EUROlineScan分析软件在免疫印迹法检测自身抗体中的应用探讨

目的比较目测判断法和EUROLineScan软件分析法在免疫印迹法检测自身抗体时的差异,为以显色条带灰度强度为基准的扫描软件分析法替代传统目测判断法提供实验依据。方法同时采用目测判断法和EUROlineScan软件分析法对免疫印迹法检测膜条显色带进行结果分析,并比较两种方法在结果判断上的差异;编写EUROlineScan软件与实验室信息系统(LIS)连接的接口,达到检测结果实时传入LIS的目的。结果在148条膜条的1184例自身抗体检测实验中,两种方法检测结果一致率为88.43%(1047/1184),κ=0.669,P=0.02;检测结果不一致主要集中分布于相邻两判断值间;目测判断法重复性为95.86%(1135/1184),而软件分析法的重复性为99.75%(1181/1184),两者比较有显著性差异(P=0.000)。结论EUROlineScan软件分析法较目测判断法在操作上更简便和快速,结果更客观、重复率更高,并可读取显色带具体的灰度值,同时具有能与LIS联机的特点,因此EUROlineScan软件分析法是免疫印迹法检测自身抗体结果判读更为有效可靠的方法。     

免疫学检验结果自动审核程序的建立及其应用

目的探讨基于实验室信息管理系统(LIS)的免疫学检验项目的自动审核程序的应用价值。方法参照美国临床和实验室标准化协会(CLSI)AUTO·10A文件的流程框架,综合运用医嘱溯源性校验、各免疫学检验项目的线性范围、不准确度、检验结果间的逻辑关系以及患者结果的回顾性校验,制定嵌入LIS的自动审核规则和审核程序。结果免疫学检验定性项目设4项规则,平均通过率85%;定量项目设9类规则,平均通过率80%。运用智能审核可有效拦截违反规则的检验报告,节省人力资源和缩短报告时间。结论基于LIS的免疫学检验项目的自动审核程序提高了工作效率,避免人为差错或经验不足而误发报告,是LIS在医学检验的智能化管理的应用方式之一。     

串口通讯技术与数据库技术在医学检验中的应用

目的在医学检验工作中,编制一个能自动将实验仪器上的结果数据自动采集到计算机上,并将结果与病员资料挂接存入数据库中,更好利用计算机对实验数据进行分析与管理.方法利用串口通讯技术和数据库技术结合.笔者多年来在检验工作中的经验自行编制出应用软件,此软件主要包括:联机程序和数据管理程序两部分.结果此软件的应用将避免医学检验工作在日常工作和科学实验活动中处理大量的实验数据时的手工录入,工作量繁大,耗时,容易出错等特点.结论串口通讯技术与数据库技术在医学检验中的应用将大大提高医学检验工作者分析和处理实验数据的效率,对实现实验室的电脑化管理具有重要意义.     

运用实验室信息系统实施检验危急值在ISO15189体系中的意义

目的探究运用实验室信息系统(LIS)实施检验危急值在国际标准化组织(ISO)15189体系中的意义。方法运用LIS的报警功能使检验危急值得以优先处理,运用LIS与医院信息系统连接,使检验危急值发送到医院信息系统和医生移动电话。结果通过LIS与信息中心的转换对接,LIS中的危急值传输到HIS系统、护士工作站、医生移动电话。结论健全检验危急值制度,优化LIS在检验危急值播报过程中的功能是实践ISO15189体系中结果发放的重要内容。     

实验室信息系统在医学检验质量控制方面的应用价值

目的应用实验室信息系统（LIS）对医学检验过程进行全面质量控制。方法在LIS中设置倒控制节点程序,利用计算机对人员行为进行规范,以减少和防止各种人为差错事故。结果与结论在LIS中的重要节点设立倒控制程序,能有效规范各个操作规程,提高检验质量和安全,防范差错事故发生。     

串口通讯技术与数据库技术在医学检验中的应用

目的 在医学检验工作中，编制一个能自动将实验仪器上的结果数据自动采集到计算机上，并将结果与病员资料挂接存入数据库中，更好利用计算机对实验数据进行分析与管理。方法 利用串口通讯技术和数据库技术结合。笔者多年来在检验工作中的经验自行编制出应用软件，此软件主要包括：联机程序和数据管理程序两部分。结果 此软件的应用将避免医学检验工作在日常工作和科学实验活动中处理大量的实验数据时的手工录入，工作量繁大，耗时，容易出错等特点。 结论 串口通讯技术与数据库技术在医学检验中的应用将大大提高医学校验工作者分析和处理实验数据的效率，对实现实验室的电脑化管理具有重要意义。     

LIS系统与HIS系统数据交换及整合的应用

我院通过将检验科信息系统（LIS系统）与医院信息系统（HIS）进行整合，实现了患者信息、诊断信息、检验申请信息及检验结果的同步传输，实现了完整意义上的信息共享。下面对我院LIS系统和HIS系统的信息共享与交换整合的设计和实现进行简单的介绍。     

检验医学专业实习生实验室信息系统介绍及培训

目前实验室信息系统（laboratory information system,LIS）在医院检验科的应用越来越广泛,LIS也是医院信息系统（hospital information system,HIS）的一部分,本院对来检验科实习的检验医学专业实习生进行了LIS介绍和培训,内容主要包括LIS运行基本流程、LIS中标本接收和处理、LIS在大型自动化检验仪器上的应用。目的是使学生们能较快地熟悉和使用LIS,并能正确回答临床医护人员的咨询。     

日立7020全自动生化分析仪故障报警分析

我科于 1 998年购置了一台日本日立公司生产的 HI-TACHI-70 2 0型全自动生化分析仪。在日常工作中偶尔出现的故障报警 ,我们按《指导手册》中故障报警总汇的提示均能迅速排除 ,但有两种故障报警比较特殊 ,按《指导手册》中的提示不能排除。现将这两种情况总结如下。1　联机通讯中断1 .1　现象及处理方法　主机在运行分析过程中 ,所测得的数据不能传输到微机上 ,要想排除这一故障 ,只能停机重新开始 ,但有时停机也不能排除此故障 ,这给日常工作带来了诸多不便。经过向日立公司和清华同方公司咨询及反复观察 ,我们做了如下处理 :给机器安上…     

基于LIS的ISO15189认可管理信息中间件设计及应用

目的探讨基于实验室信息管理系统(LIS)的ISO15189认可管理信息中间件的设计及其应用。方法基于LIS,通过中间件技术作为底层基础平台设计ISO15189认可管理信息中间件,采用数据仓库技术、数据清洗和提取技术等实现LIS的多功能管理作用。结果 ISO15189认可管理信息中间件使LIS实现跨越多系统的数据交换与传输、数据共享、数据智能处理等功能;从实验室各种业务系统中抽取、转换、加载需要的数据,构建数据仓库;从不同角度对多维数据集操作,将数据灵活地呈现给用户。结论基于LIS的ISO15189认可管理信息中间件在ISO15189认可管理中具有较高价值,让管理工作标准、高效、智能。     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.