Practice guidelines: the radiology perspective

Clinical practice guidelines have emerged as a reality for medical practitioners over the past 20 years. Although virtually all groups interested in the development of practice guidelines hope for improvements in patient care, secondary expectations vary widely among those using them. Their use in daily practice by physicians has met with resistance from barriers including concerns of “cookbook” medicine, a loss of autonomy, and increased professional liability. The recent experience of the ACR in addressing these challenges illustrates that physicians are receptive to steps perceived to mitigate the risks accompanying the use of guidelines as well as to efforts to increase their understanding of implementing guidelines in clinical practice. The experiences of other medical societies and an inventory of future trends reveal additional challenges associated with the use of practice guidelines, as third parties look to guidelines as points of reference for gauging the performance of health care providers.     

Establishing new principles for nutrient reference values (NRVs) for food labeling purposes

Many countries such as The Republic of Korea have established their own nutritional standards, collectively termed Nutrient Reference Values(NRVs), and they vary due to the science which was reviewed, the purposes for which they are developed, and issues related to nutrition and food policy in the country. The current effort by the Codex Alimentarius Committee on Nutrition and Foods for Special Dietary Uses (CNFSDU) to update the NRVs that were established following the Helsinki Consultation in 1988 represents an opportunity to develop a set of reference values reflecting current scientific information to be used or adapted by many countries. This paper will focus on possible approaches to selecting or developing reference values which would serve the intended purpose for nutrition labeling to the greatest extent possible. Within the United States, the Food and Drug Administration (U.S. FDA) is currently reviewing regulations on nutrition labeling to better address current health issues, and is expected to enter into a process in the next few months to begin to explore how best to update nutrient Daily Values (DVs), most of which are still based on the Recommended Dietary Allowances (RDAs) of the Food and Nutrition Board, U.S. National Academy of Sciences, last reviewed and revised in 1968. In this presentation, I review the current purposes in the U.S. for nutrition labeling as identified in the 1938 Food, Drug, and Cosmetic Act as amended, the scientific basis for current nutrition labeling regulations in the United States, and the recommendations made by the recent Committee on Use of Dietary Reference Intakes in Nutrition Labeling of the Institute of Medicine (2003) regarding how to use the DRIs in developing new DVs to be used on the label in the United States and Canada. Based on these reviews, I then provide examples of the issues that arise in comparing one approach to another. Much of the discussion focuses on the appropriate role of nutrient labeling within the Nutrition Facts panel, one of the three major public nutrition education tools in the United States (along with MyPyramid and Dietary Guidelines for Americans).     

带随机输出噪声的参考模型自适应系统

讨论了带随机输出噪声的线性时不变对象的参考模型自适应系统。提出一种适用于这种系统的混合自适应控制律,证明该系统所有信号的有界性,计算机仿真验证这种新的混合自适应控制律在存在随机输出噪声的系统中的性能。     

Quisqualate lesions of rat NBM: Selective effects on working memory in a double Y-maze

Some authors have reported that quisqualic acid lesions of the nucleus basalis magnocellularis (NBM), although producing large cortical cholinergic losses, have little effect on memory. The purpose of the present study was to investigate the effects of quisqualic acid lesions of the NBM on working and reference memory in a double Y-maze. Each trial started with placement into one of the two end arms of the first Y-maze, and the correct response was to go down the stem (reference memory). Access was then given to the second Y-maze, the correct response being conditional upon the side of the first Y-maze from which that trial had begun (working memory). Rats were trained to an 88% correct criterion and were then given either bilateral quisqualic acid (60 nM, 0.5 microliters) or sham lesions (0.9% saline, 0.5 microliters) of the NBM. One week postsurgery, rats were tested on the double Y-maze task with delays of 0, 5 or 30 seconds being introduced prior to both the working and reference memory choice. NBM lesions produced a 63.2 +/- 6.2% decrease of cortical choline acetyltransferase (ChAT) compared to unoperated controls. Delays affected only the working memory of the sham group. Rats with lesions showed a significant impairment of working memory at all delays, but no change in reference memory. Results indicate that quisqualic acid lesions of the NBM that produce significant reductions in cortical ChAT selectively impair working memory.     

A flexible, efficient, checkerboard immunoblot system for the detection and semiquantitation of specific antinuclear antibodies.

In this paper an uncomplicated method for the simultaneous detection and semiquantitation of 11 of the 12 commonly studied antinuclear antibodies (ANA) in a single run is described. This new application of checkerboard immunoblotting (CBIB) is based upon available technology and employs purified antigens which can be either purchased or produced in-house. CBIB requires no electronic instrument, can be formatted to meet the needs of the user, is rapidly performed, and has acceptable labor and materials costs. Data on the use of the method to examine available reference antisera is presented. CBIB has also proven practical for the clinical study of 18 sera, at two dilutions per membrane, for each set of specific antinuclear antibodies, also at two or more dilutions.     

论医院质量管理推行ISO9000族标准的必要性

为了迎接医疗市场的竞争和挑战 ,医院将应用于工业企业的ISO90 0 0族标准引入到医疗服务领域。它通过严格的过程控制 ,使医院实现了质量管理制度健全化、系统化、合理化 ,大大减少了服务中的差错 ,全面提高了服务质量 ;通过工作程序化及持续改进 ,改善了医务人员的工作环境 ,提高了医院运作效率和运营效益。本文从现行的质量管理的不足分析入手 ,从八个方面阐述医院质量管理推行IS0 90 0 0族标准的必要性 ,以此来说明医院的质量管理采用ISO90 0 0族标准 ,将会使医院的质量管理有一个质的飞跃。事实证明通过认证的医院已从中收益。     

猪肾碱性磷酸酶的提纯及性质研究

目的：从猪肾中提取碱性磷酸酶(ALP)，并对其能否作为参考品进行研究。方法：从猪肾皮质中分离刷状缘微绒毛膜，用正丁醇溶解膜结合的酶，经硫酸铵沉淀，DEAE-Sephacel、ConA-Sepharose、Sephadex G-200及抗γ-谷酰基转移酶(GGT)免疫亲和层析提纯ALP。结果：提纯的ALP比活达402kU／g蛋白，几乎不含杂酶(未检出ALT、AST、ChE、AMY、CK、LDH，GGT仅含2U／780U ALP)。其对底物4-硝基磷酸酚(4-NPP)的Km值为1．35mmol／L，最适pH值为10．40。结论：提纯的猪肾ALP与人血清中的ALP酶动力学特性非常相似，为进一步研制ALP参考品奠定了基础。     

Topographical Displays of Somatosensory Evoked Potentials

Abstract: The distribution of somatosensory evoked potentials (SEPs) after stimulation of the median nerve at the wrist was examined in 10 normal subjects using isopotential maps. The latencies of continuous negative and positive peaks were measured in each lead. The differences of the potentials at these latencies were measured in all the leads and the isopotential maps were constructed. The distribution of P0–NI was all similar. The latencies of P0 were almost the same in all the leads at about 13 msec. The distribution of NI-PI-NII was divided into three types—N16–P20–N28 localized in the frontal region, N17–P22–N30 localized in the central region and N19–P25–N33 distributed in the parieto-occipito-temporal regions. The distributions of NII-PII and PII-NIII were all similar, with high amplitudes in the central region. The latencies of PII and NIII were almost the same in all the leads at about 45 msec and 68 msec.     

Optimization of self-reference thermometry using complex field estimation.

Referenceless, or self-reference, thermometry is a technique for mapping temperature differences in the region of interest (ROI) using the baseline phase estimated by extrapolating the field in the surrounding region for estimation (RFE) and subtracting the estimated baseline from the measured field. In the present work a self-reference technique based on complex field estimation using 2D polynomials comprising complex-valued coefficients was proposed and optimized. Numerical simulations with a Gaussian-profiled phase distribution demonstrated that the ROI radius had to be 2.3-2.5 times the standard deviation (SD) of the Gaussian function in order to keep the error below 8% of the peak phase change. The area ratio between the ROI and the RFE had to be larger than 2.0 to maintain the error level. Based on the simulations, and phantom and volunteer experiments, the complex-based method with independently optimized polynomial orders for the two spatial dimensions was compared with the phase-based method using the similar-order optimization strategy. The complex-based method appeared to be useful when phase unwrapping was not removed. Otherwise, the phase-based method yielded equivalent results with less polynomial orders.