Sysmex XE-2100对未成熟粒细胞临界值的确定

目的对Sysmex XE-2100全自动血细胞分析仪的白细胞分类报警系统(Q-Flags)中提示的"未成熟粒细胞?(Imm Gran?)"报警信息的可信度进行分析,选择最佳临界值以确定手工镜检复查的标准。方法选择本院门、急诊及住院患者的1 200例标本,根据仪器分类报警系统中"Imm Gran?"不同提示值的标本进行分类、染色、镜检,计数200个白细胞,以查见原始和幼稚细胞细胞大于或等于1%,早幼粒和中幼粒细胞大于或等于1%,晚幼粒细胞大于2%为阳性标准。把Imm Gran的临界值分别设为10、20、30……290、300,通过数据分析确定最佳临界值。其中假阴性率的最大可接受限不能超出5%。最后选择744例标本验证新确定临界值的可信度。结果 (1)通过比对确定临界值为150是最佳临界值。修改后,在假阴性不超过5.00%(4.51%)的情况下,假阳性率由56.36%降到35.64%,真阴性率由43.64%提高到64.36%,总符合率由57.00%提高到71.83%。(2)验证试验显示无初发白血病细胞漏检。结论 (1)重新建立了合适的Imm Gran临界值后,在保证检验质量的同时,减少了镜检复片数量,又提高了工作效率。(2)Imm Gran报警提示值在150～300范围时应进行手工分片镜检复查。(3)Q-Flags中临界值应根据自己实验室的实际情况重新修定。     

Development,piloting and validation of the Recommending Cardiac Rehabilitation (ReCaRe) instrument

BackgroundHealth practitioners’ values, attitudes and beliefs largely determine their referrals to cardiac rehabilitation (CR).ObjectiveTo develop and test the Recommending Cardiac Rehabilitation scale (ReCaRe), designed to assess health professionals attitudes, values and beliefs to CR referral.MethodsReCaRe was appraised for: content validity (Delphi method, expert panel); interpretability and face validity (interview, health professionals); factor structure and internal consistency (survey, health professionals); and test-retest reliability (survey, health professionals). Normative scores were collated.ResultsReCaRe initially comprised 75 items. Initially, a Content Validity Index (CVI) was calculated for ratings of item relevance (CVI range; 0.27–1.0), which resulted in the removal of 19 items. After preliminary validation and psychometric testing, 34 items were factor-analysed (n = 24) providing a 17-item, four-factor scale: perceived severity and susceptibility (α = 0.93, κ = 0.37); perceived service accessibility (α = 0.91, κ = 0.67); perceived benefit (α = 0.97, κ = 0.47); perceived barriers and attitudes (α = 0.82, κ = 0.49). ReCaRe normative scores (n = 75) are reported.ConclusionsThis psychometric analysis found ReCaRe to demonstrate good face validity, internal consistency and fair to substantial test-retest reliability. The next step is to validate these initial findings on a larger sample size to confirm whether ReCaRe can enable identification of factors impacting CR referral.     

Sysmex XE-2100型血细胞分析仪异淋报警信息可信度评价

目的探讨Sysmex XE-2100型血细胞分析仪的异淋报警功能的可信度并确认人工阅片的意义。方法对284份外周血标本采用Sysmex XE-2100型血细胞分析仪进行血常规检查;并分别对Sysmex XE-2100型血细胞分析仪提示异淋阳性及异淋阴性的标本进行人工阅片(油镜分类200个白细胞,异淋比例>5%为阳性临界标准),记录并统计结果。结果 284份外周血标本Sysmex XE-2100型血细胞分析仪提示异淋阳性92份标本中,人工阅片异淋阳性23份,阳性预测率为25.00%,敏感度为60.53%;192份未提示异淋阳性的标本中人工阅片异淋阳性15份,阴性预测率为92.19%,特异度为71.95%。结论 System XE-2100型血细胞分析仪的预设异淋报警功能较差,导致人工阅片率偏高,厂家应根据全国各实验室实际情况重新调整或设置报警功能。     

Reversible Cabozantinib-Induced Cardiomyopathy

Cabozantinib is a multitargeted tyrosine kinase inhibitor, with activity against vascular endothelial growth factor receptor, as well as MET, RET, and AXL. It is currently approved for treating advanced thyroid and kidney cancers, and is being investigated in other cancers. We present a case of reversible heart failure due to cabozantinib use in a 70-year-old man with metastatic renal cell carcinoma. This is, to our knowledge, one of the first reported cases of cardiomyopathy associated with cabozantinib use.     

气相色谱法测定家兔血清中甲基正壬酮含量

目的建立家兔血清中甲基正壬酮含量测定方法。方法采用气相色谱法,选用甲醇对甲基正壬酮的血清溶液进行液液萃取,用气相色谱测定。色谱柱:OV-17毛细管柱(30m×0.25mm,25μm),程序升温80℃→150℃→200℃,速率为5℃/min,保持时间分别为2min及5min,流量7.5ml/min,FID检测器,柱头温度210℃,检测器温度250℃,分流比5:1。结果血清中的甲基正壬酮在1.964～31.44μg/ml中有良好的线性关系(r=0.9999),平均回收率为97.89%。结论该方法能够测定到家兔血清中甲基正壬酮的血药浓度,给今后的体内代谢研究和个体化给药方案提供了可靠的血药浓度测定方法。     

Simultaneous recording of the gastro-entero-pancreatic hormonal peptide response to food in man

The serum or plasma concentrations of gastrin, gastric inhibitory polypeptide (GIP), gut glucagon-like-immunoreactivity (gut GLI), secretin, vasoactive intestinal polypeptide (VIP), insulin, glucagon, and pancreatic polypeptide (PP) were recorded simultaneously following the ingestion of a normal, mixed meal in seven healthy, normal weight men. The concentrations of PP and gastrin increased within 10 min. Subsequently GIP, insulin, glucagon, and gut GLI increased in the order mentioned. The mean concentrations of secretin and VIP were not affected by the meal, although transient decreases in secretin concentrations could be detected in all subjects. The concentrations of the other hormones remained elevated for 4 hr or more. Perhaps the period of observation following food stimulation of gastroentero-pancreatic hormones should be extended.     

淋巴细胞参数在筛选淋巴细胞增殖及反应性增生疾病中的应用

目的：探讨淋巴细胞参数在淋巴细胞增殖及反应性增生疾病筛查中的应用。方法选取健康对照组128例、淋巴瘤患者100例、多发性骨髓瘤（MM）患者35例、淋巴细胞反应性增生（RL）患者34例、慢性淋巴细胞白血病（CLL）患者5例。分别用 Sysmex XE-2100血液分析仪进行外周血血细胞分析,记录相应淋巴细胞参数值,并对其进行疾病组与对照组差异比较分析;以受试者操作特性曲线（ROC 曲线）评价各淋巴细胞参数在筛选淋巴细胞增殖及反应性增生疾病患者中的作用。结果高荧光淋巴细胞（HFL）：对照组0.008±0.008,淋巴瘤组0.016±0.058,MM 组0.019±0.063,RL 组0.040±0.070,CLL 组0.388±0.158,RL 组和 CLL 组与对照组比较,差异有统计学意义（P ＜0.05）;淋巴细胞百分率（LY％）：对照组34.4％±5.9％,淋巴瘤组26.6％±13.1％,MM 组31.0％±13.1％,RL 组29.2％±15.4％,CLL 组44.5％±38.5％,淋巴瘤组与对照组比较,差异有统计学意义（P ＜0.001）;淋巴细胞结构参数-X（LY-X）：对照组833.5±22.7,淋巴瘤组867.9±28.5,MM 组867.9±26.6,RL 组859.2±27.8,CLL 组894.0±65.4,除 CLL 组外各组与对照组比较,差异有统计学意义（P ＜0.001）;淋巴细胞结构参数-Y（LY-Y）：对照组659.6±23.0,淋巴瘤组669.4±43.5,MM 组665.9±37.1,RL 组665.9±40.0,CLL 组778.4±152.1,淋巴瘤组与对照组比较,差异有统计学意义（P ＜0.05）。LY-X 筛选淋巴细胞增殖及反应性增生疾病患者 ROC 曲线 AUC＝0.819,截断值（cut-off 值）为842.5时敏感度为80.5％,特异度为60.1％。结论淋巴细胞参数,尤其是 LY-X 能敏感地反应淋巴细胞的形态变化,有助于筛选淋巴细胞增殖及反应性增生疾病患者。     

Sysmex XE-2100全自动血细胞分析仪工作原理和故障维修思路

目的：探讨Sysmex XE—2100全自动血细胞分析仪主要工作原理及维修思路。方法：运用Sysmex XE-2100全自动血细胞分析仪的各数据测量原理和测试通道来分析日常维修中出现的问题。结果：Sysmex XE-2100故障维修50例,成功率100%,没有因为机器的故障影响临床使用。结论：全自动血细胞分析仪的红细胞（RBC）、白细胞（WBC）、压力等故障在日常维修中经常会碰到,只有掌握全自动血细胞分析仪的红细胞、白细胞、压力等的测量通道原理,才能更好的帮助我们维修全自动血细胞分析仪,既节约成本,又不影响临床使用。     

Evaluation of nucleated red blood cell count by Sysmex XE-2100 in patients with thalassaemia or sickle cell anaemia and in neonates

Background

Current haematology analysers have variable sensitivity and accuracy for counting nucleated red blood cells in samples with low values and in all those conditions characterised by altered sensitivity of red blood cells to the lysing process, such as in beta-thalassaemia or sickle-cell diseases and in neonates. The aim of our study was to evaluate the performance of the automated analyser XE-2100 at counting nucleated red blood cells in the above-mentioned three categories of subjects with potentially altered red blood cell lysis sensitivity and yet a need for accurate nucleated red blood cell counts.

Materials and methods

We measured nucleated red blood cell count by XE-2100 in peripheral blood samples of 187 subjects comprising 55 patients with beta-thalassaemia (40 major and 15 traits), 26 sickle-cell patients, 56 neonates and 50 normal subject. Results were compared with those obtained by optical microscopy. Agreement between average values of the two methods was estimated by means of Pearson’s correlation and bias analysis, whereas diagnostic accuracy was estimated by analysis of receiver operating characteristic curves.

Results

The comparison between the two methods showed a Pearson’s correlation of 0.99 (95% CI; 0.98–0.99; p<0.001) and bias of −0.61 (95% CI, −1.5–0.3). The area under the curve of the nucleated red blood cell count in all samples was 0.98 (95% CI, 0.96–1.00; p<0.001). Sub-analysis revealed an area under curve of 0.99 (95% CI, 0.98–1.00; p<0.001) for patients with thalassaemia, 0.94 (95% CI, 0.85–1.00; p<0.001) for patients with sickle cell anaemia, and 1.00 (95% CI, 1.0–1.0) for neonates.

Discussion

XE-2100 has excellent performance for nucleated red blood cell counting, especially in critical populations such as patients with haemoglobinopathies and neonates.