26万女性队列人群中乳腺癌与人工流产关系的研究（上海）

目的：评估人工流产（指手术流产）对乳腺癌危险性的可能影响。方法：研究在上海267040例妇女的一项乳房自我检查随机试验的队列人群中进行，由队列研究和巢式病例对照研究两部分组成。结果：依据基线调查表采集的资料分析，人工流产不增加乳腺癌危险性。调整潜在的混淆因素后，OR=1．06（95％CI：0．91～1．25）。人工流产次数增加无危险性趋势增加。从更详细的652例乳腺癌病例和694例对照资料分析，得出相似的结果。人工流产发生在首次生育后不增加危险性；少数妇女在首次生育前人工流产以及妊娠13周后人工流产，虽然被观察到危险性有增加，但无显著性统计学意义。结论：在中国，人工流产不是乳腺癌发生的重要原因。     

Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group

BACKGROUND: Neutralization of tumor necrosis factor a (TNF-alpha) for three to six months reduces the symptoms and signs of rheumatoid arthritis. However, the capacity of this approach to effect a more sustained benefit and its effect on joint damage are not known. METHODS: We treated 428 patients who had active rheumatoid arthritis despite methotrexate therapy with placebo or infliximab, a chimeric monoclonal antibody against TNF-alpha, in intravenous doses of 3 or 10 mg per kilogram of body weight every 4 or 8 weeks in combination with oral methotrexate for 54 weeks. We assessed clinical responses with use of the criteria of the American College of Rheumatology, the quality of life with a health-status questionnaire, and the effect on joint damage radiographically. RESULTS: The combination of infliximab and methotrexate was well tolerated and resulted in a sustained reduction in the symptoms and signs of rheumatoid arthritis that was significantly greater than the reduction associated with methotrexate therapy alone (clinical response, 51.8 percent vs. 17.0 percent; P<0.001). The quality of life was also significantly better with infliximab plus methotrexate than with methotrexate alone. Radiographic evidence of joint damage increased in the group given methotrexate, but not in the groups given infliximab and methotrexate (mean change in radiographic score, 7.0 vs. 0.6, P<0.001). Radiographic evidence of progression of joint damage was absent in infliximab-treated patients whether or not they had a clinical response. CONCLUSIONS: In patients with persistently active rheumatoid arthritis despite methotrexate therapy, repeated doses of infliximab in combination with methotrexate provided clinical benefit and halted the progression of joint damage.     

开设综合性生理学实验课的实践与体会

生理学探索性、综合性实验有利于提高学生的系统综合和创新能力，为此，根据实验室现有条件，我们对传统实验教学进行改革，设计成为探索性综合性实验并在七年制学生中开展。该实验既与课本知识紧密结合，又与临床密切相关。实践证明，该实验使学生系统性掌握生理学知识的同时为他们临床分析解决问题奠定了基础。     

止痛消痔膏治疗痔疮临床观察

目的：探讨止痛消痔膏对痔疮的临床治疗效果。方法：采用完全随机的方法,将110例受试对象分配到治疗组（60例）和对照组（50例）。治疗组采用止痛消痔膏,对照组采用马应龙痔疮膏。根据疗效标准判断疗效。结果：治疗组60例患者中,有效率为99.99%,对照组50例患者中,有效率达78%。结论：止痛消痔膏治疗湿热性痔病疗效肯定。     

High intravenous doses of human immune globulin suppress neonatal group B streptococcal immunity in rats

We evaluated the effect of intravenously administered immune globulin (IVIG) on neonatal group B streptococcal (GBS) infection in vivo and in vitro. A suckling rat model was used to compare the impact of penicillin (150 mg/kg) with albumin control, high-dose IVIG (2.7 gm/kg), or low-dose IVIG (0.68 gm/kg) on survival and bacteremia. Three lots of IVIG (two standard and one hyperimmune) with varying titers of GBS type III activity were used. An opsonophagocytic assay was then employed to evaluate in vitro the effect of concentrations of penicillin (none to 2.4 micrograms/ml), IVIG (none to 20 mg/ml), organism-specific (GBS type III-specific) activity (none to 1280(-1], and quantity of organisms (10(4) to 10(6] on the killing of several strains of GBS type III. Low doses of IVIG enhanced suckling rat survival (p less than 0.0025) and bacterial clearance (p less than 0.01). High doses of IVIG did not improve survival and in fact delayed bacterial clearance (p less than 0.05) when compared with low doses. Survival and bacterial clearance increased as the GBS type III activity of the IVIG lot increased. GBS opsonophagocytosis was suppressed at all penicillin concentrations (p less than 0.01) by high levels of IVIG (20 mg/ml). High-dose IVIG suppression of GBS opsonophagocytosis decreased as type III activity of the lot increased. We speculate that high doses of nonspecific IVIG may cause blockade of neutrophil or bacterial receptors necessary for GBS immunity in neonates.     

Remission following an elemental diet or prednisolone in Crohn's disease

The short- and long-term effects of an elemental diet in children with acute Crohn's disease were compared with those of prednisolone in historical controls. Clinical remission was induced in 25 of 30 and in 18 of 28 episodes treated for six weeks with an elemental diet and prednisolone. Patients with proximal disease had longer remission after treatment with an elemental diet (p < 0.05) than did patients with colonic disease after treatment with prednisolone (p < 0.01). Disease activity index score improved in both groups compared with the pretreatment scores (p < 0.05). However, the improvement in the elemental diet group was significantly better than in the prednisolone group (p < 0.001). Changes in linear growth were better after treatment with an elemental diet compared with steroids (p < 0.001). Serum albumin and haematocrit concentrations all improved significantly in the children treated with an elemental diet (p < 0.001) but not in those treated with steroids. Thus an elemental diet was better than prednisolone in proximal disease and confirmed improved growth and nutritional status.     

Physician/nurse attitudes and treatment adherence in children with cancer: A pilot study and new instrument

A new instrument designed to assess the treatment team's attitudes towards individual families was field tested to assess its correlation with missed appointments. We hypothesized that positive attitudes about families would be associated with high treatment adherence as measured by appointment keeping. The oncologists rated ease of working with parents, estimated appointment adherence and child's degree of illness in 18 children being treated for cancer. The 35 cohabitating parents were assessed for marital discord and parental-estimated appointment adherence. Actual appointment adherence was determined by clinic chart review. Physician-estimated adherence varied systematically with each physician and degree of the patient's morbidity. Factors related to actual adherence include: physician's discomfort in working with parents, father's estimate of home-treatment adherence, with a statistical trend for distance travelled to be inversely related to adherence. Neither marital discord nor parent-estimated adherence was related to appointment adherence. Results are discussed in terms of implications for facilitating adherence.     

Clinical assessment of flap perfusion by fiberoptic fluorometry

Perfusion fluorometry, a method which quantifies tissue fluorescence after intravenous fluorescein injection, has been highly predictive of skin flap survival in animals. It is advantageous because it is objective, simple, noninvasive, repeatable, and can be used to monitor flap perfusion constantly by following both uptake and elimination of dye. We applied this method clinically to a variety of flaps used in head and neck surgery. All flaps with good fluorometric values survived totally. Based on experience with 37 flaps, fluorometric indices have been established that accurately predict necrosis. Serial dye injections have been used to document transient flap ischemia in the early postoperative period. Representative cases illustrating the advantages of fluorometry in flap assessment are presented.     

Oncologic emergencies II. Hematologic and infectious complications of cancer and cancer treatment

Proper supportive care of the child with cancer is necessary to maximize the child's quality and length of life. This article discusses the pathophysiology, diagnosis, and management of the common hematologic and infectious complications of childhood cancer that the primary care physician must face.     

Sex differences in the practice patterns of recently trained obstetrician-gynecologists

Sex differences in practice patterns, as modified by family roles, are investigated in a national survey of 1420 active obstetrician-gynecologists who graduated from medical school between 1974 and 1979. Women are more likely than men to be practicing in multispecialty groups, and men are more likely than women to be practicing in obstetrics-gynecology partnerships. On average, men and women report working over 60 hours per week. In all practice arrangements except academic medicine, women work fewer total hours per week, although the differences are small and translate into significantly fewer patient encounters than men in only two practice arrangements: partnerships and multispecialty groups. When marital status and presence of children under age 18 are controlled, significant sex differences in hours worked remain only for married respondents with children. Family roles have an opposite effect on hours of work reported by men and women, decreasing the number of hours worked by women and increasing the number worked by men.