ABSTRACT
Objective To explore the applicability of the three commonly used CT examination decision rules in Chinese head injured children. Methods This prospective observational study included 1538 children and adolescents (aged < 18 years), who were treated at the Emergency Department of First Hospital of Shanxi Medical University after head injuries. The three clinical decision rules include the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE; UK); the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury, that was developed by the Pediatric Emergency Care Applied Research Network (PECARN; USA), and the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule. Diagnostic accuracy had been evaluated by using the rule-specific predictor variables to predict each rule-specific outcome measure in populations who met inclusion and exclusion criteria for each rule. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and ROC curve were referred to the diagnostic accuracy. Indicators were characterized by 95％ CI. Results Of the 1538 patients, CTs were obtained for 339 patients (22.04％). Forty-nine patients (3.19％) had positive CT results, 8 patients (0.52％) underwent neurosurgery, 2 patients (0.13％) died, and 1 patient (0.07％) may be missed. In this study, CHALICE was applied for 1394 children (90.70％; 95％ CI: 89.24％-92.15％), PECARN for 801 children (52.11％; 95％ CI: 49.62％-54.61％), and CATCH for 325 patients (21.15％; 95％CI: 19.10％-23.19％). The validation sensitivities of CHALICE, PECARN, and CATCH rules were 92.6％(74.2％-98.7％), 100％ (56.1％-100％), and 85.7％ (42.0％-99.2％), respectively; the specificities were 78.1％(75.7％-80.2％), 48.0％ (44.5％-51.5％) and 70.8％ (65.4％-75.6％); positive predictive value were 7.7％ (5.1％-11.3％), 0.9％ (0.4％-1.9％) and 6.1％ (2.5％-13.2％); and negative predictive value were 99.8％ (99.2％-100％), 99.1％ (98.1％-99.6％), and 99.6％ (97.2％-100％), respectively. Conclusions The clinical decision rules of CHALICE, PECARN and CATCH have high sensitivities. The specificity of PECARN rule is lower than those of CHALICE and CATCH rules. The above three clinical decision rules can be used for the decision of CT examination in Chinese children with head injury in practice.
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Objective To observe the clinical efficacy and safety of 0.1% and 0.03% tacrolimus ointment in patients aged 18 to 65 years with atopic dermatitis (AD). Methods Treatment was given twice daily to all affected areas for 3 weeks in a multicentre, randomized, double blind, parallel, and vehicle-controlled study. Follow-up visits were scheduled on day 1(baseline), and 1, 2 and 3 weeks post-treatment. The therapeutic effect and safety were evaluated. Results A total of 211 adults with moderate to severe AD in 6 study centres were enrolled in the efficacy evaluation. The efficacy rates were 88.4%, 77.8% and 30.0% in patients treated with 0.1%, 0.03% tacrolimus ointment, and the vehicle, respectively (P
ABSTRACT
Objective: To investigate the role of nuclear factor ?B (Rel/NF-?B) in pathogenesis of atopic dermatitis(AD) and the effect of topical 0.1%(mass fraction) or 0.03%(mass fraction) tacrolimus ointment on expression of NF-?B in lesional AD skin. Methods: Immunohistochemistry has been employed to study the expression of NF-?B in normal skin and lesional AD skin before and after using topical tacrolimus ointment. Results: The expressions of NF-?Bp50 and NF-?Bp65 were scattering or negative in normal keratinocytes. NF-?Bp50 was overexpressed on nuclear of basal and suprabasal keratinocytes in 9 cases of AD, NF-?Bp65 was overexpressed in cytoplasm and perinuclear of basal and suprabasal keratinocytes. After using topical tacrolimus ointment for three weeks , nuclear NF-?Bp50 expressed on basal and suprabasal keratinocytes were lost and NF-?Bp50 was expressed sparsely on basal keratinocytes cytoplasm or nuclear. NF-?Bp65 was expressed sparsely on basal and suprabasal keratinocytes cytoplasm. Conclusion: These data suggest that increased NF-?B activity may represent the basis of initiation or maintenance of the skin inflammatory response in atopic dermatitis. Topical tacrolimus may directly or indirectly inhibit NF-?B nuclear expression in keratinocytes and inhibit skin innate immuno-inflammatory response in atopic dermatitis that related to NF-?B.
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Objective To study the relationship between apoptosis regulation and epidermal proliferation in psoriasis. Methods The expression of apoptosis molecule PDCD5 (programmed cell death 5) on psoriatic lesions was observed by direct immunofluorescence. The positive rates and the average of fluorescence intensity of PDCD5 were analyzed quantitatively with FACS and computer CELL Quest software. The expression of PDCD5 mRNA in psoriatic lesions was detected by RT-PCR. Results The expression of PDCD5 protein was obviously lower in psoriatic epidermal cells than that of the normal skin. The positive rate and the average fluorescence intensity of PDCD5 in psoriatic epidermal cells were notably lower than those of the normal skin (P