Factors influencing routine cognitive impairment screening in older at-risk drinkers: Findings from a qualitative study in the United Kingdom

Cognitive Impairment (CI) screening is recommended for those engaged in harmful levels of alcohol use. However, there is a lack of evidence on implementation. This paper explores the barriers and facilitators to CI screening experienced across a service specifically for older drinkers. The findings draw on data gathered as part of an evaluation of a multilevel programme to reduce alcohol-related harm in adults aged 50 and over in five demonstration areas across the United Kingdom. It is based on qualitative interviews and focus groups with 14 service providers and 22 service users. Findings are presented thematically under the section headings: acceptability of screening, interpretation and making sense of screening and treatment options. It is suggested that engagement with CI screening is most likely when its fit with agency culture and its purpose is clear; where service providers have the technical skills to administer and discuss the results of screening with service users; and where those undertaking screening have had the opportunity to reflect on their own experience of being screened. Engagement with CI screening is also most likely where specific intervention pathways and engagement practices can be accessed to respond to assessed need.     

Needle biopsy of renal allografts: comparison of two techniques

Two techniques for renal allograft biopsy were retrospectively evaluated to compare relative safety and efficacy. After ultrasound (US) localization of the kidney and biopsy with a hand-held 14-gauge cutting needle, an adequate specimen was obtained in 74 of 77 cases (96%). Major complications occurred in six of these 77 cases (8%). One hundred four biopsies were performed by using a smaller 18-gauge cutting needle with a spring-loaded biopsy "gun" and real-time US guidance. With this newer technique, specimens adequate for diagnosis were obtained in 99 biopsies (95%). There was a single major complication with this technique (1%). The 18-gauge needle with real-time US guidance yields comparably adequate specimens with a lower frequency of complications.     

转化生长因子—β1及其受体的表达与大鼠肝纤维化关系 …

探讨肝纤维化形成过程转化生长因子－β及其受体的表达对胶原合成的影响。方法：采用免疫组化和斑点杂交技术,观察实验性大鼠肝纤维化过程肝内ＴＧＦ－β１,ＴＧＦ－βＲⅡ和Ⅰ、Ⅲ型前胶原ｍＲＮＡ及其蛋白表达的动态变化。结果随着肝纤维化程度的加重,肝内ＴＧＦ－β１、ＴＧＦ－βＲⅡ和Ⅰ、Ⅲ型前胶原ｍＲＮＡ及其蛋白表达均明显增加,组间比较均有显著差异（Ｐ〈０．０５或Ｐ〈０．０１）。ＴＧＦ－β１与Ⅰ、Ⅲ型前胶原ｍＲ     

小柴胡汤分解剂抗柯萨奇B3病毒感染及其对心肌炎防治作用的研究

目的 :探讨小柴胡汤分解剂在体外及体内抗柯萨奇 B3病毒 (CVB3)及保护心肌细胞的作用。方法 :用小柴胡汤分解剂通过体外微量细胞培养 ,作用于被 CVB3直接损伤的细胞模型及经腹腔感染 CVB3m Balb/ c小鼠心肌炎模型 ,分析不同浓度分解剂的效应。结果 :在体外细胞上分解剂 A、B液自 1∶ 32稀释度对 vero细胞的毒性作用已丧失 ,至 1∶ 2 5 6稀释度时 ,仍能对抗 CVB3对细胞致病变作用。在体内分解剂 A、B液治疗组小鼠 35只 ,心肌炎发生率 37.14% ;而 2 0只对照组小鼠心肌炎发生率 5 9.1% ,两者有显著性差异 (χ2 =4.6 8,P <0 .0 5 ) ,在预防给药组更为明显 (P <0 .0 1)。结论 :小柴胡汤分解剂 A、B液在体内、体外均具有抗病毒及保护心肌的作用。     

Pharmacodynamic Analysis of Analgesic Clinical Trials Using Empirical Methods

Data from analgesic clinical trials have characteristics such as ordered categorical longitudinal responses with repeated measures, delay of effect with respect to analgesic plasma concentration, and right-hand censoring of response due to remedication. In order to determine the concentration-effect relationship of such data, we propose convolving an empirical function for plasma concentration, in the form of broken lines which connect each pair of neighboring observations, with a monoexponential function, to generate effect site concentration Effect site concentration and time are used, simultaneously, as independent variables in the fit of the model for the logit of the probability of having a specific pain relief (PR) score at each time point pre-remedication, via maximum likelihood. Using corresponding effect site concentration, the probabilities of having specific PR scores post-remedication are predicted via the concentration-response relationship established. The overall (pre- and post-remedication) predictions and corresponding standard errors for the responses are then estimated. Inference of the PR scoring, using a posterior method, is proposed. An illustration using real data is used to demonstrate these methods.     

Design and use of internal receiver coils for magnetic resonance imaging

This review describes coils for MRI that are inserted into the body through natural orifices. It covers the design and implementation of small internal receiver coils for use in the pelvis and gastrointestinal tract. Normal anatomy delineated by the high resolution obtained by using these coils and the appearances in a number of disease states for each clinical application are described.     

An active liver transplant programme for hepatocellular carcinoma in cirrhotic patients: is it justified?

Even at an early stage, hepatocellular carcinoma (HCC) in patients with cirrhosis is often deemed unresectable because of limited liver reserve. In these circumstances, liver transplantation (LTx) offers some hope for palliation or cure. The results of LTx for selected cirrhotic patients with HCC were analysed. The outcomes were compared with those of patients who underwent LTx for other forms of hepatic malignancy and those who underwent LTx for non-malignant conditions. Four hundred and eighty LTx were performed in 441 patients between January 1986 and December 1998. Twenty-eight LTx recipients (25 males, 3 females) of mean age 51 (14 63) yr had cirrhosis and HCC. Twenty-seven patients had underlying predisposing conditions (11 had hepatitis B, 10 had hepatitis C, 2 had hepatitis B and C, 1 had haemochromatosis, 1 had autoimmune hepatitis, 1 had alcoholic cirrhosis and 1 had alpha-1 antitrypsin deficiency). In 22 patients, HCC was diagnosed pre-LTx, and in 6 patients, the cancers were discovered incidentally. The average tumour size and number were 2.8 (0.4-11.5) cm and 1.3 (1-4), respectively. Two patients with known HCC died during and shortly after the LTx operation. Of the other patients, 3 died; 1 died of HCC recurrence 18 months post-LTx, 1 died of graft failure from recurrent hepatitis C and 1 died of fungal sepsis. Twenty-three (82%) patients survived to 22.5 (0.5-96) months post-LTx without HCC recurrence and with 1- and 3-yr actuarial patient survival rates of 87 and 76%, respectively. Equivalent survival rates of patients who underwent LTx for other malignancies (n = 11) were 82 and 46% (p = NS), and for those who underwent LTx for benign causes (n = 402), they were 77 and 73% (p = NS). All 15 patients with known HCC, who met the selection criteria now in use, survived. LTx can result in prolonged. cancer-free survival in a good proportion of patients with cirrhosis and HCC, particularly when the cancers are incidental, or when diagnosed pre-LTx, conforming to established selection criteria. An active LTx programme for this group of patients is justified.     

晚期肺癌73例外科治疗分析

目的 总结近９ａ实施的肺癌手术２０３例,其中属于Ⅲｂ或Ⅳ期的晚期肺癌７３例,旨在讨论晚期肺癌的手术指征,手术操作要点。方法 行全肺切除１８例（左肺１５例,右肺３例）,肺叶切除５４例,肺癌切除后复发余肺切除１例,经心包内处理肺血管１７例,合并民房部分切除２例;支气管成形术１３敢管隆凸成形术１例。结果 除１例因急性呼吸功能衰竭导致死亡外,其余均临床治愈,术后生存率１ａ内为９５％,１ａ以不足２ａ为８０％