Light emitting diode-red light for reduction of post-surgical scarring: Results from a dose-ranging,split-face,randomized controlled trial

Scarring has significant esthetic and functional consequences for patients. A need exists for anti-scarring therapeutics. Light emitting diode-red light (LED-RL) has been shown to modulate skin fibrosis. The aim of this study is to evaluate the safety and efficacy of LED-RL to reduce post-operative scarring. Cutaneous Understanding of Red-light Efficacy on Scarring was a randomized, mock-controlled, single-blind, dose-ranging, split-face phase II clinical trial. Starting 1 week post-surgery, patients received LED-RL irradiation and temperature-controlled mock therapy to incision sites at fluences of 160, 320 or 480 J/cm², triweekly for 3 weeks. Efficacy was assessed at 1, 3 and 6–12 months. The primary endpoint was difference in scar pliability between LED-RL-treated and control sites. Secondary outcomes included Patient and Observer Scar Assessment Scale, collagen and water concentration, and adverse events. There were no significant differences in scar pliability between treated and control scars. At certain fluences, treated scars showed greater improvements in observer rating and scar pliability, reflected by greater reductions in induration, from baseline to 6 months compared to control scars. Treatment-site adverse events included blistering (n = 2) and swelling (n = 1), which were mild and resolved without sequelae. LED-RL phototherapy is safe in the early postoperative period and may reduce scarring.     

Suture Closure versus Non-Closure of Subcutaneous Fat and Cosmetic Outcome after Cesarean Section: A Randomized Controlled Trial

Introduction

To investigate the effect of subcutaneous fat suture closure versus non-closure at cesarean section (CS) on long-term cosmetic outcome.

Material and Methods

Women undergoing planned or unplanned CS were randomized to either subcutaneous fat suture closure or non-closure using a 1∶1 allocation algorithm. Participants and outcome assessors were blinded to group allocation. Scar evaluation was performed after two and six months. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) summary scores six months after surgery. Secondary outcome measures were Vancouver Scar Scale (VSS) summary scores, retraction of the scar below the level of the surrounding skin, duration of surgery, and development of hematoma, seroma, surgical site infection (SSI) or wound disruption. Data were analyzed according to the intention to treat principle.

Results

A total of 116 women were randomized and 91 participants, 47 in the closure and 44 in the non-closure group, completed the trial and were analyzed. There were no differences in patient morphometrics or surgery indications between groups. At two and six months no significant differences were found with respect to POSAS or VSS scores between groups. After two months significantly more women in the non-closure group described their scar as being retracted below the level of the skin (36% vs. 15%, p = 0.02) whereas no difference was observed at six months. There were significantly more hematomas in the non-closure (25%) compared to the closure group (4%) (p = 0.005). There was no difference in duration of surgery, SSI, seroma formation or wound disruption between groups.

Conclusions

Suture closure of the subcutaneous fat at CS does not affect long-term cosmetic outcome. (Level I evidence).

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01542346","term_id":"NCT01542346"}}NCT01542346.     

Development of the behaviour observation scale for psychomotor therapy for elderly people with dementia (BPMT-dem). Reliability and concurrent validity

This article describes the development of the Behaviour observation scale for Psychomotor Therapy for elderly people with dementia (BPMT-dem). This scale was developed in the late 1980s in order to evaluate the effect of psychomotor group therapy on the cognitive, social, and emotional functioning of elderly people with dementia within the therapy situation. The currently described research investigates inter-assessor reliability and internal consistency of the ten subscales (such as memory, orientation, contact with others, initiative, anxious behaviour, aggressive behaviour) and three domains, as well as the scale's correlation with other observation scales (concurrent validity) in two different patient groups. The first group consisted of clients receiving psychomotor therapy in a nursing home or a psychiatric hospital (N = 130). Inter-assessor reliability (Cohen's kappa) varied between 0.27 and 1.00 the internal consistency of the subscales (Cronbach's alpha) was calculated between 0.46 and 0.86, and that of the domains between 0.76 and 0.81. Based on the findings of this study 15 of the original 88 items were removed, 5 items were moved to other subscales and the text of 2 items was changed. Next, the subscale internal consistency and concurrent validity of this modified (73-item version) BPMT-dem was investigated in a group of 41 elderly participating in a support programme in meeting centres for elderly people with dementia and their caregivers. Cronbach's alpha for the subscales in this study was calculated between 0.47 and 0.86. To determine concurrent validity, the BPMT-dem was compared with (subscales of) the Assessment Scale for Elderly Patients (ASEP), Behavioural assessment for Intramural Psychogeriatrics (BIP), Brief Cognitive Rating Scale (BCRS) and the Cornell Scale for Depression in Dementia. Correlations with related BPMT-dem subscales varied between 0.38 and 0.75. The inter-assessor reliability and concurrent validity of the 73-item version of the BPMT-dem are satisfactory. The internal consistency of 6 subscales is sufficient, and recommendations are proposed to improve the consistency of the remaining subscales. Further research to test the unidimensionality and scalability of the subscales of the BPMT-dem, as well as the effect of the recommended reformulation and removal of items, is recommended. Before the instrument can be used in actual practice, the psychometric qualities of the BPMT-dem73 need to be studied in a larger and in terms of severity of dementia more heterogeneous study sample, so that statements can also be made on which norms to use in various subgroups of elderly with dementia.     

Reconstruction of burn scar of the upper extremities with artificial skin

The management of upper-extremity burn contractures is a major challenge for plastic surgeons. After approval by the Food and Drug Administration, artificial skin (Integra) has been available in Taiwan since 1997. From January of 1997 to July of 1999, the authors applied artificial skin to 13 severely burned patients for the reconstruction of their upper extremities, resulting in an increased range of motion in the upper-extremity joints and improved skin quality. An additional benefit was the rapid reepithelialization of the donor sites. There were no complications of infection throughout the therapeutic course, and the overall results were satisfactory. During the 2-year study, scar condition was monitored between 8 and 24 months, and a good appearance and pliable skin were obtained according to the Vancouver Scar Scale. According to this evaluation of Oriental skin turgor, normal pigmentation was restored about 6 months after the resurfacing procedure. For patients with severe burns in whom there is insufficient available skin for a full-thickness skin graft or another appropriate flap for scar revision, Integra is an alternative. The two major concerns in dealing with artificial skin are (1) a 10- to 14-day waiting period for maturation of the neo-dermis, necessitating a two-stage operation, and (2) prevention of infection with antibiotics and meticulous wound care.     

Dermal substitution in acute burns and reconstructive surgery: a subjective and objective long-term follow-up.

Tissue engineering and dermal substitution are currently prominent topics of wound-healing research. However, no extensive clinical trials with objective evaluation criteria have been published so far that support the clinical effectiveness of dermal equivalents in the long term. The dermal substitute that is discussed here is derived from bovine collagen and elastin-hydrolysate and has been shown to improve skin elasticity during a short-term clinical follow-up of scar reconstructions. In this study we will present the long-term outcome by means of objective and subjective scar assessment tools for dermal substitution in acute burn wounds and scar reconstructions.In a clinical trial, an intraindividual comparison was performed between the conventional split-thickness autograft and a combination of the collagen/elastin substitute with an autograft. After 1 year, scars were evaluated by the Cutometer SEM 474 for objective elasticity measurements and by planimetry to establish scar contraction. An independent observer subjected scars to a generally accepted clinical scar assessment tool: the Vancouver Scar Scale. In addition, patients gave their impression of the outcome. Forty-two paired burn wounds and 44 paired scar reconstructions were included and evaluated 1 year after surgery.Although substituted scar reconstructions demonstrated an elasticity improvement of approximately 20 percent compared with control wounds, no statistically significant differences were found for skin elasticity, scar contraction, Vancouver Scar Scale, and patient's impression in both categories after 1 year. An extensive long-term follow-up shows that the dermal substitute, which was proven effective in a clinical trial on a short-term basis, did not yield statistical evidence for a long-term clinical effectiveness of dermal substitution.     

Three new observational scales for use in Dutch nursing homes: scales from the Resident Assessment Instrument for Activities of Daily Living, cognition and depression

The reliability and validity of three MDS scales for ADL, cognition and depression are described. The scales consist of items of the Minimum Data Set of the Resident Assessment Instrument and are available just after an MDS assessment. Data collection took place in nine Dutch nursing homes (N = 227) and consisted of three MDS assessments within one month to determine reliability. Several criterion measures were assessed in order to determine convergent validity. Intra- and inter-rater reliability and internal consistency were determined as well as correlation coefficients of the criterion measures and the MDS scales. All three MDS scales appear reliable, especially the ADL-Hierarchy has very good psychometric properties (intra- and inter-rater Intra Class Correlation were 0.81 and 0.83, respectively). Convergent validity of the ADL-Hierarchy and the Cognitive Performance Scale is good, the Depression Rating Scale appears valid in residents with moderate cognitive disorders at the most, but the results are more difficult to interpret in residents with severe cognitive disorders. The MDS scales appear useful in clinical practice and for research purposes in the Dutch nursing homes.     

不同量表用于机械通气新生儿急性疼痛评估的价值分析

目的:分析和比较不同量表用于机械通气新生儿急性疼痛评估的价值。方法:使用总结性、回顾性研究方法,研究时间为2017年3月份到2018年7月份,选择在医院NICU接受机械通气诊治的新生儿56例作为研究对象,所有新生儿都给予高频震荡通气治疗,急性疼痛采用新生儿疼痛/激惹与镇静量表、新生儿急性疼痛评估量表进行评估与分析,记录评估效果。结果:新生儿疼痛/激惹与镇静量表的总体Cronbachα系数为0.698分,最高评分为基础行为状态,最低评分为心率增快。新生儿急性疼痛评估量表的内部一致性总体Cronbachα系数为0.822,最高评分为胎龄,最低评分为SaO2。新生儿疼痛/激惹与镇静量表的护理人员一致性组内相关系数(ICC)为0.992,新生儿急性疼痛评估量表的护理人员一致性组内相关系数ICC为0.987。以新生儿疼痛/激惹与镇静量表作为效标,新生儿急性疼痛评估量表的效标关联效度Spearman相关系数为r=0.855,P=0.007。12名护理人员对新生儿急性疼痛评估量表的选择率为66.7%,对新生儿疼痛/激惹与镇静量表的选择率为33.3%。结论:新生儿疼痛/激惹与镇静量表和新生儿急性疼痛评估量表在机械通气新生儿急性疼痛评估中都有很好的信度与一致性,其中新生儿急性疼痛评估量表的可行性和临床实用性更好。     

光动力疗法联合复方倍他米松对增生性瘢痕患者负性情绪和瘢痕组织p-STAT3、Egr-1表达的影响

目的:探讨光动力疗法联合复方倍他米松注射液局部封闭治疗增生性瘢痕(HS)的临床疗效及对患者负性情绪和瘢痕组织酪氨酸磷酸化STAT3(p-STAT3)、早期生长因子-1(Egr-1)表达的影响。方法:选取我院于2016年1月～2017年6月期间收治的HS患者118例,采用随机数字表法将患者随机分为对照组(n=59)和研究组(n=59),对照组给予复方倍他米松注射液治疗,研究组在对照组基础上联合光动力疗法治疗,两组患者均治疗4个月。比较两组患者临床疗效、瘢痕评分、负性情绪、瘢痕组织p-STAT3、Egr-1表达量,记录两组治疗期间不良反应发生情况。结果:研究组患者治疗后的临床总有效率为81.36%(48/59),高于对照组的54.24%(32/59)(P0.05)。治疗后随着时间的延长,温哥华瘢痕评定量表(VSS)、北卡罗来纳大学瘢痕量表评分不断下降,且研究组低于对照组(P0.05)。两组患者治疗后1年焦虑自评量表(SAS)、抑郁自评量表(SDS)评分低于治疗前,且研究组低于对照组(P0.05)。两组患者治疗后1个月瘢痕组织p-STAT3、Egr-1表达量低于治疗前,且研究组低于对照组(P0.05)。治疗期间两组不良反应发生率比较无差异(P0.05)。结论:光动力疗法联合复方倍他米松注射液局部封闭治疗HS,安全有效,可有效改善瘢痕症状,减轻患者负性情绪,降低瘢痕组织中p-STAT3、Egr-1表达。     

Ontwikkeling van de Gedragsobservatieschaal Psychomotorische therapie voor demente ouderen (GPMT-dem).

PDevelopment of the Behaviour observation scale for Psychomotor Therapy for elderly people with dementia (BPMT-dem).Reliability and concurrent validity This article describes the development of the Behaviour observation scale for Psychomotor Therapy for elderly people with dementia (BPMT-dem). This scale was developed in the late 1980s in order to evaluate the effect of psychomotor group therapy on the cognitive, social, and emotional functioning of elderly people with dementia within the therapy situation. The currently described research investigates inter-assessor reliability and internal consistency of the ten subscales (such as memory, orientation, contact with others, initiative, anxious behaviour, aggressive behaviour) and three domains, as well as the scale’s correlation with other observation scales (concurrent validity) in two different patient groups. The first group consisted of clients receiving psychomotor therapy in a nursing home or a psychiatric hospital (N = 130). Inter-assessor reliability (Cohen’s kappa) varied between 0.27 and 1.00, the internal consistency of the subscales (Cronbach’s alpha) was calculated between 0.46 and 0.86, and that of the domains between 0.76 and 0.81. Based on the findings of this study 15 of the original 88 items were removed, 5 items were moved to other subscales and the text of 2 items was changed. Next, the subscale internal consistency and concurrent validity of this modified (73-item version) BPMT-dem was investigated in a group of 41 elderly participating in a support programme in meeting centres for elderly people with dementia and their caregivers. Cronbach’s alpha for the subscales in this study was calculated between 0.47 and 0.86. To determine concurrent validity, the BPMT-dem was compared with (subscales of) the Assessment Scale for Elderly Patients (ASEP), Behavioural assessment for Intramural Psychogeriatrics (BIP), Brief Cognitive Rating Scale (BCRS) and the Cornell Scale for Depression in Dementia. Correlations with related BPMT-dem subscales varied between 0.38 and 0.75. The inter-assessor reliability and concurrent validity of the 73-item version of the BPMT-dem are satisfactory. The internal consistency of 6 subscales is sufficient, and recommendations are proposed to improve the consistency of the remaining subscales. Further research to test the unidimensionality and scalability of the subscales of the BPMT-dem, as well as the effect of the recommended reformulation and removal of items, is recommended. Before the instrument can be used in actual practice, the psychometric qualities of the BPMT-dem73 need to be studied in a larger and in terms of severity of dementia more heterogeneous study sample, so that statements can also be made on which norms to use in various subgroups of elderly with dementia. Tijdschr Gerontol Geriatr 2007; 38: 88-99     

Reliability and validity of the Wolfram Unified Rating Scale (WURS)

Background

Wolfram syndrome (WFS) is a rare, neurodegenerative disease that typically presents with childhood onset insulin dependent diabetes mellitus, followed by optic atrophy, diabetes insipidus, deafness, and neurological and psychiatric dysfunction. There is no cure for the disease, but recent advances in research have improved understanding of the disease course. Measuring disease severity and progression with reliable and validated tools is a prerequisite for clinical trials of any new intervention for neurodegenerative conditions. To this end, we developed the Wolfram Unified Rating Scale (WURS) to measure the severity and individual variability of WFS symptoms. The aim of this study is to develop and test the reliability and validity of the Wolfram Unified Rating Scale (WURS).

Methods

A rating scale of disease severity in WFS was developed by modifying a standardized assessment for another neurodegenerative condition (Batten disease). WFS experts scored the representativeness of WURS items for the disease. The WURS was administered to 13 individuals with WFS (6-25 years of age). Motor, balance, mood and quality of life were also evaluated with standard instruments. Inter-rater reliability, internal consistency reliability, concurrent, predictive and content validity of the WURS were calculated.

Results

The WURS had high inter-rater reliability (ICCs>.93), moderate to high internal consistency reliability (Cronbach’s α = 0.78-0.91) and demonstrated good concurrent and predictive validity. There were significant correlations between the WURS Physical Assessment and motor and balance tests (r_s>.67, p<.03), between the WURS Behavioral Scale and reports of mood and behavior (r_s>.76, p<.04) and between WURS Total scores and quality of life (r_s=-.86, p=.001). The WURS demonstrated acceptable content validity (Scale-Content Validity Index=0.83).

Conclusions

These preliminary findings demonstrate that the WURS has acceptable reliability and validity and captures individual differences in disease severity in children and young adults with WFS.

     

Multi-Dimensional Health Assessment Questionnaire in China: Reliability,Validity and Clinical Value in Patients with Rheumatoid Arthritis

Objective

To evaluate the psychometric properties and clinical utility of Chinese Multidimensional Health Assessment Questionnaire (MDHAQ-C) in patients with rheumatoid arthritis (RA) in China.

Methods

162 RA patients were recruited in the evaluation process. The reliability of the questionnaire was tested by internal consistency and item analysis. Convergent validity was assessed by correlations of MDHAQ-C with Health Assessment Questionnaire (HAQ), the 36-item Short-Form Health Survey (SF-36) and the Hospital anxiety and depression scales (HAD). Discriminant validity was tested in groups of patients with varied disease activities and functional classes. To evaluate the clinical values, correlations were calculated between MDHAQ-C and indices of clinical relevance and disease activity. Agreement with the Disease Activity Score (DAS28) and Clinical Disease Activity Index (CDAI) was estimated.

Results

The Cronbach''s alpha was 0.944 in the Function scale (FN) and 0.768 in the scale of psychological status (PS). The item analysis indicated all the items of FN and PS are correlated at an acceptable level. MDHAQ-C correlated with the questionnaires significantly in most scales and scores of scales differed significantly in groups of different disease activity and functional status. MDHAQ-C has moderate to high correlation with most clinical indices and high correlation with a spearman coefficient of 0.701 for DAS 28 and 0.843 for CDAI. The overall agreement of categories was satisfying.

Conclusion

MDHAQ-C is a reliable, valid instrument for functional measurement and a feasible, informative quantitative index for busy clinical settings in Chinese RA patients.     

Using method triangulation to validate a new instrument (CPWQ-com) assessing cancer patients' satisfaction with communication

Purpose: Patients’ perceptions of care including the communication with health care staff is recognized as an important aspect of the quality of cancer care. Using mixed methods, we developed and validated a short instrument assessing this communication. Methods: Based on focus group interviews with 77 informants, an 8-item instrument was developed. This short instrument aimed at assessing overall aspects of the communication between cancer patients and health care staff. The items were validated first through cognitive interviews with patient–observer agreement with 52 cancer patients who completed the questions and then participated in tape-recorded open-ended interviews. Observer ratings of the interviews were compared with the patients’ written responses collected before interviews and kappa values were calculated. The comprehensibility of each item was subsequently elaborated in traditional cognitive interviews with 17 cancer patients. Finally, psychometric analyses took place with data from 1490 cancer patients. Results: The weighted kappas concerning patient–observer agreement ranged 0.31–0.88. Disagreements mainly consisted of the observer choosing the response category indicating the highest level of satisfaction whereas the patients had chosen the second highest level. Cognitive interviews showed that the questions were generally interpreted as intended. One item was excluded due to low validity. A sum scale of the remaining seven items had high reliability (Cronbach's alpha 0.89). Conclusions: Seven items performed well. They proved to be valid measures of satisfaction with communication with the health care staff and constitute a sum scale with high reliability. The cognitive interviews provided valuable insight into the patients’ perception of communication.     

Reliability and external validity of the six scales of 72-item Sleep-Wake Pattern Assessment Questionnaire (SWPAQ)

The 72-item Sleep-Wake Pattern Assessment Questionnaire (SWPAQ) provides possibility to self-assess individual variation along as many as 6 factorial dimensions. We examined reliability and external validity of each of its 12-item scales, E, M, W, V, F, and S (evening and morning lateness, anytime and daytime wakeability, anytime and night-time sleepability, respectively). Questionnaire data were collected from residents of Novosibirsk and two smaller Russian cities (N = 755 and 720, respectively). Analysis of these two data-sets suggested good and acceptable internal consistency of each of the scales, respectively. Evidence for external validity of each of the 6 scales was obtained by applying stepwise linear regression analysis to data collected from 160 participants of sleep deprivation experiments who were asked to self-report 6 characteristics of their sleep for a week prior to the experiment. As expected, predictors of scales? scores were a later self-reported time for going to bed (E, W), an earlier/later time for final awakening (W/M), a shorter/longer sleep latency (F, S/E), a shorter/longer total sleep time (W + V/F), a lower/higher sleep satisfaction score (M/W + V), a lower/higher nap frequency (V/F), and a lower self-scored sleepiness after deprivation from sleep for a night (W, V).     

Decision-Making in Multiple Sclerosis Consultations in Italy: Third Observer and Patient Assessments

Objective

To assess decision-making in multiple sclerosis (MS) from third observer and patient perspectives.

Method

Audio recordings of first-ever consultations with a participating physician (88 outpatients, 10 physicians) at four tertiary MS care clinics in Italy, were rated by a third observer using the Observing Patient Involvement in Shared Decision Making (OPTION) and by patients using the Perceived Involvement in Care Scale (PICS).

Results

Mean patient age was 37.5, 66% were women, 72% had MS, and 28% had possible MS or other disease. Mean PICS subscale scores (range 0 poor, 100 best possible) were 71.9 (SD 24.3) for "physician facilitation" (PICS-F); 74.6 (SD 22.9) for "patient information exchange" (PICS-I); and only 22.5 (SD 16.2) for "patient decision making" (PICS-DM). Mean OPTION total score (0 poor, 100 best possible) was 29.6 (SD 10.3). Poorest OPTION scores were found for items assessing “preferred patient approach to receiving information” and “preferred patient level of involvement.” Highest scores were for “clinician drawing attention to identified problem”, “indicating need for decision making,” and “need to review the decision.” Consultation time, woman physician, patient-physician gender concordance and PICS-F were associated with higher OPTION total score; older physician and second opinion consultation were associated with lower OPTION score.

Conclusions

In line with findings in other settings, our third observer findings indicated limited patient involvement abilities of MS physicians during first consultations. Patient perceptions of physician skills were better than third observers’, although they correlated. Consultations with women physicians, and younger physicians, were associated with higher third observer and patient-based scores. Our findings reveal a need to empower Italian MS physicians with better communication and shared decision-making skills, and show in particular that attention to MS patient preferences for reception of information and involvement in health decisions, need to be improved.     

综合医院住院患者对自身常见心理问题的评价及其影响因素

本研究主要针对综合医院非精神科住院患者对自身常见心理问题的评价及其影响因素进行调查分析。本研究选取1 329名非精神科住院患者作为调查对象,使其在规定指导语下完成患者健康抑郁症状群量表(depression scale of the patient health questionnaire, PHQ-9)、躯体症状群量表(somatic symptom scale of thepatient health questionnaire, PHQ-15)、广泛性焦虑量表(generalized anxiety disorder 7-item scale, GAD-7)、健康焦虑量表(whiteley-7 scale, WI-7)等自评量表,并回答封闭式问题"您认为自己目前存在心理或者情绪问题吗?"。根据上述两种对自身心理问题评价方式的结果是否一致将患者分为心理问题评价一致组和心理问题评价不一致组。调查得到如下结果:心理问题评价一致组人数占研究总人数的48.3%。通过单因素方差分析和二元Logistic回归分析结果得出,该综合医院非精神科男性住院患者及少数民族患者较女性患者及汉族患者更难意识到自身心理问题(B=-0.227, p=0.044; B=0.643, p=0.022)。本研究说明,加强普及大众心理健康教育,尤其是对非精神科住院患者(特别是男性和少数民族患者)的心理健康教育,使之能正确评价自身心理问题并寻求治疗,是非常有必要的。而非精神科医生则需要更多关注到男性患者和少数民族患者,早期识别并正确处理其心理问题,促进疾病恢复,提高患者满意度。     

经口腔前庭入路与经乳晕入路腔镜甲状腺切除术对甲状腺微小乳头状癌VAS评分、创伤-免疫指标及美观程度的影响

摘要 目的：对比经口腔前庭入路腔镜甲状腺切除术（TOETVA）与经乳晕入路腔镜甲状腺切除术（ETE）对甲状腺微小乳头状癌疼痛视觉模拟（VAS）评分、创伤-免疫指标及美观程度的影响。方法：回顾性分析我院2020年3月~2021年12月期间接收的100例甲状腺微小乳头状癌患者的临床资料。按照入路方式的不同将患者分为A组（n=47,经ETE治疗）和B组（n=53,经TOETVA治疗）。对比两组围术期指标、创伤-免疫指标、美观程度及并发症发生率。结果：两组术中出血量、中央区淋巴结清扫数目、术后住院时间对比无差异（P>0.05）。B组的手术时间长于A组,术后第1 d颈部VAS评分低于A组（P<0.05）。两组术后3 d CD8⁺、白介素-6（IL-6）、C反应蛋白（CRP）、皮质醇（Cor）升高,但B组低于A组（P<0.05）。两组术后3 d CD4⁺下降,但B组高于A组（P<0.05）。B组的温哥华疤痕评定量表（VSS）评分、患者与观察者瘢痕评估量表（POSAS）评分均低于A组（P<0.05）。两组并发症发生率组间对比统计学差异不明显（P>0.05）。结论：与经ETE相比,经TOETVA治疗甲状腺微小乳头状癌,可获得与其相当的手术效果,且经TOETVA可更好地减轻术后疼痛、术后创伤,提高美观度。     

Hepatic stellate cells and astrocytes: Stars of scar formation and tissue repair

Scar formation inhibits tissue repair and regeneration in the liver and central nervous system. Activation of hepatic stellate cells (HSCs) after liver injury or of astrocytes after nervous system damage is considered to drive scar formation. HSCs are the fibrotic cells of the liver, as they undergo activation and acquire fibrogenic properties after liver injury. HSC activation has been compared to reactive gliosis of astrocytes, which acquire a reactive phenotype and contribute to scar formation after nervous system injury, much like HSCs after liver injury. It is intriguing that a wide range of neuroglia-related molecules are expressed by HSCs. We identified an unexpected role for the p75 neurotrophin receptor in regulating HSC activation and liver repair. Here we discuss the molecular mechanisms that regulate HSC activation and reactive gliosis and their contributions to scar formation and tissue repair. Juxtaposing key mechanistic and functional similarities in HSC and astrocyte activation might provide novel insight into liver regeneration and nervous system repair.Key words: p75 neurotrophin receptor, transforming growth factor-β, neurotrophins, epidermal growth factor, extracellular matrix, collagen, chondroitin sulfate proteoglycans, matrix metalloproteinases, scar, neurons, hepatocytes     

Mokken scale analysis of the UPDRS: dimensionality of the Motor Section revisited

The dimensionality and reliability of the Motor Section of the Unified Parkinson Disease Rating Scale (UPDRS III) was studied with non-parametric Mokken scale analysis. UPDRS measures were obtained on 147 patients with PD (96 men, 51 women, mean age 61, range 35-80 yrs). Mokken scale analysis revealed a four-dimensional structure of the UPDRS III. Left-sided bradykinesia and rigidity appeared to co-occur with axial signs, gait disturbance, and speech/hypomimia, whereas right-sided bradykinesia and rigidity formed a second scale. Two further small scales were found consisting of right- and left-sided tremor. Results from the scale analysis reveal that all four subscales are strong. The reliability of the two tremor scales is low because they only contain three and four items, respectively.     

Pro-Environmental Behavior: Does It Matter How It’s Measured? Development and Validation of the Pro-Environmental Behavior Scale (PEBS)

Many empirical studies examine the performance of pro-environmental behavior. A review of 49 recent studies revealed 42 unique measures of pro-environmental behavior. Analysis of these studies indicates a lack of consistency among the various behavioral measures. To address the issue of inconsistency in such a critical variable, I developed a new measure, the Pro-Environmental Behavior Scale (PEBS). The behaviors included in this scale are those identified by environmental scientists as having the greatest impact on the environment. Principal components analysis generated a 19-item scale with four dimensions. Coefficient alpha for the full scale was .76. Coefficient alphas for the subscales ranged from .62 to .74. Bivariate Pearson correlations between the PEBS and the New Ecological Paradigm Scale, the Environment Identity Scale, and the Environmental Regulations Attitude Scale demonstrated the scale’s construct validity. Test-retest correlations were strong, demonstrating reliability of the PEBS.     

The suicide assessment scale: Psychometric properties of a Norwegian language version

ABSTRACT: BACKGROUND: Rating scales are valuable tools in suicide research and can also be useful supplements to the clinical interview in suicide risk assessments. This study describes the psychometric properties of a Norwegian language version of the Suicide Assessment Scale Self-report version (SUAS-S). METHODS: Participants were fifty-two patients (mean age = 39.3 years, SD = 10.7) with major depression (53.8%), bipolar disorder (25.0%) and/or a personality disorder (63.5%) referred to a psychiatric outpatient clinic. The SUAS-S, the screening section of the Beck Scale for Suicidal Ideation (BSS-5), the Beck Depression Inventory (BDI), Beck's Hopelessness Scale (BHS), the Symptom Check-List-90 R (SCL-90R) and the Clinical Global Impression for Severity of Suicidality (CGI-SS) were administered. One week later, the patients completed the SUAS-S a second time. RESULTS: Cronbach's alpha for SUAS-S was 0.88 and the test-retest reliability was 0.95 (95% CI: 0.93- 0.97). SUAS-S was positively correlated with the BSS-5 (r = 0.66; 95% CI: 0.47-0.85) for the study sample as a whole and for the suicidal (r = 0.52) and non-suicidal groups (r = 0.50) respectively. There was no difference between the SUAS-S and the BSS-5 in the ability to identify suicidality. This ability was more pronounced when the suicide risk was high. There was a substantial intercorrelation between the score on the SUAS-S and the BDI (0.81) and the BHS (0.76). The sensitivity and specificity of the SUAS-S was explored and an appropriate clinical cut-off value was assessed. CONCLUSIONS: The study revealed good internal consistency, test-retest reliability and concurrent validity for the Suicide Assessment Scale Self-report version. The discriminatory ability for suicidality was comparable to that of the BSS-5.