Guidelines for medical and health information sites on the internet: principles governing AMA web sites. American Medical Association

Access to medical information via the Internet has the potential to speed the transformation of the patient-physician relationship from that of physician authority ministering advice and treatment to that of shared decision making between patient and physician. However, barriers impeding this transformation include wide variations in quality of content on the Web, potential for commercial interests to influence online content, and uncertain preservation of personal privacy. To address these issues, the American Medical Association (AMA) has developed principles to guide development and posting of Web site content, govern acquisition and posting of online advertising and sponsorship, ensure site visitors' and patients' rights to privacy and confidentiality, and provide effective and secure means of e-commerce. While these guidelines were developed for the AMA Web sites and visitors to these sites, they also may be useful to other providers and users of medical information on the Web. These principles have been developed with the understanding that they will require frequent revision to keep pace with evolving technology and practices on the Internet. The AMA encourages review and feedback from readers, Web site visitors, policymakers, and all others interested in providing reliable quality information via the Web.      

Expanding insurance coverage through tax credits, consumer choice, and market enhancements: the American Medical Association proposal for health insurance reform

Donald J. Palmisano, MD, JD; David W. Emmons, PhD; Gregory D. Wozniak, PhD

JAMA. 2004;291:2237-2242.

Recent reports showing an increase in the number of uninsured individuals in the United States have given heightened attention to increasing health insurance coverage. The American Medical Association (AMA) has proposed a system of tax credits for the purchase of individually owned health insurance and enhancements to individual and group health insurance markets as a means of expanding coverage. Individually owned insurance would enable people to maintain coverage without disruption to existing patient-physician relationships, regardless of changes in employers or in work status. The AMA's plan would empower individuals to choose their health plan and give patients and their physicians more control over health care choices. Employers could continue to offer employment-based coverage, but employees would not be limited to the health plans offered by their employer. With a tax credit large enough to make coverage affordable and the ability to choose their own coverage, consumers would dramatically transform the individual and group health insurance markets. Health insurers would respond to the demands of individual consumers and be more cautious about increasing premiums. Insurers would also tailor benefit packages and develop new forms of coverage to better match the preferences of individuals and families. The AMA supports the development of new health insurance markets through legislative and regulatory changes to foster a wider array of high-quality, affordable plans.

     

Medical licensing requirements

While there are differences among the licensing jurisdictions in regard to the details of licensing, in general boards require applicants to have graduated from an acceptable school, to have completed a period of residency training in the United States or Canada, and to pass an acceptable licensing examination. Applicants for licensure should seek information about the detailed requirements for licensure from the licensing board where they want to be licensed. Medical graduates who are being licensed through FLEX should keep in mind that later applications for licensure by endorsement will depend on fulfilling acceptable licensing requirements in connection with initial licensure. Thus, graduates should be informed in general of licensing requirements at the time of initial licensure. The annual AMA licensing publication, cited previously, is a good source of information of this kind. Boards are increasing the length of graduate medical education required for licensure at present; they are also adding to the requirements for endorsement of licenses, for instance, setting limits to the number of years a licensing examination will be accepted for licensure endorsement. The AMA will continue its efforts to provide information about licensing requirements and to adopt policy positions in regard to licensing that will serve the interests of the medical profession while protecting the health and welfare of the American public.     

扩张型心肌病患者主动脉瓣环与二尖瓣环偶联机制及其与心功能的关系研究

目的 运用斑点追踪技术比较扩张型心肌病患者与正常人群主动脉瓣环和二尖瓣环位移（AE）及主动脉瓣二尖瓣环平面夹角（AMA）的大小及变化规律;评价二者间的偶联机制并探讨瓣环偶联运动与左室功能的相关性。方法 纳入35例扩张型心肌病患者及35例性别年龄相匹配的健康人作为对照,采集经胸超声心动图图像。在胸骨旁长轴切面,使用Philips QLAB 9.0软件对瓣环各点AE及AMA进行二维定量。在心尖四腔心切面,使用Tomtec Arene1.0三维软件获取左室射血分数（LVEF）及整体纵向、环向及径向应变参数。结果 与正常对照相比,扩张型心肌病患者各瓣环处AE明显减小,AMAmax及AMAmin增大,AMAmax-min减小,差异有统计学意义,其AE及AMA在心动周期内的变化规律与正常对照略有差异,即AMA在舒张期较早地达到最大值且变化幅度减小。各AE均与LVEF及各向应变正性相关,AMAmax及AMAmin与各AE、LVEF及各向应变负性相关,AMAmax-min与各AE、LVEF及各向应变正性相关(P均<0.05)。结论 斑点追踪技术可用于快速方便地定量AE、AMA、LVEF及各向应变。扩张型心肌病患者主动脉瓣环和二尖瓣环的偶联运动存在异常,与左室收缩功能密切相关。瓣环位移及夹角可较方便、快速地判断心脏整体及局部收缩功能。     

42例原发性胆汁性肝硬化临床分析

目的:分析原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)的临床特征,旨在提高对该病的诊治水平.方法:对临床/病理诊断PBC的42例住院患者的临床资料进行回顾性分析,总结抗线粒体抗体(anti mitochondrial antibody,AMA)阴性患者及合并干燥综合征(Sj(o)gren syndrome,SS)患者的临床、生化和免疫学特征.结果:本组患者中女性占78.6%(33/42),确诊时的平均年龄(61.1±10.8)岁,最常见的临床症状为乏力(76.2%,32/42).患者血清碱性磷酸酶(alkaline phosphatase,ALP)、γ-谷氨酰转肽酶(γ-glutamyltranspeptidase,γ-GT)及总胆汁酸(total bile acid,TBA)明显升高,转氨酶轻中度升高(73.8%,31/42),血清总胆红素(total bilirubin,TBil)升高.TBil、凝血酶原时间与病程呈正相关(P=0.000,r=0.696;P=0.005,r=0.424);血清白蛋白水平与病程呈负相关(P=0.002,r=-0.462).88.1%(37/42)患者血清IgM升高,81%(34/42)患者AMA/AMA-M2阳性.AMA阴性患者血清IgA、IgM水平低于AMA阳性者,血清总胆固醇(total cholesterol,TCho)水平高于AMA阳性者.15例PBC患者合并SS,和未合并SS的PBC患者比较,生化及免疫学等多方面检查差异皆无统计学意义.结论:PBC主要累及中老年女性,血清ALP、γ-GT及TBA水平升高及AMA/AMA-M2阳性有助于诊断本病.AMA阴性PBC患者除血清IgA和IgM较低及血清TCho水平较高外,其他临床特征和AMA阳性者相似;合并SS的PBC患者临床特征和无SS的PBC者相似.     

血清学筛查在高龄孕妇产前诊断中应用价值分析

目的：探讨血清学筛查在高龄孕妇产前诊断中的应用价值。方法回顾性分析2012年1月1日-2012年10月31日行胎儿染色体核型分析的高龄孕妇314例,按预产期年龄分为35～39岁组和≥40岁组;按血清学筛查情况分为血清学筛查低危组、血清学筛查高危组和未做血清学筛查组,分析各组胎儿染色体异常率。结果胎儿染色体异常率4．14％（13/314）。≥40岁组胎儿染色体异常率13．21％（7/53）,高于35～39岁组2．30％（6/261）（ P＝0．001）。血清学筛查高危组胎儿染色体异常率7．69％（7/91）,高于血清学筛查低危组0（0/64）（ P＝0．022）。结论对高龄孕妇进行血清学筛查,有助于减少介入性产前诊断率。     

“胡桃夹”现象在正常儿童人群中的百分比及临床意义

目的 探讨“胡桃夹”现象在正常儿童人群中出现的百分比及临床意义.方法 回顾性分析2012年1月至2016年3月在重庆医科大学附属儿童医院放射科因非肾脏相关疾病行CT血管成像(computed tomographic angiography,CTA)检查的儿童腹部CTA影像及临床资料,共246例,男131例,女115例;年龄范围1月～＜13.0岁,平均年龄(4.94±3.48)岁;所有儿童均除外左肾及左肾静脉相关疾病与变异,尿常规检查未见异常.按年龄分为7组:婴儿期(1月～＜1.0岁)为l组,其他1.0～＜13.0岁儿童以两岁为间隔分为6组.在CTA图像上,以同时具有左肾门部左肾静脉最大内径(D2)≥3倍腹主动脉与肠系膜上动脉间的左肾静脉内径(D1)以及腹主动脉与肠系膜上动脉之间的夹角(aortomesentericangle,AMA) ＜45°为标准,判断是否存在“胡桃夹”现象,分析“胡桃夹”现象在正常儿童人群出现的百分比,以及AMA的变化.结果 246例中,34例(13.82％)出现“胡桃夹”现象,婴儿组出现百分比为0％,余下各组百分比依次为5.77％(3/52),12.20％(5/41),16.67％ (8/48),18.75％(6/32),23.81％(5/21),28.00％ (7/25),各年龄组“胡桃夹”现象出现的百分比存在显著的等级趋势性增高差异(x2=13.879,P＜0.01),年龄越大出现百分比相对越高,而AMA随年龄的增大逐渐变小.结论 “胡桃夹”现象在正常儿童人群出现的百分比约为13.82％,其可以作为一种正常的解剖变异出现在一部分正常儿童中,正确认识这一现象可避免将其过度诊断为“胡桃夹”综合征.     

中国近代医学社团——博医会

从17世纪下半叶起,西欧相继出现了柏林皇家医学会、巴黎外科学会、爱丁堡和伦敦医学会等医学团体,它们通过举办会议,编辑期刊,极大地推动了当时欧洲医学的进步.19世纪末期,西方在华医学传教士为了更好地进行医学传教及医学教育工作,借鉴西方的医学社团制度,成立了"中国博医会"."博医会"致力从事医学名词的统一与标准化、教会医院...     

The law, the AMA, and partial-birth abortion. American Medical Association.

The three articles by Dr. Gans Epner, Drs. Sprang and Neerhof, and Dr. Grimes centered around the issue that criminal laws against so-called partial-birth abortion go beyond banning any one abortion procedure or just "late-term" procedures. It is noted that even the authors gave different definitions of "late term". In addition, neither the phrase "late term" nor "intact dilation" and evacuation is present or defined in any of the partial-birth abortion laws passed in 27 states or in the federal bill. Evidence shows that 17 courts across the US have blocked partial-birth abortion laws as unconstitutional, finding such laws could, at any point in a pregnancy, outlaw an abortion performed using the most common and safest procedures. In these terms, the endorsement of the federal partial-birth abortion law by the American Medical Association gave credibility to the deception that partial-birth abortion legislation is a ban on the intact dilation and extraction procedure. Moreover, it has endorsed government intrusion in a private medical decision and sanctioned a law that subjects physicians to criminal prosecution for providing necessary health care.     

Relation of antimyocardium antibodies to mortality in patients with acute myocardial infarction

BACKGROUND: Antimyocardium antibodies (AMA) have been observed in patients with acute myocardial infarction (AMI). At present it is unknown if these AMA play a role in the pathogenesis of acute or chronic myocardial damage or if they are only produced as a result of tissue destruction, disappearing later without clinical manifestations. However, some studies have shown that patients with AMI and AMA have higher possibilities of presenting heart failure and death. The aim of the present study was to determine if there is an association (odds ratio, OR) between AMA and death in patients with AMI. METHODS: The design was a cross-sectional study. One hundred patients with acute myocardial infarction were recruited consecutively at the Coronary Care Unit of the Hospital de Especialidades at La Raza National Medical Center, IMSS, Mexico City. IgG antimyocardium antibodies were identified using the enzyme-linked immunosorbent assay technique (ELISA). RESULTS: Of the 100 patients studied, 81 were males and 19 females, with an average age of 58 +/- 11 years. Of the population studied, 44% showed AMA. It was observed that patients with positive AMA had an OR for heart failure of 3.40 (CI 95% 0.97-12.5, p = 0.06) and for death of 7.94 (CI 95%, 1.49-56.1, p = 0.003). This variable was analyzed with other confounding variables using logistic regression, and an OR of 11.8 (CI 95% 1.63-86.3, p = 0.001) was obtained. CONCLUSIONS: AMAs were an independent predictive factor for mortality in patients with AMI.     

原发性胆汁性肝硬化患者自身抗体谱检测分析

目的：对确诊PBC患者自身抗体AMA/AMA-M2、ANA进行分析,为临床诊断提供实验室参考.方法：间接免疫荧光法检测55例确诊PBC患者与71例AIH患者血清ANA、AMA/AMA-M2等抗体.结果：55例PBC患者中AMA检出率为80％（44/55）,AMA-M2检出率为58.1％（32/55）,37例ANA阳性,检出率67.3％,其中11例（20％）均质型,7例（12.7％）为着丝点型,6例（10.9％）核膜型,5例（9.1％）为颗粒型,3例（5.5％）为核点型,6例（10.9％）为混合型;而71例AIH患者中AMA检出率为14.1％ （10/71）,AMA-M2检出率为2.8％（2/71）,40例ANA阳性,检出率56.3％,其中4例（5.6％）均质型,3例（4.2％）为着丝点型,7例（9.9％）核膜型,9例（12.7％）为颗粒型,7例（9.9％）为核点型,10例（14.1％）为混合型.结论：PBC患者AMA的检出率明显高于其他自身抗体指标,且AMA-M2仅见于PBC患者与AIH＋ PBC重叠综合征的患者;ANA在PBC患者中的检出率仅次于AMA,但是不能单独用于PBC的诊断.     

抗霉素A诱导血小板凋亡的分子机制研究

目的：探讨抗霉素 A（AMA）诱导血小板凋亡及其分子机制。方法取健康志愿者单采血小板,离心洗涤得到洗涤血小板,将洗涤血小板与不同浓度的 AMA 孵育后,流式细胞术检测线粒体跨膜电位（ΔΨm）去极化、磷脂酰丝氨酸（PS）暴露、细胞内活性氧（ROS）、线粒体 ROS、P-选择素表达和整合素αⅡbβ3活化;Western blot 法检测半胱氨酸天冬氨酸蛋白酶3（Caspase-3）的活化。在抑制试验中,先将洗涤血小板与线粒体靶向的 ROS 拮抗剂 Mito-TEMPO 预孵育,然后再与 AMA 孵育,流式细胞术检测相关凋亡指标。结果AMA 剂量依赖性诱导血小板ΔΨm 去极化、PS 暴露、细胞内ROS 和线粒体 ROS 升高以及 Caspase-3活化;但是 AMA 不能诱导血小板活化。线粒体靶向的 ROS 拮抗剂抑制 AMA诱导的血小板ΔΨm 去极化、PS 暴露、Caspase-3活化以及线粒体 ROS 的生成。结论 AMA 能够诱导血小板发生凋亡,线粒体 ROS 可能在 AMA 诱导的血小板凋亡过程中起重要作用。     

抗线粒体抗体亚型在原发性胆汁性肝硬化中的诊断价值

目的研究抗线粒体抗体（AMA）及其分型对原发性胆汁性肝硬化（PBC）的诊断价值。方法应用间接免疫荧光法测定血清中AMA抗体,用免疫印迹法检测AMA-M2、M4、M9亚型。78例PBC患者、35例其他肝病患者和20名健康体检者检测AMA及M2,其中30例PBC患者检测M4、M9型。结果78例PBC患者中74例（94.9%）AMA及M2均阳性。35例其他肝病患者M2均阴性。20名健康体检者AMA及M2均阴性。结论AMA及其分型,特别是M2抗体检测可作为临床诊断PBC的重要血清免疫学指标。     

美国医学会杂志

JAMA是享誉世界的综合性医学周刊(www.ama.org/public/journals/jama),月发行量十几万份. 其网络版做得朴实无华,与新英格兰医学杂志之华丽无法比较. 主页为排列式文字链接. 其网络版突出之处设有最近新闻一栏. 美国医学会下辖十几个医学专业期刊,该栏将JAMA和其他各期刊上最重要文章的摘要收入其中,基本可反映美国医学界的主要学术动态. JAMA在线期刊不仅提供本周出版的JAMA目录和文摘,还提供下周即将出版期的目录和文摘. 该刊还设有医学继续教育栏,对年轻医师的成长是一种非常有益的辅导和帮助. 该刊还设有适于学生阅读文章的链接,颇有新意. 非常遗憾的是该网络版中过刊仅从1995年至今,似乎少了一些. 该刊网页较新颖的是将全世界主要期刊中有关老年医学的文章汇集于一起. 进入该栏,可看到一幅世界地图,按六大区分别设六个键,北美部分最为丰富,大约收录有上百个杂志,文章甚多. 亚洲和澳洲共为一部分,其中收录有中国《中华医学杂志》的三篇文章,中国台北《台湾医学会杂志》的文章也被收录. 这对从事老年医学的医生和学者非常方便,每种杂志均注明了主编及各杂志编辑部地址、电话、传真,若需联系随即可得. JAMA网页也附有一个投稿须知,较详细地说明并告诉作者,若所投文章中无图、表的话,即可通过E-mail传递文章,大大缩短了文章发表时间. 另外,JAMA网络版还设有广告刊例,详细说明广告位置、大小与价格的关系. 从该刊网页看,插有小块与医学有关的广告,广告收入对维持发展在线期刊是非常重要的. JAMA与新英格兰医学杂志相比,显得小气,仅有文摘而不提供任何全文. (许昌泰摘)     

Effect of anti-cardiac myosin antibody on prognosis of patients with acute myocardial infarction

Immunolog'ilcal dysfunction plays an importantrole in the evolution and progression of acute myocardial infarction (AMI), which induces extension of AMI and postinfarction complications[" 2].Recent studies shoWed that anti--cardiac myosin antibody (AMA) colld be detected in the serum ofpatients with AMI at the end of the first week after the infarction, with a detection rate of 25 %['].In this study we investigated AMA and changes ofleft ventricular function, studied the relationshipbetw…     

Genetic counseling, prenatal screening and diagnosis of Down syndrome in the second trimester in women of advanced maternal age: a prospective study

Background The incidence of autosomal trisomy in livebirths is strongly dependent on maternal age.Special consideration is given to the provision of prenatal screening and cytogenetic testing to women ...     

血清学检测在高龄产妇产前诊断中预测胎儿染色体异常的应用效果研究

目的探讨血清学检测在与AMA产前诊断中预测胎儿异常的应用意义。方法选取该院进行产前诊断的AMA进行侵入性诊断,并对出现异常结果的AMA进行血清学的检测,观察检测中的异常结果出现率。结果经过两种不同方式的检测,羊水检测发现在20例研究对象中有3例检测出染色体异常,占33.3%的检测率,而血清学检测检测出共有6例异常结果,检测率为66.6%,明显大于羊水检测的方法,与不同年龄段的AMA染色体异常率检测差异有统计学意义。结论血清学检测在提高AMA胎儿染色体异常的异常率中非常具有优越性,可作为常用的诊断方案。