脑白质高信号患者血浆脂蛋白磷脂酶A2水平及其与认知功能障碍的关系

目的 探讨脑白质高信号(WMH)患者血浆脂蛋白磷脂酶A2(Lp?PLA2)水平及其与认知功能障碍的关系.方法 选取WMH患者97例为病例组(WMH组),以MoCA量表23分为界分为认知障碍组(CI组)37例和非认知障碍组(NCI组)60例,同期健康体检者52例为对照组(HC组).采用t检验分析WMH组与HC组血浆Lp?...     

2016—2020年血培养污染率质量指标室间质量评价结果分析

目的 回顾分析2016—2020年血培养污染率质量指标室间质评结果,了解国内微生物实验室血培养情况,为实验室建立初步质量规范提供参考。方法 国家卫生健康委临床检验中心联合31个省(自治区、直辖市)和新疆生产建设兵团临床检验中心同步开展质量指标室间质量评价计划,并通过已开发的Clinet-EQA系统在线回报结果,收集2016—2020年实验室的基本信息和血培养污染质量指标数据,对全国、各省份和不同等级医院结果进行统计分析,同时用西格玛度量评价实验室质量水平。结果 2016—2020年全国和三级医院血培养污染率中位数整体呈现下降趋势。全国最高0.53%,最低0.00%;三级医院最高0.91%,最低0.54%;二级和其他医院近5年中位数均为0.00%。按照省份对2019和2020年三级医院中位数进行排序,结果显示黑龙江、吉林、辽宁、江西、内蒙古、宁夏、青海、甘肃和新疆生产建设兵团中位数较低。结论 目前国内微生物实验室血培养情况乐观,实验室仍需加强血培养污染率质量指标监测,严格执行临床微生物实验室血培养操作规范,持续改进。     

肌电图辅助定位小切口尺神经松解术治疗肘管综合征

Objective To evaluate the therapeutic effect of in situ ulnar nerve decompression at the cubital tunnel via a small incision assisted with electromyography localization and discuss the surgical indications.Methods Twelve patients who were diagnosed with idiopathic cubital tunnel syndrome (CuTS) without intrinsic muscle atrophy and elbow deformity were involved in the study.Before the operation, short-segment nerve conduction test (SSCT) was carried out.The exact compression site was determined by the ＞ 50%reduction in amplitude or ＞ 0.5 ms lengthening in latency of action potentials recorded upon stimulation of the ulnar nerve around the elbow at 1 cm intervals.An in situ ulnar nerve release at the compression site was performed.Compression of the ulnar nerve was observed and documented to verify the accuracy of pre-operative SSCT localization.Results Intraoperative findings confirmed that lesions were located from 3 cm above to 1 cm below the medial epicondyle, which coincided with the compression sites determined by SSCT.All the patients reported alleviation of hand discomfort postoperatively.Follow-up at 3 months postoperatively showed that paresthesia in the distribution of the ulnar nerve in the hand disappeared.Pinprick sensation recovered.There was no subjective or measurable weakness in pinch or grip strength and no clumsiness or loss of coordination.Claw deformity disappeared.Six months after the surgery, the strength of abductor digiti minimi returned to normal.Two-point discrimination of the little finger was 5.0 mm on average.Nerve conduction velocity returned to ＞ 45.0 m/s.Action potential amplitude increased and SSCT yielded no positive findings.Mild atrophy was reversed one year postoperatively.Elbow flexion test, Tinel' s sign and Froment' s test were all negative.Conclusion In situ ulnar nerve decompression via a small incision assisted with electromyography localization is a suitable procedure for certain CuTS cases.     

正中神经返支卡压征二例

病例1男,16岁.因双手拇指无力,大鱼际肌萎缩4个月而来我院就诊.专科检查:右手大鱼际肌萎缩(++),左手大鱼际肌萎缩(+),双手拇指外展、对掌受限,双手拇指及大鱼际痛温觉正常.神经电生理检查:双侧拇短展肌肌电图为神经性损害,正中神经远端运动潜伏期(LAT)延长,复合肌肉动作电位(CMAP)波幅降低,正中神经感觉传导速度(SCV)、感觉神经动作电位(SNAP)正常.     

肌电图辅助定位小切口尺神经松解术治疗肘管综合征

Objective To evaluate the therapeutic effect of in situ ulnar nerve decompression at the cubital tunnel via a small incision assisted with electromyography localization and discuss the surgical indications.Methods Twelve patients who were diagnosed with idiopathic cubital tunnel syndrome (CuTS) without intrinsic muscle atrophy and elbow deformity were involved in the study.Before the operation, short-segment nerve conduction test (SSCT) was carried out.The exact compression site was determined by the ＞ 50%reduction in amplitude or ＞ 0.5 ms lengthening in latency of action potentials recorded upon stimulation of the ulnar nerve around the elbow at 1 cm intervals.An in situ ulnar nerve release at the compression site was performed.Compression of the ulnar nerve was observed and documented to verify the accuracy of pre-operative SSCT localization.Results Intraoperative findings confirmed that lesions were located from 3 cm above to 1 cm below the medial epicondyle, which coincided with the compression sites determined by SSCT.All the patients reported alleviation of hand discomfort postoperatively.Follow-up at 3 months postoperatively showed that paresthesia in the distribution of the ulnar nerve in the hand disappeared.Pinprick sensation recovered.There was no subjective or measurable weakness in pinch or grip strength and no clumsiness or loss of coordination.Claw deformity disappeared.Six months after the surgery, the strength of abductor digiti minimi returned to normal.Two-point discrimination of the little finger was 5.0 mm on average.Nerve conduction velocity returned to ＞ 45.0 m/s.Action potential amplitude increased and SSCT yielded no positive findings.Mild atrophy was reversed one year postoperatively.Elbow flexion test, Tinel' s sign and Froment' s test were all negative.Conclusion In situ ulnar nerve decompression via a small incision assisted with electromyography localization is a suitable procedure for certain CuTS cases.     

肌电图辅助定位小切口尺神经松解术治疗肘管综合征

目的 评价肌电图辅助定位小切口尺神经松解术治疗肘管综合征的疗效及手术适应证.方法 选取无明显手内在肌萎缩及肘关节畸形,具有典型临床症状和体征的肘管综合征患者12例,术前通过神经短节段传导(short-segment nerve conduction test,SSCT)检测的方法,以相邻两次动作电位波幅下降＞50%或潜伏期差＞0.5ms为定位标准,对上述患者进行卡压点定位,采用小切口局部尺神经松解术式,并观察卡压点术中与术前定位比较.结果 术中观测结果证明尺神经损害部位位于肱骨内上髁上方3 cm到肱骨内上髁下方1cm之间,与术前SSCT法检测卡压部位相符.12例术后均主诉手部有明显轻松感;术后3个月感觉异常全部恢复,刺痛觉及爪形指恢复,捏力和抓握力恢复;术后6个月时小指展肌肌力已完全恢复至正常,两点分辨觉平均为5.0 mm,神经传导速度(NCV)均＞45.0 m/s,波幅开始增加,SSCT无阳性发现;术后1年肌肉萎缩基本恢复,屈肘试验、肘部Tinel征、夹纸试验阴性,7例肌电图无阳性发现,1例NCV仍低于正常标准,但无临床症状及体征.术中观察神经卡压位置与术前肌电图定位相符.结论 肌电图辅助定位小切口尺神经松解术治疗肘管综合征是一种有效的方法.

Abstract：

Objective To evaluate the therapeutic effect of in situ ulnar nerve decompression at the cubital tunnel via a small incision assisted with electromyography localization and discuss the surgical indications.Methods Twelve patients who were diagnosed with idiopathic cubital tunnel syndrome (CuTS) without intrinsic muscle atrophy and elbow deformity were involved in the study.Before the operation, short-segment nerve conduction test (SSCT) was carried out.The exact compression site was determined by the ＞ 50%reduction in amplitude or ＞ 0.5 ms lengthening in latency of action potentials recorded upon stimulation of the ulnar nerve around the elbow at 1 cm intervals.An in situ ulnar nerve release at the compression site was performed.Compression of the ulnar nerve was observed and documented to verify the accuracy of pre-operative SSCT localization.Results Intraoperative findings confirmed that lesions were located from 3 cm above to 1 cm below the medial epicondyle, which coincided with the compression sites determined by SSCT.All the patients reported alleviation of hand discomfort postoperatively.Follow-up at 3 months postoperatively showed that paresthesia in the distribution of the ulnar nerve in the hand disappeared.Pinprick sensation recovered.There was no subjective or measurable weakness in pinch or grip strength and no clumsiness or loss of coordination.Claw deformity disappeared.Six months after the surgery, the strength of abductor digiti minimi returned to normal.Two-point discrimination of the little finger was 5.0 mm on average.Nerve conduction velocity returned to ＞ 45.0 m/s.Action potential amplitude increased and SSCT yielded no positive findings.Mild atrophy was reversed one year postoperatively.Elbow flexion test, Tinel' s sign and Froment' s test were all negative.Conclusion In situ ulnar nerve decompression via a small incision assisted with electromyography localization is a suitable procedure for certain CuTS cases.     

我国18个肿瘤标志物检验项目性能规范的制定*

摘要:目的根据意大利米兰 会议确定的性能规范设定模式,基于生物学变异(BV )和基于当前技术水平模式导出性能规范，为我国18 个肿瘤标志物检验项目推荐允许总误差( TEa)、允许不精密度( CV)和允许偏倚( Bias)。方法通 过Clinet-EQA软件收集参加国家卫生健康委临床检验中心2019- -2021 年肿瘤标志物室间质评( EQA)活动实验室的数据[包括EQA数据和室内质控(IQC)数据]。对于有BV数据的检验项目,将各项目EQA数据的“百分差值=(测量结果-靶值)/靶值X 100%"、IQC 数据的“当月在控CV”分别与基于BV导出的3种水平评价标准比较,计算各年份所有批号的百分差值通过率和CV通过率,当通过率达到80%,则该水平的性能规范满足作为该项目推荐性能规范的要求。对于无BV数据的检验项目或者基于BV导出的3种水平性能规范均无法作为推荐标准的检验项目,则基于当前技术水平来导出推荐性能规范:TEa当前= 1/2x( Poo-P),“当月在控CV"的P80 可作为该批号基于当前技术水平推导出的允许CV。利用公式| Bias |≤TEa-zxCV导出推荐允许Bias。结果18 个检验项目推荐的TEa/CV如下:AFP( 21%/7%)，CEA( 20.5%/6.8%) ,HCG( 23.4%/ 7.8%)，β-HCG(20.4%/6.8%),T-PSA和F-PSA( 24.4%/7.5%) ,CA125( 20.9%/6.5%) ,CA15-3(20.8%/ 7%) ,CA19-9( 25%/ 7.8%) ,CA50和CA242( 24%/8%) ,CA72-4( 22.8%/7.6%) ,HE4和CYFRA21-1 (21.9%/7.3%) , NSE ( 20.9%/8.2% ) , SCCA (22.9%/7.7%) , Feritin( 25%/7.1%),β2-MG(21.3%/7.1%)。结论为18个肿瘤标志物检验项目推荐了符合我国实验室当前检测水平的允许总误差、允许不精密度和允许偏倚。