心导纳微分环诊断无症状性心肌缺血

1临床材料 确诊为冠心病,经动态心电图（Hoher）出现町段下降,符合无症状性心肌缺血（SMI）诊断标准的患者30例（Ⅰ,Ⅱ,Ⅲ型各10例）;正常人30例．用导纳式HD-3181血液循环自动检测仪做左心功能检查,描记心导纳微分环（CADL）并记录总环及Ⅰ,Ⅲ,Ⅴ相面积。观察CADL的Ⅰ相离心支变化．比较前述各项指标在SMI患者组与正常组之间的差异．SMI患者组与正常组比较,CADL的总环面积、Ⅰ相面积的平均值均较正常组减小,有非常显著差异（P〈0．001）.     

Recall of Anti-Tobacco Advertisements and Effects on Quitting Behavior: Results From the California Smokers Cohort

Objectives. We assessed whether an anti-tobacco television advertisement called “Stages,” which depicted a woman giving a brief emotional narrative of her experiences with tobacco use, would be recalled more often and have a greater effect on smoking cessation than 3 other advertisements with different intended themes.Methods. Our data were derived from a sample of 2596 California adult smokers. We used multivariable log-binomial and modified Poisson regression models to calculate respondents’ probability of quitting as a result of advertisement recall.Results. More respondents recalled the “Stages” ad (58.5%) than the 3 other ads (23.1%, 23.4%, and 25.6%; P < .001). Respondents who recalled “Stages” at baseline had a higher probability than those who did not recall the ad of making a quit attempt between baseline and follow-up (adjusted risk ratio [RR] = 1.18; 95% confidence interval [CI] = 1.03, 1.34) and a higher probability of being in a period of smoking abstinence for at least a month at follow-up (adjusted RR = 1.55; 95% CI = 1.02, 2.37).Conclusions. Anti-tobacco television advertisements that depict visceral and personal messages may be recalled by a larger percentage of smokers and may have a greater impact on smoking cessation than other types of advertisements.Globally, one person dies from exposure to tobacco smoke every 6 seconds.1 Even in the United States, tobacco smoke exposure remains the leading cause of preventable death, with an estimated 480 000 adults dying from tobacco smoke exposure each year.2 Although the effects of tobacco smoke exposure are most severe among individuals who smoke on a daily basis, nondaily smoking and secondhand smoke exposure can lead to the same negative health consequences that result from daily smoking.3 Increasing smoking cessation, however, can significantly improve life expectancy; lower the risk of cancer, diabetes, heart disease, and lung disease; and, among women, lower the risk of infertility or low-birthweight children.2,4–7 Although the benefits of cessation are most prominent among the young, cessation at any age can immediately improve health outcomes.4It is recommended that tobacco control programs develop mass-reach health communication interventions to increase cessation among current smokers and reduce smoking initiation among nonsmokers.8 There are multiple pathways through which mass media are intended to promote cessation, including directly marketing cessation assistance to smokers, changing public opinions about tobacco use to create a social norm against smoking, and increasing interpersonal discussions about tobacco use.9–11 The majority of evidence indicates that these mass media campaigns are effective in motivating individuals to think about quitting, make quit attempts, obtain help in quitting, and maintain abstinence.12–31At the population level, advertisements are also associated with decreases in cigarette consumption and smoking prevalence.13,15,16,19,32–36 The magnitude of the effect of media campaigns on cessation is estimated to be relatively small; however, when this small effect is applied across an entire population, the reductions can be very meaningful. The United States Centers for Disease Control and Prevention (CDC), for example, recently estimated that its Tips From Former Smokers (TIPS) national ad campaign led to 1.64 million quit attempts and more than 100 000 Americans quitting smoking in just 1 year.19Despite this current weight of evidence and the recommendations of Article 12 of the Framework Convention on Tobacco Control,8 there are several barriers that make it difficult for many countries to develop mass media campaigns.37 One of the main barriers is the expense of developing and airing advertisements. To provide a perspective, CDC reported receiving $54 million in US federal funding to carry out the TIPS campaign,19 and since the launch of the California Tobacco Control Program (CTCP) in 1990, approximately $464 million has been spent on mass media campaigns in California, with $13.4 million currently being spent annually.38 In funding climates that are restrictive, tobacco control programs may be able to reduce costs by focusing on high-impact advertisements.39In the past decade, tobacco control advocates have begun promoting the use of mass media that rely on emotional messages, deal with the health consequences of smoking, or use personal narratives to convey their messages. These advertisements are intended to promote behavior change by evoking visceral reactions of sadness, fear, disgust, or anger in what has been referred to as a “fear appeal.”40,41 Although this concept of “scaring” smokers into quitting is anathema to many public health advocates,42,43 several researchers have demonstrated that advertisements that deal with the negative consequences of smoking in an emotionally evocative or personal way are effective. They are typically recalled more frequently even when they are aired at lower volumes,44–46 they reach socioeconomic groups equitably,34,47–50 and they are typically rated as more effective than advertisements with different themes.44,46,50–55 In addition, they promote more frequent use of quit lines12,14,26,29,47 and confer greater effects on quitting behavior.12,14,26,27,29,34,47–50Thus far, evaluations of fear appeal advertisements have predominantly relied on group-level measures of exposure rather than individual-level measures of recognition. Exposure, in evaluations of advertisements, typically refers to whether a person has viewed an advertisement, but it does not necessarily imply that the person processed the message or remembered the ad. Exposure is usually estimated via group-level measures (e.g., Nielsen ratings or gross rating points) that assess the average number of people in a given population who are likely to have viewed an advertisement.56–58 These group-level measures can be very valuable to public health programs in their assessments of how well an advertisement is reaching a population; however, when behavior change resulting from advertisements is assessed at the individual level, these group-level instruments serve only as ecological measures.By contrast, advertisement recall, a measure of an individual’s recognition of an advertisement, may reduce the possibility of ecological bias and serves as an indicator of message processing, an expected direct effect of exposure to mass media campaigns.59 Although ad recall has long been used in mass media evaluations,12,60,61 to our knowledge it has not been employed in evaluations of behavior change resulting from fear appeal advertisements.We sought to provide further evidence for the use of advertisements that deal with the health consequences of smoking in a personal and emotional way by assessing recall of 4 anti-tobacco television advertisements developed by the CTCP and demonstrating the effects of recall of these ads on smoking cessation. We tested the following hypotheses: an ad called “Stages” that depicted a woman giving a personal narrative of her negative experiences with tobacco use would be recalled more often than 3 other ads with different intended themes among the current smokers in our cohort (hypothesis 1); recall of “Stages” would be distributed more equitably across individual characteristics in multivariable analyses than would recall of the 3 other ads (hypothesis 2); and recall of “Stages” would have a greater effect on cessation than recall of the 3 other ads (hypothesis 3).     

Heart transplantation for dilated cardiomyopathy

Between 1988 and 1994, 23 patients underwent heart transplantation for dilated cardiomyopathy. The age of the 13 boys and 10 girls was from 8 months to 16 years (mean 7.1 years). Selection criteria included failure to thrive despite maximal antifailure treatment and/or intravenous inotrope dependence. The aetiology of cardiomyopathy was idiopathic (n = 13), congenital (n = 3), anthracycline induced (n = 4), Barth's syndrome (n = 1), and maternal systemic lupus erythematosus (n = 2). The waiting period of heart transplantation ranged from one day to 147 days (mean 22 days). Maintenance immunosuppression included cyclosporin, azathioprine, and prednisolone. Follow up after transplantation was from one month to 62 months (median 27 months) with a mean actuarial survival of 95% at one year and 87% at three years. Four patients developed coronary artery disease, one of whom died as a consequence 15 months after heart transplantation. Heart transplantation has emerged as an acceptable therapeutic option, at least in the short term, for patients with dilated cardiomyopathy.     

Significance of elevated serum thyrotropin during treatment of congenital hypothyroidism

Serum thyrotropin concentrations are frequently elevated during treatment of children with congenital hypothyroidism. It is unclear if elevated thyrotropin during early treatment indicates non-optimal treatment. In a cohort of 49 children with congenital hypothyroidism, we studied the decline in serum thyrotropin concentration after initiating L-thyroxine treatment, the relationship between elevated thyrotropin and treatment variables, and non-compliance with the treatment as a possible cause of elevated thyrotropin. The initial mean dose of thyroxine was 8.5 (SD 3.3) μg/kg body weight/day: 71 % of the serum samples obtained 15-21 days after the start of treatment had serum thyrotropin concentrations < 10 mU/1. Six children had no samples with serum thyrotropin < 10 mU/1 during the first 3 months of treatment. These children had a lower thyroxine dose prescribed, and serum thyrotropin was normalized when the dose was sufficiently increased. During treatment, from 6 weeks of age, serum thyrotropin > 10 mU/1 was related to a lower dose of thyroxine and lower serum thyroxine, and was not due to non-compliance with treatment.     

Steroid receptor status difference in recurrent intracranial meningioma and breast cancer in the same patient

The authors report a case of multiple recurrent intracranial meningioma associated with breast cancer in a menopausal woman. High affinity estrogen (ER) and progestin receptors (PR) were assayed independently in the meningioma and the tumor. ER were found to be very low in the meningioma and high in the breast tumor. On the contrary PR were found to be high in the meningioma and could be not detected in the breast tumor. This unique case suggests that meningioma and breast cancer are not under the same type of hormonal influence.     

Effectiveness of indoor allergen reduction in asthma management: A systematic review

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Phenotypic characterization of skin-infiltrating T cells in cutaneous T- cell lymphoma: comparison with benign cutaneous T-cell infiltrates

Using a panel of monoclonal antibodies, we have studied cell surface antigens of infiltrating mononuclear cells in skin biopsies from patients with cutaneous T-cell lymphoma (CTCL) and compared them with the T-cell surface phenotype seen in benign cutaneous T-cell infiltrations (e.g., contact dermatitis, delayed hypersensitivity skin tests, granuloma annulare) and in dermal infiltrates of lymphomatoid granulomatosis patients. We found that unlike circulating CTCL (Sezary) cells, CTCL cells infiltrating skin epidermis frequently expressed the T-cell antigen 3A1. Cutaneous infiltrates in 10 patients with mycosis fungoides (MF) and 1 patient with Sezary syndrome were OKT4 (inducer T cell), OKT8 (suppressor/cytotoxic T cell); 2 patients with MF were OKT4- , OKT8; and one MF patients's skin T cell were OKT4-, OKT8+. Similar to CTCL infiltrating cells, most of the benign skin T-cell infiltrates were usually 3A1+. OKT4+, and OKT8-. Our study shows the complex nature of T-cell antigen patterns in inflammatory and malignant skin T-cell infiltrations. We demonstrated that the CTCL the skin epidermal infiltrating T-cell phenotype is not invariate, and in many cases, is similar to the phenotype of clinically benign cutaneous T-cell infiltrations.     

人工肱骨头置换治疗复杂肱骨近端骨折的现状与进展

目的:总结近年来国内外有关人工肱骨头置换治疗复杂肱骨近端骨折的现状,分析其中存在的问题。资料来源:应用计算机检索PubMed1990-01/2006-12有关人工肱骨头置换治疗复杂肱骨近端骨折的文献,检索词"shoulder arthroplasty,fracture",限定文章的语言种类为English。另外应用计算机检索万方数据库2004-01/2006-12有关人工肱骨头置换治疗复杂肱骨近端骨折的文献,检索词"人工肱骨头置换,肱骨骨折",限定文章的语言种类为中文。资料选择:对资料进行初审,选取包括人工肱骨头置换治疗复杂肱骨近端骨折的文献,开始查找全文。纳入标准:相关的论著和综述。排除标准:重复性研究。资料提炼:共检索到90篇关于人工肱骨头置换治疗复杂肱骨近端骨折的文献,纳入34篇符合标准的文献。资料综合:对于复杂肱骨近端骨折的治疗目前仍存在很大争议,早期行半肩关节置换术是一种合适的方法。为促进人工肱骨头置换治疗复杂肱骨近端骨折的进步,分别在其适应症、禁忌证、手术时间、假体安置、假体周围软组织重建与平衡技术以及术后康复情况等方面进行综合分析。结论:人工肱骨头置换治疗肱骨近端复杂骨折,疗效满意,但应严格限制手术指征。人工肱骨头置换在技术上要求较高,并且在手术细节上需要精确的注意。合适的假体安置、合适的结节重建以及适当的物理治疗对于获得成功的结果至关重要。