乳腺癌HER-2基因荧光原位杂交检测的临床应用

目的研究荧光原位杂交(FISH)用于乳腺癌HER-2检测的临床应用及HER-2基因扩增与乳腺癌临床病理的相关性。方法应用FISH技术和免疫组化(IHC)技术检测40例乳腺浸润性导管癌石蜡包埋标本,对比分析。结果IHC检测CerbB-2(3+)/(2+)/(1+或0),其FISH阳性率分别为85.7%、50%、5.9%。24例腋窝淋巴结阳性者,其FISH检测HER-2基因扩增10例(P=0.0399)。ER/PR阴性8例,其HER-2基因扩增6例(P0.05)。结论IHC检测HER-2蛋白有很高的假阳性及假阴性,FISH有效性及准确性显著高于IHC,可在临床广泛推广应用。HER-2基因扩增与腋窝淋巴结阳性相关。     

The role of speculum and bimanual examinations when evaluating attendees at a sexually transmitted diseases clinic

BACKGROUND: With the advent of molecular techniques, self-collected specimens without a clinician's examination are often adequate to detect common genital infections. OBJECTIVE: To evaluate the additional information that speculum and bimanual examinations provides clinicians in the routine evaluation of genital infections among attendees of a sexually transmitted disease (STD) clinic. METHODS: Cross-sectional study from a database of all visit records to two STD clinics in Baltimore between 1996 and 2002. Women were stratified on the basis of reason for visit. Proportional and likelihood ratio estimates of the speculum examination in detecting clinically relevant cervicovaginal lesions (leading to a diagnosis of other infections or outside referral for further management) and bimanual examination in detecting abnormalities (leading to a diagnosis of pelvic inflammatory disease or referral) are presented. RESULTS: 15 918 of 21 703 records were included: 12 073 were symptomatic (SYM; discharge, rash, abdominal pain, dysuria, genital irritation or odour), 1676 were asymptomatic contacts of an infected partner (CON) and 2169 were asymptomatic and presented for checkup (ASYM). The median age was 26 years; 94% were black. 11.8% of SYM, 4.6% of CON and 3.9% of ASYM patients had clinically meaningful lesions detected on speculum examination. The bimanual examination detected clinically relevant abnormalities in 6.5% of SYM, 0.8% of CON and 0.6% of ASYM patients. CONCLUSION: Symptomatic women are most likely to benefit from speculum and bimanual examinations. However, their yield in evaluating asymptomatic women is low. Prospective studies are needed to determine whether eliminating speculum and bimanual examinations in a subset of women would offer an operational advantage without compromising patient safety.     

萨滞布病(脑中风)的藏医病因病机及干预策略研究

萨滞布病是临床常见病和多发病,藏医药治疗萨滞布病临床疗效显著,但其病因病机尚存在异议,为促进和提高萨滞布病因病机的认识,本研究查阅和古籍文献,发现萨滞布病是人体三因失去平衡后隆血紊乱,人体坏血增多,坏血在隆的反作用下黏性增高,出现血液堵塞或溢出现象,导致白脉和黑脉受损,进而引起偏瘫、失语等症状,同时依据文献将萨滞布病的证型分类进行总结和梳理。依据藏医理论和国内外萨滞布病前沿相关文献,提出了从神经血管单元、时间药理学、代谢组学、肠道菌群等方法藏药干预萨滞布病的策略,为新方法和新思路研究藏药干预萨滞布病提供了藏医理论衔接点。     

HPLC法同时测定莱阳梨止咳颗粒、糖浆中的盐酸麻黄碱、绿原酸、苯甲酸的含量

目的 建立高效液相色谱法测定莱阳梨止咳颗粒、糖浆中盐酸麻黄碱、绿原酸、苯甲酸的含量。方法 Agilent C₁₈色谱柱(4.6 mm×250 mm, 5μm);流动相：乙腈-0.4%磷酸,梯度洗脱;检测波长：选用210 nm(盐酸麻黄碱)、327 nm(绿原酸)、230 nm(苯甲酸);柱温：30℃;流速：1 mL·min^-1,进样量10μL。结果 盐酸麻黄碱、绿原酸、苯甲酸的含量浓度分别在0.062 2～0.622 3、0.011 6～0.115 9、0.212 3～5.307 5(莱阳梨止咳颗粒)、1.061 5～6.369 0(莱阳梨止咳口服液)μg·mL^-1范围内与峰面积呈良好的线性关系(r=0.999 9、1.000 0、1.000 0、0.999 9);莱阳梨止咳颗粒平均加样回收率分别为97.85%、95.32%、96.62%(n=6);莱阳梨止咳糖浆平均加样回收率分别为94.19%、95.24%、97.74%(n=6)。结论 所建立的测定方法简便、准确、重复性好、专属性强,可同时测定莱阳梨止咳颗粒、糖浆中的...     

Chronic venous leg ulcer treatment: Future research needs

The prevalence and costs of chronic venous ulcer care in the US are increasing. The Johns Hopkins University Evidence‐Based Practice Center recently completed a systematic review of the comparative effectiveness of advanced wound dressings, antibiotics, and surgical management of chronic venous ulcers. Of 10,066 citations identified in the literature search, only 66 (0.06%) met our liberal inclusion criteria for providing evidence on the effectiveness of interventions for chronic venous ulcers. Based on review of those studies, members of our team and a panel of informed stakeholders identified important research gaps and methodological deficiencies and prioritized specific future research needs. Based on that review, we provide the results of our assessment of future research needs for chronic venous ulcer care. Advanced wound dressings were considered to have the highest priority for future research, followed by venous surgery and antibiotics. An imperative from our assessment is that future research evaluating interventions for chronic venous ulcers meet quality standards. In a time of increasing cost pressure, the wound care community needs to develop high‐quality evidence to justify the use of present and future therapeutic modalities.     

跨专业团队合作式自我管理教育对体检高血压患者的干预效果研究

目的 探讨跨专业团队合作式自我管理教育在体检高血压患者干预中的应用效果。方法 选取2019年4—6月在武汉某三级综合性教学医院的100名体检的高血压患者为研究对象,实施跨专业团队合作式自我管理教育。分别在干预前、干预3个月末、干预6个月末评估患者低密度脂蛋白胆固醇控制达标率、高血压治疗态度与信念评分、高血压治疗依从性评分、血压控制达标率。结果 干预前、干预3个月末、干预6个月末高血压患者低密度脂蛋白胆固醇及血压控制达标率比较差异具有统计学意义（P<0.001）。干预前、干预3个月末、干预6个月末高血压患者坚持治疗态度与信念、服药治疗态度与信念、治疗性生活方式态度与信念、持续治疗困扰与顾虑得分比较差异有统计学意义（P<0.001）。干预前、干预3个月末、干预6个月末高血压患者遵医服药行为、不良服药行为、日常生活管理行为、烟酒嗜好管理行为得分比较差异有统计学意义（P<0.001）。结论 跨专业团队合作式自我管理教育对体检高血压患者进行健康管理,可提高患者治疗的态度与信念及治疗依从性,从而提高患者血压及低密度脂蛋白胆固醇控制达标率。     

Does the Number of Trauma Lists Provided Affect Care and Outcome of Patients with Fractured Neck of Femur?

INTRODUCTION

Delay in surgery for fractured neck of femur is associated with increased mortality; it is recommended that patients with fractured neck of femur are operated within 48 h. North West hospitals provide dedicated trauma lists, as recommended by the British Orthopaedic Association, to allow rapid access to surgery. We investigated trauma list provision by each trust and its effects on the time taken to get neck of femur patients to surgery and patient survival.

PATIENTS AND METHODS

The number of trauma lists provided by 13 acute trusts was determined by telephone interview with the theatre manager. Data on operating delays, reasons for delay and 30-day mortality were obtained from the Greater Manchester and Wirral fractured neck of femur audit.

RESULTS

A total of 883 patients were included in the audit (35–126 per hospital). Overall, 5–15 trauma lists were provided each week, and 80% of lists were consultant-led. Of patients, 31.8% were operated on within 24 h and 36.9% were delayed more than 48 h; 37.7% of delays were for non-medical reasons. The 30-day mortality rates varied between 5–19% (mean, 11.8%). There were no significant relationships between the number of trauma lists and these variables. When divided into hospitals with > 10 lists per week (n = 6) and those with < 10 lists per week (n = 7) there were no significant differences in 48-h delay, non-medical delay or mortality. However, 24-h delay showed a trend to be lower in those with > 10 lists (34.6% of patients versus 28.9%; P = 0.09).

CONCLUSIONS

Most trusts provided at least one dedicated daily list. This study shows that extra lists may enable trusts to cope better with fractured neck of femur but do not change mortality.     

Fuzzy Logic in neurosurgery: predicting poor outcomes after lumbar disk surgery in 501 consecutive patients

Background

Despite a lot of research into patient selection, a significant number of patients fail to benefit from surgery for symptomatic lumbar disk herniation. We have used Fuzzy Logic-based fuzzy inference system (FIS) for identifying patients unlikely to improve after disk surgery and explored FIS as a tool for surgical outcome prediction.

Methods

Data of 501 patients were retrospectively reviewed for 54 independent variables. Sixteen variables were short-listed based on heuristics and were further classified into memberships with degrees of membership within each. A set of 11 rules was formed, and the rule base used individual membership degrees and their values mapped from the membership functions to perform Boolean Logical inference for a particular set of inputs. For each rule, a decision bar was generated that, when combined with the other rules in a similar way, constituted a decision surface. The FIS decisions were then based on calculating the centroid for the resulting decision surfaces and thresholding of actual centroid values. The results of FIS were then compared with eventual postoperative patient outcomes based on clinical follow-ups at 6 months to evaluate FIS as a predictor of poor outcome.

Results

Fuzzy inference system has a sensitivity of 88% and specificity of 86% in the prediction of patients most likely to have poor outcome after lumbosacral miscrodiskectomy. The test thus has a positive predictive value of 0.36 and a negative predictive value of 0.98.

Conclusion

Fuzzy inference system is a sensitive method of predicting patients who will fail to improve with surgical intervention.