结核生物蛋白芯片技术在结核病临床诊断中的价值探讨

目的利用结核生物芯片技术,探讨国产重组结核分枝杆菌蛋白38kD(γTPA38)、16kD(γTPA16)和脂阿拉伯甘露糖(LAM)用于肺结核与肺外结核的早期诊断价值。方法采用CCD原理结合视频采集方法,应用结核生物芯片检测系统,对门诊及住院患者血清标本3448例进行了检测。结果 LAM、16kD、38kD结核生物蛋白芯片联合检测门诊患者782例,阳性219例,阳性率为28.0%(219/782)。住院患者2666例,结核生物蛋白芯片联合检测阳性1368例,阳性率为52.0%(1386/2666)。实验室检查了结核生物蛋白芯片联合检测阳性的1386例住院患者的细菌涂片,其中菌阳患者213例,菌阴患者1155例。还对69例健康人群及肺部其他疾病患者血清标本进行了16kD、38kD、LAM抗体的检测,结果阴性66例,特异性为95.7%(66/69),3448例患者3种抗原联合检测,结果阳性1587例,敏感度为46.0%(1587/3448)。结论结核生物芯片检测系统联合运用16kD、38kD、LAM3种抗原检测其对应的抗体有较好的灵敏度和很高的特异性。对结核病血清学诊断有较高的参考价值。     

结核蛋白芯片检测诊断结核病的价值

目的探讨结核蛋白芯片检测诊断结核病的价值。方法使用结核蛋白芯片系统检测4 093例患者的血清结核抗体,其中结核病441例,非结核病3 652例。采用结核蛋白芯片技术检测结核分枝杆菌中ESAT-6、CFP10、LAM、38KD和16KD 5种成分,分析其结果。结果 441例结核患者中297例结核抗体阳性,3 652例非结核患者中,647例阳性,结核蛋白芯片检测的灵敏度为67.35%,特异度为82.28%。结论结核蛋白芯片是诊断结核病的较有效方法,具有特异性好、快速方便等优点,对快速诊断结核病起辅助作用。     

结核抗体蛋白芯片法对老年肺结核的诊断价值研究

目的探讨结核抗体蛋白芯片法对老年肺结核的诊断价值。方法选择93例肺结核及77例肺部非特异性感染老年患者,均行痰涂片抗酸染色试验,均采用结核分枝杆菌IgG抗体检测试剂盒(蛋白芯片)检测抗结核分枝杆菌脂阿拉伯甘露醇(LAM)、基因工程重组的16 kD和38 kD的IgG抗体,计算两种方法诊断结核分枝杆菌感染的敏感性及特异性;并分别构建受试者工作特征曲线,通过比较曲线下面积(area under the curve,AUC)评价其诊断效能。结果蛋白芯片法和痰涂片抗酸染色试验诊断结核分枝杆菌感染的敏感性分别为68.82%和33.33%,特异性分别为100.00%和97.40%;AUC分别为0.84和0.65,提示蛋白芯片法的诊断效能显著高于痰涂片抗酸染色法,差异有统计学意义(P0.01)。结论蛋白芯片法检测抗结核分枝杆菌LAM、16 kD和38 kD抗体快捷简便,对诊断老年肺结核有较高的实用价值。     

应用蛋白芯片技术检测结核杆菌抗体的研究

目的评价蛋白芯片技术检测结核杆菌抗体的应用价值。方法应用结核杆菌蛋白芯片检测仪和试剂盒检测80例结核病患者和85名健康人群的血清标本。结果结核病患者标本阳性率为86.25%,健康人群阴性率是96.47%;结核杆菌抗原的抗体检出率以脂阿拉伯甘露聚糖(LAM)为最高(81.25%);2种抗原的抗体均为阳性的比例(51.25%)高于3种抗原的抗体均为阳性的比例(27.5%)和单个抗体阳性的比例(7.5%);蛋白芯片检测法的阳性预测值和阴性预测值分别是95.83%和88.17%。结论蛋白芯片技术具有简便、快速、敏感性高、特异性强和检测成本较低的特点,是结核病辅助诊断的有效方法。     

蛋白芯片联合检测多种结核抗体在结核病诊断中的应用价值

目的设计并建立一种基于结核分支杆菌表面抗原表位的蛋白芯片检测方法,用来进行临床分离样本的检测,探讨其在临床诊断中的应用价值。方法利用生物信息学方法,分析结核分枝杆菌抗原Ag85A,38 kD,CFP10,MPT51,16 kD,TB10.4和ESAT-6的表位,并克隆表达这些优势肽段,用于制备多靶点的蛋白芯片;使用该芯片对300株临床分析样本进行检测,与商品化蛋白芯片结果进行比较,分析其敏感性与特异性。结果在200例临床确诊结核病人中,商品化芯片检测敏感性为35.5%。而本文建立的蛋白芯片检测敏感性为98.5%;在100例临床检测非结核病人中,商品化芯片特异性92%,而本文建立的蛋白芯片特异性97%。结论基于优势表位的蛋白芯片敏感性及特异性均显著高于商品化试剂盒,具有较高的临床诊断价值,可提高检测阳性率。     

结核蛋白芯片在肺结核诊断中的应用价值

目的:通过蛋白芯片检测系统检测结核蛋白抗体,探讨血清学抗体联合检测在肺结核诊断中的应用价值.方法:收集本院2011年3-5月采用蛋白芯片检测系统检测CFP10、LAM、ESAT-6、38KD、16KD抗体的患者资料,对52例临床诊断为肺结核患者(菌阳20例、菌阴32例)、33非结核患者资料进行回顾性分析,评价蛋白芯片在肺结核诊断中的应用价值.蛋白芯片检测结果判断标准:5种抗体任一阳性结果判为阳性,5种抗体全阴结果判为阴性.结果:(1)肺结核菌阳组、菌阴组CFP10、LAM、ESAT-6、38KD、16KD五项抗体阳性检出率分别为10％、60.0％、10％、10％、20％;9.3％、46.9％、9.3％、15.6％、9.3％.(2)肺结核组、非结核组五项抗体联合检测阳性率分别为71.2％、15.1％,差异有统计学意义(x2=22.5,P=0.00);肺结核菌阳组、菌阴组抗体联合检测阳性率分别为85.0％、62.5％,差异无统计学意义(x2=3.03,P=0.081),与同组LAM抗体(五抗体中检出率最高者)检出率相比较,通过抗体联合检测,菌阳组检出率提高25.0％,菌阴组提高15.6％.(3)五项抗体联合检测肺结核的特异性为84.8％,敏感性为71.2％,准确率为74.3％,阳性预测值为87.5％,阴性预测值为62.2％,阳性似然比为4.6,阴性似然比为0.339.结论:应用蛋白芯片联合检测血清学抗体试验是辅助诊断肺结核的较好方法,具快速、便捷、高敏感性、高准确率及阳性预测值等优势,具有较高的临床应用价值.     

结核蛋白芯片对肺结核及肺外结核的诊断价值

目的探讨结核蛋白芯片检测对诊断肺结核及肺外结核的价值。方法使用蛋白芯片系统检测血清结核抗体的病例共4765例,其中肺结核334例,肺外结核83例,肺结核并肺外结核69例,非结核病4279例。我们采用的蛋白芯片包含了结核分枝杆菌（MTB）中5种成分,即ESAT-6、CFP10、LAM、38KD和16KD。结果 334例肺结核中227例结核抗体阳性,83例肺外结核中50例阳性,69例肺结核并肺外结核中51例阳性,4279例非结核病797例阳性,结核蛋白芯片检测肺结核的阳性率为67.96%,肺外结核的阳性率为60.24%,肺结核并肺外结核的阳性率为73.91%,非结核病的阳性率为18.62%。结论结核蛋白芯片是对肺结核及肺外结核的辅助诊断有重要价值。但在淋巴结结核、结核性胸膜炎中阳性率偏低,敏感性稍差。     

应用蛋白芯片技术检测结核杆菌抗体的研究

目的评价蛋白芯片技术检测结核杆菌抗体的应用价值。方法应用结核杆菌蛋白芯片检测仪和试剂盒检测80例结核病患者和85名健康人群的血清标本。结果结核病患者标本阳性率为86.25%,健康人群阴性率是96.47%;结核杆菌抗原的抗体检出率以脂阿拉伯甘露聚糖（LAM）为最高（81.25%）;2种抗原的抗体均为阳性的比例（51.25%）高于3种抗原的抗体均为阳性的比例（27.5%）和单个抗体阳性的比例（7.5%）;蛋白芯片检测法的阳性预测值和阴性预测值分别是95.83%和88.17%。结论蛋白芯片技术具有简便、快速、敏感性高、特异性强和检测成本较低的特点,是结核病辅助诊断的有效方法。     

不同免疫学检验方法对于结核病的临床价值研究

目的探讨蛋白芯片法与胶体金法对于结核病的临床价值。方法选取该院从2015年2~11月所收治的90例确诊结核病患者作为临床研究对象,同时采用蛋白芯片法与胶体金法进行检测并比较两种检测方法的差异性,分析不同方法在结核病辅助诊断当中的临床价值。结果结核组患者的胶体金法阳性反应率为73.3%(66/90),显著高于对照组[7.8%(7/90)],差异有统计学意义(P0.05);结核组患者蛋白芯片法的阿拉伯甘露糖脂(LAM)、蛋白16kD和蛋白38kD阳性反应率为53.3%(48/90)、22.2%(20/90)和53.3(48/90),高于对照组5.6%(5/90)、0%(0/60)和5.6%(5/90),差异有统计学意义(P0.05)。结果表明,结核组患者的胶体金法阳性反应率显著高于蛋白芯片法阳性反应率,差异有统计学意义(P0.05)。结论胶体金法在结核病的辅助诊断中更有优势,其灵敏度高、操作简单,有利于推广,对于结核病的早诊断、早治疗具有较强实用性,是一种比较理想的免疫学检验方法。值得在今后临床工作中推广应用。     

结核抗体蛋白芯片法对泌尿系结核的诊断价值

近年来泌尿系结核发病率有所上升,但由于部分医生缺乏认识以及氟喹诺酮类抗菌药物的广泛使用,使得泌尿系结核症状多不典型,又缺乏快速特异性的检查措施,使不少患者延误诊治[1,2]。本研究中我们采用蛋白芯片法检测血清抗结核分枝杆菌脂阿拉伯甘露醇(LAM)、基因工程重组的16kD(结核分枝杆菌蛋白,分子量16kD)和38kD(结核分枝     

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.