Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies

The GRADE approach to grading the quality of evidence and strength of recommendations provides a comprehensive and transparent approach for developing clinical recommendations about using diagnostic tests or diagnostic strategies. Although grading the quality of evidence and strength of recommendations about using tests shares the logic of grading recommendations for treatment, it presents unique challenges. Guideline panels and clinicians should be alert to these special challenges when using the evidence about the accuracy of tests as the basis for clinical decisions. In the GRADE system, valid diagnostic accuracy studies can provide high quality evidence of test accuracy. However, such studies often provide only low quality evidence for the development of recommendations about diagnostic testing, as test accuracy is a surrogate for patient-important outcomes at best. Inferring from data on accuracy that using a test improves outcomes that are important to patients requires availability of an effective treatment, improved patients' wellbeing through prognostic information, or – by excluding an ominous diagnosis – reduction of anxiety and the opportunity for earlier search for an alternative diagnosis for which beneficial treatment can be available. Assessing the directness of evidence supporting the use of a diagnostic test requires judgments about the relationship between test results and patient-important consequences. Well-designed and conducted studies of allergy tests in parallel with efforts to evaluate allergy treatments critically will encourage improved guideline development for allergic diseases.     

钛合金过敏反应致Cage移位1例报道

目的报告1例钛合金过敏反应致Cage移位的患者。方法报告1例行“经后路减压、钉棒系统内固定、脊柱椎间融合器（cage）植入植骨术”的高敏体质患者。结果钉棒系统内固定术后，Cage向后移位。结论钛合金生物相容性较好，但仍然有导致过敏反应的可能，引起内固定物松动或脱落。     

Analysis of P53 mutation and invasion front grading in oral squamous cell carcinomas

We examined P53 mutation and invasion front grading (IFG) in 30 cases of oral squamous cell carcinomas (OSCCs). The association of P53 mutation and IFG scores with clinicopa-thological parameters was evaluated. P53 mutation existed in exon 5-8 in 15 out of the 30 OSCCs (50%). The incidence of P53 mutation was not associated with age, gender, N value and TNM stage. However, there was a significant correlation between P53 mutation and T value (P=0.046). There were no statistically significant correlations amo...     

Diagnostic dilemmas and potential pitfalls in the evaluation of endometrial adenocarcinoma

Endometrial adenocarcinoma is the most common malignancy of the gynaecologic tract, and therefore one of the most commonly encountered surgical pathology specimens. Accurate diagnosis, grading and staging are necessary to direct therapy for this common disease. Evaluation of these cases is usually straightforward. Some cases, however, may be complicated by a variety of issues such as difficulty assessing depth of invasion; difficulty assessing cervical involvement; possibility of synchronous ovarian primaries; evaluation of lymphovascular space invasion; difficulties with FIGO grade (especially in the company of altered differentiation); and subtle patterns of myoinvasion. The purpose of this review is to emphasize these problematic areas and offer straightforward guidelines to apply when these situations are encountered. Proper recognition of these diagnostic challenges will hopefully improve grading and staging accuracy, and subsequently therapy, for the multitudes of women affected by this disease.     

乌拉尔甘草种子质量分级标准的研究

目的:制定乌拉尔甘草种子质量分级标准。方法:对所搜集的24份不同种源的乌拉尔甘草种子进行千粒重、净度、水分、发芽率等指标的测定,利用数理统计方法分析出划分种子等级的主要指标和参考指标,运用标准差法制定乌拉尔甘草种子质量分级标准。结果:发芽率是乌拉尔甘草种子质量分级的主要指标,千粒重、净度和含水量是质量分级的重要参考指标。结论:1级种子的发芽率不低于85%,净度不低于92%,千粒重不低于13 g,含水量不高于11%;2级种子发芽率75%～85%,净度83%～92%,千粒重11～13 g,含水量不高于11%;3级种子发芽率65%~75%,净度74%~83%,千粒重9~11 g,含水量不高于11%;达不到3级种子标准的为不合格种子。     

综合评分法优选驱虫斑鸠菊的提取工艺

目的优选驱虫斑鸠菊的最佳提取工艺。方法采用正交试验设计,以紫铆素含量、总黄酮含量及浸膏得率为指标,考察影响提取的因素。结果驱虫斑鸠菊的最佳提取工艺为加入10倍量水,浸泡1 h,煎煮1 h,共3次。结论该工艺可提高驱虫斑鸠菊的提取率。     

RF-Ⅱ系统加Cage植入治疗腰椎滑脱症

目的探讨RFⅡ-系统复位固定加Cage椎间植骨融合术治疗腰椎滑脱证的疗效。方法本组采用RF-Ⅱ系统将滑脱提拉复位,椎板减压,Cage椎间植骨融合治疗腰椎滑脱症26例,其中退变型19例,峡部裂型7例,L4滑脱16例,L5滑脱10例,其中Ⅰ度20例,Ⅱ度6例。结果术后随访12-36个月,根据Nakai分级:优21例,良4例,可1例,优良率89.6%。结论RF-Ⅱ系统复位固定加Cage椎间植骨融合术是治疗腰椎滑脱症的一种有效方法,达到彻底减压,滑脱椎体复位,固定及椎间融合。     

综合评分法筛选驱虫斑鸠菊水提取液澄清工艺

目的:优化驱虫斑鸠菊水提取液的澄清工艺。方法:采用正交试验设计,以浸膏量、浸膏中紫铆素和总黄酮含量为评分指标,筛选驱虫斑鸠菊水提取液的澄清条件。结果:驱虫斑鸠菊水提取液的澄清条件为:ZTC1+1型澄清剂的加入顺序为先加入0.5%(g.mL-1)澄清剂B溶液,再加入1.0%(g.mL-1)澄清剂A溶液;澄清剂B和A的最佳用量分别为2.0%(V/V)和0.5%(V/V);反应温度分别为(80±1)℃和(60±1)℃;反应时间均为2h。结论:该工艺简便、可行,可为实际生产提供理论依据。     

240例肝穿刺活检的病理诊断与B超显像比较分析

目的：探讨B型超声显像在慢性肝炎分级分期中的作用，寻求超声检查方法对慢性乙型肝炎患者病理分级分期的诊断标准。方法：对240例慢性乙型肝炎患者B超表现与肝组织病理分级分期进行对比分析。结果：超声诊断慢性乙型病毒性肝炎的声像图征象如肝脏的包膜、实质回声、血管走形和胆囊壁的改变及门静脉、脾静脉、脾脏厚度和慢性乙型肝炎肝组织炎症活动程度显著相关（P〈0．05）；结论B超的声像图在评价慢性病毒性肝炎病情的轻重有重要的价值。     

细胞增殖核抗原在乳腺导管癌组织中的表达及其与组织学分级的关系

采用抗PCNA单克隆抗体PC_(10)对45例乳腺导管癌进行免疫组化研究,其中导管内癌3例.导管内癌为主的浸润性导管癌4例,浸润性导管癌38例.参照Bloom—Richardson氏分级法对浸润性导管癌进行分级.结果显示:PCNA平均指数导管内癌为4.80,导管内癌为主的浸润性导管癌为11.23,浸润性导管癌Ⅰ级8.30、Ⅱ级24.56、Ⅲ级42.65.湿润性导管癌Ⅰ、Ⅱ、Ⅲ级之间有显著性差异(P<0.01).表明PCNA指数与乳腺癌组织学分级有密切关系.