抗角蛋白抗体对类风湿性关节炎诊断价值的系统评价

目的系统评价抗角蛋白抗体(AKA)诊断类风湿性关节炎(RA)的准确性。方法计算机检索PubMed(1966～2010.6)、Cochrane图书馆(2010年第6期)、中国生物医学文献数据库(1978～2010.6)、中国期刊全文数据库(1994～2010.6)、中文科技期刊全文数据库(1989～2010.6)、中华医学会数字化期刊库(1997～2010.6)等,收集用AKA诊断RA的试验研究,依据QUADAS质量评价标准评价纳入研究的质量后,采用Meta-Disc软件(version 1.4)进行Meta分析。结果共纳入69个研究,合计14?890例受试者。Meta分析结果显示:与美国风湿病协会修订的RA分类标准相比,AKA诊断RA的合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比和SROC曲线下面积分别为0.41(0.39,0.42)、0.94(0.94,0.95)、9.52(7.21,12.57)、0.63(0.60,0.66)、15.24(11.62,19.98)和0.613?6。结论 AKA可以作为确诊RA的方法之一,并建议临床医生使用时,与其它的自身抗体检测方法联用。     

Therapeutic Jurisprudence and Sex Offenders: A Psycho-Legal Approach to Protection

Societal response to sex offenders is marked by uncertainty about whether punishment or treatment should occur. The distinction between punishment, prevention, and protection is useful to determine how best to assess, treat, and manage sex offenders within the criminal justice system. Once convicted, both law and psychology are concerned with sex offenders changing their behavior in order to protect the community. Therapeutic jurisprudence is a legal theory that aims to maximize therapeutic effects of the law and minimize anti-therapeutic consequences of the law. Therapeutic jurisprudence provides a framework to combine legal and psychological processes to balance prevention and protection. Legal and correctional practitioners can work together to address both community protection and offender protection concerns.     

继发性限制型心肌病的诊疗思路

限制型心肌病在临床中比较少见，本文报告1例，旨在通过继发性限制型心肌病的病因查找、证据验证，以期给读者提供一个明晰的诊断思路。     

宫颈胎盘部位滋养细胞肿瘤一例并文献复习

目的通过对1例原发于宫颈的胎盘部位滋养细胞肿瘤(PSTT)的资料及相关文献的复习,全面介绍胎盘部位滋养细胞肿瘤的临床特征、病理特点、治疗方式及预后。方法对收治1例罕见原发于宫颈部位的PSTT的临床病理资料进行分析,并以"胎盘部位滋养细胞肿瘤"为主题词查阅中国知网(CNKI)及PubMed等文献数据库进行文献复习。结果该例原发于宫颈部位的PSTT患者术后化学疗法后,目前情况良好,已随访3年,无复发及转移征象。2011年9月1日前,CNKI数据库共报道300余例PSTT病例,PubMed数据库共160余例,其中有2例原发于宫颈部位的PSTT。原发于宫颈部位的PSTT罕见,易误诊,往往需要宫颈活组织检查或宫颈搔刮才能确诊。结论原发于宫颈部位的PSTT的预后是否遵循PSTT尚需收集更多的病例证实。PSTT因其发病率低,临床表现多无特异性,通常需要通过诊断性刮宫、活组织检查甚至术后病理检查才能确诊。PSTT首选的治疗方式为手术,多数患者病灶清除后可治愈,对有高危因素的患者术后宜选择依托泊苷+甲氨蝶呤+放线菌素D+环磷酰胺+长春新碱(EMA-CO)方案或依托泊苷+甲氨蝶呤+放线菌素D+依托泊苷+顺铂(EMA-EP)方案进行化学治疗,以期改善预后。     

Hypnosis Before Diagnostic or Therapeutic Medical Procedures: A Systematic Review

The aim of this systematic review was to estimate the efficiency of hypnosis prior to medical procedures. Different databases were analyzed to identify randomized controlled trials (RCTs) comparing hypnosis to control interventions. All RCTs had to report pain or anxiety. Eighteen RCTs with a total of 968 patients were included; study size was from 20 to 200 patients (14 RCTs ≤ 60 patients). Fourteen RCTs included 830 adults and 4 RCTs included 138 children. Twelve of 18 RCTs had major quality limitations related to unclear allocation concealments, provider’s experience in hypnosis, patient’s adherence to hypnotic procedures, and intention-to-treat design. This systematic review observed major methodological limitations in RCTs on hypnosis prior to medical procedures.     

Headaches Associated With Chronic Use of Analgesics: A Therapeutic Approach

We evaluated 102 patients attending the Headache Study Center of the University of Modena who were suffering from chronic daily headache with daily drug intake. Patients underwent either day hospital treatment followed by a standard prophylactic therapy or they started prophylactic therapy immediately. After 30 and 120 days, both the Headache Index and the daily drug intake had significantly improved (P<0.001), and there were no differences in reduction of mean values of the Headache Index or daily drug intake with respect to the two treatments, nor with regard to the prophylactic therapy chosen. Twenty-eight percent of patients reverted to daily drug intake after a 4-month follow-up; these patients took bar-biturate-containing mixtures in a higher percentage than other drugs, and within the group of relapsing patients the outpatients relapsed to analgesic intake more than the day hospital-treated patients (P<0.05).     

细菌生物被膜的防治进展

细菌生物被膜（bacterialbiofilm,BF）是指多个细菌不可逆地黏附于机体或物体表面,被自身细胞分泌的基质所包裹,能表达一套与浮游细菌不同的基因,即一个新的表型。它是细菌的三维聚集体,在许多生物医学材料相关性感染和慢性感染疾病中起着重要作用,所致疾病迁延不愈,是医学工作者面临的巨大挑战。因此,如何防止其形成和有效清除已形成的生物被膜,在临床实践中至关重要。现对细菌生物被膜的防治综述如下。     

支气管肺类癌的临床特点及预后因素分析

  目的  探讨支气管肺类癌, 包括典型类癌(typical carcinoid, TC)及不典型类癌(atypical carcinoid, ATC)的临床特点及手术治疗经验, 并分析可能的预后因素。   方法  回顾总结2000年1月至2014年1月在北京协和医院接受手术治疗并经病理检查证实为TC或ATC的57例患者临床资料, 同时进行生存和预后分析。   结果  57例患者中男性35例, 女性22例, 中位年龄49岁(12~85岁), 中位病程3个月(1~156个月), 临床症状缺乏特异性, 12例伴有异位促肾上腺皮质激素综合征。术后病理确诊TC 39例, ATC 18例; Ⅰ期为主, 共41例, Ⅱ期和Ⅲ期各7例, IV期2例。5年、10年存活率分别为92.4%及89.0%。Kaplan-Meier分析显示, 病理类型、T分期及N分期的P值分别为0.001、0.000、0.004。   结论  支气管肺TC及ATC缺乏特异性临床表现, 手术效果良好, 病理分型、肿瘤T分期和N分期可能是预后的影响因素。     

植入前综合症的诊治进展

植入前综合征(pre-engraftment syndrome,PES),亦称植入前免疫反应(pre-engraftment immune reactions,PIR),是指造血干细胞移植(hematopoietic stem cell transplantation,HSCT)后,特别是脐血移植后常见的免疫反应,主要临床表现为发热、皮疹、腹泻和/或黄疸等症状.目前,有关PES的报道甚少,本文就HSCT后PES的发病情况、发病机制、诊断及治疗,综述如下.     

Diagnostic and Therapeutic Uses of Intestinal Intubation

Intubation of the intestine is widely employed in the clinical management of patients. In this article are discussed some of the more important applications of this procedure in the diagnosis and treatment of intestinal, biliary and pancreatic diseases.     

Narrow Complex Tachycardia with VA Block: Diagnostic and Therapeutic Implications

To review our experience with cases of narrow complex tachycardia with VA block, highlighting the difficulties in the differential diagnosis, and the therapeutic implications. Prior reports of patients with narrow complex tachycardia with VA block consist of isolated case reports. The differential diagnosis of this disorder includes: automatic junctional tachycardia, AV nodal reentry with final upper common pathway block, concealed nodofascicular (ventricular) pathway, and intra-Hissian reentry. Between June 1994 and January 1996, six patients with narrow complex tachycardia with episodes of ventriculoatrial block were referred for evaluation. All six patients underwent attempted radiofrequency ablation of the putative arrhythmic site. Three of six patients had evidence suggestive of a nodofascicular tract. Intermittent antegrade conduction over a left-sided nodofascicular tract was present in two patients and the diagnosis of a concealed nodofascicular was made in the third patient after ruling out other tachycardia mechanisms. Two patients had automatic junctional tachycardia, and one patient had atroventricular nodal reentry with proximal common pathway block. Attempted ablation in the posterior and mid-septum was unsuccessful in patients with nodofascicular tachycardia. In contrast, those with atrioventricular nodal reentry and automatic junctional tachycardia readily responded to ablation. The presence of a nodofascicular tachycardia should be suspected if: (1) intermittent antegrade preexcitation is recorded, (2) the tachycardia can be initiated with a single atrial premature producing two ventricular complexes, and (3) a single ventricular extrastimulus initiates SVT without a retrograde His deflection. The presence of a nodofascicular pathway is common in patients with narrow complex tachycardia and VA block. Unlike AV nodal reentry and automatic junctional tachycardia, the response to ablation is poor.     

超声对化脓性髋关节炎的诊断意义

意义.     

风湿性关节炎超声诊断价值的探讨

目的 探讨肢体风湿性关节炎超声诊断的价值。方法 应用高分辨力超声（１０ＭＨｚ以上的高频探头）检查临床初诊为风湿性关节炎患者３２例,８６个关节。结果 风湿性关节炎超声图像显示关节旁软组织病变,如滑膜增厚,关节积液,滑囊炎,腱鞘周围积液,关节旁软组织肿胀,关节软骨和关节面下骨质侵蚀等。结论 超声检查有助于风湿性关节炎肢体侵犯的诊断和鉴别,也有助于治疗方法的选择。