The use of discriminant function analysis to predict student success on the NCLEX-RN

Predicting whether a student will be successful on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) has been an important endeavor for faculty in schools of nursing for the past 2 decades. Extensive documentation exists in the literature concerning research aimed at exploring the academic and nonacademic predictors of success on the NCLEX-RN. Reviews of the findings of these studies indicate that various factors emerge as academic predictors of success. The results of this study suggest that first-time success on the NCLEX-RN can be predicted with a high level of accuracy using existing student data. The findings also support the belief that it is possible to identify students who may be at risk for unsuccessful first time performance on the NCLEX-RN. Early identification of at-risk students will promote timely intervention strategies to optimize the students' potential for success.     

Usefulness of six non-proprietary indirect markers of liver fibrosis in patients with chronic hepatitis C.

BACKGROUND: The aim of the study was to perform a comprehensive diagnostic evaluation of six popular, non-proprietary, indirect markers of liver fibrosis in a cohort of patients with chronic hepatitis C representing the full spectrum of disease severity. METHODS: A total of 167 consecutive, hepatitis C virus RNA positive, untreated patients with chronic hepatitis C were studied. Liver biopsy with histological evaluation and age/platelet index, aspartate aminotransferase/alanine aminotransferase ratio, aspartate aminotransferase to platelet ratio index, Bonacini's discriminant score, Forn's fibrosis index and FibroIndex were assessed in all patients. RESULTS: The area under the receiver operating characteristic curves of the six tests was always greater when performed to discriminate patients with METAVIR score F4 than when assessed to discriminate patients with METAVIR score > or =F2. At step-wise discriminant analysis the only indirect marker of fibrosis entered was FibroIndex, with the following correct classification of the patients: total=52.1, patients with scores F0-F1=62.2, patients with scores F2-F3=26.0 and patients with score F4=68.4. CONCLUSIONS: The ability to correctly classify patients using a panel of non-proprietary indirect markers of liver fibrosis is far from being ideal. Among them, FibroIndex appears to possess the best discriminating capacity. The simultaneous use of several indirect markers of liver fibrosis does not improve their diagnostic accuracy.     

Phospholipids in blood serum and the differential diagnosis of chronic hepatitis B and the cirrhotic stage of the disease

The study was carried out for the purpose of determining the diagnostic criteria applicable to the cirrhotic stage of chronic viral B-hepatitis (CVBH) by using the data of the phosphor-lipid spectrum of the blood serum. The phosphor-lipid spectrum of the blood serum was examined in 70 patients with CVBH and in 20 patients with small-nodular hepatic cirrhosis. Reliably lower contents of lysophosphatidyl serine (LPS), of lysophosphatidyl ethanolamine (LFE) and of phosphatidyl ethanolamine (PE) were found in patients with CVBH at the cirrhotic stage as compared to patients with CVBH, who did and did not abuse the alcohol. However, the latters had a higher level of the relative content of phosphatidyl choline (PC) as compared to the controls.     

Effect of transport conditions on the stability of biochemical markers in blood

We examined the stability of lipids, carotenoids, alpha-tocopherol, and endogenous hormones in plasma prepared from whole blood that had been mailed to a central location for processing. Initially, to simulate transport conditions, whole-blood samples were stored in the laboratory, either at room temperature or cooled, for up to 72 h before processing. In the latter samples, lipid concentrations changed up to 1.4% per day, carotenoids up to -5.5%, and hormones up to 9.5%. In a second study, analyte concentrations in plasma from cooled whole blood mailed via overnight courier were compared with those from plasma that had been immediately separated, frozen, and mailed via overnight courier. Concentrations of cholesterol, high-density lipoprotein subfraction 3, apolipoprotein B, and retinol were stable. Overall, for each marker except estradiol, the between-person variation was at least twice the within-person variation. In a third study, at least 340 micrograms of DNA was recovered from 30 mL of cool-shipped whole blood. Our results indicate that shipping whole-blood samples by overnight courier is feasible for assay of several biochemical markers of interest in epidemiological research.     

Prospective analysis of discordant results between biochemical markers and biopsy in patients with chronic hepatitis C

BACKGROUND: The FibroTest and ActiTest are noninvasive biochemical markers of liver injury that are intended for use as alternatives to liver biopsy in patients with chronic hepatitis C. The aims of this study were to assess the quality of biopsy and the prevalence of discordances between biopsy and markers, to identify factors associated with discordances, and to attribute these discordances to either markers or biopsy failure. METHODS: Fibrosis stage and activity grade were prospectively assessed on the same day by a liver biopsy and by markers. On the basis of risk factors for failure and independent endpoints, discordance was classified as being attributable to biopsy or to markers. RESULTS: Only 74 of 537 patients (14%) had a biopsy size > or =25 mm. Discordance was observed in 154 of 537 patients (29%), including 16% for fibrosis staging and 17% for activity grading. Steatosis, an inflammatory profile, and biopsy size were associated with discordance. Discordance was attributable to failure of markers in 13 patients (2.4%) and to biopsy failure in 97 (18%; P <0.001 vs Fibrotest and Actitest), and was nonattributable in 44 patients (8.2%). The most frequent failures attributable to markers were false negatives (1.3%) attributable to inflammation. The most frequent failures attributable to biopsy were false negatives of activity grading (10.1%) and of fibrosis staging (4.5%), both associated with smaller biopsy size and steatosis. False positives of fibrosis staging (3.5%) were associated with fragmented biopsies. CONCLUSION: In this series, the size of liver biopsy is adequate in only a minor proportion (approximately 14%) of patients with chronic hepatitis C. When biopsy and marker results are discordant, a reason can be identified in more than two-thirds of cases and, in those cases, biopsy failure is >7 times more common than diagnostic failure of markers.     

乙型慢性病毒性肝炎病患者血小板及凝血功能检测及临床意义

目的 探讨血小板参数及凝血功能与慢性肝炎病患者病情进展的关系.方法 206例乙型慢性病毒性肝炎患者分为4组:A组(54例慢性肝炎患者)、B组(56例慢性肝炎中度患者)、C组(48例慢性肝炎重度患者)、D组(48例肝炎肝硬化患者),对照组为50例健康体检者.各组均用五分类血球仪和全自动血凝仪检测血小板数(PLT)、血小板平均体积(MPV)、血小板体积分布宽度(PDW)及凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB).结果 B组中的PT、APTT、PLT与对照组比较有差异(P<0.05).C组、D组中的PT、APTT、TT及PLT与对照组比较有显著差异(P<0.01).C组中的FIB和D组中的MPV与对照组比较有差异(P<0.05).D组中的FIB与对照组比较有显著差异(P<0.01).结论 血小板参数及凝血指标检测可对临床慢性肝炎诊治提供部分依据,有利于临床对症治疗.     

Significance of biochemical tests in the diagnosis of chronic viral hepatitis C

The purpose of the investigation was to study whether there was a correlation between the laboratory parameters and the pathomorphological pattern of a liver biopsy specimen in chronic viral hepatitis C. Analysis of the results of studies (general clinical blood analysis, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, gamma-glutamyltranspeptidase, serum immunoglobulins, and a study of liver biopsy specimens) led to the conclusion that there was a correlation between the level of the enzymes and the histological liver tissue sclerosis index. There was no correlation with the histological activity index. Based on the statistical analysis, the authors defined the threshold points for ALT (over 122 U/l, diagnostic efficiency 72%) and ACT (over 48 U/l, diagnostic efficiency 81%), indicating the stage of disease, which had a histological sclerosis index of more than 1.     

Validation of the FibroTest biochemical markers score in assessing liver fibrosis in hepatitis C patients

BACKGROUND: Determining the stage of fibrosis by liver biopsy is important in managing patients with hepatitis C virus infection. We investigated the predictive value of the proprietary FibroTest score to accurately identify significant fibrosis in Australian hepatitis C patients. METHODS: Serum obtained from 125 confirmed hepatitis C patients before antiviral therapy was analyzed for haptoglobin, alpha(2)-macroglobulin, apolipoprotein A1, bilirubin, and gamma-glutamyltransferase activity, and the FibroTest score was computed. Liver fibrosis pathology was staged according to a defined system on a scale of F0 to F4. We used predictive values and a ROC curve to assess the accuracy of FibroTest scores. RESULTS: The prevalence of significant fibrosis defined by liver biopsy was 0.38. The most useful single test for predicting significant fibrosis was serum alpha(2)-macroglobulin (cutoff value, 2.52 g/L; sensitivity, 75%; specificity, 67%). The negative predictive value of a FibroTest score <0.1 was 85%, and the positive predictive value of a score >0.6 was 78%. Although 33 of the 125 patients had FibroTest scores <0.1 and were therefore deemed unlikely to have fibrosis, 6 (18%) had significant fibrosis. Conversely, of the 24 patients with scores >0.6 who were likely to have significant fibrosis, 5 (21%) had mild fibrosis. Of the 125 patients in the cohort, 57 (46%) could have avoided liver biopsy, but discrepant results were recorded in 11 of those 57 (19%). CONCLUSION: The FibroTest score could not accurately predict the presence or absence of significant liver fibrosis.     

慢性乙型肝炎乙肝病毒血清标志物检测研究

目的对慢性乙型肝炎患者进行乙肝病毒（HBV）血清标志物检测,分析结果,评价感染复制状况,选择适合临床防治需要、容易普及开展的标志物。方法采用酶联免疫吸附试验（ELISA）检测乙肝5项标志物[乙型肝炎病毒表面抗原（HBsAg）、乙型肝炎病毒表面抗体（抗-HBs）、乙型肝炎病毒e抗原（HBeAg）、乙型肝炎病毒e抗体（抗-HBe）、乙型肝炎病毒核心抗体（抗-HBc）]、前S1抗原、前S2抗原及前S2抗体,实时荧光定量检测HBV-DNA。286例慢性乙型肝炎患者分为HBeAg阳性组（126例）和HBeAg阴性组（160例）,比较各组前S1抗原、前S2抗原、前S2抗体和HBV-DNA检出率。结果HBeAg阳性组,前S1抗原、前S2抗原、前S2抗体和HBV-DNA阳性率分别为：93.7%、77.0%、0和95.2%。HBeAg阴性组,前S1抗原、前S2抗原、前S2抗体和HBV-DNA阳性率分别为：55.0%、36.3%、0和58.1%。组内比较,HBeAg阳性组或HBeAg阴性组,前S1抗原与前S2抗原检出率差异具有统计学意义（P〈0.05）,前S1抗原与HBV-DNA检出率差异无统计学意义（P〉0.05）,前S2抗原与HBV-DNA检出率差异具有统计学意义（P〈0.05）。组间相同项目比较,前S1抗原检出率、前S2抗原检出率、HBV-DNA检出率差异均具有统计学意义（P〈0.05）。结论慢性乙型肝炎患者,前S1抗原与HBV-DNA具有良好的相关性,实验室常规开展乙肝5项和前S1抗原检测,可以判断乙肝病毒感染复制状况,为慢性乙型肝炎的预防、诊断和治疗提供实验依据。     

人前列腺特异性抗原、%p2PSA及前列腺健康指数肿瘤标记物在异体成分输血前后的变化及对策

目的探讨前列腺癌6个肿瘤标记物在异体成分输血前后的变化,为临床合理筛查和评测前列腺癌诊疗及进展复发等问题提供间接参考依据。方法本组患者119例,均为男性,平均年龄61.59(20~92)岁。在每例患者接受异体成分输血前后48 h以内,收集冻存并统一专人检测所有患者的血清标本。异体输血成分为浓缩红细胞,均为2~4 U小剂量输血。检测项目包括人前列腺总特异性抗原(t PSA)、人前列腺游离特异性抗原(f PSA)、人2型早期前列腺特异性抗原(p2PSA,pro PSA)、%f PSA、%p2PSA和前列腺健康指数(PHI)等6个指标。按输血前t PSA结果分组:所有患者为A组;t PSA<4 ng/ml 109例(91.60%)为B组;t PSA异常(t PSA>4 ng/ml)10例(8.40%)为C组。SPSS 19.0作各组输血前后6个前列腺指标的均数比较、95%可信区间及多样本组间均数比较(One-Way ANOVA)。结果三组t PSA、f PSA及%f PSA值在输血前后总体变化不大。B组t PSA值由输血前的(0.77±0.07)ng/ml轻微上升至输血后的(0.82±0.08)ng/ml(P>0.05)。但C组t PSA在输血后轻微下降(P>0.05),输血前后值分别为(13.13±3.86)ng/ml及(12.93±3.92)ng/ml。但各组患者输血后p2PSA、%p2PSA及PHI值均有大幅下降(P<0.05),以B组最显著。B组患者输血前后%p2PSA的95%CI分别为25.51~70.48 ng/ml及9.97~21.95 ng/ml,PHI的95%CI分别为19.61~30.45 ng/ml及7.84~11.81 ng/ml,输血后下降幅度甚至超过50%(P<0.01)。结论异体输血对PSA影响较小,但对%p2PSA及PHI干扰较大。如果将来同时结合PSA、%p2PSA及PHI等多项指标而综合实施前列腺癌筛查和评测诊疗时,需要询问患者有无近期异体输血史,必要时应在异体输血1周后检测或复查肿瘤标记物,以避免输血对前列腺癌肿瘤标记物的影响。     

妇女慢性乙型肝炎标志物和新生儿感染的关系研究

目的 探索妇女慢性乙型肝炎标志物和新生儿感染的关系.方法 回顾性分析2017年8月至2018年8月于海南省人民医院接受治疗的712例慢性乙型肝炎患者及其新生儿的临床资料,检测孕妇和新生儿HBV-DNA载量分析和乙型肝炎标志物定量.统计不同孕妇类型血HBV-DNA阳性率和乳汁HBV-DNA阳性率、新生儿HBsAg阳性率和...     

聚类判别法分析社区健康老年人人体测量指标与血液生化指标的关系

目的用聚类判别法探讨社区健康老年人无创的人体测量参数与实验室检查结果的关系,并建立判别函数。 方法整群随机抽取浦东新区浦兴街道的11个社区居民委员会,调查65岁以上居民,横断面调查体质量、血压、血糖、血脂等,排除既往患高血压、糖尿病、冠心病及此次实验室检查肝肾功能不全者。选择年龄、收缩压、舒张压、体质量指数共4个变量进行R型聚类分析,建立判别函数。采用方差分析比较各类老年人人体测量指标及血液生化指标的差异。 结果共聚为3类。3类人群中,第1类人群年龄最小,无创的肥胖指标及血压最高,同时实验室检测的血糖、血脂、肝功能指标亦最高,经LSD多重比较,除收缩压、空腹血糖的第1类与第2类比较以及胆红素各类差异无统计学意义外,其余参数第1类与其他类比较差异均具有统计学意义（P均<0.0125）。回顾法及交叉验证法两种方法估计判别函数的误判概率,均小于0.2。 结论对社区健康老年人,可以用无创的人体测量参数预估实验室检查中血糖、血脂以及肝功能等生化指标。     

慢性重型乙型肝炎患者外周血树突状细胞表型和功能的研究

目的:研究慢性重型乙型肝炎患者外周血树突状细胞(DC)表型、免疫功能和分泌细胞因子的特性。方法:从20例慢性重型乙型肝炎患者和10例健康人外周血中分离单个核细胞培养DC,用流式细胞仪检测DC的表面标志CD80和CD86的表达。用3H-TdR掺入法检测DC诱导混合性淋巴细胞反应(MLR)的能力。并用ELISA方法检测MLR中细胞因子IL-12的分泌水平。结果:慢性重型乙型肝炎患者组的DC细胞CD80、CD86的表达率较正常人组高(P0.05),诱导MLR的能力也较强(P0.05),MLR中细胞因子IL-12的分泌水平也较高(P0.05)。结论:慢性重型乙型肝炎患者外周血树突状细胞免疫功能亢进,免疫刺激能力也较高。     

肝功能异常患者肝炎病毒标志物检测结果分析

目的 探讨凉山彝族地区病毒性肝炎感染状况,为预防病毒性肝炎提供依据.方法 用酶联免疫吸附试验(ELISA)法检测820例肝功能异常患者血清中甲、乙、丙、丁、戊型肝炎病毒标志物,经统计学处理分析5型肝炎病毒标志物在人群中的阳性趋势和在不同性别组、不同年龄组中的阳性分布趋势.结果 抗-HAV-IgM、乙型肝炎(下称乙肝)病毒表面抗原(HBsAg)、丙型肝炎病毒抗体(抗-HCV)、丁型肝炎病毒抗体(抗-HDV)、抗-HEV-IgM在820例肝功能异常患者中的阳性率为:23.78%、31.10%、4.63%、0.98%、3.17%;抗-HAV-IgM组阳性率最高为57.78%(P＜0.05),HBsAg组阳性率最高为39.04%(P＜0.05),抗-HDV组阳性率最高为2.71%(P＜0.05),抗-HCV、抗-HEV-IgM在不同年龄组的差异无统计学意义(P＞0.05);抗-HAV-IgM阳性率女性组高于男性组(P＜0.05),HBsAg阳性率男性组高于女性组(P＜0.05),抗-HCV、抗-HDV、抗-HEV-IgM在男女性别组中的差异无统计学意义(P＞0.05).结论 凉山彝族地区病毒性肝炎以甲、乙型肝炎为主,因此抓好甲、乙型肝炎预防工作是减少凉山地区病毒性肝炎发病的关键,注意个人饮食卫生和环境卫生有助于预防甲、戊型肝炎传播,接种甲、乙肝疫苗是预防甲、乙型肝炎最有效措施,加强对血液及血液制品的监管和管理好静脉吸毒人群所用的注射器能有效控制乙、丙型肝炎的传播.     

慢性活动性肝炎患者生化指标组间典则相关分析

目的 分析慢性乙型肝炎患者多个血清生化指标间相关关系,探讨多因素间的联系。方法 将生化指标分成肝功能和纤维化与凝血两大类指标,采用典则相关分析法研究两因素集团间联系。结果 第一典则相关系数反映胆碱脂酶、白蛋白、低密度脂蛋白胆固醇(LDL-C)和透明质酸(HA)、Ⅳ型胶原(PC Ⅳ)存在依存关系,在典则变量上呈现负相关,相关系数(r1)为-0．87824,第二典则相关系数(r2)决定总胆红素和凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血激酶时间(APTT)的正相关关系,其r2=0．75059,而第三典则相关系数(r3)决定高密度脂蛋白胆固醇(HDL-C)和Ⅲ型胶原(PCⅢ)的正相关关系,其r3=0．73733。结论 集团因素的检验指标可采用多元典则相关分析法有效地得出其组间相互联系的指标。     

慢性活动性肝炎患者生化指标组间典则相关分析

目的分析慢性乙型肝炎患者多个血清生化指标间相关关系,探讨多因素间的联系。方法将生化指标分成肝功能和纤维化与凝血两大类指标,采用典则相关分析法研究两因素集团间联系。结果第一典则相关系数反映胆碱脂酶、白蛋白、低密度脂蛋白胆固醇(LDL C)和透明质酸(HA)、Ⅳ型胶原(PCⅣ)存在依存关系,在典则变量上呈现负相关,相关系数(r1)为-0.87824,第二典则相关系数(r2)决定总胆红素和凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血激酶时间(APTT)的正相关关系,其r2=0.75059,而第三典则相关系数(r3)决定高密度脂蛋白胆固醇(HDL C)和Ⅲ型胶原(PCⅢ)的正相关关系,其r3=0.73733。结论集团因素的检验指标可采用多元典则相关分析法有效地得出其组间相互联系的指标。     

肝硬化判别评分诊断慢性乙型病毒性肝炎肝纤维化的临床价值

目的:探讨肝硬化判别评分诊断慢性乙型病毒性肝炎肝纤维化的临床价值。方法:172例慢性乙型病毒性肝炎患者均接受肝组织病理检查,并同时检测肝功能、血常规和凝血功能,用ROC曲线评价肝硬化判别评分诊断无或轻度肝纤维化(S0/S1)、显著肝纤维化(S2/S3/S4)、严重肝纤维化(S3/S4)和肝硬化(S4)的能力。结果:S4的肝硬化判别评分明显高于S0、S1、S2和S3(P<0.01);肝纤维化分期和肝硬化判别评分的相关系数rs=0.375(P<0.01);肝硬化判别评分诊断显著肝纤维化的ROC曲线下的面积0.726,阳性预测值95.3%,肝硬化的AUC 0.814,阴性预测值96.5%,严重肝纤维化的AUC仅有0.626,敏感度38.8%。结论:肝硬化判别评分和肝纤维化分期有一定的相关性,肝硬化判别评分可以用于评估慢性乙型病毒性肝炎患者有无显著肝纤维化或肝硬化,但对S2和S3的区分能力有限。     

早期血气分析对急性有机磷农药中毒患者预后的预测

目的 探讨急性有机磷农药中毒(AOPP)患者的酸碱平衡与死亡率的关系.方法 回顾性研究我院2000-01～2006-01在急诊科就诊并收入住院的78例连续的、中毒时间在24 h内的AOPP患者,依据第一次动脉血气结果 判断是否存在酸中毒及酸中毒类型,并对各类型的死亡率进行比较.结果 AOPP患者分为无酸中毒组、代谢性酸中毒组、呼吸性酸中毒组和混合型酸中毒组,组间死亡率比较差异有统计学意义(P＜0.01).有代谢性酸中毒的AOPP患者死亡率为22.5%,其中71.4%死于心力衰竭;有呼吸性酸中毒的AOPP患者死亡率为42.9%,其中66.7%死于呼吸衰竭.结论 酸碱度能有效预测AOPP患者的死亡率, 代谢性酸中毒组的死亡原因与呼吸性酸中毒组不同.