Developing an Evidence-Based Exercise Guideline on Improving Shoulder Motion and Lessening the Severity of Lymphedema for Breast Cancer Patients after Axillary Lymph-Node Dissection

Exercise is proven to be effective, safe and the preferred intervention for improving the range of shoulder motion of breast cancer patients who have undergone surgery for axillary lymph-node dissection. The application of evidence-based guidelines to clinical practice can help healthcare professionals to provide good quality care to patients and, in turn, produce better patient outcomes. The purpose of the present paper is to describe the development process of an evidenced-based guideline. Challenges in the implementation of evidence-based practice are identi.ed and strategies for tackling them discussed.     

Prevalence and characteristics of aquagenic pruritus in a young African population

Background

The internet is an increasingly important tool for physicians, but the extent to which it is used by dermatologists is unknown. We aimed to investigate the utilization of the internet by dermatologists in Saudi Arabia for medical purposes during their daily practice and to clarify the reasons for its use and non-use.

Methods

A self-administered questionnaire was distributed to all 160 dermatologists attending the National Dermatology conference in 2007.

Results

A total of 107 questionnaires were completed. Sixty-two percent of respondents had access to the internet in the workplace. The use of the internet to update medical knowledge was reported by 91%. Only 27% had internet access in consultation rooms. The majority of information retrieval occurred outside patient consultation hours (91%). Only 13% reported using the internet during patient consultation. Possible reasons included: lack of access (54%), time pressure (37%), possible interference with the physician-patient relationship (30%), and that use of the internet was too time-consuming (10%). The mean searching time used to solve a clinical problem was 34 ± 3 minutes. Fifty-eight percent used Pubmed; however, 77% of the dermatologists had no training at all in how to use this tool.

Conclusion

Professional medical use of the internet is widespread among dermatologists in Saudi Arabia. Providing access to the internet in the workplace and training of dermatologists to perform effective electronic searches are badly needed to improve the professional medical use of internet, which is expected to lead to better delivery of patient care.     

选择外科导航系统的参考要素

外科导航系统可提供外科手术过程中的实时指导，是一种极具应用前景的互动式工具。它可以在术中为外科医生提供实时信息，从而有利于手术的进程，改善手术效果，减少并发症。该系统的运用可降低手术创伤。该系统中计算机的运用有助于术前计划的制定和术后资料的收集。计算机辅助外科手术导航系统的应用已有十多年历史。随着近年来技术的发展，该技术得以进一步改良，并精确化了手术程序。虽然外科导航系统是一门相对较新的技术．但由于其显的优点，将会在临床上越来越广泛地应用。我们调研了五个外科导航系统的生产商，旨在介绍目前临床上可选择的外科导航系统和注意事项。     

Hepatitis B and C in doctors and dentists in Nigeria

We surveyed a random sample (n = 75) of doctors and dentists at University College Hospital, Ibadan, Nigeria. They were offered anonymous testing for hepatitis B surface antigen (HBsAg), hepatitis Be antigen (HBeAG), antibodies to hepatitis B core antigen (anti-HBc) and to hepatitis C virus (anti-HCV), by enzyme immunoassay. The results suggest a high prevalence of hepatitis B virus (HBV) with a high potential of transmissibility, as well as a high prevalence of HCV infection. The majority of the doctors and dentists use universal precaution for protection against viral hepatitis on < 50% of the occasions when they carry out procedures on their patients. Infection with HBV was associated with type of specialty (surgeons, dentists) and lack of HBV vaccination (p < 0.05). After logistic regression, these factors were independently associated with HBV infection (p < 0.05). Sixty (80%) had not received prior HBV vaccination. Unvaccinated personnel were more likely to be surgeons, dentists, < 37 years of age, and have fewer years of professional activity (p < 0.05). After logistic regression, only fewer years of professional activity remained independently associated with lack of vaccination (p < 0.05). To reduce the occupational exposure of HBV, universal precautions must be rigorously adhered to when the doctors and dentists carry out procedures on their patients, and all health-care workers should be vaccinated with HBV vaccine and the HCV vaccine, when it becomes available.      

二烯丙基二硫化物诱导胃癌BGC823 细胞周期G2/M期阻滞的机制*

目的:以细胞周期作为抗癌药物新靶点的研究,可能是很有前途的。笔者的前期工作发现,二烯丙基二硫化物（diallyl disulfide,DADS）可抑制人胃癌BGC 823 细胞增殖,其增殖抑制与细胞周期G2/M期阻滞有关;DADS可能是通过抑制细胞分裂周期蛋白25C（Cell division cycle protein 25C,Cdc25C）、cyclinB 1 表达使部分BGC 823 细胞停滞在G2/M期,但G2/M期阻滞的机制还未完全阐明。本研究进一步探讨DADS诱导人胃癌BGC 823 细胞周期G2/M期阻滞的可能机制。方法:RT-PCR 检测Chk1 和Chk2 在mRNA 水平的改变;Western blot检测DADS处理BGC 823 细胞前后细胞周期相关蛋白ATM-RAD3 相关基因（ATM-RAD3-related gene,ATR ）、细胞周期检查点蛋白激酶1（checkpoint kinase1,Chk1）、细胞周期检查点蛋白激酶2（checkpoint kinase2,Chk2）表达和ATR 、Chk1、Chk2 的磷酸化程度;免疫共沉淀检测Chk1、Chk2 与Cdc25C 结合情况。结果:RT-PCR 检测显示,Chk1 和Chk2 的mRNA 水平在处理组与未处理组之间无显著性差异（P>0.05）。 Western blot检测显示,总Chk1 和Chk2 蛋白表达在细胞处理前后均无明显改变,但15mg/LDADS刺激BGC 823 细胞2h 后,处理组细胞Chk1 磷酸化程度明显增加,并呈时间依赖性（P<0.05）,而Chk2 磷酸化程度在处理组与未处理组之间无显著性差异（P>0.05）。 15mg/L DADS 作用15～120min,ATR 磷酸化程度明显增加,呈时间依赖性（P<0.05）,而ATR 表达无改变。免疫共沉淀分析表明,DADS 能促进BGC 823 细胞Chk1 与Cdc25C 结合,而对Chk2 与Cdc25C 结合无影响。结论:DAD诱导人胃癌BGC 823 细胞G2/M期阻滞与Chk1 的活化有关,DADS可能是通过激活ATR 、Chk1,调节Cdc25C 的表达引起人胃癌BGC 823 细胞G2/M期阻滞。