Preface: The birth of a good article requires you to constantly collect data and sort out ideas. This website has collected a wealth of sample articles on medical testing programs for you, which are only for reference. Welcome to read and collect them.
Part 1: Model text of medical testing scheme
Key words: forbidden aromatic amine; Database; azo dye
CLC No.: TS190 Document ID Code: A
Prohibit aromatic amine testing Database plays an important role in the detection of azo dyes. Especially in the textile industry, the use of azo dyes is prohibited in the production of clothing. Because azo dyes have a carcinogenic effect, the detection means are gradually strengthening. The state requires that all imported and exported clothing should have a national qualified detection report, which is the detection of azo dyes. The establishment of a database of banned aromatic amines can reduce the links of detection and increase the efficiency of detection, which is of great significance to detection.
1、 Reasons for the establishment of a database of banned aromatic amines
（1） Establish a special database for textile testing. The textile inspection database can help clothing inspection and plays an important role in the inspection process. Before the establishment of a special database for textile testing, it is necessary to analyze a single standard sample and use gas chromatography for testing. The instrument used is mainly a gas chromatograph. After testing, it needs to be processed by a computer. After processing, a single substance peak can be found and automatically searched by a computer, The retrieval of substances in the American National Standard Mass Spectrometry Database (NIST98) adds a series of procedures, which are more complex in the process of use. In addition, there are more than 300000 kinds of chemical substances in the American National Standard Mass Spectrometry Database, which brings great difficulties to the retrieval and a series of problems in the process of analysis, This is mainly reflected in that these databases are not specially formulated for the textile industry, and they will face some difficulties in the process of use. It is very difficult to judge whether aromatic amines are banned, which also brings great difficulties to the detection staff, and the work efficiency is also extremely low. For example, the total ion flow diagram of 4-aminobiphenyl single label is shown in Figure 1. It can be seen from the above description that it is very difficult to analyze a single standard sample, and it will be more complex in actual operation, especially the total ion current diagram of sample detection is very complex. If the US Egypt standard mass spectrometry library is used continuously for retrieval, it will bring great difficulties to the work.
（2） Remove impurities and interfering substances. During the detection of azo dyes, there are many factors affecting the detection results, and isomers are the key factors. The interference of these factors can be minimized by using the forbidden aromatic amine database. Speed up the detection, and the accuracy of detection will also be improved. Textile clothes need to be dyed, and chemical dyes will be used during dyeing, which will easily contaminate impurities in the process of dyeing, and affect the quality of dyes. These impurities mainly include auxiliaries such as dyes, fibers and finishing agents. In the process of detection, the aging of the detection instrument will lead to a lot of air drilling into the instrument, and there will be an air peak. The air summit will interfere with the mass spectrum, and there will be a series of errors in observing the detection results using the mass spectrum. In the process of detection, the liner, sampling probe and splitter plate will be polluted due to long-term detection, This will lead to tail peaks or ghost peaks on the mass spectrum. During detection, these impurities will be automatically excluded from the mass spectrum of banned aromatic amine, which will greatly affect the results and facilitate the accuracy of detection.
（3） It can solve the problem of false positive. Using gas chromatography or mass spectrometry for chemical detection and judging by isomers is a widely used method. Since non prohibited fuels will also decompose carcinogens during reduction and splitting, it is very likely to judge 1-naphthylamine in non prohibited fuels as 2-naphthylamine. In the process of sample detection, because the retention time of isomers is the same, it will be similar to the mass spectrum, and can not be accurately distinguished In the mass spectrometry database, 2-naphthylamine has a higher matching degree, which is likely to lead to confusion of results. This problem is also known as false positive. This problem often occurs in the detection process, which needs our attention. The forbidden aromatic amine database is used to retrieve the chemical data, and the difference between the two substances can be known by effectively comparing the peak value and time with the 2-naphthylamine single label spectrum. The ion mass nucleus ratio can also be used as the monitoring ion for material judgment, so that problems can be found in time and false positive problems can be judged better.
2、 Establish a database of banned aromatic amines
（1） A brief introduction to the database. The establishment of a database of banned aromatic amines must be based on NIST98 Based on the above, mass spectrometry or gas chromatography is used for quantitative and qualitative analysis. There are 21 kinds of prohibited aromatic amines, so it is necessary to establish a standard database for basic analysis, and to compile the information to establish a database. In this way, there will be reference data in the process of detection, no need for repeated detection, and many links will be reduced, It improves the efficiency of detection and reduces the cost of detection. The information in the database of forbidden aromatic amine is as follows: molecular formula, Chinese and English names, characteristic ions, chemical formula, starting time, grace, limited ions, total ion flow diagram of single standard, peak time, ratio of characteristic ion peak to limited ion, etc. In the process of detection, the detection method also has certain requirements. There must be internal standard name, mass spectrum condition, external standard name, gas chromatography condition, etc. Only when the above basic requirements are met, can the detection be carried out, which is also the basic basis for detection. In the process of detection, relevant problems must be handled in a timely manner to ensure the accuracy of each link of detection.
（2） The process of database establishment and analysis conditions. In the process of detection, a database needs to be established according to the following basic requirements. In the process of establishing the database, standard samples need to be prepared, basic conditions for gas chromatography need to be formulated, samples need to be tested, and qualitative and quantitative analysis of samples need to be carried out. Quantitative analysis includes two points, one is internal standard, the other is external standard. The database can be established only when relevant requirements are met, In the process of establishing the database, we must pay attention to the relevant links to ensure the accuracy of each detection process, so that the final detection results will not have problems.
（3） Use the information obtained to establish a database. Take 4-aminobiphenyl as an example to establish and analyze the database. The relevant detection information includes English name and Chinese name. The molecular formula is C12H11N, and the structural formula is
In the process of detection, it is necessary to establish the corresponding detection information of single or mixed labels of 21 banned aromatic amines, so that a database of banned aromatic amines can be established. In the process of establishing the database of banned aromatic amines, the corresponding molecular structure or corresponding database information must be considered. This paper takes 4-aminobiphenyl as an example to establish the database. The corresponding flow diagram is shown in Figure 2. In the process of establishing the database, the information in the database must be accumulated, and the relevant signs must be established in the database, Clarify every information, apply the information reasonably, and can be applied scientifically in the process of database establishment.
3、 Disable the use of aromatic amine database
Establish a database to determine whether the sample contains azo dyes, and compare the retention time, proportion of characteristic ions and limiting ions, starting time and other data in the database to minimize the retrieval time, which is conducive to the accuracy of the retrieval results. When testing, use the disabled aromatic amine database, The suspicious substances in the sample can be found to the greatest extent, so that the problems can be solved in time.
conclusion
Through the establishment and use of the database of banned aromatic amines, the detection time was reduced, the detection accuracy was improved, and the uncertainties in the detection process were eliminated. Foreign standards stipulate that in order to avoid the influence of impurities, interfering substances and isomers, two or more chromatographic methods must be used for qualitative confirmation. In fact, impurity interference and misidentification of isomers often occur, and a variety of chromatographic methods can effectively avoid such problems.
reference
Part 2: Model text of medical testing scheme
1、 Leading organization
In order to strengthen the medical treatment guarantee for the prevention and control of the epidemic, the leading organization of the medical treatment team is specially established
group leader:
Deputy group leader:
Members:
The daily office of the medical treatment group is located in the town health center, and the specific person in charge is comrade. The main responsibilities are to organize the formulation and revision of technical schemes for diagnosis and treatment of viral pneumonia; To guide the village level streets to do a good job in medical treatment and medical security for epidemic diseases; Organize medical personnel to assist in medical treatment; Put forward suggestions on strategies and measures to improve medical treatment, starting from January 27, 2020 and ending with the first level response to the major public health epidemic in the province. After the epidemic situation is lifted, the leading organization will be dissolved and the work will stop automatically.
2、 Job requirements
（1） Organize the formulation and revision of technical scheme for diagnosis of viral pneumonia. Conscientiously implement the Program for Diagnosis and Treatment of Viral Pneumonia (Trial Version III) issued by the General Office of the National Health Commission and the Office of the State Administration of Traditional Chinese Medicine, the Guidelines for the Prevention and Control of Viral Pneumonia in Medical Institutions issued by the General Office of the National Health Commission (First Version), and the Work Plan for the Prevention and Control of Viral Pneumonia (Trial Version II), The Monitoring Plan for Virus infected Pneumonia Cases (Second Edition), the Management Plan for Suspected Exposed Persons and Close Contacts of Virus infected Pneumonia (Second Edition), the Epidemiological Investigation Plan for Virus infected Pneumonia (Second Edition), and the Technical Guidelines for Laboratory Testing of Virus infected Pneumonia (Second Edition) strictly identify suspected cases, confirmed cases, and clustered cases, Do a good job of patient treatment.
（2） We will do a good job in medical treatment of epidemic diseases and medical disability. According to the screening situation of each village and street, we should do a good job in patient registration and referral, implement the first diagnosis responsibility system, and implement hospital infection prevention and control measures.
Part 3: Model text of medical testing scheme
Graduated from the Danish University of Technology with a master's degree in food science, he has more than ten years of experience in food testing and quality management. He has successively worked in scientific research institutions, food and food additive manufacturing enterprises and third-party testing institutions. He is now the technical manager of the laboratory of Intertek Group Food Service in Greater China.
Gulyi
Master of Food Microbiology. At present, he is a senior technical service engineer of 3M China Food Safety Department, mainly responsible for the application and partial research and development of microbial detection products. He has rich experience in technology, audit, supplier management and other aspects.
With the globalization of food trade, the convenience and popularity of processed food and the change of people's eating habits, food safety issues have begun to affect people's lives more and more profoundly. Especially in recent years, various food safety incidents frequently exposed in China have aroused great concern of the whole society, and the industry is also thinking about how to avoid the recurrence of similar incidents. In addition to continuously strengthening the production operation process, the proposal and continuous improvement of various test method standards and industry specifications are also increasingly valued, which also puts forward higher requirements for food testing technology and products. Recently, 3M (Minnesota Mining and Manufacturing Corporation) (hereinafter referred to as 3M) and Intertek Group (hereinafter referred to as Intertek) The microbiological laboratory established by the cooperation was officially completed and put into operation, which can not only provide international leading quality and safety control experience for the existing food system, but also promote the development of the food industry in terms of product quality and industrial structure.
3M is a multinational enterprise with a history of more than 100 years. It is known for its courage in innovation and wide range of products. In recent years, 3M has made a great breakthrough in microbial detection. Its landmark microbial detection product Petrifilm is mainly used for microbial detection of products in food, beverage and other related industries. It is widely used in the global food detection field. Compared with the traditional method, Petrifllm can effectively shorten the test time, make the operation procedure more simple, and do not need very high operating skills, which can significantly improve the quality of microbiological experiments and improve laboratory efficiency. 2007. Petrifilm test film has been officially listed as China's entry-exit inspection and quarantine industry standard, and this method is being recognized by more and more domestic food production and processing enterprises and various inspection institutions.
Intertek is the world's leading third-party organization for quality and safety. It has always been committed to helping customers strengthen food monitoring and quality management. At the same time, through its global vision, it will deliver cutting-edge information and technology in the international market and food industry to local customers. The cooperation between 3M and Intertek has realized the perfect combination of technology and platform. The introduction of micro rapid detection series products will improve the detection level and inject fresh blood into Intertek's food detection field.
In this issue of Intertek Shishang Interview, Ms. Wu Haiping, the technical manager of Intertek Food Service Greater China Laboratory, and Mr. Gu Eryi, the senior technical service engineer of 3M China, were invited to introduce the specific cooperation between 3M and Intertek.
3M and Intertek cooperate to win
Reporter: 3M and Intertek have strong cooperation in rapid microbial detection. Please talk about the original intention of this cooperation?
Wu Haiping: Intertek is at the forefront of advanced technical safety technology in food testing and certification. Its services cover all aspects of product development, operation and production processes, marketing, supply chain management, quality and sustainable development. As a third-party independent testing agency at the forefront of advanced technology in food testing and certification, Intertek has strong capabilities and rich experience in the field of food testing and certification. The cooperation between 3M and Intertek can be described as a strong alliance.
Gulyi: The cooperation between 3M and Intertek in rapid microbial detection has indeed integrated the advantages of both sides. 3M is the industry leader in the field of food hygiene inspection. Its Food Safety Department has provided reliable inspection schemes for indicator bacteria, pathogenic bacteria, toxins, environmental cleanliness, etc. for the food safety inspection market.
It is worth noting that this cooperation is not the first time that 3M and Intertek have joined hands. We have had cooperation before and have never been interrupted. In the past cooperation, the two sides have established good mutual trust. This cooperation is aimed at effectively improving the capabilities of both sides in rapid microbial detection, identification and new method development, and realizing the alliance of technology research and development and market operation through the establishment of a laboratory for rapid microbial detection methods.
Reporter: Please briefly talk about the main cooperation project between 3M and Intertek in the establishment of microbial rapid detection laboratory?
Gulyi: 3M and Intertek have many cooperation projects in the establishment of microbial rapid testing laboratories. The two sides will build a cooperative laboratory platform based on their existing technical resources and laboratories to establish "Intertek-3M Microbiological cooperative laboratory ", and through technical exchanges, personnel training and other forms, jointly improve the detection capability of the cooperative laboratory and expand the service projects of cooperative detection.
Reporter: We know that 3M has strong technical advantages in the field of food detection. For example, Petrifilm-3M microbial detection products have been widely recognized in the field of global food detection. How will 3M bring its own advantages into play in the cooperation with Intertek?
Gulyi: As an industry leader in the field of food hygiene inspection, 3M has strong technical advantages. 3M Food Safety Department can provide reliable inspection programs for food safety inspection market, such as indicator bacteria, pathogenic bacteria, toxins, and environmental cleanliness. In cooperation, 3M will provide Intertek with advanced technologies and products. In addition, 3M has always been known for its innovation and wide range of products. Under the guidance of the spirit of innovation, 3M has created an industrial miracle that has developed more than 60000 high-quality products over a hundred years. At present, these products have covered family life, medical treatment, transportation, construction, commerce, education, electronics, communications and other fields, greatly changing the way people live and work.
Nowadays, food safety inspection has attracted much attention in the world, and food safety has become a hot issue worldwide. Faced with increasingly severe tests and challenges in the field of food safety, 3M will adhere to the spirit of innovation and continue to provide innovative solutions. Relying on its strong R&D and production strength in the world, it will forge ahead and strive to become the most respected supplier of products and solutions in food safety testing.
Rapid detection - highlights of 3M and Intertek's cooperation in microbial detection
Reporter: What more perfect services can 3M and Intertek provide for food enterprises in terms of microbial detection?
Gulyi: Rapid detection is the biggest highlight of this cooperation in microbial detection. The cooperation between 3M and Intertek Food Department will further improve the ability of rapid detection of food microorganisms on the basis of the original Petrifilm rapid detection of microorganisms and standard sampling process. At the same time, 3M will provide high-quality services for Chinese food enterprises in terms of international standard methods, rapid detection of pathogenic bacteria and rapid physical and chemical detection. (Petrifilm microbial detection products are mainly used for microbial detection in food, beverage and related industries, and are widely used in the global food detection field. More than 80 of the top 100 food enterprises in the United States use this series of products as a daily microbial detection method. In 2007, the Petrifilm test film was officially listed as China's entry-exit inspection and quarantine industry standard, and this method is gradually recognized by more and more food production and processing enterprises and various inspection institutions. Compared with the traditional method, it can shorten the test time, simplify the operation procedure, and do not require high operating skills, which is helpful to improve the quality of microbiological experiments and improve the efficiency of the laboratory.)
Reporter: In your opinion, what are the deficiencies or needs to be updated in the current detection technology for food microorganisms?
Gulyi: In terms of food microorganism detection,
At present, the shortcomings of detection technology are mainly reflected in the complicated operation, high requirements for equipment investment and long detection process. With its strong R&D strength in the world, 3M will provide simpler and faster detection schemes and means for the food industry in the field of pathogenic bacteria detection, and help the food industry laboratory to improve its response speed and accurate detection capability. Its landmark microbial detection product Petrifilm is one of them.
Reporter: In the field of food microorganism detection in the future, what projects need to be jointly developed by Intertek and 3M?
Wu Haiping: According to international experience, foodborne diseases caused by microorganisms are the number one food safety problem at present. Foodborne diseases are also the top food safety issue in China. In the future cooperation, we will pay more attention to food borne diseases and the detection of microorganisms, especially pathogenic bacteria. At the same time, chemical hazards are also serious, such as the abuse of antibiotics is a growing problem. We will further strengthen cooperation in these new food safety testing fields.
Reporter: Excuse me, what is the expected goal of this cooperation between Intertek and 3M?
Wu Haiping: Intertek and 3M both saw the huge demand in the food safety market, so they continued to increase investment and cooperation in this field, and identified food industry safety as an important platform for the company's development strategy. The expected goal of both parties is to strive to rely on innovative products and technologies, continue to be committed to providing advanced and practical solutions, and help food and beverage enterprises cope with increasingly severe food safety challenges.
Wu Haiping: From the cooperation with 3M, we can see that 3M has strong technical advantages and constantly innovative corporate culture. We believe that 3M will create more excellent food detection products in the cooperation and become the most respected supplier in food safety detection.
Gul Yi: Intertek, a third-party independent testing agency standing at the forefront of advanced technology in food testing and certification, has strong capabilities and rich experience in the field of food testing and certification. We will make persistent efforts to provide more advanced and practical solutions for food and beverage enterprises and contribute to the development of the food testing industry.
Reporter: In the cooperation between 3M and Intertek, we also saw the extraordinary strength of Intertek and 3M. We believe that this cooperation between the two sides will open a new chapter in food testing laboratories. Thank you very much for joining us in this Intertek interview and sharing the cooperation process between 3M and Intertek.
About Intertek
Part 4: Model of Medical Testing Scheme
Key words: medical equipment; Electrical system; Safety inspection
DOI：10.16640/ki.37-1222/t.2015.21.125
1. Brief analysis of electrical safety of medical equipment
During the normal operation of medical equipment, it often contacts with medical staff and patients. If its electrical safety performance is relatively low, it is likely to cause electric shock injury accidents due to its own defects or improper operation. In order to ensure the smooth progress of medical behavior, it is necessary to take effective measures to conduct electrical safety testing on various medical equipment, find out the potential safety hazards in time, ensure the rationality and standardization of the operator's implementation, and reduce the safety incidents caused by illegal operations. The electric shock accident of general medical equipment is mainly manifested in two aspects, that is, the formation of a loop between people and the network power supply, or the current generated by the network power supply voltage between the loop resistors flows through the human body and produces the corresponding physiological response. In the event of an electric shock accident, people will feel pain and numbness, resulting in skin and limb burns, and even cardiac fibrillation and respiratory arrest in serious cases. For this reason, it is necessary to do a good job in the electrical safety detection of medical equipment, ensure the safety of both equipment operators and patients, ensure that there is no current on the surface of the equipment, and will not cause click accidents. During detection, it is necessary to determine that the existing leakage current is less than the human safety limit. If the equipment shell leaks electricity, the protective grounding resistance of the equipment should be reduced to the minimum, so as to minimize the impact of the leakage current on human safety. The clinical use of equipment that fails in electrical safety testing shall be prohibited.
2 Analysis of the contents of electrical safety testing of medical equipment
(1) Insulation impedance. It includes two kinds of insulation impedances: power supply part to ground and application part to ground. During electrical safety detection, it is necessary to detect the breakdown degree of insulation materials under two conditions respectively. In general, 500V DC test voltage will be applied at both ends of the detection in actual detection work. The larger the measured insulation impedance value, the safer the equipment operation effect will be proved [1]; (2) Protective grounding resistance. The so-called protective grounding resistance is to measure the resistance between the protective ground of the tested equipment and the power ground wire when the power ground wire is open circuit, that is, the impedance value between the medical equipment shell grounding protection column and the power line grounding plug. If the insulation layer of the medical equipment breaks down and makes the equipment shell charged, it will play the role of shunt, thus reducing the current value flowing through the human body and reducing the impact of current on personal safety; (3) Leakage current. The detection of leakage current of medical equipment mainly includes ground leakage current, patient leakage current, enclosure leakage current and patient auxiliary leakage current. The earth leakage current refers to the current flowing from the power supply part through or across the insulation into the protective grounding conductor, while the shell leakage current refers to the current flowing into the earth or other parts of the shell through the external conductor connection rather than the protective grounding conductor from the equipment shell and shell parts accessible to patients and operators when the equipment is in normal operation [2]. In addition, the patient leakage current is the current that flows into the ground through the device application part and the patient, and the patient auxiliary leakage current is the current that flows into the ground through the patient before each application part.
3 Analysis of electrical safety testing methods for medical equipment
(1) Power supply voltage detection. For the electrical safety detection of medical equipment, the first step is to ensure that its power supply voltage meets the actual application requirements, which is the basic part of safety detection and directly affects the safety of equipment operation. Generally, the power supply voltage required for the operation of medical equipment is 220 V AC, while for large medical equipment, such as X-ray machines Most of CT and other power supplies are three-phase, and the power supply voltage is AC 380V. If the power supply voltage exceeds the normal range or there are abnormal wiring problems, such as common ground wire open circuit and polarity error, the electrical safety detection can not be carried out normally, so it is necessary to timely determine the fault location and take effective measures to optimize [3]. In addition, for some medical devices, the stability of power supply voltage is low, or uninterruptible power supply is selected for power supply, so that when conducting electrical safety inspection on them, the voltage output by regulated power supply and uninterruptible power supply can be directly measured; (2) Power insulation resistance test. The insulation resistance of the power supply is the insulation resistance between the power input terminal of the equipment under test and the protective ground of the equipment under test. The insulation resistance should be ≥ 10M Ω. When using ESA601 to detect the insulation resistance of the power supply, the schematic diagram is shown in Figure 1. First, turn off the power switch of the equipment to be tested, short the zero line and the live line of the input power equipment, and apply 500V DC voltage between them and the equipment protection ground. Wherein, R1 is the voltage divider to avoid the transformer breakdown caused by excessive voltage. The measured insulation resistance will affect the value of voltage drop on R1, as well as the current through R2 and R3 branches. Using a voltmeter to measure the voltage values at both ends of R3, the branch current flowing through R3 can be measured. Based on this, the insulation resistance between the equipment power input terminal and the protective ground can be calculated, and then the insulation resistance between the equipment power input terminal and the protective ground can be obtained; (3) Leakage current detection. The so-called leakage current refers to the induced current between the conductive parts of the equipment to be tested and the power supply ground after the equipment to be tested starts up and works normally. When conducting safety detection on the leakage current of medical equipment, turn on the power supply of the equipment and input the power supply to the primary transformer of the equipment, so that the corresponding inductive potential can be formed at the protective ground of the equipment, the exposed part of the enclosure and the patient application part. After switching the switch S5, the corresponding leakage current formed between it and the power supply ground PE flows through the microammeter MD and is detected. At the same time, the simulation of single fault of power supply is completed by adjusting the polarity switch S2, zero line switch S1 and ground wire switch S3, such as polarity reversal, ground wire open circuit and zero line open circuit, and the leakage current of equipment under different fault conditions is measured (Figure 2).
4 Conclusion
In order to improve the operation safety of medical equipment, it is necessary to do a good job in its electrical safety detection, that is, analyze the necessity of safety detection in combination with its operation characteristics, determine the key detection contents, and select appropriate methods and schemes for processing in combination with the actual situation, so as to constantly improve the accuracy of the detection effect, And take measures according to the results to ensure that the equipment can be kept in good condition.
reference:
[1] Peng Run, Yan Lexian, Yin Jun Discussion on carrying out electrical safety testing of medical equipment in hospitals [J]. Medical Equipment, 2012 (11): 122-123+153
[2] Su Yongxing, Xia Huilin, An Wenhao Leakage current detection for electrical safety of medical equipment [J]. China Medical Equipment, 2010 (01): 10-11+4
Part 5: Model of Medical Testing Scheme
Key words: glycogen phosphorylase BB isoenzyme acute myocardial infarction early diagnosis of myocardial ischemia
The statistical results of early diagnosis of acute myocardial infarction (AMI) show that [1, 2], about 1/4 of AMI patients do not have typical symptoms and signs at the time of onset; Although ECG examination is simple, fast, reliable and reproducible, about 50% of AMI patients still have no typical changes in ECG, resulting in high mortality of AMI complications. Serum enzymology is convenient, safe, fast and low cost, which has become the main direction of early diagnosis of AMI in recent years.
The dynamic determination of changes in serum enzyme activity for AMI began in the 1950s. In 1962, WHO recommended myocardial creatine kinase isoenzyme (CK-MB) as an early diagnostic indicator of AMI, and called it the "gold standard". With the development of modern monoclonal antibody technology, CK-MB can be directly used for bedside detection [3], but its practical application is limited due to its poor diagnostic specificity, low positive rate of early diagnosis, short diagnostic window, etc. At present, many known serum enzymology indicators, such as aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), CKMM3/MM1, and non enzymology indicators, such as myoglobin, troponin T (cTnT), troponin I (cTnI), and cardiac light chain (cMLC), have shortcomings similar to CK-MB.
In recent years, some foreign scholars have found that only GPBB rises above the diagnostic reference value [4] in patients with unstable angina pectoris in supine position and patients with transient ST-T changes in electrocardiogram, suggesting that GPBB is an extremely sensitive biochemical indicator for early diagnosis of AMI. In vivo, GPBB only exists in the heart except brain tissue. Therefore, GPBB is significantly more sensitive and specific to myocardial hypoxia than the above biochemical indicators.
Biochemical properties of GPBB and its early release mechanism during ischemia
Glycogen phosphorylase GP (EC2.4.1.1), as the key enzyme of glycogen decomposition reaction, catalyzes the first step reaction of glycogen decomposition, converts glycogen into G-1-P, and provides energy source for muscle contraction [5]. There are three kinds of isoenzymes of GP in mammals: GPBB (myocardial and brain type), GPMM (muscle type) and GPLL (liver type), whose functions and immunological characteristics are different. BB type only exists in a large number of cardiac myocytes and brain cells. Although BB type and MM type exist in cardiac muscle at the same time, the content of MM type is extremely low [6]. The molecular weight of BB type is about 188kD, which is larger than that of MM type and LL type. It exists in the form of dimer composed of the same subunit under normal physiological conditions [6]. The cDNA cloning results showed that the three isoenzymes of GP were coded by three different genes [7], and the primary structure comparison found that the homology of GPBB with GPMM and GPLL was 83% and 80% respectively, but at the C-terminal BB type was 21 and 16 amino acid residues more than that of MM and LL type [8]. This indicates that GPBB has a highly myocardial specific structure. The release of GPBB into blood at the early stage of ischemia is related to the main role of GPBB in myocardial energy metabolism. GPBB can be detected in the blood ten minutes after ligating the coronary artery of animals. At this time, myocardial tissue necrosis has not been found [9], indicating that GPBB release is closely related to myocardial ischemia. Under normal physiological conditions, GPBB tightly binds to the sarcoplasmic reticulum in the form of GPBB glycogen complex in cardiomyocytes. Myocardial ischemia and hypoxia affect the activity of respiratory chain enzymes in mitochondria. The oxidative phosphorylation process is blocked, reducing ATP production and increasing ADP and inorganic phosphate. However, myocardial activity continues to consume ATP, so the reserves of high-energy phosphate compounds are sharply reduced and glycogen begins to decompose. During acute ischemia, glycogen decomposes, making the combined GPBB from the combined type to the free type, and the soluble GPb (dephosphorylated type) diffuses into the cytoplasm, and then enters the peripheral blood due to the increased permeability of the cell membrane. On the other hand, during myocardial ischemia, the level of cMP in myocardium increases, leading to the conversion of GPb type into GPa type (phosphorylated type) catalyzed by glycogen phosphorylase kinase, thus stimulating sympathetic nerve and accelerating glycogen decomposition. The experiment confirmed that GPBB in peripheral blood of patients with AMI absorbed type b [9], so it can be inferred that type b activity catalyzes glycogen decomposition in ischemic myocardial area, and cAMP or Ca2+and metabolic intermediates produced with glycogen reduction also increase the activity of this enzyme, which increases the activity of GPBB in peripheral blood.
Because the mechanism of GPBB releasing into the blood is different from other series of biochemical indicators, it can release into the blood faster than other series of marker components earlier and significantly exceed the normal upper limit (URL) within 4 hours after myocardial ischemia.
Evaluation of the value of GPBB in the early diagnosis of ischemic heart disease 2.1 Acute myocardial infarction
In recent years, countries have been committed to controlling the expenditure of medical expenses, advocating to reduce the frequency of testing, reduce the cost of diagnosis and improve the accuracy of early diagnosis. Therefore, the early diagnosis scheme of AMI is proposed to apply different biochemical indicators at different times of onset. Recently Keffer [10] proposed that only cTnT and CK-MB (quality) should be tested 8 hours before CK-MB, and cTnT should be tested 8 hours later. The scheme does not emphasize the peak finding of serial measurement, and generally three times at most. The determination of cTnT requires an expensive test system, which is not popular in China at present. In addition, CK-MB is often used for early diagnosis in the scheme, but CK-MB is not a specific enzyme of myocardial cells, and it also exists in normal skeletal muscle. When skeletal muscle is injured, the serum CK-MB level is significantly higher than the normal upper limit [11]. Secondly, the concentration of CK-KB did not increase within 4 hours after the onset of AMI, but it returned to normal after 48-72 hours [9], often requiring repeated measurements, which is not conducive to the early diagnosis and observation of the course of AMI.
In recent years, the establishment of GPBB IEMA [12] (onestep sandwich immunometric assay) makes the determination method of GPBB very sensitive. The determination range is 0.5~200 μ g/L, the minimum is 0.3 μ g/L (protein content/EDTA plasma), and the URL is 7 μ g/L [13]. The cross reaction of MM type, LL type and BB type is less than 1%. In addition, the determination results are not affected by age, gender and race [13].
Mair et al. [13] compared GPBB with biochemical indicators currently used in clinical practice through a large number of cases, and found that within 4 hours after the onset of chest pain in AMI patients, GPBB increased by 70%, myoglobin by 43%, cTcT by 33%, and CK-MB by 56%. Within 2-3 hours after the onset of myocardial infarction, the sensitivity of GPBB was the strongest, appearing the earliest and increasing the most; GPBB increased regardless of pathological Q wave in ECG. By comparing URLs, we found that cTnT increased significantly after AMI onset, but its peak value was late. GPBB was similar to CK-MB myoglobin. Therefore, GPBB can be considered as one of the most ideal indicators for early diagnosis of AMI.
2.2 Diagnostic application of other ischemic heart disease For patients with Braunuld Ⅲ unstable angina pectoris accompanied by transient ST-T changes, only GPBB increases early and exceeds the upper limit of normal reference value [13]. From angina pectoris to unstable angina pectoris to AMI is a continuous pathological process. There is often a lack of clear boundaries between unstable angina pectoris and non Q wave AMI. At present, only GPBB has good differential diagnostic value among biochemical indicators. Therefore, GPBB can be used to monitor patients with unstable angina pectoris, detect changes in the condition in time, and give treatment at any time.
Since coronary artery bypass grafting (CABG) can not avoid myocardial injury, the absolute value of related myocardial protein markers (CK-MB, cTnT, cMLC, etc.) is greatly increased, and the sensitivity of related myocardial markers is reduced. GPBB is a sensitive indicator for monitoring blood supply and metabolism [14], so it is the best indicator for AMI monitoring after CABG. Comparing the change phase of GPBB in patients with myocardial infarction around the operation field with that in patients with non operation myocardial infarction, it can be found that the peak time of GPBB is different (the former is late), and the peak value of GPBB is significantly different (the former is low). In contrast, CK-MB has nothing to do with myocardial ischemia induced by CABG.
3 Outlook
The discovery of GPBB and the establishment of its detection method provide a solution to simplify the diagnosis of AMI, which will greatly shorten the diagnosis time and reduce the cost of diagnosis. Further shortening the determination time of GPBB and exploring a more rapid and simple detection method will be the key to make GPBB go out of the laboratory and replace CK-MB as the first indicator of bedside rapid detection.
reference
1 Rozenman Y et al. Annu Rev Med,1994; 45:31～44
2 Rusnak RA et al.Ann Emerg Med,1989; 18:1029～1034
3 Mail J.Clin Chem,1995; 41(7):963～965
4 Rabitzsch G et al.Clin Chem,1995; 41:966～978
5 Jaffe AS.Clin Chem,1993; 39:1567～1569
6 Newgard CB et al.Crit Rev Biochem ; Mol Biol,1989; 24:69～99
7 Kato A et al.J Neurochem,1989; 52:1425～1432
8 Newgard CB et al.J Biol Chem,1988; 263:3850～3857
9 Michael LH et al.Am J Physiol,1985; 48:H350～H359
10 Keffer JH.Am J Clin Pathol,1997; 107~398
11 Apple FS et al.Clin Chem,1984; 30:413～416
12 Hofmann U et al.Biochem Biophys Acta,1989; 48:S132～S136
Part 6: Model of Medical Testing Scheme
Key words: higher vocational colleges; Omics era; Medical laboratory
1、 The concept of the era of omics and its influence on medical laboratory teaching
（1） Concept of the era of omics
In the era of omics, the main goal is to regulate the genome and prompt its function. The core issues of research mainly include the regulation of genome expression, diversity, specific functions of protein products, and the simulation of genomes of various organisms. The scope of research in the era of omics can enable people to better understand the relationship between the structure and function of human genetic inheritance, human individual development, growth, tissue aging and death.
（2） The Influence of Histology Era on the Teaching of Medical Laboratory Specialty
For the sake of human health, the Human Genome Project has been established internationally. The applied genomics has been widely used in clinical medicine, mainly to detect certain diseases, so as to prevent in advance. For example, genetic diseases can be diagnosed through the detection of various chromosomes; Prevent cervical cancer by detecting HPV virus; To guide bone marrow matching through gene testing; Through the detection of hepatitis B virus, the mutation sites of drug resistance were analyzed to guide drug use. It can be seen that the era of omics has promoted the wide application of various detection technologies. Therefore, there are higher requirements for medical laboratory professionals. In terms of medical laboratory teaching in higher vocational colleges, we should constantly improve students' testing skills and practical ability according to the development of the times and the actual needs of the medical laboratory field, so that they can adapt to the future jobs [1].
2、 Teaching practice of medical laboratory specialty in the era of omics
（1） Improve students' basic testing skills
There are many operation items in the medical laboratory specialty, and the accuracy of the examination results has a direct impact on the determination of patients' treatment plans. Therefore, teachers should gradually cultivate students' basic examination skills in the teaching process. Through specific classroom experiments, students can be taught various inspection operation methods, and the opening time of the school laboratory can be increased to provide more opportunities for students to practice inspection operation. During the teaching process, teachers can give targeted training to students, for example, how to observe the morphology of bacteria, the count of parasite eggs, blood cells, etc., which requires students to repeatedly use microscopes for observation, and teachers should give appropriate guidance. For another example, students should be repeatedly trained to use instruments and equipment such as making blood slides, preparing culture media, using micro straws, and operating chromosomes. When students are operating, if they have questions, teachers should guide them in a timely manner, correct the wrong operations of students, and constantly improve students' basic testing skills.
（2） Carry out laboratory teaching based on clinical cases
In order to improve students' biochemical test ability, during the teaching process, according to specific clinical cases, reasonable questions can be raised in the teaching process to stimulate students to think, so that they can learn and test knowledge in the process of practice. For example, for the common clinical cases of "liver and gallbladder diseases", teachers can ask students guiding questions: What are the common liver function tests? What items should be checked for bile duct blockage? What are the biochemical indicators and other problems in the identification of jaundice? Then let the students divide into test groups to develop specific test plans. Teachers will comment on and optimize the plans of different groups to determine the final general plan. Then collect samples to test specific test items. After the trial, the members of the teacher's guidance group will analyze the results and make them clear the specific significance of different detection indicators in clinical practice. Through clinical cases, teachers carried out laboratory teaching, which not only stimulated students' interest in laboratory teaching, but also deepened students' understanding of clinical diseases.
（3） Using Task based Teaching to Cultivate Students' Testing Ability
In the era of group learning, the main purpose of medical laboratory specialty in higher vocational colleges is to cultivate students' operational ability for various tests. Therefore, in order to improve the teaching quality, teachers can carry out various practical teaching projects for students through the current needs of the laboratory departments in major hospitals. Before the practical training, the teacher first assigns the task to the students and puts forward the test problems involved in completing the task, such as the detection method, collection method and precautions of blood routine test. According to the tasks assigned by teachers, students can learn independently or cooperatively by consulting materials, and carry out practical training according to specific processes, such as collecting samples, transporting samples, testing samples, analysis results, waste disposal, etc. Then they can analyze the test sheet and record the process and results of the training [2]. In the process of task teaching, the preparation, operation and result analysis of training are all completed by students independently. At the same time, if students encounter problems that they do not understand in the training process, they can also solve them through mutual discussion between students, which can not only mobilize the enthusiasm of all students, but also cultivate students' ability to actively explore and cooperate in learning, thus improving their ability in medical testing.
Chapter 7: Model of Medical Testing Scheme
1 Project overview
The total area of a deep foundation pit project in Bao'an Central Area is 100000 m2, and the perimeter of the plot is 1.3 km. The excavation depth of the foundation pit is about 17 m, the total excavation volume is about 1.66 million m3, and the total construction period is 411 calendar days. The safety level of each support section is determined as Grade I, which belongs to the super large and super deep foundation pit near the subway.
1.1 Topography
The project site is close to the coastline, and the geomorphic part is the coastal platform plain offshore area. The shallow stratum is mainly composed of marine and terrestrial sediments. The site ground is filled manually, and the site is basically flat. The foundation is located below the groundwater level, which is a complex site; There are many kinds of rock and soil, which are uneven and have great changes in properties. It is a moderately complex foundation.
1.2 Surrounding environment
There are municipal trunk roads on the west, northwest, north and northeast. The underground is Shenzhen Metro Lines 1 and 5, with a total side length of about 730m. The right of way is only about 13m from the subway line. The south and east are municipal trunk roads, opposite to many and high-rise civil buildings. The south side is about 328m long, and the east side is about 240m long; There are power, telecommunications, gas, water supply and drainage pipelines around the foundation pit, and the pipelines around the site are staggered and complex; The station hall floor of Metro Line 1 is connected to the second underground floor of the project.
1.3 Foundation pit support design
1.3.1 Foundation pit support form
In combination with the geological conditions of the site and the surrounding environment, the foundation pit adopts the reinforced concrete internal support form, and the support structure is pile anchor or occluded pile+internal support; A closed water stop curtain is set around the foundation pit.
1.3.2 Construction sequence of foundation pit
Support bored piles and snap piles shall be constructed at the same time around. In order to avoid cross construction interaction and effectively use the land resources on the site, the surrounding support piles shall be constructed first, and then the middle soil retaining piles, column piles and engineering piles shall be constructed. During the construction of column piles, the surrounding column piles shall be constructed first, and then the column piles in the center of the construction site.
The earthworks shall be guided by the design requirements, and the excavation shall be carried out in the order of first inside the ring and then outside the ring. The excavation requirements of "first support and then excavation, layering, symmetry, balance and time limit" shall be followed.
2 Key points for quality and safety supervision and inspection of deep foundation pit engineering
The excavation depth of the foundation pit of the project is large, and the foundation pit is adjacent to subway facilities, municipal roads, various pipelines and buildings. It is necessary to ensure the normal operation of the subway, the stability and safety of the foundation pit itself, and the safety of surrounding buildings and underground pipelines. The following are the key supervision points of the project in the process of project supervision and management.
2.1 Quality behavior and procedure legality inspection of responsible subject
Before earth excavation, the excavation conditions shall be reviewed. Including: ① qualifications of survey, design, construction, supervision and other units, staffing and employment qualifications of relevant personnel, and job certificates of professional personnel; ② Have legal foundation pit construction drawings, reviewed construction plans, foundation pit monitoring plans, support structure detection plans, etc. The design unit shall participate in the review of the construction scheme and monitoring scheme, and comprehensively review the design scheme according to the final construction scheme and the information fed back from the site. At the same time, the design construction drawing and construction scheme shall be reviewed by experts in the expert database published by the Municipal Construction Bureau.
2.2 On site entity quality supervision
(1) Whether the support structure is consistent with the support design drawing, design change and construction scheme. ① Whether the forming of support structure is consistent with the design; ② Whether the section length, layer thickness and anchor setting of foundation pit excavation are consistent with the design requirements.
(2) The condition of the foundation pit structure, the surrounding environment of the foundation pit and the construction ramp in the pit: ① Whether there is water leakage, soil gushing, quicksand and piping in the foundation pit; ② Whether the slope support structure has cracks; ③ Whether the surrounding pipelines are damaged or leaked; Whether there are new cracks in surrounding buildings and whether cracks develop; Whether the surrounding roads (ground) have cracks, subsidence and deformation development; Construction changes of adjacent foundation pits and buildings.
(3) Whether the foundation pit wall leaks seriously; Whether the soil behind the wall has cracks, subsidence and sliding; Whether the drainage system inside and outside the foundation pit (drainage ditch, sump, pumping equipment, grit chamber) is set according to the design requirements, whether it is unobstructed, and whether there is ponding.
(4) Whether there is over excavation in foundation pit earthwork excavation; Whether the top of the foundation pit is overloaded, whether the ground around the foundation pit is overloaded, and whether the surcharge is carried out according to the design requirements.
(5) Monitoring facilities: ① Whether the monitoring points meet the requirements; ② Whether the benchmark and monitoring points are in good condition; ③ Whether the monitoring elements are intact and protected; ④ Whether there are obstacles affecting the observation work.
The on-site physical inspection is mainly visual inspection, supplemented by tools and instruments such as hammer, drill rod, measuring ruler, magnifying glass, and camera, photography and other equipment. In case of any abnormal or dangerous situation, the problem shall be raised in time and rectification shall be required.
2.3 Emergency plan inspection for abnormal and dangerous situations
2.3.1 Personnel, machinery and materials emergency preparedness inspection
Check whether the project has an effective and feasible emergency plan, and whether its organization, emergency rescue organization, emergency knowledge training, and emergency rescue equipment provided by the project department meet the requirements.
Whether the Project Department is equipped with emergency rescue equipment: ① medical equipment. ② Rescue equipment and materials: site construction machinery (such as excavators, drills, grouting machines, mud trucks, etc.) and regular tools (ropes, shovels, crowbars, hand-held cutting machines, waterproof tarpaulins, sandbags, etc.). ③ Lighting fixtures. ④ Communication equipment: telephone, mobile phone, interphone, alarm, etc.
2.3.2 Review of treatment methods
According to the construction drawings, the accumulated experience of similar projects and the actual situation of on-site construction, the following safety risks exist during the excavation of the deep foundation pit of the project: surrounding subsidence, foundation pit leakage, quicksand, piping, foundation pit and surrounding environment and subway monitoring abnormalities. Check whether there are corresponding emergency measures for different situations.
2.3.3 Stop work immediately and notify the construction unit and design unit in case of the following conditions
(1) The edge displacement of foundation pit is large or the displacement rate suddenly increases.
(2) Continuous cracks or wide discontinuous cracks appear on the ground surface at the top of the foundation pit.
(3) Cracks or large uneven settlement of surrounding buildings or roads.
(4) The foundation pit slope has local collapse or other abnormal phenomena.
2.4 Quality assurance data verification
2.4.1 Monitoring report inspection
(1) Third party monitoring
The third-party monitoring is the key point of the project information construction, which is an important means to monitor whether the foundation pit is stable, judge whether the foundation pit support design is reasonable, whether the construction method and process are feasible, and whether the foundation pit is safe to use in the main construction. The monitoring content of the project is divided into foundation pit monitoring and subway monitoring. Check whether the monitoring content and frequency of foundation pit and surrounding buildings meet the design and specification requirements, and whether the monitoring report is timely.
(2) Treatment method for detection data exceeding the standard during construction
Carefully implement the third-party monitoring scheme, strengthen the self construction monitoring and special person patrol system during construction, timely communicate and exchange monitoring information, ensure the safety of foundation pit construction and subway tunnel operation, and provide basis for rescue.
① When abnormal conditions occur during construction or the monitoring value reaches the early warning value, the cause shall be analyzed, the cause shall be found from the aspects of construction, geological survey and design, and the excavation method and sequence of foundation pit shall be checked whether they are carried out according to the drawings and construction scheme; Whether the soil quality exposed after excavation is different from the geotechnical investigation report; Recheck or evaluate the original design, and take corresponding measures according to the situation and deal with it in a timely manner.
② When the monitoring data reaches the control value, the responsible subjects of all parties shall analyze the causes and propose measures, and the construction unit shall organize relevant experts from the expert database published by the Municipal Construction Bureau to evaluate, and take corresponding measures and deal with them in a timely manner according to the evaluation results.
2.4.2 Inspection and test report of support structure
The scope of work includes: construction of occluding pile, drilling, punching cast-in-place pile, rotary jet grouting pile, internal support system, anchor cable, earth excavation, shotcrete surface course, drainage system, support replacement, internal support removal, monitoring, etc. During the construction process, it is necessary to do a good job in the inspection of relevant building materials and the detection of various piles. The piles and anchor cables tested should be representative. The specific detection scheme should be jointly formulated by the supervision, design, construction and construction units.
(1) Factory certificate, re inspection report and concealed acceptance data of conventional building materials (reinforcement, steel strand, concrete, cement, etc.).
(2) Basic test of prestressed anchor cable: before construction, select a representative stratum for the test, and the test quantity is 3.
(3) Support pile: conduct pile integrity test, and adopt low strain test. When the low strain detection belongs to Class III pile, core pulling detection shall be added. If the detection result does not meet the design and specification requirements, the design unit shall be notified in time to take necessary reinforcement and risk elimination measures.
(4) Quality of water stop curtain: 14 days after the completion of construction, core drilling method shall be adopted to detect the integrity of the pile body, and uniaxial ultimate compressive strength test and indoor permeability test shall be conducted.
(5) Prestressed anchor cable: conduct pull-out test and cement paste test block strength inspection.
2.4.3 Strengthen inspection of interception and drainage measures in rainstorm season
(1) Cement mortar shall be used to seal the surface cracks in time to prevent surface water infiltration.
(2) At the top of the foundation pit, temporary measures shall be taken to intercept the surface water to prevent infiltration or direct flow into the foundation pit.
(3) At the bottom of the foundation pit, sewage pump shall be used to pump water, and drainage facilities at the bottom of the pit shall be provided to keep the bottom of the foundation pit as dry as possible to prevent the soil at the bottom of the foundation pit from being softened by water. In the rainstorm season, reasonably organize the discharge of surface water, and arrange sufficient drainage equipment to pump and drain the collected surface water. At the same time, around the foundation pit, the surface water should be dredged to avoid a large amount of surface water flowing into the foundation pit.
Chapter 8: Model of Medical Testing Scheme
[Key words] Suspected abnormal reaction of vaccination; monitor
Adverse Event Following Immunization (AEFI) refers to the reaction or event suspected to be related to vaccination after vaccination. With the implementation of the expanded national immunization program, the number of vaccine types, doses and recipients has increased significantly, and the number of AEFI reported cases has increased year by year. The public has paid more attention to AEFI. In order to understand the operation of AEFI monitoring system in Ganjingzi District from 2009 to 2012, analyze its epidemiological characteristics, evaluate the quality of monitoring work, and improve the monitoring work. The AEFI monitoring in Ganjingzi District from 2009 to 2012 is analyzed.
1 Data and methods
1.1 Data collection
1.1.1 AEFI monitoring scope AEFI monitoring covers all vaccinated people; The statistical data are AEFI cases reported by all vaccination units in Ganjingzi District from 2009 to 2012.
1.1.2 The classification and reporting scope of EFI shall be in accordance with the National Monitoring Plan for Suspected Abnormal Vaccination Reactions [1].
1.1.3 EFI reporting method After medical institutions and vaccination units in the jurisdiction find AEFI, they shall timely fill in the case report card of suspected abnormal vaccination reaction and report it to Ganjingzi District CDC, which will report AEFI case report card, case questionnaire and investigation report through the network through the Information Management System of Suspected Abnormal Vaccination Reaction.
1.2 Methods
1.2.1 Data sorting and analysis AEFI cases in Ganjingzi District from 2009 to 2012 were exported through the Information Management System for Suspected Vaccination Abnormal Reaction, and Excel 2003 software was used for statistical analysis.
1.2.2 Descriptive analysis is used to analyze the distribution characteristics of AEFI and related indicators.
2 Results
2.1 General situation A total of 50 cases of AEFI were reported in Ganjingzi District from 2009 to 2012, including 13 cases in 2009, 23 cases in 2010, 2 cases in 2011 and 12 cases in 2012. There was no abnormal reaction of mass vaccination.
2.2 The causes of AEFI: Among 50 cases of AEFI, 42 cases had general reactions, accounting for 84.00%; There were 6 cases of abnormal reactions (4 cases of allergic rash, 1 case of thrombocytopenic purpura, 1 case of vaccine associated paralytic poliomyelitis), accounting for 12%; There were 2 cases of coincidence (4%).
2.3 Time distribution 50 AEFI cases were mainly distributed in September, accounting for 44.00%, followed by November, accounting for 26.00%; Except that there was no AEFI report in January, October and December, other months were scattered.
2.4 The age and gender of AEFI were 25 males and 25 females among 50 AEFI patients, with the same incidence of male and female.
3 Discussion
According to the 50 AEFI cases reported in Ganjingzi District from 2009 to 2012, the general reaction is the main one, accounting for 84%; It mainly occurred from September to November, accounting for 70.00%; 22 cases ≤ 1 year old, accounting for 44.00%. Because the vaccination times of the group>15 years old are far lower than those of children, AEFI is less reported [2]; The National Immunization Program (NIP) vaccine is the main vaccine, accounting for 98.00%, with measles vaccine, influenza A vaccine and cell-free DPT vaccine reported as the majority; 40.00% occurred in the first dose of inoculation; 78.00% had AEFI ≤ 1 day after inoculation.
Since the implementation of AEFI network direct reporting in 2008, especially since the introduction of the National Monitoring Plan for Suspected Vaccination Anomaly in 2010, the AEFI monitoring work in Ganjingzi District has gradually stepped onto the right track, with increased sensitivity. The number of reports has increased year by year, but the quality needs to be improved. In order to further improve the quality of AEFI monitoring in the whole region, the following measures will be taken in the future:
3.1 While strengthening AEFI passive monitoring, active monitoring can be carried out in some vaccination units [3].
3.2 Train grass-roots personnel to improve the timeliness and accuracy of AEFI reports.
3.3 Carry out standardized outpatient service construction and improve the quality of vaccination service [4].
3.4 Strengthen AEFI monitoring and supervision, and regularly analyze the supervision.
3.5 Strengthen publicity and education, guide the public to correctly understand AEFI, and create a good social atmosphere for vaccination.
reference
[1] General Office of the Ministry of Health Office of the State Food and Drug Administration National Monitoring Plan for Suspected Abnormal Vaccination Reaction [S]. 2010-06-03
[2] Yuan Ding Monitoring and Analysis of Suspected Abnormal Vaccination Reaction in Xinhua County from 2009 to 2011 [J]. Practical Preventive Medicine, 2012, 19 (10): 1504-1506
Chapter 9: Model of Medical Testing Scheme
[Key words] The practical significance of fecal monitoring for schistosomiasis control in farm cattle
CLC No.: S852.72 Document ID No.: A Article No.: 1009-914X (2016) 13-0373-01
According to? National Schistosomiasis Surveillance Program (2014)? The monitoring point monitoring has reached the transmission interruption standard. Luoxian County has selected a fixed monitoring point. As a national monitoring point for schistosomiasis prevention and control, Guangxi Village, Mianyuan Town, Mianzhu City has carried out fixed-point monitoring for five consecutive years since 2015. The pathogenic detection of schistosomiasis in farmed cattle adopts the method of hatching hairy metacercaria in plastic cup top tube, which is a clinical detection method stipulated by the national standard acceptance of schistosomiasis prevention and control [1]. The operating steps of the method of hatching trichosae in plastic cups are as follows: fecal sample collection - tube cup number - fecal sample mixing - filtering and filling fecal samples - water injection and plastic cover covering - water injection and cotton spreading - inverted tube jacking - hatching and observation results - result registration. The fecal miracidium hatching method is the first choice for clinical diagnosis, prevention and monitoring of schistosomiasis in farm cattle, which can improve the accuracy of clinical diagnosis. The specific analysis of the operation and practical significance of fecal examination for schistosomiasis prevention and control in farm cattle can scientifically evaluate the effectiveness of schistosomiasis prevention and control, and provide scientific basis for formulating and improving schistosomiasis prevention and control strategies.
1. Pathogenic monitoring of cattle (plastic cup top tube incubation method)
1.1 Fecal collection
Collect fresh dung of cattle. It can collect the feces naturally discharged by cattle, or use the method of removing feces, that is, wear rubber gloves, stretch into the rectum of cattle to collect feces, and replace the gloves on each head. The amount of feces is 250g, packed in special bags. The fecal sample collector shall fill the livestock information in the "fecal card for schistosomiasis inspection of farm cattle" (see Table 1)
1.2 Preparation of tools
Plastic pipe jacking cup: the plastic pipe jacking cup has a diameter of 12M, a height of 10M, and a volume of 1000ml; there is a round neck collar with an opening on the top of the cover, a height of 1.2M, and an inner diameter of 1.8M; the pipe jacking is a 12M × 1.3M glass test tube, and the nozzle is covered with a rubber gasket.
Enamel cup, bamboo chopsticks, 20 holes/25.4 copper screen; Marker, absorbent cotton, tweezers, scissors, magnifying glass, thermometer, sodium bicarbonate, bleaching powder, sodium thiosulfate, pH test paper, disposable gloves, plastic bucket for 200K tap water, etc.
1.3 Operation steps
According to the number of the fecal sample to be inspected, use a marking pen to number the plastic pipe jacking cup;
Take 50g cow dung to be measured each time and put it into an enamel cup, add a small amount of dechlorinated water with pH adjusted for more than 12 hours, mix it evenly with bamboo chopsticks, and then inject it into the plastic top tube cup through a copper screen. Clean the enamel cup and bamboo chopsticks with a small amount of water for many times, continue to inject the cleaned water into the plastic top tube cup, repeatedly clean the copper screen with clean water, and add clean water to the cup mouth;
Install the plastic cover and add water to the neck;
Fill the top pipe with chlorine removal water with adjusted pH value, then lay a thin layer of absorbent cotton on the neck of the glass top pipe, and quickly insert it upside down into the neck of the plastic cover;
Incubate the plastic top tube cup in the 25 ± 3 ℃ room.
1.4 Result observation
When the plastic top tube cup is incubated at 25 ± 3 ℃, observe the metacercaria once every 1 hour and 3 hours after incubation, and observe the metacercaria again every 5 hours for the negative. Pay attention to the difference between the metacercaria and the protozoa in the water. There should be more than 2 people to identify it, and if necessary, suck it out and identify it under the anatomical microscope or microscope.
According to? National Schistosomiasis Surveillance Program (2014)? It is stipulated that the plastic cup top tube incubation method should be used to detect at least 100 pieces of feces, and three pieces of feces should be checked? Domestic animal surveillance questionnaire for national schistosomiasis surveillance points? (Attached Table 5)
2. Discussion
The fecal examination for schistosomiasis prevention and control of farm cattle adopts the fecal miracidium incubation method, comprehensively improving the accuracy of clinical examination and diagnosis, so as to take timely prevention and treatment or medical measures to minimize the harm of the disease. In addition to comprehensively improving the accuracy of clinical diagnosis, we also need to strengthen the level of prevention and control [2]. In terms of prevention and control, we need to do a good job: (1) master the knowledge of schistosomiasis cases in cattle. Clinical prevention and treatment should first have sufficient knowledge of the disease, be able to judge the development of the disease in a timely manner, formulate a scientific treatment plan according to the actual situation, and the treatment plan should have strong adjustability, inclusiveness, and be able to make corresponding adjustments according to the change of the disease. (2) Enhance the accuracy of experimental inspection. In the process of experimental inspection, professionals need to be arranged to operate in strict accordance with relevant regulations, pay attention to detail inspection, pay attention to measuring the changes of the condition in different periods of time and different number of hairy worms, comprehensively improve the accuracy of inspection and diagnosis [3], and provide an objective theoretical basis for clinical medical work. (3) Comprehensively improve the comprehensive skills and quality of fecal examination staff. The fecal examination for schistosomiasis control in farm cattle is relatively complicated, with high professional requirements, and high requirements for the comprehensive skills and quality of the staff. Once a small human error occurs, it will directly affect the entire test results, which is likely to cause incalculable consequences. Therefore, it is necessary to constantly improve the comprehensive skills and quality of the relevant staff.
3. Summary
The purpose of schistosomiasis surveillance is to understand the epidemic dynamics of schistosomiasis and the changes of epidemic related factors, and to study and judge the epidemic trend; Find out the epidemic situation and potential transmission risk of schistosomiasis, and take timely intervention measures; To scientifically evaluate the effect of schistosomiasis control and provide scientific basis for formulating and improving schistosomiasis control strategies. The fecal miracidium hatching method is the first choice for clinical diagnosis, prevention and monitoring of schistosomiasis in farm cattle, which can improve the accuracy of clinical diagnosis. It is worthy of further promotion and application.
reference:
[1] Hu Hehua, Yu Qing, Zhang Xia, etc Evaluation on the input and effect of comprehensive control in schistosomiasis endemic areas based on the stratification of human and animal epidemic situation Ⅱ Analysis on the correlation between the epidemic situation change and the cost input in the lake marsh embankment type areas from 2006 to 2013 [J]. Chinese Journal of Schistosomiasis Control, 2015, (1): 17-21
