62例原发性脑干损伤临床治疗体会

目的：归纳总结对原发性脑干损伤患者的诊疗经验.方法：回顾性总结我院2006-02～2011-06收治的62例原发脑干损伤病例的治疗并评定疗效.结果：死亡34例,植物状态9例,重残8人,中残11人.结论：原发性脑干损伤患者病情重,病情变化快,致死率、致残率高,通过保持气道通畅、低温、药物治疗、神经外科重症监护病房特级护理、后期行康复锻炼、可以尽可能降低伤员致死、致残率.     

Evaluation of the quality of clinical laboratories in the Slovak Republic: conceptual and contextual remarks

The paper demonstrates conceptual parallels and relationships between intellectual capital measurement methods and the evaluation of quality in clinical laboratories in the Slovak Republic. It explores further the contextual links of those parallels with the tangibility (or intangibility) of quality indicators of laboratory diagnostics. It also highlights the problems which laboratory staff in Slovakia are confronted with. Presented at the conference Quality in the Spotlight, March 2007, Antwerp, Belgium.     

Small-volume radial flow cell for all-solid-state ion-selective electrodes

A flow cell with a radial distribution of four all-solid-state ion selective electrodes (ISEs), or alternatively three ISEs and one reference electrode, was designed and optimized for mass production. The radial distribution of the electrodes reduces the cell volume and is expected to minimize cross-contamination between different electrodes. Two different cell prototypes were developed and tested for all-solid-state K⁺-ISEs based on a solvent polymeric ion-selective membrane (ISM) and a conducting polymer, poly(3,4-ethylenedioxythiophene), as solid internal contact. In the first prototype, PEDOT was electropolymerized from an aqueous solution of the monomer and the doping ion salt, sodium polystyrenesulfonate (NaPSS). The second prototype employed an aqueous dispersion of PEDOT(PSS) that is commercially available (Baytron P, Bayer AG). Compared to electrochemical synthesis, solution casting of the polymer dispersion was found to be a more advantageous method to deposit the conducting polymer layer aiming at mass production. The resulting prototypes of the flow cell had a small volume (ca. 17-37 μl), which makes them suitable for application in clinical analysis.     

Biparametric multicommutated flow analysis system for determination of human serum phosphoesterase activity

A multicommutated flow analysis (MCFA) system constructed of microsolenoid valves and pumps offering simultaneous determination of activity of acid phosphatase (ACP) and alkaline phosphatase (ALP) in human serum samples has been developed. The MCFA system is based on optoelectronic flow-through detector made of two light emitting diodes and operating according to paired emitter detector diode (PEDD) principle. This photometric PEDD device has been dedicated for detection of p-nitrophenol (NP) generated in the course of enzymatic hydrolysis of p-nitrophenyl phosphate and optimized for the determination of NP in human serum samples. The developed PEDD-based MCFA system allows independent optimization of conditions for reaction and detection steps of photometric ACP and ALP bioassays. Moreover, it allows elimination of photometric interferences from serum matrix components according to two-points kinetic mode of measurement. The single measurement cycle takes 12 min, consists of four measurements (two for each phosphoesterase) and enables determination of serum ACP and ALP activities at physiological and pathological levels. The real analytical utility of the developed MCFA system has been confirmed by analysis of control sera as well as real human serum samples from healthy persons and oncological patients.     

Sensitivity and significance of disease outcome measures in inflammatory bowel disease

In inflammatory bowel disease (IBD), proxy measures of clinical outcome are often collected into summary indices of qualitative self-rated disease markers, clinical observations, and quantitative biochemical analyses. In Crohn's disease (CD), a frequently used index is the Crohn's disease activity index (DCAI). This index consists of six qualitative variables and two quantitative variables. The aim of this presentation is to illustrate the use of this index to calculate its range, to estimate errors in the index, its sensitivity, and the number of significant steps in the index. The measure of sensitivity of the summary index was analyzed for the signal-to-noise ratio (SNR), the reference change value (RCV) and the confidence interval (CI). If identical errors were assumed in patient self-rated health and clinically judged disease manifestations, such as tumours and fistulas, the majority of the variance of the index was caused by the self-rated experience of health, the number of days over which the individual variable was rated, and the prognostic multiplier of each variable.The range of the index has no upper limit, but can be estimated to 403 units, of which patient self-rating of well-being account for up to one-third of the summary index maximal score range. The median signal noise measure of index sensitivity was 18 SDs. The two disease classification limits of 150 units for moderate disease and 450 for severe disease on average cover an interval of limit ±41.5 units vs. ±60.5 units. In judgments on change in clinical outcome the RCV interval of steps of 121 units are valid. Conclusion: Both variance and range of the CDAI summary score are primarily decided by the self-rated experience of well-being. Variables on disease signs have a minor impact on the index. Rating of the two important outcome parameters: Self-experienced health and medical outcome would favourably be given in two individual scores.Presented at the 10th Conference Quality in the Spotlight, March 2005, Antwerp, Belgium.     

An improved automatic time-of-flight picker for medical ultrasound tomography

Objective and motivationTime-of-flight (TOF) tomography used by a clinical ultrasound tomography device can efficiently and reliably produce sound-speed images of the breast for cancer diagnosis. Accurate picking of TOFs of transmitted ultrasound signals is extremely important to ensure high-resolution and high-quality ultrasound sound-speed tomograms. Since manually picking is time-consuming for large datasets, we developed an improved automatic TOF picker based on the Akaike information criterion (AIC), as described in this paper.MethodsWe make use of an approach termed multi-model inference (model averaging), based on the calculated AIC values, to improve the accuracy of TOF picks. By using multi-model inference, our picking method incorporates all the information near the TOF of ultrasound signals. Median filtering and reciprocal pair comparison are also incorporated in our AIC picker to effectively remove outliers.ResultsWe validate our AIC picker using synthetic ultrasound waveforms, and demonstrate that our automatic TOF picker can accurately pick TOFs in the presence of random noise with absolute amplitudes up to 80% of the maximum absolute signal amplitude. We apply the new method to 1160 in vivo breast ultrasound waveforms, and compare the picked TOFs with manual picks and amplitude threshold picks. The mean value and standard deviation between our TOF picker and manual picking are 0.4 μs and 0.29 μs, while for amplitude threshold picker the values are 1.02 μs and 0.9 μs, respectively. Tomograms for in vivo breast data with high signal-to-noise ratio (SNR) (∼25 dB) and low SNR (∼18 dB) clearly demonstrate that our AIC picker is much less sensitive to the SNRs of the data, compared to the amplitude threshold picker.Discussion and conclusionsThe picking routine developed here is aimed at determining reliable quantitative values, necessary for adding diagnostic information to our clinical ultrasound tomography device - CURE. It has been successfully adopted into CURE, and allows us to generate such values reliably. We demonstrate that in vivo sound-speed tomograms with our TOF picks significantly improve the reconstruction accuracy and reduce image artifacts.     

2008—2012年《中华实用儿科临床杂志》载文文献计量分析

目的:分析《中华实用儿科临床杂志》近5年发展情况,为提高该刊质量提供参考依据. 方法:通过中国生物医学文献数据库收集该刊2008—2012年的文献题录,采用文献计量学方法,对文献的时间分布、单位分布、作者分布、作者合作情况、单位合作情况、高频关键词、高频主题词等指标进行统计分析. 结果:2008—2012年《中华实用儿科临床杂志》共载文3 459篇,单篇论文的长度在逐年增长;涉及作者13 870位,每篇论文作者平均数量大于4,每篇论文的平均合作单位数量多于1.45,关键词和主题词符合本刊的主题.2008—2010年被引的文献为1 131条,占期间总文献量的62%.结论:2008—2012年发表的论文选择更具有针对性,向着更为合理性的方向发展,研究方法也多采用定量分析方法,并且论文形式多样,文献被引次数越来越多.     

泌尿外科临床教学探讨

通过分析临床学教中存在的问题,寻找提高临床教学质量的方法及对策,旨在培养合格的高素质水平临床医学生。     

Inflammation markers in point-of-care testing (POCT)

Inflammation is a central issue in medicine. Inflammatory processes may be local or systemic, acute or chronic, and they may be benign or fatal. In bacterial or viral infections fast and reliable diagnosis is essential for appropriate treatment, e.g. antimicrobial therapy. The time to diagnosis is critical because uncontrolled infections may lead to sepsis with a mortality rate close to 50%. Beside clinical signs, laboratory markers are important in detecting, differentiating, and monitoring inflammation, particularly acute infections. Currently several inflammation markers including leukocyte count and leukocyte differentiation, C-reactive protein (CRP), procalcitonin (PCT), and interleukins (IL) 6 and 8, is available, and potential future serum markers are under development. In this article the clinical use of these markers in routine laboratory and in point-of-care testing is described and the diagnostic value of the four groups of laboratory marker is compared. Current data show that leukocyte count or, better, neutrophil count, CRP, and PCT are well suited to support of rapid diagnosis of inflammation and infections in children and adults whereas measurement of IL-6 and 8 are preferable for detection of sepsis in neonates.