165例患者不规则抗体筛选结果分析及临床意义

目的分析165例患者的不规则抗体筛选及鉴定结果,探讨抗体筛选在临床输血中的意义。方法对患者进行抗体筛选并对抗体筛选结果阳性者进行抗体特异性鉴定,以确定抗体的临床意义。结果 165例抗体筛选标本中,检出抗体阳性标本62例,占送检标本的比例为37.5%。62例抗体筛选阳性标本中,检出IgM性质冷自身抗体16例,占抗体筛选阳性标本25.8%,检出IgG+IgM性质抗体8例,占抗体筛选阳性标本12.9%,检出IgG性质抗体38例,占抗体筛选阳性标本61.3%。检出IgG+IgM和IgG性质抗体患者中,女性患者较男性患者所占比例高。确定不规则抗体特异性12例,其中IgM冷自身抗-M1例,同种抗体中IgG抗-c1例,IgG抗-Ec2例,IgG抗-E5例,IgG抗-Ce1例,IgG抗-D1例,温自身抗体IgG抗-e1例。12例抗体特异性确定的患者中,女性患者较男性患者所占比例高。结论对输血前患者,尤其是对有输血史及妊娠史的患者进行不规则抗体筛选及鉴定,有利于为患者找到合适的血液,保证临床输血的安全,减少溶血性输血反应的发生。抗体筛选结果为免疫溶血性疾病的诊断提供依据。     

南昌地区汉族健康人群中抗A(B)抗体效价检测分析

目的探讨南昌地区汉族健康人群(献血人群和孕妇)中IgM和IgG抗A、抗B抗体效价的范围。方法 ABO正反定型和RhD血型鉴定均采用试管凝集法;抗体筛选和抗体筛选鉴定用盐水、凝聚胺法进行抗体筛选;抗体筛选阳性再用谱细胞于盐水、凝聚胺和抗人球蛋白介质中进行抗体鉴定;采用盐水倍比稀释直接离心试管法检测IgM抗A(B)抗体效价,用2-Me灭活IgM抗A(B)后,用凝聚胺法进行IgG抗A或抗B的血型抗体效价检测。结果 A:B:O=41:26:138;RhD阴性9例;85例孕妇中IgG抗A(B)效价≥64为8.4%(10/119),而120例无偿献血者和孕妇的丈夫IgG抗A(B)效价≥64为4.1%(8/193),IgM抗A(B)效价≥64为32.6%(61/187);孕妇IgG抗A(B)效价高的人数比其他健康人要多且均为O型。结论 A型和B型的人大多数是IgM为主,成年O型人血清中IgG抗A和抗B占有优势,尤其是有妊娠史或流产史的女性。为进一步探讨本地区IgM和IgG抗A、抗B抗体效价的高低与身体不同健康状态及某些疾病相关性提供了一定的参考价值。为南方汉族健康人群IgG抗A(B)效价提供参考。     

正常O型人血清ABO血型抗体主要类别的分析

目的通过检测O型及A/B型人血清中IgM类及IgG类抗体的效价,分析正常O型人血清中ABO血型抗体的主要类别。方法分别以盐水介质法和间接抗人球蛋白法检测O型及A/B型人血清中IgM类和IgG类抗A或抗B抗体的效价。结果 O型人血清中IgM类抗A/抗B抗体效价均显著高于IgG类抗A/抗B抗体（均P〈0.01）;O型人血清中IgM类抗A/抗B抗体效价与B/A型人比较无显著性差异（均P〉0.05）,而IgG类抗A/抗B抗体效价显著高于B/A型人（均P〈0.01）;O型人血清中IgG类与IgM类抗A/抗B抗体效价的比值均显著高于B/A型人（均P〈0.01）。结论 O型人ABO血型抗体仍以IgM类为主,但其IgG类抗体效价及在血清中所占的比例要明显高于A/B型人。     

献血者抗-Wr~a的血清学研究——附1例报告

目的研究1名献血者的抗-Wr~a的血清学特征,并探讨该抗体的临床意义。方法对该名献血者进行直接抗人球蛋白试验(DAT)、间接抗球蛋白试验(IAT)、热放散试验等鉴定红细胞和血清中的抗体,用2-Me处理血清中的IgM抗体,用标准血清试剂检测其红细胞上的Wr~a抗原。结果抗-Ig G+C3d1+w,抗-Ig G1+w,抗-C3d阴性。两个批号的谱细胞均显示血清中检出IgM+IgG抗-Wr~a,抗体效价:IgM抗体为2,IgG抗体为1。Wr~a抗原表型检测结果为Wr(a-)。结论 1/3的自身免疫性溶血性贫血患者含有抗-Wr~a,建议在交叉配血过程中增加对患者抗-Wr~a的鉴定和献血者Wr~a抗原的确认。     

血清抗头孢菌素和抗青霉素IgG与IgM抗体联合检测分析

头孢菌素与青霉素均为半抗原,进入血液后与血浆蛋白结合可刺激机体产生相应抗体(抗体类型可为IgE、IgG和IgM).长期以来国内外对青霉素和头孢菌素的IgE抗体关注较多,而对IgG/IgM类抗体缺乏应有的重视.为了了解本地区临床患者血清中抗青霉素和抗头孢菌素的IgG/IgM类抗体检出情况,我科用微柱凝胶抗人球蛋白法对240例住院患者血清进行抗头孢唑啉、头孢呋辛、头孢哌酮和抗青霉素IgG与IgM抗体联合检测分析,现报告如下.     

用ELISA检测乙型肝炎病毒IgM类核心抗体

本文报导了乙型肝炎病毒IgM 类核心抗体的ELISA 检测法及对104例各类肝炎病人血清的测定结果。试验利用羊抗人IgM、人IgM 固相吸附法,选择性结合已知抗原(HBc Ag),检出特异性IgM 类抗HBc。以高于正常人P/N 值均值的2个标准差(2.1)为阳性。乙型病毒性肝炎检测阳性率,急性黄疸型及无黄疸型为100%,慢性活动性75.6%,慢性迁延性66.7%;甲型病毒性肝炎及正常人无阳性。类风湿因子假阳性率为27.3%。本试验经酶标记羊抗人IgM、IgG 选择性结合、羊抗人IgM 封闭试验证实,羊抗人IgM 特异性好。试验稳定,易于推广。     

Lewis血型系统抗体检出情况分析及其临床输血策略的探讨

目的 通过对现阶段Lewis血型系统抗体检出率的分析,探讨产生Lewis血型系统抗体患者的临床输血策略。方法 应用盐水试管法及卡式抗人球蛋白法等血清学方法进行实验检测,对证实存在Lewis血型系统抗体的标本进行回顾性分析。结果 2 923例送检标本中有147例检出Lewis抗体,抗Le^a抗体83例占56.5%(83/147),抗Le^b抗体51例占34.7%(51/147),抗Le^a+Le^b抗体13例占8.8%(13/147)。单纯IgM型135例占91.8%(135/147),IgG型或IgG+IgM型Lewis抗体12例占8.2%(12/147)。血型正反不一致标本中有38例检出Lewis抗体,其中26例为抗Le^b抗体,占68.4%(26/38),卡式抗体筛选试验Lewis抗体漏检率为28.5%(42/147)。51例输注了红细胞,未发生输注无效或输血反应。结论 Lewis血型系统抗体检出率与文献报道^[6,9]存在差异,Lewis血型系统抗体的临床意义不可忽视,应尽可能采用三种介质交叉配血来保证输血安全。     

与免疫相关的血细胞减少患者骨髓造血细胞自身抗体的研究

目的　了解与免疫相关的血细胞减少患者骨髓造血细胞结合的自身抗体的类型、分布、数量及临床意义 ,考察骨髓单个核细胞直接抗人球蛋白试验 (BMMNC Coombs)的敏感性。方法　对 32例临床疑诊为免疫性全血细胞减少的患者进行BMMNC Coombs试验和流式细胞术 (FACS)双标法检测骨髓造血干 祖细胞、有核红细胞、粒细胞结合的自身抗体的种类及结合率。结果　FACS双标法检出的骨髓造血细胞自身抗体的阳性率为 90 .6 %,BMMNC Coombs试验检出的阳性率为 5 0 .0 %,前者显著高于后者 ( χ2 =12 .6 5 ,P <0 .0 5 )。FACS检测自身抗体阳性的 2 9例患者中IgG型占 6 .9%,IgM型占13 .8%,IgG +IgA型占 3 .4%,IgG +IgM型占 31.0 %,IgG +IgM +IgA型占 44 .8%;2 9例中含IgG型 2 5例 ,占 86 .2 %,含IgM型 2 6例 ,占 89.7%,含IgA型 14例 ,占 48.3 %。IgG型血红蛋白减少得最严重 ,含IgM型的患者可有血管内溶血的实验室发现 ,IgM和IgM +IgG型组治疗的起效时间明显短于其他组。91.3 %的患者可检出造血干 祖细胞上有自身抗体 ,而且多表现为全血细胞减少 ;约 5 0 .0 %的患者红、粒系细胞上有自身抗体 ,13例BMMNC Coombs试验阴性而FACS检测阳性的患者中有 11例在造血干细胞上有自身抗体。与有核红细胞和造血干 祖细胞结合的三种抗体     

香港汉人献血者中Miltenberger抗体频率的调查

Miltenberger(Mi)复合物由一系列低频率抗原组成,这些抗原与某些MNSs血型系统单倍型遗传有关,目前已有9个亚型(Mi.Ⅰ～Mi.Ⅸ)。作者用Mi谱红细胞调查了香港随机汉人献血者中Mi抗体频率及血清学特性。结果,在1年多时间内,从56161名随机汉人献血者中,共检出32例血清含Mi抗体,阳性率为0.057％,其中22例含抗-Mur+Hut,4例含抗-Vw+Mur+Hut,4例含单特异性抗-Mur,2例含单特异性抗-Hil。24例抗体为IgG和IgM混合型,4例为单纯型IgG,4例为单纯型IgM,未发现针对主要血型系统普通抗原的免疫抗体。24例血清经两期EDTA-抗球蛋白技术检测,9例固定补体。     

抗体筛查检出IgM、IgG抗-E一例

临床输血前抗体筛查常可检出Rh血型系统抗体。这些抗体大多通过免疫产生,多属IgG型。免疫早期也可出现IgM型抗体,但很少见。我们在做抗体筛查时检出1例IgM、IgG抗-E,可能由于患者多次输血产生,现报告如下。一、材料和方法1.临床病例患者,男,69岁,诊断为肝硬化、消化道出血。血型为O型Rh(D)阳性,分别     

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.     

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.     

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.     

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.     

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.     

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.