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世界核心医学期刊文摘（胃肠病学分册） 2005年第11期1卷 21-22页

作者： Takahashi Y. Tanaka H. Kinjo m. Sakumoto K. 赵萌 Division of Gastroenterology and Endocrinology Department of Medicine Tomishiro Chuo Hospital 25 Ueda Tomishiro Okinawa 901- 0243 JapanDr.

PURPOSE: Colonoscopy can be painful for patients and difficult for colonoscopists; however, it is hard to predict how painful or difficult the examination will be. This study was designed to identify factors that predict pain and difficulty during sedation-free colonoscopy. mETHODS: A total of 848 consecutive sedation-free colonoscopies were evaluated in a prospective manner. Factors were recorded, including patient pain, intubation time, demographic data, history of abdominal surgery, bowel preparation status, diverticular disease, bowel habits, anxiety level, and number of previous colonoscopies. These factors were analyzed to determine their association with pain and difficulty. RESULTS: Almost all colonoscopies (845/848; 99.6 percent) were successful. Univariate analyses showed that lower body mass index, younger age, female gender, anxiety level, first time, intubation time, preparation status, previous hysterectomy, and previous gynecologic surgery were predictors of patient pain, and lower body mass index, female gender, anxiety level, preparation status, previous hysterectomy, previous gynecologic surge-ry, and constipation were predictors of difficulty of intubation. multivariate logistic regression analyses revealed that lower body mass index, younger age, intubation time, preparation status, previous hysterectomy, and antispasmodic agent use were predictors of patient pain, and lower body mass index, female gender, constipation, preparation status, and previous hysterectomy were predictors of difficulty of intubation. CONCLUSIONS: By use of intubation time and patient pain, several patient characteristics were identified that may predict technical difficulty and pain associated with the procedure. These findings have implications for the practice and teaching of colonoscopy.

关键词：结肠镜检插管时间肠道准备插管困难统计学资料子宫切除肠憩室病腹部手术记录资料因素分析

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新发晚期卵巢癌患者使用拓扑替康/卡铂后使用紫杉醇/卡铂治疗的Ⅱ期研究

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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 60-61页

作者： Gordon A.N. Asmar L. messing m.J. 张剑萍 Texas Oncology P.A. Ch arlesA. Sammons Cancer C. DallasTX United States

Objective. Incorporating topotecan into standard platinum/taxane chem otherapy for advanced ovarian cancer has been complicated by myelosuppression. This study evaluated sequential doublets of topotecan and carboplatin, followed by paclita xel and carboplatin, in newly diagnosed advanced ovarian cancer patients. method s. Forty-five patients (median age, 56 years; range, 38-77 years) with stage I II/IV disease and GOG performance status mg/m2/day on days 1 to 3) and carboplatin (AUC 4 on day 1) , followed by four cycles of paclitaxel (175 mg/m2 via 3-h IV infusion on day 1 ) and carboplatin (AUC 5 on day 1). All cycles were 21 days. Antitumor response was assessed after four and eight cycles; patients with clinical complete respon se (CR) underwent second-look laparotomy for determination of pathologic CR (PC R). Dose reductions were instituted for grade 4 neutropenia and thrombocytopenia , and for grade 3/4 nonhematologic toxicity. Results. Among 41 CA-125 evaluable patients, complete and partial responses were observed in 29 (70.7%) and 11 (26.8%) patients, r espectively. Of the 12 clinical CRs (43%) in 28 evaluable patients, 10 patients underwent second-look laparotomy, with 3 PCRs (30%). median time to progressi on was 14 months and actuarial survival was 23 months. Neutropenia was the prima ry toxicity and cause of dose adjustments and delays, including two deaths. Conc lusion. The antitumor activity observed is comparable with other series, althoug h neutropenic complications were increased. Progression-free and actuarial surv ivals were slightly inferior. A Phase Ⅲtrial (GOG182) of sequential doublets in the reverse sequence is ongoing.

关键词：晚期卵巢癌拓扑替康标准化疗方案抗肿瘤效应非血液系统毒性行为状况紫杉烷类肿瘤进展剖腹探查术完全缓解率

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粒细胞吸附分离性输血治疗伴有类风湿性关节炎患者的下肢溃疡:3例成功治疗病例报道

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世界核心医学期刊文摘（皮肤病学分册） 2005年第3期1卷 13-14页

作者： mori S. Nagashima m. Yoshida K. S. Yoshino 刘超 Dept. of Joint Disease/Rheumatism Nippon Medical School 1- 1- 5 Sendagi Bunkyo-ku Tokyo 113- 8603 JapanDr.

Background. The treatment of inflammatory leg ulcers complicated by r heumatoi d arthritis (RA), which are unresponsive to conventional care, can be frustratin g. Furthermore, as granulocytes and monocytes (Gm) are major sources of inflamma tory cytokines, they have the potential to initiate and perpetuate in-flammato ry skin lesions. Accordingly, a recent study reported the remission of pyoderma gangrenosum following the reduction of activated peripheral blood Gm by adsorpti ve apheresis (GmA). methods. In this clinical study, we applied GmA to three cas es, each with one leg ulcer below the knee and RA. The ulcers had not responded to conventional therapy, including disinfection, dressing, and antimicrobials, a nd therefore were thought to represent inflammatory vasculitic lesions. GmAwas p erformed using a column with a capacity of 335mL, filledwith cellulose acetate b eads that selectively adsorb granulocytes and monocytes/macrophages (Adacolumn). Each patient received one GmA session/week for five consecutive weeks. The dura tion of one session was 60 min, with a flow rate of 30 mL/min. Results. The ulce rs began to recede after two GmA sessions and, by the end of the fifth session, the ulcers in all three patients had healed. No recurrence has been observed up to the time of this report. The treatmentwas well tolerated and no severe sideef fects were observed. Conclusions. GmA, which depletes activated neutrophils and monocytes/macrophages, appears to be effective for inflammatory skin ulcers whic h do not respond to conventionalmedications.

关键词：类风湿性关节炎细胞吸附输血治疗下肢溃疡分离性血管炎炎症细胞因子坏疽性脓皮病商品名单核巨噬细胞

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荟萃分析:类固醇激素剂量对脓毒症患者存活率和休克的影响

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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 1-2页

作者： minneci P.C. Deans K.J. Banks S.m. 任延平 Critical Care med icine Department National Institutes of Health Building 10 10 Center Drive B ethesda MD 20892 United StatesDr.

Background: Previous meta analyses demonstrated that high dose glucoc orticoi ds were not beneficial in ***, lower dose glucocorticoids have been studied. Purpose: To compare recent trials of glucocorticoids for sepsis with p revious glucocorticoid trials. Data Sources: Systematic mEDLINE search for studi es published between 1988 and 2003. Study Selection: Randomized,controlled trial s of sepsis that examined the effects of glucocorticoids on survival or vasopres sor requirements. Data Extraction: Two investigators independently collected dat a on patient and study characteristics, treatment interventions, and outcomes. D ata Synthesis: The 5 included trials revealed a consistent and beneficial effect of glucocorticoids on survival (12=0%; relative benefit, 1.23, >; P=0.036) and shock reversal (12=0%; relative benefit, 1.71 >; Pme regardless of adrenal function. In contrast, 8 trials published before 1989 demonstrated a survival disadvantage with steroid treatment (12=14%; relative benefit, 0.89 >; P=0 .008). In comparison with the earlier trials, the more recent trials administere d steroids later after patients met enrollment criteria (median, 23 hours vs. mg vs. 23 975 mg; P=0.01) to patie nts with higher control group mortality rates (mean, 57%vs. 34%; P=0.06) who w ere more likely to be vasopressor dependent (100%vs. 65%; P=0.03). The relati onship between steroid dose and survival was linear, characterized by benefit at low doses and increasing harm at higher doses (P=0.02). Limitations: We could n ot analyze time related improvements in medical care and potential bias seconda ry to nonreporting of negative study results. Conclusions: Although short course s of high dose glucocorticoids decreased survival during sepsis, a 5-t

关键词：脓毒症患者存活率类固醇激素荟萃分析加压药资料提取糖皮质激素试验结果随机对照试验肾上腺功能

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对早产胎膜早破患者行积极保胎治疗不能延长孕周及降低新生儿发病率

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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 18-19页

作者： Combs C.A. mcCune m. Clark R. Fishman A. 张剑萍 C.A.Combs Obstetrix Medical Gro up Good Samaritan HospitalS. Jose Calif Pediatrix med. Group Fort Lauderdal eFL United States Dr.

Objective This study was undertaken to evaluate whether aggressive to colysis i mproves pregnancy outcome after preterm premature rupture of the membranes (PPRO m). Study design Retrospective case-control study of patients with PPROm before 34 weeks of gestation, followed by a prospective cohort study with historical c ontrols. The retrospective phase covered 1995 through 1999 when we used tocolysi s aggressively. With the use of survival analysis, we compared latency in our ca ses with 4 published control series in which tocolysis was never used. On the ba sis of the results, we adopted a new protocol in mid-2000 limiting tocolysis to 48 hours after betamethasone dosing and we conducted a 2-year prospective eval uation of this new protocol. Results In the retrospective phase, tocolysis was u sed in 94%of 130 cases and maintained during 84%of 1162 total antenatal patien t-days. There was no difference in latency between our cases and the published controls. One or more complications of tocolysis occurred in 18%. In the prospe ctive study, 43%of 63 patients received tocolytics, but these were used at lowe r doses and were given during only 7%of 770 patient-days. Latency with this ve ry limited tocolytic regimen (median 4.5 days, interquartile range 2.3 to 14.0) was not significantly different than during the last 24 months of aggressive toc olysis (median 3.8 days, 1.8 to 14 days, P=.16) and there were no differences in neonatal morbidity. Conclusion Aggressive tocolysis after PPROm causes significant maternal morbidity, but does not incr ease latency or decrease neonatal morbidity compared with either very limited to colysis or no tocolysis at all.

关键词：早产胎膜早破新生儿发病率保胎治疗 PPROm 妊娠结局生存分析回顾性队列研究出生前倍他米松无显著性差异

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心脏病专家在非心源性胸痛中的角色:一项全国性调查

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世界核心医学期刊文摘（胃肠病学分册） 2006年第4期2卷 46-47页

作者： Wong W.-m Risner-Adler S Beeler J. R. Fass 张欣 Southern Arizona VA Health Care System 3601 South Sixth Avenue (1-111G-1) Tucson AZ 85723-0001 United StatesDr.

Background: The current assumption is that noncardiac chest pain (NCCP) patien ts diagnosed by a cardiologist are commonly referred to a gastroenterologist for further evaluation. Thus far, there are no studies that assess the clinical app roach and referral patterns of cardiologists when evaluating subjects with NCCP. Aim: To determine the extent of involvement of cardiologists in the management of NCCP patients. methods: Cardiologists were randomly selected from the America n College of Cardiology national membership list and sent a 20-item questionnai re that included demographic information, characteristics of practice, preferenc es of diagnostic tests, referral patterns, and treatment plans. Results: A total of 246 (33%) cardiologists returned the questionnaire. A mean of 12.6%of pati ents were diagnosed with NCCP and 45.5%were treated by a cardiologist in the pa st 6 months. Of the NCCP patients that were referred, most ended up in the prima ry care physician clinic (45.9%) followed by gastroenterologist clinic (29.3%) . most cardiologists are either comfortable (35%) or very comfortable (43.1%) in diagnosing NCCP. Proton pump inhibitors (44.9%), life-style modifications ( 28.7%), and H2 blockers (11.8%) are the three most commonly used therapeutic m odalities for NCCP. Conclusion: Cardiologists manage about half of the diagnosed NCCP patients by themselves. Of those NCCP patients that are referred, cardiolo gists prefer to send them to a prim.ry care physician rather than a gastroentero logist.

关键词：心脏病专家非心源性胸痛初级保健医师诊断试验统计学资料胃肠病问卷调查内科医师临床评估

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变异型克-雅病的神经心理学特征:遗传性和散发性朊蛋白病患者的对照研究

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世界核心医学期刊文摘（神经病学分册） 2005年第8期1卷 21-22页

作者： Cordery R.J. Alner K. Cipolotti L. m.N. Rossor 李锐 Dementia Research Group Natl. Hosp. Neurol. and Neurosurg. Queen Square London WC1N 3BG United Kingdom Prof.

Objective: To assess cognitive function in variant Creutzfe- ldt-Jakob disease (vCJD). We describe the neuropsychological profiles of 10 c ases and compare these data with cross sectional data obtained from patients wit h histologically confirmed sporadic CJD and cases with inherited prion disease w ith confirmed mutations in the prion protein gene. methods: Patients referred to the Specialist Cognitive Dis orders Clinic at the National Hospital for Neurology and Neurosurgery and the National Prion Clinic at St m.ry’s Hospital, London for further investigation o f suspected CJD were recruited into the study. The neuropsychological test batte ry evaluated general intelligence, visual and verbal mem.ry, nominal skills, lit eracy skills, visual perception and visuospatial functions, and visuospatial and executive function. Results: The results indicate that moderate to severe cogni tive decline is a characteristic feature of vCJD. Specifically,verbal and visual mem.ry impairments and executive dysfunction were pervasive in all disease grou ps. Nominal skills were impaired in variant and sporadic CJD, significantly so w hen compared with the inherited prion disease group. Perceptual impairment was l ess frequent in the vCJD group than in the sporadic and inherited groups. Conclu sion: This study confirms the occurrence of generalised cognitive decline in pat ients with vCJD. Although decline in cognitive function ultimately affects all d omains, there is a suggestion that some components of visual perception may be s pared in vCJD. The results also suggest that nominal function may be preserved i n some cases with inherited prion disease.

关键词：克-雅病朊蛋白病神经心理学变异型认知功能圣玛丽医院神经外科执行功能组织学确诊词汇记忆

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炎症和止血因子与卒中复发风险的关系

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世界核心医学期刊文摘（神经病学分册） 2006年第3期2卷 41-42页

作者： Woodward m. Lowe G.D.O. Campbell D.J. 牛亚利 Cardiovascular and medical Division University of Glasgow Royal Infirmary Glasgow G31 2ER United Kingdom

Background and Purpose -Several prospective studies have shown significant as sociations between plasma fibrinogen, viscosity, C-reactive protein (CRP), fibr in D-dimer, or tissue plasminogen activator (tPA) antigen and the risk of prima ry cardiovascular events. Little has been published on the associations of these variables with recurrent stroke. We studied such associations in a nested case -control study derived from the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). methods -Nested case-control study of ischemic (n=472) and hemorrhagic (n=83) strokes occurring during a randomized, placebo-controlled mu lticenter trial of perindopril-based therapy in 6105 patients with a history of stroke or transient ischemic attack. Controls were matched for age, treatment g roup, sex, region, and most recent qualifying event at entry to the parent trial . Results -Fibrinogen and CRP were associated with an increased risk of recurre nt ischemic stroke after accounting for the matching variables and adjusting for systolic blood pressure, smoking, peripheral vascular disease, and statin and a ntiplatelet therapy. The odds ratio for the last compared with the first third o f fibrinogen was 1.34 (95%CI, 1.01 to 1.78) and for CRP was 1.39 (95%CI, 1.05 to 1.85). After additional adjustment for each other, these 2 odds ratios stayed virtually unchanged. Plasma viscosity, tPA, and D-dimer showed no relationship with recurrent ischemic stroke, although tPA was significant for lacunar and la rge artery subtypes. Although each of these variables showed a negative relation ship with recurrent hemorrhagic stroke, none of these relationships achieved sta tistical significance. Conclusions -Fibrinogen and CRP are risk predictors for ischemic but not hemorrhagic stroke, independent of potential confounders.

关键词：复发风险缺血性卒中非出血性卒中血浆纤维蛋白原血黏度心血管事件培哚普利安慰剂对照二聚体

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伴有自主神经受累的慢性炎症性脱髓鞘性多发神经根性神经病

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世界核心医学期刊文摘（神经病学分册） 2005年第5期1卷 26-27页

作者： Yamamoto K. Watarai m. Hashimoto T. Ikeda S.-I. 李锐 Departmen t of Neurology Nagano Municipal Hospital Tomitake 1333- 1 Nagano 381- 8551 Japan Dr.

We report a case of chronic acquired neuropathy predominantly affecting senso ry and autonomic nerves. Investigations showed a demyelinating polyradiculoneuro pathy with axonal degeneration and depletion of postganglionic noradrenergic fib ers in the rectal mucosa. Intravenous immunoglobulin and corticosteroid administ ration were effective in alleviating symptoms and improving electrophysiological abnormalities. This neuropathy may be a novel variant of chronic inflammatory d emyelinating polyradiculoneuropathy (CIDP), in which autoimmunoreactivity is directed not only against myelin but also against axon-or ganglion-compos ing protein. Autonomic nerve involvement does not exclude a diagnosis of CIDP.

关键词：脱髓鞘性神经根性慢性炎症肾上腺素能纤维自身免疫反应髓鞘蛋白构成蛋白变异型免疫球蛋白皮质激素治疗

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鼻内接触点头痛和难治性偏头痛患者的外科治疗

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世界核心医学期刊文摘（神经病学分册） 2005年第9期1卷 40-41页

作者： Behin F. Behin B. Bigal m.E. Lipton R.B. 周永 142 Palisade Avenue Jersey City NJ 07306 United StatesDr.

Contact point headaches have been attributed to intranasal contact between opp osing mucosal surfaces, resulting in referred pain in the distribution of the tr igeminal nerve. In subjects with prim.ry headaches, contact points may be associ ated with treatment refractoriness. We aimed to assess the benefits of surgical correction in patients with refractory migraine or transformed migraine, and rad iographic evidence of contact points in the sinonasal area. We reviewed charts o f patients who underwent endoscopic sinus surgery and septoplasty for contact po int in the same surgical facility, from October 1998 through August 2003. Subjec ts eligible for surgery had: (i) refractory migraine (failed to standard pharmac ological headache treatments) or refractory transformed migraine; (ii) contact p oints demonstrated by computed tomography scan; (iii) reported significant heada che improvement after topical anaesthesia to the contact area. Headache characte ristics were assessed preoperatively and at follow-up (6-62 months after surge ry) using a standardized questionnaire. A total of 21 subjects (72.5%women) wer e assessed. mean headache frequency was reduced from 17.7 to 7.7 headache days p er month (P=0.003). mean headache severity was reduced from 7.8 to 3.6 on a 0-1 0 scale (P=0.0001). Headache-related disability was reduced from 5.6 (10-point scale) to 1.8 (P mproved by 50%or more; nine (42.9%) were pain free at the last follow -up. A total of 18 (95.8%) had at least a 25%reduction in their headache scor es. Two patients (9.5%) had increase in their headache score by less than 25%. For selected patients with refractory headaches, demonstrable contact points, a nd positive response after topical anaesthesia, surgical approach toward the tri ggering factor may be useful. Prospective studies are necessary to confirm our r esults.

关键词：难治性偏头痛接触点黏膜接触神经分布区内窥镜鼻窦手术鼻中隔成形术放射影像学局部麻醉转换性分量表

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