摘要：目的:与其他选择性环氧合酶-2(COX-2)抑制剂相比较,罗非昔布增加心血管疾病发生风险可能与其对血压(BP)的影响不同有关。罗非昔布主要由细胞溶质还原酶代谢,并可与醛固酮竞争代谢。假设罗非昔布对血压的影响是由于醛固酮水平升高所致。设计:前瞻性、随机、交叉研究。

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：目的确定尽力解决与早为父母相关的社会不利因素的干预对青少年妊娠的影响，评估这种干预对英国青年人的适当性。设计系统性回顾，包括一个对早为父母干预的对照试验的统计学荟萃分析，以及一个定性研究的主题综合，调查了生活在英国的青年人对早成为父母的观点。数据来源12个电子目录式数据库，5个核心期刊，相关研究的引用列表，研究作者，以及该领域的专家。回顾方法2名独立的研究员分别对所有研究的方法学质量进行评估和数据摘要。结果纳入10个对照试验及5个定性研究。对照试验评估孩童时期早期干预或青年发展计划。全部汇集效应的排列结果表明，在接受过一项干预的个体中，青少年的妊娠率较接受标准实践或无干预的个体低39％（相对危险度0．61；95％可信区间0．48～0．77）。定性研究显示，3个主要因素与早为父母相关：厌学，恶劣的物质条件及不幸的童年，以及对未来的期望过低。对这些因素相关的、对照试验中采用计划的内容与青少年妊娠的比较显示，孩童时期的干预和青少年发展计划，二者对于减少无意的青少年妊娠都是适当的策略。这些计划的目标在于，通过学业支持促进与学校的接合，通过指导和社会救助改善不幸的童年，通过职业发展和工作经历唤起渴望。然而，这些途径都不能直接解决所有影响年轻人早为父母之路的社会、社区及家庭层面的因素。结论这一小的、但可靠的证据支持，早期孩童时期的干预和青少年发展计划对于减少无意的青少年妊娠是有效和适当的。结合对照试验和定性研究的发现，为有效的公共政策提供了一个有力的循证基础。

摘要：此研究的目的是设计一个全景腔内显示技术．以影像变形极少的带状显示，明确其作为CT结肠成像（CTC）节省时间的主要三维显示方法的可行性。对照带状显示与其他4种三维显示方法显示10个10mm、10个20mm电子生成息肉影像的变形。52例病人行CTC检查．并于同天行结肠镜检查。对照2名独立读片医生利用带状显示与常规腔内显示的诊断操作与影像诊断时间。

摘要：Objective: B- type natriuretic peptide (BNP) is synthesized in cardiac ventricles in response to volume expansion. This study evaluated BNP levels to determine trends during pregnancy, and to assess BNP as a diagnostic tool in preeclampsia. Study design: We studied 163 BNP levels in 118 pregnant women, ranging from first trimester to term. An additional 34 patients with preeclampsia were studied and compared to 25 normal control patients at term. Plasma BNP values were determined using a standard assay. Results: The median BNP levels during the 1st, 2nd, 3rd trimester, and at term were equivalent (18.4, 17.9, 15.5, and 17.8 pg/mL, respectively, P = .796). The median BNP levels in normal patients, mild preeclamptics, and severe preeclamptics were 17.8, 21.1, and 101 pg/mL, respectively, with the severe group being significantly higher than the mild group (P=.003) and any phase of normal pregnancy (P <.001 in each case). A BNP cut-off of < 40.6 pg/mL had a negative predictive value of 92% in excluding preeclampsia. Conclusion: In normal pregnancies, median BNP values are < 20 pg/mL, and stable throughout gestation. In severe preeclampsia BNP levels are elevated. This may reflect ventricular stress and/or subclinical cardiac dysfunction associated with preeclampsia.

摘要：Objective: The objective of the study was to determine whether the Toyota production system process improves Papanicolaou test quality and patient safety. Study design: An 8-month nonconcurrent cohort study that included 464 case and 639 control women who had a Papanicolaou test was performed. Of fice workflow was redesigned using Toyota production system methods by introducing a 1-by-1 continuous flow process. We measured the frequency of Papanicolaou tests without a transformation zone component, follow-up and Bethesda System diagnostic frequency of atypical squamous cells of undetermined significance, and diagnostic error frequency. Results: After the intervention, the percentage of Papanicolaou tests lacking a transformation zone component decreased from 9.9%to 4.7%(P = .001). The percentage of Papanicolaou tests with a diagnosis of atypical squamous cells of undetermined significance decreased from 7.8%to 3.9%(P = .007). The frequency of error per correlating cytologic-histologic specimen pair decreased from 9.52%to 7.84%. Conclusions: The introduction of the Toyota production system process resulted in improved Papanicolaou test quality.

摘要：摘要目的比较通过辅助生殖生育的男性和可让女性自然受孕的男性罹患前列腺癌的风险和严重程度。设计基于国家登记的队列研究。研究地点1994年1月到2014年12月,瑞典。参与者1994-2014年,瑞典有1181490名出生儿童及相同数量的父亲。根据受孕方式进行分组:体外受精(In Vitro Fertilization,IVF)组20618例,胞质内单精子注射(Intracytoplasmic Spermn Injection,ICSI)组14882例,自然受孕组1145990例。

摘要：Objectives: We assessed the impact of intravenous fluconazole prophylaxis (FP) in extremely low birthweight (ELBW[<1000 g]) infants on the incidence of and ou tcome from invasive candidiasis (IC) in all infants admitted to a neonatal inten sive care unit (NICU). Study design: Beginning April 1, 2002, FP was given to EL BW infants aged < 5 days admitted to the NICU of Woman’s Hospital of Texas. Inf ants in NICU in whom IC developed during the first 2 years of FP (FP period) wer e compared with those with IC during 2000-2001. Results: During 2000-2001 and the FP period, the incidence of IC in ELBW infants decreased from 7%(15 of 206) to 2%(5 of 240) (P = .01), and the IC-related mortality rate decreased from 1 2%(4 of 33) to 0 (0 of 40) (P = .04); the incidence of IC increased from 0.1%( 4 of 2806) to 0.2%(8 of 3372) in infants of birth weight ≥1000 g (P = .06), an d no IC-related deaths occurred. During the FP period, IC developed in older in fants (24 vs 12 days; P = .12) who had similar risk factors for IC. Conclusion: Invasive candidiasis occurred in our NICU in spite of FP and shifted to bigger,m ore mature infants who had a better outcome.

摘要：目的 与“不用针灸”对比,确定“使用针 灸”的治疗方法对慢性头痛患者的头痛、健康状 况及无病时间的影响。 设计 随机对照试验。 试验场所 英格兰和威尔士的开业医生诊所。 受试对象 401位慢性头痛患者,主要是偏 头痛患者。 干预 患者被随机分配进入针灸治疗组(在 3个月内接受12次针灸治疗)和对照组(接受常 规治疗)。 主要结果测定指标 治疗前、治疗后3个月 及12个月对头痛积分,SF-36健康状况及用药量 进行评估。每3个月对治疗方法作1次评估。头 痛积分即判定疗效的主要终点指标。 结果 针灸组治疗后12个月的头痛积分(针 灸组161例患者,平均头痛积分为16．2,标准差 13．7,比治疗前减少34％)比对照组低(对照组140 例患者,平均头痛积分为22．3,标准差17．0,比 治疗前减少16％)。两种方法调整后的差异为4．6 (95％可信区间为2．2-7．0;P=0．0002)。对于包 含缺失数据的灵敏度分析,该结果也是肯定的。 针灸组的患者每年少头痛22(8-38)天。尽管达到 统计学差异的项目仅有生理功能、精力和健康改 变等,SF-36的资料也有利于针灸组。与对照组相 比,针灸组的患者减少了15％的服药量(P=0．02), 减少了25％的就诊量(P=0．10),同时减少15％的 病休时间(P=0．2)。 结论 针灸在初级保健中用于治疗慢性头痛, 特别是偏头痛,可以产生与临床相关的持久益 处。应当考虑扩大英国国家医疗保险体系中针灸 治疗的范围。

摘要：为了提高系统综述和荟萃分析文章报告的质量,2009年由国际著名专家组成的系统综述和荟萃分析优先报告的条目(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)小组在国际重要医学期刊包括《英国医学杂志》、《临床流行病学杂志》、《内科学年鉴》和美国《公共科学图书馆医学杂志》等同步发表了《系统综述与荟萃分析优先报告条目:PRISMA声明》。该标准的制定对于改进和提高系统综述和荟萃分析的报告质量将起到重要作用。该声明较以往制定的《随机对照试验荟萃分析报告质量》(Quality of Reporting of Meta-Analyses),即《QUOROM声明》更加全面、完善。由于近年采国内外对系统综述的高度重视,发表的文章数量也越来越多,因此,有必要规范报告的标准,提高报告的质量。这份声明对系统综述和荟萃分析类文章报告的27个条目及流程图进行了定义和介绍,对相关条目进行了详细的解释和说明。及时向国内读者和临床试验研究人员介绍该声明具有重要的现实意义和学术价值。北京中医药大学循证医学中心刘建平等在第一时间内翻译了该声明,本刊希望通过介绍中文版《系统综述与荟萃分析优先报告的条目:PRISMA声明》,以进一步提高国内系统综述文章撰写和报告的质量,同时也有助于改进研究设计的方法学质量。本文的英文原文"Preferred reporring items for systematic reviews and meta-analyses:the PRISMAstatement"发表于PLoS Med.2009;6(7):***:10.1371/***.1000097。该文中文版本由北京中医药大学循证医学中心李迅、曹卉娟翻译,刘建平审校(Tel:010-64286760;E-mail:jianping_l@***)。中文译文的翻译出版由国家重点基础研究发展计划(973计划)项目资助(No.200608504602)。