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对来自Barrett食管的细胞学标本进行荧光原位杂交:初步可行性研究

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世界核心医学期刊文摘（胃肠病学分册） 2005年第2期1卷 32-33页

作者： Falk G.W. Skacel M. Gramlich T.L. 赵丽娜 Ctr. Swallowing Esopha geal Disord. Depts. Gastroenterol.Hepatol. C. Cleveland Clinic Foundation Cl eveland OHUnited StatesDr.

Background Endoscopic brush cytology is a promising surveillance technique for Barrett’s esophagus. However, there is a need for ancillary biomarkers to incr ease the sensitivity of cytology and to allow identification of patients at increased risk for disease progression. The aims of this study were to eval uate the feasibility of fluorescence in situ hybridization of endoscopic brush c ytology specimens and to determine if there are specific chromosomal changes in cytologic specimens from patients with cancer that are not present in patients w ithout dysplasia. Methods Archival cytology slides from 16 patients with Barrett ’s esophagus were studied: 8 negative for dysplasia and 8 positive for adenocar cinoma. Fluorescence in situ hybridization was used to detect two alterations: H ER-2 gene(17q11.2-q12) and 20q13.2 region amplification. Observations For 7 of 8 adenocarcinoma cases, there was amplification/aneusomy of at least one of the two analyzed regions by fluorescence in situ hybridization. None of the samples negative for dysplasia were abnormal for either of the two genomic regions stud *** Fluorescence in situ hybridization is feasible by using routine Barrett’s esophagus cytologic specimens. Differences in genomic makeup can be d etected in cells from patients negative for dysplasia and in those with adenocar cinoma.

关键词： Barrett 荧光原位杂交初步可行性研究不典型增生阴性样阴性患者刷检非整倍体生物标记

急性脑卒中患者溶栓治疗后症状无改善的预测因素及其与预后的关系

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世界核心医学期刊文摘（神经病学分册） 2005年第6期1卷 3-4页

作者： Saposnik G. Young B. Silver B. 黄卫东 Stroke Service London Health Sciences Centre University of Western Ontario 339 Windermere Rd London Ont. N6A 5A5 Canada Dr.

Context: The focus of thrombolytic therapy in acute stroke has been on favorable outcome at 3 months. Few studies have analyzed outcome at 24 hours. An early and reliable prediction of poor outcome has implications for clinical management and discharge planning. Abstract:Objective: To evaluate predictors of lack of improvement at 24 hours after receiving alteplase and their relationship with poor outcome at 3 months. Design, Setting, and Participants: Prospective cohort of consecutive patients with acute stroke who received alteplase and were admitted to a university hospital from January 1999 to March 2003. Participants were recruited from 2 academic centers in a major city in Ontario and 33 affiliated hospitals from 7 counties. Main Outcome Measures: Lack of improvement defined as a difference between the National Institutes of Health Stroke Scale score at baseline and at 24 hours of 3 points or less. Poor outcome at 3 months defined by a modified Rankin Scale score of 3 to 5 or death. Results: Among 216 patients with acute stroke who were treated with alteplase, 111 (51.4% ) had a lack of improvement at 24 hours. After adjusting for age, sex, and stroke severity, baseline glucose level on admission (odds ratio [OR] 2.89; 95% confidence interval [CI], 1.40- 5.99 for a glucose level > 144 mg/dL [ > 8 mmol/L]), cortical involvement (OR, 2.66; 95% CI, 1.36- 5.20), and time to treatment (OR, 1.01; 95% CI, 1.0- 1.02 for each 1 minute increase in time to treatment) were independent predictors of lack of improvement. At 3 months, 43 patients (20.2% ) had died; of the 170 survivors, 75 patients (44% ) had poor outcomes. After adjusting for age, sex, and stroke severity, lack of improvement at 24 hours was an independent predictor of poor outcome (OR, 12.9; 95% CI, 5.7- 29.6)- and death (OR, 7.5; 95% CI, 2.9- 19.6). Patients with a lack of improvement had longer lengths of hospitalization (14.5 vs 9.6 days; P=.02). Conclusions: Among patients with acute stroke treated with

关键词：急性脑卒中急性卒中阿替普酶队列研究预后研究出院计划血糖浓度大学医院附属医院时基线

社会经济状况与急性心肌梗死后死亡率之间的关系

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世界核心医学期刊文摘（心脏病学分册） 2007年第11期3卷 1-2页

作者： Alter D.A. Austin P.C. 杜媛 Institute for Clinical Evaluative Services 2075 Bayview Avenue G106 Toronto Ont. M4N 3M5 Canada Dr.

背景:社会经济状况与心血管死亡率之间的关联梯度已在许多人群中观察到,包括那些可提供广泛社会医疗覆盖的国家。但存在这种梯度的中介原因尚未阐明。目的:调查社会经济状况、其他健康因素以及急性心肌梗死(MI)后2年死亡率三者之间的关... 详细信息

背景:社会经济状况与心血管死亡率之间的关联梯度已在许多人群中观察到,包括那些可提供广泛社会医疗覆盖的国家。但存在这种梯度的中介原因尚未阐明。目的:调查社会经济状况、其他健康因素以及急性心肌梗死(MI)后2年死亡率三者之间的关系。设计:前瞻性队列研究。地点:加拿大安大略省。

关键词：社会经济状况收入财政管理死亡率心血管

美沙酮治疗对阿片使用者心脏复极化和传导性的影响

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世界核心医学期刊文摘（心脏病学分册） 2005年第9期1卷 36-37页

作者： Martell B. A. Arnsten J. H. Krantz M. J. Gourevitch M. N. 王睿 dr. VA Connecticut Hlthcare. Coop. S. Building 36/116A-4 950 Campbell AvenueWest Haven CT 06516 United States

We prospectively assessed the effect of oral methadone on the corrected QT interval(QTc) among 160 patients free of structural heart disease and measured serum methadone concentrations and simultaneous QTc intervals in a subset of 44 participants. Mean±SD QTc increased by 12.4±23 ms(p< 0.001) at 6 months, by 10.7±30 ms(p< 0.001) at 12 months, and the QTc change from baseline to 12 months correlated with the trough(r=0.37, p=0.008) and peak(r=0.32, p=0.03)serum methadone concentrations.

关键词：复极化传导性谷值清美亚组

对存在治疗选择偏倚的观察性研究的分析:采用倾向评分和工具变量法评价有创性心脏治疗对AMI患者生存率的影响

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世界核心医学期刊文摘（心脏病学分册） 2007年第7期3卷 5-6页

作者： Stukel T.A. Fisher E.S. Wennberg D.E. 黄浙勇 Institute for Clinical Evaluative Sciences G106 2075 Bayview Ave Toronto Ont. M4N 3M5 Canada Dr.

背景：在观察性研究中，对治疗组和非治疗组间结果的比较可能会因组间患者预后的差异而产生偏倚，常见的原因是未发现的治疗选择偏倚。目的：比较4种分析方法排除观察性研究中选择偏倚的效果：多因素模型风险校正、倾向评分风险校正、... 详细信息

背景：在观察性研究中，对治疗组和非治疗组间结果的比较可能会因组间患者预后的差异而产生偏倚，常见的原因是未发现的治疗选择偏倚。目的：比较4种分析方法排除观察性研究中选择偏倚的效果：多因素模型风险校正、倾向评分风险校正、倾向评分匹配法和工具变量法。设计、地点和患者：此项全国性队列研究纳入1994—1995年间122124例享有医疗保险的老年急性心肌梗死（AMI）住院患者（65～84岁），所有病例均适合行心导管术。基线资料来自心血管合作项目，并与医疗保险管理数据连接，以确保足够充分的预后参数。

关键词：心脏治疗倾向评分 AMI患者偏倚工具生存率有创性老年急性心肌梗死

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双胎的胎儿生长速率和早期早产

世界核心医学期刊文摘（妇产科学分册） 2006年第3期2卷 11-12页

作者： Hediger M.L. Luke B. Gonzalez-Quintero V.H. 朱磊 National Institute of Child Health and Human Development National Institutes of Health Department of Health and Human Services 9000 Rockville Pike Bethesda MD 20892-7510 United States Dr.

Objective: Our objective was to determine whether slow fetal growth rates and twin growth patterns from 20 weeks’gestation to delivery are associated with very preterm delivery. Study design: Available charts were reviewed for twin pregnancies, delivered between 1979 and 2002, at 4 U.S. medical centers. The sample of 1612 pregnancies delivered at 28 week’s gestation or greater and had at least 2 ultrasound evaluations of fetal size from 20 to 28 weeks or from 28 weeks to delivery for estimation of fetal growth rates (grams per week). Slow fetal growth (below the 10th percentile) was defined as less than 90 grams per week at 20-28 weeks and 168 g/week from 28 weeks to delivery. The main outcome measure was the timing of delivery. Results: Of the women delivering twins, 5.3%delivered extremely preterm (28-30 weeks), 8.5%very preterm (31-32 weeks), and 40.1%preterm (33-36 weeks). Patterns of growth for the pair were highly associated with very preterm delivery. Compared with neither growing slowly (1.7%), 4.9%delivered very preterm if only 1 twin grew slowly. Very preterm was 14.6%(adjusted odds ratio 9.81; 95%confidence interval, 3.50-27.48) with both growing slowly from 28 weeks on and 20.0%(adjusted odds ratio 15.04; 95%confidence interval 5.13-44.11) with both growing slowly over both intervals. Survival analyses indicated that twins with normal growth in both intervals remained undelivered for a significantly longer number of days (P < .0001) than pairs in which one or both twins were growing slowly. Conclusion: Very preterm delivery of twins seems to be preceded by slowed or compromised fetal growth for the pair.

关键词：分娩孕周生长速率分娩期间超声检查生存分析生长速度生长模式研究设计

对于特应性干性皮肤局部使用烟酰胺后引起皮肤水分增加效应

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世界核心医学期刊文摘（皮肤病学分册） 2005年第7期1卷 50-51页

作者： Soma Y. Kashima M. Imaizumi A. 惠海英 Department of Dermatology St. Marianna Univ. Sch. of Medicine2-16-1SugaoMiyamae-kuKawasaki216- 8511 Japan Dr.

Background: Certain moisturizers can improve skin barrier function in atopic dermatitis. The effect of topical nicotinamide on atopic dr. skin is unknown. We examined the effect of topical nicotinamide on atopic dr. skin and compared the results with the effect of white petrolatum in a left-right comparison study. Methods: Twenty-eight patients with atopic dermatitis, with symmetrical lesions of dr. skin on both forearms, were enrolled, and were instructed to apply nicotinamide cream containing 2% nicotinamide on the left forearm and white petrolatum on the right forearm, twice daily over a 4- or 8- week treatment period. Transepidermal water loss and stratum corneum hydr.tion were measured by instrumental devices. The amount of the stratum corneum exfoliated by tape stripping (desquamation index) was determined by an image analyzer. Results: Nicotinamide significantly decreased transepidermal water loss, but white petrolatum did not show any significant effect. Both nicotinamide and white petrolatum increased stratum corneum hydr.tion, but nicotinamide was significantly more effective than white petrolatum. The desquamation index was positively correlated with stratum corneum hydr.tion at baseline and gradually increased in the nicotinamide group, but not in the white petrolatum group. Conclusions: Nicotinamide cream is a more effective moisturizer than white petrolatum on atopic dr. skin, and may be used as a treatment adjunct in atopic dermatitis.

关键词：干性皮肤特应性烟酰胺白凡士林右前臂水合作用增湿剂左前臂胶带粘贴法丢失率

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采用丘脑深部电刺激治疗癫痫患者的长期随访

世界核心医学期刊文摘(神经病学分册) 2006年第10期 58-59页

作者： Andr.de D.M. Zumsteg D. Hamani C. R.A. Wennberg 高宗强 Toronto Western Hospital 399 Bathurst Street 5W444 Toronto Ont. M5T 2S8 Canada Dr.

The authors describe long- term follow- up (mean, 5 years) in patients with anterior (AN) (n = 6) or centromedian (n = 2) thalamic deep brain stimulation (DBS) for epilepsy. Five patients (all AN) had ≥ 50% seizure reduction, although benefit was delayed in two until years 5 to 6, after changes in antiepileptic dr.gs. DBS electrode implantation in AN patients was followed by seizure reduction 1 to 3 months before active stimulation, raising the possibility of a beneficial microthalamotomy effect.

关键词：癫痫患者长期随访丘脑间脑

日本社区内首次卒中患者的10年卒中复发情况:福冈研究

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世界核心医学期刊文摘（神经病学分册） 2005年第7期1卷 22-23页

作者： Hata J. Tanizaki Y. Kiyohara Y. 胡慧敏 Dept.of Med. and Clinical Science Graduate School of Medical Sciences Kyushu University Maidashi 3-1 -1 Higashi-kuFukuoka 812-8582 Japan Dr.

Background: Very few population based cohort studies have focused on the long term recurrence of stroke. Objective: To examine 10 year c umulative recurrence rates for stroke in a Japanese cohort according to patholog ical type and clinical subtype of brain infarction. Methods: During a 32 year fo llowup of 1621 subjects ≥40 years of age, 410 developed first ever *** were followed up prospectively for 10 years after stroke onset. Results: During follow up, 108 (26%) experienced recurrent stroke. The cumulative recurrence r ates were 35.3%atfive years and 51.3%at 10 years. The 10 year recurrence rates of subarachnoid haemorrhage (SAH), brain haemorrhage, and brain infarction were 70.0%, 55.6%, and 49.7%, respectively;the difference between SAH and brain i nfarction was significant (p = 0.004). Most recurrent episodes after SAH or brai n haemorrhage happened within a year after the index stroke, whereas recurrence of brain infarction increased consistently throughout the observation period. Ca rdioembolic stroke had a higher recurrence rate (75.2%) than lacunar infarction (46.8%) (p =0.049). The 10 year risk of stroke recurrence increased with age a fter lacunar or atherothrombotic brain infarction, but not after the other types or subtypes. After atherothrombotic brain infarction, cardioembolic stroke, or SAH, the type and subtype of most recurrent strokes were the same as for the ind ex stroke,but recurrence after lacunar infarction or brain haemorrhage showed di vergent patterns. Conclusions: Japanese people have higher recurrence rates of s troke than other populations. Recurrence rate after a first brain infarct increa ses consistently through the next 10 years.

关键词：首次卒中脑梗死复发复发率 recurrence 福冈卒中发作队列研究临床亚型 infarct 蛛网膜下腔出血