MRI对子宫内膜癌浸润、淋巴结转移、宫颈间质受累的诊断价值分析

目的探讨磁共振成像(MRI)在子宫内膜癌浸润、淋巴结转移、宫颈间质受累中的诊断价值。方法选取74例子宫内膜癌患者为研究对象,均接受术前MRI检查和手术病理检查。以术后病理检查为依据,评估术前MRI对子宫内膜癌患者肌层浸润深度、淋巴结转移情况、宫颈间质受累情况的诊断准确性。结果MRI诊断子宫内膜癌浸润程度的准确性为89.2%(66/74),其中鉴别浅肌层浸润的准确性为90.2%(46/51),鉴别深肌层浸润的准确性分别为87.0%(20/23);诊断有无淋巴结转移的准确性为79.7%(59/74);诊断有无宫颈间质受累的准确性为95.9%(71/74)。结论术前MRI检查可在子宫内膜癌患者肌层浸润鉴别和宫颈间质受累的诊断评估中发挥积极影响,但在淋巴结转移的诊断中准确性较低,建议将其作为辅助手段应用于早期预测筛查中,以节省治疗时间,提高诊疗效率。     

Older people's preferences for involvement in their own care: a qualitative study in primary health care in 11 European countries

OBJECTIVE: The aim of the study was to explore the views of people aged over 70 years on involvement in their primary health care in 11 different European countries. METHODS: Older patients were asked about their views on patient involvement in a face-to-face interview. All interviews were audio-recorded, transcribed and analysed in accordance with the principles of 'qualitative content analysis'. An international code list was used. RESULTS: Four hundred and six primary care patients aged between 70 and 96 years were interviewed. Their views could be categorized into four major groups: doctor-patient interaction, GP related topics, patient related issues and contextual factors. CONCLUSION: People over 70 do want to be involved in their care but their definition of involvement is more focussed on the 'caring relationship', 'person-centred approach' and 'receiving information' than on 'active participation in decision making'. PRACTICE IMPLICATIONS: The desire for involvement in decision making is highly heterogeneous so an individual approach for each patient in the ageing population is needed. Future research and medical education should focus on methods and training to elicit older patients' preferences. The similar views in 11 countries suggest that methods for enhancing patient involvement in older people could be internationally developed and exchanged.     

Identifying residents’ educational needs to optimising postgraduate medical education about shared decision-making

ObjectiveTo investigate how to optimise resident engagement during workplace learning of shared decision-making (SDM) by understanding their educational needs.MethodsA qualitative multicentre study was conducted using video-stimulated interviews with 17 residents in General Practice. Video recordings of residents’ recent clinical encounters were used to facilitate reflection on their educational needs.ResultsData analysis resulted in five themes regarding residents’ educational needs for learning SDM: acquiring knowledge and skills needed to perform SDM; practising SDM; reflection and feedback; longitudinal and integrated training; and awareness and motivation for performing SDM.ConclusionResidents expressed a need for continuous attention to be paid to SDM during postgraduate medical education. That would help them engage in two parallel learning processes: acquiring the knowledge and skills necessary to perform SDM, and practising SDM in the clinical workplace. Alignment between the educational curriculum, workplace learning and resident learning activities is essential to operationalise SDM attitude, knowledge and skills into clinical performance.Practice ImplicationsThe identified educational needs provide ingredients for fostering the development of SDM proficiency. The findings suggest that residents and clinical supervisors need parallel training to bridge the gap between education and clinical practice when learning SDM.     

粘膜皮肤淋巴结综合征临床诊断及所致冠状动脉损害的超声心动图研究（附238例分析）

报告粘膜皮肤淋巴结综合征（ＭＣＬＳ）２３８例。除主要临床特征外，急性期血液呈高粘滞、高凝聚、低血色素贫血。其严重并发症为冠状动脉损害，超声心动图显示冠状动脉扩张１４５例（６０．９２％），冠状动脉瘤３８例（１５．９６％），冠状动脉血栓４例（１．６８％），心肌梗塞２例（０．８４％）。应用超声心动图诊断，随访研究ＭＣＬＳ所致冠状动脉损害在临床上具有应用推广价值。     

Fathers' involvement in Swedish child health care - the role of nurses' practices and attitudes

Aim: To investigate how nurses in Swedish child health care perceived working with fathers, and to what extent they offered support to, and included fathers in clinical encounters. Methods: A random sample of all nurses in Swedish child health care, 499 nurses, were asked to complete a postal questionnaire. The response rate was 70%. Data were analysed with content analysis, the chi‐square test and logistic regression models. Results: Almost all of the nurses found working with fathers positive. Fathers’ participation in child health care was much lower than that of mothers’. Almost 90% of the nurses estimated that it rarely came to their attention that a father was distressed, and less than one of five nurses had offered supportive counselling to any distressed father in the previous year. Nurses with regular supervision on mental health issues and nurses with a paediatric specialization were more likely to offer supportive counselling to fathers. Approximately 50% of the nurses had an ambivalent attitude towards fathers’ caring capacity when compared to that of mothers. Conclusions: Fathers received less support from child health nurses, and many nurses were ambivalent about fathers’ caring abilities. Methods need to be developed to involve both parents in child health care.     

Retailer branding of consumer sales promotions. A major development in food marketing?

This article examines retailer branding of consumer price promotions. It discusses the mechanics of price promotions, consumers’ reactions to them and the benefits that accrue to those that use them. It describes how large food retailers can now deploy branded price promotion systems that are fundamentally different to ‘traditional’ price promotions in both their mechanics and their effects on consumer decision processes. The article describes a field experiment that compared the performance of a food retailer’s branded price promotion system with that of a generic (manufacturer) price promotion. The research involved three experiments that covered two food categories (sliced bread and margarine) and two levels of discount (10% and 20%). The results indicate that food retailers are able to attach powerful brands to their price promotion systems, and these brand heuristics can significantly increase consumer purchase intent relative to an equivalent generic/manufacturer promotion. This incremental heuristic effect was stable in both categories and for both levels of price discount studied. These results are consistent with the predictions of alternative, non-cognitive and heuristic based models of food consumer choice that have been published recently in ‘Appetite’.     

Extracellular high-mobility group box 1 is increased in patients with Behçet's disease with intestinal involvement

High-mobility group box 1 (HMGB1) protein has been demonstrated to play an important role in chronic inflammatory diseases including rheumatoid arthritis, and systemic lupus erythematosus. This study investigated the association between extracellular HMGB1 expression and disease activity, and clinical features of Behçet''s disease (BD). Extracellular HMGB1 expression in the sera of 42 BD patients was measured and was compared to that of 22 age- and sex-matched healthy controls. HMGB1 expression was significantly increased in BD patients compared to healthy controls (78.70 ± 20.22 vs 10.79 ± 1.90 ng/mL, P = 0.002). In addition, HMGB1 expression was significantly elevated in BD patients with intestinal involvement compared to those without (179.61 ± 67.95 vs 61.89 ± 19.81 ng/mL, P = 0.04). No significant association was observed between HMGB1 concentration and other clinical manifestations, or disease activity. It is suggested that extracellular HMGB1 may play an important role in the pathogenesis of BD.     

The impact of Patient and Public Involvement in the SlowMo study: Reflections on peer innovation

BackgroundThe SlowMo study demonstrated the effects of SlowMo, an eight‐session digitally supported reasoning intervention, on paranoia in a large‐scale randomized‐controlled trial with 362 participants with schizophrenia‐spectrum psychosis.AimThe current evaluation aimed to investigate the impact of Patient and Public Involvement (PPI) in the SlowMo study.MethodPPI members were six women and three men from Sussex, Oxford and London with experience of using mental health services for psychosis. They received training and met at least 3‐monthly throughout the project. The impact of PPI was captured quantitatively and qualitatively through (i) a PPI log of recommendations and implementation; (ii) written subjective experiences of PPI members; (iii) meeting minutes; and (iv) outputs produced.ResultsThe PPI log revealed 107 recommendations arising from PPI meetings, of which 87 (81%) were implemented. Implementation was greater for recruitment‐, data collection‐ and organization‐related actions than for dissemination and emergent innovations. Qualitative feedback revealed impacts on study recruitment, data collection, PPI participants'' confidence, knowledge, career aspirations and society more widely. Outputs produced included a film about psychosis that aired on BBC primetime television, novel webpages and journal articles. Barriers to PPI impact included geography, travel, funding, co‐ordination and well‐being.DiscussionA future challenge for PPI impact will be the extent to which peer innovation (innovative PPI‐led ideas) can be supported within research study delivery.Patient and Public ContributionPlanned Patient and Public Contribution in SlowMo comprised consultation and collaboration in (i) design, (ii) recruitment, (iii) qualitative interviews and analysis of service users'' experiences of SlowMo therapy and (iv) dissemination.     

骨髓摄取FDG弥漫增高征象在初诊弥漫性大B细胞淋巴瘤的临床价值探讨

目的 探讨初诊弥漫大B细胞淋巴瘤（Diffuse large B-cell lymphoma，DLBCL）患者骨髓摄取氟代脱氧葡萄糖（FDG）弥漫增高征象的临床价值。方法 回顾性分析在我院行PET/CT检查的114例初诊DLBCL住院患者。所有患者均行骨髓活检（Bone marrow biopsy，BMB）。计数数据分析用χ²检验，计量数据分析用t检验或Wilcoxon检验。结果 根据骨髓摄取FDG类型分为骨髓正常组（51.8%）、单纯局灶组（10.5%）、单纯弥漫组（28.1%）、弥漫+局灶组（9.6%），诊断骨髓受累的比例分别为0%、100%、15.6%和100%，IV期的比例分别为33.9%、100%、59.4%、100%。单纯弥漫组患者比骨髓正常组更年轻（57 ±17岁vs 70 ±13岁）、血红蛋白（Haemoglobin，HGB）水平更低（108.1 ±23.8 g/dLvs 119.4 ±19.0 g/dL）、IV期和B症状发生频率更高（59.4%和46.9% vs 33.9%和22.0%）差异有统计学意义，（P < 0.05）；性别比例、白细胞计数（White blood cell，WBC）、乳酸脱氢酶（Lactate dehydrogenase，LDH）升高率、国际预后指数（IPI）评分 > 2比例无统计学差异。结论 DLBCL初诊患者中，骨髓摄取FDG 弥漫增高患者比骨髓摄取FDG正常者更年轻，更容易发生骨髓受累、分为IV期，更容易出现贫血、B症状、LDH升高、IPI评分 > 2，这些提示其病情更重、预后可能更差。     

Lymphovascular space invasion in endometrial carcinoma: Tumor size and location matter

ObjectiveTo analyze histological factors possibly associated with lymphovascular space invasion (LVSI) and to determine which of those can act as independent surrogate markers.MethodsRetrospective cohort study performed between January 2001 and December 2014. LVSI was defined as the presence of tumor cells inside a space completely surrounded by endothelial cells. Risk factors evaluated included myometrial invasion, tumor grade, size, location, and cervical invasion. Univariate logistical regression models were applied to study any possible association of LVSI with these factors. Values were adjusted by multivariate logistic regression analysis.ResultsA total of 327 patients with endometrial carcinoma treated in our Centre were included. LVSI was observed in 120 patients (36.7%). Lower uterine segment involvement (OR 5.21, 95% CI:2.6–10.4, p < 0.001) and size ≥2 cm (OR 2.62, 95% CI: 1.14–6.1, p < 0.001) were independent factors for LSVI in multivariate analysis. In univariate analysis, LVSI was a surrogate marker in type 1 tumors with deep myometrial invasion (IB, 51.9% vs. IA, 16.0%; p < 0.001), grade 3 (G3 55.8% vs. G1 16.2%; p < 0.001), size ≥2 cm (37.9% vs. 16.1%, p = 0.005), those with involving the lower segment of the uterus (58.9% vs. 22.5%, p < 0.001) and/or with cervical stromal invasion (65.4% vs. 26.1%, p < 0.001), and in type 2 tumors (61.5% vs. 30.5%, p < 0.001). The use of uterine manipulator did not increase the rate of LVSI (35.5% vs. 40.5%, p = 0.612) as compared to no manipulator use.ConclusionsSize ≥2 cm and involvement of the lower uterine segment are independent factors for LSVI, in type 1 tumors, which can be used for surgical planning. LVSI is also more common in type 1 tumors with deep myometrial invasion, grade 3 and/or cervical stromal invasion, and also in type 2 tumors. The use of a uterine manipulator does not increase LVSI.