新生儿阑尾炎误诊1例并文献复习

目的:探讨新生儿阑尾炎的误诊原因和临床特点。方法:报告1例新生儿阑尾炎误诊病例。结果:误诊为肠梗阻,术后死亡,病理诊断为急性化脓性阑尾炎、先天性巨结肠(HD)。结论:新生儿阑尾炎早期出现的症状是腹胀和呕吐,特点是穿孔早且容易发生腹膜炎,发生弥漫性腹膜炎时腹部体征不明显,无腹肌紧张。腹部B超检查有助于诊断。     

血浆D-二聚体联合床旁超声对下肢深静脉血栓的诊断价值

目的:探讨血浆D-二聚体水平联合床旁超声对下肢深静脉血栓的诊断价值。方法:回顾性分析2018年4月至2019年3月复旦大学附属中山医院厦门医院69例重症监护室行床旁下肢静脉彩超检查患者的病例资料,记录血浆D-二聚体水平以及彩超检查结果,计算彩超发现下肢深静脉血栓的血浆D-二聚体水平截断值,分析血浆D-二聚体水平对床旁彩超发现下肢深静脉血栓的诊断效能。结果:床旁彩超诊断无血栓组39例,血栓组30例,男女比例分别为26∶13和15∶15,平均年龄分别为(63.7±13.8)岁和(65.9±12.6)岁,血浆D-二聚体水平分别为3.26(0.91,6.22)mg/L和6.72(3.33,13.24) mg/L(P0.05)。血浆D-二聚体截断值为4.54 mg/L,其对应的灵敏度为66.7%,特异度为69.2%,阳性预测值为60.6%,阴性预测值为72.2%,诊断准确率为68.1%。结论:血浆D-二聚体水平大于4.54 mg/L可作为临床医师申请床旁下肢静脉彩超检查的参考依据,从而减少医疗资源的浪费。     

第二代丙型肝炎诊断试剂质量控制参考品的建立

为了更加全面、客观地检测国产丙型肝炎诊断试剂的质量，特别是对用于筛查献血员的诊断试剂进行严格的质量控制，在建立第一代丙型肝炎诊断试剂质控参考品的基础上，用雅培、联合生物技术公司、北京生物制品研究所等国内外试剂对４００份血浆进行检测，选出１９８份血浆，用多种试剂及不同的方法（酶联免疫吸附试验、免疫斑点试验、聚合酶链反应）对其进行了反复的核验，建立了我国第二代丙型肝炎诊断试剂质量控制参考品。用此参考品对国产试剂进行了检定并制定了相应的检定标准，此套参考品及检定标准已获卫生部批准。     

Diagnostic value of peripheral blood T-cell activation and soluble IL-2 receptor for acute rejection in liver transplantation

Background: T-cells play an important role in the pathogenesis of rejection. Monitoring T-cells activation markers in peripheral blood may contribute to diagnosis of acute rejection after liver transplantation (LTX). Methods: Lymphocyte subset distribution, expression of T-cell activation markers (flow cytometry), concentration of soluble (s) interleukin-2 receptor (IL-2R) (solid phase chemiluminescence immunoassay), and liver enzymes as well as bilirubin were prospectively tested in peripheral blood samples of LTX patients with (n=69) and without acute rejection (n=50). Acute rejection was assessed by standard criteria including liver biopsies. Results: Intra-individual monitoring of immune parameters revealed an up-regulation of IL-2 receptor (CD25) expression on CD4 and CD8 T-cells together with increases in sIL-2R levels in patients with acute rejections. Measuring sIL-2R levels resulted in highest diagnostic efficiency (>85%). This level of diagnostic efficiency was not reached by any other marker tested. From all conventional markers of hepatocellular integrity and function, alkaline phosphatase reached the highest level of diagnostic efficiency with 70%. Conclusions: Monitoring of up-regulation of the IL-2/IL-2R pathway represents a useful tool for assessment of acute rejection after LTX.     

血清透明质酸对慢性病毒性肝炎肝纤维化诊断价值的系统评价

目的系统评价当前研究血清透明质酸诊断肝纤维化文献的质量,分析偏倚和变异产生的来源,并了解血清透明质酸对诊断慢性病毒性肝炎所致早期肝硬化、肝纤维化的准确性。方法采用计算机和手工检索全面收集当前研究血清透明质酸对慢性病毒性肝炎所致肝纤维化的诊断性试验文献,并根据QUADAS(quality assessment of diagnostic accuracy studies)质量评价标准评价符合纳入标准的文献的质量,用Meta-disc软件对敏感性、特异性、阳性似然比( LR)、阴性似然比(-LR)、诊断性试验比值比等进行合并分析和异质性检验,对无异质性的文献用DPS2005软件绘制SROC曲线。结果共纳入符合纳入标准的文献24篇,其中中、英文文献各占一半。在合并分析中,放射免疫法诊断肝硬化文献,以及区分有无肝纤维化的文献合并 LR分别为7．029、3 608；合并-LR分别为0．198、0．319。酶联免疫法中,诊断肝硬化的文献、鉴别轻、重度肝纤维化的文献,区分有无肝纤维化的文献的合并 LR分别为6 093、9．806和4．308；合并-LR分别为0．354、0．347和0．563。结论本系统评价所纳入24篇文献的偏倚主要来自参考标准判读时未实施盲法,存在变异的可能性较大,报告质量较差。放射免疫法和酶联免疫法血清透明质酸对肝硬化具有较好的诊断价值,对有无肝纤维化的判别价值也可认可,但该两种检测方法在鉴别轻、重度肝纤维化的诊断价值尚需进一步研究。     

The Impact of Nontuberculous Myobacteria on Management of Presumed Pulmonary Tuberculosis

Background: The presence of nontuberculous mycobacteria (NTM) in sputum or bronchial washings may cause diagnostic problems which affect clinical management. Patients and Methods: In a retrospective analysis of 135 patients in a Dutch tuberculosis center, patients with NTM isolates were thoroughly investigated. Colonization or contamination by NTM was differentiated from true lung disease. Results: 25 HIV-seronegative and two HIV-seropositive patients with NTM were identified. NTM were a likely cause of disease in only 14 (52%) patients. In 15 (55%), their presence led to preliminary diagnosis and treatment of tuberculosis. Unnecessary or inappropriate treatment was instituted in 17 (63%) patients with NTM. In two patients, detection of NTM in sputum also led to delay in diagnosing malignant disease. Conclusion: In this series, NTM in sputum or bronchial washings poorly reflected disease and often led to diagnostic and therapeutic errors. Although it is common knowledge that the presence of NTM should be considered in smear-positive patients, this apparently is a diagnostic pitfall in clinical practice. Reliable DNA-based techniques and better communication between physicians and microbiologists may improve management of suspected mycobacterial infections. Received: July 20 · Revision accepted: December 21, 2000     

Estimation tools for reducing the impact of sampling and nonresponse errors in dual-frame RDD telephone surveys

We discuss alternative estimators of the population total given a dual-frame random-digit-dial (RDD) telephone survey in which samples are selected from landline and cell phone sampling frames. The estimators are subject to sampling and nonsampling errors. To reduce sampling variability when an optimum balance of landline and cell phone samples is not feasible, we develop an application of shrinkage estimation. We demonstrate the implications for survey weighting of a differential nonresponse mechanism by telephone status. We illustrate these ideas using data from the National Immunization Survey-Child, a large dual-frame RDD telephone survey sponsored by the Centers for Disease Control and Prevention and conducted to measure the vaccination status of American children aged 19 to 35 months.