基于Web of Science核心集的乳腺癌患者共享决策研究的可视化分析

目的 基于可视化软件分析乳腺癌患者共享决策的研究现状、热点及前沿。方法 检索Web of Science核心集数据库自建库至2023年1月乳腺癌患者共享决策领域的文章,采用CiteSpace 5.7.R1软件进行计量学分析。结果 共检索到1 283篇文献,最终纳入759篇文献进行可视化分析。发文量呈波动上升趋势;美国奠定了该研究领域的基础;欧美等发达国家及其机构间合作紧密;研究热点集中在乳腺癌共享决策不同女性群体、患者需求、不同决策阶段及干预技术开发等方面。结论 近年来乳腺癌患者共享决策问题持续受到关注,发达国家研究较多。建议中国临床科研人员拓宽合作领域,聚焦相关研究热点,促进中国乳腺癌患者共享决策研究的发展。     

基于质谱技术应用CLINPROT系统建立乳腺癌诊断模型

目的应用液体蛋白芯片-飞行时间质谱技术(CLINPROT)系统筛选乳腺肿瘤患者血清中潜在的肿瘤标志物,并基于差异蛋白建立乳腺癌诊断预测模型。方法收集病理确诊的乳腺癌患者血清标本43例及健康女性血清标本24例,并随机分为建模组和验证组。应用ClinProt Tools系统对建模组中的乳腺癌患者和健康女性血清进行差异蛋白的筛选,建立差异蛋白质图谱,应用ClinProTools v3.0软件建立乳腺癌诊断预测模型,而后利用该诊断模型对验证组血清标本进行分组验证,初步评估该模型的诊断效能。结果通过分析病例组和对照组质谱峰信息,得到24个具有明显差异的蛋白峰(P0.05)。根据遗传算法选取表达差异最显著的3个蛋白质建立乳腺癌诊断预测模型,该模型对建模组乳腺癌的识别能力为91.67%。后利用验证组标本对该模型的诊断效能进行评估,结果显示其对验证组乳腺癌识别准确率为85.7%。结论利用ClinProt Tools v3.0软件成功建立并评估了乳腺癌诊断预测模型,为乳腺癌诊断提供了新的途径。     

SELDI技术在乳腺癌淋巴结转移诊断中的应用研究

目的应用表面增强激光解析/电离飞行时间质谱(SELDI-TOF-MS)技术和蛋白芯片从乳腺癌患者血清中筛选出乳腺癌淋巴结转移的特异性蛋白标志物,为预测淋巴结转移提供更早且简单易行的方法。方法用SELDI-TOF-MS技术及IMAC-30蛋白芯片检测了39例发生淋巴结转移和45例未发生转移的乳腺癌患者的血清蛋白指纹图谱,采用Ciphergen Biomaker Wizard软件筛选差异表达蛋白,用SPSS17.0软件对数据进行统计分析。结果乳腺癌发生淋巴结转移组与未转移组相比共有31个差异蛋白峰(P<0.05),判别分析选出质荷比为4781、5329、5895、6012和8918的5个差异蛋白并评价其诊断效能,其中质荷比为4781的蛋白的诊断效能最高,灵敏度为84.62%,特异度为88.89%。结论 SELDI蛋白质谱技术在预测乳腺癌患者的淋巴结转移诊断方面具有一定的价值。     

血清survivin定量检测在乳腺癌诊断中的临床价值

目的探讨血清生存素(survivin)测定在乳腺癌诊断中的临床意义。方法采用酶联免疫吸附试验(ELISA)定量检测健康对照组(22例健康体检者)、乳腺癌患者无转移组(24例)和乳腺癌患者有远处转移组(32例)血清survivin蛋白的表达水平。结果健康对照组血清survivin表达水平为0.31±0.06 ng/ml;无转移的乳腺癌患者sur-vivin表达水平为0.49±0.05 ng/ml;有转移的乳腺癌患者survivin表达水平为1.02±0.18 ng/ml。统计软件分析显示与健康对照组相比,survivin在乳腺癌患者(包括无转移组和转移组)的表达升高(P<0.01);而乳腺癌转移组中survivin的表达明显高于无转移组(P<0.01)。结论血清survivin的蛋白质表达的定量检测可作为乳腺癌发生和转移的预警指标之一。     

乳腺癌根治术患者生活质量的调查

目的了解乳腺癌根治术后患者生活质量,分析影响生活质量的相关冈素。方法应用描述性及相关性的研究方法,采用乳腺癌治疗功能评价量表（FACT—B4．0中文版）,对500例乳腺癌根治术患者进行评定,采用SPSS15．0统计软件进行资料分析。结果乳腺癌根治术患者的生活质量降低,在社会家庭状况、情感状况、功能状况方面得分较低。患者年龄、经济情况、教育程度、治疗费用、病程、规律锻炼及对疾病的适应状况是影响总体生活质量的相关因素。结论乳腺癌根治术后患者的生活质量低于一般人群,影响因素较多,有必要埘其进行有针对性的心理社会干预,尽可能促进身心康复。     

同伴教育对乳腺癌患者生活质量的Meta分析

目的 评价同伴教育对乳腺癌患者生活质量的影响。方法 计算机检索多个中英文数据库中有关同伴教育应用于乳腺癌患者的随机对照试验,运用Cochrane Handbook对文献质量进行评价,采用RevMan 5.3软件进行Meta分析。结果 本研究共纳入11篇随机对照试验,Meta分析结果显示：同伴教育较常规干预提高了乳腺癌患者的生活质量,合并效应具有统计学意义[WMD=11.58,95%CI（5.19~17.98）,P＜0.01];同伴教育可提高乳腺癌患者希望水平方面,合并效应无统计学意义[WMD=4.12,95%CI（-6.91~15.15）,P=0.46]。对于同伴教育是否提高乳腺癌患者的自我效能和降低患者的抑郁焦虑情绪等方面尚缺乏有力证据。结论：同伴教育能提高乳腺癌患者生活质量,而对提高患者的希望水平无明显作用,在提高乳腺癌患者自我效能、降低抑郁焦虑情绪方面缺乏有力证据,以期开展多中心、大样本、高质量的临床随机对照试验对研究结果进行证实。     

乳腺癌康复期患者体力活动情况调查与分析

目的调查乳腺癌康复期患者体力活动情况,为指导乳腺癌患者康复提供科学依据。方法采用方便取样法选择在门诊随访的乳腺癌康复期患者107例,采用国际体力问卷（IPAQ）中文版评估患者体力活动情况,采用SPSS软件进行分析。结果本组107例患者中6例有重体力活动,活动中位时间27．86min／d;34例有中等强度体力活动,活动中位时间25．71min／d;100例患者有步行活动,活动中位时间60．00min／d;107例患者每日静坐中位时间8．00h;5例患者没有体力活动。结论乳腺癌康复期患者体力活动消耗量不足,有待提高。     

口服化疗乳腺癌患者灵性需求和照护的真实体验

目的深入了解与探讨口服化疗乳腺癌患者对于灵性需求和照护的真实体验。方法 2014年1-7月,采用目的抽样法选取在上海市某三级甲等医院住院的9名乳腺癌患者为研究对象,采用现象学研究方法,对其进行半结构式访谈,现场录音,借助NVivo 8.0软件,根据Colaizzi的7步分析法对资料进行分析,提炼主题。结果口服化疗乳腺癌患者的灵性需求可归纳为4个主题:精神寄托的需求,提升希望的需求,面对死亡的需求和自我实现的需求;灵性照护可归纳为3个主题:尊重宗教信仰,提升希望及死亡教育。结论口服化疗乳腺癌患者的居家支持性护理应该满足患者的灵性需求,给予灵性照护。     

虚拟现实技术对乳腺癌患者干预效果的Meta分析

目的 评价虚拟现实技术干预对乳腺癌患者症状及康复管理的效果。方法 计算机检索Cochrane Library、CINAHL、Medline、PubMed、Embase、Web of Science、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普中文科技期刊数据库中虚拟现实技术干预对乳腺癌患者症状及康复管理的随机对照试验和类实验研究,检索时限为建库至2022年6月20日。统计分析采用RevMan 5.3.0软件。结果 共纳入10项研究,674例患者。Meta分析结果显示,虚拟现实技术干预可改善乳腺癌患者的负性情绪、疼痛和术后肩关节活动度(P<0.01)。结论 虚拟现实技术干预作为非药物干预手段,可改善乳腺癌患者的负性情绪、疼痛和术后肩关节活动度。今后仍需开展大样本、高质量研究进一步验证虚拟现实技术干预对乳腺癌患者症状及康复管理的有效性。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.