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5个美国健康计划中治疗A型链球菌性咽炎效果的测定

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世界核心医学期刊文摘（儿科学分册） 2005年第10期1卷 46-47页

作者： mangione-Smith R. Elliott m.N. Wong L. 平智广 Univ. of California Los Angeles Department of Pediatrics 10833 Le Conte Ave. Los A ngeles CA 90095-1752United States Dr.

Background: There is a high degree of professional consensus that children dia gnosed with pharyngitis should only receive antibiotics if they have a positive test for group A streptococcus (GAS). Objectives: To develop and test the validity of a quality of care performance measure that examines GAS testing ra tes in children diagnosed with pharyngitis and prescribed an antibiotic. Design: The measure developed examines the annual rate of GAS testing in children aged 2 to 18 years with an episode of pharyngitis who were prescribed antibiotics. Th e measure was tested for feasibility of implementation and validity in 5 health plans in the United States. Health plan administrative data were used to identif y episodes of pharyngitis using international Classification of Diseases, Ninth Revision (iCD-9) codes 462, 463, and 034.0. Pharmacy data (National Drug Codes) were used to determine if antibiotics were prescribed for the pharyngitis episo de. Laboratory claims data (Current Procedural Terminology codes) were used to d etermine whether a GAS test was performed. Rates of GAS testing in children with pharyngitis who received antibiotics were calculated for each health plan. medi cal record abstractions were performed on a random sample (n = 465) of cases to assess percent agreement with laboratory claims data for GAS testing. Sensitivit y of the administrative data for accurately identifying when GAS tests were perf ormed was also assessed. Results: Of the 120 158 children aged 2 to 18 years who had at least 1 episode of pharyngitis during the measurement year, 51172 (43%) received antibiotics. Group A streptococcal testing rates for patients who were prescribed antibiotics varied widely among the participating health plans (59% -83%of cases; Pment between administrative and medical rec ords data for GAS tests was 86%. The sensitivity of the administrative data for accurately identifying when GAS tests were performed was 85%. Conclusions: Thi s qua

关键词：链球菌性咽炎 A型链球菌评估手段炎症状管理数据国际分类病例记录执行措施实验室数据病例摘要

日本年轻女性宫颈瘤样病变中HPV16的感染状况:881例门诊患者研究

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世界核心医学期刊文摘（妇产科学分册） 2005年第1期1卷 58-59页

作者： masumoto N. Fujii T. ishikawa m. 龚雯洁 Dept.of Obstetrics and Gyne cology Keio University School of Medicine Tokyo 160-8582 Shinjuku Japan

Objective. Human papillomavirus (HPV) infection is reported to be rel ated to c arcinogenesis in the uterine cervix. in Japan, screening for cervical cancer by cytology is performed in women over 30 years old. The purpose of this study was to determine whether there is an association between patient age and cervical ne oplasia or HPV infection in Japanese women. methods. Specimens from 881 randomly selected patients who came to our clinic were tested for HPV DNA by using Hybri d Capture ii, whereas specimens from a 204-patient randomly selected subset dia gnosed with cervical neoplasia were tested for HPV DNA by using polymerase chain reaction (PCR). HPV typing was performed in all the PCR -positive cases. Results. The HPV-positive rate in the 20-to 29-year-old pa tients (29.0%in the normal cytology/histology group and 85.5%in the abnormal g roup) was higher than in the 30-to 59-year-old patients, and the rate decline d until age 60 when age increased. While HPV 18, HPV 52, other HPV types, and HP V types as a whole were frequently detected in 30-to 49-year-old patients, HP V 16 was detected more frequently in the younger group than the other HPV types (P = 0.03). Among the HPV 16-positive patients with cervical neoplasia, the pro portion of cervical intraepithelial neoplasia (CiN) 3 cases was high (44%) in t he 20-to 29-year-old group. Conclusions. Screening for cervical neoplasia by cytology should also be performed in women under 30 years old in Japan. The HPV typing could be a tool to strictly follow-up younger women who were diagnosed w ith CiN.

关键词：瘤样病变 HPV16 瘤样增生 DNA 女性群体

与肠功能失调相关的肛门失禁亚型:临床、生理及社会心理方面的特征

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世界核心医学期刊文摘（胃肠病学分册） 2005年第4期1卷 19-20页

作者： Crowell m.D. Lacy B.E. Schettler V.A. 樊菁 Gastrointest. Physiol. and motility Div. of Gastroenterol. and Hepatol. Mayo Clinic Scottsdale 13400 E. Shea Blvd. Scottsdale AZ 85259 United StatesDr.

BACKGROUND: We hypothesized that functional anal incontinence with no structur al explanation comprises distinct pathophysiologic subgroups that could be ident ified on the basis of the predominant presenting bowel pattern. mETHODS: Consecu tive patients (n = 80) were prospectively grouped by bowel symptoms as 1) incont inence only, 2) incontinence +constipation, 3) incontinence +diarrhea, and 4) incontinence +alternating bowel symptoms. The Hopkins Bowel Symptom Questionnai re, the Symptom Checklist 90-R, and anorectal manometry were completed. RESULTS : Significant group differences were found between subcategories of incontinent patients on the basis of symptoms. Abdominal pain was more frequent in patients with altered bowel patterns. Patients with alternating symptoms reported the hig hest prevalence of abdominal pain, rectal pain, and bloating. Basal anal pressur es were significantly higher in alternating patients (P = 0.03). Contractile pre ssures in the distal anal canal were diminished in the incontinent only and dia rrhea groups (P = 0.004). Constipated patients with incontinence exhibited eleva ted thresholds for the urge to defecate (P = 0.027). Dyssynergia was significant ly more frequent in patients with incontinence and constipation or alternating b owel patterns. CONCLUSiONS: Distinct patterns of pelvic floor dysfunction were i dentified in patient subgroups with anal incontinence, based on the presence or absence of altered bowel patterns. Physiologic assessments suggested different p athophysiologic mechanisms among the subgroups. The evaluation of patients with fecal incontinence should consider altered bowel function.

关键词：肛门失禁功能失调肠道症状社会心理肛门直肠测压交替性便时盆底功能直肠痛腹胀症状

经皮冠脉介入术后左室重塑的证据:经皮冠脉介入对左室射血分数和左室容积的影响

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世界核心医学期刊文摘（心脏病学分册） 2005年第1期1卷 35-36页

作者： Zellweger m.J. Tabacek G Zutter A.W. 王亭忠 Cardiol. and Nuc l. med. Department University Hospital Petersgraben 4CH-4031Basel Switzerland

Background: Post-stress ejection fraction (EF), end-dia-stolic (EDV) and en d-systolic (ESV) volumes by gated myocardial perfusion SPECT (mPS) are well val idated, reproducible and of prognostic significance. However, little is known ab out the impact of percutaneous coronary intervention (PCi) on left ventricular v olumes and remodeling. methods: Thirty-eight patients who underwent mPS before and 6 months after PCi were evaluated. mPS were interpreted deriving summed stre ss(SSS), rest(SRS) and difference(SDS=SSS-SRS; extent of ischemia) scores. EF, EDV and ESV were generated by QGSTm. Pre-PCi mPS were compared to post-PCi mPS . Results: Single vessel disease was present in 63%of patients. PCi of one vess el was performed in 82%of patients. After 6 months, SSS (10.6±6.3 vs. 2.8±4.3 , pimproved; however, EF d id not change significantly(55±10 vs. 57±13, p=ns). Still, EDV(105±25 ml vs. 96±25 ml, p=0.006) and ESV(49±19 ml vs. 41±18 ml, p=0.001) were significantly reduced. Conclusion: Results of mPS documented the beneficial effect of PCi on symptoms and extent of ischemia. in addition, the findings showed a significant decrease in ESV and EDV after PCi as compared to pre-PCi findings which points to a positive effect on left ventricular remodeling even in the absence of signi ficant changes in EF.

关键词：冠脉介入术左室重塑射血分数左室容积单支血管病变心肌灌注支血管收缩末期容积预后价值舒张末期容积

FLAG方案治疗复发或难治性急性髓系白血病临床观察

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海南医学院学报 2010年第6期16卷 729-731页

作者：戴秋新徐昕孟文俊杨建刚徐茂忠赵钰东南大学医学院附属江阴医院血液科江苏江阴214400

目的:探讨FLAG方案治疗复发或难治性急性髓系白血病患者的疗效。方法:采用FLAG方案治疗复发或难治性急性髓系白血病患者37例。FLAG方案为氟达拉滨(Flu)30 mg/m2,dl～d5,阿糖胞苷(Ara-C)2 g,d1～d5,粒细胞集落刺激因子(G-CSF)5μg/kg d0... 详细信息

目的:探讨FLAG方案治疗复发或难治性急性髓系白血病患者的疗效。方法:采用FLAG方案治疗复发或难治性急性髓系白血病患者37例。FLAG方案为氟达拉滨(Flu)30 mg/m2,dl～d5,阿糖胞苷(Ara-C)2 g,d1～d5,粒细胞集落刺激因子(G-CSF)5μg/kg d0直到白细胞恢复超过>1.5×109/L。结果:37例患者中12例完全缓解(CR),CR率为32.4%。随访中位总生存期(overall survival,OS)为6.2个月,中位无进展生存期(progression-freesurvival,PFS)为10.3个月。26例复发患者FLAG方案治疗前少于3个疗程化疗的患者与3个及3个以上化疗疗程的患者疗效比较,差异有统计学意义(P<0.01)。结论:FLAG方案治疗复发、难治的急性髓系白血病患者效果良好。

关键词：急性髓系白血病复发难治氟达拉滨

抗体阳性的神经系统副瘤综合征:CT和PET对肿瘤诊断的价值

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世界核心医学期刊文摘（神经病学分册） 2005年第1期1卷 35-36页

作者： Linke R. Schroeder m. Helmberger T. Voltz R. 赵正卿 inst. for Clinical Neuroimmunology Klinikum GrosshadernD-81366 MunichGermany Dr.

Objective: To assess use of whole body 18F fluoro 2 deoxyglucose (FDG) PET and CT for diagnosing tumor in patients with antibody positive paraneoplastic neurologic syndromes (PNS). methods: in order to directly compare CT and FDGPET imaging in patients with various antineuronal antibodies, the authors performed in parallel CT scanning and FDG PET in a series of 13 consecutive patients (9 women, 4 men, aged 59 ± 14 years) with positive antineuronal antibodies (anti Hu: 8, anti Yo: 4, anti Tr: 1) in whom the authors were searching for a tumor or tumor recurrence. Results: A new tumor or tumor recurrence was found in 10/13 patients (5 small cell lung cancer, 2 ovarian cancer, and 1 each neuroblastoma, Hodgkin’ s lymphoma, and lymph node metastasis of adenocarcinoma). All tumors except one with good clinical evidence for small cell lung cancer were confirmed histologically. For detection of tumor or tumor recurrence, CT was positive in 3/10 patients (sensitivity of 30% ), and FDG PET in 9/10 (sensitivity of 90% , difference between methods p mbination of both methods showed a sensitivity of 100% . Conclusions: FDG PET imaging is useful in tumor screening of patients with antineuronal antibodies, but should be complemented by CT scanning to increase sensitivity and accuracy of tumor dia gnosis.

关键词：肿瘤诊断 CT PET 抗神经元抗体肿瘤筛查肿瘤复发小细胞肺癌霍奇金淋巴瘤淋巴结转移成神经细胞瘤

1例色素性视网膜炎患者行包括视网膜色素上皮层的胎儿视网膜移植后的视力变化

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世界核心医学期刊文摘（眼科学分册） 2005年第1期1卷 30-31页

作者：秦雪娇 Radtke N.D Aramant R.B Seiler m.J 3Audubon Plaza Dr LouisvilleKY 40217United States.Dr

Objective:To report the subjective and objective im-provement in vision in a patient with autosomal dominant retinitis pigmentosa after transpl antation of a sheet of fe-tal neural retina together with its r etinal pigment ***:A sheet of fetal n eural retina with its retinal pigment epithelium was tran splanted into the subretinal space under the fovea uni laterally in a patient with retinitis pigmentosa with visu al acuity of 20/800in the treated *** Treatment dia betic Retinopathy Study visual acuity testing,scanni ng laser ophthalmo-scope,tissue typing of the donor and recipient,fluo-rescein angiography,multifocal electroretinogram,multi-focal visually evoked potential,an d clinical examination were ***:No clinical evid ence of rejection was *** was no retinal ed ema or *** transplant sheet lost its pigmen tation by *** Outcome measures:A change in visual acuity from20/800to 20/400(7months),20/250(9months),and 20/160(1year)was observed by Early Treatment diabetic Retinopathy Study visual a cuity ***-pendently,scanning laser ophthalm oscope testing at a different institution at 9months sh owed a visual acuity of20/270at a 40°field of ***:This study indicates that fetal retina transpl anted with its retinal pigment epithelium can survive 1year without apparent clinical evidence of rejection and s how continued im-provement in Early Treatment diabetic Retinopathy Study visual acuity.

关键词：视网膜色素上皮色素性视网膜炎视力变化网膜移植视网膜电图神经视网膜视网膜水肿激光扫描检眼镜黄斑区视网膜

北曼哈顿3个种族总同型半胱氨酸水平与认知关系的研究

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世界核心医学期刊文摘（神经病学分册） 2005年第1期1卷 32-33页

作者： Wright C.B. Lee H.-S. Paik m.C. 陈云春 Division of Stroke and Critical Care Coll. Phys./Surgs. of Columbia Univ. 710W168th Street New York NY 10032 United States Dr.

Objective: Several studies implicate elevated homocysteine as a risk factor for dementia and cognitive decline, but most studies have involved subjects older than 55 years from homogeneous populations. The authors examined homocysteine and cognition in a tri ethnic community sample 40 years and older. method: The Northern manhattan Study includes 3,298 stroke free subjects. Of these 2,871 had baseline fasting total homocysteine (tHcy) levels and mini mental State Examination (mmSE) scores available. The authors used multiple linear regression to examine the cross sectional association between baseline tHcy levels and mean mmSE scores adjusting for sociodemographic and vascular risk factors. Results: Homocysteine levels were related to age, renal function, and B12 deficiency. Those with B12 deficiency had tHcy levels five points higher (9.4 vs 14.4 nmol/L). mean mmSE scores differed by age, sex, and race ethnic group. Those with hypertension, dia betes, cardiac disease, and B12 deficiency had lower mmSE scores. in multivariate analyses, elevated tHcy was associated with lower mean mmSE scores for those older than 65 but not for those 40 to 64. Adjusting for B12 deficiency and sociodemographic factors the mean mmSE was 2.2 points lower for each unit increase in the log tHcy level (95% Ci 3.6, 0.9). Adding vascular risk factors to the model did not attenuate this effect (mean mmSE - 2.2 points; 95% Ci - 3.5, - 0.9). Conclusions: Elevated homocysteine was independently associated with decreased cognition in subjects older than 65 in this tri ethnic cohort, adjusting for sociodemographic and vascular risk factors.

关键词：认知关系认知功能人口统计学多重线性回归子后肾功能多元分析子及

中、低收入国家卫生智囊团的实践影响政策变化

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中国卫生政策研究 2012年第8期5卷 34-42页

作者： Sara Bennett Adrijana Corluka Jane Doherty Viroj Tangcharoensathlen Walaiporn Patcharanarumol Amar Jesani Joseph Kyabaggu Grace Namaganda A m Zakir Hussain Ama de-Graft Aikins 约翰霍普金大学公共卫生学院美国马里兰州巴尔的摩威特沃特斯兰德大学公共卫生学院南非约翰内斯堡国际卫生政策项目泰国曼谷阿努撒德罕信托印度孟买全球卫生与社会转型非洲研究中心乌干达坎帕拉独立咨询顾问孟加拉加纳大学加纳

近年来,中、低收入国家独立卫生政策研究机构的数量与日俱增,原因在于政府研究能力有限和民主化进程中的压力。本研究的目标是:(1)调查中﹑低收入国家中卫生政策研究机构对卫生政策的议程设置﹑制定﹑执行、监管和评估所作的贡献;(2)评... 详细信息

近年来,中、低收入国家独立卫生政策研究机构的数量与日俱增,原因在于政府研究能力有限和民主化进程中的压力。本研究的目标是:(1)调查中﹑低收入国家中卫生政策研究机构对卫生政策的议程设置﹑制定﹑执行、监管和评估所作的贡献;(2)评估包括组织形式和结构在内的哪些因素支持中﹑低收入国家的卫生政策研究机构对卫生政策发挥积极作用。本研究在孟加拉﹑加纳﹑印度﹑南非﹑乌干达和越南选取了6家卫生政策研究机构开展案例研究,研究对象包括两个非政府组织、两所大学和两个政府办政策研究机构。案例研究通过文献查阅、财务信息分析、对工作人员和其他利益相关人员进行半结构式访谈,以及对结论草案进行多次反馈等方式开展。其中有些机构对他们各自国家的政策发展作出了巨大贡献。这些机构都积极建言献策,多数从事与政策相关的研究,而开展政治对话﹑系统评价或委托性研究的机构则相对较少。这些机构所开展的工作大多以政府或出资人的需求为导向,多数机构的主要成果一般为研究报告,经常与面向政府官员的口头汇报相结合。在支持对政策的有效参与方面,有几个关键因素,其中包括支持性的政策环境﹑管理和财务的相对独立性,以及与决策者建立可增进信任和影响的密切关系。当研究机构与政府之间的正式关系未处在重要位置时,政府内部单位则面临相当大的困难。

关键词：政策分析政策研究