我国农村居民健康感知影响因素分析*

摘 要：2019年8月,重庆市荣昌区作为全国567个紧密型县域医共体建设试点县之一,以“人通、医通、财通”为抓 手,加快整合医疗卫生资源,促进医疗卫生工作重心下移和资源下沉,积极推动分级诊疗制度建设,为辖区内居民提供全方 位的健康服务。     

射野孔径形状控制器对直肠癌快速容积旋转调强放射治疗计划质量、机器传输能力和准确性的影响研究

目的:研究Eclipse15.5治疗计划系统中射野孔径形状控制器(ASC)对直肠癌快速(RapidArc)容积旋转调强放射治疗(VMAT)计划质量、机器传输能力和剂量传输准确性的影响。方法:选取医院收治的20例直肠癌患者,对每个病例生成ASC"off"、ASC"verylow"、ASC"moderate"和ASC"veryhigh"共4组RapidArc对照计划。其中ASC调节等级分别设置为关闭(off)、非常低(verylow)、中等(moderate)和非常高(veryhigh),其他计划参数设置保持一致,使用射野剂量系统(PD)验证剂量传输的准确性。主要评价指标包括剂量体积直方图(DVH)、Paddick适形指数(PCI)、梯度指数(GI)、均质性指数(HI)、剂量率(DoseRate)、机架转速(GantrySpeed)、机器跳数(MUs)、每角度机器跳数(MU/deg)和Gamma通过率,采用单因素方差分析和Kruskal-Wallis秩和检验检测4组ASC计划之间各项统计指标的差异。结果:4组ASC计划间除计划靶区平均剂量(PTV D_med)差异有统计学意义(F=3.243,P=0.027)外,其他DVH、PCI、GI和HI指标差异均无统计学意义。机器传输能力中ASC为very low、moderate和very high的MUs较off分别下降14.4%、20.9%和29.6%。4组计划间DoseRate、MU/deg和MUs差异有统计学意义(x²=16.621,x²=16.007,x²=15.877;P=0.001)。剂量传输准确性中4组计划间3%/3 mm和2%/2 mm的Gamma通过率差异均无统计学意义。结论:计划设计过程中需考虑ASC对各项计划指标的影响,应根据计划的复杂性和临床需要调整ASC的等级。     

21世纪全球视域下的黄芩科研知识图谱构建及可视化分析

目的 对21世纪以来国内外黄芩Scutellaria baicalensis相关研究进展进行可视化分析,梳理其研究前沿,分析发展方向,为今后黄芩相关研究提供科学依据。方法 对Web of Science（WOS）数据库中的英文文献,中国知网、万方、维普中的中文文献进行检索并进行数据清洗。利用VOSviewer、Coocation等软件对发文量、地区/作者合作网络、关键词共现、主题演化路径进行可视化分析,并对黄芩相关的研究前沿热点进行分析。结果 纳入英文文献1560篇、中文文献22 214篇。黄芩相关领域发文量在2014年以前每年呈现上升趋势,之后每年发文量趋于稳定状态,我国在黄芩相关研究领域占主导地位。合作网络显示国际上中国与美国合作较为紧密,国内各地区合作较为散乱,协作程度较为薄弱。关键词分析表明未来黄芩的研究主要集中在代谢组学、化学成分、作用机制、抗肿瘤、阿尔茨海默症等方向。结论 黄芩相关研究进展迅速,近年来对黄芩的研究逐步稳定,2019年后有回温现象。在后续的研究过程中应注重各地区、各机构之间的合作创新。代谢组学、化学成分、作用机制、抗肿瘤、阿尔茨海默症等方向成为近年来黄芩相关领域的研究热点。黄芩不良反应机制研究还不够完善,同时在其质量评价方面需要更深一步的研究。     

抗—HEV IgG与乙型肝炎标志物关系的研究

近年已有学者提出戊型肝炎的肠道外传播途径,深圳市散发性戊型肝炎的高发区,本研究以乙型肝炎作为肠道包传播途径的标记探讨该病在我市的传播途径。研究发现抗－ＨＥＶ ＩｇＧ阳性率与乙型肝炎标记物及输血史,手术史等无相关性,提示我市散发性戊型肝炎以肠道途径传播而非肠道外传播为主。     

Improvement of brain single photon emission tomography (SPET) using transmission data acquisition in a four-head SPET scanner

Attenuation coefficient maps (-maps) are a useful way to compensate for non-uniform attenuation when performing single photon emission tomography (SPET). A new method was developed to record single photon transmission data and a-map for the brain was produced using a four-head SPET scanner. Transmission data were acquired by a gamma camera opposite to a flood radioactive source attached to one of four gamma cameras in the four-head SPET scanner. Attenuation correction was performed using the iterative expectation maximization algorithm and the-map. Phantom studies demonstrated that this method could reconstruct the distribution of radioactivity more accurately than conventional methods, even for a severely non-uniform-map, and could improve the quality of SPET images. Clinical application to technetium-99m hexamethylpropylene amine oxime (HMPAO) brain SPET also demonstrated the usefulness of this method. Thus, this method appears to be promising for improvement in the image quality and quantitative accuracy of brain SPET.This work was presented in part at the World Congress on Medical Physics and Biomedical Engineering, 7–12 July 1991, Kyoto, Japan     

Ultrastructural organization of proteoglycans and fibrillar matrix of the tectorial membrane

The molecular and supramolecular structure of the tectorial membrane (TM) was studied by transmission electron microscopy (TEM). Collagen (type A) fibrils in the TM were found associated with proteoglycans (PGs) and type B fibrils. Most PGs were orthogonally oriented and attached D-periodically to collagen fibrils. Computer averaged projections of PG particles and linear aggregates of PGs in crystalline arrays, stained with Cuprolinic blue, showed an elongated, electron-dense structure 50–65 nm in length and 10 nm in width. Image analysis of type B fibrils showed that they are constructed of globular domains arranged with a periodicity of 12–14 nm. Each globular domain contains two thin ‘arms', extended in opposite directions, which contact the ‘arms' of adjacent fibrils. Numerous type B fibrils were found between collagen fibrils. They are attached to adjacent collagen fibrils by the ‘arms' of their globular domains. An association of type B fibrils and PGs with collagen seems to result in the local ordered arrangement of the TM matrix. A hypothetical model of the TM matrix supramolecular structure is presented.     

孕期弓形体感染对胎、婴儿的影响及治疗

目的：研究孕期弓形体感染胎、婴儿的结局，母婴传播途径及治疗。方法：应用ＥＬＩＳＡＩｇＭ方法筛查３８７８例孕妇弓形体近期感染情况。追踪８２例弓形体近期感染孕妇分娩的胎、婴儿预后、收集脐血、羊水、胎盘及尸解的器官组织了解母婴传播途径及病理改变。观察应用螺旋霉素系统治疗孕期弓形体感染者的胎、婴儿预后，并与未治疗组对照。结果：本组孕妇弓形体近期感染发生率为４．４１％（１７１／３８７８），其胎、婴儿出现临床症状为３０．４８％（２５／８２）；孕早期感染以畸胎、流产多见，孕晚期感染表现为早产、低体重儿、黄疸及弓形体感染性肺炎等。从胎盘、羊水、脐血及尸解器官组织中可查出弓形体ＤＮＡ。显示弓形体可通过胎盘感染胎儿，严重者造成器官损害。应用螺旋霉素治疗孕期弓形体感染有效。治疗组先天性弓形体感染发生率低于对照组（Ｐ＜０．０１）。结论：孕妇近期弓形体感染可通过胎盘感染胎儿，造成畸胎、流产、早产、低体重儿及急性弓形体感染症状。螺旋霉素治疗孕期弓形体感染有效。     

盆腔静脉瘀血症患者瘀血静脉超微结构观察

为探讨盆腔静脉瘀血症患者瘀血静脉形态学改变,本文对11例瘀血症患者和6例结扎术后无任何症状和体征的妇女盆腔静脉进行了扫描及透射电镜观察.发现瘀血静脉壁间渗出增多;内皮细胞数量增多、体积变小且外形肿胀;细胞表面粗糙,突起增粗,小孔及凹陷增多、变大;细胞质致密并含大量饮液泡,线粒体肿胀而数量增多;染色质呈块状分布于核的周边;内皮细胞间嵌合连接和紧密连接正常存在.这些变化说明缺氧是引起本症盆腔静脉超微结构改变的主要原因,提示本症是一种功能性疾病.     

Long-term follow-up of the clinical relevance of short outer dynein arms in human nasal cilia

Clinical significance of short outer dynein arms was examined in a long-term follow-up study of 76 patients with various respiratory symptoms. Clinical evaluations, nasal mucociliary transport rate (NMTR) measurement and transmission electron microscopy were performed. Follow-up examinations took place 5–11 years later. In the initial examination four patients and on follow-up seven patients were found to have short outer dynein arms in their nasal mucosal biopsies. Short dynein arms were associated with a slow NMTR, poorly coordinated ciliary beat direction, and clinical symptoms of perennial rhinitis and recurrent sinusitis. Short dynein arms were found to be a significant histologic finding and probably represent a variant of primary ciliary dyskinesia. In some cases short outer dynein arms may be a reversible finding with improving clinical symptoms. It is obvious that at least part of dynein defects are acquired. Received: 23 December 1997 / Accepted: 15 May 1998     

山西省严重急性呼吸综合征病例接触史和传播链分析

目的　了解严重急性呼吸综合征 (SARS)的传播过程 ,分析其接触史以及可能导致个别 SARS病例接触史不详的原因 ,对流行病学调查质量做出评估。方法　 SARS病例个案调查与接触史专题调查相结合 ,用传播链示意图分析传播关系。结果　 4 4 8例 SARS病例中 ,有明确接触史者 4 11人 ,占 91.7% ,发现传播链 31条 ,涉及 2 0 8人 ,占有接触史总数的 5 0 .6 %。续发病例最多四代 ,以二代为多 ,占 6 8.8%。结论　引起医院传播和家庭聚集性暴发案例 ,虽然与超级传播者或“毒王”有关 ,但用对其传染性认识不足 ,就诊环境设置不合理 ,污染严重 ,个体防护不当解释更为科学、客观。传播链研究不仅可用于 SARS潜伏期的计算 ,而且还可作为评价 SARS防控效果的一个重要指标。