摘要：Purpose: To review the role of concurrent chemoradiotherapy protocols with special emphasis on selection of appropriate chemotherapy drug, its timing and schedule with respect to radiation fractionation. Methods: Literature review was done to explore the mechanism of chemotherapy drug and radiation interactions and to review the exploitable strategies in chemoradiation protocols. Results: Integration of chemotherapy with radiation has sound scientific basis in terms of spatial cooperation, non-overlapping toxicity profile and enhancement of tumor radioresponse. Extensive literature review revealed that concomitant chemoradiotherapy protocol yield best result for locally advanced head neck cancer when compared to radiotherapy alone or neoadjuvant chemotherapy followed by radiotherapy. Concurrent chemoradiotherapy using chemoboost protocol with Cisplatin and 5FU along with radiation is a pragmatic approach yielding good locoregional control and overall survival for locally advanced head and neck cancer. Mitomycin C, targeting hypoxia is also a potent chemotherapeutic drug when used concurrently with radiation results in good locoregional control and overall survival for locally advanced head neck cancer. Pooled data from these two trials represent the subset of patients selectively benefiting from either of these protocols on the basis of various prognostic factors. Toxicity associated with majority of chemoradiotherapy protocols are often the cause of concern. Judicious use of concurrent chemotherapy protocol schedule along with newer radiation technique, such as intensity modulated radiotherapy,

摘要：目的 若亲代患妊娠剧吐，评估其子代妊娠剧吐的复发风险。设计 基于人群的队列研究。资料 来自挪威的注册数据。研究对象 1967--2006年挪威医学出生登记的生育链接数据资料：544087对母女及399777对母子：主要观察指标在患妊娠剧吐妇女的母亲及其女儿以及婆媳间妊娠剧吐风险。

摘要：国际糖尿病足工作组(IWGDF)自1999年以来发布了糖尿病足病预防和治疗的循证指南。这是IWGDF发布的第一部关于糖尿病患者活动期夏科神经性骨关节病诊断和治疗的指南。我们遵循GRADE方法,以人群-评估-比较-结局(PACO)和人群-干预-比较-结局(PICO)的格式设计临床问题,系统检索医学文献,并提出有依据的推荐。这些推荐是基于我们系统综述的证据,如无证据则参考专家意见,并考虑到与干预相关的受益和危害、患者偏好、可行性和适用性以及成本的权衡。我们在本章节介绍了2023年糖尿病患者活动期夏科神经性骨关节病的诊断和治疗指南,并提出了未来的关键研究方向。

摘要：Objective: This study was undertaken to investigate the impact of incorporating assessment of the nasal bone into first-trimester combined screening by fetal nuchal translucency(NT) thickness and maternal serum biochemistry. Study design: In this prospective combined screening study for trisomy 21, the fetal nasal bone was also examined and classified as present or absent. A multivariate approach was used to calculate patient-specific risks for trisomy 21 and the detection rate(DR) and false-positive rate(FPR) were estimated. We examined 2 screening strategies; first, integrated first-trimester screening in all patients and second, first-stage screening of all patients using fetal NT and maternal serum free fl-hCG and PAPP-A, followed by second-stage assessment of nasal bone only in those with an intermediate risk of 1 in 101 to 1 in 1000 after the firststage. Results: The nasal bone was absent in 113(0.6%) of the 20,165 chromosomally or phenotypically normal fetuses and in 87(62.1%) of the 140 fetuses with trisomy 21. With combined first-trimester NT and serum screening, the DR of 90%was achieved at a FPR of 5%. Inclusion of the nasal bone, either in all cases or in about 10%of the total in the 2-stage approach, halved the FPR to 2.5%. Conclusion: Inclusion of the nasal bone in first-trimester combined screening for trisomy 21 achieves a DR of 90%for a FPR of 2.5%.

摘要：To study the impact of the introduction of reimbursement of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) laboratory costs in Belgium which is linked to an embryo transfer strategy leading to prevention of multiple pregnancies. The impact on the incidence of multiple and twin pregnancy rate as well as on ongoing pregnancy rate in our centre is calculated. Study design: Observational cohort study of all patients in the first year (July 1, 2003- June 30, 2004)- since the implementation of the law and comparison of ongoing pregnancy rate and multiple pregnancy rate of our centre with Belgian data. Results: Our results of one year of IVF/ICSI since reimbursement of laboratory costs show a total conception rate of 42.2% with 29.7% ongoing pregnancies beyond 25 weeks amenorrhea. The multiple pregnancy rate was 8.5% including five monozygotic twin pregnancies. These data show an important decline of multiple pregnancy ratewhen compared to Belgian data (2002) with 24.4% multiple pregnancy rate in the year prior to reimbursement. Conclusion: The introduction of reimbursement of IVF/ICSI laboratory costs coupled to a restriction in the number of embryos for transfer has reached the goal of halving the multiple pregnancy rate since its introduction while maintaining an optimal ongoing pregnancy rate.

摘要：背景:全球均有对广泛耐药结核病的文献报道,但对儿童广泛耐药结核病的文献报道非常罕见。目的:报告南非农村地区广泛耐药结核病患儿的特征。设计:在南非共和国图盖拉渡口地区,对2006年1月—2007年12月间登记的经痰培养确诊为广泛耐药结核病的患儿进行了回顾性评估。从患儿病案中获得其人口统计学、临床和微生物学信息。结果:4例6～8岁的儿童为广泛耐药结核病患者。其中2例患儿先前有结核病史。4例患儿均为感染了人类免疫缺陷病毒的孤儿,其中3例在诊断患有广泛耐药结核病之前已接受了高效抗逆转录病毒治疗。在接受标准化抗广泛耐药结核病和高效抗逆转录病毒治疗后,所有患儿的临床表现、影像学均改善,痰培养阴转。其中2例患儿较好地耐受了抗广泛耐药结核病和高效抗逆转录病毒同时治疗。另外2例出现了环丝氨酸相关的神经精神系统不良反应。4例患儿的存活时间均超过24个月,广泛耐药结核病均得到治愈。在诊断为广泛耐药结核病之前,这些患儿在儿科病房的平均住院时间为8个月(5～17个月),包括3个月的住院重叠期。结论:广泛耐药结核病依靠微生物学来确诊,合并艾滋病的广泛耐药结核病患者也能被成功诊断。尽管需要对同时接受两种治疗的潜在交叉毒性开展更多的研究,但本研究显示患儿同时接受抗广泛耐药结核病和高效抗逆转录病毒治疗是可行且有效的。

摘要：The Giant Radio Array for Neutrino Detection(GRAND)is a planned large-scale observatory of ultra-high-energy(UHE)cosmic particles,with energies exceeding 10~8 Ge *** goal is to solve the long-standing mystery of the origin of UHE cosmic *** do this,GRAND will detect an unprecedented number of UHE cosmic rays and search for the undiscovered UHE neutrinos and gamma rays associated to them with unmatched *** will use large arrays of antennas to detect the radio emission coming from extensive air showers initiated by UHE particles in the *** design is modular:20 separate,independent sub-arrays,each of 10000 radio antennas deployed over 10000 km^2.A staged construction plan will validate key detection techniques while achieving important science goals *** we present the science goals,detection strategy,preliminary design,performance goals,and construction plans for GRAND.

摘要：Objective: The purpose of this study was to determine the extent that the administration of sulprostone reduces the need for manual removal of the placenta in patients with retained placenta. Study design: A double-blinded sequential randomized controlled trial of sulprostone versus placebo was conducted among 103 patients with retained placenta. Results: In the first phase of this sequential study, sulprostone was compared with placebo. The null hypothesis of equal effectiveness of both treatments was rejected after 50 patients. In patients with retained placenta, the placenta was expelled after sulprostone in 13 of 24 cases (51.8% , bias adjusted), whereas expulsion after placebo was achieved in only 4 of 26 cases (17.6% , bias adjusted). The difference was significant (P = .034). In the second phase of the study, in which the placebo arm was stopped, results were confirmed; in 25 of 53 patients (47% ), the placenta was expelled. Conclusion: Sulprostone reduces the need for the manual removal of the placenta by 49% .

摘要：目的 比较子宫颈癌筛查中传统子宫颈涂片、单层细胞学,以及人乳头状瘤病毒检测的敏感性、特异性和观察者间的可信性。 设计 对同时进行了此3项检查并有参考标准(阴道镜和组织学)者进行横断面研究。 研究单位 法国的公立大学和私人诊所,本研究完全独立于病例提供者。 研究对象 因先前检出的细胞学异常而进行阴道镜检查的828名妇女和参加常规涂片检查的1757名妇女。 主要结果判定指标 临床读片和最优化解释(为取得一致所进行的双盲读片)。根据诊断异常的不同阈值计算出敏感性、特异性和加权κ值。 结果 根据Bethesda系统,传统子宫颈涂片检查得到的结果更为满意(91％比87％),比单层细胞学更可靠(加权κ值0.70比0.57),其敏感性和特异性更高。这些结果适用于临床读片和最优化解释,区分高级别和低级别病变,以及有低和高异常发生率的人群。人乳头状瘤病毒检测与单层细胞学检查同时进行,不论是系统性的还是只对于意义不明的非典型细胞,并不比传统涂片检查优越。 结论 在子宫颈癌筛选中,单层细胞学检查不如传统子宫颈涂片检查可靠,且更容易出现假阳性和假阴性结果。

摘要：目的确定皮质激素是否可有效预防成年危重症患者拔管后喉部水肿，并降低因喉部水肿导致的再插管。设计荟萃分析。数据来源：检索数据库PubMed，Cochrane Controlled Trials Register，Web of Science，and Embase，对语言、研究时间和发表状态没有限制。选择标准关于静脉使用皮质激素预防成年患者拔管后并发症的随机、安慰剂对照研究。回顾方法检索并根据纳入和排除标准选择文献、提取数据、评估方法学的可靠性，然后进行独立分析并重复。汇总分析数据得到优势比和95％可信区间，风险差异和需治数。研究终点：主要终点：拔管后发生喉部水肿。次要终点：由于喉部水肿导致的再插管。结果6项临床研究纳入分析（n=1923）。与安慰剂组相比，拔管前应用激素可降低喉部水肿（OR=0．38，95％可信区间为0．17～0．85）和再插管（OR=0．29，95％可信区间为0．15～0．58）的发生率，相应的风险差异分别为-0．10（-0．12～-0．07；需治数为10）和-0．02（-0．04～-0．01;需治数为50）。亚组分析显示，多次给药可明显降低喉部水肿（OR=0．14，95％可信区间为0．08～0．23）和再插管（OR=0．19，95％可信区间为0．07～0．50）的发生率，相应的风险差异分别为-0．19（-0．24--0．15；需治数为5）和-0．04（-0．07--0．02；需治数为25）。单次给药只发现有降低喉部水肿和再插管发生率的趋势，可信区间包含1。没有报道激素相关的副作用。结论成年患者拔管前预防性多次给予皮质激素可降低拔管后喉部水肿和因其所致再插管的发生率，且很少引发不良事件。