两种巢式PCR检测慢性粒细胞白血病患者骨髓移植后微小残留病的比较

目的比较2种巢式聚合酶链反应(PCR)检测骨髓移植后慢性粒细胞白血病(CML)患者微小残留病。方法分别用一步法逆转录-PCR(RT-PCR)和两步法RT-PCR2种巢式PCR检测骨髓移植后CML患者BCR-ABL融合基因，并做2种方法的灵敏度实验。结果2种巢式PCR灵敏度实验中，一步法RT-PCR和两步法RT-PCR的巢式PCR可分别检测出0．1和1PgK562细胞总RNA中的BCR-ABL融合基因；同时对19份来自12例骨髓移植后CML患者标本检测，一步法RT-PCR的巢式PCR检测出阳性的最长移植时间为690d；两步法RT-PCR的巢式PCR为415d。结论一步法RT-PCR的巢式PCR检测骨髓移植后CML微小残留病具有较高灵敏度．操作简便快速．特别适用于临床检测。     

一步法RT-PCR检测慢性粒细胞白血病BCR-ABL融合基因

目的：建立一步法RT-PCR检测CML患者BCR—ABL融合基因的实验方法。方法：Trizol试剂提取细胞RNA,用特异引物一步法RT—PCR检测BCR—ABL融合基因．并作灵敏度试验。结果：本方法的灵敏度可达到10pg水平。对25例CML患者检测BCR-ABL融合基因,阳性率为100％．并可检测出BCR—ABL融合基因各种融合方式。结论：一步法RT—PCR检测BCR-ABL融合基因有很好的灵敏度和特异性,操作简便、快速,特别适用于临床检测。     

ECLIA和ELISA检测血清HBsAg的结果比较

目的 比较电化学发光免疫分析(ECLIA)和酶联免疫吸附试验(ELISA)检测血清HBsAg结果。方法 采用ECLIA一步法和KLISA一步法、二步法测定定值血清中的HBsAg:用ELISA一步法和二步法检测经ECLlA筛选的190例HBsAg模式如下的临床标本：①HBsAg光放射强度(COI)在1-20，20例；②HBsAg COI在21-4000、160例；③HBsAg COI大于4000、6例；④HBsAg阴性(其COI值小于1)，HBeAg和HBcAb阳性4例；结果 ELISA一步法灵敏度为1ng／ml．二步法灵敏度为0．2ng／ml、ECLIA灵敏度为0．05ng／m1；在190例临床标本中。ELISA一步法阳性检出率为84．2％，二步法阳性检出率为92．6％．ECLIA阳性检出率为97，4％：结论 ELISA一步法受钩状效应(hook effect)影响明显，敏感度低。HBsAg漏检明显：ELISA二步法能较好地避免钓状效应，敏感度较高，HBsAg漏检率较低，但费时：而ECLIA灵敏度高．受HOOK效应影响较小、HBsAg漏检率低，且自动化程度高，检测时间短。     

ECLIA和ELISA检测血清HBsAg的结果比较

目的 比较电化学发光免疫分析(ECLIA)和酶联免疫吸附试验(ELISA)检测血清HBsAg结果。方法 采用ECLIA一步法和ELISA一步法、二步法测定定值血清中的HBsAg；用ELISA一步法和二步法检测经ECLIA筛选的190例HBsAg模式如下的临床标木：①HBsAg光放射强度(COI)在1～20，20例；②HBsAg COI在21～4000，160例；③HBsAg COI大于4000，6例；④HBsAg阴性(其COI值小于1)，HBeAg和HBcAb阳性4例。结果 ELISA一步法灵敏度为1ng／ml，二步法灵敏度为0．2g／ml，ECLIA灵敏度为0．05ng／ml。存190例临床标本中，ELISA一步法阳性检出率为84．2％，二步法阳性检出率为92．6％，ECLIA阳性检出率为97．4％。结论 ELISA一步法受钩状效应(hook effect)影响明显，敏感度低，HBsAg漏检明显：ELISA二步法能较好地避免钩状效应，敏感度较高，HBsAg漏检率较低，但费时：而ECLIA灵敏度高，受HOOK效应影响较小，HBsAg漏检率低，且自动化程度高，检测时间短。     

ELISA一步法和二步法检测临界值范围HBsAg的性能比较

目的比较酶联免疫吸附试验（ELISA）一步法和二步法检测乙型肝炎表面抗原（HBsAg）的性能。方法将二步法初检吸光度（A）值〉0．0735的标本均用一步法检测,并将初检临界值范围内的标本再用二步法复测,将所有复检范围内的标本用电化学发光法检测。结果HBsAg检测结果4值〉0．5250的标本两法符合率为96．8％,A值在0．0735～0．5250之间的标本两法符合率为65．1％,两法的检测性能差异有统计学意义（P〈0．05）。结论二步法测定HBsAg与一步法比较,敏感性高。一步法存在漏检,二步法在检测低水平和过高浓度的HBsAz标本中具有显著优势。     

酶联一步法测HBsAg前带现象浅析

酶联一步法检测HBsAg，由于高滴度的HBsAg中，只有少部分同包被的Anti－HBs结合，因而造成假阴性。笔者于1995～1996年检测的1684例乙肝两对半的试验中，采用原血清和1：10稀释血清同时用酶联一步法检测HB一sAg，（用统计学处理P＞0．05）结果见附表：讨论：1．酶联一步法检测乙肝两对半（H13sAg）确有简便、快速、特异性强，结果清晰的优点，确实给人少事杂设备简陋的乡卫生院开展乙肝两对半的检测提供了方便。但该法对高滴度的HB－sAg容易产生前带现象，造成假阴性，必须引起乡村卫生院检验人员的重视，以免贻误诊断。2．为防止酶…     

细菌性阴道病实验室诊断方法的比较

【目的】比较细菌性阴道病的4种实验室诊断方法。【方法】随机选择就诊病人100例分别用Amsel法,组织多胺试验．一步法唾液酸酶活性的检测试验,革兰染色细菌评分法检测细菌性阴道病。【结果】Amsel法阳性率28％,组织多胺试验阳性率24％,一步法唾液酸酶活性的检测试验阳性率34％,革兰染色细菌评分法阳性率30％;唾液酸酶活性检测法与Amsel法,革兰染色细菌评分法相比较差异无显著性;组织多胺试验与Amsel法,革兰染色细菌评分法相比较差异无显著性;以Amsel法为标准,一步法唾液酸酶活性检测法和组织多胺试验的灵敏度分别为92．9％和71．4％,特异性分别为88．9％和94．4％,阳性预期值分别为76．5％和83．3％,阴性预期值分别为97．0％和89．5％;以革兰染色细菌评分法为标准．一步法唾液酸酶活性检测法和组织多胺试验的灵敏度分别为93．8％和66．7％,特异性分别为92．1％和94．3％,阳性预期值都为83．3％,阴性预期值分别为97．2％和86．8％。【结论】一步法唾液酸酶活性的检测试验和组织多胺试验快速,简便,易于标准化,可以用于临床诊断细菌性阴道病。     

一步法HBV-DNA检测试剂的临床应用分析

目的：比较一步法与煮沸法检测HBV-DNA的结果,分析一步法临床推广价值。方法利用已知浓度的标准品检测其准确度,利用室内质控品评价其精密度,采用两种方法分三个批次进行平行检测临床标本62例,比较两种方法的灵敏度、检测结果的一致性及相关性。结果实测校准品与理论值对数据的偏差在可接受范围（0．08＜0．3 lgIU／mL ）,精密度满足临床需求（cv％＝5．62％＜10％）,两种方法阳性符合率为100％,阴性符合率为97．0％,总符合率为98．4％,两者检测结果线性关系良好,有显著相关（Y＝0．7839 X＋0．7101,R2＝0．9163）。结论一步法试剂有操作简便,抗污染力强、定量准确、重复性好,成本低等优点,特别适合基层实验室推广应用。     

一步法RT-PCR检测急性早幼粒细胞白血病PML-RARα融合基因

目的：建立一步法RT—PCR检测APL患者PML—RARα融合基因的实验方法。方法：用特异引物一步法RT—PCR检测PML—RARα融合基因,并作灵敏度试验。结果：本方法的灵敏度可达到1：10^3水平。对25例APL患者检测PML—RARα融合基因,阳性率为100％,并可检测出PML—RARα融合基因各种融合方式。结论：一步法RT—PCR检测PML—RARα融合基因有很好的灵敏度和特异性,操作简便、快速,特别适用于临床检测。     

金标斑点渗滤法快速检测尿HCG

用双抗体夹心法建立了一种检测尿ＨＣＧ的金标免疫斑点渗滤法，对临床３５０份尿标本进行了检测，并与酶标一步法及试纸条法进行比较。经临床验证阳性符合率为１００％，阴性符合率为１００％，该法无前带现象，敏感性优于其它二法，且快速简便，２分钟内即可邮结果。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.