应用秩和比法研究门诊人数增长与门诊医疗质量因子的关系

目的研究医院门诊人数增长与门诊医疗质量因子的关系,找出影响门诊人数增长的主要门诊医疗质量因子。方法利用秩和比法对实例进行分析。结果影响门诊人数增长的门诊质量因子,首先是高中级职称比(χ2=32.43,P<0.05),其次是副高以上职称的坐诊工时比(χ2=31.91,P<0.05),再次是新技术项目或重大改革(χ2=28.54,P>0.05)。结论研究医院门诊人数增长与门诊医疗质量因子的关系时,秩和比法有应用推广的价值。     

Comparative study of TRUE Test and Finn Chamber patch test techniques in Singapore

This is a report on a comparative study of the reactivity of TRUE Test and Finn Chamber patch test techniques. 413 patients attending a contact dermatitis clinic in Singapore were simultaneously patch tested with panels 1 and 2 of the TRUE Test standard series and with corresponding allergens (Hermal, Hamburg) using Finn Chambers. The left/right application of the TRUE Test and Finn Chambers was randomized. The concordance of positive patch test reactions to the 2 test techniques was studied. The number of patient with positive reactions was 38% and 42% for TRUE Test and Finn Chamber techniques, respectively (n.s.). The overall concordance of positive patch test reactions was 64% (209/328). 13% (42/328) of positive reactions appeared on TRUE Test only and 24% (77/328) on Finn Chamber only. When only relevant positive reactions were considered, the concordance rate was 67%; 11.6% of positive reactions appeared on TRUE Test only and 21% on Finn Chamber only. Positive reactions to p-phenylenediamine (PPD) and neomycin were more frequent with the Finn Chamber technique than with TRUE Test, i.e., false negative reactions to PPD and neomycin were more likely to occur with TRUE Test. It appeared that the TRUE Test and Finn Chamber techniques were comparable when used for patch testing. However false negative and false positive patch test reactions can occur when using either technique.     

Cranial CT interpretation by senior emergency department staff

The aims of the present study were to determine the rate of misinterpretation of non‐contrast cranial CT scans by emergency specialists and trainees compared with specialist radiologists, and the proportion of misinterpretations that is consequential. A 12‐month prospective blinded cohort study was performed. One‐hundred and ninety of 1282 scans (14.8%) were misinterpreted, and 78 of these (41.1%) were of potential or actual consequence. We conclude that the performance of senior emergency department staff in non‐contrast cranial CT interpretation is no better than moderately good, and a large proportion of misinterpretations are of potential or actual clinical consequence.     

Automated interpretation of the pulmonary function test by a portable spirometer in Chinese adults

IntroductionA portable spirometer is a promising alternative to a traditional pulmonary function test (PFT) spirometer for respiratory function evaluation.ObjectivesThis study aimed to investigate the accuracy of automated interpretation of the PFT measured by a portable Yue Cloud spirometer in Chinese adults.MethodsThe PFT was performed to evaluate subjects prospectively enrolled at Ruijin Hospital (n = 220). A Yue Cloud spirometer and a conventional Jaeger MasterScreen device were applied to each patient with a 20‐min quiescent period between each measurement. Pulmonary function parameters, including forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF), maximal expiratory flow at 25%, 50%, and 75% of the FVC (MEF25, MEF50, and MEF75, respectively), and maximal mid‐expiratory flow (MMEF), were compared by correlation analyses and Bland–Altman methods. The Yue Cloud spirometer automatically interpreted the PFT results, and a conventional strategy was performed to interpret the PFT results obtained by the Jaeger machine. Concordance of the categorization of pulmonary dysfunction, small airway dysfunction, and severity was analyzed by the kappa (κ) statistic.ResultsSignificantly similar correlations of all variables measured with the two spirometers were observed (all p < 0.001). No significant bias was observed in any of the measured spirometer variables. A satisfactory concordance of pulmonary function and severity classification was observed between the automated interpretation results obtained with the Yue Cloud spirometer vs. a conventional spirometer interpretation strategy (all κ > 0.80).ConclusionThe portable Yue Cloud spirometer not only yields reliable measurements of pulmonary function but also can automatically interpret the PFT results.     

足三里穴中枢神经网络作用机制的静息态脑功能磁共振成像研究

目的:应用静息态磁共振成像技术的局部一致性探讨足三里穴的中枢神经网络作用机制。方法:选择12名青年健康志愿者,于针刺足三里前及针刺足三里拔针后25 min分别进行静息态脑功能磁共振成像扫描,应用脑功能成像局部一致性(regional homogeneity,ReHo)方法处理功能磁共振(fMRI)成像数据。结果:针刺拔针后25 min后右侧额中回、左侧额上回、右侧颞上回、后扣带回、右侧中央旁小叶、右侧苍白球、右侧枕中回、左侧额内侧回等脑区的ReHo值较针刺前增高;双侧中央后回、左侧枕中回、左侧颞中回、左侧颞下回、左侧梭状回、左侧中央旁小叶、右侧额内侧回等脑区的ReHo值较针刺前减低(P0.05,K值≥10)。结论:针刺足三里后额叶、颞叶、枕叶、扣带回相关脑区局部一致性发生改变,提示足三里的认知影响、镇痛及胃肠功能调节的中枢神经网络作用机制存在。     

两台不同生化分析仪检测结果一致性校正

目的:达到不同的生化检测系统(仪器、试剂、方法等不同)对同一份标本的测定结果,具有较好的可比性、一致性。方法:按照美国临床实验室标准化委员会(NCCLS)EP 9-A文件的要求,以Roche P800生化分析仪及Roche原装配套的试剂、校准品、质控品、测定程序为标准检测系统(参比系统);用LEADMAN多项标准液的标示值校准"MT-100+/中生试剂"的检测系统为A检测系统;用病人新鲜混合血清作为临时校准品,LEADMAN多项标准液经标准系统准确度传递后,其标示值转换为实际校正值,再用此值校正"MT-100+/中生试剂"系统为B检测系统。在上述三个检测系统上同时测定40份病人血清的葡萄糖(G lu)、尿素(UREA)、肌酐(Cr)、a-淀粉酶(AMY)[浓度覆盖整个可测范围]。并对所测结果进行偏倚评估、相关性及线性回归分析。结果:A检测系统测定的指标与标准系统测定的比较,相对偏倚均大于5.0%(绝对值),其线性回归不理想,但相关系数(r)均>0.975。B检测系统测定的指标与标准系统测定的比较,相对偏倚均小于5.0%(绝对值),其线性回归良好,相关系数(r)均>0.990。结论:两台不同的生化分析仪对同一份...     

Reproducibility and prognostic significance of area of residual tumor (ART) in post-neoadjuvant resections of pancreatic ductal adenocarcinoma

BackgroundThe pathologic assessments of tumor response after neoadjuvant chemoradiotherapy (NACRT) are critical to improving the prognostic stratification for patients with pancreatic ductal adenocarcinoma (PDAC). Here we clarified the utility of our new grading system based on the area of residual tumor (ART) as compared to existing systems, such as the College of American Pathologists (CAP) and MD Anderson (MDA) score. Methods: Eight reviewers individually evaluated the tumor regression grade of 30 patients with PDAC based on three types of grading systems. The interobserver concordance and clinicopathological characteristics were compared between the three systems. Results: The interobserver concordance (kappa value) of the ART, CAP, and MDA score were 0.61, 0.48, and 0.53, respectively. Discrepant cases, which were 27% of the cases, exhibited smaller tumor and tumor bed sizes than concordant cases. The reduction in tumor size evaluated by microscopy showed a correlation with the rate of change in carcinoembryonic antigen (CEA) level, CA19-9 level, and tumor size on computed tomography (CT). The ART score was correlated with the tumor size on CT before and after NACRT and disease-free survival. The CAP and MDA scores were not associated with prognosis. Conclusion: The ART grading system may be the most practical system to assess the tumor response in post-NACRT resections of PDAC.     

The use of genetically modified mice in cancer risk assessment: Challenges and limitations

Abstract

The use of genetically modified (GM) mice to assess carcinogenicity is playing an increasingly important role in the safety evaluation of chemicals. While progress has been made in developing and evaluating mouse models such as the Trp53^+/?, Tg.AC and the rasH2, the suitability of these models as replacements for the conventional rodent cancer bioassay and for assessing human health risks remains uncertain. The objective of this research was to evaluate the use of accelerated cancer bioassays with GM mice for assessing the potential health risks associated with exposure to carcinogenic agents. We compared the published results from the GM bioassays to those obtained in the National Toxicology Program’s conventional chronic mouse bioassay for their potential use in risk assessment. Our analysis indicates that the GM models are less efficient in detecting carcinogenic agents but more consistent in identifying non-carcinogenic agents. We identified several issues of concern related to the design of the accelerated bioassays (e.g., sample size, study duration, genetic stability and reproducibility) as well as pathway-dependency of effects, and different carcinogenic mechanisms operable in GM and non-GM mice. The use of the GM models for dose-response assessment is particularly problematic as these models are, at times, much more or less sensitive than the conventional rodent cancer bioassays. Thus, the existing GM mouse models may be useful for hazard identification, but will be of limited use for dose-response assessment. Hence, caution should be exercised when using GM mouse models to assess the carcinogenic risks of chemicals.     

Problematic alcohol use and marital distress: An interdependence theory perspective

This article reviews current literature examining problematic alcohol use and marital distress and introduces a new alcohol and marriage model within the theoretical framework of interdependence theory. Although marriage is generally associated with decreased heavy drinking and alcohol problems, many couples develop and maintain alcohol use disorders during committed relationships and marriage. When one person is affected by an alcohol use disorder, it both affects and is affected by their close relationships, particularly the relationship with their partner or spouse. While the causal connections between problematic drinking and marital distress are complex and only partially understood, available evidence demonstrates that the two problems often exacerbate each other, forming a detrimental cycle. Research using cross-sectional and longitudinal methods reveals covariation between the two as well as support for both causal directions. New models using the Actor–Partner Interdependence Model (APIM) are presented and structured around the concept that these reverse temporal effects may be operating through different mechanisms and with different moderators. Thus, determinants are presented for each directional effect. Finally, avenues for future research are discussed.