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The first 150 words of the full text of this article appear below. Key points Coronary artery disease accounts for >30% ofdeaths in Western society. The diagnosis of myocardial infarctionshould be qualified by size, causation and time from occurrence. Mortalityis reduced by immediate or primary percutaneouscoronary intervention or thrombolysis within the first 24 hof onset of ST-segment elevation myocardial infarction. Strategiesto reduce platelet activation (glycoprotein IIb/IIIa receptorantagonists, or clopidogrel) are now recommended in the treatmentof high-risk non-ST-segment myocardial infarction/unstable angina. Elevatedserum troponins may be the result of non-ischaemic myocardialdamage, especially in critical illness.
Pathophysiology
Changes in the definition of terms relating to the diagnosisof myocardial infarction (MI) have evolved by better understandingof the pathophysiology culminating in the new term of acutecoronary syndrome (ACS). Figure 1 illustrates the processesthat occur in the development of an acute coronary event. 相似文献
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Martin-Hirsch P Rash B Martin A Standaert B 《BJOG : an international journal of obstetrics and gynaecology》2007,114(4):408-415
OBJECTIVE: To evaluate the time from abnormal Papanicolaou smear detected during routine screening to the initiation of investigation and treatment of subjects and to evaluate its related costs. DESIGN: Retrospective study of clinical records from women with abnormal cervical smears. SETTING: Six specialist gynaecology/colposcopy clinics in England and Wales. SAMPLE: Six hundred subsequent women (100 per clinic) with first abnormal cervical smear result at the specialist gynaecology/colposcopy clinic. METHODS: Details of all clinic visits, tests and procedures during 24 months starting from the first abnormal cervical smear were collected from the year 2002. MAIN OUTCOME MEASURES: Patterns of management after initial abnormal smear, time to start the investigation and/or treatment expressed in days/months and treatment costs by cytology and histology grades. RESULTS: Significant age differences were observed between women with early grades of precancer lesions (32 years) and cancer (49 years) (P < 0.05). Subgroup analysis of women younger than 26 years indicates a representation of this age group in all the histology grades including cancer. Median time to initiate the investigation and/or treatment was 50 days. In contrast, for 5% of women, delay in management lasted for >1 year. Colposcopy and repeated cervical smears were the most frequent systematic investigations performed, while the large loop excision of the transformation zone procedure was the principal therapeutic procedure. Analysis of average treatment costs by referral cytology showed small differences between the three grades of cytological diagnoses (mild dyskaryosis, 408.96 British pound; moderate dyskaryosis, 442.55 British pound and severe dyskaryosis, 493.74 British pound). Analysis by histology grade showed that the cost for women with a negative result (263.34 British pound) differed markedly from that for women with cervical intraepithelial neoplasia (CIN) (CIN1, 419.39 British pound; CIN2, 572.29 British pound; and CIN3, 584.92 British pound). CONCLUSION: Time to investigation could be improved for a subgroup of women. Costs associated with investigation and treatment of women with abnormal cervical smears differ significantly between analyses by cytology and histology grade. This needs to be borne in mind when designing cost-effectiveness studies of cervical screening. 相似文献
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腺病毒载体介导的PML生长抑制因子对前列腺癌细胞生长和致瘤能力的抑制效果 总被引:1,自引:0,他引:1
为探讨用腺病毒载体携带PML(PromyelocyticLeukemia)基因作为前列腺癌基因治疗的可能性,应用重组人携带PML基因腺病毒(AdPML)感染培养的前列腺癌细胞,观察表达PML蛋白的癌细胞与对照组癌细胞的体外生长和裸鼠体内致瘤能力变化,对荷瘤裸鼠瘤体周围注射AdPML,观察治疗组和对照组肿瘤生长的变化。结果显示,感染AdPML的前列腺癌细胞体外生长和裸鼠体内致瘤能力明显下降,荷瘤裸鼠瘤体周围注射AdPML后肿瘤生长速度明显减慢。证实了PML是一种生长抑制因子,提示其可能被应用于前列腺癌的基因治疗研究 相似文献
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Berbaum KS; el-Khoury GY; Franken EA Jr; Kathol M; Montgomery WJ; Hesson W 《Radiology》1988,168(2):507-511
The effect of knowledge of localizing symptoms and signs in the detection of fractures was studied. Forty radiographs of the extremities were examined twice by seven radiologists; the sessions were separated by 4 months. In 26 cases, a subtle fracture was present; 14 cases were normal. In half of the cases at each session, the precise location of pain, tenderness, or swelling was provided. The observer was asked to determine if the case was normal or abnormal (provide the exact location of the fracture) and to indicate the degree of confidence in the diagnosis. Responses were converted to a numeric scale for analysis. Analysis of receiver operator characteristic parameters indicates that clues regarding location of trauma facilitate detection of fractures. The improvement is based largely on an increased true-positive rate without an increased false-positive rate, regardless of the decision criteria of the radiologist (overall willingness to "overread" or "underread"). This has direct clinical applicability and reinforces the plea of radiologists for precise clinical information. 相似文献
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I?Satish?RaoEmail author Anand?C?Loya KS?Ratnakar VR?Srinivasan 《BMC clinical pathology》2005,5(1):11