血清糖类抗原（CA－50）测定在喉癌诊断中的初步应用

本文应用ＩＲＭＡ法测定了２０例喉鳞状细胞癌患者和２０例正常成人血清ＣＡ－５０值，并对其中１６例喉癌患者进行了术前、术后自身对照观察，结果发现：喉癌患者血清ＣＡ－５０值明显高于正常对照（Ｐ＜０．０１），异常阳性率为５０％；喉癌组术前、术后ＣＡ－５０比较无显著差异。初步研究可示，血清ＣＡ－５０作为肿瘤标志在喉癌辅助诊断中具有一定的研究价值。     

血清糖类抗原（CA—50）测定在喉癌诊断中的初步应用

本文应用ＩＲＭＡ法测定了２０例喉鳞状细胞癌患者和２０例正常成人血清ＣＡ－５０值，并对其中１６例喉癌者进行了术前，术后自身对照观察，结果发现：喉癌患者血清ＣＡ－５０值明显高于正常对照（Ｐ＜０．０１），异常阳性率为５０％；喉癌组术前，术后ＣＡ－５０比较无显著差异，初步研究可示，血清ＣＡ－５０作为肿瘤标志在喉癌辅助诊断中具有一定的研究价值。     

血清CA72—4测定鉴别胃良,恶性病变的价值

该文测定４３例胃良、恶性病变患者的血清ＣＡ７２－４值，并与ＣＡ１９－４９、ＣＡ５０、ＣＥＡ进行比较，结果表明：ＣＡ７２－４对胃癌的诊断率（５７．１４％）明显高于ＣＡ１９－９（４２．８６％）、ＣＡ５０（２３．８１％）及ＣＥＡ（９．２５％），均Ｐ＜０．０５，不仅敏感度高，而且特异度达９５．４５％；ＣＡ７２－４与ＣＡ１９－９或ＣＡ５０联合测定，优于单测ＣＡ７２－４，其诊断率分别达７１．４３％、６１．９０％。认为ＣＡ７２－４可作为胃癌诊断及随访的一种有价值的血清肿瘤标志物。     

化学发光免疫分析法测定血清CA—125的临床应用

为了探讨血清ＣＡ－１２５在临床肿瘤中的诊断价值。用化学发光免疫分析法测定盆腔良性肿瘤和各类恶性肿瘤以及正常对照者血清ＣＡ－１２５。结果显示：以６８Ｕ／ｍｌ为阳性预期值，各类肿瘤ＣＡ－１２５的阳性率分别为：盆腔良肿瘤５．４％，肝癌３８．８％，肺癌３５．２％，结直肠癌３１．８，乳腺癌３０．０％，子宫内膜癌５０．０％，卵巢癌７９．２％。以卵巢良性肿瘤与恶性肿瘤相比较，ＣＡ－１２５诊断卵巢癌的灵敏度为７９     

血甭MG7—Ag和TAG—72在胃癌诊断中的应用

目的：探讨血清ＭＧ７－Ａｇ和ＴＡＧ＿７２检测对胃癌的诊断价值。方法：采用放射免疫分析法对９４例患者血清癌单抗ＭＧ７相关抗原（ＭＧ７－Ａｇ）和单抗Ｂ７２相关抗原即肿瘤相关糖蛋白抗原ＴＡＧ－７２）水平进行检测。结果：血清ＭＧ７－Ａｇ和ＴＡＧ－７２测定诊断胃癌的敏感性分别为５２．８％和６９．４％,特异性分别为８６．２％和８４．５％,两者联合检测可提高胃癌的阳性检出率达８６．１％。胃癌切除后血清ＭＧ７－Ａ     

免疫斑点法测抗钙调素自身抗体及其与其他8种自身抗体的关系

目的 探讨抗钙调素（ＣａＭ）自身抗体与自身免疫病及其他自身抗体的相互关系。方法 采用ＳＰＡ－免疫斑点法（ＳＰＡ－ＩＤＡ）对３４０例自身免疫病患者，４８例肿瘤患者，５２例正常人血清进行抗ＣａＭ抗体测定，并随机取自身免疫病患者血清同时检测其他８种自身抗体。结果 各类延寿央免疫病患者体内不同程度地存在着抗ＣａＭ自身抗体，４８例肿瘤患者血清中仅１例阳性，５２例正常人血清中无１例阳性。经统计学分析，抗ＣａＭ     

miRNA-21在结直肠癌中的表达研究

目的 检测MicroRNA-21（miRNA-21）在正常人和结直肠癌患者血清,以及结直肠癌患者癌组织和癌旁组织中的表达,探讨其与结直肠癌临床病理参数的关系.方法 采用实时荧光定量PCR（RT-qPCR）技术检测正常人和结直肠癌患者血清,以及结直肠癌患者癌组织和癌旁组织中的表达,分析miRNA-21的表达与结直肠癌临床病理参数的关系.结果 miRNA-21在结直肠癌患者血清中表达水平显著高于正常人血清（P＜0.05）;结直肠癌组织中miRNA-21表达水平明显高于癌旁组织;中晚期（Ⅲ期和Ⅳ期）结直肠癌组织中miRNA-21表达水平明显高于早期（Ⅰ期和Ⅱ期）结直肠癌（P＜0.05）;低分化肿瘤组织中miRNA-21表达水平明显高于中高分化者;有淋巴结转移的结直肠癌组织中miRNA-21表达水平明显高于无淋巴结转移者.结论 miRNA-21在结直肠癌患者血清及肿瘤组织中呈高表达,可能与结直肠癌的发生发展有关.     

血液透析对慢性肾功能衰竭患者血清SIL2R、IL6和TNFα的影响

目的：探讨慢性肾功能不全（ＣＲＦ）患者细胞免疫功能状况,以及血液透析（血透）的影响。方法：应用酶联免疫吸附（ＥＬＩＳＡ）双抗体夹心法检测３０例ＣＲＦ未透析患者和６２例血透患者血透前后及对照组血清可溶性白介素－α受体（ＳＩＬ－２Ｒ）、白介素－６（ＩＬ－６）和肿瘤坏死因子－α（ＴＮＦ－α）水平。结果：与对照组相比,ＣＲＦ未透析患者和血透患者血清ＳＩＬ－２Ｒ、ＩＬ－６和ＴＮＦ－α水平无显著差异。血清ＳＩＬ－２Ｒ较透前显著增高。结论：ＣＲＦ患者均存在显著的细胞免疫功能紊乱,单次透析对细胞免疫功能无显著影响。     

结直肠癌p53基因点突变和蛋白表达的研究

目的了解中国人结直肠癌ｐ５３基因的突变谱，探讨聚合酶链反应－单链构象多态（ＰＣＲ－ＳＳＣＰ）银染技术用于研究结直肠癌中ｐ５３基因突变的可行性。方法应用ＰＣＲ－ＳＳＣＰ银染技术检测４１例结直肠癌ｐ５３基因突变，以ＡＢＣ免疫组织化学染色检测结直肠癌Ｐ５３蛋白的表达。结果３４％（１４／４１）的病例显示有ｐ５３基因突变，其中外显子５，６，７和８各有４，１，５和４例突变。２０例有Ｐ５３蛋白异常表达，阳性率为４９％。结论导致Ｐ５３蛋白异常堆积的ｐ５３基因突变是结直肠癌的一种常见的分子结构改变，可能在结直肠癌的发生和发展中起着重要的作用。ＰＣＲ－ＳＳＣＰ银染技术是一简便、快速、有效的检测基因点突变的方法     

α—L—岩藻糖苷酶在肝细胞癌诊断的应用与评价

研究发现肝细胞癌（ＨＣＣ）患者平均血清α－Ｌ－岩藻糖苷酶（ａ－Ｌ－ｆｕｃｏｓｉｄａｓｅ，ＡＦＵ）水平明显升高，邦联ＡＦＵ可作为诊断ＨＣＣ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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

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.     

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.