中华传统文化视角下疾病终末期患者尊严模型解析

目的:解析加拿大Chochinov疾病终末期患者尊严模型在中华文化情境下的适用性,并基于此对模型进行调适。方法:采用内容分析法,按照选定分析范围、抽取样本、确定分析单位和分析框架、资料分析四步完成。首先检索中、英文数据库中以中华文化背景下临终尊严为主题的文献,然后以尊严模型为框架对文献内容进行编码、归纳和分析。结果:尊严模型包含的多数主题符合我国临终患者的认知,如身体功能、医疗不确定性、死亡焦虑、隐私界限、照护要旨、他人负担、后事担忧等。但也出现了矛盾的主题,如忍受痛苦、自主性等,以及新的主题,包括家庭支持、病耻感和财务担忧。结论:加拿大版疾病终末期患者尊严模型并不完全符合中国文化,调适后的尊严模型更具我国文化特色,但仍需实证研究对模型进行验证。     

SQUAMOUS CELL CARCINOMA IN KAUAI, HAWAII

Background. It is estimated that over 100,000 new cases of squamous cell carcinoma are diagnosed in the United States annually. This number is compounded by an increasing concern over the ozone layer depletion and the continued sunbathing behavior of many individuals. This could be particularly acute in Hawaii, which may have the highest rates of skin cancer in the country. We believe the updated information on skin cancer is essential to address the magnitude of the problem. Methods. A prospective 5-year population-based incidence study was conducted on Kauai, Hawaii, between 1983 and 1987 to investigate the frequency of squamous cell carcinomas in resident Caucasians. Results. A total of 58 residents, 37 men and 21 women, were identified with an initial episode of squamous cell carcinoma during the 5-year period. The average annual incidence rate per 100,000 Kauai Caucasian residents, standardized to the 1980 U.S. white population, was 153 for men and 92 for women with a combined rate of 118. The average patient age was 66.4 years. The head and neck was the most common anatomic site, with the extremities second. Subsequent new squamous cell carcinoma occurred in 13.8% of patients. Only one patient (2%) developed a recurrence after treatment. Twenty-five patients (43%) had basal cell carcinoma simultaneously or at other earlier times. Conclusions. In Kauai the incidence rate of squamous cell carcinoma is the highest yet documented in the United States. No consistent trend in incidence rates was appreciated during this 5-year period.     

冠状动脉慢血流患者的腺苷负荷心肌灌注显像研究

目的:评价腺苷负荷心肌灌注单光子发射计算机断层扫描(SPECT)在诊断冠状动脉慢血流(CSF)中的临床价值。方法:根据冠状动脉造影(CAG)结果不同,分为CSF组、正常血流(NCF)组和CAG阳性组。使用校正的TIMI血流分级方法评价冠状动脉血流速度。3组均行CAG、静息心电图(ECG)、腺苷负荷ECG、静息及腺苷负荷SPECT检查,评价其心肌血流灌注情况。结果:CSF组腺苷负荷SPECT诊断心肌缺血阳性率(84%),明显高于平静ECG(20%)及腺苷负荷ECG(52%)。CSF组在腺苷负荷SPECT中显示心肌缺血的范围和程度高于NCF组,低于CAG阳性组。结论:CSF与心肌缺血关系密切,腺苷负荷SPECT可以作为检测CSF者心肌缺血的一种有效的无创性检查方法。     

Late Gadolinium Enhancement of the Esophagus is Common on Cardiac MR Several Months after Pulmonary Vein Isolation: Preliminary Observations

Background: Pulmonary vein isolation (PVI) as a treatment for atrial fibrillation (AF) is commonly performed. This procedure can damage the esophagus. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) offers noninvasive assessment of scar. We sought to examine the prevalence of esophageal hyperenhancement on LGE‐CMR prior to and following PVI. Methods: Seventy‐four patients underwent LGE‐CMR prior to and 1.7 ± 1.9 months post PVI for AF. Transmural esophageal hyperenhancement was visually assessed. The pre‐ and post PVI esophageal position was measured, relative to the vertebral body. Results: Prior to PVI, 3% (2/74) of patients had esophageal LGE on CMR. At post‐PVI follow‐up, 30% (23/74) of the studies demonstrated new esophageal hyperenhancement adjacent to an ablation site. Most (74%, 17/27) positive esophageal LGE studies were performed >30 days after PVI, while no (0/9) studies performed >2 months post PVI were positive for esophageal hyperenhancement. The presence of post‐procedural esophageal hyperenhancement was not associated with longer ablation time (P = 0.42), use of an irrigated catheter (74% with LGE vs 47% without, P = 0.16), right‐sided esophageal location (56% with LGE vs 39% without, P = 0.17), size of left atrium cavity (58 ± 8 mm with LGE vs 61 ± 10 mm without, P = 0.15), or the timing of the LGE‐CMR study after PVI (36 ± 10 days with LGE vs 60 ± 66 days without, P = 0.09). Conclusion: Though rare before PVI, new esophageal LGE is seen in almost one‐third of patients after PVI. The clinical implications to remain to be explored, but clinicians should be aware of this frequent imaging finding. (PACE 2010; 33:661–666)     

A case-controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterectomy in a fellowship training program

To determine whether total laparoscopic radical hysterectomy (TLRH) is a feasible alternative to an abdominal radical hysterectomy (ARH) in a gynecologic oncology fellowship training program. We prospectively collected cases of all of the patients with cervical cancer treated with TLRH and pelvic lymphadenectomy by our division from 2000 to 2006. All of the patients from the TLRH group were matched 1:1 with the patients who had ARH during the same period based on stage, age, histological subtype, and nodal status. Thirty patients were treated with TLRH with a mean age of 48.3 years (range, 29-78 years). The mean pelvic lymph node count was 31 (range, 10-61) in the TLRH group versus 21.8 (range, 8-42) (P < 0.01) in the ARH group. Mean estimated blood loss was 200 cc (range, 100-600 cc) in the TLRH with no transfusions compared to 520 cc in the ARH group (P < 0.01), in which five patients required transfusions. Mean operating time was 318.5 min (range, 200-464 min) compared to 242.5 min in the ARH group (P < 0.01), and mean hospital stay was 3.8 days (range, 2-11 days) compared to 5.6 days in the ARH group (P < 0.01). All TLRH cases were completed laparoscopically. All patients in the TLRH group are disease free at the time of this report. In conclusion, it is feasible to incorporate TLRH training into the surgical curriculum of gynecologic oncology fellows without increasing perioperative morbidity. Standardization of TLRH technique and consistent guidance by experienced faculty is imperative.     

Total Cavopulmonary Connection: A Modified Technique Without Prosthetic Material

An alternative method to create an intraatrial, cavocaval channel without using any prosthetic material in total cavopulmonary connection is described. This new technique avoids possible thrombotic complication, limitation of heart growth by intraatrial prosthetic material, and reduction in secretion of antinaturetic peptide.     

Immune effector cells induced by complete Freund's adjuvant exert an inhibitory effect on antigen-specific type 2 T helper responses

Background II has hecn well documented that environmental factors such as antigenpresenting cells and related cytokines could affect the development of T helper cells. Objective The purpose of this study is to investigate the effect of different adjuvants on T cell development. Methods Ovalbumin (OVA) combined with aluminum hydroxide (Alum) plus pertussis toxin (PT) or complete Freund's adjuvant (CFA) were used to sensitize mice; the production of IgG and IgE anli-OVA antibodies was then followed. In addition, OVA-specific proliferative responses and cytokine production by spleen cells were also investigated. Results The data showed that the adjuvants themselves could modify the pattern of immune response: (1) IgG_2a > anti-OVA antibody was higher in mice sensitized with OVA + CFA compared to that of mice sensitized with OVA + Alum + PT; (2) the ratio of IFN-γ/IL-4 produced by OVA-stimutated spleen cells was higher in mice sensitized with OVA + CFA than that of mice sensitized with OVA + Alum + PT; (3) increased percentage of γδ T cells was noted in the peritoneal exudate cells of OVA + CFA immunized mice; and (4) the immune response of mice sensitized wilh OVA + Alum+ PT was inhibited by the adoptively transferred ascitic cells from OVA + CFA immunized mice. Conclusion In general, the data suggested higher IgG2a and the ratio of IFN-γ/IL-4 was noted In mice sensitized with OVA + CFA. Further elucidation of the regulatory mechanism of allergen-specific T helper cells development and exploration of possible agents for inmiunotherapy might shed light on the management of atopic diseases.     

KERATOACANTHOMA IN JAPANESE HAWAIIANS IN KAUAI, HAWAII

Background. This is the first incidence report of keratoacanthoma (KA) in a Japanese ethnic population. Methods. The study was designed as a 5-year prospective incidence study using an island-wide survey of Japanese residents in Kauai, Hawaii, during the years 1983 through 1987. Results. Eleven Japanese residents of Kauai, three men and eight women, had ka. The crude incidence is 22.1 per 100,000 Japanese Kauaiian population. Two thirds of the lesions were on the extremities. No recurrence was noted, but a nonmelanoma skin cancer developed in some patients. Conclusions. The incidence of ka in a Japanese ethnic population is not low. Ultraviolet light exposure must, in part, contribute to the development of ka. This is supported by fact that the incidence of ka in Japanese residents in Kauai is much higher than in Japan and that most of the KAS appear on exposed skin.     

NON-MELANOMA SKIN CANCER AND KERATOACANTHOMA IN FILIPINOS: AN INCIDENCE REPORT FROM KAUAI, HAWAII

Background. Non-melanoma skin cancer is the most common malignancy in the white population of the United States with an estimated 700,000 new cases each year. Regrettably, data on minority racial groups are either scarce or lacking entirely. Methods. This study was designed as a 5-year prospective incidence study of non-melanoma skin cancer and keratoacanthoma by using an island-wide survey of Kauai's Filipino residents and covers the years of 1983 to 1987. Results. Seven basal cell carcinoma (incidence: 12.3/ 100,000), one squamous cell carcinoma (incidence: 1.8/ 100,000) and four keratoacanthoma (incidence: 7/100,000) patients are reported. Conclusions. To the best of our knowledge, this is the first population-based incidence report on non-melanoma skin cancer and keratoacanthoma in this population.     

Comparison of parenteral iron sucrose and ferric chloride during erythropoietin therapy of haemodialysis patients

Aim:   To compare the effects of i.v. iron sucrose and Fe chloride on the iron indices of haemodialysis patients with anaemia.
Methods:   One hundred and eight haemodialysis patients receiving recombinant human erythropoiesis-stimulating agent (ESA) (mean age 59.37 years) were enrolled and randomly assigned to an iron sucrose or an Fe chloride group. Iron supplements were administered at 100 mg/week during the first 4 weeks (loading dose). Ferritin and transferrin saturation (TSAT) were then measured and dose adjusted. Ninety-eight subjects completed treatment; 51 in the iron sucrose group and 47 in the Fe chloride group. Ferritin, TSAT, haematocrit (Hct), reticulocyte count, serum albumin, fractional clearance of urea (Kt/V) and intact parathyroid hormone (iPTH) were measured.
Results:   There was no significant difference in baseline characteristics between the groups. Significant differences between the groups were observed in both iron indices and ESA dosage. Hct at week 24 (31.1% vs 29.7%, P  = 0.006) and ferritin at week 20 (731.3 vs 631.7 ng/mL, P  = 0.006) in the iron sucrose group were significantly higher than in the Fe chloride group. ESA dosage used in the iron sucrose group at week 8 was significantly lower than in the Fe chloride group (244.9 vs 322.6 U/kg per month, P  = 0.003), and iron sucrose group received significantly lower iron dose than the Fe chloride group at week 8 ( P  = 0.005).
Conclusion:   Although the differences in ESA dosage, ferritin and iron dosage between two groups were found during the study period while similar results were shown at the end of 24 week study. Thus, iron sucrose and Fe chloride are safe and work equally well for haemodialysis patients.