• 【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。
  • 【患有肺囊性纤维化的患者,在呼气压力为正值且振荡的呼气压力为正值的情况下,进行胸部物理治疗时,血气压力立即变化。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Lagerkvist AL,Sten GM,Redfors SB,Lindblad AG,Hjalmarson O
    BACKGROUND & AIMS: OBJECTIVE:To assess and compare immediate effects of chest physiotherapy with positive expiratory pressure (PEP) versus oscillating PEP on transcutaneously measured blood-gas tensions in patients with cystic fibrosis. METHODS:Fifteen patients (mean age 12.5 y, range 6.9-21.5 y) participated. The treatments were randomized and performed on 2 separate occasions, 8 weeks apart. Spirometry was conducted before and after each treatment. We transcutaneously measured oxygen tension (P(tO2). RESULTS:There were no changes in spirometry values. During PEP, different trends in blood-gas tension were seen, and there were no consistent changes. During oscillating PEP, P(tO2) increased and P(tCO2) decreased. During oscillating PEP, P(tCO2) was lower and the intra-individual change in P(tCO2) was more pronounced than during PEP. The results obtained immediately after oscillating PEP showed a higher P(tO2) and a lower P(tCO2) than with PEP. CONCLUSION:PEP and oscillating PEP can both cause transitory effects on blood gases in patients with cystic fibrosis. However, oscillating PEP alters blood-gas tensions more than does PEP, and hyperventilation during oscillating PEP may reduce treatment time.
    背景与目标: 目的:评估和比较采用呼气正压(PEP)和振荡PEP进行胸部物理治疗对囊性纤维化患者经皮测量的血气张力的即时效果。
    方法:15例患者(平均年龄12.5岁,范围6.9-21.5岁)参加了研究。治疗是随机的,分别在两个不同的场合进行,相隔8周。在每次治疗之前和之后进行肺活量测定。我们经皮测量了氧气张力(P(tO2)。
    结果:肺活量测定值没有变化。在PEP期间,观察到了血气紧张的不同趋势,并且没有一致的变化。在振荡PEP期间,P(tO2)增加而P(tCO2)减少。在振荡PEP期间,P(tCO2)较低,并且P(tCO2)的内部个体变化比PEP期间更为明显。振荡PEP后立即获得的结果显示,与PEP相比,P(tO2)更高,P(tCO2)更低。
    结论:PEP和振荡PEP均可对囊性纤维化患者的血气产生短暂影响。但是,与PEP相比,振荡PEP对血气压力的改变更大,并且在振荡PEP期间过度换气可能会减少治疗时间。
  • 【在其他健康的分枝杆菌病患者中发现了新的STAT1等位基因。】 复制标题 收藏 收藏
    DOI:10.1371/journal.pgen.0020131 复制DOI
    作者列表:
    BACKGROUND & AIMS: :The transcription factor signal transducer and activator of transcription-1 (STAT1) plays a key role in immunity against mycobacterial and viral infections. Here, we characterize three human STAT1 germline alleles from otherwise healthy patients with mycobacterial disease. The previously reported L706S, like the novel Q463H and E320Q alleles, are intrinsically deleterious for both interferon gamma (IFNG)-induced gamma-activating factor-mediated immunity and interferon alpha (IFNA)-induced interferon-stimulated genes factor 3-mediated immunity, as shown in STAT1-deficient cells transfected with the corresponding alleles. Their phenotypic effects are however mediated by different molecular mechanisms, L706S affecting STAT1 phosphorylation and Q463H and E320Q affecting STAT1 DNA-binding activity. Heterozygous patients display specifically impaired IFNG-induced gamma-activating factor-mediated immunity, resulting in susceptibility to mycobacteria. Indeed, IFNA-induced interferon-stimulated genes factor 3-mediated immunity is not affected, and these patients are not particularly susceptible to viral disease, unlike patients homozygous for other, equally deleterious STAT1 mutations recessive for both phenotypes. The three STAT1 alleles are therefore dominant for IFNG-mediated antimycobacterial immunity but recessive for IFNA-mediated antiviral immunity at the cellular and clinical levels. These STAT1 alleles define two forms of dominant STAT1 deficiency, depending on whether the mutations impair STAT1 phosphorylation or DNA binding.
    背景与目标: 转录因子信号转导子和转录激活因子1(STAT1)在抵抗分枝杆菌和病毒感染的免疫中起着关键作用。在这里,我们表征了来自其他健康的分枝杆菌病患者的三个人STAT1种系等位基因。像新的Q463H和E320Q等位基因一样,先前报道的L706S对干扰素γ(IFNG)诱导的γ激活因子介导的免疫和干扰素α(IFNA)诱导的干扰素刺激的基因因子3介导的免疫都具有内在的危害,如用相应等位基因转染的STAT1缺陷细胞所示。然而,它们的表型作用是由不同的分子机制介导的,L706S影响STAT1磷酸化,Q463H和E320Q影响STAT1 DNA结合活性。杂合子患者表现出特别受损的IFNG诱导的γ活化因子介导的免疫力,导致对分枝杆菌的易感性。确实,IFNA诱导的干扰素刺激基因因子3介导的免疫性没有受到影响,并且这些患者对病毒性疾病特别不敏感,这与两种表型均隐性的其他同样有害的STAT1突变的患者不同。因此,在细胞和临床水平上,这三个STAT1等位基因在IFNG介导的抗分枝杆菌免疫中占主导地位,而在IFNA介导的抗病毒免疫中却处于隐性地位。这些STAT1等位基因定义了两种主要形式的STAT1缺陷,具体取决于突变是否损害STAT1磷酸化或DNA结合。
  • 【类风湿关节炎患者中性粒细胞的肌动蛋白聚合与非甾体类抗炎药的治疗有关。】 复制标题 收藏 收藏
    DOI:10.1016/s0009-8981(96)06505-9 复制DOI
    作者列表:De Clerck LS,Mertens AV,De Gendt CM,Bridts CH,Stevens WJ
    BACKGROUND & AIMS: There is evidence that neutrophil functions such as chemotaxis and oxygen radical formation are disturbed in rheumatoid arthritis (RA). Medication might also influence these functions. Cyclic formation and depolymerisation of actin microfilaments is crucial in cell motility, but this phenomenon has not been studied in RA. The aim of this study was to investigate basal and dynamic (formyl-methionyl-leucyl-phenylalanine (fMLP)-induced) neutrophil actin polymerisation in ten RA patients (a) during therapy with non-steroidal anti-inflammatory drugs (NSAIDS) and (b) after stopping NSAIDS> The results were compared with those of ten age-matched controls. Basal F-actin content in RA patients with NSAIDS was significantly lower than in RA patients without NSAIDS and controls35.5 (25.0-49.0), 50.5 (27.0-75.0) and 52.5 (32.0-85.0), respectively. Conversely, upon stimulation with fMLP, the actin polymerisation curve of RA patients with NSAIDS was higher than for RA patients without NSAIDS and controls. These results suggest that, in RA, the effects orf NSAIDS on neutrophil functions might be related to changes in the actin polymerisation-depolymerisation cycle.

    背景与目标: 有证据表明,类风湿关节炎(RA)中性粒细胞功能(如趋化性和氧自由基的形成)受到干扰。药物治疗也可能影响这些功能。肌动蛋白微丝的循环形成和解聚对于细胞运动至关重要,但尚未在RA中研究此现象。这项研究的目的是研究10名RA患者的基础和动态(甲酰基-甲硫基-亮氨酰-苯丙氨酸(fMLP)诱导)嗜中性白细胞肌动蛋白聚合反应(a)在使用非甾体抗炎药(NSAIDS)治疗期间和( b)停止NSAIDS后>将结果与十个年龄匹配的对照组的结果进行比较。 NSAIDS的RA患者的基础F-肌动蛋白含量显着低于非NSAIDS的RA患者和对照组,分别为35.5(25.0-49.0),50.5(27.0-75.0)和52.5(32.0-85.0)。相反,在用fMLP刺激后,患有NSAIDS的RA患者的肌动蛋白聚合曲线高于没有NSAIDS和对照的RA患者。这些结果表明,在RA中,NSAIDS对中性粒细胞功能的影响可能与肌动蛋白聚合-解聚循环的变化有关。

  • 【冠状动脉患者预后评估:通用严重性指标的表现和定制。】 复制标题 收藏 收藏
    DOI:10.1378/chest.111.6.1666 复制DOI
    作者列表:Sarmiento X,Rué M,Guardiola JJ,Toboso JM,Soler M,Artigas A
    BACKGROUND & AIMS: STUDY OBJECTIVE:To assess the prognostic performance of general severity systems (APACHE II [acute physiology and chronic health evaluation], simplified acute physiology score [SAPS II], and mortality probability models [MPM II]) in coronary patients and to derive new customized indexes for coronary patients using a reduced number of variables.

    DESIGN:Inception cohort.

    SETTING:Adult medical and surgical ICUs in 17 hospitals in Catalonia and the Balearic Islands.

    PATIENTS:Four hundred fifty-six patients with acute myocardial infarction.

    MEASUREMENTS AND RESULTS:The APACHE II, SAPS II, and MPM II variables and survival status at hospital discharge have been collected. Performance of the severity systems was assessed by evaluating calibration and discrimination. Logistic regression was used to customize the MPM II(24) and SAPS II indexes. Discrimination was high enough for all of the models. However, calibration of the MPM II(24) was not as satisfactory as for the other models. The MPM II(24) and SAPS II were both reduced to five variables (MPM II(24 cor:) age, PaO2, continuous vasoactive drugs, urinary output, and mechanical ventilation; SAPS II(cor:) age, PaO2/FI(O2) ratio, systolic BP, Glasgow coma score, and urinary output). Both models showed better calibration and discrimination than the original ones.

    CONCLUSIONS:Prognostic indexes developed for multidisciplinary patients show good performance when applied to patients with acute myocardial infarction, but customization can reduce the number of variables necessary to compute them without a loss of, and a possible improvement in, prognostic accuracy.

    背景与目标: 研究目标:评估以下方面的一般严重程度系统的预后性能(APACHE II [急性生理学和慢性健康评估],简化的急性生理学评分[SAPS II]和死亡率概率模型[MPM II])。

    DESIGN :初始队列。

    设置 :加泰罗尼亚和巴利阿里群岛的17家医院中的成人医疗和外科加护病房。

    患者:456例急性心肌梗死患者。

    测量与结果:已收集了APACHE II,SAPS II和MPM II变量以及出院时的生存状况。严重性系统的性能通过评估校准和判别来评估。 Logistic回归用于自定义MPM II(24)和SAPS II索引。对所有模型的歧视程度都很高。但是,MPM II(24)的校准不如其他型号令人满意。 MPM II(24)和SAPS II都减少到五个变量(MPM II(24 cor :)年龄,PaO2,连续血管活性药物,尿量和机械通气; SAPS II(cor :)年龄,PaO2 / FI( O2)比,收缩压,格拉斯哥昏迷评分和尿量)。两种模型均显示出比原始模型更好的校准和辨别力。

    结论:针对多学科患者开发的预后指标在应用于急性心肌梗死患者时显示出良好的性能,但定制可以减少计算变量所需的变量数量,而不会损失预后准确性,并且可能会改善预后准确性。

  • 【躯体化患者医疗服务的独特模式。】 复制标题 收藏 收藏
    DOI:10.1097/01.mlr.0000228028.07069.59 复制DOI
    作者列表:Barsky AJ,Orav EJ,Bates DW
    BACKGROUND & AIMS: BACKGROUND:Somatizing patients have maladaptive and increased rates of medical care utilization. If there were a way of routinely identifying such patients, one that did not require intensive, case-by-case review, they could be targeted for specific interventions to improve their use of medical care. OBJECTIVE:We sought to identify patterns of medical care utilization that would distinguish somatizing and nonsomatizing medical outpatients with acceptable sensitivity and specificity. DESIGN:Subjects completed questionnaires assessing somatization and sociodemographic characteristics. Their medical care utilization was obtained for the 12 months preceding the index visit. We then used multivariable logistic regression and recursive partitioning to identify patients with a provisional diagnosis of somatoform disorder. These exploratory models used various patterns of medical care utilization and sociodemographic characteristics as the independent variables. SUBJECTS:We studied consecutive adults attending 2 primary care practices on randomly chosen days. MEASURES:The provisional diagnosis of a somatoform disorder was assessed with a 15-item self-report questionnaire. The number of primary care visits, specialty visits, mental health visits, emergency visits, and inpatient and outpatient costs were obtained for the 12 months preceding the index visit from our hospital's automated medical records, which also provided a rating of aggregate medical morbidity. Self-reported utilization outside our hospital system was obtained from a subsample of patients. RESULTS:Complete data were obtained on 1440 patients. Somatizing patients had more specialty care than primary care visits, higher outpatient than inpatient costs, and more emergency visits than nonsomatizing patients. A regression model containing 7 measures of utilization and 4 sociodemographic characteristics distinguished somatizing and nonsomatizing patients with a c-statistic = 0.73. Recursive partitioning identified 10 terminal nodes with a very high specificity (99%) but a very low sensitivity (15%). CONCLUSIONS:We identified 7 discrete patterns of medical care utilization that distinguished somatizing and nonsomatizing patients. However, they did so with only modest specificity and sensitivity. This algorithm might be used effectively as the first step in a 2-step screening procedure whose second step would entail more intensive screening or individual, case-by-case review to identify somatizing patients in primary care practice.
    背景与目标: 背景:躯体化患者适应不良,医疗利用率更高。如果有一种常规识别此类患者的方法,而无需进行深入的个案审查,则可以针对他们采取特定的干预措施,以改善他们对医疗的使用。
    目的:我们试图确定可以利用可接受的敏感性和特异性来区分躯体化和非躯体化门诊患者的医疗利用模式。
    设计:受试者完成问卷调查,评估躯体化和社会人口统计学特征。在索引访问之前的12个月中获得了他们的医疗保健利用率。然后,我们使用多变量logistic回归和递归分区来确定患有躯体形式疾病的临时诊断的患者。这些探索性模型使用了各种医疗保健利用模式和社会人口统计学特征作为自变量。
    受试者:我们研究了在随机选择的日子里连续参加2种初级保健实践的成年人。
    措施:用15个项目的自我报告调查表对躯体形式障碍的临时诊断进行了评估。在索引访问之前的12个月中,从我们医院的自动医疗记录中获得了初级保健就诊,专科就诊,心理健康就诊,急诊就诊以及住院和门诊费用的数量,还提供了总的发病率。我们从患者子样本中获得了我们医院系统外部的自我报告利用率。
    结果:获得了1440例患者的完整数据。躯体化患者比初级保健就诊者拥有更多的专科护理,门诊患者比住院费用更高,并且急诊就诊者比非躯体化患者更多。包含7个使用率度量标准和4个社会人口统计学特征的回归模型以c统计量= 0.73区分了躯体化和非躯体化的患者。递归分区确定了10个终端节点,它们的特异性很高(99%),但敏感性很低(15%)。
    结论:我们确定了7种离散的医疗服务利用模式,分别区分了躯体化和非躯体化的患者。但是,他们这样做只是出于适度的特异性和敏感性。该算法可以有效地用作两步筛查程序中的第一步,该步骤的第二步将需要进行更深入的筛查,或者进行逐项个案审查,以识别初级保健实践中的躯体化患者。
  • 【一项一般实践研究,比较喷雾剂(“ Otomize”)与标准滴剂(“ Sofradex”)在治疗外耳道炎中的功效和耐受性。】 复制标题 收藏 收藏
    DOI:10.1185/03007999009111486 复制DOI
    作者列表:Smith RB,Moodie J
    BACKGROUND & AIMS: :In an open, multi-centre study in general practice, a comparison was made of the efficacy, tolerability and acceptability of a neomycin/dexamethasone preparation administered by metered-dose spray ('Otomize') and a framycetin/gramicidin/dexamethasone preparation ('Sofradex') administered as drops in 60 patients with otitis externa. Patients were allocated at random to receive one or other preparations 3-times daily for 10 days and were followed-up again 14 days after cessation of therapy. Clinical assessments were carried out under observer blind conditions on entry (Day 0) and on Days 10 and 24 of the severity of erythema, swelling and debris in the affected ear(s). A global assessment of clinical outcome was made by the doctor on Day 10. There were no significant differences in the two groups at the start of treatment. Significant improvement occurred in both groups from Day 0 to Day 10 and from Day 10 to Day 24 in all symptoms, with the proportion symptom-free in the 'Otomize' group significantly greater than in the 'Sofradex' group at 24 days, and approaching significance at 10 days. Significantly more patients in the 'Otomize' group were rated as having a good clinical outcome by the physician, and fewer patients experienced discomfort on application. Few side-effects were reported by either treatment group, none necessitating discontinuation of therapy.
    背景与目标: :在一项开放,多中心的常规研究中,比较了通过定量喷雾(“ Otomize”)和新霉素/短杆菌肽/短杆菌肽/地塞米松制剂给药的新霉素/地塞米松制剂的疗效,耐受性和可接受性( “ Sofradex”)在60例外耳炎患者中以滴剂形式给药。随机分配患者每天3次接受一种或其他制剂,共10天,并在停止治疗后14天再次随访。在进入者(第0天)以及第10和第24天观察者失明的情况下,对患病耳朵的红斑,肿胀和碎屑的严重程度进行了临床评估。在第10天,医生对临床结果进行了全面评估。治疗开始时,两组之间没有显着差异。从第0天到第10天,从第10天到第24天,两组的所有症状均有显着改善,在第24天,“ Otomize”组中无症状的比例显着大于“ Sofradex”组,并且接近在10天的意义。医师认为“ Otomize”组中的更多患者具有良好的临床效果,并且更少的患者在使用时感到不适。任一治疗组均报告很少有副作用,没有副作用需要终止治疗。
  • 【口腔护理对老年患者手术恢复的影响的初步研究。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2842.2006.01634.x 复制DOI
    作者列表:Sato M,Yoshihara A,Miyazaki H
    BACKGROUND & AIMS: :This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.
    背景与目标: :这项研究旨在阐明消化道手术后口腔护理的有效性,包括刷牙,义齿清洁和舌头清洁。受试者包括接受消化道手术的30位年龄在60-98岁(74.9 /-7.8岁)的老年患者。将受试者随机分为干预组和对照组。在干预组中,每天从基线(手术日)开始,在每天的5分钟内,每天进行以下口腔护理,并持续5天:用聚维酮碘漱口,刷牙,使用专用刷子清洁义齿和使用舌刷清洁舌头。在对照组中,受试者仅含聚维酮碘。我们在基线和5天后比较了两组之间的以下变量:口干的感觉,口内气体浓度,肺音,体温和细菌菌群。在干预组中,肺音异常(干音或湿音)的患者数量从1增加到2,在对照组中从0增加到4(P <0.05)。对照组术前平均细菌种类为3.64 /-1.34,术后为3.50 /-1.74,而干预组术前为3.08 /-0.95,术后为2.62 /-0.65。操作上。在干预组中,细菌种类的数量显着减少(P <0.05)。这些发现表明,接受消化道手术的老年患者的术后口腔护理降低了在口腔中发现的细菌种类的数量。反过来,这种效果可能会改善呼吸功能。

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