Comparison of parent and teacher reports of attention-deficit/hyperactivity disorder symptoms from two placebo-controlled studies of atomoxetine in children.

BACKGROUND: The validity of parent reports regarding children's attention-deficit/hyperactivity disorder (ADHD) symptoms has been questioned. This study assessed whether parent reports were as sensitive as teacher reports to document change in ADHD symptoms during clinical trials with atomoxetine. METHODS: Data were compared from two randomized, double-blind, placebo-controlled clinical trials of atomoxetine using different versions (parent or teacher) of the same rating scale (Attention-Deficit/Hyperactivity Disorder Rating Scale-IV [parent or teacher] Version: Investigator Administered and Scored - ADHD RS). Exclusion criteria included history of bipolar disorder, psychosis, seizures, alcohol abuse, or positive drug screen. Patients (6-16 years old) were treated with atomoxetine (titrated to a maximum dose of 1.8 mg/kg/day) administered once daily for up to 7 weeks. Parent and teacher ratings were compared using an analysis of covariance (ANCOVA) model. RESULTS: The analysis (n = 318) showed that treatment effects (mean change, baseline to endpoint) were similar between parent and teacher ratings (total, p = .762; inattention, p = .519; hyperactive/impulsive, p = .955). Effect sizes also were similar based on total scores (parent ratings = .69; teacher ratings = .63). CONCLUSIONS: Parent reports are as sensitive as teacher reports in assessing the efficacy of long-acting pharmacologic treatment for ADHD in children during clinical trials using the nonstimulant atomoxetine.     

Framing the child at risk

Risk Assessment Reports are one form of accounting practice which delineate the space of risk considered in a child abuse neglect investigation. The paper analyses two Risk Assessment Reports, contrasting what is reported, what is directly observed and what is hypothesized and implied by child protection practitioners during the assessment of risk. From an analysis of these two reports (each 4 – 5 pages long), the paper identifies the rhetorical strategies and their realizations used by two practitioners in framing the child at risk. The paper problematizes the tension between the institutional need to constrain the exercise of professional judgement through Risk Assessment Models, and the extent to which practitioners actually localize the framing of risk to specific areas of investigation.     

儿童精神分裂症患者的预后及相关因素分析

目的探讨儿童精神分裂症的预后及其影响因素。方法收集1987—1997年首次住院的儿童(起病年龄≤14岁)精神分裂症患者(儿童组)124例和同期首次住院的成人(起病年龄25～30岁)精神分裂症患者(成人组)120例,采用社会功能缺陷量表(SDSS)、日常生活能力量表(ADL)、大体评定量表(GAS)及自制调查表,以随访与量表现场测评相结合的方法获得资料,数据采用多因素回归分析。结果(1)儿童组服药依从性(90例,77.6%)好于成人组(73例,64.0%；)χ~2= 5.11,P＜0.05)；复发率(29.3%)低于成人组(42.1%；χ~2=4.10,P＜0.05)。(2)儿童组预后良好者(91例,78.4%)显著多于成人组(65例,57.0%)。(3)儿童组的社会功能[(2.11±1.02)分]和日常生活能力[(18.78±9.17)分]优于成人组[(3.48±1.86)分和(21.82±8.67)分；P＜0.01和P＜0.05]。(4)经多因素回归分析,影响儿童精神分裂症预后的主要因素有：社会家庭关爱程度,首次住院疗效,起病形式,服药时间和病期(P＜0.01)。结论儿童精神分裂症患者总体预后较好；充分的家庭关爱,首次住院疗效好,急性起病,坚持长期治疗和病期较短者的预后更好。     

检测子宫内膜异位症患者血清中差异表达蛋白的研究

目的：检测子宫内膜异位症（内异症）患者血清中差异表达的蛋白。方法：采用表面增强激光解吸／离子化飞行时间质谱（SELDI—TOF—MS）技术，选用WCX2蛋白质芯片对50例内异症及48例对照组血清标本进行检测以筛选内异症血清中差异表达的蛋白。结果：在Mr 0～50000范围内，检测出106个蛋白峰。内异症患者血清中差异表达的蛋白峰有4个。将发现的差异蛋白峰在Swiss蛋白数据库中搜索，发现Mr 9280蛋白峰与玻璃粘连蛋白Vitronectin相符。Vitronectin属于整合素家族，在内异症的粘附、侵袭、血管形成过程中起重要作用。其他的蛋白峰没有发现与之相匹配的蛋白，提示可能为新的蛋白质。结论：内异症患者血清中存在差异表达的蛋白，其对内异症的早期诊断具有一定的临床意义。SELDI蛋白芯片技术是一种快速、简单易行、样本用量少、高通量、重复性好的分析方法，具有广阔的临床应用前景。     

Cerebral autoregulation is preserved in multiple system atrophy: A transcranial Doppler study.

Patients with multiple system atrophy (MSA) present large changes in blood pressure (BP) due to autonomic disturbances. We analyzed how this change may influence dynamic cerebral autoregulation (DCA). Simultaneous recordings of arterial BP (Finapres) and middle cerebral artery (MCA) blood flow velocity (BFV) (transcranial Doppler) were performed in 10 patients with MSA (61 +/- 12 yr of age) and 12 healthy volunteers (61 +/- 11 yr of age): cerebral BFV response to oscillations in mean BP was studied in the supine position by cross-spectral analysis of mean BP and mean MCA BFV. The DCA was also studied during the decrease in BP the first seconds when standing up from a sitting position by the assessment of the cerebrovascular resistance index (CR; mean BP/mean MCA BFV ratio). The MCA BFV/BP cross-spectral analysis showed a phase for the mid-frequency band (0.07-0.2 Hz) significantly larger in MSA, suggesting more active autoregulation in response to larger changes in BP. Changes in CR reflecting the rate of autoregulation, when standing did not differ between the two groups. These data suggest that dynamic cerebral autoregulation is preserved in MSA.     

癫痫手术后短期内癫痫发作病因分析及临床意义

目的:研究癫痫手术后短期癫痫发作的原因以及对预后的判断价值。方法:回顾性分析73例患者资料,将抗癫痫药物使用情况、以及是否颞叶癫痫、是否由肿瘤引起的癫痫、是否外伤性癫痫发作作为危险因素与术后短期癫痫发作进行Logistic回归模型分析。并对所有患者进行了12个月以上的随访。手术后短期癫痫发作与患者术后长期控制结果进行χ2检验。结果:19例患者发生APOSs。手术后抗癫痫药物使用不合理可能是APOSs独立的危险因素。癫痫手术患者出现APOSs组与未出现APOSs组在术后随访的癫痫Enge分级评分中无统计学差异。结论:抗癫痫药物的使用不当可能是手术后短期癫痫发作的主要原因之一。癫痫手术后APOSs的出现不能预测患者的长期预后情况。     

Spinocerebellar ataxia types 2 and 3 segregating simultaneously in a single family.

Spinocerebellar ataxia (SCA) types 2 and 3 are autosomal-dominant neurodegenerative disorders caused by mutations in two different genes. We identified mutations for SCA2 and SCA3 segregating simultaneously in a single Brazilian family. The index patient had SCA2, whereas her two second-degree cousins had SCA3. Disease was more rapidly progressive in the SCA2 patient, who presented severe brainstem and pancerebellar atrophy, as opposed to the two SCA3 patients, who had only mild cerebellar vermian atrophy. In such situations, molecular confirmation of all patients may avoid misdiagnosis of SCA subtypes and eventual errors in predictive testing of unaffected family members.     

MPO和NAT2基因多态性与成人急性白血病易感性

目的研究髓过氧化物酶（MPO）和N-乙酰基转移酶2（NAT2）基因多态性与成人急性白血病易感性的关系.方法用1∶1配对病例-对照研究方法,收集成人急性白血病患者和对照各139例,应用聚合酶链-内切酶片段（PCR-RFLP）方法分析病例组和对照组MPO和NAT2的基因多态性,比较不同基因型与成人急性白血病易感性.结果 MPO-463A等位基因分布频率病例组低于对照组,MPO（G-463A）各基因型在病例组与对照组中的分布差异有统计学意义（χ^2=7.026,P〈0.05,OR=0.505,95%CI=0.325～0.847）.NAT2乙酰化表型频率在病例组与对照组的分布差异无统计学意义（χ^2=2.260,P〉0.05）;但NAT2＊5 481T等位基因和NAT2＊6 590A等位基因分布频率病例组高于对照组（P〈0.05）.结论 MPO与成人急性白血病易感性相关,携带MPO（G-463A）突变基因型（GA/AA）个体可降低白血病的发病风险;NAT2乙酰化表型可能与白血病的易感性无关,但NAT2＊5（C481T）、NAT2＊6（G590A）单核苷酸突变频率病例组明显高于对照组.     

镍铬合金烤瓷修复体394件中远期修复效果回顾性分析

目的:了解镍铬合金烤瓷修复体的中远期修复效果。方法:对我科1995年7月～2005年3月具有完整病历记载并能正常复诊的312例(394件)镍铬合金烤瓷修复体的临床资料进行了回顾性分析。结果:镍铬合金烤瓷修复体3年以上成功率为96.2%,5年以上成功率为92.9%,牙龈炎症、松动脱落、瓷崩是镍铬合金烤瓷修复体失败的3种主要表现。结论:为确保镍铬合金烤瓷修复体的中远期疗效,应从适应证的选择、固位体的设计、基牙制备、烤瓷工艺等方面严格把关。