影响药物毒性神经病理学评价质量的主要因素

神经毒性是许多药物或化合物常见的毒副作用。在新药研发早期要进行神经毒性筛选。对于可能通过血脑屏障影响神经系统的小分子药物或疫苗类的生物制品在临床前安全性评价中要进行非人灵长类动物的神经毒性评价。毒性病理学或神经病理学评价是临床前药物神经毒性评价的金标准。针对影响药物毒性神经病理学评价质量的几个主要因素,包括神经病理学评价的一般策略、最佳的评价时机、特殊的神经组织屏障系统、神经组织病理制片中的取材方法以及人工假象对神经病理学诊断的干扰,进行详细的解析,以期为我国神经毒性评价指导原则的制定和药物非临床神经毒性研究提供参考。     

小柴胡汤瓦锅煎煮与机器煎煮质量的多维度评价

目的:从HPLC指纹图谱、指标性成分含量、出膏率、密度及pH值方面,多维度评价传统瓦锅煎煮与现代机器煎煮所得小柴胡汤的质量。方法:分别采用传统瓦锅煎煮法、机器常压一煎法和机器常压两煎法制备汤液。HPLC色谱柱为Agilent ZORBAX SB-C₁₈(250 mm×4.6 mm,5 μm),检测波长为205 nm,流动相为乙腈-0.1%磷酸水溶液,柱温为30 ℃,流速为1.0 mL·min^-1,检测的指标性成分有甘草苷、甘草酸铵、黄芩苷、人参皂苷Rg1、人参皂苷Rb1、柴胡皂苷a和柴胡皂苷d。结果:3种方法制备的小柴胡汤HPLC指纹图谱相似度大于99%;机器两煎法中甘草苷、柴胡皂苷d的含量高于瓦锅煎煮(P<0.05),其余成分的含量、出膏率、密度与瓦锅煎煮无统计学差异(P>0.05);机器一煎法中人参皂苷Rg1、人参皂苷Rb1、柴胡皂苷a的含量低于瓦锅煎煮(P<0.05),其余成分的含量与瓦锅煎煮无统计学差异,机器一煎的出膏率和密度虽低于瓦锅煎煮,但均达到了瓦锅煎煮的90%以上。结论:小柴胡汤现代机器煎煮与传统瓦锅煎煮的质量无明显差异。     

基于COSMIN指南的健康老龄化测评工具的系统评价

目的 评价健康老龄化测评工具,为老龄化研究提供参考。 方法 在中国知网、万方、维普、SinoMed、Web of Science、PubMed数据库中检索,基于COSMIN指南对纳入研究进行评价。 结果 纳入的14项研究共包含14种健康老龄化测评工具,存在一定的偏倚风险,推荐等级均为B级：9项研究缺少比较拟合指数、塔克-刘易斯指数等涉及结构效度的类似指标;7项研究未进行多组因素分析或者项目功能差异分析;12项研究的组内相关系数或加权Kappa值未报告;12项研究未定义假设。 结论 应继续完善健康老龄化测评工具,依据测评工具质量评价的指南,规范研究设计和报告,为筛选出优质的测量工具以更准确地评估老龄化水平提供基础。     

Analysis of the optical quality by determining the modulation transfer function for anterior corneal surface in myopes

AIM: To describe the characteristics of modulation transfer function (MTF) of anterior corneal surface, and obtain the the normal reference range of MTF at different spatial frequencies and optical zones of the anterior corneal surface in myopes. METHODS: Four hundred eyes from 200 patients were examined under SIRIUS corneal topography system. Phoenis analysis software was applied to simulate the MTF curves of anterior corneal surface at vertical and horizontal meridians at the 3, 4, 5 , 6, 7mm optical zones of cornea .The MTF values at spatial frequencies of 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55 and 60 cycles/degree (c/d) were selected. RESULTS: The MTF curve of anterior corneal surface decreased rapidly from low to intermediate frequency (0-15cpd) at various optical zones of cornea, the value decreased to 0 slowly at higher frequency (>15cpd). With the increase of the optical zones of cornea, MTF curve decreased gradually. 3) In the range of 3 mm- 6 mm optical zones of the cornea, the MTF values measured at horizontal meridian were greater than the corresponding values at horizontal meridian of each spatial frequency, the difference was statistically significant (P<0.05). At 7 mm optical zones of cornea, the MTF values measured at horizontal meridian were less than the corresponding values at vertical meridian at 10-60 spatial frequencies(cpd), and the difference was statistically significant in 25, 30, 35, 40, 45, 50 cpd (P<0.05). CONCLUSION: MTF can be used to describe the imaging quality of optical systems at anterior corneal surface objectively in detail.     

N-乙酰半胱氨酸治疗COPD合并肺结核临床观察

目的：评价N-乙酰半胱氨酸（NAC）对慢性阻塞性肺疾病（COPD）合并肺结核患者肺功能、细胞免疫功能和生活质量的影响。方法：93例患者随机分为对照组47例和观察组46例,对照组予常规治疗,观察组加服NAC,6个月为一个疗程。比较抗结核作用、肺功能、细胞免疫功能和生活质量,记录不良反应。结果：治疗后,与对照组相比,观察组肺功能指标FEV₁/FVC和PEF,CD4+T、CD4+Foxp3+调节性T细胞亚群比例明显升高,CD4+/CD8+和SGRQ问卷中症状、活动、影响维度评分明显降低,组间均有显著性差异（P<0.05）。其余指标组间无差异。结论：NAC可明显改善COPD合并肺结核患者的肺功能、细胞免疫功能和生活质量,值得临床推广。     

Reliability and validity testing for the Child Oral Health Impact Profile‐Reduced (COHIP‐SF 19)

Objectives: This study assessed the reliability and validity of the Child Oral Health Impact Profile–Short Form 19 (COHIP‐SF 19) from the validated 34‐item COHIP. Methods: Participants included 205 pediatric, 107 orthodontic, and 863 patients with craniofacial anomalies (CFAs). Item level evaluations included examining content overlap, distributional properties, and use of the response set. Confirmatory factor analysis identified potential items for deletion. Scale reliability was assessed with Cronbach's alpha. Discriminant validity of the COHIP‐SF 19 was evaluated as follows: among pediatric participants, scores were compared with varying amounts of decayed and filled surfaces (DFS) and presence of caries on permanent teeth; for orthodontic patients, scores were correlated with anterior tooth spacing/crowding; and for those with CFA, scores were compared with clinicians' ratings of extent of defect (EOD) for nose and lip and/or speech hypernasality. Convergent validity was assessed by examining the partial Spearman correlation between the COHIP scores and a standard Global Health self‐rating. Comparisons between the COHIP and the COHIP‐SF 19 were completed across samples. Results: The reduced questionnaire consists of 19 items: Oral Health (five items), Functional Well‐Being (four items), and a combined subscale named Socio‐Emotional Well‐Being (10 items). Internal reliability is ≥0.82 for the three samples. Results demonstrate that the COHIP‐SF 19 discriminates within and across treatment groups by EOD and within a community‐based pediatric sample. The measure is associated with the Global Health rating (P < 0.05), thereby indicating convergent validity. Conclusions: Reliability and validity testing demonstrate that the COHIP‐SF 19 is a psychometrically sound instrument to measure oral health‐related quality of life across school‐aged pediatric populations.     

单病种协作防治体系在医疗质量管理与监控中的作用探讨

加强医疗质量管理与监控是提升医疗质量,合理利用医疗资源,产生良好社会效益的有效手段。本文通过对医疗质量管理与现状的分析,剖析单病种协作防治体系在医疗质量管理与监控中的作用,为医疗质量管理与监控提供实践和理论基础。     

Correlates of change in self-perceived oral health among older adults in Brazil: findings from the Health, Well-Being and Aging Study

BackgroundIdentifying changes in the oral health status of older populations, and their predictors and explanations, is necessary for public health planning. The authors assessed patterns of change in oral health–related quality of life in a large cohort of older adults in Brazil during a five-year period and evaluated associations between baseline characteristics and those changes.MethodsThe sample consisted of 747 older people enrolled in a Brazilian cohort study called the Health, Well-Being and Aging (Saúde, Bem-estar e Envelhecimento [SABE]) Study. Trained examiners measured participants' self-perceived oral health by using the General Oral Health Assessment Index (GOHAI). The authors calculated changes in the overall GOHAI score and in the scores for each of the GOHAI's three dimensions individually by subtracting the baseline score from the score at follow-up. A positive difference indicated improvement in oral health, a negative difference indicated a decline and a difference of zero indicated no change.ResultsThe authors found that 48.56 percent of the participants experienced a decline in oral health and 33.48 percent experienced an improvement. Participants with 16 or more missing teeth and eight or more years of education were more likely to have an improvement in total GOHAI score. Deterioration was more likely to occur among those with two or more diseases. Improvement and decline in GOHAI functional scores were related to the number of missing teeth. The authors found no significant model for the change in the psychosocial score, and self-rated general health was the only variable related to both improvement and decline in pain or discomfort scores.ConclusionsThe authors observed a bidirectional change in self-perceived oral health, with deterioration predominating. The strongest predictor of improvement in the total GOHAI score was the number of missing teeth, whereas the number of diseases was the strongest predictor of deterioration.Clinical ImplicationsDental professionals and policymakers need to know the directions of change in older adults' oral health to establish treatment priorities and evaluate the impact of services directed at this population.     

The influence of dental attendance on change in oral health-related quality of life

Crocombe LA, Brennan DS, Slade GD. The influence of dental attendance on change in oral health–related quality of life. Community Dent Oral Epidemiol 2012; 40: 53–63. © 2011 John Wiley & Sons A/S Abstract – Background: Few longitudinal studies have investigated the association between dental attendance and oral health–related quality of life (OHRQoL). These studies were limited to older adults, or to study participants with an oral disadvantage and did not assess if dental attendance had a different effect on OHRQoL for different people. Objective: This project was designed to test whether routine dental attendance improved the OHRQoL of survey participants and whether any patient factors influenced the effect of dental attendance on change in OHRQoL. Methods: Collection instruments of a service use log book and a 12 month follow‐up mail self‐complete questionnaire were added to the Tasmanian component of the National Survey of Adult Oral Health 2004/06. The dependent variable was change in OHIP‐14 severity and the independent variable was dental attendance. Many putative confounders/effect modifiers were analysed in bivariate, stratified and three‐model multivariate analyses. These included indicators of treatment need, sociodemographic characteristics, socioeconomic status, pattern of dental attendance and access to dental care. Results: None of the putative confounders were associated with both dental attendance and the change in mean OHIP‐14 severity. The only statistically significant interaction for change in OHIP‐14 severity was observed for dental attendance by residential location (P < 0.01). In multivariate analysis, there was a statistically significant association of dental attendance with change in mean OHIP‐14 severity. It also showed that the difference in association of attendance between Hobart, the capital city of Tasmania, and other places was statistically significant based on the interaction between residential location and attendance (P < 0.05). Conclusion: The effect of dental attendance on OHRQoL was influenced by a patient's residential location.     

全口义齿腭皱对语音恢复的作用

目的:研究金属基托全口义齿腭皱对修复后辅音声学特征的影响。方法:30例无牙颌患者分别戴入光滑面金属基托全口义齿(第一组)和有腭皱金属基托全口义齿(第二组),应用Minispeech lab测量并分析患者在初戴前,初戴时,初戴后1周、2周、4周、8周时汉语拼音/j/、/q/的第二强频区(F2)值、带宽(B2)值和嗓音起始时间(V.O.T.)。结果:第一组中,与初戴前相比,/j/、/q/的F2值从初戴后2周开始差异有统计学意义(P<0.05),/j/的B2值在初戴后8周,/q/的B2值在初戴后4周差异有统计学意义(P<0.05);第二组中,与初戴前相比,/j/、/q/的F2值从初戴后1周开始差异有统计学意义(P<0.05),/j/的B2值从初戴后2周开始,/q/的B2值从初戴后4周开始差异有统计学意义(P<0.05)。结论:金属基托全口义齿的腭皱能够缩短金属基托全口义齿初戴后患者语音恢复的时间。