Effect of blood sampling schedule on the ability to discriminate between postprandial glycemic responses

ObjectiveThe blood glucose responses elicited by foods are often determined using blood samples taken at 15-min intervals. Our objective was to see whether taking blood samples at 10-min intervals affected the results.MethodsOvernight-fasted healthy subjects (n = 11) were studied on nine different occasions with seven different test meals. Blood samples were obtained at fasting and at 10, 15, 20, 30, 40, 45, 50, 60, 90, and 120 min after starting to eat. Peak rise, incremental area under the curve, and relative glycemic response were calculated using the 10- and 15-min sampling schedules.ResultsWith 10-min intervals, peak rise was 4% greater than with 15-min intervals (P < 0.001), but sampling interval did not significantly affect mean incremental area under the curve or relative glycemic response. The 10-min blood sampling schedule had a slightly greater ability to discriminate between foods and between subjects for peak rise and relative glycemic response.ConclusionsWe conclude that the blood sampling schedule used may influence the accuracy and precision of measurements of glycemic response; however, the difference between taking blood samples at 10-min and 15-min intervals is quite small.     

The Application of ‘Elite Interviewing’ Methodology in Transdisciplinary Research: a Record of Process and Lessons Learned during a 3-Year Pilot in Urban Planetary Health Research

This paper sets out the rationale and process for the interviewing methodology utilized during a 3-year research pilot, ‘Moving Health Upstream in Urban Development’ (UPSTREAM). The project had two primary aims: firstly, to attempt to value economically the health cost benefits associated with the quality of urban environments and secondly, to engage with those in control of urban development in the UK in order to determine what are the barriers to and opportunities for creating healthy urban environments, including those identified through the utilisation of economic valuation. Engagement at senior level with those who have most control over key facets of planning and development implementation—such as land disposal, investment, development delivery and planning permission—was central to the approach, which encompassed the adoption of ‘elite interviewing’, a method developed in the USA in the 1950s and used in the political sciences but relatively unutilized in the health and environmental sciences [¹]. Two rounds of semi-structured interviews were undertaken with 15 senior decision-makers from the UK’s main urban development delivery agencies, both public and private. The ‘elite interviewing’ approach successfully enabled the UPSTREAM project to capture and analyse the information received from the interviewees, all of whom held influential or leadership posts in organisations that are important actors in the process of planning, developing and constructing the built environment in the UK. Having academic and practitioner research leads on an equal footing created some minor tensions, but it also appeared to strengthen the rigor of the approach through a broad knowledge of context ‘in-house’. This form of co-production at times challenged academic traditions in qualitative analysis, but it also appeared to build trust with interviewees and provided greater clarity of the real-world context under investigation. Findings from this study are written up in a separate paper.     

Sociological autopsy: An integrated approach to the study of suicide in men

This paper’s main aim is to argue the methodological case for a particular approach to researching the sociology of suicide. By way of illustrating the use of this approach it also offers some brief examples of substantive findings about the gendered character of men’s suicides. The first half of the article explains and justifies the research approach. This is a qualitatively-driven mixed method and dual paradigm study of individual suicides. It is a sociological study which draws on the tradition of psychological autopsies of suicide; hence the term ‘sociological autopsy’. The second half of the article offers brief illustrative findings from a specific research project which employed the sociological autopsy approach. This was a study of 100 suicide case files from a coroner’s office in the UK. There is discussion of common sense assumptions about suicide in men; the construction of evidence in case files; a typology of gendered suicides where relationship breakdown seems to be the principal trigger; and the value of case-based analysis, with a single case discussed in some detail.     

改良经闭孔尿道中段悬吊术治疗女性压力性尿失禁的临床效果评价

目的评价改良自制聚丙烯网片及穿刺锥经闭孔尿道中段悬吊治疗女性压力性尿失禁（stress urinary incontinence,SUI）的安全性和治疗效果。方法选择2005年1月至2005年12月确诊为单纯性SUI患者86例,分为2组,改良组40例,采用自制聚丙烯网片及穿刺锥行闭孔尿道中段悬吊术（改良TVT-O术）；对照组46例采用TVT-O术。对2组患者术中情况及术后疗效进行定期随访,对比分析。结果2组患者均在静脉麻醉下完成手术。改良组平均手术时间（27±6）min,对照组（45±5）min；改良组平均术中出血（50±5）ml,对照组（80±5）ml；2组患者术后6 h去除导尿管后均能自行排尿,2组各有1例剩余尿＞100 ml,经留置导尿48h后好转；2组患者均无膀胱损伤等相关并发症发生；改良组平均住院（5．0±0．5）d,平均住院费（2462±160）元,对照组平均住院（7．5±0．5）d,平均住院费（8956±230）元；改良组在手术时间、出血量、住院时间、治疗费用均明显少于对照组,差异有统计学意义（P＜0．01）。改良组手术有效率90％（36/40）,好转率10％（4/40）；对照组手术有效率87％（40/46）,好转率13％（6/46）,2组均无无效或加重患者。2组患者手术疗效对比,差异无统计学意义（P＞0．05）。结论改良自制聚丙烯网片及穿刺锥TVT-O术方法简单、操作安全、悬带调节方便、术后恢复时间短,效果确切,且价格低廉,易为患者接受。     

循证医学方法对TRIFMA 与ECLIA测定TSH方法学评价

目的 实践循证检验医学，探讨TRIFMA与ECLIA测定TSH方法学的评价。方法 用我科自备低、中、高类质控血清与258例血清标本分别在AutoDELFIA1235与Elecsy system2010机上测定TSH的浓度。结果 诊断性试验技术质量(方法学)评价显示二者的相关性r=0．9966，n=130；灵敏度TRIFMA=0．0015mU／L，ECLIA=0.005mU／L；TRIFMA与ECLIA稳定性好、线性范围宽、健全性试验好；回收率均在92％～103％。诊断性试验准确性评价ROC曲线显示二者敏感度与特异度均在95％以上；阳性似然比均大于24；诊断准确度高。结论本方法学实践循证检验医学并查找相关文献，示TRIFMA与ECLIA是目前测定TSH的最佳方法，应用于临床能促进免疫分析整体水平的提高。     

Proposed Recommendations for Research on Biochemical Markers for Problematic Drinking

Biochemical markers can serve as valuable tools in screening for problematic drinking, determining whether a health problem is likely alcohol related, and monitoring alcoholics for relapse during and after treatment. Furthermore, biochemical markers can assist in forensic investigations; in identification of public health, safety, and transportation workers who may drink excessively and who, as a result, may put others at risk; in evaluation of efficacy of treatments for alcohol abuse; and in recognition of early phase alcohol-related tissue damage. Within all of these contexts, a biochemical marker or set of markers may corroborate verbal reports or may provide valuable independent information on alcohol use when an individual is unable or unwilling to offer valid data about alcohol consumption.     

临床诊断的思维方法

文章将临床诊断思维归纳为病变部位定位诊断法、病因机理诊断法、模板诊断法、概率诊断法四种方法，结合临床经验阐述了各种诊断方法的特点、步骤、适应性、局限性及相互关系，提出有机运用各种诊断思维，有益于减少误诊误治。     

Technical aspects of an impact acceleration traumatic brain injury rat model with potential suitability for both microdialysis and PtiO2 monitoring

This report describes technical adaptations of a traumatic brain injury (TBI) model—largely inspired by Marmarou—in order to monitor microdialysis data and P_tiO₂ (brain tissue oxygen) before, during and after injury. We particularly focalize on our model requirements which allows us to re-create some drastic pathological characteristics experienced by severely head-injured patients: impact on a closed skull, no ventilation immediately after impact, presence of diffuse axonal injuries and secondary brain insults from systemic origin… We notably give priority to minimize anaesthesia duration in order to tend to banish any neuroprotection.Our new model will henceforth allow a better understanding of neurochemical and biochemical alterations resulting from traumatic brain injury, using microdialysis and P_tiO₂ techniques already monitored in our Intensive Care Unit. Studies on efficiency and therapeutic window of neuroprotective pharmacological molecules are now conceivable to ameliorate severe head-injury treatment.     

改良一步式经皮肾造瘘法应用疗效评价

目的评价改良一步式经皮肾穿刺造瘘法临床应用效果。方法因结石或输尿管狭窄所致梗阻性肾积液或积脓、并有开放性肾切开取石术病史的患者65例,男34例、女31例,平均年龄45岁。随机分2组行经皮肾造瘘引流术。一步式组32例,以改良一步式经皮肾造瘘管直接穿刺引流；逐步式组33例,以传统经皮肾筋膜扩张套管进行肾穿刺造瘘。术前2组平均年龄、肾积液厚度、血肌酐、血红蛋白浓度差异无统计学意义。比较2组患者手术时间、出血量、术中术后并发症。结果一步式组与逐步式组一次穿刺成功率（96．9％vs 78．8％）、手术时间（10．2±2．4 vs 25．6±5．7 min）、平均出血量（5．2±2．6 vs 30．3±6．4 ml）、平均穿刺次数（1．1±0．6 vs 2．3±1．2次）、并发症发生率（3．1％vs 9．1％）等差异均有统计学意义（P＜0．05）。结论一步式经皮肾穿刺造瘘法与传统逐步筋膜扩张套管法比较操作简便、出血量少、成功率高。