金菊花乙酸乙酯提取物对大鼠实验性肝损伤的影响

目的：观察金菊花乙酸乙酯提取物（EAEDM）对肝损害的防护作用,方法：建立大鼠急性乙醇中毒肝损害模型,通过大鼠灌胃EAEDM,以对照组对照,测定血清过氧化脂质（MDA）,谷胱甘肽过氧化物酶（GSH－PX）,血清谷丙转氨酶（ALT）和血清谷草转氨酶（AST）的含量,结果：EAEDM能降低MDA,ALT和AST的活性,减少肝脏MDA的生成,增加GSH－PX的活性,结论：EAEDM对肝损伤具有防护作用。     

The repeatability of three methods for measuring prospective patients' values in the context of treatment choice for end-stage renal disease.

In the context of the choice of treatment for end-stage renal disease (ESRD), three approaches to value assessment were examined for their repeatability over time within subjects. If formal decision analyses are to be used to advise patients about treatment choice, then repeatable value assessment methods, an essential component of such analyses, are needed. The methods assessed were standard gamble (SG), time trade-off (TTO), and visual analogue (VA). Sixty-six nephrology clinic patients were interviewed on two occasions, 10 days apart, by one of two interviewers. An information session was conducted 1 week before the first interview. Subjects were taught about the treatments using an information package developed expressly for the study and a video produced by a pharmaceutical company for use in this decision context. Patients differed widely in the values provided for the various treatments of ESRD, with responses that ranged across the entire scale (0 to 100). The repeatability of the three methods was poor, with the coefficients of repeatability (95% range of differences from one occasion to the next) observed as +/- 27.4 for SG, +/- 38.4 for TTO, and +/- 36.5 for VA. When subsets defined by characteristics that may have improved the repeatability were analyzed, the magnitude of the error did not vary substantially. The poor repeatability of these methods raises questions about their use for decision analyses applied to the individual context.     

SARS患者外周血中T淋巴细胞亚群变化及其临床意义

目的 了解SARS患者外周血T淋巴细胞亚群的变化规律及其临床意义。方法 采用免疫细胞化学方法对12例临床确诊SARS患者和20例健康献血员外周血淋巴细胞亚群进行检测。结果12例患者外周血CD~ 、CD_4~ 和CD_8~ 细胞的百分率均较对照组明显降低(P值均<0.05),其中CD_4~ 细胞下降幅度最大;CD_4~ 细胞减少与淋巴细胞降低的关联性最明显(r=0.679,P<0.05)。结论 SARS患者细胞免疫功能存在明显损伤,临床应用糖皮质激素宜严格掌握指征。     

Inhibin expression in normal and pre-eclamptic placental tissue.

Serum inhibin levels increase during normal pregnancy, but are significantly higher in patients with pre-eclampsia. The aim of this study was to demonstrate possible increased expression of inhibin within the placentas of women with pre-eclampsia compared with non-pre-eclamptic controls. Cellular expression of inhibin alpha and beta A subunits was studied using immunohistochemistry on formalin-fixed, paraffin-embedded placental sections from cases of pre-eclampsia (n = 23) and gestational age-matched non-pre-eclamptic controls (n = 16). Immunohistochemistry was performed using monoclonal antibodies against inhibin alpha and beta A subunits by the indirect immunoperoxidase technique. Intensity of staining was graded by a semiquantitative scoring method. Differences in distribution and intensity of staining between control and pre-eclamptic placentas were analyzed using a nonparametric Mann-Whitney U test. Staining for both inhibin alpha and beta A was predominantly confined to the cytoplasm of syncytiotrophoblast, with weak expression within intermediate trophoblast. The intensity of staining for inhibin alpha was significantly greater in the syncytiotrophoblast of pre-eclamptic patients (mean staining intensity controls = 0.97, disease = 1.87; p < 0.001). Inhibin beta A staining was generally stronger than for the alpha subunit, and was also significantly increased in pre-eclamptic patients compared with controls (mean controls = 1.72, disease 2.19; p < 0.05). This is the first evidence for increased placental inhibin presence in pre-eclampsia, suggesting increased inhibin production within the placenta, a finding that could account for increased serum inhibin levels in pre-eclampsia.     

小儿烧伤输液中应用套管针37例

1 临床资料 2003-10/2004-07收治小儿烧伤37例,年龄1月龄-8岁.使用套管针静脉输液.选择粗直、有弹性、无静脉瓣易于固定的血管.常用上肢静脉有掌静脉、头静脉、前臂内侧静脉及重要静脉,下肢常用足背静脉弓及大隐静脉,头皮静脉常选用额正中静脉、颞浅静脉及耳后静脉、额角分支等较粗直的血管.促使血管充盈,以提高穿刺的成功率.     

Identifying predictors of delayed diagnoses in symptomatic breast cancer: a scoping review

Delayed diagnosis of breast cancer can adversely impact patient outcomes. To better understand this issue, we conducted a scoping review of literature from 1996 to 2015 that examined predictors of delayed presentation and diagnosis among women with breast cancer symptoms. We performed searches to identify studies of predictors of the time from symptom onset to first presentation (the patient interval), first presentation to diagnosis (the diagnostic interval) and symptom onset to diagnosis (the total interval) among women with breast cancer symptoms. Two reviewers independently reviewed and abstracted the findings of these studies. Of the 22 studies included in this review, 16 examined predictors of the patient interval, six examined predictors of the diagnostic interval and four examined predictors of the total interval. A total of 116 predictors were examined; three had evidence of an association with a less timely diagnosis: not disclosing symptoms to others, non‐lump breast symptoms and African American ethnicity. Improving awareness of atypical breast cancer symptoms and encouraging disclosure could improve the timeliness of a breast cancer diagnosis. Access concerns for vulnerable groups need to be addressed. Future research should be more purposeful in its choice of predictors, possibly through the use of established conceptual frameworks.     

Interrater reliability of measurements of comorbid illness should be reported

OBJECTIVE: Comorbidity indices are commonly used to stratify patients to control for treatment selection bias. The objectives here were to review the reporting of interrater reliability when studies use comorbidity indices in clinical research publications and to report the interrater reliability of four common indices in a particular research setting. STUDY DESIGN AND SETTING: Four trained abstractors reviewed the same 40 charts of patients with squamous cell carcinoma of the head and neck from a regional cancer center. Scores for the Charlson Index, the Index of Co-existent Disease, the Cumulative Illness Rating Scale, and the Kaplan-Feinstein Classification were calculated, and the intraclass correlation coefficient was used to assess interrater reliability. RESULTS: The details on the training of abstractors and the results of interrater reliability tests are not commonly reported. In our study setting, the Charlson Index had excellent reliability and the others had acceptable reliability. CONCLUSION: If the quality of a study using an index or scale is to be assessed, the reliability and interrater reliability of the score assignment process should be reported.