深化家庭医生首诊职能的分析与实践

目的深化家庭医生首诊职能的实施。方法设立激励机制，赋予家庭医生使用三级医疗机构资源的权限，对通过家庭医生首诊的患者给予优先处理措施，向家庭医生反馈患者就诊信息。结果接受家庭医生首诊的55名患者对服务的评价较为积极。结论三级医疗机构和社区卫生服务中心均能够通过家庭医生首诊的实施获益。     

Changes in intraarticular pressure on the blood supply in the retinaculum of the femoral neck

BackgroundThis study aimed to analyze the effects of intracapsular pressure (IAP) on blood flow in the femur after a femoral neck fracture.MethodsFour simplified vascular models were used to measure the effect of vessel length on arterial blood flow in 10 New Zealand white rabbits. Ten models were evaluated under 10 different blood pressures.FindingsIAP increased following fracture of the femoral neck, and deformation had the greatest potential effect on blood flow in the retinacular artery. When blood pressure was fixed at 60 mm Hg, an increase in IAP caused a reduction in blood flow. When the IAP was relatively high (above 60 mm Hg), and higher than the blood pressure, blood flow continued to drop as intracapsular pressure increased. Shortening of blood vessels had no significant effect on blood supply. However, the p-value was uniformly significant (<0.05) when stretched and twisted blood vessels were compared with normal blood vessels.InterpretationThe results of computational fluid-structure interaction similarly indicated that a smaller blood vessel diameter and twisted blood vessels will result in decreased flow velocity when IAP increases. This study also revealed a close relationship between IAP and the hip joint's position and traction.     

Custom 3-Dimensional Printed Ultrasound-Compatible Vascular Access Models: Training Medical Students for Vascular Access

PurposeTo generate 3-dimensional (3D) printed ultrasound (US)-compatible vascular models (3DPVAM) and test them for noninferiority in training medical students in femoral artery access.Materials and MethodsA 3DPVAM of normal femoral artery (FA) anatomy was developed from an anonymized computerized tomography (CT) examination. Students were randomized to a 3DPVAM or a commercial model (CM) simulation experience (SE) for US-guided FA access. Students completed a pre-SE questionnaire ranking their self-confidence in accessing the artery on a 5-point Likert scale. A standardized SE was administered by interventional radiology faculty or trainees. Students completed a post-SE questionnaire ranking comfort with FA access on a Likert scale. Student questionnaire results from the 3DPVAM group were compared with those from the CM group by using chi-square, Wilcoxon signed-rank, and noninferiority analyses.ResultsTwenty-six and twenty-three students were randomized to 3DPVAM and commercial model training, respectively. A total of 76.9% of 3DPVAM trainees and 82.6% of CM trainees did not feel confident performing FA access prior to the SE. In both groups, training increased student confidence by 2 Likert points (3DPVAM: P < 0.001; CM P < 0.001). The confidence increase in 3DPVAM trainees was noninferior to that in CM trainees (P < 0.001).ConclusionsGeneration of a custom-made 3DPVAM is feasible, producing comparable subjective training outcomes to those of CM. Custom-made 3D-printed training models, including incorporation of more complex anatomical configurations, could be used to instruct medical students in procedural skills.     

基于TCGA数据库挖掘甲状腺乳头状癌淋巴结转移相关的突变基因及其机制探讨北大核心

目的:挖掘并筛选与甲状腺乳头状癌(papillary thyroid carcinoma,PTC)淋巴结转移相关的突变基因及其潜在的机制。方法:从TCGA数据库获得377例PTC患者的测序数据及完整的临床资料,并分为淋巴结转移组(LM,n=212)与无淋巴结转移组(NLM,n=165)。利用R语言(v3.6.2)对转移组特有的突变基因进行富集分析。采用String在线软件绘制蛋白互作网络,Cytoscape软件筛选网络中的核心基因。在UALCAN网站上验证基因表达量与淋巴结转移之间的关系。利用荧光实时定量PCR测定候选基因在细胞系中mRNA的表达量。结果:一共筛选出1197个仅在LM组发生突变的基因,它们主要富集在黏着连接、细胞黏附分子(cell adhesion molecules,CAMs)通路。CAMs通路的核心基因ITGB1与VCAN的表达量与淋巴结转移相关。与正常甲状腺细胞系相比,VCAN基因在PTC细胞系TPC-1和B-CPAP中mRNA的表达量较高,尤其是B-CPAP细胞系。结论:CAMs通路可能是PTC淋巴结转移相关机制之一,其中VCAN基因可能是潜在的分子标志物。     

髓内钉和微创钢板在肱骨干骨折内固定治疗中的应用

背景:随着微创技术的开展,髓内钉和微创钢板内固定广泛应用于肱骨干骨折并取得良好效果,但也并存一些并发症,如何改进内固定的设计及操作以减少或避免并发症成为研究热点.目的:总结近年来肱骨干骨折微创内固定的治疗进展.方法:由第一作者检索PubMed/MEDLINE(http://www.ncbi.nlm.nih.gov/PubMed)、Web of knowledge (http://apps. isiknowledge.com)、OVID(http://ovidsp.tx.ovid.com)、Elsevier(http://www.sciencedirect.com)、中国期刊网(http://epub. edu.cnki.net)及万方数据库(http://wanfang.lib.sjtu.edu.cn)2005/2010有关髓内钉和微创钢板内固定治疗肱骨干骨折的文献,英文检索词为“humeral shaft fractures,internal fixation,minimally Invasvie",中文检索词为“肱骨干骨折,微创,内固定".排除重复性研究及肱骨干病理性骨折相关文献,纳入32篇文献进行综述.结果与结论:只有准确掌握肱骨干骨折及不同内固定种类的特点,做到个体化治疗,才能达到最好的治疗效果并最大程度减少并发症.目前深化了对肩袖损伤的认识,初步寻找到减少肩袖损伤的方法,改进了髓内钉及钢板的设计,在方便操作、减少手术时间的同时一定程度上避免了神经血管损伤.     

临床研究管理中合同研究组织的作用及其发展趋势

临床研究涉及人体对药物、医疗器械的安全及疗效的极其复杂过程,需要遵守严格的法律法规并在高质量的技术指导和过程监督下进行.合同研究组织(CRO)对临床研究管理的顺利开展起着重要的作用.本文分析了CRO在临床研究管理中的作用及运营模式,及其在中国的发展趋势.并就我国CRO机构面临的机遇和挑战,提出了建议.     

大鼠跟腱应力屏蔽对转化生长因子β的影响

背景：应力屏蔽引起的肌腱组织内各种细胞因子的改变与肌腱挛缩密切相关,其中转化生长因子β的改变情况尚不清楚。目的：观察应力屏蔽对跟腱转化生长因子β浓度的影响。方法：取雄性SD大鼠20只随机分为2组,左后肢行跟腱应力屏蔽后分别饲养2周和4周,随机抽取的10只大鼠的右后肢正常跟腱组织做对照。以ELISA定量检测各组转化生长因子β的质量浓度。结果与结论：造模组转化生长因子β均比正常组显著升高（P均〈0.01）;造模2周与4周组间差异无显著性意义（P〉0.05）。结果表明跟腱应力屏蔽2周后转化生长因子β已明显升高,到屏蔽4周未见下降,肌腱的合成代谢增强。     

Psychometric properties of the Arabic self-report version of the strengths and difficulties questionnaire

Students in middle school tend to display emotional and behavioural difficulties (EBDs) compared to other forms of psychopathology. Early identification of EBDs is therefore a priority in order to prevent the chronic co-morbidity with other forms of psychopathology which may affect students’ academic achievement. Assessment of EBDs has been traditionally undertaken via proxy reporting; but psychometrically rigorous instruments are needed so that children and adolescents can report on their own emotions and behaviours. Such need increases in the Omani context given the lack of EBDs adequate assessment instruments. In the current study the factor structure of the Arabic self-report version of the Strengths and Difficulties Questionnaire (A-SDQ) was examined in a sample of 815 middle school students (mean age = 14 years). The study tested the SDQ original five-factor model which received considerable empirical support. Responses on the A-SDQ were compared to responses obtained via proxy reports from teachers and parents through confirmatory factor analyses (CFAs). Results showed a reasonable fit for the three informant forms. Nevertheless, there were differences in item loadings across the three informant forms. Additionally, participants’ self-report responses were tested for invariance across gender. CFAs provided support to the invariance hypothesis for item loadings, indicating that the items were similarly valid indices of the five factors for males and females. Factor correlations, factor variances and item residuals were not invariant across gender.What this paper addsThis paper, to our knowledge, is the first research paper that provides empirical evidence on the Arabic self report version of the Strengths and Difficulties Questionnaire (A-SDQ) within a school-based sample. Though the focus was on the self-report version we collected data from the proxy versions for parents and teachers to provide additional evidence on the construct validity of the (A-SDQ) through cross informant data.     

关于医疗卫生体制改革的认知差异性

卫生改革的顺利实施依赖于卫生系统内不同群体的合作,但是现有的文献表明,不同群体对于医疗卫生体制改革的认知存在较为明显的差异,影响卫生政策的实践效果.通过对文献的分析,对差异的程度进行定性分析;对认知差异的定量研究是未来研究需关注的领域.