剖宫产可能增加儿童罹患过敏性疾病风险的Meta分析

目的 利用Meta分析方法评价剖宫产与儿童过敏性疾病之间的关系,为儿童过敏性疾病防治提供循证依据。方法 检索五大数据库,最后一次检索时间为2017年9月5日,按照预先设定的标准检索、筛选、纳入和分析文献。采用Rev Man 5.3软件进行Meta分析,根据异质性结果选择相应的效应模型分析并进行亚组分析。结果 共有63篇文献纳入分析,总样本量为4 818 347人。与阴道分娩相比,剖宫产儿哮喘、食物过敏、过敏性鼻结膜炎、吸入性过敏、喘息、枯草热的患病率分别增加19%、31%、14%、29%、4%、16%(P＜0.05)。亚组分析显示:对儿童哮喘而言,剖宫产不增加3岁以下儿童哮喘发生风险,其余各亚组差异均有统计学意义(P＜0.05);对儿童喘息而言,队列研究、通过问卷调查(父母报告症状)、父母无过敏性疾病组,剖宫产与儿童喘息有关联,OR值分别为1.05(95%CI:1.01~1.08)、1.07(95%CI:1.01~1.14)、1.05(95%CI:1.00~1.10)。结论 剖宫产是儿童多种过敏性疾病的危险因素,应做好孕产妇健康宣教和产科质量管理,把好儿童生命质量第一关。     

Prevalence of celiac disease in Germany:A prospective follow-up study

AIM:To determine the prevalence of celiac disease in a randomly selected population sample. METHODS:A total of 2157 subjects (1036 males; 1121 females) participating in a population-based cross-sectional study underwent laboratory testing for tissue transglutaminase and antibodies to immunoglobulin A, endomysium and antigliadin. In a second step, all subjects who had been examined serologically were surveyed using a questionnaire that included questions specific to celiac disease. Subjects with positive antibody titers and those with histories positive for celiac disease then underwent biopsy. At the first follow up, antibody titers were again determined in these subjects and subjects were questioned regarding symptoms specific for celiac disease and disorders associated with celiac disease. The second follow up consisted of a telephone interview with subjects positive for celiac disease.RESULTS:Antibody tests consistent with celiac disease were reported in eight subjects, corresponding to an overall prevalence of 1:270 (8/2157). The prevalence among women was 1:224 and 1:518 in men. Classical symptoms were observed in 62.5% of subjects. Atypical celiac disease was present in 25.0%, and transient celiac disease in 12.5%. False-negative test results were returned in three subjects. This yields a sensitivity and specificity of 62.5% and 50.0%, respectively, for tissue transglutaminase immunoglobulin-A antibody; of 62.5% and 71.4% respectively, for endomysium antibody; and of 62.5% and 71.4%, respectively, for antigliadin antibody.CONCLUSION:The prevalence rate in our collective lies within the middle tertile of comparable studies in Europe. The use of a single antibody test for screening purposes must be called into question.     

Dynamic Changes in Erectile Function and Histological Architecture After Intracorporal Injection of Human Placental Stem Cells in a Pelvic Neurovascular Injury Rat Model

IntroductionThe human placenta provides a bountiful and noncontroversial source of stem cells which have the potential for regeneration of injured tissue. These cells may restore erectile function after neurovascular tissue injury such as that seen in radical pelvic surgeries and pelvic trauma.AimTo determine the effect of human placenta–derived stem cells on erectile function recovery and histological changes at various time points in a cavernous nerve injury rat model and to study the fate of injected stem cells throughout the regenerative process.MethodsHuman placental stem cells (PSCs) were dual labeled with monomeric Katushka far red fluorescent protein (mKATE)-renLUC using a lentivirus vector. A pelvic neurovascular injury–induced erectile dysfunction model was established in male, athymic rats by crushing the cavernous nerves and ligating the internal pudendal neurovascular bundles, bilaterally. At the time of defect creation, nonlabeled PSCs were injected into the corpus cavernosum at a concentration of 2.5 × 10⁶ cells/0.2 mL. The phosphate-buffered saline–treated group served as the negative control group, and age-matched rats (age-matched controls) were used as the control group. Erectile function, histomorphological analyses, and Western blot were assessed at 1, 6, and 12 weeks after model creation. The distribution of implanted, dual-labeled PSCs was monitored using an in vivo imaging system (IVIS). Implanted cells were further tracked by detection of mKATE fluorescence in histological sections.Main Outcome MeasureThe main outcome measure includes intracavernous pressure/mean arterial pressure ratio, neural, endothelial, smooth muscle cell regeneration, mKATE fluorescence, and IVIS imaging.ResultsThe ratio of intracavernous pressure to mean arterial pressure significantly increased in PSC-injected rats compared with phosphate-buffered saline controls (P < 0.05) at the 6- and 12-week time points, reaching 72% and 68% of the age-matched control group, respectively. Immunofluorescence staining and Western blot analysis showed significant increases in markers of neurons (84.3%), endothelial cells (70.2%), and smooth muscle cells (70.3%) by 6 weeks in treatment groups compared with negative controls. These results were maintained through 12 weeks. IVIS analysis showed luminescence of implanted PSCs in the injected corpora immediately after injection and migration of cells to the sites of injury, including the incision site and periprostatic vasculature by day 1. mKATE fluorescence data revealed the presence of PSCs in the penile corpora and major pelvic ganglion at 1 and 3 days postoperatively. At 7 days, immunofluorescence of penile PSCs had disappeared and was diminished in the major pelvic ganglion.Clinical ImplicationsPlacenta-derived stem cells may represent a future “off-the-shelf” treatment to mitigate against development of erectile dysfunction after radical prostatectomy or other forms of pelvic injury.Strength & LimitationsSingle dose injection of PSCs after injury resulted in maximal functional recovery and tissue regeneration at 6 weeks, and the results were maintained through 12 weeks. Strategies to optimize adult stem cell therapy might achieve more effective outcomes for human clinical trials.ConclusionHuman PSC therapy effectively restores the erectile tissue and function in this animal model. Thus, PSC therapy may provide an attractive modality to lessen the incidence of erectile dysfunction after pelvic neurovascular injury. Further improvement in tissue regeneration and functional recovery may be possible using multiple injections or systemic introduction of stem cells.Gu X, Thakker PU, Matz EL, et al. Dynamic Changes in Erectile Function and Histological Architecture After Intracorporal Injection of Human Placental Stem Cells in a Pelvic Neurovascular Injury Rat Model. J Sex Med 2020;17:400–411.     

广州市某三甲医院分院医疗安全不良事件情况分析

目的 分析我院医疗安全不良事件的特点,有针对性的提出预防措施。方法 通过PDCA循环提高医疗安全不良事件报告数,对2010年~2017年上报至我院2137例的时间、科室、事故等级、涉及人员进行回顾性分析。结果 近几年医疗安全不良事件上报例数呈上升趋势,护理类为主;多发科室是内科、医技科室;Ⅲ级事件和Ⅳ级事件为多发类型;涉及人员类型从高到低为护理人员、医师、其他、技师,涉及人员职称从高到低为初级、中级、其他、高级;不良事件上报和医疗投诉两者呈负相关关系（r=-0.81,P＜0.05）。结论 医务人员应严格执行各项流程和规章制度,加强交流沟通,努力提升自己的各项专业知识和技能,防范不良事件的发生,降低医疗投诉。     

Mother-child Agreement on the Child's Past Food Exposure

ObjectiveTo assess mother-child agreement on the child's past food exposure, and factors affecting response discrepancy.MethodsTwelve- to 14-year-old children and their mothers (n = 78) in an urban community, a rural community, and 2 orthodontic clinics completed a 69-item food questionnaire to determine mother-child level of agreement on the child's past consumption frequency; response discrepancies; the frequencies that the mother cooked for and ate together with her child; food types; mother-child pair effect; and food item effect.ResultsSixty-eight percent of food items had moderate to good agreement (Kqw ≥ 0.41). Rural pairs had lower odds of producing response discrepancy (odds ratio = 0.55). Variances of the mother-child pair and food item random effects were 0.87 and 0.08, respectively.Conclusions and ImplicationsThe child's past food exposure recall by the mother and the child had moderate to good agreement, especially among rural mother-child pairs. Mother-child disagreement was not affected by the food items.     

A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research,long-term care,policy and social networks

One of the key issues facing public healthcare is the global trend of an increasingly ageing society which continues to present policy makers and caregivers with formidable healthcare and socio-economic challenges. Ageing is the primary contributor to a broad spectrum of chronic disorders all associated with a lower quality of life in the elderly. In 2019, the Chinese population constituted 18 % of the world population, with 164.5 million Chinese citizens aged 65 and above (65+), and 26 million aged 80 or above (80+). China has become an ageing society, and as it continues to age it will continue to exacerbate the burden borne by current family and public healthcare systems. Major healthcare challenges involved with caring for the elderly in China include the management of chronic non-communicable diseases (CNCDs), physical frailty, neurodegenerative diseases, cardiovascular diseases, with emerging challenges such as providing sufficient dental care, combating the rising prevalence of sexually transmitted diseases among nursing home communities, providing support for increased incidences of immune diseases, and the growing necessity to provide palliative care for the elderly. At the governmental level, it is necessary to make long-term strategic plans to respond to the pressures of an ageing society, especially to establish a nationwide, affordable, annual health check system to facilitate early diagnosis and provide access to affordable treatments. China has begun work on several activities to address these issues including the recent completion of the of the Ten-year Health-Care Reform project, the implementation of the Healthy China 2030 Action Plan, and the opening of the National Clinical Research Center for Geriatric Disorders. There are also societal challenges, namely the shift from an extended family system in which the younger provide home care for their elderly family members, to the current trend in which young people are increasingly migrating towards major cities for work, increasing reliance on nursing homes to compensate, especially following the outcomes of the ‘one child policy’ and the ‘empty-nest elderly’ phenomenon. At the individual level, it is important to provide avenues for people to seek and improve their own knowledge of health and disease, to encourage them to seek medical check-ups to prevent/manage illness, and to find ways to promote modifiable health-related behaviors (social activity, exercise, healthy diets, reasonable diet supplements) to enable healthier, happier, longer, and more productive lives in the elderly. Finally, at the technological or treatment level, there is a focus on modern technologies to counteract the negative effects of ageing. Researchers are striving to produce drugs that can mimic the effects of ‘exercising more, eating less’, while other anti-ageing molecules from molecular gerontologists could help to improve ‘healthspan’ in the elderly. Machine learning, ‘Big Data’, and other novel technologies can also be used to monitor disease patterns at the population level and may be used to inform policy design in the future. Collectively, synergies across disciplines on policies, geriatric care, drug development, personal awareness, the use of big data, machine learning and personalized medicine will transform China into a country that enables the most for its elderly, maximizing and celebrating their longevity in the coming decades. This is the 2nd edition of the review paper (Fang EF et al., Ageing Re. Rev. 2015).     

The significance of epidermal growth factor receptor uncommon mutations in non-small cell lung cancer: A systematic review and critical appraisal

Uncommon epidermal growth factor receptor (EGFR) mutations collectively account for 10% of EGFR mutations, harboring heterogeneous molecular alterations within exons 18–21 with clinically variable responses to EGFR tyrosine kinase inhibitors (TKIs) in advanced Non-Small Cell Lung Cancer (NSCLC) patients. In addition, with the introduction of different NGS gene approach an improvement of EGFR mutations detection was reported. Today, no specific studies have prospectively evaluated uncommon sensitizing mutations in detail and no firm standard of care has been established in the first-line setting. The aim of this comprehensive review is to critically consider the clinical role of uncommon EGFR mutations highlighting the results of several in vitro and in vivo studies, which singly evaluated the sensitivity of uncommon mutations to currently European of Medicines Agency (EMA)-approved EGFR TKIs in cell lines, xenograft models and humans, in order to obtain a practical guide for refining the clinical decision-making process.     

孕期维生素D缺乏与儿童湿疹相关性的Meta分析

目的 利用Meta分析方法系统评价孕妇血清或脐血中维生素D水平与儿童湿疹的关系,为儿童湿疹防治提供依据。方法 按照PRISMA指南,检索PubMed、Ebsco、Web of Science、中国生物医学数据库(CBM)、中国知网(CNKI)、万方数据库、维普中文科技期刊数据库(VIP)等,检索时间均为1998年1月1日-2016年2月29日,中文文献检索以“湿疹”和“维生素D”为关键词,英文文献检索以“eczema”和“vitamin D”为主题词。按照预先设定的标准检索、筛选、纳入和分析文献。采用Revman 5.3软件进行Meta分析,根据异质性结果选择相应的效应模型分析。结果 共有11篇文献纳入分析,总样本量为5 919人。孕期维生素D缺乏与儿童湿疹之间存在关联性,RR值为1.11(95%CI:1.04~1.19,P＜0.01);孕妇维生素D缺乏的暴露-反应关系合并效应值[RR值为1.12(95%CI:1.05~1.20)]高于脐血维生素D缺乏[RR值为1.08(95%CI:1.02~1.13)];孕期维生素D缺乏,6月龄组、1岁组、2岁组儿童湿疹患病率分别增加16%、10%和10%(P＜0.01)。结论 孕期维生素D缺乏是小年龄段儿童湿疹的危险因素,孕晚期规律补充维生素D能够降低婴幼儿湿疹的发病率。