应用不同版智商常模对同一批儿童智商的分析

目的 验证第二次修订的中国联合型瑞文测验智商常模的实用性和准确性。方法 应用中国联合型瑞文测验图册和ＣＲＴ－ＲＣ,ＣＲＴ－ＲＣ２及ＣＲＴ－ＣＣ,ＣＲＴ－ＣＣ２,测验及判定同一批农村,城市的７－１４岁儿童智商水平。结果 ＣＲＴ－ＲＣ的智商均值为１０４．７５±１３．８３,智商呈轻度偏态分布,ＩＱ≤７９占７．６％,ＩＱ≥１２０占１２．７％,两者差异显著;     

农村成人瑞文智力测验评价方法的初探

瑞文智力测验是评价缺碘对智力损伤的常用方法之一。瑞文智力测验已有城市儿童和成人常模及农村儿童常模应用于相应人群的智商评价，农村成人瑞文测验的评价一直是空白，在暂时难于建立农村成人常模的情况下，使用城市成人常模和农村14．5岁儿童常模评价农村成人的智商是否有差别，哪一个更适合评价农村成人？我们使用上述常模对同一组农村成人智力测验结果进行了对比评价，现将结果报道如下。     

济南市学龄儿童智力水平调查研究

本文报告应用瑞文测验（ＣＲＴ－ＲＣ）中国农村版和城市智商常模对济南市区学龄儿童的智商进行了测试，结果表明：济南市儿童智商基本呈正常分布，略向高值偏移。儿童的智商除受碘元素影响外，也与学生的生活营养水平和父母的文化程度有关，且不同年龄、性别和不同测试时间儿童的智商水平无显著性差异（Ｐ〉０．０５），但智商与学生的学习成绩明显相关（Ｐ〈０．０１），智商与数学的相关系数大于与语文的相关系数，说明ＣＲＴ－Ｒ     

湖南省城乡5—16岁儿童瑞文测验智力水平分析

用瑞文测验方法测定了湖南省碘缺乏病非病区或轻度缺碘地区城市和农村５～１６岁儿童智力水平。结果表明，城乡儿童智商发育基本正常，均值高于全国常模，呈轻度偏态分布。农村儿童的学龄前期、小学和中学的三个阶段智商呈上升趋势，认为这与社会刺激较少及升学率不高有关     

辽宁省碘缺乏病轻病区不同时期出生儿童智力水平分析

目的了解和比较辽宁省碘缺乏病轻病区不同时期出生儿童智力水平。方法在3个县(市)4个乡6所学校,以病区未防治时期、供应碘盐初期、全民食盐加碘后出生7～14岁儿童为调查对象,用中国联合型瑞文测验图册(CRT-C)和第二版农村儿童智商常模(CRT-RC2)测验判定儿童智商(IQ)。结果碘缺乏病轻病区未防治时期、供应碘盐初期、全民食盐加碘后出生儿童智商分别为94.7±14.6、99.2±14.7、104.9±15.2,全民食盐加碘后儿童智商明显高于未防治时期儿童和供应碘盐初期儿童(P<0.01);IQ≤69者分别占5.6%、3%、2.4%,全民食盐加碘后智力落后儿童比例明显低于未防治时期儿童(P<0.005)。结论全民食盐加碘后碘缺乏病轻病区出生儿童智力水平有明显提高。     

沿海农村小学生智商测定分析

目的了解沿海平原区农村7～12岁小学生智商水平,为防治因缺碘造成的儿童智力障碍提供背景资料。方法实验组选在秦皇岛市郊区的黄土坎小学和抚宁县小部落小学7-12岁小学生。对照组选在承德市郊区狮子沟小学和隆化县韩麻营小学,智力测验采用“中国第二次修订的《联合瑞文测验》（CRT—C2）”量表,用农村儿童（CRT—RC2）常模表判定智商。结果智力水平：实验组郊区农村小学生530名,平均智商为98．26±14．42,对照组为550名,平均智商为95．87±11．59,相比差异显著;实验组县区农村小学生285名,平均智商为99．93±11．32,对照组为260名,平均智商97．16±10．57,相比差异显著。两组的10、12岁组智商相比都有非常显著差异;两组小学生智商频数均呈正态分布,实验组（郊区农村）智商等级频数分布,智力落后小学生占0．94％,对照组则高出一倍占1．82％,实验组（县区农村）占0．70％,对照组为1．92％。在两组边缘等级比例中,实验组也明显低于对照组,而实验组优秀和非常优秀两组小学生所占百分比都明显高于对照组。结论沿海农村小学生智商水平明显高于缺碘山区农村小学生,由于缺碘山区居民碘摄入不足,导致农村小学生大脑神经轻度发育落后。     

哈尔滨市市区学龄儿童智力水平调查研究

应用《瑞文测验》对哈尔滨市市区1410名小学生进行了智力调查。结果表明,儿童平均智商水平为101.51±14.42,智商呈正态分布,证明从整体上说哈尔滨市学龄儿童的智力发育基本上是正常的。但其中太平区儿童智商较低(89.72±14.30),明显低于其它各区,并低于本智力量表的常模;智商分布向中下水平偏移;在被测试的142名儿童中,智力落后者(IQ≤69)发生率为8.5％,明显高于其它各区;其中未发现智力优秀(IQ120～129)和超优(IQ≥130)者。提示太平区儿童的智力发育受到一定损伤,该区儿童可能存在一定程度的碘缺乏。     

呼和浩特市儿童智商水平及分析

本文报道了呼和浩特市１２５３名儿童智商检验结果，平均智商为１０３，较国内同类城市及城市儿童智商常模仿低，全市三个区儿童智商平均水平存在统计学显著差异，但碘缺乏病病情无明显差别。     

2005年云南省8～10岁儿童智商检查结果分析

为了解和掌握云南省儿童智商状况,作者对2005年云南省第5次碘缺乏病(IDD)监测中的儿童智商资料进行了分析,现将结果报道如下. 1 对象与方法     

碘缺乏病区供应碘盐后出生的儿童听力状况

目的 了解ＩＤＤ病区供应碘盐后出生的不同智商水平儿童听力状况和轻度智力落后儿童听力损伤程度。方法 用ＣＲＴ－Ｃ２图册和ＣＲＴ－ＲＣ２测验、判定７～１４岁儿童智商，用纯音诊断测听仪测儿童听力。结果 ＩＱ５０～６９、ＩＱ７０～７９、ＩＱ８０～１９三组儿童听力减退分别为４７．３％、１７．３％、２．２％，ＩＱ≥１２０组儿童听力正常。轻度智力落后儿童中的ＩＱ５０～５９与ＩＱ６０～６９两部分儿童听力减退率分别     

不同碘摄入水平对儿童甲状腺功能及智力的影响

目的通过对山西省平遥县不同水碘含量地区儿童智商和甲状腺功能的调查,进一步探讨高碘对人体造成的危害。方法郝开村、郝家堡、左家堡的水碘、尿碘、盐碘含量测定均采用国标法,智力测验采用瑞文测验,甲状腺肿大采取触诊法,血清TT4、TSH采用化学发光法测定。结果郝开村、郝家堡、左家堡3个村的水碘分别为28.7μg/L、147.5μg/L、1 476.6μg/L、997.3μg/L、802.6μg/L 儿童尿碘中位数分别为237.9μg/L、357.8μg/L、1 362.7μg/L 盐碘平均值分别为24.86 mg/kg、28.28 mg/kg、1.96 mg/kg 儿童智商分别为100.1、108.2、105.5 甲状腺肿大率分别为2.5%、11.27%、24.05% TSH平均值分别为2.88 MIU/L、3.63 MIU/L、4.82 MIU/L。结论摄入过量的碘可以导致血清TSH水平增高、甲状腺肿大。     

2005年全国碘缺乏病监测8～10岁儿童智力测定结果分析

目的了解全民食盐加碘10年后8-10岁儿童智力水平。方法以省为单位采用人口比例概率抽样方法(PPS),按省份、年龄、性别和碘营养状况分组,用中国联合型瑞文测验(CRT-C2)方法测定儿童智商(IQ)。结果全民食盐加碘10年后,32个省份的38 448名儿童中,IQ均值为103．4。其中男、女儿童IQ均值分别为103．4和102．0,IQ≤69者占4．4％。实施食盐加碘措施较差的省份,儿童IQ明显低于全国平均值。碘营养适宜时IQ均值最高(103．8),碘不足时儿童IQ均值降低(98．7),碘过量(103．2)与碘适宜比较儿童IQ值未见明显改变。结论碘不足明显影响了8-10岁儿童智力发展,在全国非高碘病区实施食盐加碘防治碘缺乏病策略是正确、有效的;非高碘地区碘过量没有明显影响8-10岁儿童智力发育;近10年来,随着生活水平的提高,全国儿童智力发育水平又有所增长,现有的IQ检测常模有必要再重新修订。     

Performance parameters of the diagnostic scoring systems for autoimmune hepatitis

The diagnostic criteria for autoimmune hepatitis (AIH) have been codified by an international panel, and a revision of the original scoring system based on 12 clinical components has been promulgated. A simplified scoring system has been proposed recently that is based on four clinical components. The goals of this study were to compare the performance parameters of the revised original and the simplified scoring systems and to determine the prowess of each as a diagnostic instrument. Diagnostic scores were determined using each scoring system in 435 patients with diverse chronic liver diseases, including 153 individuals with AIH by codified clinical criteria. The sensitivity, specificity, and predictability of each scoring system for the pretreatment diagnosis of AIH were determined. The revised original scoring system had greater sensitivity for the diagnosis than the simplified scoring system (100% versus 95%), and seven patients diagnosed as AIH using the revised original system were nondiagnostic by the simplified system (5%). The revised original scoring system also ascribed a diagnosis of AIH to 20 of 21 patients with cryptogenic chronic hepatitis, whereas only five patients were similarly classified by the simplified system (95% versus 24%). The simplified system had greater specificity (90% versus 73%) and predictability (92% versus 82%) for AIH than the revised original system, and it more commonly excluded the diagnosis in other diseases with concurrent immune features (83% versus 64%). CONCLUSION: The revised original scoring system performs better in patients with few or atypical features of AIH, and the simplified system is better at excluding the diagnosis in diseases with concurrent immune manifestations. Each system has attributes that can be exploited.     

Clinical performance of original and revised Bethesda guidelines for the identification of MSH2/MLH1 gene carriers in patients with newly diagnosed colorectal cancer: proposal of a new and simpler set of recommendations

Identification of individuals who should undergo hereditary nonpolyposis colorectal cancer (HNPCC) genetic testing is a critical and difficult issue. For this purpose, the National Cancer Institute outlined a set of recommendations, the Bethesda guidelines, which have recently been revised. OBJECTIVE: To compare the clinical performance of original and revised Bethesda guidelines for the detection of MSH2/MLH1 gene carriers in patients with colorectal cancer. METHODS: A total of 1,222 patients with newly diagnosed colorectal cancer were included in the EPICOLON study, a prospective, multicenter, nationwide epidemiology survey aimed at establishing the incidence of HNPCC in Spain (JAMA 2005; 293:1986-1994). Performance characteristics of the original and revised Bethesda guidelines were assessed with respect to the presence of MSH2/MLH1 germline mutations. Logistic regression analysis was performed to establish the most effective strategy. RESULTS: Original or revised Bethesda guidelines were equivalent strategies in terms of sensitivity (100%vs 100%; ns), specificity (98.1%vs 97.9%; ns), and overall accuracy (98.1%vs 97.9%; ns), as well as positive (25.8%vs 24.2%) and negative predictive values (100%vs 100%). The most discriminating individual variables were criteria number 1 (i.e., fulfillment of the Amsterdam criteria; RR = 34.14; 95% CI = 6.85-170.16; p < 0.001) and number 2 (i.e., individuals with two HNPCC-related neoplasms; RR = 35.63; 95% CI = 4.83-262.6; p < 0.001) of the original guidelines, and criterion number 1 of the revised guidelines (i.e., colorectal cancer diagnosed under 50 yr of age; RR = 29.34; 95% CI = 3.81-225.96; p= 0.001). The aggregation of these three criteria was equivalent to both Bethesda guidelines in terms of sensitivity (100%) and negative predictive value (100%), but superior to the revised criteria regarding specificity (98.5%; p < 0.05), overall accuracy (98.5%; p < 0.05), and positive predictive value (30.8%). CONCLUSIONS: Original and revised Bethesda guidelines are equivalent, highly effective criteria for the identification of MSH2/MLH1 gene mutation carriers in patients with newly diagnosed colorectal cancer. A new set of recommendations, based on a combination of some of their individual criteria, may provide additional advantages in terms of effectiveness.     

Diagnostic value and utility of the simplified International Autoimmune Hepatitis Group criteria in acute‐onset autoimmune hepatitis

Background: The diagnosis of autoimmune hepatitis (AIH) is already difficult, and that of acute‐onset AIH with atypical features is even more challenging, even though the revised original diagnostic criteria created by an international AIH group were widely accepted and incorporated into clinical practice. Aims: Recently, simplified diagnostic criteria were proposed. We compared the performance parameters of the simplified scoring system in patients with acute‐onset AIH and examined its usefulness and limitations. Methods: Fifty‐five patients with acute‐onset AIH (29 non‐severe, 14 severe and 12 fulminant) were assessed according to the simplified scoring system and compared with the revised original one. Results: Of the 55 patients, 22 (40%) were diagnosed as ‘definite’ AIH, 28 (51%) as ‘probable’ and five (9%) as ‘non‐diagnostic’ based on the revised original scoring system. By the simplified scoring system, six (11%) were diagnosed as ‘definite’ AIH, 16 (29%) as ‘probable’ and 33 (60%) as ‘non‐diagnostic’. Anti‐nuclear antibody titres did not differ among the three groups. The immunoglobulin G level was higher in fulminant than in non‐severe patients (P=0.01). Sixty‐five per cent showed acute hepatitis (massive necrosis, submassive necrosis and severe acute hepatitis) and 35% showed chronic hepatitis. Conclusions: The revised original scoring system performed better in patients with acute‐onset AIH than the simplified scoring system.     

Re-analysis of clinical features of 89 patients with autoimmune hepatitis using the revised scoring system proposed by the International Autoimmune Hepatitis Group

OBJECTIVE: The diagnostic criteria of autoimmune hepatitis (AIH) were recently modified by the International Autoimmune Hepatitis Group. This study was performed to assess the impact of the revised scoring system on the diagnosis of AIH. PATIENTS AND METHODS: We re-analyzed the clinical features of 89 patients diagnosed as AIH in Nagasaki Prefecture, Japan, using the revised scoring system, and compared the scores and final diagnosis with our previously published results using the original system. RESULTS: Of the 89 patients with AIH, 40 (45%) were classified using the new system as "definite" AIH, 41 (46%) as "probable" AIH, and 8 (9%) patients were categorized as "others". Of these, 37 (42%), 35 (39%), and 4 (4%) patients who were classified as "definite", "probable", and "others" by the original system remained in the same category by the revised system, respectively. However, 3, 4, and 6 patients were re-categorized as "definite" from "probable", "others" from "probable", and "probable" from "definite", respectively. The difference in aggregate scores between the above two systems ranged from -5 to +2. The main contributing factors to the changes in aggregate AIH score were "other autoimmune disease(s)" and "interface hepatitis without lobular involvement and bridging necrosis on liver histology". However, the main contributing factors to the demotions from "definite" to "probable" and form "probable" to "others" were those related to the characteristics of biliary diseases, i.e., antimitochondrial antibody positive, biliary changes in liver histology, and alkaline phosphatase: aspartate aminotransferase ratio between 1.5 and 3.0. Moreover, two patients who had no histological evidence of AIH were both re-categorized as "others" from "probable" AIH. CONCLUSION: Our results indicated that the diagnosis, whether based on the revised or original system, was the same in the majority of AIH patients, but the revised scoring system excluded cases who had features suggestive of biliary diseases from "definite" AIH, and also confirmed that a diagnosis of "definite" AIH should not be made without liver histology.     

A model predicting operative mortality in the UK has only limited value in Denmark

Purpose

Postoperative mortality from colorectal cancer varies between surgical departments. Several models have been developed to predict the operative risk. This study aims to investigate whether the original and the revised Association of Coloproctology of Great Britain and Ireland (ACPGBI) model can predict 30-day mortality after colorectal cancer surgery in Denmark.

Methods

Data were collected from the Danish Colorectal Cancer Group database which has >?95% completeness. All patients operated on from January 2007 to December 2013 were included. The individual estimated operative risk was calculated with the original and revised ACPGBI models. Discrimination and calibration were evaluated with a Receiver Operating Characteristic (ROC) curve analysis and a Hosmer-Lemeshow test, respectively.

Results

In total, 22,807 patients underwent open or laparoscopic colorectal cancer surgery. After excluding 1437 patients because of missing data, 21,370 patients were left for the analyses. The observed 30-day mortality was 5.0%. The original and revised ACPGBI models estimated an operative risk of 7.0 and 4.0%, respectively, with a significant difference in observed and estimated mortality in both models. However, in patients with an estimated risk of at least 26%, i.e., high-risk, good calibration was found with the original ACPGBI model. Discrimination was good with an AUC of 0.83 (95% CI 0.82–0.84) in both models.

Conclusion

The original and revised ACPGBI models are not suitable prediction models for postoperative mortality in the Danish colorectal cancer population. However, the original model might be applicable in predicting mortality in high-risk patients.

     

Overlap of autoimmune hepatitis and primary biliary cirrhosis: an evaluation of a modified scoring system

OBJECTIVE: The coexistence of autoimmune hepatitis (AIH) with primary biliary cirrhosis (PBC) as an overlap syndrome has been previously described. The ability to detect AIH overlap with a revised version of the International Autoimmune Hepatitis Group (IAHG) scoring system, however, remains unknown. Our specific aim was to evaluate the revised IAHG scoring system and its ability to identify AIH overlap in PBC. MErHODS: One hundred forty-one PBC patients with first-time visits to the Mayo Clinic from January 1, 1990 to December 31, 1992 were evaluated. The calculation of individual revised IAHG scores was performed and compared to original IAHG scores. RESULTS: Among 137 PBC patients with available liver histologies, use of the original IAHG scoring system detected "definite" and "probable" AIH overlap among 2.2% and 62% of cases, respectively. Application of the revised IAHG scoring system, however, revealed no individuals (0%) with definite AIH overlap (>15 points). Twenty-six subjects (19%) fulfilled IAHG criteria for probable AIH overlap (10-15 points). The presence of antinuclear antibody and/or smooth muscle antibody positivity (p = 0.05), other autoimmune disorders (p < 0.01), and total histological score (p < 0.001) were significantly greater in the PBC plus probable AIH group than in subjects with PBC alone. CONCLUSION: A reduction in the prevalence of definite 2.2% vs 0%) and probable (62% vs. 19%) AIH overlap among PBC subjects was observed with use of the revised IAHG coring system relative to the original criteria. Applicability of the revised IAHG scoring system, however, remains questionable, as nearly 20% of PBC patients will be classified with probable AIH overlap.     

Prevalence of the metabolic syndrome in the island of Gran Canaria: comparison of three major diagnostic proposals.

AIMS: The present study was conducted to estimate the prevalence of the metabolic syndrome in a Canarian population, and to compare its frequency as defined by the most commonly used working definitions. METHODS: Cross-sectional population-based study. One thousand and thirty adult subjects were randomly selected from the local census of Telde, a city located on the island of Gran Canaria. Participants completed a survey questionnaire and underwent physical examination, fasting blood analyses, and a 75-g standardized oral glucose tolerance test. The prevalence of the metabolic syndrome was estimated according to the definitions proposed by the World Health Organization (WHO), the European Group for the Study of Insulin Resistance (EGIR) and the National Cholesterol Education Program (NCEP), the latter with the original (6.1 mmol/l) and the revised criterion (5.6 mmol/l) for abnormal fasting glucose. RESULTS: The adjusted prevalence of the metabolic syndrome was 28.0, 15.9, 23.0 and 28.2%, using the WHO, EGIR, NCEP and revised NCEP criteria, respectively. The measure of agreement (kappa statistic) was 0.57 between the WHO and the original NCEP definitions, and 0.61 between the WHO and the revised NCEP definitions. After excluding diabetic subjects, the agreement between the EGIR and WHO proposals was fairly good (kappa=0.70), whereas concordance of the EGIR with the original and the revised NCEP definitions was moderate (kappa=0.47 and 0.46, respectively). CONCLUSIONS: Whichever the considered diagnostic criteria, the prevalence of the metabolic syndrome in this area of the Canary Islands is greater than that observed in most other European populations.