肾小球滤过率和蛋白尿预测心血管高危患者结局

<正>较低的肾小球滤过率(eGFR)和较高的尿白蛋白肌酐比值(ACR)与主要心血管复合终点相关,例如,对eGFR<30ml/min·1.73m2和非常高的尿ACR校正后风险比为2.53(95%CI:1.61～3.99)。然而,将有关eGFR和尿ACR的信息添加到危险再分类分析中,对分配至中危分类的患者比例并未带来有意义的     

A systematic review of the psychometric properties of transition readiness assessment tools in adolescents with chronic disease

Background

Health care transition of adolescents with chronic conditions may be unsuccessful when patients have not acquired the necessary skills and developmental milestones. It is therefore critical for health care providers to assess the readiness for transition of their adolescent patients. This is currently hindered by the lack of a recognised, well-established transition-readiness assessment tool.

Methods

We conducted a systematic review of all transition-readiness tools for adolescents with chronic medical conditions published in peer-reviewed journals. Tools were rated by the methodological quality of the validation studies, and the psychometric measurement qualities of each tool.

Results

Ten different assessment tools were identified. Seven targeted specific diseases and 3 tools were generic. Most tools were poorly validated with only one tool, the Transition Readiness Assessment Questionnaire (TRAQ) demonstrating adequate content validity, construct validity, and internal consistency.

Conclusion

The TRAQ was the best-validated transition-readiness tool, with additional benefits of disease-neutrality. Further research should focus on testing the predictive validity of this tool, and exploring correlation with transition-outcomes, in an international population.     

Noncellular immunoadsorbents for preparing typing sera that recognize high-frequency red cell antigens

The feasibility of using salivary ABH substance, covalently coupled to an affinity gel as an immunoadsorbent for anti-A and -B in sera containing antibodies to high-frequency antigens was investigated. Several examples of anti-Hy (n = 4), -Jra (n = 3), -U (n = 3), -Lub (n = 3), -Tja (n = 8), and -Vel (n = 6), plus one anti-Coa, were treated by batch adsorption with the affinity gel. Titration of the adsorbed sera with ABO-incompatible cells lacking the relevant high-frequency antigen, in parallel with ABO-compatible cells expressing the high-frequency antigen, revealed that ABO antibodies could be adsorbed to exhaustion without loss of the sera's activity against cells bearing high-frequency antigens.     

持续腰池脑脊液引流治疗隐球菌性脑膜炎的临床探讨

0引言 隐球菌性脑膜炎(隐脑)是由隐球菌属中某些种或变种侵犯中枢神经系统引起的一种深部真菌病. 隐脑在我国仍以散发为主,近年来发病呈明显上升的趋势;而在一些发展中国家,AIDS患者隐脑的发病率更高[1]. 隐脑的误诊率较高,其治疗中存在较多问题,因为在现有的抗真菌治疗条件下,国内外文献报道其病死率仍高达25%～60%[1]. 现将我科1997-01/2005-01收治的19例中,进行了持续腰池脑脊液(CSF)引流的9例隐球菌脑膜炎患者与对照组10例观察报告如下,探讨有效的治疗手段.     

Coiled-spring sign of appendiceal intussusception

Appendiceal intussusception has been considered a rare entity that is difficult to diagnose radiographically. However, a characteristic coiled-spring appearance in the cecum with nonfilling of the appendix has been observed on double-contrast barium enema (DCE) examinations in 11 cases of apparent or proved appendiceal intussusception. In two surgically proved cases, the intussusception was precipitated by an appendiceal mucocele and by endometriosis implants in the appendix. In four other cases, the intussusception was transient and the coiled-spring defect in the cecum disappeared with filling of the appendix on the DCE examination (three cases) or on a subsequent barium enema study (one case). The remaining five cases were unproved, although two patients had undergone prior appendectomy and the coiled-spring finding presumably resulted from an intussuscepted appendiceal stump. Only one patient was found to have appendiceal-related symptoms. It appears that appendiceal intussusception often occurs as a transient phenomenon in asymptomatic patients, and that it can be diagnosed on the routine DCE examination by a characteristic coiled-spring defect in the cecum.