尿液有形成分两种仪器检测结果的分析与比较

[目的]分析和探讨流式细胞仪UF1000i和尿化学分析仪CLINITEK500检测尿液有形成分的临床应用价值。[方法]3836份尿液标本以流式细胞仪UF1000i分析系统检测红细胞（RBC）、白细胞（WBC）、管型（CAST）等成分,尿化学分析仪CLINITEK500测定尿液中LEU、BLD、PRO等指标,与显微镜下人工判定的结果进行比较。[结果]尿流式细胞分析仪在灵敏度、特异性、准确度、阳性预测值和阴性预测值都优于尿化学分析仪,经X2检验在a=0．05水准,两者差异有统计学意义（P〈0．05）。[结论]两种仪器联合应用可以降低单用其中一种仪器的假阳性及假阴性率。     

Clinical tests for screening and diagnosis of cervical spine myelopathy: a systematic review

Objective

The purpose of this review was to investigate the diagnostic accuracy for screening and confirmation of clinical tests for cervical spine myelopathy (CSM) and to investigate the quality of the studies that have investigated these values.

Methods

This study was a systematic review that used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms for PubMed included myelopathy; diagnosis, differential; sensitivity and specificity; and physical examination. Search terms for Cumulative Index to Nursing and Allied Health Literature were limited to myelopathy and sensitivity and specificity. Qualitative assessment included report of diagnostic accuracy metrics (sensitivity, specificity, and positive and negative likelihood ratios) and quality scores using the Quality Assessment of Diagnostic Accuracy Studies tool. Scores were created for single tests and clustered test findings.

Results

After evaluation, 12 full-text articles were selected, scored, and tabulated. Nearly all of the 18 tests demonstrated high levels of specificity and low levels of sensitivity, suggesting that they are poor screening tools. Only one study was scored as high quality. One study involved clustering of test findings but was considered low quality.

Conclusion

Nearly all of the clinical tests for CSM seem to be poor screening tools, which implies that manually oriented clinicians may perform treatment methods in a situation of doubt or uncertainly. More high-quality studies are needed, and manual therapists need to be cognizant that the current clinical tests for CSM lack strong diagnostic accuracy measures that are necessary for clinical decision making.     

18F-FDG PET/CT对宫颈癌术后临床怀疑复发和转移病人中的应用价值

目的观察¹⁸F-氟代脱氧葡萄糖(¹⁸F-FDG)正电子发射断层显像技术/计算机体层扫描(PET/CT)对宫颈癌术后临床怀疑复发与转移患者的诊断价值。方法前瞻性纳入喀什地区第一人民医院2018年7月至2020年11月期间收治的118例宫颈癌术后怀疑复发与转移患者为研究对象,采用随机数字表法其分为观察组(n=59)与对照组(n=59)。对照组予给予以常规血清癌抗原19-9(CA19-9)检测,观察组行¹⁸F-FDG PET/CT检查。2组均以组织病理学结果为金标准,评估2组对宫颈癌怀疑复发与转移的诊断价值并对比组间差异。结果¹⁸F-FDG PET/CT检查诊断对宫颈癌复发及转移的特异度(76.92%)、灵敏度(93.48%)以及准确率(89.83%)均显著高于CA19-9检测(38.46%、60.87%、55.93%),2组比较差异有统计学意义(P<0.05),同时观察组诊断结果与组织病理学结果吻合度较高(Kappa=0.766,P<0.05)。结论¹⁸F-FDG PET/CT检查应用于宫颈癌术后临床怀疑复发与转移的诊断,可清晰显示其状况,灵敏度、准确率等均明显高于血清CA19-9检测。     

Representativeness of nodal sampling with endobronchial ultrasonography in non-small-cell lung cancer staging

The objective of our study was to determine the procedure-related requirements of mediastinal node sampling with endobronchial ultrasonography with real-time transbronchial needle aspiration (EBUS-TBNA) that would provide negative predictive value (NPV) for the identification of stage III disease in non-small-cell lung cancer (NSCLC) high enough to consider the technique equivalent to cervical mediastinoscopy. Representative EBUS-TBNA was defined as a sampling procedure obtaining satisfactory samples from normal nodes in regions 4R, 4L and 7 or diagnosing malignancy in mediastinal nodes. NPV was estimated using the results of postsurgical staging in patients who underwent surgery as a reference. Two-hundred ninety-six patients staged with EBUS-TBNA were included. Representative samples from regions 4R, 4L and 7 showing nonmalignant cytology were obtained from 98 patients (33.1%) and EBUS-TBNA detected N2/N3 disease in 150 (50.7%). Accordingly, an EBUS-TBNA procedure accomplishing the representativeness criteria required for sampling was attained in 248 of the participating patients (83.8%). The NPV of the procedure in this setting was 93.6%, with false-negative results only found in 5 patients, four of them with nodal metastasis out of the reach of EBUS-TBNA (regions 5, 8 and 9). In conclusion, representative sampling of regions 4R, 4L and 7 is achieved in more than 80% of patients staged using EBUS-TBNA, and in the procedures that attain this requirement a NPV >90% for mediastinal malignancy is reached, a figure equivalent to cervical mediastinoscopy.     

甲状腺影像报告与数据系统(TI-RADS)观察者一致性与阳性预测值的研究

目的 回顾性研究不同观察者使用甲状腺影像报告与数据系统(TI-RADS)词典对甲状腺结节描述的一致性,并确定不同TI-RADS分类对恶性甲状腺结节的阳性预测值。 方法 对2016年6－11月获得病理结果的172例连续患者的188个甲状腺结节使用TI-RADS超声词典进行评估,计算不同超声征象及TI-RADS最终分类的κ值,计算不同TI-RADS分类对恶性甲状腺结节的阳性预测值。 结果 对于甲状腺结节结构、回声、形态、边缘、局灶性强回声的判断,κ值分别为0.743(0.713－0.772)、0.418(0.319－0.517)、0.468(0.389－0.547)、0.397(0.291－0.503)、0.566(0.514－0.617)(括号内为95%可信区间);对于结节TI-RADS分类的判断,κ值为0.782(0.749－0.815)。TI-RADS 1～5类的阳性预测值分别为0(0/8)、0(0/23)、14.3%(4/28)、29.7%(11/37)和85.7%(78/91)。 结论 不同医师对结构判断的一致性很好,对于回声、形态、局灶性强回声判断的一致性中等,对于边缘判断的一致性不够理想。但最终得到甲状腺结节总体TI-RADS分类一致性很好,表明该分类系统在不同医师间的应用不易导致对患者最终临床处置的不同,具有较好的应用价值。     

Evaluation of the operative parameters for a human prolactin radioimmunoassay in serum

Summary A sensitive homologous radioimmunoassay (RIA) for human prolactin (hPRL) was evaluated. The experimental parameters of this double antibody solid phase (DASP)-hPRL-RIA are described. The RIA measures concentrations of hPRL as low as 1 ng/ml of human serum and allows repetitive measurements and accurate delineation of serum hPRL. The assay is specific for hPRL; only HGH shows a weak cross-reaction. The antigen recovery tests are quantitative. The serum concentrations of hPRL in a group of randomly selected male and female individuals averaged 6.7±3.3 ng/ml and 7.4±3.3 ng/ml, respectively. In a chronobiological study performed on 21 subjects (5 male and 16 female), a statistically significant rhythm with a 24-h period was detected. Presented at the First European Congress of Nuclear Medicine Society, May 1976.     

经胸心脏超声对A型急性主动脉夹层诊断价值的荟萃分析

目的 系统评价经胸心脏超声(transthoracic echocardiography,TTE)在疑诊A型急性主动脉夹层早期诊断中的价值.方法 计算机检索PubMed、EMbase、The Cochrane Library、中国知网(CNKI)、万方数据库,收集有关TTE诊断A型急性主动脉夹层的诊断性试验,检索时限截至2015年12月.由2位评价者根据纳入与排除标准独立筛选文献、提取资料和评价质量后,采用Meta-Disc 1.4软件进行分析,并绘制汇总受试者工作特征(SROC)曲线、计算曲线下面积和Q*指数.结果 最终纳入9个研究,共1 631例患者.敏感性为79％,特异性为95％,阳性似然比为11.99,阴性似然比为0.22,诊断比值比为74.25,SROC曲线下面积为0.940 7,Q*指数为0.878 3.结论 TTE作为单独检查方法对A型急性主动脉夹层的早期诊断具有较高的初筛价值.但其敏感性受多因素影响,临床上尚需联合其他诊断指标,以进一步提高诊断的准确性.     

Interpretation of positive molecular tests of common viruses in the cerebrospinal fluid

Many central nervous system infections are historically difficult to diagnose. Polymerase chain reaction (PCR) has revolutionized the diagnosis of these infections because of their high sensitivity despite the lack of data on clinical usefulness. We conducted a retrospective study that included patients with positive cerebrospinal fluid (CSF) PCR for herpes simplex virus, varicella-zoster virus, JC virus, cytomegalovirus (CMV), and Epstein-Barr virus (EBV) between January 2009 and December 2011. The positive results were grouped into definite, likely, and possible true positives and likely false-positive categories based on pre-specified definitions specific to each virus. Of 1663 CSF viral PCR tests, 88 were positive (5%). The combined positive predictive value (PPV) was 58%. The PPVs were least for CMV and EBV at 29 and 37%, respectively. A positive CSF viral PCR result has to be interpreted with caution due to several false-positive results.     

乳腺浸润性导管癌的超声特征

目的分析乳腺浸润性导管癌(IDC)的声像图特征,提高超声对IDC的诊断价值.方法回顾性分析56例经病理证实的IDC二维图像特征及能量多普勒血流形态、频谱参数.结果56例中显示毛刺征或蟹足征34例,周边高回声晕30例,内部微钙化36例,后方回声衰减35例;能量多普勒显示无血流1例,星点状或短线状血流55例,穿入型、分支状、不规则型血流分别为37例、34例、24例.45例肿块内部血流表现为高速高阻型(Ps≥17 cm/s,RI≥0.7).21例有腋窝淋巴结肿大.结论IDC在声像图上有其特征性表现,超声可成为诊断IDC的有效影像学方法之一.     

超声诊断乳腺导管内癌的价值探讨

目的探讨乳腺导管内癌的超声诊断价值。方法回顾性总结2000年9月-2006年12月期间经我院手术病理证实为乳腺导管内癌的36例病例的超声声像图特征。结果乳腺导管内癌在超声上主要表现为导管型、结节伴钙化型及肿块型(包括混合性肿块及实质性肿块)。声像图特征多表现为形态欠规则,边界欠清,无包膜的略低回声区,内部回声欠均匀,部分可测及较丰富血流信号。伴有细钙化的病灶仍较有意义。结论乳腺导管内癌没有特异性超声诊断特征,但部分特征有一定提示性,可帮助检出病灶,对早期发现术后复发病灶也很有价值。     

超声对乳腺导管内癌的诊断价值

目的探讨乳腺导管内癌的超声诊断价值。方法分析44例乳腺导管内癌声像图。结果腺病型11例,腺体局部增厚,结构紊乱;导管扩张型7例,3例单纯导管扩张,4例扩张导管壁欠光整,内见隆起性小光团;实性肿块型24例,腺体内实性低回声,纵横比〈1;混合肿块型2例,腺体内见境界尚清的囊实混合性肿块,以囊性为主,内部见团絮状弱回声。结论超声检查乳腺导管内癌有一定的鉴别诊断价值。     

脓毒症实验室诊断及其研究进展

脓毒症是一类因多种病原菌引起的机体全身性的过度炎症反应,临床症状与全身性炎症反应综合征(SIRS)相似,由于目前缺少理想的实验室诊断指标,尽管近年来诊断和治疗的技术不断进步,但脓毒症发生率和死亡率仍居高不下。本文就近几年临床应用较多、研究较热门的诊断标志物作一综述。     

An analysis of the diagnostic methods for acute pulmonary embolism

In spite of numerous sophisticated investigative procedures, acute pulmonary embolism (PE) is very frequently misdiagnosed. In order to improve the diagnostic approach to PE, the sensitivity and specificity of the commonly used methods were reviewed in a group of 421 patients with angiographically proved PE without associated cardio-pulmonary disease. The specificity of diagnostic procedures was, by decreasing order: positive pulmonary angiography (to affirm) = negative perfusion lung scan (to eliminate) > chest X-ray clinical symptoms, positive perfusion lung scan, ECG, blood gas, serum enzymes.     

Humpty Dumpty儿童跌落风险评估量表敏感度和特异度的评价

目的 研究Humpty Dumpty儿童跌落风险量表（HDFS）的敏感度和特异度,探索该量表的最佳临界值,以便更好地识别跌落高风险患儿。方法 采用回顾性病例配对对照研究设计,根据年龄、性别、诊断三大因素按照1∶1配对,对52例跌落病例和52例未跌落病例进行病史回顾,运用HDFS进行各条目的评估。结果 HDFS的最佳预测工作点是16分,此时灵敏度为0.558,特异度为0.635,ROC曲线下面积为0.610。经比较,当工作点为≥13分时,跌落组和对照组得分分别为（15.77 ± 1.46）、（15.22 ± 1.21）分,2组得分比较差异有统计学意义（t=3.98,P<0.05）。结论 HDFS具有部分识别跌落高风险患儿的能力,最佳理论工作点为16分,推荐最佳工作点为13分。HDFS的使用能为高风险跌落患儿护理干预提供一定参考依据。HDFS的理论诊断价值处于较低水平,需要更进一步的研究来验证或改善评估工具。     

SPA-ABC法用于急性日本血吸虫病的诊断且与ELISA、IHA的比较

本文报道了ABC—ELISA、常规ELISA、IHA检测90例急性血吸虫病人的血清特异抗体,其阳性检出率分别为100％、98.9％、97.8％。同一样本用两种方法做,ABC—ELISA较常规ELISA敏感者37例,抗体滴度平均高出1.3倍;较IHA敏感者62例,抗体滴度平均高出2.0倍。但50例健康人血清检测:ABC—ELISA未出现假阳性,常规ELISA、IHA假阳性各为2％、4％。显示SPA—ABC法敏感性高、特异性强且有助于低水平抗体的急性血吸虫病患者的诊断。