86例异位妊娠的超声诊断价值

目的：探讨B超对异位妊娠的诊断价值。方法：对2004年1月～2009年1月的86例异位妊娠患者，采用超声诊断仪进行检查、分析。结果：超声检查的86例异位妊娠患者，诊断符合84例，确诊率为97．6％，误诊2例，误诊率为2．4％。结论：超声检查有着无创性、可重复性等不可比拟的优越性，为异位妊娠患者的诊断及治疗提供了可靠的依据。     

CR与屏-胶系统摄影在乳腺疾病诊断中的价值

目的评价X线计算机成像技术在乳腺摄影中的应用价值。方法抽取乳腺CR片和屏-胶乳腺片各500例,由1位副教授和2位主管技师,对摄影条件、照片影像质量及照片影像显示进行对比。结果①CR系统照片影像质量明显高于屏-胶系统;②摄影条件CR数字摄影比屏-胶系统摄影电压高2~3kV,曝光量高35%左右;③照片的X线征象显示率明显高于屏-胶系统。结论CR摄影提高了照片影像质量,为临床提供可靠诊断依据。缺点是曝光条件比屏-胶系统高,相对增加了患者的X线辐射剂量。     

Auditing your acute pain service—a UK NHS model

This audit has been conducted in order to provide an evidence base that clarifies the strengths and weaknesses of acute pain management at a UK hospital. Consequently, it sets the strategic direction for service improvement. Awarding up to three stars has identified the quality of each component that constitutes the acute pain service. Six different components were audited and star ratings have been awarded as shown below:

• Pain tool (including patient and staff understanding): no stars.

• Pain team (including education and clinical support): two stars.

• Intermittent opioid analgesia (sub-cut and oral morphine): two stars.

• Epidural patient controlled analgesia (EPCA): two stars.

• Intravenous patient controlled analgesia (IVPCA): two stars.

• Single-dose intrathecal opioid analgesia: three stars.

These star ratings were pulled together in order to award the acute pain service an overall rating. Consequently, the acute pain service was awarded two stars. The findings of this audit identify that this acute pain service provides a safe way to deliver hi-tech pain relief at ward level and can be relied upon to provide good quality pain management. However, too many patients are likely to miss out on the full benefits of the service due to the weaknesses as identified. The quality of the pain relief is impeded across the hospital due to low patient expectation and poor patient education, and also due to a lack of relevant knowledge amongst nursing staff. Developments in the role of the acute pain nurse, staff training and education programs, and a reduction in the variety of pain management pumps are combining to facilitate the opportunities required to address the weaknesses and to build on the strengths of the acute pain service.     

3423份病案质量调查分析

随机抽查某医院2001年9月-2002年6月出院病案3423份,占同期出院病案的26.9％。按有关标准对其质量进行了 审查,并针对存在的质量问题,提出了对策性意见。     

Development of sample handling procedures for foods under USDA's National Food and Nutrient Analysis Program

The National Food and Nutrient Analysis Program (NFNAP) was implemented in 1997 to update and improve the quality of food composition data maintained by the United States Department of Agriculture (USDA). NFNAP was designed to sample and analyze frequently consumed foods in the U.S. food supply using statistically rigorous sampling plans, established sample handling procedures, and qualified analytical laboratories. Methods for careful handling of food samples from acquisition to analysis were developed to ensure the integrity of the samples and subsequent generation of accurate nutrient values. The infrastructure of NFNAP, under which over 1500 foods have been sampled, mandates tested sample handling protocols for a wide variety of foods. The majority of these foods were categorized into several major areas: (1) frozen foods; (2) fresh produce and/or highly perishable foods requiring refrigeration; (3) fast foods and prepared foods; (4) shelf-stable foods; (5) specialized study and non-retail (point of production) foods; and (6) foods from remote areas (e.g. American Indian reservations). This paper describes the sample handling approaches, from the collection and receipt of the food items to the preparation of the analytical samples, with emphasis on the strategies developed for those foods. It provides a foundation for developing sample handling protocols of foods to be analyzed under NFNAP and for other researchers working on similar projects.     

Quality Control in Laboratory Hemostasis and Thrombosis

<正>laboratory equipment,akey to success is not only high quality,complete,technician knowledge,skills,and experiment a clear purpose,select the project has specificity     

个体患者适形调强放疗计划模体内剂量实测验证技术的建立

目的建立个体患者适形调强放疗（IMRT）计划的模体内剂量实测验证技术。方法选择1例鼻咽癌患者，设计IMRT计划。将患者计划转移到模体上设计杂交计划。执行杂交计划时，用针点电离室测量感兴趣点的剂量，并与该点的计算剂量比较。用胶片剂量测量系统测量杂交计划中感兴趣平面的剂量，胶片与计划剂量矩阵登记后，依次进行计划，胶片分析、计划，胶片剖面分析和计划／胶片等剂量线分析。采用复合判断标准评价验证结果。结果针点电离室测量得到杂交计划单次照射的总剂量为121．5cGy，比计算值低约4％。计划，胶片分析得到高剂量、高梯度区域的距离差别均在4mm以内；计划／胶片剖面分析显示，计划与胶片在通过靶区的剖面具有较好的一致性；计划，胶片等剂量线分析显示，计划与胶片对应值的等剂量线重合良好。按照复合判断标准，该计划验证通过。结论初步建立了个体患者IMRT计划的模体内剂量实测验证技术，建立并优化了剂量登记技术、剂量归一方法和评价方法。     

中西医结合医院单病种的质量管理及其作用

针对中西医结合医院单病种质量评定没有现成的、规范的标准的现状,就中西医结合单病种的质量管理方法及其在中西医结合医院建设中的作用进行了论述。     

Occupational chronic exposure to metals

Summary Stainless steel welders (n = 103) were examined. To estimate external exposure, personal air sampling was used. Internal exposure was quantified by the determination of nickel levels in erythrocytes, plasma and urine. Men and women (n = 123) were examined for control purposes. In the plasma and erythrocytes of the controls the nickel concentration was below the level of detection (< 1.81 μg/l). The element concentrations in urine were between < 0.1 and 13.3 μg/l. Of the controls 95% showed nickel levels in urine below 2.2 μg/l (reference value). The average concentration of nickel in the air was 93 ± 81 μg/m³. The average concentration of nickel in the plasma samples was 4.9 ± 4.0 μg/l (95th percentile 12.8 μg/L). In erythrocytes nickel could not be detected. The nickel concentrations in the urine of the welders were 18.5 ± 28.5 μg/l on average (95th percentile 52.5 μg/l). Only a weak correlation between the nickel levels of plasma and urine could be detected (C_urine = 2.07 + 8.45 C_plasma; r = 0.294; p < 0.01). Based on our results and on the reported literature a future limit value for the nickel concentration in urine should lay between 30 and 50 μg/l. This value corresponds to an external exposure of 500 μg nickel per cubic metre.     

Pyridinium crosslinks of collagen as a marker of bone resorption rates in children and adolescents: Normal values and clinical application

The aim of our study was to establish normal values of urinary pyridinoline (Pyr) and deoxypyridinoline (DPyr) excretion for children aged 3–18 years, examine the biological variability of the marker, and assess its clinical value for pediatric patients with growth hormone deficiency. Pyr and DPyr was measured in first void urine samples from 692 healthy subjects (340 boys, 352 girls) by high-performance liquid chromatography. At sampling, age, body height, and weight was recorded for all individuals. Short-term variability in crosslinks excretion was examined in four healthy children. The clinical value of the marker was studied in seven patients with growth hormone (GH) deficiency. In childhood, crosslinks excretion exceeded normal adult values by about fivefold and declined during puberty. In the age range of 13–18 years, gender-related differences in Pyr and DPyr levels were observed, presumably resulting from the earlier onset of puberty in girls. Urinary levels of Pyr and DPyr were highly correlated both in males and females. Pyr/DPyr ratio was significantly higher in adolescents than children, suggesting enhanced release of Pyr from extraosseous sources. In both genders, neither age nor anthropometric variables showed a linear effect on crosslinks excretion. The range of within-subject, short-term variability in urinary Pyr and DPyr was relatively high (CV: 6%–21%), indicating that single measurements of crosslinks excretion may not adequately reflect bone resorption rates in children. Pyr and DPyr levels were significantly lower in GH-deficient patients and normalized during human growth hormone (hGH) therapy. Significant correlations between growth velocity (GV) and crosslinks levels were found, but individual prediction of GV increment during hGH treatment may be inaccurate. Pyr/DPyr ratio was not related to GV. It is concluded that measurement of urinary Pyr and DPyr excretion in children may be a valuable tool to assess bone resorption rates in population-based studies. In individual patients, however, only qualitative evaluation of disease severity and response to treatment seems justified.