Measuring disease activity and response to treatment in rheumatoid arthritis

Introduction: Effective treatment of rheumatoid arthritis (RA) requires suppression of the underlying inflammation. Measurement of such inflammation, the disease activity, is mandatory to target treatment and maximize outcomes. However, this is not as straightforward as it may seem.

Areas covered: The many tools developed to measure disease activity in RA, from composite scores and patient-reported outcomes, to laboratory markers and imaging are discussed, with a focus on their utility in guiding therapy and assessing response. The complex issues in measuring disease activity in RA, whether in clinical trials or normal clinical practice, and in the context of national guidelines and recommendations, available time, and resources are considered.

Expert commentary: The key to effective management of RA is the rapid suppression of inflammation, ideally to remission, with maintenance of such remission. The aim is to prevent disability and maximize quality of life. Central to this is the ability to determine disease activity (potentially open to suppression) as opposed to damage (irreversible). A variety of measures are currently available, allowing better assessment of response to treatment. In the future, the development of predictive biomarkers allowing targeting of drugs may revolutionize this field and render the tools of today redundant.     

Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News

Introduction

Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners.

简明膳食自评工具在食管癌术后患者中的应用评价

目的将简明膳食自评工具（SDSAT）应用在食管癌术后患者中，评价其信度和效度。 方法本研究通过3个研究分别测量SDSAT的评定者间信度、重测信度和预测效度。研究A选择食管癌术前患者60例，由2位研究者分别进行SDSAT的测量，评价评定者间信度。研究B最终纳入食管癌术后1个月患者30例进行SDSAT的测量，间隔2周复测1次，比较2次结果，评价重测信度。研究C最终共纳入171例食管癌患者通过测量术前、术后1个月和术后3个月3个时间点测量，评价SDSAT对前白蛋白含量的预测程度。 结果评定者间信度是0.854（P<0.01）。 重测信度是0.782（P<0.01）。通过广义预测方程发现SDSAT对患者的前白蛋白含量预测效果好（P<0.01）。结论SDSAT信效度好，适合应用于评价食管癌术后患者的饮食状况。     

Stage line diagram: An age‐conditional reference diagram for tracking development

This paper presents a method for calculating stage line diagrams, a novel type of reference diagram useful for tracking developmental processes over time. Potential fields of applications include: dentistry (tooth eruption), oncology (tumor grading, cancer staging), virology (HIV infection and disease staging), psychology (stages of cognitive development), human development (pubertal stages) and chronic diseases (stages of dementia). Transition probabilities between successive stages are modeled as smoothly varying functions of age. Age‐conditional references are calculated from the modeled probabilities by the mid‐P value. It is possible to eliminate the influence of age by calculating standard deviation scores (SDS). The method is applied to the empirical data to produce reference charts on secondary sexual maturation. The mean of the empirical SDS in the reference population is close to zero, whereas the variance depends on age. The stage line diagram provides quick insight into both status (in SDS) and tempo (in SDS/year) of development of an individual child. Other measures (e.g. height SDS, body mass index SDS) from the same child can be added to the chart. Diagrams for sexual maturation are available as a web application at http://vps.stefvanbuuren.nl/puberty . The stage line diagram expresses status and tempo of discrete changes on a continuous scale. Wider application of these measures scores opens up new analytic possibilities. Copyright © 2009 John Wiley & Sons, Ltd.     

肺结核健康相关生存质量测定量表的研制概况及策略

通过综合查阅国内外结核生存质量相关研究的文献,探讨国内外肺结核生存质量研究的概况,为进一步研制肺结核病健康相关生存质量测定量表提供依据。国内外有关结核病生存质量研究的报告主要集中在研究结核对患者生存质量的影响或采用SF-36等普适性量表进行测定,国内外均缺乏成熟的结核生存质量特异性测定量表。为配合现代结核病控制策略,帮助掌握肺结核病人详细的生存质量资料,需要按照国际上科学、规范和标准化的方法,开展考虑到生存质量测定量表等价性等问题的、便于比较和运用的结核病健康相关生存质量测定量表的研制。     

Immunoglobulin mimicry by Hepatitis C Virus envelope protein E2

Hepatitis C virus (HCV) establishes persistent infection in the majority of infected individuals. The currently accepted hypothesis of immune evasion by antigenic variation in hypervariable region 1 (HVR1) of glycoprotein E2 does not however, explain the lack of subsequent immune recognition. Here, we show that the N-terminal region of E2 is antigenically and structurally similar to human immunoglobulin (Ig) variable domains. E2 is recognized by anti-human IgG antibodies and also possesses common amino acid (aa) sequence features of the conserved v-gene framework regions of human Ig light chains in particular but also heavy chains and T cell receptors. Using a position specific scoring system, the degree of similarity of HVR1 to Ig types correlated with immune escape and persistence in humans and experimentally infected chimpanzees. We propose a unique role for threshold levels of Ig molecular mimicry in HCV biology that not only advances our concept of viral immune escape and persistent infection but also provides insight into host-dependent disease patterns.     

锥板式粘度计测定低切血液粘度方法的实验研究

我们用锥板式粘度计从低切到高切、从高切到低切、以及先在８０ｓ－１下旋转６０ｓ、静止１００ｓ、再从低切到高切三种方法，测定了Ｖｉｓｔｅｒ大白鼠在低切变率为５．７５－１时的血液粘度。组间对照显示，三种测法所得低切血液粘度之间无显著差异，表明这些方法均可用来测量低切血液粘度。从低切稳定性来看，第二种测法最好。就用粘度法反映红细胞聚集性而言，第一种测法比较合适。     

蛙类肠系膜内微小动脉的压力检测

根据Wiederhielm的阻抗平衡压力检测原理,设计了一个改进的伺服零微血管测压系统。利用该系统检测了蟾蜍及蛙肠系膜内微小动脉的压力、获得了各管径级的压力和脉压的参数,并观察了药物的作用,探讨了微动脉内压力的波动特性以及应激情况下压力的骤变式与脉动式的交替,为微循环研究提供一些有价值的现象。