Psychometric evaluation of the Taiwan version of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire.

BACKGROUND AND PURPOSE: To adapt the Taiwan version of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and evaluate its psychometric properties. METHODS: The DASH questionnaire was adapted through the process of translation, back-translation, and expert review. Eighty two subjects with upper extremity disorders were recruited in a medical center and 46 of these patients could be followed up to assess retest reliability in less than 10 days. Cronbach alpha and intraclass correlation coefficient were used to evaluate the internal consistency and test-retest reliability. Principal axis factor analysis was performed to assess the factor-construct validity, while concurrent validity was tested with the Medical Outcomes Study Short Form-36 (SF-36) Taiwan version questionnaire. RESULTS: The internal consistency of the Taiwan version of the DASH questionnaire was high (Cronbach alpha = 0.96) and the test-retest reliability was satisfactory (intraclass correlation coefficient = 0.9). Principal axis factor analysis confirmed the 1-factor model. The Pearson correlation coefficients of the DASH questionnaire to the SF-36 showed a correlation with physical component summary scores rather than mental component summary scores. Bodily pain, physical function and role-physical scores among the SF-36 subscales were most significantly correlated with DASH disability/symptom scores. CONCLUSION: The Taiwan version of the DASH questionnaire is a valid and reliable measure of health status for patients with upper-extremity disorders.     

体外循环心脏直视术后神经系统并发症防治18例报告

目的探讨心脏直视手术后神经系统并发症发生的原因、预防措施及救治体会。方法回顾性分析心脏直视手术后18例神经系统并发症的临床表现及诊治过程。结果18例中,一过性的神经精神功能紊乱13例,中枢神经系统功能障碍4例;经治疗,1例死亡,17例患者均痊愈出院,随访中,有2例留下后遗症。结论引发体外循环心脏直视手术后神经系统并发症的主要原因是脑栓塞和脑氧供需失衡、年龄偏大、原有神经系统疾病和糖尿病、术前心功能差、大动脉病变及体外循环时间长等,治疗方法以支持性为主,消除脑组织本身所发生破坏性反应,此外,可以通过改进各项技术措施加以预防。     

Effects of kadsurenone on the systemic inflammatory response in rat model of acute pancreatitis

Objective： To study the effects of kadsurenone on inflammatory mediators Platelet-activating factor （PAF）, tumor necrosis factor-α（TNF-α） and interleukin-6（IL-6） in rat model of acute pancreatitis（AP）. Methods： SD male rats （104） were randomly divided into sham group （n = 24）, AP group （n = 40） and kadsurenone group （n = 40）. The rats were killed 3, 6, 12 and 24 hours after operation. The serum level of PAF, TNF-α and IL-6 was measured. Results： The serum level of PAF, TNF-α and IL-6 of AP group was significantly increased（P 〈 0.01 ）compared with control group. The serum level of TNF-α got to a peak 6 hours after operation, and the serum IL-6 getting to a peak 12 hours after operation in AP group. After kadsurenone was administered to AP rats, pancreas and lung myeloperoxidase （MPO）, serum amylase activity was reduced. Histology showed a trend toward improvement. The serum level of PAF, TNF-α and IL-6 was significantly decreased （P 〈 0.05）. Conclusion. Kadsurenone can reduce the severity of systemic inflammation in rats with AP and relieve the damage of the pancreas and lung in AP rats. These results suggested that kadsurenone may be useful in the treatment of acute pancreatitis.     

10年间妊娠合并糖尿病发生状况及母儿结局的变化

目的探讨10年间妊娠合并糖尿病发生状况及母儿结局的变化,并分析其原因。方法近10年我院妊娠合并糖尿病孕妇共计58例,将其分成两组,1994年1月~1998年12月前5年19例患者作为A组,1999年1月~2003年12月后5年39例患者作为B组,对两组资料中孕妇一般情况、病情严重程度、治疗情况及分娩方式、围产儿并发症等情况进行比较分析和统计学处理。结果①A组孕妇孕晚期体重指数(BMI)、年龄、正规产检率、无症状患者均明显低于B组,其确诊孕周晚于B组;②A组治疗前空腹血糖值、酮症酸中毒发生率、早产率均高于B组;③A组单纯饮食控制不佳需加用胰岛素者及血糖控制不良率高于B组,A组经阴道产钳助产率亦高于B组;④A组围产儿并发症,死胎发生率、新生儿窒息率、IRDS发生率均高于B组。结论妊娠合并糖尿病对母儿可造成多种危害,近5年妊娠合并糖尿病发生率虽上升,但母儿并发症并未相应增多,与孕妇健康意识增强、孕期进行筛查,早发现,早治疗密切相关。     

输卵管妊娠术后生殖状况及其影响因素分析

目的分析引起输卵管妊娠手术治疗后不同生殖状况的相关因素,探讨改善生殖状况,提高宫内妊娠率的方法.方法对自1999-01-2003-12在中山大学附属第一医院等两家医院的424例输卵管妊娠患者经腹腔镜或剖腹手术治疗后患者生殖状况及其相关影响因素进行多重Logistic回归分析及x2分析,找出引起术后不孕及重复性异位妊娠的原因.结果424例患者术后宫内妊娠177例,占41.7%;出现重复性异位妊娠102例,占24.1%;有145例患者术后仍然未孕,占34.2%.多重Logistic回归分析提示,盆腔炎、不孕、异位妊娠、输卵管手术、输卵管粘连、输卵管伞端闭锁是输卵管妊娠术后不孕及重复性异位妊娠的危险因素.结论积极预防盆腔病变,治疗不孕症是改善输卵管妊娠术后生殖状况的重要手段.     

Membrane phospholipid abnormalities in postmortem brains from schizophrenic patients

Previous studies in schizophrenia have shown alterations in membrane phospholipids and polyunsaturated fatty acids. However, these studies have primarily examined peripheral (non-neuronal) cell types. The purpose of the present study was to examine whether the membrane deficits seen in peripheral tissues are also observed in the brain. The caudate was the primary region of interest for this study. Using high-pressure liquid chromatography in conjunction with an evaporative light-scattering detector, we first measured the level of various membrane phospholipids (PL) in schizophrenic (n=11) and control groups with (n=7) and without (n=14) other mental disorders. Polyunsaturated fatty acids (PUFAs) were then determined by capillary gas chromatography. Within groups, there are no significant correlations between membrane PL levels and other collection and demographic parameters including age, postmortem interval, storage time and brain weight. Significantly lower amounts of phosphatidylcholine and phosphatidylethanolamine were found in postmortem brain tissue from schizophrenic patients than in those from control groups, even after accounting for potential confounds. In addition, strong reductions of total PUFAs and saturated fatty acids were found in schizophrenic brains, relative to control brains. Specifically, the reduced PUFAs were largely attributable to decreases in arachidonic acid (AA) and, to a lesser extent, its precursors, linoleic and eicosadienoic acids. There are no significant differences between the control groups with and without other mental disorders. The present findings suggest that deficits identified in peripheral membranes may also be present in the brain from schizophrenic patients. Such a deficit in membrane AA may contribute to the many biological, physiological, and clinical phenomena observed in schizophrenia.     

穿山甲临床应用琐谈

穿山甲性微寒。味咸．归肝、胃经，临床医者多偏用其通经下乳之功效。笔者应用本品配伍于其他方药中，治疗临床诸多常见病症．均取得满意效果。本品实为通经下乳、活血祛瘀、消肿排脓、通经透络之要药。就其临床所治诸证，分述如下。     

中医正骨学认知学徒模式与传统教学模式比较研究

目的探索适合模拟医院环境下的教学模式.方法选择中医系骨伤专业2000级学生为研究对象,分为实验组和对照组,分别采用认知学徒模式和传统教学模式教学,组织专家听课.课后对学生进行基础理论、临床技能测试和操作考核,并通过向学生及专家发放调查问卷听取专家和学生对认知学徒教学模式的评价.结果实验组学生的基础理论、临床技能测试、考核成绩均高于对照组,结果有统计学意义.调查问卷反映认知学徒模式具有营造合适的学习环境,激发学生的学习兴趣,加快学生对知识和技能的掌握速度的作用.结论认知学徒模式能最大限度发挥模拟医院在医学临床教学中的作用,是适合于模拟医院教学环境的教学模式.     

p53 Codon 72 polymorphism predicts the pathologic response to neoadjuvant chemotherapy in patients with breast cancer.

PURPOSE: Recent studies have highlighted that the p53 codon 72 polymorphism plays a crucial role in modulating wild-type p53 apoptotic capacity, and as such may influence the response to chemotherapy. Thus, the purpose of this study was to investigate whether the p53 codon 72 polymorphism might influence pathologic response to neoadjuvant chemotherapy in primary breast cancer. EXPERIMENTAL DESIGN: One hundred and ten operable breast cancer patients received anthracycline-based neoadjuvant chemotherapy and p53 codon 72 polymorphism status was analyzed by PCR-RFLP. RESULTS: The distribution of initial clinical stage, tumor size, estrogen receptor or progesterone receptor status, menopausal status, or erbB2 expression was not significantly different among the polymorphic variants. However, we found that only 13% (3 of 23) of patients with the Pro/Pro variant had a good pathologic response, defined as a complete pathologic response or minimal residual disease. In comparison, 40% (22 of 55) or 37.5% (12 of 32) of patients with the Pro/Arg or Arg/Arg variant had a good pathologic response (P = 0.019). Moreover, patients with the Pro/Pro variant were more likely to have a positive axillary lymph node status than those with the Pro/Arg or Arg/Arg variant (P = 0.007). Furthermore, in multivariate analysis, p53 codon 72 polymorphism was found to be a strong predictor of pathologic response (odds ratio 6.7, 95% confidence interval, 1.4-31.2; P = 0.016). CONCLUSION: Our study indicates that breast cancer patients with the Pro/Pro variant may be less sensitive to anthracycline-based treatment than those with the Pro/Arg or Arg/Arg variant and suggests that analysis of p53 codon 72 polymorphism may provide a simple predictive marker for selecting the right breast cancer patients to anthracycline-based neoadjuvant chemotherapy in clinical setting.