基于AGREEⅡ工具评价冠心病中西医临床实践指南的质量

目的基于AGREEⅡ工具评价国内冠心病临床实践指南的方法学及质量。方法计算机检索中国知网(CNKI)、维普(VIP)、万方(Wanfang Data)和中国生物医学文献数据库(CBM),收集国内冠心病临床实践指南,检索时间从建库至2019年10月。由4名研究者独立筛选文献、提取资料后,采用AGREEⅡ工具评价纳入指南的方法学质量。结果共纳入7部国内机构制订的指南或专家共识,包括急性心肌梗死中西医结合诊疗指南、冠心病稳定型心绞痛中医诊疗专家共识、冠心病心绞痛介入前后中医诊疗指南、动脉粥样硬化中西医结合诊疗专家共识、急性心肌梗死中西医结合诊疗专家共识、中医内科常见病诊疗指南(西医疾病部分)冠心病心绞痛、胸痹心痛中医诊疗指南。AGREEⅡ评价结果表明,多数指南在“范围和目的”“参与人员”“表达的清晰性”方面较完整,但“制订的严谨性”“应用性”“编辑的独立性”方面欠佳。急性心肌梗死中西医结合诊疗指南和急性心肌梗死中西医结合诊疗专家共识欠缺的两方面得分最高,其中“应用性”平均得分为46.3%,急性心肌梗死中西医结合诊疗专家共识得分最高,为59.4%,其次为急性心肌梗死中西医结合诊疗指南得分为52.1%;“编辑的独立性”方面,平均得分为47.3%,急性心肌梗死中西医诊疗指南得分最高,为75.0%,急性心肌梗死中西医结合诊疗专家共识得分次之,为62.5%。全面评价结果显示,强烈推荐使用的指南包括2个,推荐(补充或改进)的指南包括3个,不能确定是否推荐使用的指南包括2个。结论急性心肌梗死中西医结合诊疗指南和急性心肌梗死中西医结合诊疗专家共识在国内冠心病中西医临床实践指南的方法学质量均较高,可为临床诊疗提供指导性意见。     

Development of main disturbances of hemostasis in patients with obesity

According to current views obesity especially with increased amount of visceral fat is characterized by prothrombogenic changes of hemostasis and fibrinolysis. This combined with insulin resistance, compensatory hyperinsulinemia, disturbances of carbohydrate metabolism, atherogenic dyslipidemia and hypertension substantially increases risk of origination and progression of cardiovascular diseases. Results of our study demonstrate high prevalence of various prothrombogenic abnormalities in coagulation and anticoagulation systems in patients with visceral obesity and metabolic syndrome (MS). Disturbances of hemostasis were detected by such screening methods as measurement of APTT, INR and concentration of fibrinogen in blood plasma. We received data on positive association of severity of some abnormalities of hemostasis with anthropometric and biochemical parameters of obesity and MS, parameters of lipid and carbohydrate metabolism. Revealed disturbances of hemostasis create prerequisites for development of thrombophilia and make additional contribution to increase of cardiovascular risk in this category of patients. This dictates necessity of more thorough and deepened examination of patients with visceral obesity and MS with the aim of detection and correction of pathological changes of lipid and carbohydrate metabolism, system of hemostasis and fibrinolysis at earliest stages.     

脑老化中神经元密度与毛细血管密度相对改变的研究

目 的 研究无神经系统疾病的正常增龄患者神经元及毛细血管密度的相对变化,并与阿尔茨海默病(Alzhei-mer’s diseasee,AD)患者比较,探讨在脑老化及痴呆防治中对血管因素进行干预的意义。方法 收集无神经系统疾病的正常病例脑标本28例(23-100岁)及AD尸检脑标本6例,应用荆豆凝集素(Ulex europaeus agglutinin,UEA)及甲苯胺蓝等染色显示无神经系统病史及神经病理改变的尸检病例(正常病例)额叶、枕叶、壳核、海马CA3区及AD患者海马的神经元、毛细血管形态,应用图像分析技术测定各部位神经元与毛细血管密度,分析二者比值与年龄之间的相关性。结果 正常增龄病例额叶、枕叶、壳核神经元与毛细血管数目及面积之比与年龄呈正相关。正常高龄病例(≥75岁)与AD病例海马部位两者之比较差异无显著性意义。结论脑老化中毛细血管退变可能是脑组织代谢下降、功能减退的原因之一;对血管因素的干预在脑老化及AD防治中具有重大意义。     

The quality of dying and death

During the past decade, research has examined definitions and conceptualizations of quality of dying and death in different populations. At the same time, there has been a call to clarify the distinctions between quality of dying and death and other end-of-life constructs. The purposes of this article are to (1) review research that examined definitions and conceptualizations of the quality of dying and death, (2) clarify the quality of dying and death construct and its distinction from quality of life and quality of care at the end of life, and (3) outline challenges that remain for health care professionals, researchers, and policy makers. Review of the literature revealed that the quality of dying and death construct is multidimensional, with 7 broad domains: physical experience, psychological experience, social experience, spiritual or existential experience, the nature of health care, life closure and death preparation, and the circumstances of death. The quality of dying and death is subjectively determined with numerous factors that influence its judgment, including culture, type and stage of disease, and social and professional role in the dying experience. Quality of dying and death is broader in scope than either quality of life at the end of life or quality of care at the end of life, although there is overlap among these constructs.     

重庆市医养结合服务的供需现状、问题及建议

目的调查重庆市医养结合服务的供需现状并分析问题,为重庆市下一步医养结合服务的开展提供数据支持及建议。方法运用文献资料分析与实证调查分析方法,对重庆市医养结合服务政策顶层设计及其演变、医养结合服务供需现状、医养结合服务实际开展状况、开展医养结合服务存在的问题及建议等方面进行分析。结果目前重庆市医养结合养老服务政策经历了规划阶段、发展阶段、深入完善阶段共三个阶段,医养结合服务呈现出刚性服务需求大、医养结合资源总量缺乏、区域之间医养结合服务发展不平衡的特点。但仍存在政策设计缺“项”、政策落实缺“力”、服务质量缺“质”等问题。建议应持续完善顶层设计、提升医养结合服务质量、加快智慧医养步伐。结论重庆市医养结合养老体系建设不断完善,但仍存在诸多问题和困难,建议应持续完善顶层设计、提升医养结合服务质量、加快智慧医养步伐。     

乙酰肝素酶和血管内皮生长因子C mRNA的表达与肺癌侵袭和转移的分子生物学

目的研究乙酰肝素酶(HPSE)和血管内皮生长因子(VEGF)-C mRNA的表达是否与肺癌的侵袭性生长和淋巴结转移有关。方法应用RT-PCR技术检测HPSE和VEGF-C mRNA在65例肺癌组织中的表达,并与癌旁组织和正常肺组织对比,同时结合肺癌的临床病理学特征及预后进行分析。结果肺癌组织中HPSE和VEGF-C mRNA的阳性表达率明显高于正常肺组织和癌旁组织(P<0.05);不同病理类型肺癌组织中HPSE和VEGF-C蛋白阳性表达率均无显著性差异(P>0.05);不同分化程度肺癌组织中HPSE和VEGF-C蛋白阳性表达率均无显著性差异(P>0.05);Ⅲ期和Ⅳ期肺癌组织中HPSE和VEGF-C蛋白阳性表达率明显高于Ⅰ期和Ⅱ期(P<0.05);生存3年以下的肺癌组织中HPSE和VEGF-C蛋白阳性表达率明显高于生存3年以上者(P<0.05)。结论肺癌的发生、发展可能与HPSE促血管生成和VEGF-C促淋巴管生成的协同作用有关;HPSE和VEGF-C基因表达可作为判断肺癌生物学行为和患者预后的一个参考指标。     

江滩地区纳潮引水药浸法杀灭钉螺的现场评价

［摘要］　目的　比较江滩地区纳潮引水药浸法与单纯喷洒法现场灭螺效果。方法　在2块相邻有螺江滩上分别采用纳潮引水药浸法灭螺（灭螺药为26%四聚·杀螺胺乙醇胺盐悬浮剂）与单纯26%四聚·杀螺胺乙醇胺盐悬浮剂喷洒法灭螺,在灭螺前后分别进行螺情调查并计算灭后活螺密度。结果　纳潮引水药浸法灭螺后1年和2年活螺密度下降率分别为72.19%和100.00%,单纯喷洒法灭螺后1年和2年活螺密度下降率分别为5.93%和18.15%。结论　有螺江滩纳潮引水药浸法灭螺效果明显优于单纯喷洒法灭螺,纳潮引水药浸法灭螺持续开展2年以上效果更佳。     

病毒性肝炎西医诊断和中医证型关系的探讨

目的 探讨病毒性肝炎西医诊断与中医证型的关系.方法 分析552例病毒性肝炎患者疾病不同临床类型、慢性肝炎不同临床分度、重型肝炎不同临床分期与中医证型的关系.结果 急性、慢性肝炎组中医证型均以肝胆湿热证为主,其次是肝郁脾虚证和肝络瘀阻证;慢性肝炎轻、中、重度组均以肝胆湿热证为主,但轻度组肝胆湿热证更多见;重型肝炎早期以肝...     

艾滋病预防与控制的政策研究(一)--艾滋病防治的方法

有关艾滋病预防和治疗的研究既是一项政策性很强的社会系统研究,同时也是一项需要多学科间进行合作的应用性研究.艾滋病防治的方法可主要分为检测和监测,宣传、教育和行为干预,治疗、咨询和支助这三个方面.本文是在分析以上三个方面之间,以及每一个方面的各个要素之间存在着的相互关系的基础上,对艾滋病防治的方法和政策进行系统地研究.并且,关于艾滋病防治政策的研究应该包括制定相应的法律与法规,运用以上的各种艾滋病防治的方法来制定和实施艾滋病防治的规划,解决吸毒、卖淫、非法卖血,改善妇女的社会地位,保障HIV/AIDS的人权等社会问题.最后,必须建立艾滋病防治政策实施的监视与评价系统.     

血吸虫病现场教学在人体寄生虫学课程思政教育中的探索和实践

课程思政教育是当前高校教学工作的重点内容。华中科技大学同济医学院人体寄生虫学教学团队立足人体寄生虫学课程特点,借助学校所处的地理优势,深入开展日本血吸虫病现场教学,将思政教育充分融入课程。通过展示我国血防工作成就、演示哨鼠监测实验、观察钉螺孳生环境和参观血吸虫病防治专科医院等,将知识传授、能力培养和价值塑造融为一体,达到思政育人的效果。现将现场教学的探索和实践过程进行梳理和总结,以期为医学课程思政教学提供参考。     

酶联免疫吸附试验检测大沙鼠心血冲洗液中鼠疫F1抗体的可行性分析

目的 分析酶联免疫吸附试验(ELISA)法检测大沙鼠心血冲洗液鼠疫F1抗体的可行性及其在鼠疫监测工作中的应用价值.方法 2007年,在准噶尔盆地大沙鼠鼠疫疫源地,采用弓形夹捕获大沙鼠.取大沙鼠血清、心血冲洗液和肝脾浸液,用ELISA法检测鼠疫F1抗体的阳性检出率和阳性滴度.数据处理用SPSS 17.0.结果 大沙鼠鼠疫F1抗体的阳性检出率与平均阳性滴度,血清分别为12.35%(20/162)和2535;心血冲洗液分别为10.49%(17/162)和23.75,肝脾浸液分别为6.79%(11/162)和2240.血清鼠疫F1抗体的阳性检出率与心血冲洗液比较,差异无统计学意义(χ2=1.333,P＞0.05),与肝脾浸液比较,差异有统计学意义(χ2=7.111,P＜0.0l);心血冲洗液与肝脾浸液比较,差异有统计学意义(χ2=6.250,P＜0.05).鼠疫F1抗体平均滴度,血清与心血冲洗液和肝脾浸液比较,差异有统计学意义(t值分别为2.290,3.612,P＜0.05或＜0.01).鼠疫F1抗体阳性符合率,血清与心血冲洗液为85.0%(17/20),与肝脾浸液为55.0%(11/20);心血冲洗液与肝脾浸液为64.7%(11/17).结论 ELISA法能检测到鼠心血冲洗液中鼠疫F1抗体,在鼠疫监测中,利用鼠心血冲洗液测定鼠疫F1抗体具有可行性.

Abstract：

Objective To analyse the feasibility of detecting F1 antibody to Yersinia pestis in flushing fluid of heart blood of Rhombomys opimus with enzyme linked immunosorbent assay(ELISA) method and its application value in surveillance of the disease. Methods Serum, flushing fluid of heart blood and infusion fluid of liver and spleen of Rhombomys opimus, which were caught by capture in the plague focus of Zunger basin in 2007, were taken to carry out detection for F1 antibodies to Yersinia pestis with ELISA method. The data were processed with SPSS 17.0. Results Positive rate and average titer of serum were 12.35%(11/162) and 25.35, of flushing fluid of heart blood were 10.49%(17/162) and 23.75 and of the infusion fluid of liver and spleen 6.79%(17/162) and 2240,respectively. No statistical difference was found in positive detection rate when it was compared between serum and flushing fluid of heart blood(χ2 = 1.333, P ＞ 0.05), but it was obviously different between serum and infusion fluid of liver and spleen(χ2 = 7.111, P ＜ 0.01 ) and between flushing fluid of heart blood and infusion fluid of liver and spleen(x2 = 6.250, P ＜ 0.05). There was a significant difference in average titer between serum, flushing fluid of heart blood and infusion fluid of liver and spleen(t = 2.290, 3.612, P ＜ 0.05 or ＜ 0.01 ). The plague F1 antibody positive coincidence rate of serum and flushing fluid of heart blood was 85.0%(17/20), of serum and infusion fluid of liver and spleen was 55.0% (11/20), and of flushing fluid of heart blood and infusion fluid of liver and spleen was 64.7%(11/17). Conclusions The ELISA method can detect Fl antibody in flushing fluid of heart blood,and the method is feasible in plague surveillance.     

Current views of tuberculosis inflammation

The value of histological and histochemical studies in the diagnosis of a phase of tuberculosis progression or healing is shown. Electron microscopic study of tuberculous inflammation in different phases of its evolution evaluated the functional status of cellular elements of the lung and granuloma. The body's antituberculous resistance due to molecular genetic mechanisms is realized through intercellular interactions and macrophageal functions. Immune macrophages are characterized by a higher metabolic activity, they suppress the intracellular multiplication of Mycobacterium tuberculosis (MBT) and are more protected from their toxic action. The pathogenetic mechanisms responsible for caseous pneumonia were studied. Three stages of evolution of the process: Stage 1 is the breakdown of defense and adaptive mechanisms: disorganization of connective tissue and alveolar parenchyma; enhanced permeability of blood and lymphatic microvascular walls with developed interstitial and intraalveolar edema, plasma and fibrin exudation, fibrinoid swelling of collagenous fibers, and their lysis; occurrence of lung parenchymal microinfarcts and infarction-pneumonia; type 2 alveolocytic dysfunction with surfactant destruction; Stage 2 is the breakdown of local immunity; exudative and alterative tuberculous inflammation with involvement of immunocompetent organs; suppressed T-cellular immunity, a shift of a T helper/T suppressor ratio to the latter, lymphopenia; impaired intercellular interactions, cellular apoptosis in blood and inflammation areas, and suppressed granulomatous reaction; inhibited L transformation of Mycobacteria tuberculosis, intensive MBT multiplication in the foci of tuberculous inflammation, particularly those which are resistant to many antibiotic drugs, a larger number of associations of the nonspecific microflora and fungi. Stage 3 is caseous pneumonia and generalization of a tuberculous process: a predominance of an alterative reaction of inflammation; the presence of allergic and caseous and necrotic vasculitis, bronchiolitis, and endo-panbronchitis; depressed granulomatous reaction; the development of acute alterative sequestrating pneumoniogenic caverns. Histological, histochemical, and electron microscopic studies of tuberculous inflammation may specify the mechanisms of the pathogenesis of tuberculosis and may serve as the basis for early diagnosis of the disease and for timely correction of performed treatment in order to enhance its efficiency.     

燃煤污染型与饮水型氟中毒病区人群尿氟特征的研究

目的分析燃煤污染型与饮水型氟中毒病区人群尿氟、水氟、人均摄氟量及成人与儿童尿氟之间的关系。方法采用氟离子电极法测定水氟和儿童、成人尿氟及食物氟含量。结果水氟含量与尿氟含量的相关系数儿童ｒ＝０．９３４３５,成人ｒ＝０．８３２８;摄氟量与尿氟含量相关系数成人ｒ＝０．９３０７,儿童ｒ＝０．９１７２;成人尿氟值与儿童尿氟值之间差异有显著性意义（Ｐ＜０．０５）。结论两类病区儿童、成人尿氟与人均摄氟量及水氟呈高度正相关;成人尿氟值显著高于儿童尿氟值     

Comparison of two direct assays for platelet-associated IgG (PAIgG) in assessement of immune and nonimmune thrombocytopenia

A number of methods have been developed to measure platelet-associated IgG (PAIgG). The antiglobulin consumption assay directly quantitates IgG on the platelet and is sensitive and specific. A fluorescent anti- IgG assay has recently been described and has the advantage of simplicity. We compared the results of these two PAIgG assays in immune and nonimmune thrombocytopenia and nonthrombocytopenic controls. The antiglobulin consumption assay was negative in 61 of 62 and the fluorescent negative in 54 of 62 assays in nonthrombocytopenic controls, and they were negative in 11 of 13 and 8 of 13 assays, respectively, in nonimmune thrombocytopenic patients. The antiglobulin consumption assay was positive in 54 of 58 and the fluorescent positive in 24 of 58 assays of patients with immune thrombocytopenia (ITP and SLE). The overall sensitivity and specificity of the antiglobulin consumption assay was 94% and 95% and of the fluorescent assay was 44% and 82%.     

The significance of HBsAg and HBcAg levels in the liver and their relation to histopathologic activity

The results of histological and immunohistological studies on the liver biopsies from patients with positive serum HBsAg, HBeAg, HBVDNA, and HBVDNAp showed: 1. In addition to the inclusion body like, marginal, diffuse and membranous patterns of HBsAg, we found that marginal and diffuse patterns of HBsAg may appear within one hepatocyte and this is named as transitional pattern. A preliminary suggestion about the process of formation and evolution of different patterns of HBsAg and HBcAg was raised. 2. There is a relationship between HBV replication and the activity of hepatitis. Different patterns and distributions of HBAg affect the lesion of the liver significantly. 3. According to the morphology of HBsAg and HBcAg, we suggest to divide their patterns into the following two categories: The first includes the diffuse and membranous patterns of HBsAg and the cytoplasmic and membranous HBcAg; these are related to the replication of HBVDNA. The second includes inclusion body like and marginal patterns of HBsAg with and without nuclear pattern of HBcAg; these probably reflect the integration of HBVDNA to the host genome.     

MMP-9、HPSE和VEGF-C蛋白表达在中老年人肺癌抗血管和抗淋巴管生成治疗中的意义

目的探讨基质金属蛋白酶9(MMP9)、乙酰肝素酶(HPSE)和血管内皮生长因子C(VEGFC)蛋白表达在中老年人肺癌抗血管和抗淋巴管生成治疗中的意义。方法应用免疫组化SABC法检测MMP9、HPSE和VEGFC蛋白表达在65例肺癌组织中的表达,并与癌旁组织和正常肺组织对比,同时结合肺癌的临床病理学特征及预后进行分析。结果肺癌组织中MMP9、HPSE和VEGFC蛋白的阳性表达率明显高于正常肺组织和癌旁组织(P<005);不同类型和不同分化程度肺癌组织中MMP9、HPSE和VEGFC蛋白阳性表达率无显著性差异(P>005);Ⅲ期和Ⅳ期肺癌组织中MMP9、HPSE和VEGFC蛋白阳性表达率明显高于Ⅰ期和Ⅱ期(P<005);生存3年以下的肺癌组织中MMP9、HPSE和VEGFC蛋白阳性表达率明显高于生存3年以上者(P<005)。结论MMP9、HPSE蛋白表达在肺癌的生长、侵袭和转移以及血管生成中发挥重要作用;VEGFC是促进肺癌经淋巴转移的重要因素;肺癌的生长、侵袭和转移可能是MMP9、HPSE促血管生成和VEGFC促淋巴生成二者的协同作用;MMP9、HPSE和VEGFC蛋白可作为判断肺癌生物学行为和患者预后的一个参考指标;为人肺癌抗血管和抗淋巴管生成治疗的可行性提供了一定的实验依据。     

The molecular control of corpus luteum formation, function, and regression

The corpus luteum (CL) is one of the few endocrine glands that forms from the remains of another organ and whose function and survival are limited in scope and time. The CL is the site of rapid remodeling, growth, differentiation, and death of cells originating from granulosa, theca, capillaries, and fibroblasts. The apparent raison d'etre of the CL is the production of progesterone, and all the structural and functional features of this gland are geared toward this end. Because of its unique importance for successful pregnancies, the mammals have evolved a complex series of checks and balances that maintains progesterone at appropriate levels throughout gestation. The formation, maintenance, regression, and steroidogenesis of the CL are among the most significant and closely regulated events in mammalian reproduction. During pregnancy, the fate of the CL depends on the interplay of ovarian, pituitary, and placental regulators. At the end of its life span, the CL undergoes a process of regression leading to its disappearance from the ovary and allowing the initiation of a new cycle. The generation of transgenic, knockout and knockin mice and the development of innovative technologies have revealed a novel role of several molecules in the reprogramming of granulosa cells into luteal cells and in the hormonal and molecular control of the function and demise of the CL. The current review highlights our knowledge on these key molecular events in rodents.     

No health without mental health

About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. However, because they stress the separate contributions of mental and physical disorders to disability and mortality, they might have entrenched the alienation of mental health from mainstream efforts to improve health and reduce poverty. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Health services are not provided equitably to people with mental disorders, and the quality of care for both mental and physical health conditions for these people could be improved. We need to develop and evaluate psychosocial interventions that can be integrated into management of communicable and non-communicable diseases. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of HIV, tuberculosis, and malaria; gender-based violence; antenatal care; integrated management of childhood illnesses and child nutrition; and innovative management of chronic disease. An explicit mental health budget might need to be allocated for such activities. Mental health affects progress towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS. Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care.