Should medicine assist a teenager to achieve a pregnancy?

This article discusses a scenario of a teenager seeking medical assistance for infertility. Despite its apparent simplicity, the case poses a significant challenge to healthcare professionals. It requires consideration of maternal and child welfare and examination of the legitimate limits of doctors' role vis-à-vis the policy objective of reducing teenage pregnancy rate. The negative stereotypic representation of teenage pregnancy is an important confounding factor.     

Does This Patient Have a Mole or a Melanoma?

John D. Whited, MD; James M. Grichnik, MD, PhD

JAMA. 1998;279:696-701.

Lifetime risk for malignant melanoma has increased from 1 in 1500 in the United States in 1930 to 1 in 75 projected for the year 2000. Because the tumor's thickness at excision is the primary prognostic determinant, early detection through the history and physical examination can play an important role in the patient's clinical course. Two checklists have been developed as diagnostic aids, the ABCD (A indicates asymmetry; B, border irregularity; C, irregular color; and D, diameter >6 mm) and the revised 7-point checklists. These checklists should be interpreted with some discretion, but 2 studies have found the sensitivity for the ABCD checklist to be 92% (95% confidence interval [CI], 82%-96%) and 100% (95% CI, 54%-100%); 1 study found the specificity to be 98% (95% CI, 95%-99%). The revised 7-point checklist has been reported to have a sensitivity of 79% (95% CI, 70%-85%) to 100% (95% CI, 94%-100%) and specificity of 30% (95% CI, 21%-39%) to 37% (95% CI, 28%-46%). Physicians' global assessments for detecting the presence or absence of melanoma are estimated to have a specificity of 96% to 99%, while sensitivity ranges widely from 50% to 97%. Nondermatologists' examinations appear to be less sensitive than examinations performed by dermatologists.

     

Sport is a game

运动是游戏，不是任务，当它是游戏吧，让自己乐在其中。 把目标抛开，一切由你!跟着心跳的节奏起舞，随着心情自由奔跑，无论是潇洒自在还是心血来潮，哪里有运动，哪里就有快乐。在运动中释放自己，感受其中的乐趣，发现原来生活中惊喜无处不在![编者按]     

Friedreich’s Ataxia: a review from a cardiology perspective

Background

Neuromuscular disorders are not among the common causes of cardiomyopathy in the general population; however, cardiomyopathy is known to occur in several neuromuscular disorders including Friedreich’s Ataxia (FA). In patients with neuromuscular disorders, concomitant cardiac involvement contributes significantly to morbidity and mortality and often leads to premature death.

Methods

An extensive literature search of Medline and Pubmed was conducted to include all published reports on cardiac involvement in FA. Secondary articles were identified from key paper reference listings.

Conclusion

Hypertrophic cardiomyopathy is a cardinal feature of FA; therefore all FA patients should be screened for cardiomyopathy. A cardiac examination, ECG and ECHO are advised at diagnosis, and also on the development of any cardiac symptoms. Treatment is determined by the presence of symptoms, the presence of left ventricular outflow gradient and the sudden death risk. Institution of aggressive medical therapy early in the course of the disease may help improve quality of life and provide survival benefit.     

miR-23a研究进展

微RNA(miRNA)是一类内源性长约22个核苷酸的非编码RNA分子,进化中具有高度保守性,在转录后水平调控基因的表达从而在生物过程中发挥重要的作用。miR-23a是miRNA中的一员,近期研究表明,miR-23a广泛调控机体各种生理和病理过程。miR-23a在细胞分化中起重要作用,参与骨骼肌的形成、造血细胞分化、少突细胞分化等过程。miR-23a在肝炎、牙周炎等慢性炎症反应中升高,并且与炎性细胞因子白细胞介素6的表达和分泌密切相关。miR-23a可以促进心肌细胞肥大,对心力衰竭和冠状动脉粥样硬化性心脏病等在诊断和治疗上均有很大的潜能。miR-23a在多种肿瘤中起到致癌基因作用,但是也会在个别肿瘤中出现抑癌基因作用。     

健康人脂蛋白a分析

1963年美国的Berg在人体血浆中发现了脂蛋白a(简称Lp(a)),它由脂质和蛋白质组成,其脂质部分与低密度脂蛋白(简称LDL)的脂质相似,蛋白质部分由载脂蛋白B(即(ApoB)和Lp(a)的特异抗原即糖蛋白a组成,且ApoB占65～70％。Lp(a)平均分子量为4×10~6,密度在1.05～1.1g/ml之间。去蛋白的Lp(a)的生理特性和生化特性     

脂蛋白a临床研究进展

脂蛋白a作为一种特殊的蛋白颗粒,在致动脉粥样硬化过程中起着极其重要的作用。另外,脂蛋白a在预测动脉粥样硬化性心血管疾病的发生、冠状动脉粥样硬化性心脏病(冠心病)的再发、静脉血栓事件的发生以及肾脏移植预后等方面均有重要的临床价值。目前对于脂蛋白a尚缺乏确实有效地特异性的临床干预措施。该文就脂蛋白a的临床研究进展予以综述。     

Does your hospital need a robot or a management trainer?

Executives of small hospitals and home health services have heard that this is the Age of Computers, Telecommunications, Robotics, and Gene Engineering, and they wonder if their organizations might benefit from the high technology and advanced management tools employed by big corporations and “leading edge” hospitals. But they are too tired and busy to greatly expand their technical/managerial expertise, especially since there are so many choices among possible innovations, ranging from robotics to management training, each choice demanding different new expertise, and each requiring an investment of time and energy. We helped several health care executives to identify their options for innovation. We offered a scoring scheme to sort out the innovation options (a simple but effective way to decide what innovation would be “right” for their organization), and a simple, “back of the envelope” tutorial on robotics in health care. The principle is to allow the administrators to make a quick evaluation of the paths they might wish to travel. Our point here is that for every “natural-born” innovator, there must be dozens of interested but uncommitted persons who need some gentle, simple help. To the extent that the diffusion of medical systems depends on a mass market, these fence-sitters must receive help and guidance.     

Congenital scoliosis in a neonate: can a neonatologist ignore it?

The frequency of diagnosis of congenital scoliosis in the neonatal period is expected to rise given the increasing survival of high risk neonates in the surfactant era and their frequent exposure to x rays. Considering its significant long term implications a neonatologist cannot afford to ignore the diagnosis of congenital scoliosis in a neonate as close surveillance, early detection, and treatment may prevent/minimise the wide spectrum of potentially serious deformities that can affect the developing spine. The review provides general guidelines to help the neonatologists in counselling the parents and in planning the multidisciplinary follow up for management of congenital scoliosis.     

What is a doctor, and what does a doctor do?

The Productivity Commission's recent proposal to modify the roles of health professionals raises these important questions.     

Acute promyelocytic leukemia in a hemophilia A patient:a case report

Acute promyelocyticleukemia (APL )istheM 3subtypeoftheFrench American British (FAB )classificationofacutemyeloidleukemia (AML ) HemophiliaisacongenitalbleedingdisordercharacterizedbyadeficiencyofcoagulationfactorVIIIorIX Inourcenter ,morethanonethousandpatientswithhaemophiliaAhavebeentreatedsince 1980 1　InJune 2 0 0 2 ,APLwasfirstdiagnosedinonepersonwithhaemophilia (PWH ) Thecoincidenceofthesetwodiseasesledtochallengesindevelopingatreatmentstrategy CASEREPORTA 32 year ol…     

Clinical neurophysiology referral patterns to a tertiary hospital — a prospective audit

Background Cork University Hospital (CUH) provides a tertiary service for all neurophysiology referrals in the Southern Health Board region. Aim To ascertain the number, source, symptoms and diagnosis of neurophysiology referrals at CUH. Methods We did a prospective audit of the referral patterns to the neurophysiology department over a 12-week period. Results Of 635 referrals, 254 had electromyograms (EMG), 359 had electro-encephalograms (EEG), 18 had visual evoked potentials (VEP), three had somato-sensory evoked potentials (SSEP) and one had multiple sleep latency tests (MSLT). We analysed the demographic pattern, reason for referrals, the average waiting time for neurophysiology tests and the patterns of diagnosis in this audit. Conclusions Patients from County Cork are making more use of the neurophysiology services than patients from other counties within the Southern Health Board. The average waiting time for an EEG was 32 days and for an EMG was 74 days. However, more than 35% of those patients waiting for an EEG or an EMG had their tests done within four weeks of referral. The appointments of EEG and EMG were assigned on the basis of clinical need.