10%)。PT、APTT、TT和FIB的95%参考区间分别为8.0~14.2 s、25.1~40.8 s、15.1~19.7 s、1.7~4.0 g/L。结论 Sysmex CA7000凝血仪具有精密度良好...     

Sysmex CA 6000全自动血凝仪实验性能评价

目的对日本希森美康(Sysmex)株式会社生产的CA 6000全自动血凝仪进行实验性能评价.方法在Sysmex CA 6000 血凝仪上进行重复性试验、稳定性试验、线性试验、抗生物性干扰物影响试验,并与Organon Teknika公司生产的CAM-MTX血凝仪进行相关性试验,所测指标为凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fbg).结果所测指标的批内变异系数均小于2%,日间变异系数均小于5%,Fbg的线性范围为0.395 g/L～9.44 g/L,中轻度溶血、黄疸、脂浊对CA 6000 血凝仪测定结果的影响度均小于7.8%,CA 6000血凝仪与CAM-MTX血凝仪检测结果的相关性较好,相关系数r均大于0.95.结论 CA 6000血凝仪有优良的重复性、稳定性、良好的抗生物性干扰物质的功能,良好的仪器检测间的相关性和较宽的Fbg检测范围.     

Sysmex CA6000全自动血凝仪实验性能评价

目的 对日本希森美康(Sysmex)株式会社生产的CA6000全自动血凝仪进行实验性能评价。方法 在Sysmex CA 6000血凝仪上进行重复性试验、稳定性试验、线性试验、抗生物性干扰物影响试验，并与Organon Teknika公司生产的CAM—MTX血凝仪进行相关性试验，所测指标为凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)。结果 所测指标的批内变异系数均小于2％，日间变异系数均小于5％，Fbg的线性范围为0．395g／L～9．44g／L，中轻度溶血、黄疸、脂浊对CA 6000血凝仪测定结果的影响度均小于7．8％，CA 6000血凝仪与CAM—MTX血凝仪检测结果的相关性较好，相关系数r均大于0．95。结论 CA6000血凝仪有优良的重复性、稳定性、良好的抗生物性干扰物质的功能，良好的仪器检测间的相关性和较宽的Fbg检测范围。     

Sysmex CA 7000全自动凝血仪性能评价

目的对Sysmex CA7000全自动凝血仪进行性能评价。方法对Sysmex CA 7000凝血仪上的准确性、不精密度、线性、检测限、携带污染率进行评价。检测189名健康体检者的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）并建立95%参考区间。结果准确性试验测定结果在厂家给定范围或标定靶值的±8%范围内,仪器的准确性良好。批内和天间最大变异系数（CV）为6.05%,符合厂家要求（CV〈10%）,仪器的不精密度良好。线性验证试验结果显示FIB相关系数（r）为0.999 1、FⅧ∶C为0.999 5、AT∶A为0.998 5、D-二聚体（D-D）为0.996 7,均符合厂家要求（r≥0.975）,仪器线性范围良好。检测限最大CV为10.45%,符合厂家要求（CV〈20%）,对低值样本有较好的检测能力。样本及试剂携带污染率最高CV为5.44%,均符合厂家要求（≤10%）。PT、APTT、TT和FIB的95%参考区间分别为8.0～14.2 s、25.1～40.8 s、15.1～19.7 s、1.7～4.0 g/L。结论 Sysmex CA7000凝血仪具有精密度良好、准确性可靠、检测范围宽、对低值样本有良好的检测结果、样本间及试剂间携带污染率低的特点,适合临床应用。     

全自动血凝仪SYSMEX CS5100性能验证

目的探讨SYSMEX公司的CS5100全自动血凝仪基本性能的临床应用价值。方法以凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)为分析参数,从精密度、携带污染率、线性、抗干扰能力、正确度、准确度等方面对仪器进行性能评价。结果 CS5100分析仪的批内精密度在仪器设定范围内,批间精密度符合1/3行业标准要求。Fbg的线性范围0.67~6.70g/L,涵盖95%以上住院患者的检测范围。携带污染率小,符合仪器要求。对溶血、脂血、胆红素血的抗干扰能力强,保证结果的准确性。各参数的准确度均符合1/3行业标准要求。现行参考区间适合有效。结论全自动血凝仪CS5100凝固法比浊原理测试性能良好,所测项目的结果可靠准确,能满足临床实验室工作需求。     

Sysmex CS5100全自动凝血分析仪性能评价

目的验证Sysmex CS5100全自动凝血分析仪的系统性能,确定该检测系统是否稳定、准确、可靠。方法对Sysmex CS5100全自动凝血分析仪上的准确度、不精密度、线性、检测限、携带污染率进行评价。测试20例健康体检者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)验证厂家提供的参考区间。结果准确度试验测定结果全部合格;批内最大变异系数(CV)3.82%、批间最大CV值为6.24%;线性试验FIB相关系数(r)为0.998 9、D-二聚体(DD)r为0.996 7、纤维蛋白(原)降解产物(FDP)r为0.998 5;检测限最大CV为6.13%;携带污染率最大值为-6.45%,验证全部合格。结论 Sysmex CS5100全自动凝血分析仪是一个精密度好、准确度高、检测范围宽、携带污染率低的检测系统。     

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.