无胸痛性冠心病临床分析

目的 典型的胸痛对诊断冠心病诊断十分重要。然而，临床上仍有大量无胸痛的病人冠状动脉造影诊断为冠心病（至少1根血管狭窄大于70％）。本文旨在研究胸痛存在与否对冠心病的诊断意义。方法采用横断面研究，连续人选行冠状动脉造影的61例病人，根据病人是否存在胸痛，分成胸痛组（37例），和非胸痛组（24例），胸痛包括典型的心绞痛、心肌梗死的症状之一；非胸痛的症状包括胸闷、心前区不适、憋气、心悸和气喘等。比较两组冠造阳性率，以及性别、糖尿病、高血压等因素在两组中的差别。结果胸痛组冠造阳性率高于非胸痛组，但是无统计学意义（81．8％V864％，P=0．132）；性别比在胸痛和非胸痛组间无差异（40．5％V840％，P=0．71）；糖尿病患病率在胸痛和非胸痛组间无差别无显著性意义（28％VS27％，P=0．25）；胸痛组hsCRP〉3mg／L病人的比例高于非胸痛组（18．9％vs16％，P=1．oo）；胸痛组急性心肌梗死的患病率高于非胸痛组，但是无统计学意义（51％V836％，P=0．26）；非胸痛组病人行运动试验检查的比率高于胸痛组（12．5％vs5．4％，P=0．38）；高血压患病率在两组间无差别（64．8％VS62．5％，P=0．697）。结论胸痛与无胸痛的冠心病患者在高血压、糖尿病、急性心肌梗死和高血压患病率、性别、hsCRP水平等方面无显著性差别。病人胸痛与否对冠心病的诊断不是必需的，须及时发现无胸痛的冠心病患者，以免延误病情。     

Diagnostic value of peripheral blood T-cell activation and soluble IL-2 receptor for acute rejection in liver transplantation

Background: T-cells play an important role in the pathogenesis of rejection. Monitoring T-cells activation markers in peripheral blood may contribute to diagnosis of acute rejection after liver transplantation (LTX). Methods: Lymphocyte subset distribution, expression of T-cell activation markers (flow cytometry), concentration of soluble (s) interleukin-2 receptor (IL-2R) (solid phase chemiluminescence immunoassay), and liver enzymes as well as bilirubin were prospectively tested in peripheral blood samples of LTX patients with (n=69) and without acute rejection (n=50). Acute rejection was assessed by standard criteria including liver biopsies. Results: Intra-individual monitoring of immune parameters revealed an up-regulation of IL-2 receptor (CD25) expression on CD4 and CD8 T-cells together with increases in sIL-2R levels in patients with acute rejections. Measuring sIL-2R levels resulted in highest diagnostic efficiency (>85%). This level of diagnostic efficiency was not reached by any other marker tested. From all conventional markers of hepatocellular integrity and function, alkaline phosphatase reached the highest level of diagnostic efficiency with 70%. Conclusions: Monitoring of up-regulation of the IL-2/IL-2R pathway represents a useful tool for assessment of acute rejection after LTX.     

Primary health care for Korean immigrants: sustaining a culturally sensitive model

This report describes a 4-year long bilingual interdisciplinary primary health care project that was designed to make culturally sensitive services available to underserved Korean immigrants in Chicago. It also describes some of the particular needs of this population and the strategies that the project staff adopted to identify and address the population's mental health needs. The project reflected the successful collaborative efforts of four participating principals: the Korean community, the University of Illinois at Chicago College of Nursing, the Chicago Department of Public Health, and the W. K. Kellogg Foundation. The model of service demonstrated in the project paired a bilingual advanced practice nurse, a certified family nurse practitioner, with a bilingual community advocate to conduct a program emphasizing community outreach and health promotion and prevention. A bilingual physician provided consultation for the nurse and attended to patients in need of medical care. Patients were referred to bilingual community social service agencies for assistance with a variety of other problems. A central goal of the project was for the services developed during its course to be assimilated into the regular programming of the Chicago Department of Public Health, a goal that was achieved. Finally, some of the challenges of introducing role change into an organization are discussed.