Longitudinal factorial invariance of the PedsQL™ 4.0 Generic Core Scales Child Self-Report Version: One year prospective evidence from the California State Children’s Health Insurance Program (SCHIP)

Background  The measurement of health-related quality of life (HRQOL) in pediatric medicine and health services research has grown significantly over the past decade. The paradigm shift toward patient-reported outcomes (PROs) has provided the opportunity to emphasize the value and critical need for pediatric patient self-report. In order for changes in HRQOL/PRO outcomes to be meaningful over time, it is essential to demonstrate longitudinal factorial invariance. This study examined the longitudinal factor structure of the PedsQL™ 4.0 Generic Core Scales over a one-year period for child self-report ages 5–17 in 2,887 children from a statewide evaluation of the California State Children’s Health Insurance Program (SCHIP) utilizing a structural equation modeling framework. Methods  Specifying four- and five-factor measurement models, longitudinal structural equation modeling was used to compare factor structures over a one-year interval on the PedsQL™ 4.0 Generic Core Scales. Results  While the four-factor conceptually-derived measurement model for the PedsQL™ 4.0 Generic Core Scales produced an acceptable fit, the five-factor empirically-derived measurement model from the initial field test of the PedsQL™ 4.0 Generic Core Scales produced a marginally superior fit in comparison to the four-factor model. For the five-factor measurement model, the best fitting model, strict factorial invariance of the PedsQL™ 4.0 Generic Core Scales across the two measurement occasions was supported by the stability of the comparative fit index between the unconstrained and constrained models, and several additional indices of practical fit including the root mean squared error of approximation, the non-normed fit index, and the parsimony normed fit index. Conclusion  The findings support an equivalent factor structure on the PedsQL™ 4.0 Generic Core Scales over time. Based on these data, it can be concluded that over a one-year period children in our study interpreted items on the PedsQL™ 4.0 Generic Core Scales in a similar manner. The PedsQL™ is available at .     

腹膜透析86例护理体会

1临床资料本组患者86例,年龄40~74(平均56)岁,急性肾功能衰竭15例,慢性肾功能衰竭62例,严重的水电解质紊乱、酸碱失衡和不宜行血液透析9例,行腹膜透析2mo4a.     

重型颅脑损伤后高血糖82例

1　临床资料　 1996 - 0 8/ 1999- 0 8我科共收治重型颅脑损伤患者 82 (男 5 8,女 2 4)例 ,年龄 7～ 81(平均 32 .4)岁 .本组患者伤前均无糖尿病史 .GCS评分均 <8分 .其中 6～ 8分的 42例 ;3～ 5分的 2 8例 ;3分以下的 12例 .发病至入院时间均在2 4h以内 .应用美国产“One Touch”血糖仪每日在床旁测空腹血糖 1次[1 ] ,连续测 7d.对于空腹血糖 >10 mmol· L者 ,给予低糖饮食 ,不用激素 ,少量应用甘露醇 ,适当应用胰岛素及乳酸林格液等治疗 .在 82例中 ,首次测血糖值 >10 mmol· L[2 ] 的 49例 ,最高值为 19.4mmol· L ;经上述治疗 ,结果…     

Do we truly see what we think we see? The role of cognitive bias in pathological interpretation

In the histomorphological grading of prostate carcinoma, pathologists have regularly assigned comparable scores for the architectural Gleason and the now‐obsolete nuclear World Health Organization (WHO) grading systems. Although both systems demonstrate good correspondence between grade and survival, they are based on fundamentally different biological criteria. We tested the hypothesis that this apparent concurrence between the two grading systems originates from an interpretation bias in the minds of diagnostic pathologists, rather than reflecting a biological reality. Three pathologists graded 178 prostatectomy specimens, assigning Gleason and WHO scores on glass slides and on digital images of nuclei isolated out of their architectural context. The results were analysed with respect to interdependencies among the grading systems, to tumour recurrence (PSA relapse > 0.1 ng/ml at 48 months) and robust nuclear morphometry, as assessed by computer‐assisted image analysis. WHO and Gleason grades were strongly correlated (r = 0.82) and demonstrated identical prognostic power. However, WHO grades correlated poorly with nuclear morphology (r = 0.19). Grading of nuclei isolated out of their architectural context significantly improved accuracy for nuclear morphology (r = 0.55), but the prognostic power was virtually lost. In conclusion, the architectural organization of a tumour, which the pathologist cannot avoid noticing during initial slide viewing at low magnification, unwittingly influences the subsequent nuclear grade assignment. In our study, the prognostic power of the WHO grading system was dependent on visual assessment of tumour growth pattern. We demonstrate for the first time the influence a cognitive bias can have in the generation of an error in diagnostic pathology and highlight a considerable problem in histopathological tumour grading. Copyright © 2008 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Only hydrosalpinges visible on ultrasound are associated with reduced implantation and pregnancy rates after in-vitro fertilization

A retrospective analysis of clinical and laboratory data was made of all in-vitro fertilization (IVF) patients with tubal pathology who had their first ever embryo transfer cycle between January 1st, 1992 and September 1st, 1996. The aim of the study was to determine the effect of the presence of a hydrosalpinx, whether or not visible by ultrasound, on pregnancy, multiple pregnancy and implantation rates in our patient population. The IVF success rate was also analysed by calculating cumulative ongoing pregnancy rates of the same patient group using the lifetime table approach. In the presence of an ultrasound-visible hydrosalpinx, rates of pregnancy and multiple pregnancy appeared reduced, but the differences were not significant. The rates of implantation, clinical implantation and ongoing implantation were significantly lower in the presence of an ultrasound- visible hydrosalpinx (odds ratios 0.33-0.46, C.I. 0.21-0.96). The cumulative chance of achieving an ongoing pregnancy after one or more IVF cycles was significantly reduced in the presence of an ultrasound- visible hydrosalpinx (relative hazard 0.36, C.I. 0.22-0.59). In the presence of a hydrosalpinx not visible by ultrasound the IVF outcome was not reduced. This retrospective study confirms that patients with hydrosalpinges have an impaired IVF outcome. Unique to this study and previously unobserved is the finding that there is a subgroup of patients with hydrosalpinges, those with ultrasound-visible hydrosalpinges, which is exclusively responsible for this impaired outcome.      

阿霉素注射治疗三叉神经痛61例

1　对象和方法1.1　对象　 1996 - 0 2 / 1998- 0 6我们应用阿霉素注射法治疗三叉神经痛 6 1(男 39,女 2 2 )例 .年龄 2 8～ 81(平均年龄 6 5 )岁 .病史 1.5～ 5 a.疼痛分布 :第 支疼痛 17例 , 支 2 3例 , 支 11例 , + 支 6例 , + 支 4例 .疼痛位于左侧面部2 9例 ,右侧 32例 .所有病例治疗前均曾服各种药物治疗效果不佳或无效 ,其中 2 9例 CT检查无异常 .1.2　方法　将阿霉素粉剂用生理盐水稀释成 10 g· L- 1 ,用1m L 无菌皮试针管 ,7号针头 ,抽取配制好的阿霉素注射液0 .3m L,对三叉神经末梢支进行注射 .第 支痛者注射部位为眶上神…     

Factor XIIIa formation promoted by complexing of alpha-thrombin, fibrin, and plasma factor XIII

Fibrin polymers (des A,B fibrinogen) reduced the concentration of alpha- thrombin required for 50% activation of plasma factor XIII (a2b2 tetramer) by approximately 100-fold. In the presence of fibrin, the amount of gamma-thrombin required for activation was not affected. Catalytically inactive i-Pr2P- and D-Phe-Pro-Arg-CH2-alpha-thrombin were found to inhibit over 95% of the activation by alpha-thrombin in the presence of fibrin. Unlike plasma factor XIII, the concentration of alpha-thrombin required for 50% activation of platelet factor XIII (a2 dimer) was lower, and the activation was not enhanced by fibrin. However, when the a2 platelet factor XIII was incubated with purified b- chains, the alpha- and gamma-thrombin concentrations required for activation increased tenfold and reached levels similar to those required for activation of the plasma factor XIII. When fibrin was present, the alpha-thrombin concentrations needed for activation of the a2b2 complexes were reduced, and the presence of fibrin had no effect on gamma-thrombin cleavage of the a2b2 complexes. Therefore, the b- chains must inhibit a-chain cleavage by alpha-thrombin in the absence of fibrin. These results imply that the formation of a cocomplex involving alpha-thrombin, fibrin, and plasma factor XIII causes some conformational change in plasma factor XIII such that the b-chains no longer inhibit cleavage of the a-chains.