尿液甘氨酰脯氨酸二肽氨基肽酶测定及临床应用

目的　探讨尿液甘氨酰脯氨酸二肽氨基肽酶 (GPDA)测定及临床应用价值。方法　用连续监测法以甘氨酰脯氨酰对硝基苯胺为底物检测尿液GPDA ,并对检测条件及干扰因素进行试验探讨 ,同时对 334名正常人 ,5 5例糖尿病和 36例高血压患者尿液GPDA进行检测分析。结果　尿GPDA在 35 0U/L以下线性良好 ,低、高值尿液标本的批内变异系数 (CV)分别为 1 2 7%、0 6 1% ,批间CV为 1 33% ,尿液标本 4℃存放 7dGPDA活性没有变化 ,胆红素、葡萄糖、维生素C及糖尿病治疗药物二甲双胍、格列苯脲对GPDA测定无干扰 ,血红蛋白在 5 0 0mg/L以下时对GPDA测定无干扰 ,>5 0 0mg/L产生负干扰 ,334名正常人尿GPDA活性为 (12 9± 4 1)U/g·Cr,参考值范围 4 9～ 2 0 9U/g·Cr;糖尿病、高血压病合并肾损害组尿GPDA明显高于正常对照组和未发生肾损害组 ,差异有非常显著意义 (P <0 0 0 1)。结论　甘氨酰脯氨酸二肽氨基肽酶操作简单、快速、稳定性好 ,干扰因素少 ,结果准确 ,是诊断早期肾小管损伤的敏感而特异的检验项目。     

尿β-D-半乳糖苷酶活性检测方法的建立及临床意义探讨

目的以2-氯-4-硝基苯基-β-D-半乳糖苷(CNP-GAL)为底物,建立测定尿β-D-半乳糖苷酶(GAL)活性的连续监测法,并探讨GAL在肾小管病变早期诊断中的临床意义。方法基于GAL能催化水解底物生成色原2-氯-4-硝基苯酚(CNP)的原理,对最适p H值、底物浓度、反应时间等条件进行研究,建立用于检测尿GAL的连续监测法,并用该法检测125例肾脏病变(30例继发性肾损伤、36例肾小管肾炎、25例肾癌、34例肾囊肿)患者及80名健康体检者(正常对照组)尿GAL活性。结果建立了检测尿GAL活性的连续监测法,采用柠檬酸缓冲液为最佳缓冲体系,酶促反应最适p H值为4.8,最适底物浓度为2.0 mmol/L。该法批内、批间平均变异系数(CV)分别为2.44%、4.47%,线性范围为3.2~25.6 U/L,当GAL1.6 U/L时不能被检出。继发性肾损伤、肾小管肾炎、肾癌患者的尿GAL活性均明显高于正常对照组(P0.05),而肾囊肿患者的尿GAL活性无明显增高。结论建立的GAL活性连续监测法敏感性高,结果准确,操作简便,可用于肾小管疾病的早期诊断。     

血清对氧磷脂酶活性连续检测方法的建立及临床意义

目的建立血清中对氧磷脂酶(PON)活性测定的方法,测定正常人和肝硬化患者血清中PON的活性,探讨该酶诊断肝硬化的意义.方法 PON活性测定以乙酸苯酯为底物,在PON的作用下水解,生成苯酚,用分光光度计在37℃、270 nm处连续监测3 min测定苯酚特征性的紫外吸收,计算出酶促反应速度.结果本方法的最适的测定条件为37℃、270 nm处连续监测3 min,底物浓度为10 mmol/L,最适pH值为8.0,激活剂Ca2+浓度为2 mmol/L,批内变异系数(CV)可达4.3%,批间CV为5.0%.正常人组血清PON活性为(284.95±83.76)U/ml,参考范围为201.2～368.7 U/ml,肝硬化患者组PON活性为(153.78±107.54)U/ml,两组差异有显著性(P＜0.01).结论本方法测定血清中PON的活性操作简便、精密度、线性良好.肝硬化患者血清PON活性与正常人组比较差异有显著性.     

尿α-L-岩藻糖苷酶对糖尿病早期肾损害的诊断价值

目的探讨尿α-L-岩藻糖苷酶(AFU)测定在筛查糖尿病(DM)早期肾损害中的临床应用价值。方法将178例2型DM患者按24 h尿微量白蛋白(mAlb)排泄率分为DM无肾病组(79例)、DM早期肾病组(54例)和DM临床肾病组(45例)。应用本室建立的连续监测法检测178例2型DM患者和320名正常对照者尿AFU、mAlb、尿β2-微球蛋白(β2-MG)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)含量,并进行比较。结果采用连续监测法检测尿AFU在300 U/L以下线性良好;高、低浓度样本批内变异系数(CV)分别为1.69%、1.26%,批间CV分别为4.51%、3.52%。维生素C、胆红素和血红蛋白分别为50 mg/L、136.8μmol/L和1 g/L时对尿AFU不产生干扰。DM组尿AFU、mAlb、β2-MG、NAG分别为(2.87±0.91)U/g.Cr、(67.62±21.27)mg/g.Cr、(0.48±0.32)mg/g.Cr、(29.23±8.29)U/g.Cr,均明显高于正常对照组[(0.82±0.45)U/g.Cr、(11.54±8.81)mg/g.Cr、(0.11±0.07)mg/g.Cr、(9.08±5.21)U/g.Cr](P<0.01)。DM 3个亚组之间尿AFU、mAlb、β2-MG、NAG差异均有统计学意义(P<0.01)。DM患者尿AFU与NAG呈高度正相关(r=0.859,P<0.01)。79例DM无肾病组尿AFU阳性率高达19.0%,特异性为85.7%,敏感性为91.8%,Youden指数为0.77,诊断效率89.9%。99例DM肾病患者治疗后AFU水平为(2.7±1.26)U/g.Cr,明显低于治疗前[(4.6±1.72)U/g.Cr](P<0.01)。结论尿AFU测定是筛查DM早期肾损害的一项有价值的指标。     

尿液N-乙酰-β-D-氨基葡萄糖苷酶连续监测法试剂盒性能评估

本文就国产尿液NAG活力连续监测法试剂盒进行了评价.该试剂盒酶促反应延迟时间应选为3 min,监测时间选择60 s.线性0～150 U/L,r＝0 .99 98,线性误差小于7%.重复实验,水平Ⅰ批内为26.3±1.1 U/L,CV 4.2%,随机误差8. 2 %;批间s 1.77 U/L,CV 6.7%,随机误差13.2%.水平Ⅱ批内91.3 U/L±2.43 U/L,CV 2 .6%,随机误差5.2%;批间s 4.44 U/L,CV 4.9%,随机误差9.5%.平均回收率99.5% . 测定体检健康者尿样60例,经统计学分析,结果呈偏态分布,男女间差异不显著(P＞0.05) ,单侧95%上限为2.4 U/mmol Cr(37℃).     

尿液N-乙酰-β-D-氨基葡萄糖苷酶连续监测法试剂盒性能评估

本文就国产尿液 NAG活力连续监测法试剂盒进行了评价。该试剂盒酶促反应延迟时间应选为 3m in,监测时间选择 6 0 s。线性 0～ 15 0 U / L ,r=0 .9998,线性误差小于 7%。重复实验 ,水平 批内为 2 6 .3± 1.1U / L ,CV4.2 % ,随机误差 8.2 % ;批间 s 1.77U / L ,CV 6 .7% ,随机误差 13.2 %。水平 批内 91.3U / L± 2 .43U / L ,CV2 .6 % ,随机误差 5 .2 % ;批间 s 4.44 U / L ,CV 4.9% ,随机误差 9.5 %。平均回收率 99.5 %。测定体检健康者尿样 6 0例 ,经统计学分析 ,结果呈偏态分布 ,男女间差异不显著 (P>0 .0 5 ) ,单侧 95 %上限为 2 .4U / mm ol Cr(37℃ )     

5'-核苷酸酶的自动化分析

目的评价一种5'-核苷酸酶(5'-NT)的测试方法.方法在日立7060上对其进行重复性试验、线性试验、干扰试验、回收试验,建立临床正常值参考范围结果本试验线性范围达328.0U/L;批内试验低值CV 1.68%,高值CV 1.3%,批间试验低值CV 4.86%,高值CV 4.21%;平均回收率99.5%;血红蛋白(Hb)＜800mg/L,总胆红素(TBil)＜56μmol/L及碱性磷酸酶(ALP)对5'-NT测定无干扰;正常值范围为0.32～10.14U/L(n=86).结论该法具快速、灵敏、简便、准确等优点,适合临床自动化分析.     

5''''-核苷酸酶的自动化分析

目的评价一种5'-核苷酸酶(5'-NT)的测试方法.方法在日立7060上对其进行重复性试验、线性试验、干扰试验、回收试验,建立临床正常值参考范围结果本试验线性范围达328.0U/L;批内试验低值CV 1.68%,高值CV 1.3%,批间试验低值CV 4.86%,高值CV 4.21%;平均回收率99.5%;血红蛋白(Hb)＜800mg/L,总胆红素(TBil)＜56μmol/L及碱性磷酸酶(ALP)对5'-NT测定无干扰;正常值范围为0.32～10.14U/L(n=86).结论该法具快速、灵敏、简便、准确等优点,适合临床自动化分析.     

血清对氧磷脂酶活性连续检测方法的建立及临床意义

目的建立血清中对氧磷脂酶(PON)活性测定的方法,测定正常人和肝硬化患者血清中PON的活性,探讨该酶诊断肝硬化的意义。方法PON活性测定以乙酸苯酯为底物,在PON的作用下水解,生成苯酚,用分光光度计在37℃、270nm处连续监测3min测定苯酚特征性的紫外吸收,计算出酶促反应速度。结果本方法的最适的测定条件为37℃、270nm处连续监测3min,底物浓度为10mmol/L,最适pH值为8.0,激活剂Ca2+浓度为2mmol/L,批内变异系数(CV)可达4.3%,批间CV为5.0%。正常人组血清PON活性为(284.95±83.76)U/ml,参考范围为201.2～368.7U/ml,肝硬化患者组PON活性为(153.78±107.54)U/ml,两组差异有显著性(P<0.01)。结论本方法测定血清中PON的活性操作简便、精密度、线性良好。肝硬化患者血清PON活性与正常人组比较差异有显著性。     

EIA定量检测甲状腺球蛋白抗体和甲状腺微粒体抗体在临床中的应用

目的 探讨酶免疫法定量检测血清抗甲状腺球蛋白抗体(TG-Ab)和抗甲状腺微粒体抗体(TM-Ab)在临床应用价值.方法 采用酶免疫法(EIA)定量检测血清TG-Ab和TM-Ab,并对检测条件、干扰因素、精密度和准确度进行试验探讨.结果 EIA定量测定血清TG-Ab和TM-Ab分别在880IU/ml和665IU/ml以下线性良好,TG-Ab批内和批间CV分别为3.2%和7.1%;TM-Ab批内和批间CV分别为 3.9%和7.6%.测得平均回收率为TG-Ab:92.4%、TM-Ab:101.2%.血清标本4℃存放一周内,对测定结果 无影响.胆红素、血红蛋白在0.5g/L对测定无干扰,Hb浓度＞0.5g/L对TM-Ab产生正干扰.结论 EIA定量检测能较准确检测血清甲状腺自身抗体水平,操作简便,结果准确,符合临床常规使用要求,对自身免疫性甲状腺疾病的诊断、疗效观察及预后具有临床应用价值.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.