BACKGROUND & AIMS: :Auto-anti-idiotypic mechanisms can regulate the protective immune response against Schistosoma mansoni. Anti-idiotypic responses were stimulated by immunization of mice either with nonspecifically induced lymphoblasts, produced with Con A, or with Ag-induced lymphoblasts bearing specific idiotypic receptors. The effect of the induced anti-idiotypic response upon clonotypic cellular reactivity was assessed in vitro through the suppression of antigen-mediated blast transformation by cloned T cells and in vivo by suppression of resistance to S. mansoni and delayed-type hypersensitivity responses against specific Ag. Differential regulation of humoral immune responses was studied at the levels of specific epitopic recognition, the expression of specific Id, and the production of anti-idiotypic responses directed against mAb bearing specific Id. Anti-idiotypic sensitization resulted in variable (10 to 90%) suppression of the immune response to discrete antigenic epitopes, the expression of specific idiotypic phenotypes, and anti-idiotypic, antiparatopic responses against T cell clonotypes and antibody idiotypic phenotypes. In vitro admixture and in vivo challenge studies resulted in consonant differential suppression. Thus idiotypic regulation can mold the fine specificities of the protective immune response to S. mansoni at the clonal level and may provide an approach to optimize the expression and assessment of resistance.

背景与目标： 自动抗独特型机制可以调节针对曼氏血吸虫的保护性免疫反应。通过用Con A产生的非特异性诱导的淋巴母细胞，或用Ag诱导的携带特定独特型受体的淋巴母细胞免疫小鼠，可以刺激抗独特型应答。在体外通过抑制克隆的T细胞对抗原介导的胚泡转化的抑制来评估诱导的抗独特型反应对克隆型细胞反应性的影响，并在体内通过抑制对曼氏沙门氏菌的抗性和针对特定Ag的迟发型超敏反应来评估体内诱导的抗独特型反应的作用。 。研究了在特定表位识别，特定Id的表达水平以及针对带有特定Id的mAb的抗独特型反应水平上对体液免疫反应的差异调节。抗独特型致敏作用导致对离散抗原表位的免疫反应，特异性独特型表型的表达以及针对T细胞克隆型和抗体独特型表型的抗独特型，抗副反应的变化受到抑制（10％至90％）。体外混合和体内攻击研究导致辅音差异抑制。因此，独特型调节可以在克隆水平上塑造对曼氏链球菌的保护性免疫应答的优良特异性，并且可以提供优化抗性表达和评估的方法。

BACKGROUND & AIMS: :Aboriginal Australians, including Aboriginal Health Workers (AHWs), smoke at rates double the non-Aboriginal population. This study utilized concept mapping methodology to identify and prioritize culturally relevant strategies to promote smoking cessation in AHWs. Stakeholder participants included AHWs, other health service employees and tobacco control personnel. Smoking cessation strategies (n = 74) were brainstormed using 34 interviews, 3 focus groups and a stakeholder workshop. Stakeholders sorted strategies into meaningful groups and rated them on perceived importance and feasibility. A concept map was developed using multi-dimensional scaling and hierarchical cluster analyses. Ten unique clusters of smoking cessation strategies were depicted that targeted individuals, family and peers, community, workplace and public policy. Smoking cessation resources and services were represented in addition to broader strategies addressing social and environmental stressors that perpetuate smoking and make quitting difficult. The perceived importance and feasibility of clusters were rated differently by participants working in health services that were government-coordinated compared with community-controlled. For health service workers within vulnerable populations, these findings clearly implicate a need for contextualized strategies that mitigate social and environmental stressors in addition to conventional strategies for tobacco control. The concept map is being applied in knowledge translation to guide development of smoking cessation programs for AHWs.

背景与目标： ：包括澳大利亚原住民卫生工作者（AHWs）在内的澳大利亚原住民吸烟率是非原住民人口的两倍。这项研究利用概念图方法论来确定和优先考虑与文化相关的策略，以促进AHW中的戒烟。利益相关者的参与者包括AHW，其他卫生服务员工和烟草控制人员。通过34次访谈，3个焦点小组和一个利益相关者研讨会，集体讨论了戒烟策略（n = 74）。利益相关者将策略分为有意义的组，并根据感知到的重要性和可行性对它们进行评级。使用多维缩放和层次聚类分析开发了概念图。描绘了十个独特的戒烟策略组，这些策略针对个人，家庭和同龄人，社区，工作场所和公共政策。除更广泛的策略解决了使吸烟永久化和使戒烟困难的社会和环境压力外，还代表了戒烟资源和服务。在政府协调的卫生服务机构与社区控制的卫生服务机构中，参与者对集群的重要性和可行性的看法有所不同。对于脆弱人群中的卫生服务工作者，这些发现显然暗示着除了传统的烟草控制策略外，还需要有针对性的策略来减轻社会和环境压力。概念图已应用于知识翻译中，以指导针对AHW的戒烟计划的开发。

BACKGROUND & AIMS: :The goal of the study was to elucidate the relationship between serum circulating brain-derived neurotrophic factor (BDNF) and body weight reduction via lifestyle modification and behavior therapy in obese non-diabetic patients with chronic schizophrenia. Thirty-three obese non-diabetic subjects with schizophrenia treated with stable antipsychotic medication in a day-care unit for at least 3 months were recruited. Thirty age-, body weight-matched subjects without psychiatric disorders were enrolled as controls. All participants underwent a 10-week weight reduction program, including lifestyle modification, psychosocial treatment, behavior therapy and exercise in the day-care unit. Blood biochemistry, serum BDNF, adipokine (adiponectin), inflammatory markers (C-reactive protein, tumor necrosis factor-alpha and interleukin-6) and oral glucose tolerance test were evaluated before and after the program. Serum BDNF concentrations were significantly lower among patients with schizophrenia compared to control subjects. Serum BDNF levels were significantly increased following the weight reduction program. Elevations in serum BDNF levels were positively correlated with body weight and body mass index reduction. Altogether, our results demonstrate that a non-pharmacological weight reduction program effectively reduces body weight with significant elevation of serum BDNF levels in obese non-diabetic patients with schizophrenia.

背景与目标： ：该研究的目的是阐明肥胖非糖尿病慢性精神分裂症患者的血清循环脑源性神经营养因子（BDNF）与通过生活方式改变和行为疗法减轻体重之间的关系。招募了33例在日托室中接受稳定抗精神病药物治疗，至少3个月的精神分裂症肥胖非糖尿病患者。纳入30名年龄，体重匹配且无精神疾病的受试者作为对照。所有参与者都接受了为期10周的减肥计划，包括在日间护理室进行的生活方式改变，心理社会治疗，行为疗法和锻炼。在该计划之前和之后，评估了血液生化，血清BDNF，脂肪因子（脂联素），炎性标志物（C反应蛋白，肿瘤坏死因子-α和白介素6）以及口服葡萄糖耐量测试。与对照组相比，精神分裂症患者的血清BDNF浓度显着降低。减重计划后，血清BDNF水平显着增加。血清BDNF水平升高与体重和体重指数降低呈正相关。总而言之，我们的结果表明，在肥胖的非糖尿病精神分裂症患者中，非药物减肥计划可以有效减轻体重，同时血清BDNF水平显着升高。

BACKGROUND & AIMS: OBJECTIVE:To evaluate the effect of low-level laser therapy on occlusal contact area, occlusal pressure and bite force in temporomandibular disorder patients. PATIENTS AND METHOD:Twenty patients (14 women, six men, mean age 33.1 ± 3.8 years) diagnosed with myofascial pain according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) participated in the study. Twenty healthy individuals, matched in age and gender, served as a control group. Low-level laser was applied to the mastication muscles three times per week, for a total of 10 sessions. The mandibular mobility range was evaluated. The maximum bite force, occlusal contact area and occlusal pressure were measured bilaterally with a dental pre-scale before and after treatment. All variables were analyzed descriptively. Changes in the masticatory muscle tenderness, mandibular movements, maximum bite force, occlusal contact area and occlusal pressure were compared by paired-sample Student's t-tests. RESULTS:There was a significant increase in the pressure pain threshold of the examined muscles. Mandibular movements were significantly improved in all patients. There was also a significant decrease in pain by palpation after laser exposure. However, no significant change was found in the maximum bite force, occlusal contact area or occlusal pressure after the treatment and also the values after the treatment were still significantly lower than those of the healthy individuals. CONCLUSION:This particular type of LLLT is effective at relieving pain but does not provide physical improvement.

背景与目标： 目的：探讨低水平激光治疗对颞下颌关节疾病患者的咬合接触面积，咬合压力和咬合力的影响。
患者与方法：根据《颞下颌疾病研究诊断标准》（RDC / TMD）诊断为肌筋膜疼痛的20例患者（14例女性，6例男性，平均年龄33.1±3.8岁）参加了该研究。年龄和性别相匹配的二十名健康个体作为对照组。每周三次向咀嚼肌施加低强度激光，共10次。下颌活动范围进行了评估。在治疗前和治疗后，用牙科预量尺双向测量最大咬合力，咬合接触面积和咬合压力。描述性地分析所有变量。通过成对样本的学生t检验比较了咀嚼肌压痛，下颌运动，最大咬合力，咬合接触面积和咬合压力的变化。
结果：被检查肌肉的压力疼痛阈值显着增加。所有患者的下颌运动均得到明显改善。激光照射后触诊引起的疼痛也明显减轻。然而，治疗后的最大咬合力，咬合接触面积或咬合压力没有显着变化，并且治疗后的值仍显着低于健康个体。
结论：这种特殊类型的LLLT可有效缓解疼痛，但不能改善身体状况。

BACKGROUND & AIMS: INTRODUCTION:Suicide is known as a major health concern worldwide. There is evidence for the role of brain-derived neurotrophic factor (BDNF) in suicide behavior. Therefore, this factor has been proposed as a biomarker for suicide behavior. Clinical studies have measured BDNF concentrations at central and peripheral levels. As a consequence, the aim of this study was to assess BDNF levels in blood plasma and serum to see whether there is a difference in concentrations in patients with suicide behavior when compared to those in controls, using a meta-analysis approach. METHODS:We conducted a systematic review and meta-analysis. The search strategy was performed using three databases: PubMed, EBSCO and ScienceDirect. The meta-analysis included a total of nine case-control studies, six measured the BDNF level in serum and three in plasma in suicide behavior. RESULTS:A decrease in BDNF levels in plasma was observed (d = -0.73, 95% CI -1.42 to -0.03 pg/ml). In the case of serum concentrations, no BDNF differences were encountered between cases and controls (d = 0.09, 95% CI -0.31 to 0.13 ng/ml, p(Q) = .92). CONCLUSIONS:According to the results found in the present meta-analysis, the plasma BDNF level could be suggest as a potential biomarker in suicide behavior. However, since the number of studies included in the analysis is limited, a larger number is necessary to determine conclusively the role of BDNF as a biomarker in suicide behavior.

背景与目标： 简介：自杀是全球公认的主要健康问题。有证据表明脑源性神经营养因子（BDNF）在自杀行为中的作用。因此，已经提出该因素作为自杀行为的生物标记。临床研究已经测量了中枢和外周水平的BDNF浓度。因此，这项研究的目的是使用荟萃分析方法评估血浆和血清中BDNF的水平，以查看自杀行为患者与对照组相比是否存在浓度差异。
方法：我们进行了系统的回顾和荟萃分析。搜索策略是使用三个数据库执行的：PubMed，EBSCO和ScienceDirect。荟萃分析包括九项病例对照研究，六项测量血清BDNF水平，三项血浆自杀行为。
结果：血浆中BDNF水平下降（d = -0.73，95％CI -1.42至-0.03 pg / ml）。就血清浓度而言，病例与对照之间未见BDNF差异（d = 0.09，95％CI -0.31至0.13ng / ml，p（Q）= 0.92）。
结论：根据目前的荟萃分析结果，血浆BDNF水平可能被认为是自杀行为的潜在生物标志物。但是，由于分析中包含的研究数量有限，因此有必要大量研究来确定BDNF作为自杀行为中生物标志物的作用。

BACKGROUND & AIMS: :Sound streams were generated by randomly choosing the levels of tone pips from two different distributions, A and B. Of the 18 tone pips, the first nine were drawn from distribution A and the second nine from distribution B, or the opposite. The listeners' task was to indicate order, A-B or B-A. In two conditions the A and B distributions differed in mean (condition 1) or variance (condition 2). In contrast to an ideal observer, listeners' strategies were consistent across the two conditions. Analyses suggest that listeners relied primarily on the more intense tone pips in making their decisions.

背景与目标： ：通过从两个不同的分布A和B中随机选择音高的级别来生成声音流。在这18个音高中，前9个是从分布A提取的，后9个是从分布B提取的，或者相反。收听者的任务是指示顺序，A-B或B-A。在两个条件下，A和B分布的均值（条件1）或方差（条件2）不同。与理想的观察者相反，在这两种情况下，听众的策略是一致的。分析表明，听众在做出决定时主要依靠更强烈的语调点。

BACKGROUND & AIMS: :Androgenetic alopecia (AGA) or female pattern hair loss (FPHL) is the most common form of hair loss in men and women. Despite its common occurrence, our understanding of the etiology of AGA and FPHL remains incomplete. As such, traditional therapies demonstrate modest efficacies and new therapies continue to be sought. Low-level light therapy (LLLT) is a relatively new technique used to promote hair growth in both men and women with AGA and FPHL. Currently, there exist several LLLT devices marketed for the treatment of alopecia, which claim to stimulate hair growth; yet marketing these devices only requires that safety, not efficacy, be established. A handful of studies have since investigated the efficacy of LLLT for alopecia with mixed results. These studies suffered from power, confounding and analysis issues which resulted in a high risk of bias in LLLT studies. Due to the paucity of well-conducted randomized controlled trials, the efficacy of LLLT devices remains unclear. Randomized controlled trials of LLLT conducted and reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement would greatly increase the credibility of the evidence and clarify the ambiguity of the effectiveness of LLLT in the treatment of AGA and FPHL.

背景与目标： ：雄激素性脱发（AGA）或女性型脱发（FPHL）是男女最常见的脱发形式。尽管经常发生，但我们对AGA和FPHL病因的了解仍然不完整。因此，传统疗法显示出适度的功效，并且继续寻求新疗法。低水平光疗（LLLT）是一种相对较新的技术，用于在患有AGA和FPHL的男性和女性中促进头发生长。目前，有几种用于治疗脱发的LLLT设备已上市，它们声称可以刺激头发生长。然而，销售这些设备只需要确定安全性而不是功效。此后，一些研究调查了LLLT治疗脱发的疗效，但结果不一。这些研究存在能力，混淆和分析问题，导致LLLT研究存在偏见的高风险。由于缺乏进行良好的随机对照试验，LLLT装置的功效仍不清楚。根据《合并报告标准》（CONSORT）声明进行和报告的LLLT随机对照试验将大大提高证据的可信度，并阐明LLLT在AGA和FPHL的治疗中有效性的歧义。

BACKGROUND & AIMS: :In May 1988, the English National Board (ENB, Statutory Body for Nursing Education for England) issued draft proposals for development of continuous assessment of theory and practice in basic nursing courses. As an integral part of a new curriculum the staff at Wolverhampton School of Nursing have developed a strategy for continuous assessment of theory and practice which now has formal ENB approval. In order to qualify as a person who can apply to be registered on one or more parts of the register students must have demonstrated their ability to acquire the competencies which are specified in Rule 18(1) of the Nurses, Midwives and Health Visitors Rules Approval Order (UKCC 1983). The strategy demonstrates the development and achievement of competencies of Rule 18(1) as they increase in complexity. We do not claim that the strategy is the only framework which could be developed for implementing continuous assessment, nor do we claim that it is flawless. The strategy is intended as a framework which may contribute in assisting other nurse teachers who are in the present position of developing such schemes of assessment.

背景与目标： ：1988年5月，英国国家委员会（ENB，英格兰护理教育法定机构）发布了关于对基础护理课程的理论和实践进行持续评估的建议草案。作为新课程的组成部分，伍尔弗汉普顿护理学院的员工制定了一项持续评估理论和实践的策略，现已获得ENB的正式批准。为了有资格成为一个人，可以申请在一个或多个登记册上注册，学生必须证明自己具有获得《护士，助产士和健康访客规则批准》规则18（1）规定的能力的能力。订单（UKCC 1983）。该策略说明了规则18（1）的能力随着复杂性的增加而得到发展和实现。我们既不声称该战略是为实施持续评估而可以制定的唯一框架，也不主张它是完美无缺的。该战略旨在作为一个框架，可能有助于协助目前处于制定此类评估计划的其他护士教师。

BACKGROUND & AIMS: :Signalling through the ERBB/HER receptors is intricately involved in human cancer and already serves as a target for several cancer drugs. Because of its inherent complexity, it is useful to envision ERBB signalling as a bow-tie-configured, evolvable network, which shares modularity, redundancy and control circuits with robust biological and engineered systems. Because network fragility is an inevitable trade-off of robustness, systems-level understanding is expected to generate therapeutic opportunities to intercept aberrant network activation.

背景与目标： ：通过ERBB / HER受体进行信号传递与人类癌症错综复杂，并且已经成为多种抗癌药物的靶标。由于其固有的复杂性，将ERBB信令设想为领结式配置，可演进的网络非常有用，该网络与健壮的生物和工程系统共享模块化，冗余性和控制电路。由于网络脆弱性是鲁棒性的必然折衷，因此系统级的理解有望产生治疗机会，以拦截异常的网络激活。

BACKGROUND & AIMS: :We examined whether maternal educational level as an indicator of socioeconomic status is associated with gestational hypertension. We also examined the extent to which the effect of education is mediated by maternal substance use (that is smoking, alcohol consumption and illegal drug use), pre-existing diabetes, anthropometrics (that is height and body mass index (BMI)) and blood pressure at enrollment. This was studied in 3262 Dutch pregnant women participating in the Generation R Study, a population-based cohort study. Level of maternal education was established by questionnaire at enrollment, and categorized into high, mid-high, mid-low and low. Diagnosis of gestational hypertension was retrieved from medical records using standard criteria. Odds ratios (OR) of gestational hypertension for educational levels were calculated, adjusted for potential confounders and additionally adjusted for potential mediators. Adjusted for age and gravidity, women with mid-low (OR: 1.52; 95% CI: 1.02, 2.27) and low education (OR: 1.30; 95% CI: 0.80, 2.12) had a higher risk of gestational hypertension than women with high education. Additional adjustment for substance use, pre-existing diabetes, anthropometrics and blood pressure at enrollment attenuated these ORs to 1.09 (95% CI: 0.70, 1.69) and 0.89 (95% CI: 0.50, 1.58), respectively. These attenuations were largely due to the effects of BMI and blood pressure at enrollment. Women with relatively low educational levels have a higher risk of gestational hypertension, which is largely due to higher BMI and blood pressure levels from early pregnancy. The higher risk of gestational hypertension in these women is probably caused by pre-existing hypertensive tendencies that manifested themselves during pregnancy.

背景与目标： ：我们研究了孕产妇受教育程度作为社会经济地位的指标是否与妊娠高血压相关。我们还研究了母体物质使用（即吸烟，饮酒和非法药物使用），既往糖尿病，人体测量学（即身高和体重指数（BMI））和血液对教育效果的影响程度入学压力。这项研究是在3262名荷兰孕妇中进行的，该研究参加了基于人群的队列研究“ Generation R Study”。入学时通过问卷调查确定孕产妇教育水平，并将其分为高，中高，中低和低。使用标准标准从病历中检索出妊娠高血压的诊断。计算了教育程度的妊娠高血压的赔率（OR），针对潜在的混杂因素进行了调整，并针对潜在的调解人进行了调整。经过年龄和妊娠度调整后，中低（OR：1.52； 95％CI：1.02、2.27）和低学历（OR：1.30； 95％CI：0.80、2.12）的妇女比患有HLA的妇女发生妊娠高血压的风险更高高等教育。对药物使用，既往存在的糖尿病，人体测量学和入学时血压进行的其他调整分别将这些OR衰减至1.09（95％CI：0.70，1.69）和0.89（95％CI：0.50，1.58）。这些衰减主要归因于入学时的BMI和血压的影响。受教育程度相对较低的妇女发生妊娠高血压的风险较高，这在很大程度上是由于早孕期的BMI和血压水平较高。这些妇女的妊娠高血压风险较高，可能是由于怀孕期间已存在的高血压倾向所致。

BACKGROUND & AIMS: PURPOSE:The integrin alpha(v)beta3 plays a key role in angiogenesis and tumor cell metastasis and is therefore an important target for new therapeutic and diagnostic strategies. We have developed [18F]Galacto-RGD, a highly alpha(v)beta3-selective tracer for positron emission tomography (PET). Here, we show, in man, that the intensity of [18F]Galacto-RGD uptake correlates with alpha(v)beta3 expression. EXPERIMENTAL DESIGN:Nineteen patients with solid tumors (musculoskeletal system, n = 10; melanoma, n = 4; head and neck cancer, n = 2; glioblastoma, n = 2; and breast cancer, n = 1) were examined with PET using [18F]Galacto-RGD before surgical removal of the tumor lesions. Snap-frozen specimens (n = 26) were collected from representative areas with low and intense standardized uptake values (SUV) of [18F]Galacto-RGD. Immunohistochemistry was done using the alpha(v)beta3-specific antibody LM609. Intensity of staining (graded on a four-point scale) and the microvessel density of alpha(v)beta3-positive vessels were determined and correlated with SUV and tumor/blood ratios (T/B). RESULTS:Two tumors showed no tracer uptake (mean SUV, 0.5 +/- 0.1). All other tumors showed tracer accumulation with SUVs ranging from 1.2 to 10.0 (mean, 3.8 +/- 2.3; T/B, 3.4 +/- 2.2; tumor/muscle ratio, 7.7 +/- 5.4). The correlation of SUV and T/B with the intensity of immunohistochemical staining (Spearman's r = 0.92; P < 0.0001) as well as with the microvessel density (Spearman's r = 0.84; P < 0.0001) were significant. Immunohistochemistry confirmed lack of alpha(v)beta3 expression in normal tissue (benign lymph nodes, muscle) and in the two tumors without tracer uptake. CONCLUSIONS:Molecular imaging of alpha(v)beta3 expression with [18F]Galacto-RGD in humans correlates with alpha(v)beta3 expression as determined by immunohistochemistry. PET with [18F]Galacto-RGD might therefore be used as a new marker of angiogenesis and for individualized planning of therapeutic strategies with alpha(v)beta3-targeted drugs.

背景与目标： 目的：整联蛋白α（v）beta3在血管生成和肿瘤细胞转移中起着关键作用，因此是新的治疗和诊断策略的重要目标。我们已经开发了[18F] Galacto-RGD，一种用于正电子发射断层扫描（PET）的高度alpha（v）beta3选择性示踪剂。在这里，我们在人类中显示[18F] Galacto-RGD摄取的强度与alpha（v）beta3表达相关。
实验设计：对19例实体瘤患者（肌肉骨骼系统n = 10;黑素瘤n = 4;头颈癌n = 2;胶质母细胞瘤n = 2;乳腺癌n = 1）进行了PET检查， [18F] Galacto-RGD在手术切除肿瘤病变之前。从[18F] Galacto-RGD的标准摄取值（SUV）较低且强度较高的代表性地区收集了速冻标本（n = 26）。免疫组织化学是使用alpha（v）beta3特异性抗体LM609完成的。确定染色强度（按四分制评分）和alpha（v）beta3阳性血管的微血管密度，并将其与SUV和肿瘤/血液比率（T / B）相关。
结果：两个肿瘤均未显示示踪剂摄取（平均SUV为0.5 /-0.1）。所有其他肿瘤均显示示踪剂蓄积，SUV在1.2至10.0的范围内（平均值为3.8 /-2.3； T / B为3.4 /-2.2；肿瘤/肌肉比为7.7 /-5.4）。 SUV和T / B与免疫组织化学染色强度（Spearman's r = 0.92; P <0.0001）以及微血管密度（Spearman's r = 0.84; P <0.0001）的相关性很显着。免疫组织化学证实正常组织（良性淋巴结，肌肉）和两个没有示踪剂摄取的肿瘤中缺乏alpha（v）beta3表达。
结论：通过免疫组织化学测定，人体内具有[18F]半乳糖-RGD的α（v）beta3表达的分子成像与α（v）beta3表达相关。因此，具有[18F] Galacto-RGD的PET可用作血管生成的新标志物，并可用于以alpha（v）beta3为靶标的药物的个性化治疗策略规划。

BACKGROUND & AIMS: :We analysed the trauma triage system at a specific level I trauma centre to assess rates of over- and undertriage and to support recommendations for system improvements. The triage process is designed to estimate the severity of patient injury and allocate resources accordingly, with potential errors of overestimation (overtriage) consuming excess resources and underestimation (undertriage) potentially leading to medical errors.We first modelled the overall trauma system using risk analysis methods to understand interdependencies among the actions of the participants. We interviewed six experienced trauma surgeons to obtain their expert opinion of the over- and undertriage rates occurring in the trauma centre. We then assessed actual over- and undertriage rates in a random sample of 86 trauma cases collected over a six-week period at the same centre. We employed Bayesian analysis to quantitatively combine the data with the prior probabilities derived from expert opinion in order to obtain posterior distributions. The results were estimates of overtriage and undertriage in 16.1 and 4.9% of patients, respectively. This Bayesian approach, which provides a quantitative assessment of the error rates using both case data and expert opinion, provides a rational means of obtaining a best estimate of the system's performance. The overall approach that we describe in this paper can be employed more widely to analyse complex health care delivery systems, with the objective of reduced errors, patient risk and excess costs.

背景与目标： ：我们在I级特定创伤中心分析了创伤分类系统，以评估过度分类和不足分类的发生率，并支持有关系统改进的建议。分诊过程旨在估计患者伤害的严重程度并相应地分配资源，高估（过度分类）的潜在错误会消耗过多的资源，而低估（过度分类）的潜在错误可能导致医疗错误。我们首先使用风险分析方法对整个创伤系统进行建模了解参与者行动之间的相互依存关系。我们采访了六名经验丰富的创伤外科医师，以获取他们对创伤中心发生过高和不足的比率的专家意见。然后，我们评估了在同一中心六周内收集的86例创伤病例的随机样本中的实际超检和未检穿率。我们使用贝叶斯分析将数据与专家意见得出的先验概率定量结合，以获取后验分布。结果分别为16.1％和4.9％的患者的超额分类和不足分类。这种贝叶斯方法可以使用案例数据和专家意见对错误率进行定量评估，它提供了一种合理的方法来获得对系统性能的最佳估计。我们在本文中描述的总体方法可以更广泛地用于分析复杂的医疗保健提供系统，以减少错误，降低患者风险和增加成本。

BACKGROUND & AIMS: PURPOSE:The purpose of this study is to examine the effect of establishing a dedicated operating room for unscheduled orthopedic cases and to evaluate a group of patients with isolated femur fractures. The frequency of after-hours surgery and the impact of patients who present with acute orthopedic injuries are reviewed. METHODS:A retrospective review of all orthopedic cases from the operating room scheduling system at a level-one trauma center was undertaken from October 2003 to September 2005. Before October 2004, unscheduled cases were placed on a shared add-on list, and no special priority was given to orthopedic cases. Additionally, a subset of adult patients with isolated femoral shaft fractures was identified to evaluate time from admission to surgery, operative time, frequency of transfer of care between surgeons, and total length of hospital stay. RESULTS:The number of orthopedic cases was 1799 in fiscal year 2004 (FY04) and 2046 in FY05, an increase of 14%. Overall, the hospital experienced an increase in level-one trauma activations from 1450 in FY04 to 1580 in FY05 (8.2%), and an increase in the number operative trauma cases from 447 to 494 (9.5%). Cases after 7:00 pm declined from 197 in FY04 to 165 in FY05, a decrease of 16%. Cases between midnight and 7:00 am declined from 63 in FY04 to 35 in FY05, a decrease of 44%. For the subset of femur fracture patients, transfer of care to another operating surgeon occurred 4.5 times more frequently. The median delay between admission and surgery increased from 5.7 hours to 10.9 hours. Median case duration increased from 106 to 127 minutes. CONCLUSIONS:It is possible to dramatically decrease the occurrence of after-hours orthopedic surgery in a level-one trauma center through the use of a dedicated room for unscheduled orthopedic trauma cases. Benefits include less frequent activation of after-hours operating room resources, fewer disruptions to the OR schedule and office hours, and more frequent fracture care by orthopedic traumatologists. The impact of a longer delay between admission and surgical treatment and more frequent transfer of care between surgeons deserves further evaluation.

背景与目标： 目的：本研究的目的是检查为计划外的骨科病例建立专门的手术室的效果，并评估一组孤立的股骨骨折患者。回顾了下班后手术的频率以及对患有急性骨科损伤的患者的影响。
方法：2003年10月至2005年9月，对一级创伤中心手术室排程系统中的所有骨科病例进行回顾性回顾。2004年10月之前，未排定的病例被列入共享的附加清单，没有特殊病例骨科病例被优先考虑。此外，确定了一部分成人股骨干骨折患者，以评估其从入院到手术的时间，手术时间，外科医生之间的转诊频率以及总住院时间。
结果：2004财政年度（2004财政年度）的骨科病例为1799例，05财政年度为2046例，增长了14％。总体而言，该医院的一级创伤活动从2004财年的1450增至05财年的1580（8.2％），手术创伤病例数从447增至494（9.5％）。 7:00 pm之后的病例从04财年的197下降到05财年的165，下降了16％。午夜至凌晨7:00之间的病例从04财年的63例下降到了05财年的35例，下降了44％。对于部分股骨骨折患者，将护理转移到另一名手术外科医生的频率提高了4.5倍。入院与手术之间的中位延迟时间从5.7小时增加到10.9小时。病历中位数从106分钟增加到127分钟。
结论：通过使用非预定的整形外科创伤病例专用房间，可以在一级创伤中心显着减少下班后整形外科手术的发生。好处包括减少下班后手术室资源的激活频率，减少对手术时间和办公时间的干扰，以及使整形外科医生更加频繁地进行骨折护理。入院与手术治疗之间的时间更长，外科医生之间的护理转移更加频繁的影响值得进一步评估。

BACKGROUND & AIMS: :Brevinin-2R, a member of a new family of antimicrobial peptides isolated from the skin of Rana ridibunda, displays antimicrobial activity against bacteria and fungi. In this study, we have used an assembly PCR method for the fast and extremely accurate synthesis of the brevinin-2R gene. A total of six primers were assembled in a single step PCR, and the assembly was then amplified by PCR to produce the final gene. The synthetic gene was cloned into the pET32a (+) vector to allow the expression of brevinin-2R as a Trx fusion protein in Escherichia coli. The results indicated that the expression level of the fusion protein could reach up to 25% of the total cell proteins. The expression products could be easily purified by Ni-NTA chromatography and released from the fusion protein by factor Xa protease. The peptide displayed antimicrobial activity similar to that of the purified brevinin that was reported earlier. This method allows the fast synthesis of a gene that optimized the overexpression in the E. coli system and production of sufficiently large amounts of peptide for functional and structural characterizations.

背景与目标： ：Brevinin-2R是从蛙蛙（Rana ridibunda）皮肤中分离出的新的抗菌肽家族的成员，对细菌和真菌具有抗菌活性。在这项研究中，我们使用了组装PCR方法来快速，极其准确地合成brevinin-2R基因。在一步PCR中总共组装了6个引物，然后通过PCR扩增该组装物以产生最终基因。将合成基因克隆到pET32a（）载体中，以使Brevinin-2R作为Trx融合蛋白在大肠杆菌中表达。结果表明融合蛋白的表达水平可以达到细胞总蛋白的25％。表达产物可以通过Ni-NTA色谱法容易地纯化，并且可以通过Xa因子蛋白酶从融合蛋白中释放出来。该肽显示出与先前报道的纯化的短素蛋白相似的抗微生物活性。该方法可以快速合成优化大肠杆菌系统中过表达的基因，并产生足够数量的用于功能和结构表征的肽。