• 【老年恶性神经胶质瘤患者短期疗程的前瞻性研究。】 复制标题 收藏 收藏
    DOI:10.1023/a:1005750111883 复制DOI
    作者列表:Hoegler DB,Davey P
    BACKGROUND & AIMS: Elderly patients with malignant glioma have a poor prognosis and the benefit of standard radical radiotherapy is equivocal. Twenty-two percent of the adult referral base with malignant glioma at our centre is of age 70 years or greater. A phase II study was undertaken to determine if a shorter course of therapy yields a comparable median survival to radical radiotherapy and thus constitutes an appropriate investigational palliative regimen. 25 patients were accrued between 1988-1995, all of whom had histologically proven malignant glioma, 23 glioblastoma multiforme and 2 anaplastic astrocytoma. The median age was 73 (range 70-78) and median Karnofsky Performance Status (KPS) was 70.40% had a stereotactic biopsy only for diagnosis. Radiotherapy was delivered to limited fields to a dose of 37.5 Gy in 15 daily fractions over 3 weeks. An intention-to-treat analysis was undertaken with survival determined from date of initial consultation. The median survival of the whole group was 8.0 months (95% CI 4.8-9.6). Patients with good performance status (KPS > 70) had a median survival of 10.4 months (95% CI 9.6-14.7). 37.5 Gy in 15 daily fractions appears to yield comparable median survival to that of other series of radical radiotherapy. A phase III study of this regimen is recommended in investigating optimal palliation of elderly malignant glioma patients.

    背景与目标: 老年恶性神经胶质瘤患者预后较差,标准根治性放疗的益处是模棱两可的。我们中心的成人恶性神经胶质瘤转诊基数中有22%的年龄为70岁或更高。进行了II期研究,以确定较短的疗程是否可以产生与根治性放疗相当的中位生存期,从而构成一种适当的姑息治疗方案。 1988年至1995年期间,共有25例患者,均经组织学证实为恶性神经胶质瘤,23例多形性胶质母细胞瘤和2例间变性星形细胞瘤。中位年龄为73岁(范围为70-78岁),中位Karnofsky绩效状态(KPS)为70.40%,仅进行了立体定向活检以进行诊断。放射治疗在3周内分15天内分次以37.5 Gy的剂量传送到有限的领域。进行了意向性治疗分析,生存期从初次咨询之日起确定。整个组的中位生存期为8.0个月(95%CI 4.8-9.6)。表现良好状态(KPS> 70)的患者中位生存期为10.4个月(95%CI 9.6-14.7)。 15个每日剂量中的37.5 Gy似乎可以产生与其他系列放射疗法相当的中位生存期。建议对该方案进行III期研究,以调查老年恶性神经胶质瘤患者的最佳缓解情况。

  • 【血红蛋白对同时放化疗的宫颈癌患者生存的影响取决于磁共振成像对淋巴结转移的发现。】 复制标题 收藏 收藏
    DOI:10.1111/j.1525-1438.2006.00666.x 复制DOI
    作者列表:Choi YS,Yi CM,Sin JI,Ye GW,Shin IH,Lee TS
    BACKGROUND & AIMS: :The objective of this study was to confirm whether hemoglobin (Hb) levels during chemoradiotherapy are associated with survival in patients with locally advanced cervical carcinoma and to assess impact of the Hb level on survival according to lymph node (LN) metastasis. A retrospective review of 85 cervical carcinoma patients treated with concurrent chemoradiotherapy was conducted. The stage of disease ranged between FIGO stage IB and stage IVA. Disease-free and overall survivals were evaluated by univariate and multivariate analyses. After median follow-up of 35.7 months, 24 patients developed recurrence of disease and 14 patients died from their disease. Stage, LN metastasis, and squamous cell carcinoma antigen and Hb levels during chemoradiation were correlated significantly with survival (P < 0.05). Maintenance of Hb above 10.0 g/dL was associated with better survival (P < 0.05). However, no such benefits were observed in patients with LN metastasis by magnetic resonance imaging (MRI). Multivariate Cox regression hazard model showed that Hb levels during chemoradiation were an independent prognostic factor in patients without LN metastasis by MRI. Maintenance of Hb during chemoradiation is of benefit in cervical carcinoma patients without LN metastasis but not with LN metastasis by MRI.
    背景与目标: :这项研究的目的是确定放化疗期间的血红蛋白(Hb)水平是否与局部晚期宫颈癌患者的生存相关,并根据淋巴结(LN)转移评估Hb水平对生存的影响。回顾性回顾了85例同时放化疗的宫颈癌患者。疾病的阶段在FIGO的IB阶段和IVA阶段之间。通过单因素和多因素分析评估无病生存期和总生存期。在中位随访35.7个月后,有24例患者复发疾病,有14例患者死于疾病。化学放疗期间的分期,LN转移,鳞状细胞癌抗原和血红蛋白水平与生存率显着相关(P <0.05)。维持Hb高于10.0 g / dL与更好的生存率相关(P <0.05)。但是,通过磁共振成像(MRI)在LN转移患者中未观察到此类益处。多元Cox回归风险模型显示,放化疗期间Hb水平是无LN转移的患者(通过MRI)的独立预后因素。对于没有LN转移但没有MRI的LN转移的宫颈癌患者,放化疗期间维持Hb有益。
  • 【LRRK2 I2012T,G2019S和I2020T突变在原发性震颤患者中并不常见。】 复制标题 收藏 收藏
    DOI:10.1016/j.neulet.2006.08.012 复制DOI
    作者列表:Deng H,Le W,Davidson AL,Xie W,Jankovic J
    BACKGROUND & AIMS: :Several mutations in the leucine-rich repeat kinase 2 gene (LRRK2) have been identified both in familial and sporadic cases of Parkinson's disease (PD). G2019S, located at a kinase (MAPKKK) domain, is the most common mutation in the LRRK2 gene in PD, Two adjacent mutations (I2012T and I2020T) were mapped to the same domain suggesting shared pathogenic mechanism of these mutations. Since phenotypes of PD overlap with essential tremor (ET), we investigated LRRK2 G2019S, I2012T, and I2020T mutations in a cohort of 272 patients with ET. No mutations were found in our ET cohort and, therefore, we conclude that LRKK2 I2012T, G2019S and I2020T variants are rare causes of Caucasian ET.
    背景与目标: :在家族性和散发性帕金森氏病(PD)病例中,均已鉴定出富含亮氨酸的重复激酶2基因(LRRK2)的多个突变。位于激酶(MAPKKK)结构域的G2019S是PD中LRRK2基因中最常见的突变,两个相邻的突变(I2012T和I2020T)被定位到同一结构域,表明这些突变具有共同的致病机制。由于PD的表型与原发性震颤(ET)重叠,因此我们对272名ET患者的队列研究了LRRK2 G2019S,I2012T和I2020T突变。在我们的ET队列中未发现突变,因此,我们得出结论,LRKK2 I2012T,G2019S和I2020T变体是白种人ET的罕见原因。
  • 【评估痴呆症患者的驾驶能力。】 复制标题 收藏 收藏
    DOI:10.1097/00002093-199706001-00003 复制DOI
    作者列表:Dobbs AR
    BACKGROUND & AIMS: The driving behaviors of dementia patients have received little in the way of empirical scrutiny except through retrospective reports of crash rates. Understanding the driving errors of dementia patients and how they differ from those of normal older and younger drivers is important. This knowledge is basic to the development of road tests and scoring procedures to evaluate the driving competence of older, experienced drivers, especially those whose fitness to drive may have been compromised by a medical illness that alters their mental abilities. We have drive tested over 100 currently driving elderly patients with clinically significant cognitive decline (mostly diagnosed as the early stages of Alzheimer disease) and compared their performance with that of normal drivers. The study identified the types of driving errors that distinguish and differentiate the cognitively impaired group as well as a set of driving errors typical of both cognitively impaired and normal experienced drivers but differing in the number and severity of errors. A set of errors was also identified that did not differentiate the groups and should not be used in evaluating a person's competence to drive.

    背景与目标: 除非通过回顾性报告失速发生率,痴呆症患者的驾驶行为在实证研究中很少受到关注。了解痴呆症患者的驾驶错误及其与正常年龄段和年轻驾驶员的区别是很重要的。这些知识是开发道路测试和评分程序以评估年长,经验丰富的驾驶员(尤其是那些可能会因精神疾病而患病的驾驶健康状况)的驾驶能力的基础。我们已经对100多名目前正在驾驶的具有临床上明显的认知能力下降(大多被诊断为阿尔茨海默氏病的早期阶段)的老年患者进行了驾驶测试,并将他们的表现与正常驾驶者进行了比较。该研究确定了区分和区分认知障碍人群的驾驶错误的类型,以及一组认知障碍和正常经验丰富的驾驶员典型的驾驶错误,但错误的数量和严重程度有所不同。还确定了一组错误,这些错误不会区分群体,因此不应用于评估一个人的驾驶能力。

  • 【对沙眼衣原体膜成分的体液免疫应答和体外受精患者卵泡液中人60 kDa热休克蛋白的表达。】 复制标题 收藏 收藏
    DOI:10.1093/humrep/12.5.925 复制DOI
    作者列表:Neuer A,Lam KN,Tiller FW,Kiesel L,Witkin SS
    BACKGROUND & AIMS: Recent evidence suggests that Chlamydia trachomatis can persist in the female upper genital tract in an unculturable state. Since unsuspected C. trachomatis infection has been associated with adverse in-vitro fertilization (IVF) outcome we sought to detect further evidence of C. trachomatis in the genital tracts of women undergoing IVF. The prevalence and distribution of antibodies to the major structural proteins of C. trachomatis in paired follicular fluid and sera of women undergoing IVF were examined. Sera and follicular fluid samples from 149 women were assayed for immunoglobulin (Ig)G and IgA antibodies to two C. trachomatis antigens, the major outer membrane protein (MOMP) and a recombinant lipopolysaccharide (rLPS) fragment. Additionally, the expression of human 60 kDa heat shock protein (hsp 60) in follicular fluid was determined. All cervical and follicular fluid samples were negative for C. trachomatis by polymerase chain reaction, ligase chain reaction and DNA probe. Sera from 60% of the subjects were positive for antichlamydial rLPS IgG; 36% were positive for anti-MOMP IgG. Similarly, rLPS-directed and MOMP-directed IgA were detected in sera of 34 and 14% of the subjects respectively. IgG antibodies to MOMP and rLPS were detected in 42 and 41% of the follicular fluid examined respectively. Anti-MOMP IgA was identified in 8.7% of the follicular fluid while 27.5% were positive for anti-rLPS IgA. Human hsp 60 expression was documented in 11.6% of the follicular fluid tested. IgA antibodies to both MOMP (P = 0.03) and rLPS (P = 0.02) in follicular fluid were associated with a failure to become pregnant after embryo transfer. IgG antibodies in sera and follicular fluid and IgA antibodies in sera were unrelated to IVF outcome. Similarly only anti-MOMP IgA (P = 0.02) and anti-rLPS IgA (P = 0.04) in follicular fluid were correlated with human hsp 60 expression in follicular fluid. The unique association between IgA antibodies to two chlamydial antigens in follicular fluid and both hsp 60 expression and IVF failure provides further support for the possibility that a persistent upper genital tract chlamydial infection contributes to IVF failure in some women.

    背景与目标: 最近的证据表明,沙眼衣原体可以在女性上生殖道中以无法培养的状态持续存在。由于未曾怀疑的沙眼衣原体感染与体外受精(IVF)不良结果有关,因此我们寻求在接受IVF的女性生殖道中发现沙眼衣原体的进一步证据。检查了在进行IVF的女性的配对卵泡液和血清中沙眼衣原体主要结构蛋白抗体的流行情况和分布。分析了来自149名妇女的血清和卵泡液样品中针对两种沙眼衣原体抗原,主要外膜蛋白(MOMP)和重组脂多糖(rLPS)片段的免疫球蛋白(Ig)G和IgA抗体。另外,测定了人60kDa热休克蛋白(hsp 60)在卵泡液中的表达。通过聚合酶链反应,连接酶链反应和DNA探针,所有子宫颈和卵泡液样品均为沙眼衣原体阴性。 60%的受试者血清抗衣原体rLPS IgG阳性; 36%的抗MOMP IgG阳性。同样,分别在34%和14%的受试者血清中检测到了rLPS导向和MOMP导向的IgA。在分别检查的卵泡液中有42%和41%检测到针对MOMP和rLPS的IgG抗体。在8.7%的卵泡液中发现了抗MOMP IgA,而抗rLPS IgA的阳性率为27.5%。在测试的卵泡液中有11.6%记录了人类hsp 60的表达。卵泡液中针对MOMP(P = 0.03)和rLPS(P = 0.02)的IgA抗体与胚胎移植后无法怀孕有关。血清和卵泡液中的IgG抗体以及血清中的IgA抗体与IVF结果无关。同样,卵泡液中只有抗MOMP IgA(P = 0.02)和抗rLPS IgA(P = 0.04)与人hsp 60在卵泡液中的表达相关。卵泡液中针对两种衣原体抗原的IgA抗体与hsp 60表达和IVF衰竭之间的独特联系为某些女性持续性上生殖道衣原体感染导致IVF衰竭的可能性提供了进一步的支持。

  • 【肾上腺偶发瘤患者的胰岛素敏感性】 复制标题 收藏 收藏
    DOI:10.2298/sarh0608315i 复制DOI
    作者列表:Ivović M,Vujović S,Penezić Z,Zarković M,Drezgić M
    BACKGROUND & AIMS: INTRODUCTION:Frequent use of modern imaging methods (such as ultrasound, CT and MRI) results in high incidence of accidentally discovered adrenal mass. Adrenal incidentalomas are accidentally discovered adrenal tumors by imaging methods without any prior suspicion of adrenal disease. Some studies have shown decreased insulin sensitivity in patients with adrenal incidentaloma. OBJECTIVE:The objective of our study was to assess the insulin sensitivity in patients with adrenal incidentalom a. METHOD:A total of 22 patients with accidentally discovered adrenal mass confirmed by CT/MRI were evaluated in our study. Average age was 53.31 +/- 26.5 years and average BMI 25.84 +/- 3.65 kg/m2. Control group consisted of 33 healthy subjects. Insulin sensitivity was assessed by short ITT (insulin tolerance test). Blood samples were taken before, 3, 6, 9, 12, 15, 20 and 30 minutes after i.v. bolus of regular insulin (0.05 IU/kg BW). Glycemia was determined by glucose oxidase method. Statistical analysis was done by ANCOVA, using BMI as covariate. RESULTS:Our results showed significantly lower insulin sensitivity in patients with adrenal incidentalomas comparing to the control group (4.95 +/- 0.58 vs. 6.62 +/- 0.47, p=0.015). CONCLUSION:Our patients with adrenal incidentalomas manifested lower insulin sensitivity what suggested further follow up and assessment of insulin sensitivity during endocrine evaluation of these patients.
    背景与目标: 简介:频繁使用现代成像方法(例如超声,CT和MRI)会导致意外发现的肾上腺肿块的发生率很高。肾上腺偶发瘤是通过影像学方法意外发现的肾上腺肿瘤,而没有任何先前怀疑的肾上腺疾病。一些研究表明,肾上腺偶发瘤患者的胰岛素敏感性降低。
    目的:本研究的目的是评估肾上腺偶然性a患者的胰岛素敏感性。
    方法:本研究共评估22例经CT / MRI确诊的意外发现肾上腺肿块的患者。平均年龄为53.31 /-26.5岁,平均BMI为25.84 /-3.65 kg / m2。对照组由33名健康受试者组成。胰岛素敏感性通过短期ITT(胰岛素耐受性测试)进行评估。在静脉内注射之前,3、6、9、12、15、20和30分钟之前采集血样。大剂量普通胰岛素(0.05 IU / kg体重)。血糖测定采用葡萄糖氧化酶法。由ANCOVA使用BMI作为协变量进行统计分析。
    结果:我们的结果显示,与对照组相比,肾上腺偶发瘤患者的胰岛素敏感性显着降低(4.95 /-0.58 vs. 6.62 /-0.47,p = 0.015)。
    结论:我们的肾上腺偶发瘤患者表现出较低的胰岛素敏感性,这提示对这些患者进行内分泌评估时需要进一步随访和评估胰岛素敏感性。
  • 【通过跑步机为截瘫患者的步行康复。】 复制标题 收藏 收藏
    DOI:10.1038/sj.sc.3100403 复制DOI
    作者列表:Felici F,Bernardi M,Radio A,Marchettoni P,Castellano V,Macaluso A
    BACKGROUND & AIMS: The present study was aimed at investigating the use of a treadmill for ambulation training of paraplegic subjects. To investigate the likely effectiveness of this modality of rehabilitation, six paraplegic patients (three male and three female) were studied, using new generation reciprocating gait orthoses (RGO and ARGO), in a treadmill training program. Oxygen consumption, heart rate, and pulmonary ventilation were measured when the subjects were walking at their most comfortable speed on the treadmill and on the open field. These measurements were carried out at the beginning of the study and after two and six months of treadmill training. The following findings were significantthe treadmill walking required 30% less energy than open field ambulation prior to training (P < 0.001) and 50% after training (P < 0.05). The most comfortable walking speed was faster on the treadmill than on the open field by 18% prior to training (P < 0.05) and 42% afterwards (P < 0.05). The energy cost was 50% less after 2 months training on the treadmill (P < 0.05) showing that treadmill training can improve the efficiency of over ground ambulation. It can be concluded that the treadmill training improves the RGO/ARGO walking capability, probably both the walking efficiency (short term adaptation) and physical fitness (long term adaptation).

    背景与目标: 本研究旨在调查跑步机对截瘫患者的步行训练的使用。为了研究这种康复方式的可能效果,在跑步机培训计划中,使用新一代的往复式步态矫形器(RGO和ARGO)研究了六名截瘫患者(三名男性和三名女性)。当受试者在跑步机和空旷地上以最舒适的速度行走时,测量氧气消耗量,心率和肺通气量。这些测量是在研究开始时以及跑步机训练后两个月和六个月进行的。以下发现很有意义,跑步机步行所需的能量比训练前的旷野行走减少30%(P <0.001),而训练后则减少50%(P <0.05)。在跑步机上,最舒适的步行速度要比在旷野上快,训练前提高18%(P <0.05),事后提高42%(P <0.05)。在跑步机上训练两个月后,能量消耗降低了50%(P <0.05),表明跑步机训练可以提高地面运动的效率。可以得出结论,跑步机训练可以提高RGO / ARGO的步行能力,可能同时提高步行效率(短期适应)和身体适应性(长期适应)。

  • 【超声检查和细针穿刺细胞学检查对有资格进行前哨淋巴结活检的黑色素瘤患者进行术前评估。】 复制标题 收藏 收藏
    DOI:10.1245/s10434-006-9106-9 复制DOI
    作者列表:van Rijk MC,Teertstra HJ,Peterse JL,Nieweg OE,Olmos RA,Hoefnagel CA,Kroon BB
    BACKGROUND & AIMS: BACKGROUND:Ultrasonography with fine-needle aspiration cytology (FNAC) has proven to be a valuable diagnostic tool in the preoperative workup of patients with breast cancer or penile cancer eligible for sentinel lymph node biopsy. The aim of this study was to evaluate the use of this technique in the initial assessment of patients with primary cutaneous melanoma. METHODS:A total of 107 patients with cutaneous melanoma eligible for sentinel node biopsy with clinically negative nodes were studied prospectively. Patients underwent ultrasonography of potentially involved basins and FNAC in case of a suspicious lymph node. The sentinel node procedure was omitted in patients with tumour-positive lymph nodes in lieu of lymph node dissection. RESULTS:Ultrasonography with FNAC correctly identified disease preoperatively in two of the 107 patients (2%). Thirteen of the 22 patients (59%) with a suspicious node on ultrasonographic imaging but a tumour-negative fine-needle aspirate were shown to have involved nodes. Of the 85 patients with ultrasonographically normal nodes, 25 (29%) were shown to have metastases. Of the total of 43 involved basins, 16 contained metastases > 2 mm and 25 < or = 2 mm. CONCLUSIONS:In our hands, the sensitivity and specificity of preoperative ultrasonography to detect lymph node involvement in patients with melanoma are 34% and 87%, respectively. In combination with FNAC, this is 4.7% and 100%, respectively. This yield is insufficient for this technique to be used as a routine diagnostic tool in the selection of patients eligible for sentinel node biopsy.
    背景与目标: 背景:超声检查结合细针穿刺细胞学检查(FNAC)已被证明是对乳腺癌或阴茎癌患者进行前哨淋巴结活检的术前检查中有价值的诊断工具。这项研究的目的是评估该技术在原发性皮肤黑素瘤患者的初步评估中的应用。
    方法:前瞻性研究了107例符合临床前淋巴结活检要求的前哨淋巴结活检的皮肤黑色素瘤患者。对可疑淋巴结患者进行超声检查,包括潜在受累盆和FNAC。肿瘤阳性淋巴结代替淋巴结清扫的患者省略了前哨淋巴结清扫术。
    结果:107例患者中有2例(2%)在接受FNAC的超声检查之前能正确地识别出疾病。 22例患者中有13例(59%)在超声检查中发现可疑淋巴结,但肿瘤阴性的细针抽吸物已累及淋巴结。在超声检查正常的85例患者中,有25例(29%)显示有转移。在总共43个受累盆地中,有16个包含的转移灶> 2 mm,而25个<或= 2 mm。
    结论:在我们手中,术前超声检查黑色素瘤患者淋巴结受累的敏感性和特异性分别为34%和87%。与FNAC结合使用时,分别为4.7%和100%。该产量不足以将该技术用作选择适合进行前哨淋巴结活检的患者的常规诊断工具。
  • 【晚期胰头导管腺癌患者的旁路手术与姑息性胰十二指肠切除术,重点是生活质量分析。】 复制标题 收藏 收藏
    DOI:10.1245/s10434-006-9172-z 复制DOI
    作者列表:Schniewind B,Bestmann B,Kurdow R,Tepel J,Henne-Bruns D,Faendrich F,Kremer B,Kuechler T
    BACKGROUND & AIMS: BACKGROUND:In some centers, palliative resection (PR; partial pancreaticoduodenectomy) is, in selected cases, promoted in preference to double loop bypass (DLB) surgery for advanced pancreatic cancer. This prospective study compares PR with DLB, placing particular focus on patients' quality of life (QoL). METHODS:From 01/1993 to 09/2004, 167 patients were analyzed in a prospective single center study of palliative surgical treatment of advanced ductal adenocarcinoma of the pancreatic head. Thirty-eight underwent PR and 129 underwent palliative DLB. Patients undergoing DLB were divided into: (1) locally advanced disease (LAD-subgroup; n = 61; 47%) and (2) metastasized disease (MD-subgroup; n = 68; 53%). QoL was assessed using the EORTC QLQ-C30 questionnaire supplemented by a pancreatic cancer specific module. QoL data were collected pre-operatively and for up to 12 months after surgery. RESULTS:Median survival was 7.0 months (95% CI 4.09; 9.91) in PR patients and 6.0 months (95% CI 5.39; 6.61) in patients who received DLB. Mortality and morbidity were, respectively, 7.8 and 58% for PR, and 2.6 and 42% for DLB. QoL decreased more after PR than after DLB. The DLB-group recovered quicker, reaching pre-operative QoL levels after 3 months, and were less impaired when discharged. The LAD-subgroup and the MD-subgroup presented with equal levels of QoL. CONCLUSIONS:QoL analysis revealed favorable QoL data after DLB. Additionally, the survival rates of the two groups did not differ significantly, but morbidity and mortality rates in the PR group were elevated. Therefore, the use of PR for advanced pancreatic cancer needs to be carefully evaluated.
    背景与目标: 背景:在某些中心,在某些情况下,姑息性切除术(PR;部分胰十二指肠切除术)优先于晚期胰腺癌的双环旁路手术(DLB)进行推广。这项前瞻性研究将PR与DLB进行了比较,特别关注患者的生活质量(QoL)。
    方法:从01/1993年至09/2004年,在前瞻性单中心研究中对姑息性胰腺癌晚期导管腺癌姑息性手术治疗的167例患者进行了分析。 38例接受了PR,129例接受了姑息性DLB。接受DLB的患者分为:(1)局部晚期疾病(LAD-亚组; 61例; 47%)和(2)转移性疾病(MD-亚组; 68例; 53%)。使用EORTC QLQ-C30问卷并辅以胰腺癌特定模块评估生活质量。术前和手术后长达12个月收集QoL数据。
    结果:PR患者的中位生存期为7.0个月(95%CI 4.09; 9.91),而接受DLB的患者为6.0个月(95%CI 5.39; 6.61)。 PR的死亡率和发病率分别为7.8%和58%,DLB的死亡率为2.6%和42%。 PR后的生活质量比DLB后的生活质量下降更多。 DLB组恢复更快,三个月后达到术前QoL水平,出院时受损程度较小。 LAD子组和MD子组具有相同的QoL水平。
    结论:QoL分析显示DLB后有利的QoL数据。此外,两组的生存率没有显着差异,但PR组的发病率和死亡率均升高。因此,需要仔细评估PR在晚期胰腺癌中的应用。
  • 【接受放射治疗的鼻咽癌患者的口腔护理。】 复制标题 收藏 收藏
    DOI:10.1016/s0964-1955(96)00053-x 复制DOI
    作者列表:Shieh SH,Wang ST,Tsai ST,Tseng CC
    BACKGROUND & AIMS: A randomised trial was undertaken to compare the effect of three oral care protocols in delaying the onset of stomatitis and reducing oral injury in nasopharyngeal cancer patients undergoing radiotherapy, 30 eligible patients with a mean age of 56.2 years were recruited and evenly allocated to one of the three groups using a randomly permuted blocks method. Patients allocated to group E1 and group E2 were given the same instructions on oral care at 1 day, and 1 week before radiotherapy, respectively, while those allocated to the control group were given no instructions. We use the Oral Assessment Guide to assess the oral physical conditions of these patients daily. Our findings revealed that the patients in the E2 group not only had later onset of stomatitis than those in the control and the E1 groups, but also had lesser degree of oral injury measured by the overall assessment score. We thereby recommend the use of the E2 protocol for delaying the onset of stomatitis and reducing oral injury in nasopharyngeal cancer patients undergoing radiotherapy.

    背景与目标: 进行一项随机试验以比较三种口腔护理方案在接受放射治疗的鼻咽癌患者中延迟口腔炎和减少口腔损伤的效果,招募了30名平均年龄为56.2岁的合格患者,并平均分配给其中一名患者。三组使用随机排列的块方法。分配给E1组和E2组的患者分别在放疗前1天和1周接受相同的口腔护理指导,而分配给对照组的患者则没有给予指导。我们使用《口腔评估指南》每天评估这些患者的口腔身体状况。我们的研究结果表明,E2组患者不仅比对照组和E1组患者发生口腔炎的时间要晚,而且通过总体评估得分来衡量其口腔损伤的程度也较小。因此,我们建议在接受放疗的鼻咽癌患者中使用E2方案延迟口腔炎的发作并减少口腔损伤。

  • 【医生和他们的患者对临终护理的偏爱。】 复制标题 收藏 收藏
    DOI:10.1046/j.1525-1497.1997.00058.x 复制DOI
    作者列表:Gramelspacher GP,Zhou XH,Hanna MP,Tierney WM
    BACKGROUND & AIMS: OBJECTIVE:Both physicians and patients view advance directives as important, yet discussions occur infrequently. We assessed differences and correlations between physicians' and their patients' desires for end-of-life care for themselves.

    MEASUREMENTS AND MAIN RESULTS:Study physicians (n = 78) were residents and faculty practicing in an inner-city, academic primary care general internal medicine practice. Patients (n = 831) received primary care from these physicians and were either at least 75 or between 50 and 74 years of age, with selected morbid conditions. Physicians and patients completed identical questionnaires that included an assessment of their preferences for six specific treatments if they were terminally ill. There were significant differences between physicians' and patients' preferences for all six treatments (p < .0001), with physicians wanting less treatment than their patients for five of them. Patients desiring more care (p < .01) were more often male (odds ratio [OR] 1.7). African-American (OR 1.6), and older (OR 1.02 per year). There were no such correlates with physicians' preferences. A treatment preference score was calculated from respondents' desires to receive or refuse the six treatments. Physicians' scores were highly correlated with those of their enrolled primary care patients (r = .51, p < .0001).

    CONCLUSIONS:Although patients and physicians as groups differ substantially in their preferences for end-of-life care, there was significant correlation between individual academic physicians' preferences and those of their primary care patients. Reasons for this correlation are unknown.

    背景与目标: 目标:医生和患者都认为事前指示很重要,但很少会进行讨论。我们评估了医生与患者对自己的临终护理的需求之间的差异和相关性。

    措施和主要结果:研究医师(n = 78)是住院医师以及在市中心的学术初级保健普通内科医学实践中任职的教师。患者(n = 831)从这些医生那里接受了初级护理,年龄至少75岁,或年龄在50-74岁之间,患有特定的病态疾病。内科医生和患者填写了相同的问卷,其中包括如果他们身患绝症,则对他们对六种特定疗法的偏好进行评估。在这六种治疗方法中,医师和患者的偏爱之间存在显着差异(p <.0001),其中五种方法所需要的治疗剂量均少于患者。希望得到更多护理的患者(p <.01)多为男性(优势比[OR] 1.7)。非裔美国人(OR 1.6)和更老的人(每年OR 1.02)。没有这样的关联与医生的喜好。根据受访者接受或拒绝这六种治疗的意愿计算出治疗偏好得分。医师的得分与他们参加的初级保健患者的得分高度相关(r = .51,p <.0001)。他们对临终护理的偏爱,个人学术医生的偏爱与他们的初级保健患者的偏爱之间存在显着相关性。这种关联的原因未知。

  • 【良性和恶性原发性甲状腺滤泡性甲状腺肿瘤患者血清中p53和可溶性Fas配体(sFasL)血清浓度的评估作为细胞凋亡的指标。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Kołomecki K,Maciaszczyk P,Stepień H,Cywiński J,Cielecka J,Stepień T,Kuzdak K
    BACKGROUND & AIMS: INTRODUCTION:Apoptosis (programmed cell death) is the best described mode of physiological cell death. During embryonal development and morphogenesis, apoptosis may be induced by two pathways. The first is external protein signal originating from other cell--also named as "death signal". Another one is specific cell reaction for external stress factors. Blood concentration of proteins regulating both pathways of apoptosis may be useful in early diagnosis and staging of thyroid tumors. The aim of study was evaluation of p53 and sFasL blood concentration in patients with benign follicular adenoma and follicular thyroid cancer. MATERIALS AND METHODS:The study population was composed of 28 patients: 14 with thyroid carcinoma and 14 patients with follicular neoplasm (NF). All patients underwent surgical treatment. P53 and sFasL levels were evaluated before surgery and related to the histopathological diagnosis obtained post-surgery. RESULTS:The analysis revealed high sFasL blood concentration in patients with follicular thyroid cancer in comparison with the group with follicular adenoma. There was no statistically significant difference between levels of p53 in both groups. CONCLUSIONS:Evaluation of sFasL serum level concentration may be useful in preoperative diagnosis of follicular thyroid tumors.
    背景与目标: 简介:细胞凋亡(程序性细胞死亡)是描述性的生理性细胞死亡方式。在胚胎发育和形态发生过程中,可能通过两种途径诱导细胞凋亡。第一个是源自其他细胞的外部蛋白质信号-也称为“死亡信号”。另一个是针对外部应激因素的特异性细胞反应。调节细胞凋亡的两种途径的蛋白质的血药浓度可能对甲状腺肿瘤的早期诊断和分期有用。研究的目的是评估良性滤泡性腺瘤和滤泡性甲状腺癌患者的p53和sFasL血药浓度。
    材料与方法:研究人群由28例患者组成:14例甲状腺癌和14例滤泡性肿瘤(NF)。所有患者均接受手术治疗。在手术前评估P53和sFasL水平,并与手术后获得的组织病理学诊断有关。
    结果:分析显示,与滤泡性腺瘤相比,滤泡性甲状腺癌患者的sFasL血药浓度较高。两组中p53水平之间无统计学差异。
    结论:血清sFasL水平的评估可能对甲状腺滤泡性肿瘤的术前诊断有帮助。
  • 【在明视和中视条件下测量LASIK患者视觉性能的功效。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Tang W,Heng WJ,Lee HM,Fam HB,Lai NS
    BACKGROUND & AIMS: INTRODUCTION:The aim of the study was to compare the visual performance of LASIK eyes measured using high-contrast logMAR letter charts under bright (photopic) and dim (mesopic) conditions. MATERIALS AND METHODS:A total of 46 subjects (35 +/- 8 years of age) undergoing LASIK procedures were recruited for the study. The best spectacle-corrected visual acuity (BSCVA) of each subject was measured using the high-contrast ETDRS logMAR chart under photopic and mesopic conditions at 3 visits: preoperative (Pre), 1 month postoperative (Post1) and 3 months postoperative (Post3). The differences in logMAR scores for the right eyes only were analysed for the Pre-Post1 (n = 46), Pre-Post3 (n = 18) and Post1-Post3 (n = 16) comparisons. RESULTS:The logMAR scores of subjects were worse at the 1-month postoperative visit than preoperatively, and improvement in visual performance was seen at the 3-month postoperative visit. These changes in visual performance became more evident under mesopic conditions. The means and standard errors of the differences in logMAR scores for the Pre-Post3 (0.097 +/- 0.020) were slightly larger than those of the Pre-Post1 (-0.067 +/- 0.019) and Post1-Post3 (0.031 +/- 0.012) comparisons. Under mesopic conditions, the visual performance of the subjects was statistically significant for the 3 comparisons, but not under photopic conditions. CONCLUSION:High-contrast logMAR chart performed under mesopic conditions has the potential to replace visual acuity measured under photopic conditions in providing more reliable representation of postoperative visual outcomes of LASIK eyes. Eye doctors should consider performing this vision test routinely to gauge the success of LASIK surgery.
    背景与目标: 简介:本研究的目的是比较在明亮(明暗)和暗淡(近视)条件下使用高对比度logMAR字母图测量的LASIK眼睛的视觉性能。
    材料与方法:共招募了接受LASIK手术的46名受试者(35 /-8岁)。使用高对比度ETDRS logMAR图表在以下3次就诊和视差条件下使用高对比度ETDRS logMAR图表测量每个受试者的最佳眼镜矫正视力(BSCVA):术前(Pre),术后1个月(Post1)和术后3个月(Post3) 。仅比较了Post-Post1(n = 46),Pre-Post3(n = 18)和Post1-Post3(n = 16)比较中的右眼logMAR分数的差异。
    结果:术后1个月随访时受试者的logMAR评分较术前差,术后3个月随访时视力改善。在中视条件下,视觉性能的这些变化变得更加明显。 Post-Post3(0.097 /-0.020)的logMAR得分差异的均值和标准误比Post-Post1(-0.067 /-0.019)和Post1-Post3(0.031 /-0.012)比较的均值和标准误差稍大。在中视条件下,受试者的视觉表现在3个比较中具有统计学意义,但在明视条件下则不然。
    结论:在中视条件下进行的高对比度logMAR图表有可能替代在明视条件下测量的视敏度,以提供更可靠的LASIK眼术后视觉结果的表示。眼科医生应考虑定期进行这种视力测试,以评估LASIK手术的成功率。
  • 【在麻风病人中检测抗麻风分枝杆菌培养滤液蛋白10的抗体。】 复制标题 收藏 收藏
    DOI:10.1099/jmm.0.46587-0 复制DOI
    作者列表:Parkash O,Kumar A,Nigam A,Girdhar BK
    BACKGROUND & AIMS: :The prevalence of IgG antibodies against Mycobacterium leprae recombinant culture filtrate protein-10 (rCFP-10) was investigated in serum samples from 56 leprosy patients, 15 tuberculosis (TB) patients, 14 other skin-diseased patients and 20 healthy subjects. On classifying the patients into bacterial index (BI)-positive and BI-negative groups, the assay showed 83.3 % (15/18) sensitivity for detection of BI-positive leprosy patients. On the other hand, the sensitivity for detection of BI-negative patients was 18.4 % (7/38). None of the 15 TB patients and 14 other skin-diseased patients was positive; however, only one out of 20 healthy individuals was positive, indicating that antibody response to culture filtrate protein-10 (CFP-10) was highly specific (98.0 %; 48/49). Statistically, the performance of the CFP-10-based assay was found to be comparable (P>0.05) with that of an anti-phenolic glycolipid-I (PGL-I) antibody-detecting assay. Thus, M. leprae CFP-10 is potentially a specific antigen for measuring antibody response in BI-positive leprosy patients. Being a secreted antigen, CFP-10 may act as a marker for the viability of M. leprae inside the host, and hence its serological potential is worth exploring for application in monitoring the response of patients with BI-positive leprosy (a highly infectious form) during the course of chemotherapy. When comparing the bacteriological and serological results, an agreement of 82.1 % showed that seropositivity to M. leprae CFP-10 corresponded well with bacteriological criteria. Hence, CFP-10 seems to be a suitable antigen for classification of leprosy patients into BI-positive and BI-negative groups.
    背景与目标: :从56名麻风患者,15名结核病患者,14名其他皮肤病患者和20名健康受试者的血清样本中研究了抗麻风分枝杆菌重组培养物滤液蛋白-10(rCFP-10)IgG抗体的患病率。在将患者分为细菌指数(BI)阳性和BI阴性组后,该测定显示出83.3%(15/18)的灵敏度可检测BI阳性麻风病患者。另一方面,检测BI阴性患者的敏感性为18.4%(7/38)。 15例TB患者和14例其他皮肤病患者均无阳性。然而,在20个健康个体中只有1个是阳性,表明对培养滤液蛋白10(CFP-10)的抗体反应具有高度特异性(98.0%; 48/49)。从统计学上讲,发现基于CFP-10-的检测方法的性能可与抗酚糖脂I(PGL-1)抗体检测方法相媲美(P> 0.05)。因此,麻风分枝杆菌CFP-10潜在地是用于测量BI阳性麻风病患者的抗体应答的特异性抗原。 CFP-10是一种分泌性抗原,可作为宿主体内麻风分枝杆菌生存能力的标志物,因此其血清学潜力值得探索,可用于监测BI阳性麻风病患者(一种高度感染性形式)的反应)在化疗过程中。当比较细菌学和血清学结果时,82.1%的一致性表明,对麻风分枝杆菌CFP-10的血清阳性与细菌学标准非常吻合。因此,CFP-10似乎是将麻风病人分为BI阳性和BI阴性组的合适抗原。
  • 【在胃十二指肠溃疡住院的患者中,通过组织学检查发现食道癌的风险。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:2007-04-01
    来源期刊:Gut
    DOI:10.1136/gut.2006.109082 复制DOI
    作者列表:Bahmanyar S,Zendehdel K,Nyrén O,Ye W
    BACKGROUND & AIMS: OBJECTIVE:The mechanism behind the epidemiologically evident inverse relation between Helicobacter pylori seropositivity and risk of oesophageal adenocarcinoma (OAC) remains obscure. Severe corpus gastritis is unlikely to be in the causal pathway. With the hypothesis of a uniformly low risk, the associations of OAC with duodenal ulcer and gastric ulcer were explored, both linked to H pylori infection but with different patterns of bacterial colonisation and intragastric acidity. Possible associations of oesophageal squamous cell carcinoma (OSCC) with these ulcer types were also addressed. DESIGN AND PATIENTS:Retrospective cohorts of 61,548 and 81,379 unoperated patients with duodenal ulcer and gastric ulcer, respectively, recorded in the Swedish Inpatient Register since 1965, were followed from the first hospitalisation until the date of any cancer, death, emigration, definitive surgery, or 31 December 2003. Standardised incidence ratios (SIRs), with 95% CIs, expressed relative risk of oesophageal cancer, compared with the Swedish population matched for age, sex and calendar period. RESULTS:Contrary to expectation, patients with duodenal ulcer had a significant 70% excess risk of OAC (SIR 1.7, 95% CI 1.1 to 2.5). Gastric ulcer was unrelated to OAC (SIR 1.1, 95% CI 0.6 to 1.7). Although duodenal ulcer was non-significantly associated with a small excess of OSCC (SIR 1.3, 95% CI 0.96 to 1.8), gastric ulcer was linked to 80% increased risk (SIR 1.8, 95% CI 1.4 to 2.3). CONCLUSION:The inverse association between H pylori and OAC does not pertain to all infections. The pattern of gastric colonisation and/or impact on acidity may be important. With the reservation for the possibility of confounding, this study also provides some support for the importance of intragastric environment in the aetiology of OSCC.
    背景与目标: 目的:幽门螺杆菌血清阳性与食管腺癌(OAC)风险之间的流行病学证据呈负相关。严重的胃炎胃炎不太可能在因果关系中。假设风险均一,探讨了OAC与十二指肠溃疡和胃溃疡的相关性,二者均与幽门螺杆菌感染有关,但细菌定植和胃内酸度不同。食管鳞状细胞癌(OSCC)与这些溃疡类型的可能关联也得到了解决。
    设计与患者:自1965年以来在瑞典住院患者登记表中记录的分别有61,548和81,379例未手术的十二指肠溃疡和胃溃疡患者的回顾性队列,从首次住院治疗直至癌症,死亡,移民,定型手术,或2003年12月31日。与年龄,性别和日历时期相匹配的瑞典人群相比,具有95%CI的标准发生率(SIR)表示食道癌的相对风险。
    结果:与预期相反,十二指肠溃疡患者发生OAC的风险显着增加70%(SIR 1.7,95%CI 1.1至2.5)。胃溃疡与OAC无关(SIR 1.1,95%CI 0.6至1.7)。尽管十二指肠溃疡与少量过量的OSCC无显着相关性(SIR 1.3,95%CI 0.96至1.8),但胃溃疡与80%的风险增加相关(SIR 1.8,95%CI 1.4至2.3)。
    结论:幽门螺杆菌与OAC之间的负相关并不适用于所有感染。胃定植的模式和/或对酸度的影响可能很重要。由于保留了混淆的可能性,本研究还为胃内环境在OSCC病因中的重要性提供了一些支持。

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