The importance of the cell sample in cervical cytology: a controlled trial of a new sampling device

The provision of a truly-representative cellular sample is the major prerequisite for reliable cervical cytology. We performed a trial with a cervical-sampling implement of innovative design, the Cervex Sampler. By means of the parameters of patient and doctor acceptability, the quality of the smear, the presence of endocervical cells, and the rate of squamous-cell atypia, the Cervex Sampler was compared with a modified Ayre spatula. One hundred samplers were distributed to each of 10 doctors. The parameters were assessed before, during and after the trial period. The consensus was that the Cervex Sampler was easier to use and did not cause patients any problems. Assessment of the smears that were made with the Cervex Sampler showed a significant improvement in the quantity and evenness of the distribution of the cellular sample. During the trial, statistically-significant increases occurred in the percentage of smears that contained endocervical cells (P = 0.0001) and atypical squamous cells (P = 0.028). At the end of the trial, when the doctors again used the modified Ayre spatula, these rates reverted to the same levels as before.     

Chlamydial infection among females attending an abortion clinic: prevalence and risk factors.

To determine the prevalence of Chlamydia trachomatis infection and the epidemiologic risk factors for chlamydial infection in the Quebec City region, screening was done with an enzyme immunoassay in 920 females who attended an abortion clinic between November 1985 and June 1986. The organism was detected in 105 (11.4%) of the patients. After adjustment for confounding variables, four variables were found to be independent risk factors for chlamydial infection: age 24 years or less (prevalence ratio 3.0 [p less than 0.001]), two or more sexual partners during the previous year (prevalence ratio 1.8 [p = 0.001]), no contraception or the use of a nonbarrier method (prevalence ratio 1.9 [p = 0.030]) and living in an urban area (prevalence ratio 1.6 [p = 0.046]). The results confirm that chlamydial infection is prevalent in this population. The identified risk factors may prove useful in determining the target population for screening programs.     

骨髓组织印片评估有核细胞量的价值

目的：研究骨髓印片评估有核细胞量的价值。方法：272例经骨髓活检术获取的组织块置于载玻片上轻轻滚动制成印片，Wright—Giemsa染色，按有核细胞评判标准与骨髓涂片同步检查。结果：有核细胞明显减少和极度减少，明显增多和极度增多的4个级别，骨髓印片明显高于骨髓涂片（P〈0．05），而印片与切片比较无明显差异（P〉0．05）。以骨髓切片细胞量变化为标准，切片减少组中印片和涂片的符合率（84．4％和97．9％）较高；细胞量正常和增加组中印片的符合率（84．4％和93．2％）高于涂片（60％和64％），两组比较有显著性差异（P〈0．01）；灵敏度、特异性、Youden index、阳性预示值和阳性似然比，印片优于涂片。以切片诊断为金标准，印片诊断再生障碍性贫血和造血减低阳性率为37．1％，假阳性率为7．3％，比涂片（阳性率66．9％、假阳性率29．89，5）低，（P〈0．01）；诊断指标的性能印片优于涂片，其中印片诊断为脾功能亢进和骨髓增殖性疾病（除感染和少数骨髓增殖性疾病外）涂片为假阴性结论。结论：骨髓印片在评估有核细胞量优于骨髓涂片，印片和涂片简便快速联检可提高骨髓细胞学的诊断水平。     

Health-related quality of life of severely obese children and adolescents

CONTEXT: One in 7 US children and adolescents is obese, yet little is known about their health-related quality of life (QOL). OBJECTIVE: To examine the health-related QOL of obese children and adolescents compared with children and adolescents who are healthy or those diagnosed as having cancer. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 106 children and adolescents (57 males) between the ages of 5 and 18 years (mean [SD], 12.1 [3] years), who had been referred to an academic children's hospital for evaluation of obesity between January and June 2002. Children and adolescents had a mean (SD) body mass index (BMI) of 34.7 (9.3) and BMI z score of 2.6 (0.5). MAIN OUTCOME MEASURES: Child self-report and parent proxy report using a pediatric QOL inventory generic core scale (range, 0-100). The inventory was administered by an interviewer for children aged 5 through 7 years. Scores were compared with previously published scores for healthy children and adolescents and children and adolescents diagnosed as having cancer. RESULTS: Compared with healthy children and adolescents, obese children and adolescents reported significantly (P<.001) lower health-related QOL in all domains (mean [SD] total score, 67 [16.3] for obese children and adolescents; 83 [14.8] for healthy children and adolescents). Obese children and adolescents were more likely to have impaired health-related QOL than healthy children and adolescents (odds ratio [OR], 5.5; 95% confidence interval [CI], 3.4-8.7) and were similar to children and adolescents diagnosed as having cancer (OR, 1.3; 95% CI, 0.8-2.3). Children and adolescents with obstructive sleep apnea reported a significantly lower health-related QOL total score (mean [SD], 53.8 [13.3]) than obese children and adolescents without obstructive sleep apnea (mean [SD], 67.9 [16.2]). For parent proxy report, the child or adolescent's BMI z score was significantly inversely correlated with total score (r = -0.246; P =.01), physical functioning (r = -0.263; P<.01), social functioning (r = -0.347; P<.001), and psychosocial functioning (r = -0.209; P =.03). CONCLUSIONS: Severely obese children and adolescents have lower health-related QOL than children and adolescents who are healthy and similar QOL as those diagnosed as having cancer. Physicians, parents, and teachers need to be informed of the risk for impaired health-related QOL among obese children and adolescents to target interventions that could enhance health outcomes.     

Chlamydial cervicitis: testing the practice guidelines for presumptive diagnosis

OBJECTIVE: To test the recommendation from the Canadian guidelines for sexually transmitted diseases (STDs) that mucopurulent endocervical discharge and 10 or more polymorphonuclear leukocytes (PMNs) per high-power field of a Gram-stained endocervical smear or, when Gram staining is not possible, the presence of endocervical discharge and one of edema, erythema or induced mucosal bleeding of the cervix can be considered diagnostic for chlamydial cervicitis. METHODS: A total of 596 consecutive women attending 2 family planning clinics for routine care underwent vaginal speculum examination and were tested for Chlamydia trachomatis and Neisseria gonorrhoeae. PMN counts from Gram-stained endocervical smears and the presence or absence of putative indicators of chlamydial infection were recorded. RESULTS: The prevalence of chlamydial cervicitis was 6.2% (37/596), and no women tested positive for N. gonorrhoeae. Presumptive diagnosis of chlamydial cervicitis based on the guidelines criteria of mucopurulent endocervical discharge and 10 or more PMN per high-power microscopic field had a sensitivity and specificity of 18.9% and 97.0% respectively, a positive predictive value of 29.2% and a positive likelihood ratio (LR) of 6.2 (p = 0.003). Presumptive diagnosis based on endocervical discharge with edema, erythema or induced mucosal bleeding of the cervix had a sensitivity and specificity of 43.2% and 80.0% respectively, a positive predictive value of 12.5% and a positive LR of 2.2 (p = 0.002). In the presence of bacterial vaginosis or vaginitis, the LR for the criteria of mucopurulent endocervical discharge and 10 or more PMN per high-power field was 5.4 (p = 0.04), whereas the LR was 4.3 (p = 0.10) if bacterial vaginosis and vaginitis were absent. CONCLUSIONS: In this setting, the practice of making a presumptive diagnosis of chlamydial cervicitis on the basis of the criteria given in the Canadian STD guidelines was not supported.     

Systematic intervention for elderly inpatients with delirium: a randomized trial.

OBJECTIVE: To assess a systematic intervention in cases of delirium in elderly inpatients. DESIGN: Randomized, controlled trial. SETTING: University-affiliated, primary acute care hospital. PATIENTS: Patients aged 75 years or over admitted to the medical department. They were screened within 24 hours after admission, and 88 patients with delirium (according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third revised edition) were detected and enrolled in the trial. The patients were randomly allocated to the treatment group (42) or the control group (46); all were followed up until the end of the study. INTERVENTION: Patients were assessed on enrolment and 1, 2, 4 and 8 weeks later. Those in the treatment group received a consultation by a geriatric internist or psychiatrist and follow-up by a liaison nurse. Those in the control group received regular medical care. OUTCOME MEASURES: Short Portable Mental Status Questionnaire (SPMSQ), Crichton Geriatric Behavioural Rating Scale (CGBRS), use of restraints, length of hospital stay, discharge to a setting providing more care than was needed before admission and mortality rate. RESULTS: Two weeks after admission, patients in the treatment group showed an improvement in their mean SPMSQ scores, from 8.2 (standard deviation [SD] 1.9) to 7.9 (SD 2.5), whereas the control group showed a deterioration, from 8.4 (SD 1.7) to 9.1 (SD 1.1); this difference had disappeared by the end of the 8-week period (p < 0.05). Mean CGBRS scores were higher in the treatment group (32.0 [SD 8.6]) than the control group (28.5 [SD 9.4]) on enrolment and had improved more markedly by the end of the 8-week period (to 23.9 [SD 7.8] v. 25.0 [SD 7.0], p = 0.06). There was no statistically significant difference between the groups in use of restraints, length of hospital stay, discharge to a setting providing more care than was needed before admission or mortality rate. CONCLUSION: The beneficial effects of systematic detection and intervention in cases of delirium in elderly inpatients were small.     

Characteristics of false-negative ThinPrep cervical smears in women with high-grade squamous intraepithelial lesions

OBJECTIVE. To examine the cellular characteristics and other possible factors affecting the correct prediction of ThinPrep cervical smears from patients with high-grade squamous intraepithelial lesions. DESIGN. Retrospective study. SETTING. Private anatomical pathology service, Hong Kong. PATIENTS. Patients (n=98) with biopsy-confirmed high-grade squamous intraepithelial lesion of the uterine cervix encountered between 2004 and 2006. MAIN OUTCOME MEASURES. Correct prediction of the cervical ThinPrep Papanicolaou tests. RESULTS. There were no significant differences in age, hormonal status, degree of inflammation, and the presence or absence of endocervical/metaplastic cells between the true-positive and false-negative groups. There was a significant difference in the number of abnormal cells present and the screening time between the two groups. Approximately 79% (34/43) false-negative smears had 100 or less abnormal cells, while only 11% (5/45) true-positive smears had 100 or less abnormal cells (P<0.001). The true-positive smears were also more likely to contain koilocytic cells and abnormal cells with hyperchromatic nuclei. CONCLUSIONS. The number of abnormal cells present, the presence or absence of koilocytic cells, and the presence or absence of abnormal cells with nuclear hyperchromasia appeared to be independent factors affecting the correct prediction of smears from patients with high-grade squamous intraepithelial lesions.     

First-year family medicine residents' use of computers: knowledge, skills and attitudes.

OBJECTIVE: To identify the computer knowledge, skills and attitudes of first-year family medicine residents. DESIGN: Cross-sectional survey of family medicine residents during the academic year 1993-94; sampling began in July 1993 and ended in October 1993. SETTING: Canada. PARTICIPANTS: All 727 first-year family medicine residents, of whom 433 (60%) responded. OUTCOME MEASURES: Previous computer experience or training, current use, barriers to use, and comfort with and attitudes regarding computers. RESULTS: There was no difference in age or sex between the respondents and all first-year family medicine residents in Canada. French-speaking respondents from Quebec were underrepresented (p < 0.001). Only 56 respondents (13%) felt extremely or very comfortable with computer use. The most commonly cited barriers to obtaining computer training were lack of time (243 respondents [56%]) and the high cost of computers (214 [49%]) but not lack of interest (69 [16%]). Most residents wanted more computer training (367 [85%]) and felt that computer training should be a mandatory component of family medicine training programs (308 [71%]). CONCLUSIONS: Computer knowledge and skills and comfort with computer use appear low among first-year family medicine residents in Canada, and barriers to acquisition of computer knowledge are impressive. Computer training should become an integral part of family medicine training in Canada, and user-friendly applicable computer systems are needed.     

骨髓组织印片细胞学检查的诊断价值

目的 研究骨髓组织印片(简称印片)细胞学检查的应用价值.方法 自患者髂后上棘抽吸骨髓后,用骨髓活检针以环钻二步法将获取的骨髓组织(长度0.6 cm以上)置于载玻片上,均匀滚动制成印片272张,以同步采集的骨髓涂片(简称涂片)和骨髓切片(简称切片)为对照,进行细胞学检查.结果 印片有核细胞量明显高于涂片,差异有统计学意义(P<0.01),而与切片的差异则无统计学意义(P<0.05);印片细胞数减少者涂片大多减少,反之差异明显;以切片为金标准,印片诊断性能指标和Youden指数优于涂片;印片还可大体观察肿瘤细胞的组织形态(浸润结构).结论 印片评估有核细胞有明显的长处,也可初步了解组织形态学概况,同涂片快速检查互补,可明显提高涂片的细胞学诊断水平,可作为常规项目应用.     

Prevalence of risk factors associated with human papillomavirus infection in women living with HIV

BACKGROUND: Concurrent infection with HIV and human papillomavirus (HPV) in women is associated with increased rates of cervical dysplasia and shorter survival following the development of cervical cancer. The authors examined risk factors for HPV infection at study entry in HIV-positive women enrolled in the Canadian Women's HIV Study, a prospective open cohort study. METHODS: Subjects eligible for this analysis included the 375 HIV-positive women in the Canadian Women's HIV Study for whom HPV test results were available. Questionnaires on behavioural and clinical information, Pap smears, cervicovaginal lavage specimens and vaginal tampon specimens for HPV detection and typing by polymerase chain reaction were obtained at study entry. RESULTS: Overall, 67.2% (252/375) of the women were HPV-positive; the global prevalence of intermediate- and high-risk oncogenic HPV types was 49.1% (184/375). Women with squamous cell dysplasia (32/294) were more likely to have HPV infection than those without dysplasia (90.6% v. 62.6%; p = 0.002). Multivariate logistic regression analysis, with adjustment for number of lifetime partners and history of STD, revealed that the following risk factors were independently associated with HPV infection: CD4 count of less than 0.20 x 10(9)/L (adjusted odds ratio [OR] 1.99 [95% confidence interval (Cl) 1.17-3.37 (p = 0.011)]), non-white race (adjusted OR 2.00 [95% Cl 1.17-3.42 (p = 0.011)]), inconsistent condom use in the 6 months before study entry (adjusted OR 2.02 [95% Cl 1.16-3.50 (p = 0.013)]), and lower age, with women age 30-39 years (adjusted OR 0.51 [95% Cl 0.30-0.87 (p = 0.013)]) and age 40 years or older (adjusted OR 0.52 [95% Cl 0.26-1.01 (p = 0.052)]) compared with women less than 30 years of age. INTERPRETATION: Close monitoring for HPV-related effects is warranted in all HIV-positive women, particularly younger, non-white women who do not always use condoms. Counselling for women living with HIV, particularly younger women, should emphasize the importance of regular cytological screening, with increasing frequency as the CD4 count falls.     

The prevalence and impact of overweight and obesity in an Australian obstetric population

OBJECTIVE: To assess the prevalence and impact of overweight and obesity in an Australian obstetric population. DESIGN, SETTING AND PARTICIPANTS: The Mater Mother's Hospital (MMH), South Brisbane, is an urban tertiary referral maternity hospital. We reviewed data for the 18 401 women who were booked for antenatal care at the MMH, delivered between January 1998 and December 2002, and had a singleton pregnancy. Of those women, 14 230 had an estimated pre-pregnancy body mass index (BMI) noted in their record; 2978 women with BMI < or = 20 kg/m2 were excluded from further study; the remaining 11 252 women were divided into four categories: "normal" (BMI 20.01-25 kg/m(2)), "overweight" (BMI 25.01-30 kg/m(2)), "obese" (BMI 30.01-40 kg/m(2)) and "morbidly obese" (BMI > 40 kg/m(2)). MAIN OUTCOME MEASURES: Prevalence of overweight and obesity in an obstetric population; maternal, peripartum and neonatal outcomes associated with raised BMI. RESULTS: Of the 14 230 women, 6443 (45%) were of normal weight, and 4809 (34%) were overweight, obese or morbidly obese. Overweight, obese and morbidly obese women were at increased risk of adverse outcomes (figures represent adjusted odds ratio [AOR] [95% CI]): hypertensive disorders of pregnancy (overweight 1.74 [1.45-2.15], obese 3.00 [2.40-3.74], morbidly obese 4.87 [3.27-7.24]); gestational diabetes (overweight 1.78 [1.25-2.52], obese 2.95 [2.05-4.25], morbidly obese 7.44 [4.42-12.54]); hospital admission longer than 5 days (overweight 1.36 [1.13-1.63], obese 1.49 [1.21-1.86], morbidly obese 3.18 [2.19-4.61]); and caesarean section (overweight 1.50 [1.36-1.66], obese 2.02 [1.79-2.29], morbidly obese 2.54 [1.94-3.32]). Neonates born to obese and morbidly obese women had an increased risk of birth defects (obese 1.58 [1.02-2.46], morbidly obese 3.41 [1.67-6.94]); and hypoglycaemia (obese 2.57 [1.39-4.78], morbidly obese 7.14 [3.04-16.74]). Neonates born to morbidly obese women were at increased risk of admission to intensive care (2.77 [1.81-4.25]); premature delivery (< 34 weeks' gestation) (2.13 [1.13-4.01]); and jaundice (1.44 [1.09-1.89]). CONCLUSIONS: Overweight and obesity are common in pregnant women. Increasing BMI is associated with maternal and neonatal outcomes that may increase the costs of obstetric care. To assist in planning health service delivery, we believe that BMI should be routinely recorded on perinatal data collection sheets.     

先天性牙齿缺失患者EDA基因突变检测及其表现型分析

目的：探讨EDA基因突变在单纯型和综合征型先天性牙齿缺失患者中的检出率,并汇总EDA基因突变的患者口内恒牙缺失情况,尝试分析EDA基因突变相关的恒牙列缺失牙位分布特点。方法：临床收集到174例（143例单纯型、31例综合征型）先天性牙齿缺失患者以及451名正常对照者,通过采集外周静脉血或者取颊黏膜拭子,提取基因组DNA,PCR扩增EDA基因编码区并测序,与数据库筛查比对。对于EDA基因突变的患者,记录汇总口内缺失牙位,对比不同牙位缺失率的差异。结果：共检测出33例EDA突变患者,单纯型先天性牙齿缺失患者中EDA基因突变检出率为9.09%（13/143）,综合征型先天性牙齿缺失患者中EDA基因突变检出率为64.52%（20/31）,检测出10种尚未见报道的EDA基因突变。EDA突变相关的先天缺牙患者中,牙列左、右同名牙缺失数目几乎没有差异,单纯型患者缺失恒牙数（15.9 ± 6.4）比综合征型患者少（23.9 ± 4.3）。EDA突变相关的单纯型先天缺牙患者中,上颌中切牙,上、下颌第一磨牙缺牙率较低;下颌中切牙,上、下颌侧切牙,上颌第一前磨牙缺牙率较高。EDA突变相关的综合征型先天缺牙患者中,各牙位缺牙率均较高,上颌中切牙,上、下颌尖牙,上、下颌第一磨牙缺牙率相对较低。结论：EDA突变检测和表现型分析有助于更全面了解EDA基因以及其在外胚层器官发育中的功能。     

Dictated versus database-generated discharge summaries: a randomized clinical trial

BACKGROUND: Hospital discharge summaries communicate information necessary for continuing patient care. They are most commonly generated by voice dictation and are often of poor quality. The objective of this study was to compare discharge summaries created by voice dictation with those generated from a clinical database. METHODS: A randomized clinical trial was performed in which discharge summaries for patients discharged from a general internal medicine service at a tertiary care teaching hospital in Ottawa were created by voice dictation (151 patients) or from a database (142 patients). Patients had been admitted between September 1996 and June 1997. The trial was preceded by a baseline cohort study in which all summaries were created by dictation. For the database group, information on forms completed by housestaff was entered into a database and collated into a discharge summary. For the dictation group, housestaff dictated narrative letters. The proportion of patients for whom a summary was generated within 4 weeks of discharge was recorded. Physicians receiving the summary rated its quality, completeness, organization and timeliness on a 100-mm visual analogue scale. Housestaff preference was also determined. RESULTS: Patients in the database group and the dictation group were similar. A summary was much more likely to be generated within 4 weeks of discharge for patients in the database group than for those in the dictation group (113 [79.6%] v. 86 [57.0%]; p < 0.001). Summary quality was similar (mean rating 72.7 [standard deviation (SD) 19.3] v. 74.9 [SD 16.6]), as were assessments of completeness (73.4 [SD 19.8] v. 78.2 [SD 14.9]), organization (77.4 [SD 16.3] v. 79.3 [SD 17.2]) and timeliness (70.3 [SD 21.9] v. 66.2 [SD 25.6]). Many information items of interest were more likely to be included in the database-generated summaries. The database system created summaries faster and was preferred by housestaff. Dictated summaries in the baseline and randomized studies were similar, which indicated that the control group was not substantially different from the baseline cohort. INTERPRETATION: The database system significantly increased the likelihood that a discharge summary was created. Housestaff preferred the database system for summary generation. Physicians thought that the quality of summaries generated by the 2 methods was similar. The use of computer databases to create hospital discharge summaries is promising and merits further study and refinement.     

The effectiveness of coordinated care for people with chronic respiratory disease

OBJECTIVES: To evaluate the effectiveness of coordinated care for chronic respiratory disease. DESIGN AND SETTING: Community-based geographical control study, in western (intervention) and northern (comparison) metropolitan Adelaide (SA). PARTICIPANTS: 377 adults (223 intervention; 154 comparison) with chronic obstructive pulmonary disease, asthma or other chronic respiratory condition, July 1997 to December 1999. INTERVENTION: Coordinated care (includes care coordinator, care guidelines, service coordinator and care mentor). MAIN OUTCOME MEASURES: Hospital admissions (any, unplanned and respiratory), functionality (activities of daily living) and quality of life (SF-36 and Dartmouth COOP). RESULTS: At entry to the study, intervention and comparison subjects were dissimilar. The intervention group was 10 years older (P < 0.001), less likely to smoke (P = 0.014), had higher rates of hospitalisation in the previous 12 months (P < 0.001) and had worse self-reported quality of life (SF-36 physical component summary score [P < 0.001] and four of nine COOP domains [P = 0.002-0.013]). After adjustment for relevant baseline characteristics, coordinated care was not associated with any difference in hospitalisation, but was associated with some improvements in quality of life (SF-36 mental component summary score [P = 0.023] and three of nine COOP domains [P = 0.008-0.031]) compared with the comparison group. CONCLUSIONS: Coordinated care given to patients with chronic respiratory disease did not affect hospitalisation, but it was associated with an improvement in some quality-of-life measures.     

宫颈管细胞学检查在诊断子宫内膜癌中的价值

应用瑞典欧立宫颈管毛刷获取宫颈管细胞 ,对 1 0 93例需进行分段诊刮术的病人进行细胞学检查 ,并与以分段诊刮术或子宫全切术获得的子宫内膜组织的病理结果进行比较。结果 :宫颈管毛刷和宫颈管搔刮术取材满意率分别为 82 .5 %和 1 7.0 %。 60例子宫内膜癌病人中 48例接受了分期手术 ,其中 1 4例宫颈受累。在判断宫颈是否受累方面 ,宫颈管细胞学的敏感性为 71 .4% ,特异性为 82 .4% ;宫颈管搔刮术的敏感性为 5 0 .0 % ,特异性为 79.4%。提示 :宫颈管细胞学检查阳性不一定代表宫颈管受累 ,但对术前决定分期、术式和判断预后有一定的参考价值     

Outcomes in adults with bicuspid aortic valves

Nikolaos Tzemos, MD; Judith Therrien, MD; James Yip, MD; George Thanassoulis, MD; Sonia Tremblay, MD; Michal T. Jamorski, BSc; Gary D. Webb, MD; Samuel C. Siu, MD, SM

JAMA. 2008;300(11):1317-1325.

Context  Bicuspid aortic valve is the most common congenital cardiac anomaly in the adult population. Cardiac outcomes in a contemporary population of adults with bicuspid aortic valve have not been systematically determined.

Objective  To determine the frequency and predictors of cardiac outcomes in a large consecutive series of adults with bicuspid aortic valve.

Design, Setting, and Participants  Cohort study examining cardiac outcomes in 642 consecutive ambulatory adults (mean [SD] age, 35 [16] years; 68% male) with bicuspid aortic valve presenting to a Canadian congenital cardiac center from 1994 through 2001 and followed up for a mean (SD) period of 9 (5) years. Frequency and predictors of major cardiac events were determined by multivariate analysis. Mortality rate in the study group was compared with age- and sex-matched population estimates.

Main Outcome Measures  Mortality and cause of death were determined. Primary cardiac events were defined as the occurrence of any of the following complications: cardiac death, intervention on the aortic valve or ascending aorta, aortic dissection or aneurysm, or congestive heart failure requiring hospital admission during the follow-up period.

Results  During the follow-up period, there were 28 deaths (mean [SD], 4% [1%]). One or more primary cardiac events occurred in 161 patients (mean [SD], 25% [2%]), which included cardiac death in 17 patients (mean [SD], 3% [1%]), intervention on aortic valve or ascending aorta in 142 patients (mean [SD], 22% [2%]), aortic dissection or aneurysm in 11 patients (mean [SD], 2% [1%]), or congestive heart failure requiring hospital admission in 16 patients (mean [SD], 2% [1%]). Independent predictors of primary cardiac events were age older than 30 years (hazard ratio [HR], 3.01; 95% confidence interval [CI], 2.15-4.19; P<.001), moderate or severe aortic stenosis (HR, 5.67; 95% CI, 4.16-7.80; P<.001), and moderate or severe aortic regurgitation (HR, 2.68; 95% CI, 1.93-3.76; P<.001). The 10-year survival rate of the study group (mean [SD], 96% [1%]) was not significantly different from population estimates (mean [SD], 97% [1%]; P = .71). At last follow-up, 280 patients (mean [SD], 45% [2%]) had dilated aortic sinus and/or ascending aorta.

Conclusions  In this study population of young adults with bicuspid aortic valve, age, severity of aortic stenosis, and severity of aortic regurgitation were independently associated with primary cardiac events. Over the mean follow-up duration of 9 years, survival rates were not lower than for the general population.

     

Position and susceptibility to inflammation of vermiform appendix in Accra, Ghana

OBJECTIVES: To determine the normal (non-inflamed) position of the vermiform appendix in Ghana and carry out a pilot study to test the hypothesis "The retrocaecal appendix is less prone to inflammation". DESIGN: Retrospective autopsy study. SETTING: The pathology department and the department of surgery theatres of the Korle Bu Teaching hospital in Accra, Ghana SUBJECTS: Consecutive autopsies and inflamed appendices at appendicectomy. Deaths occurring from untreated appendicitis were excluded from the autopsy study. Conversely non-inflamed appendices and appendices from interval appendicectomy were excluded from the appendicitis study. RESULTS: There were 1358 autopsies and 323 inflamed appendices. In the autopsy study the retrocaecal position was the most common (914 [67.3%]). Other positions were pelvic (294 [21.6%]), preileal (66 [4.9%]), postileal (51 [3.8%]) and paracaecal (33 [2.4%]). These positions were similar in males and females. The positions of 323 inflamed appendices were: retrocaecal (183 [56.7%]), pelvic (66 [20.4%]), preileal (20 [6.2%]), postileal (15 [4.6%]) and paracaecal (39 [12.1%]). Comparing the nonretrocaecal to the retrocaecal position by chi square, the non-retrocaecal position was more prone to inflammation (p<0.001). CONCLUSION: The position of the normal appendix in Ghana differs from Western literature. The retrocaecal position appears less prone to inflammation in Ghanaians.     

The utility of coagulation activity for prediction of risk of mortality and cardiovascular events in guideline-treated myocardial infarction patients

Background: Despite improved treatment of myocardial infarction (MI), real-world patients still suffer substantial risk for subsequent cardiovascular events. Little is known about coagulation activity shortly after MI and whether coagulation activity markers may identify patients at increased risk despite contemporary treatment.

Objective: To evaluate D-dimer concentration and thrombin generation potential shortly after discharge after MI and evaluate if these markers could predict the risk of future cardiovascular and bleeding events.

Methods: Unselected MI patients (n?=?421) were included in the observational REBUS study (NCT01102933) and followed for two years. D-dimer concentrations, thrombin peak, and endogenous thrombin potential (ETP) were analyzed at inclusion (3–5 days after MI) and at early follow-up (after 2–3 weeks).

Results: Seventy-five patients (17.8%) experienced the composite endpoint (all-cause death, MI, congestive heart failure, or all-cause stroke), and 31 patients (7.4%) experienced a clinically relevant bleeding event. D-dimer concentrations at early follow-up were associated with the composite endpoint (HR [per SD increase] 1.51 [95% CI 1.22–1.87]) and with clinically relevant bleeding (HR [per SD increase] 1.80 [95% CI 1.32–2.44]). Thrombin generation potential was not significantly associated with either the composite endpoint or with clinically relevant bleeding. Higher thrombin peak and ETP at early follow-up were both inversely associated with stroke (HR [per SD increase] 0.50 [95% CI 0.30–0.81] and 0.43 [95% CI 0.22–0.83], respectively).

Conclusion: In unselected MI patients treated according to contemporary guidelines, D-dimer measurements may identify patients at increased risk of new cardiovascular and bleeding events. The inverse association of thrombin generation potential and risk of stroke has to be further investigated.     

早孕期经宫颈细胞中寻找胎儿细胞及免疫细胞化学研究

目的研究早孕妇女生殖道中胎儿细胞的存在情况,用免疫细胞化学法确证胎儿细胞来源,寻找无创或微创的产前诊断取材方法及时机。方法将健康早孕妇女宫颈取材标本分为两组:HE染色组(Ⅰ)和免疫细胞化学组(Ⅱ);选择通水术中输卵管通畅的健康妇女为对照,分为两组:HE染色组(Ⅲ)和免疫细胞化学组(Ⅳ)。无菌棉拭子术、宫颈粘液吸引术、宫颈管灌洗术和宫腔内灌洗术采集标本,HE染色和免疫细胞化学染色后观察滋养细胞存在情况。结果(1)早孕妇女经宫颈细胞中存在可代表胎儿细胞的滋养细胞;(2)宫颈管灌洗术和宫腔内灌洗术取材方法较好,获得胎儿细胞较多;(3)取材时机为妊娠50～79d。结论早孕妇女生殖道中存在胎儿细胞,在妊娠50～79d用宫颈灌洗术或宫腔内灌洗术取材,是一种较为安全有效的产前诊断技术。     

Growth deficits in children with sickle cell disease

BACKGROUND: Growth deficits are common in children with sickle cell disease. Few prospective studies are available and the pathophysiologic basis for the impaired growth is not clearly understood. Our objectives were to collect data on anthropomorphic measurements of children with sickle cell disease prospectively followed for 1 year and to correlate them with hematologic data. METHODS: One hundred children <8 years of age (73 with homozygous SS sickle cell anemia [HbSS] and 27 with hemoglobinopathy SC [HbSC]) were included. Standardized Z scores of weight for age (waz), height for age (haz), and weight for height (whz) were compared to the National Center for Health Statistics (NCHS) reference population. RESULTS: At study entry, the means (standard deviation [SD]) of waz, haz, and whz were -0.69 (1.06), -0.65 (1.11), and -0.32 (1.00), respectively. After 1 year of study, children with HbSS presented a significant decrease in waz (p = 0.01) and whz (p = 0.02); the decrease in haz was not statistically significant (p = 0.48). The effect was similar for children older or younger than 24 months of age. The decrease in waz and whz was significant for boys but not for girls. After 1 year of follow-up, lower mean waz scores were observed among patients with lower hemoglobin concentration and higher reticulocyte count (p = 0.03 and p = 0.08). Hemoglobin concentration was higher in girls. The anthropomorphic measurements did not deteriorate significantly in children with HbSC. CONCLUSIONS: Growth deficits may be demonstrable in children with HbSS, even during a short period of observation. Fast red blood cell turnover may be partially responsible for the observed effect.