Satisfaction of health care professionals managing patients with inflammatory bowel disease

Background and aimsThe aim of the present study was to analyze the satisfaction of health care professionals who attend patients with inflammatory bowel disease (IBD) and to determine the variables more related with satisfaction/dissatisfaction.MethodsCross-sectional, self-administered written 15-item questionnaire was evaluated using a Likert scale, completed by Spanish gastroenterologists and nurse practitioners specialized in IBD patient care.ResultsA total of 202 surveys, 133 physicians (65.8%) and 69 nurses (34.2%) were conducted. Global scoring of satisfaction was 54.0 for physicians and 64.2 for nurses (p < 0.001). In both groups the highest scores were achieved in those items related to their professional careers and management of personal and professional lives as well as those that refer to their interdisciplinary relationship with other medical units, management of patients within the hospital setting and finally communication with the patient. The items that attained the lowest score included those related to the length and staff available for the medical consult, work environment and the balance among health care provider needs for contribution, recognition and fulfillment. With regard to the variables involved with satisfaction, the results show that those physicians that only took care of IBD patients achieved a higher degree of satisfaction. This could be related with the fulfillment of their own professional expectations.ConclusionsThe level of satisfaction of health care professionals that take care of IBD patients is low and may impact on patient care. Therefore, new strategies to increase the degree of satisfaction of IBD health care providers should be implemented.     

强迫症患者在风险明确及不明确情境下的决策分离

目的:探讨强迫症(OCD)患者在风险明确及不明确情境下的决策功能。方法:对45例符合美国精神障碍诊断与统计手册第4版(DSM-IV)OCD诊断标准的患者和48名性别构成、年龄、受教育年限相匹配的对照组被试进行爱荷华博弈任务(IGT)、色子任务(GDT)、连线任务(TMT)、Stroop色词任务(SCWT)和威斯康星卡片分类任务(WCST)测试,同时对OCD患者进行Yale-Brown强迫症状量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)和贝克抑郁量表(BDI)评定。结果:OCD组IGT净得分低于对照组(P0.05),而两组GDT净得分差异无统计学意义(P0.05)。两组TMT、SCWT和WCST得分差异无统计学意义(均P0.05)。OCD组在IGT及GDT上的净得分与发病年龄、病程、Y-BOCS、HAM A、BDI得分不相关,OCD组中接受药物治疗与没有接受药物治疗的病人的IGT和GDT净得分差异无统计学意义(均P0.05)。结论:OCD患者在风险不明确情境下决策受损,而在风险明确情境下决策未受损,即OCD患者在风险明确及不明确情境下决策出现明显的分离。     

大鼠肝缺血再灌注后高胆红素血症与Mrp2、Mrp3表达及定位改变的关系

目的 研究大鼠肝脏缺血再灌注后多耐药相关蛋白2(Mrp2)、多耐药相关蛋白3(Mrp3)表达及定位的改变,探讨肝缺血再灌注后发生高胆红素血症的分子机制.方法 实验分为假手术组(Sham组)和肝缺血30 min再灌注组(IR组).检测血浆和胆汁中DBIL含量.RT-PCR和免疫组织化学方法检测毛细胆管膜上Mrp2和基底膜...     

A meta-analysis of the association between gout,serum uric acid level,and obstructive sleep apnea

Previous epidemiological investigations have evaluated the association between gout, serum uric acid levels, and obstructive sleep apnea syndrome (OSAS), but with inconsistent results. We conducted this meta-analysis aiming at providing clear evidence about whether OSAS patients have higher serum uric acid levels and more susceptible to gout. Relevant studies were identified via electronic databases from inception to December 17, 2018. Study selection was conducted according to predesigned eligibility criteria, and two authors independently extracted data from included studies. The hazard ratio (HR) and weighted mean difference (WMD) and their corresponding 95% confidence interval (CI) were derived using random-effects models. We conducted meta-, heterogeneity, publication bias, sensitivity, and subgroup analyses. Eighteen studies, involving a total of 157,607 individuals (32,395 with OSAS, 125,212 without OSAS) and 12,262 gout cases, were included. Results show that serum uric acid levels are elevated in patients with OSAS (WMD?=?52.25, 95% CI 36.16–64.33); OSAS did not reach statistical significance as a predictor of gout (but there was a trend, HR?=?1.25, 95% CI 0.91–1.70) and that the association between OSAS and serum uric acid was quite robust. OSAS may be a potential risk factor for hyperuricemia and the development of gout and thus, effective OSAS therapy may present as a valuable preventive measure against gout. Still, it is vital to undertake clinical studies with better designing to corroborate these associations and shed new light on it.

     

全反式维甲酸对肺气肿模型大鼠的干预作用

目的研究不同时间段给予全反式维甲酸(ATRA)对肺气肿模型大鼠的干预作用及其机制。方法60只SD大鼠随机分为6组:生理盐水组(N组)、模型组(P组)、棉籽油组(C组)、早期干预组(R1组)、中期干预组(R2组)和后期干预组(R3组),每组10只。N组大鼠气管滴注生理盐水1mL·kg-1,其余5组气管滴注5%木瓜蛋白酶1mL·kg-1建立肺气肿模型。R1、R2和R3组分别于造模后15～30d、30～45d和45～60d给予ATRA500μg·kg-1腹腔注射,C组给予棉籽油腹腔注射。观察各组支气管肺泡灌洗液(BALF)中血管内皮生长因子(VEGF)含量和细胞数,肺组织病理学改变及肺组织血管内皮生长因子受体2(VEGFR-2)、基质金属蛋白酶1(MMP-1)的表达水平。结果与N组比较,P组BALF中细胞总数明显升高(P<0.01),其中以巨噬细胞和中性粒细胞为主。R1、R2和R3组与P组比较细胞总数降低(P<0.01),此3组之间无显著差异。与N组比较,其余5组平均肺泡面积和内衬间隔增大,每个视野内肺泡数减少(P<0.01);与P组相比,R1、R2和R3组肺泡数增加、平均肺泡面积减小(P<0.01),以R1组最为明显。与N组相比,P组VEGF和VEGFR-2表达降低,MMP-1表达增高(P<0.01);与P组相比,R1、R2和R3组VEGF和VEGFR-2表达增高,MMP-1表达降低(P<0.05),R1、R2和R3组之间无显著差异。结论ATRA可以促进肺泡再生,早期干预效果较佳,这种作用可能与调节VEGF、VEGFR-2、MMP-1有关。     

The association of the BLK gene with SLE was replicated in Chinese Han

Systemic lupus erythematosus (SLE) is an autoimmune disease influenced by genetic and environmental factors. Recently, single nucleotide polymorphisms (SNPs) in the region of B lymphoid tyrosine kinase (BLK) have been shown to be associated with SLE in Caucasian population. In this paper, we genotyped SNP rs2248932 in 1,396 SLE patients of Chinese Han and 4,362 ethnically matched control subjects by using the Sequenom MassArray system. We confirmed that SNP rs2248932 in BLK gene was significantly associated with SLE (P = 1.41 × 10^?8 for the allele frequency, Odds ratio [OR] = 0.74, 95% confidence interval (CI): 0.66–0.82).The association of BLK in Chinese SLE patients was consistent with a dominant model (P = 8.88 × 10^?9, OR = 0.69, 95% CI: 0.61–0.79). In contrast to the Caucasian, this risk allele was the major allele in the Chinese Han; the risk allele frequency was higher in Chinese Han than in Caucasian. We did not find the association between this SNP and any subphenotype of SLE. The SNP rs2248932 was correlated to the expression of BLK mRNA. We conclude that the association of the BLK region with SLE was replicated in Chinese Han population living in mainland.     

One novel susceptibility locus associate with systemic lupus erythematosus in Chinese Han population

The aim of the study is to explore additional susceptibility factors for systemic lupus erythematosus (SLE) in Chinese Hans. Based on our previous GWAS of SLE, we performed a multistage replication study involving 3,152 cases and 7,050 controls from China to identify additional susceptibility loci for SLE by using the Sequenom MassArray system. All Chinese Han samples used in this study were obtained from doctors through collaboration with multiple hospitals in two geographic regions (central and southern China). Single-marker association analyses were performed using logistic regression with gender as a covariate in each case–control cohort. The joint analysis of all combined samples was performed using logistic regression with gender and sample cohorts as covariates. The significant association evidence for rs906868 (OR = 1.14, 95 % CI 1.08–1.20, P _combined = 7.71 × 10^?10) and rs7579944 (OR = 1.13, 95 % CI 1.07–1.19, P _combined = 5.55 × 10^?9) was observed, which located at 2p23.1. In this region, limb bud and heart development homolog (LBH) was the only gene indicated, suggesting LBH might be a susceptibility gene for SLE, although its function was still unknown. The results indicated that the SNP rs7579944, rs906868 at 2p23.1 showed significant association with SLE. The genes LBH which located in this loci might be the predisposing genes of SLE.     

慢性缺氧应激可能通过EMT增强乳腺癌MCF-7细胞恶性生物学行为

目的:探讨慢性缺氧应激对人乳腺癌MCF-7细胞恶性生物学行为的影响及可能机制。方法:将人乳腺癌MCF-7细胞分为缺氧组(1%O_2、5%CO_2和94%N_2)和正常对照组(常氧)进行培养。利用MTT法、CCK-8实验、细胞直接计数法及细胞侵袭和迁移实验对MCF-7细胞活力、增殖及侵袭和迁移能力进行检测;用软琼脂集落形成实验及Matrigel 3D培养技术检测MCF-7细胞非锚定生长能力及极性改变情况;利用MCF-7细胞构建裸鼠皮下种植瘤模型,检测慢性缺氧应激对体内肿瘤生长及肺转移的影响;利用倒置显微镜观察MCF-7细胞形态改变;Western blot检测低氧诱导因子1(hypoxia-inducible factor-1,HIF-1)和磷酸化的糖原合成酶激酶3β(glycogen synthase kinase-3β,GSK-3β)在缺氧环境下表达水平的改变,以及E-钙黏连蛋白(E-cadherin)、N-钙黏连蛋白(Ncadherin)、波形蛋白(vimentin)、基质金属蛋白酶3(matrix metalloproteinase-3,MMP-3)、MMP-9等上皮-间充质转化(epithelial-mesenchymal transition,EMT)相关蛋白的表达水平。结果:与正常对照组相比较,慢性缺氧组MCF-7细胞活力、增殖能力及侵袭迁移能力增强,细胞非锚定生长能力提高且在3D培养系统更容易发生极性改变,呈现侵袭样生长,体内生长及转移能力增强;除了HIF-1被缺氧诱导表达升高外,GSK-3β呈现活化趋势,且上皮样标志物E-cadherin蛋白表达水平明显下降,而间充质样标志物N-cadherin、vimentin、MMP-3和MMP-9蛋白表达水平明显升高。结论:慢性缺氧应激促进了乳腺癌细胞恶性生物学行为,且其机制可能与EMT有关。     

HCMV活动性感染与尿路上皮癌的相关性研究

目的分离和鉴定尿路上皮癌患者的肿瘤组织和抗凝血标本中人巨细胞病毒(HCMV),结合临床资料分析比较HCMV活动性感染与尿路上皮癌发生发展及其复发的相关性。方法采集33例经病理检测确诊为尿路上皮癌患者的组织和血标本,进行如下处理:分别采用细胞培养病毒分离法进行病毒分离;PCR法检测患者的抗凝血及组织DNA标本中HCMV UL55和UL83基因;IFA法检测抗凝血标本中HCMV pp65抗原;ELISA法检测HCMV IgG及IgM抗体;记录分析结果,确定尿路上皮癌患者HCMV活动性感染率。结果在33份抗凝血标本中,分离到1株临床分离株,该标本经盲传3代出现典型HCMV特征性细胞病变效应(CPE),经鉴定为HCMV。HCMV UL55和UL83基因、HCMV pp65抗原血症及HCMV IgM抗体检测均为阳性的有6份,因此可以判定在33例尿路上皮癌患者中,HCMV活动性感染者有6例,活动性感染率为18.2%(6/33)。结合患者的临床资料进一步分析发现,尿路上皮癌患者复发及病理分级均与HC-MV活动性感染相关,且HCMV活动性感染者其病理分级程度升高。结论结合临床资料分析发现,尿路上皮癌复发及病理分级程度升高均与HCMV活动性感染有关。     

远程医疗的趋势与变革

随着互联网的发展,远程医疗从最初的萌芽时代,到以现代信息技术为基础的高速发展,对现代医疗机构及医疗模式造成改变,使医疗机构之间的协同分工初露端倪,医疗服务模式发生新的变换,医生与患者之间的沟通呈现出多样化、病人院前院后信息虚拟化而形成的信息连续化,分析远程医疗对诊疗模式产生的影响。指出远程医疗移动互联应用会逐渐深入,远程虚拟医疗中心会逐渐出现并发展壮大,基层医疗机构功能性将发生一定的转变,第三方远程医疗企业将会兴起,远程医疗将成为个人家庭的一项基本订阅服务。