Keap1与食管鳞状上皮细胞癌淋巴结转移和浸润深度的关系

目的分析Keleh样环氧氯丙烷相关蛋白1(Keleh-like ECH-associated protein 1,Keap1)的表达水平与食管鳞状上皮细胞癌(esophageal squamous cell carcinoma,ESCC)淋巴结转移和浸润深度的关系。方法采用免疫组化SP法检测ESCC患者的癌组织和癌旁组织中Keap1的表达水平,通过单因素和多因素分析及趋势χ2检验分析其与ESCC淋巴结转移和浸润深度的关系。结果 Keap1高表达与淋巴结转移(OR=3.945,95%CI:1.485~9.147)和浸润深度(OR=4.683,95%CI:1.692~10.275)有关;Keap1高表达是ESCC淋巴结转移的危险因素(Waldχ~2=23.579,P0.01),趋势χ~2检验结果显示,ESCC患者淋巴结转移的风险随Keap1表达水平的升高而升高(χ~2=5.173,P=0.023);Keap1的表达是ESCC侵及浆膜的危险因素(Waldχ~2=26.587,P0.01),趋势χ2检验结果显示,ESCC侵及浆膜的风险随Keap1表达水平的升高而升高(χ~2=9.788,P=0.002)。结论 Keap1的表达与ESCC的发生、发展有关,Keap1的表达可促进ESCC的淋巴结转移和浸润。     

结直肠癌组织中RREB1 和ANKRD1 的表达与临床病理特征和预后的相关性研究

目的 探讨结直肠癌（colorectal cancer,CRC）组织ras 反应元件结合蛋白1 (ras-responsive element bindingprotein 1,RREB1),ankyrin 重复结构域1 (ankyrin repeat domain 1,ANKRD1）的表达及与临床病理特征和预后不良的关系。方法 选取2013 年1 月～ 2016 年12 月复旦大学附属中山医院厦门医院收治的105 例CRC 患者,应用免疫组织化学SP 法检测CRC 患者癌组织和癌旁组织RREB1 和ANKRD1 蛋白表达,分析RREB1 和ANKRD1 蛋白表达与患者临床病理特征的关系,患者均随访5 年,比较不同RREB1 和ANKRD1 表达患者的预后情况,并分析CRC 患者预后不良的影响因素。采用Spearman 相关系数分析RREB1 与ANKRD1 表达的相关性。结果 CRC 癌组织RREB1 蛋白阳性率（59.05%）显著高于癌旁组织(27.61%),差异有统计学意义（χ2=21.120,P=0.000）。CRC 癌组织ANKRD1 蛋白阳性率(31.43%) 显著低于癌旁组织(60.95%),差异有统计学意义（χ2=18.410,P=0.000）。TNM 分期Ⅲ期、淋巴结转移N1 ～ N2 患者RREB1 蛋白阳性率高于TNM 分期Ⅰ～Ⅱ期、淋巴结转移N0 患者,差异有统计学意义（χ2=4.263,8.199,均P ＜ 0.05）。TNM 分期Ⅲ期、淋巴结转移N1 ～ N2 患者ANKRD1 蛋白阳性率低于TNM 分期Ⅰ～Ⅱ期、淋巴结转移N0 患者,差异有统计学意义（χ2=5.515,7.411,均P ＜ 0.05）。RREB1 高表达组5 年生存率（54.84%）低于RREB1 低表达组（74.42%）,差异有统计学意义（χ2=5.459,P=0.020）;ANKRD1 高表达组的5 年生存率（78.79%）高于ANKRD1 低表达组（55.56%）,差异有统计学意义（χ2=5.130,P=0.024）。RREB1 高表达（HR=2.437,95%CI:1.113 ～ 4.684）、ANKRD1 低表达(HR=0.573,95%CI:0.185 ～ 1.952)、TNM 分期Ⅲ期(HR=2.202, 95%CI:1.357 ～ 4.215)和淋巴结转移N1 ～ N2(HR=1.247, 95%CI:1.532 ～ 4.368) 是CRC 患者预后不良的危险因素 (均P ＜ 0.05)。Spearman秩相关分析结果,CRC 癌组织中RREB1 与ANKRD1 表达呈负相关（r=-0.389,P=0.036）。结论 CRC 癌组织中RREB1 表达升高,而 ANKRD1 表达降低,二者共同参与CRC 的发生发展,有望成为评估CRC 患者预后的组织肿瘤标志物。     

三角形四肽重复干扰诱导蛋白2在肺癌中的表达及其临床意义

目的研究三角形四肽重复干扰素诱导蛋白2(interferon-induced protein with tetratricopeptide repeats 2,IFIT2)在肺癌组织中的表达,并分析其表达水平与患者临床病理特征及预后的关系。方法用组织芯片技术和免疫组织化学染色法分别检测90例肺腺癌、78例肺鳞癌组织,以及相应癌旁组织中IFIT2的表达,用Wilcoxon秩和检验比较肺癌及癌旁组织中IFIT2表达水平的差异,χ~2检验分析肺癌组织中IFIT2表达水平与患者临床病理特征的关系,用Kaplan-Meier生存分析法分析IFIT2表达水平与患者预后的关系,拟合Cox模型评价不同指标与患者预后的关系。结果 IFIT2在肺腺癌、肺鳞癌组织中不表达和低表达为主,在癌旁组织中高表达,在癌组织及癌旁组织中的表达差异有统计学意义(P0.01);IFIT2染色强度与肺腺癌、肺鳞癌患者临床病理特征无相关性(P0.05);Kaplan-Merier生存分析显示,在肺腺癌中,IFIT2低表达患者总生存期(OS)较IFIT2高表达患者短(HR=2.392,95%CI:1.103～5.186,P=0.027),多因素Cox比例风险模型显示,远处转移(HR=8.033,95%CI:3.664～17.614,P=0.000)可作为肺腺癌患者预后评判的独立风险因素;在肺鳞癌中,IFIT2低表达患者总生存期(OS)较IFIT2高表达患者短(HR=2.907,95%CI:1.118～7.559,P=0.029),多因素Cox比例风险模型显示,淋巴结转移(HR=3.390,95%CI:1.029～11.175,P=0.045)和IFIT2低表达(HR=3.762,95%CI:1.236～11.451,P=0.020)均可作为肺鳞癌患者预后评判的独立风险因素。结论 IFIT2在肺癌组织中下调表达,提示其在肺癌发生发展过程中发挥重要作用,可作为肺癌患者预后评估的重要因素。     

口腔鳞状细胞癌组织中lncRNA DLEU1的表达及其与临床病理参数和预后的关系

目的探讨口腔鳞状细胞癌（OSCC）组织中长链非编码RNA（lncRNA）淋巴细胞白血病缺失基因1（DLEU1）的表达及与临床病理参数和预后的关系。 方法收集2017年1月至2017年12月南通大学附属医院保存的98例OSCC组织及癌旁组织,实时荧光定量-聚合酶链式反应（qRT-PCR）检测癌组织和癌旁组织中lncRNA DLEU1表达。分析lncRNA DLEU1表达与OSCC患者临床病理参数的关系,K-M法绘制不同lncRNA DLEU1表达OSCC患者生存曲线,多因素Cox回归分析OSCC患者预后不良影响因素。 结果OSCC组织中lncRNA DLEU1表达（1.863±0.572）高于癌旁组织（1.058±0.211）（t=13.058,P＜0.001）。lncRNA DLEU1表达与OSCC患者肿瘤区域淋巴结转移（TNM）分期、淋巴结转移有关（P＜0.05）。中位随访26个月,lncRNA DLEU1≥1.863生存率为61.22%,低于lncRNA DLEU1＜1.863的79.59%（Log-rank χ²=4.819,P=0.028）。TNM分期Ⅲ~Ⅳ期（HR=4.612,95%CI：1.482~11.352）、淋巴结转移（HR=4.370,95%CI：1.442~10.246）、lncRNA DLEU1≥1.863（HR=4.231,95%CI：1.350~10.260）是OSCC患者预后不良的独立风险因素（P＜0.05）。 结论OSCC组织中lncRNA DLEU1高表达,与TNM分期、淋巴结转移和预后相关,可能成为新的OSCC诊治和预后分子标志物。     

KIF4A蛋白在胰腺癌组织中的表达及临床意义

目的:探讨驱动蛋白家族4A(kinesin family member 4A,KIF4A)蛋白在胰腺癌组织中的表达情况及临床意义。方法:选择东南大学附属中大医院手术切除并经病理证实的72例胰腺癌患者的癌组织及癌旁组织标本。采用免疫组织化学法检测KIF4A蛋白表达情况;比较KIF4A在胰腺癌组织中的表达与患者临床参数的关系;采用Kaplan-Meier法分析KIF4A在胰腺癌中的表达与患者预后的关系;采用Cox比例风险模型进行胰腺癌预后的多因素分析。结果:KIF4A阳性细胞主要表达在细胞核内,与癌旁组织相比,KIF4A在胰腺癌组织中的阳性表达率显著升高(χ~2=32.211,P0.05)。肿瘤TNM分期Ⅲ期患者胰腺癌组织中KIF4A阳性表达率高于Ⅰ+Ⅱ者,分化程度低的患者KIF4A阳性表达率高于分化程度高+中者,有淋巴结转移的患者KIF4A阳性表达率高于无淋巴结转移者(P0.05)。生存分析结果显示胰腺癌组织中KIF4A阳性表达组生存时间明显低于KIF4A阴性表达组(χ~2=10.306,P=0.001)。Cox比例风险回归模型结果显示:TNM分期(P=0.011)、肿瘤分化程度(P0.001)、淋巴结转移(P=0.001)、KIF4A阳性表达(P=0.043)是胰腺癌患者预后的独立危险因素。结论:KIF4A在胰腺癌组织中呈阳性表达,且与TNM分期、分化程度、淋巴结转移及不良预后有关,KIF4A可作为胰腺癌患者预后的分子标志物。     

术前纤维蛋白原与食管鳞状细胞癌患者预后的关系

目的:评估血浆纤维蛋白原(fibrinogen,FIB)对预测可手术食管鳞状细胞癌患者预后的价值。方法:回顾性分析郑州大学附属肿瘤医院/河南省肿瘤医院2015年6月至2016年4月334例接受手术治疗的食管鳞状细胞癌患者,以FIB指标的最佳截点值2.90 g/L为界,血浆FIB≥2.90 g/L为高FIB组,血浆FIB2.90 g/L为低FIB组。分析FIB水平与患者临床病理特征的关系,应用Kaplan-Meier生存分析及Cox比例风险回归模型分析术前FIB水平对患者总生存期(overall survival,OS)的影响。结果:食管鳞状细胞癌患者低FIB组163例(48.8%),高FIB组171例(51.2%)。食管鳞状细胞癌患者T分期与FIB水平相关(W=10 817,P=0.015)。高FIB组患者平均生存期为26.60个月,低FIB组患者平均生存期为29.17个月,低FIB组的平均生存期显著优于高FIB组,差异有统计学意义(χ~2=6.5497,P=0.011)。单因素分析显示血浆FIB水平(HR=1.994,95%CI:1.163～3.418,P=0.012),T分期(HR=2.213,95%CI:1.196-4.097,P=0.011),N分期(HR=3.883,95%CI:2.278-6.621,P0.001),TNM分期(HR=0.248,95%CI:0.139～0.443,P0.001)与OS密切相关。在α=0.1的水平,血浆FIB为食管鳞状细胞癌的独立预后因素(HR=1.680,95%CI:1.062～2.805,P=0.062),对比低FIB组,高FIB组患者的死亡风险高68%。结论:术前血浆纤维蛋白为食管鳞状细胞癌的不良生存预后因子。     

三角形四肽重复干扰素诱导蛋白2在肺癌中的表达及其临床意义

目的研究三角形四肽重复干扰素诱导蛋白2(interferon-induced protein with tetratricopeptide repeats 2,IFIT2)在肺癌组织中的表达,并分析其表达水平与患者临床病理特征及预后的关系。方法用组织芯片技术和免疫组织化学染色法分别检测90例肺腺癌、78例肺鳞癌组织,以及相应癌旁组织中IFIT2的表达,用Wilcoxon秩和检验比较肺癌及癌旁组织中IFIT2表达水平的差异,χ~2检验分析肺癌组织中IFIT2表达水平与患者临床病理特征的关系,用Kaplan-Meier生存分析法分析IFIT2表达水平与患者预后的关系,拟合Cox模型评价不同指标与患者预后的关系。结果 IFIT2在肺腺癌、肺鳞癌组织中不表达和低表达为主,在癌旁组织中高表达,在癌组织及癌旁组织中的表达差异有统计学意义(P0.01);IFIT2染色强度与肺腺癌、肺鳞癌患者临床病理特征无相关性(P0.05);Kaplan-Merier生存分析显示,在肺腺癌中,IFIT2低表达患者总生存期(OS)较IFIT2高表达患者短(HR=2.392,95%CI:1.103～5.186,P=0.027),多因素Cox比例风险模型显示,远处转移(HR=8.033,95%CI:3.664～17.614,P=0.000)可作为肺腺癌患者预后评判的独立风险因素;在肺鳞癌中,IFIT2低表达患者总生存期(OS)较IFIT2高表达患者短(HR=2.907,95%CI:1.118～7.559,P=0.029),多因素Cox比例风险模型显示,淋巴结转移(HR=3.390,95%CI:1.029～11.175,P=0.045)和IFIT2低表达(HR=3.762,95%CI:1.236～11.451,P=0.020)均可作为肺鳞癌患者预后评判的独立风险因素。结论 IFIT2在肺癌组织中下调表达,提示其在肺癌发生发展过程中发挥重要作用,可作为肺癌患者预后评估的重要因素。     

结直肠癌组织中USP11 和PPP1CA 表达水平与临床病理的相关性研究

目的 探讨结直肠癌组织中泛素特异性蛋白酶11(ubiquitin-specific protease 11,USP11)、蛋白磷酸酶1 催化亚基α(protein phosphatase 1 catalytic subunit α,PPP1CA) 表达水平与临床病理的相关性。方法 收集佛山市第一人民医院2015 年1 月～ 2016 年4 月87 例结直肠癌患者外科手术切除的癌组织和癌旁组织标本及临床资料。采用实时荧光定量PCR 检测USP11 mRNA 和PPP1CA mRNA 表达水平,免疫组织化学检测USP11 和PPP1CA 蛋白表达水平。采用Spearman 相关性分析结直肠癌组织中USP11 mRNA 与PPP1CA mRNA 表达的相关性,并分析二者与结直肠癌临床病理特征的关系。术后随访5 年,统计总生存率,K M 法绘制USP11 和PPP1CA 蛋白表达阳性与阴性结直肠癌患者生存曲线。采用多因素COX 回归分析结直肠癌患者预后不良影响因素。结果 癌组织中USP11 mRNA[3.49(3.45,3.52)] 和PPP1CAmRNA 表达水平[1.13(1.11,1.15)] 高于癌旁组织[1.02(0.99,1.06),0.35(0.34,0.36)], 差异均有统计学意义（ Z= -11.397,-11.423,均P ＜ 0.001）。结直肠癌组织中USP11 mRNA 与PPP1CA mRNA 表达呈正相关(rs =0.658,P ＜ 0.001)。USP11 和PPP1CA 表达与结直肠癌TNM 分期和淋巴结转移有关(χ2=5.386 ～ 6.471,均P ＜ 0.05),与性别、年龄、组织学分型和分化程度无关(χ2=0.039 ～ 1.130,均P ＞ 0.05)。中位随访34 个月,术后5 年总生存率为64.37%,USP11和PPP1CA 蛋白表达阳性组术后5 年总生存率为55.17% 和57.41%,低于USP11 和PPP1CA 蛋白表达阴性组（82.76%,75.76%）,差异有统计学意义（Log-rankχ2=8.900,9.081,均P＜ 0.01)。TNM分期Ⅲ～Ⅳ期(HR=1.896,95%CI 1.359 ～ 2.749)、淋巴结转移(HR=1.818,95%CI 1.391 ～ 2.698)、USP11 阳性(HR=2.404,95%CI 1.791 ～ 3.754)、PPP1CA 阳性(HR=2.556,95%CI 1.868 ～ 3.852) 为结直肠癌患者预后不良独立风险因素(P=0.009,0.013,0.019,0.010)。结论 结直肠癌中USP11 和PPP1CA 高表达,与TNM 分期和淋巴结转移有关,二者可能共同影响患者预后。     

乳腺癌组织中LncRNA ADAMTS9-AS1与miR-513a-5p的表达及临床意义

目的研究乳腺癌组织中长链非编码RNA(LncRNA)ADAMTS9-AS1、miR-513a-5p的表达,并分析二者的关系及临床意义。方法选取2015年8月—2017年8月诊治的乳腺癌患者83例为研究对象。应用实时定量PCR检测乳腺癌及癌旁组织中LncRNA ADAMTS9-AS1、miR-513a-5p的表达。Pearson相关分析二者的相关性,在线生物信息学软件分析二者的相互作用位点,Kaplan-Meier生存分析二者表达对乳腺癌患者预后的影响,多因素Cox回归分析影响患者预后的危险因素。结果与癌旁组织比较,乳腺癌组织中LncRNA ADAMTS9-AS1表达降低,miR-513a-5p表达升高(P0.01)。乳腺癌组织中LncRNA ADAMTS9-AS1与miR-513a-5p表达呈明显负相关(P0.01),且二者存在潜在的结合位点。乳腺癌组织中LncRNA ADAMTS9-AS1、miR-513a-5p表达与肿瘤分期及淋巴结转移有相关性(P0.05,P0.01)。Kaplan-Meier生存分析结果LncRNA ADAMTS9-AS1低表达及miR-513a-5p高表达乳腺癌患者的3年总体生存率较低(P0.01)。乳腺癌组织中LncRNA ADAMTS9-AS1低表达、miR-513a-5p高表达、高肿瘤分期及伴有淋巴结转移是影响乳腺癌患者预后的独立危险因素(P0.05,P0.01)。结论乳腺癌组织中LncRNA ADAMTS9-AS1表达下调,而miR-513a-5p表达上调,二者表达与乳腺癌患者肿瘤分期及不良预后有关,可作为乳腺癌的肿瘤标志物。     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.