Identification of promotion and prevention associated surgeon behaviors in the operating room to facilitate resident self-regulated learning

BackgroundThe regulatory focus theory (RFT) posits that people can pursue goals with a promotion or prevention focus. Greater alignment of RFT motivational styles between faculty and residents may enhance resident operative autonomy. This study establishes a set of faculty behaviors residents can identify to infer faculty motivational styles.Methods10 behaviors associated with promotion and prevention motivational styles were identified. General surgery residents rated faculty on how strongly they exhibit these behaviors. Faculty conducted a self-assessment of how strongly they exhibit these behaviors.ResultsThere is a positive correlation between resident and faculty ratings for the promotion-associated behaviors of “works quickly,” “high energy,” and “mostly provides broad oversight,” and for the prevention-associated behaviors of “works slowly and deliberately,” “quiet and calm,” and “preference for vigilant strategies.”ConclusionResidents can observe faculty operative behaviors to infer faculty motivational styles. Residents may use this knowledge to adjust to faculty motivational styles and enhance operative interactions.     

妊娠期甲状腺功能减退症孕妇不同时期治疗效果及妊娠结局

目的:探究妊娠期甲状腺功能减退症孕妇不同时期治疗效果及血清促甲状腺激素(TSH)、游离甲状腺激素(FT4)、甲状腺过氧化物酶抗体(TPOAb)水平和妊娠结局。方法:2017年6月30日-2018年5月30日本院产前检查孕妇中筛选患有甲状腺功能减退症者120例,选择60例为一般给药组,在孕8周前行L-T4替代治疗;60例为推迟给药组,在孕8周后行L-T4替代治疗;另选同期产前健康健康孕妇60例为对照组。检测不同妊娠期TSH、FT4、TT4及TPOAb水平。统计围生期结局。结果:治疗前,一般给药组与推迟给药组血清TSH、FT4、TT4及TPOAb水平与对照组存在差异(P<0.05),治疗后在孕30周时两给药组血清上述指标与对照组无差异(P>0.05)。一般给药组自然流产、妊娠期糖尿病、胎盘早剥比例低于延迟给药组(P<0.05),但与对照组没有差异(P>0.05);妊娠期高血压、低出生体重儿两给药组及与对照组均无差异(P>0.05);一般给药组子代6月龄、12月龄时Gesell量表评分高于推迟给药组(P<0.05),与对照组无差异(P>0.05)。结论:对甲状腺功能减退症孕妇妊娠早期及早干预,可有效降低围产期不良结局发生几率,保证新生儿的早期发育。     

粒细胞—巨噬细胞集落刺激因子与HBsAg融合蛋白基因的 …

目的 研究粒细胞－巨噬细胞集落刺激因子（ＧＭ－ＣＳＦ）的免疫活性。方法 用聚合酶链反应（ＰＣＲ）技术扩增出粒细胞－巨噬细胞集落刺激因子（ＧＭ－ＣＳＦ）３８４ｂｐ的基因片段及ＨＢｓＡｇ８４６ｂｐ基因片段，扩增产物经柱纯化后，由Ｔ４ＤＮＡ酶连结因子１２３０ｂｐ的片段，将此片段命名为ＬＧＨ，克隆到ｐＵＣ１９质粒中，利用菌落ＰＣＲ法快速筛选阳性克隆及限制酶切鉴定片段的大小。结果 该基因全长１２３０ｂｐ，经     

以大剂量阿糖胞苷为主的联合化疗在儿童急性白血病中的应用

目的 :探讨大剂量阿糖胞苷 ( HDAC)治疗儿童急性白血病的效果和不良反应。　方法 :应用 HDAC治疗 3例急性髓细胞白血病 (每次 2 .0 g/m2 ,每 12 h1次 ,共 6次为一个疗程 )和 4例高危型急性淋巴细胞白血病 (每次1.0 g/m2 ,每 12 h1次 ,共 8次为一个疗程 )共 16个疗程 ,九个疗程在 HDAC结束后使用惠尔血 ( 2～ 3μg/kg)皮下注射 ,连续 10～ 14天。　结果 :6例按计划完成 HDAC治疗 ,并继续用常规方案治疗者 ,在 2 0～ 42个月的随访期内无病生存 ,1例 AL L- L3型在一个疗程 HDAC后出现中枢神经系统白血病复发 ,骨髓仍缓解 ,7个月后放弃治疗 .骨髓严重抑制和感染是最主要的不良反应 ,加用惠尔血可使粒细胞缺乏的持续时间缩短 ,感染发生率降低。　结论 :以 HDAC为主的联合化疗方案可安全地用于儿童急性白血病的强化治疗 ,对降低复发、提高无病生存率有积极意义     

The predictive value of basal follicle stimulating and growth hormone levels as determined by immunofluorometry during assisted reproduction

Purpose Our purpose was (a) to investigate relationships of baseline endocrine serum levels with selected assisted reproduction (AR) parameters and (b) to evaluate the clinical applicability of an immunofluorometric assay (IFMA) as an alternative to a radioimmunoassay (RIA).Methods Basal endocrine values (analyzed by RIA—rFSH, rLH, and rE₂; analyzed by IFMA—fFSH, fLH, and fGH) were determined for female patients (n = 142) preceding ovarian stimulation for AR.Results Specific AR parameters correlated significantly with RIA- and IFMA-determined FSH levels, although IFMA correlations consistently exceeds that of RIA. Cutoff values of fFSH 11.68 IU/L or rFSH 15.0 IU/L indicated a poor response. The high-basal fFSH group was older (34 vs 31 years; P = 0.0334) and yielded fewer oocytes (2.9 vs 4.6 oocytes; P = 0.0018) than the low-basal fFSH group (<11.68 IU/L). Lower cumulative embryo scores and conception rates were also associated with the high-fFSH group, compared to the low-fFSH group.Conclusions This study confirms the negative impact of elevated basal FSH levels on AR. Basal LH, GH, and E₂ levels are, in comparison to baseline FSH levels, unsuitable indices for estimating ovarian responsiveness. IFMA can be regarded as an alternative to RIA in both clinical and research laboratories.     

Ovarian stimulation in women undergoing in-vitro fertilization and embryo transfer using recombinant human follicle stimulating hormone (Gonal-F) in non-down-regulated cycles

In order to assess the efficacy and safety of recombinant humanfollicle stimulating hormone (FSH) in routine clinical use,ovarian stimulation with recombinant human FSH was performedin 71 patients prior to in-vitro fertilization (IVF) withoutgonadotrophin-releasing hormone (GnRH) analogues in a multicentre,non-comparative study. Human chorionic gonadotrophin (HCG) wasadministered to 58 patients (81.7%), 15 of whom underwent 19cycles with an initial dosage of three ampoules daily of recombinantFSH and 43 of whom underwent 152 cycles with four ampoules dailyfrom day 3 onwards. No significant differences were detectedbetween these two groups in all test parameters. The mean durationof treatment was 9.06 and 8.86 days respectively with a meannumber of 24.06 and 23.25 vials of recombinant human FSH administered.A mean number of 6.26 and 5.88 oocytes respectively was collected.The number of transferred embryos was 2.4 and 2.2. A clinicalpregnancy rate of 23.8% (10 out of 42) per transfer was achieved(30.9 and 20.6% respectively). Local tolerance of s.c. administrationwas excellent. Mild pain at the injection site was the dominantfinding in <20% of patients. Two cases of ovarian hyperstimulationsyndrome were noted. Recombinant human FSH is very attractiveto patients because it can be self-administered s.c. and thepreparation does not come from a human source. In conclusion,these data support the safety and efficacy of recombinant humanFSH in routine use for IVF.     

大鼠三叉神经本体觉中枢传导通路的电生理学证明

近年来形态学上发现了三叉神经领域本体感觉中枢通路,在此基础上,本文用电生理学方法,通过电刺激咬肌神经和压下颌,观察了由四级神经元组成的此通路的二级（三叉神经脊束核吻侧亚核背内侧部及邻接的网状结构）、三级（沿三叉神经感觉主核内缘存在的“带状区”）中继核团以及作为最后驿站的丘脑腹后内侧核等处的单位放电反应;另外又分别刺激或损毁二、三级中继核团,观察了丘脑腹后内侧核的单位放电变化,结果证明电刺激咬肌神经和压下颌,在上述核团都出现对本体觉冲动反应的单位放电,包括兴奋性反应单位、抑制性反应单位和无关单位三种类型,以兴奋性单位为主,占神经元单位放电总数的５２．９％～６７．７％．分别刺激二和三级神经元的所在核团,在丘脑腹后内侧核处发生相应的单位放电效应;损毁二和三级核团,本体觉传入冲动被阻断。本研究结果从电生理学上确证了形态学上发现的三叉神经本体感觉中枢通路的客观存在,从定性研究方面支持了定位研究的结果,并填补了以往生理学上只证明初级传入核团与丘脑腹后内侧核之间存在着一条多突触联系的本体觉传递通路但未能判断其具体行径和中继部位的空白,本研究并对方法论以及一些有关问题进行了讨论．     

Haematological improvement by long-term administration of recombinant human granulocyte-colony stimulating factor and recombinant human erythropoietin in a patient with severe aplastic anaemia

A 6-year-old girl with post-hepatitic severe aplastic anaemia was referred to our hospital. Haematological examination showed a haemoglobin level of 5.2 g/dl, platelet count of 8,000/l, and white blood cell count of 130/l with 17% neutrophils. She was treated with recombinant human granulocytecolony stimulating factor (15 g/kg/day i.v.) and cyclosporin A (6 mg/kg/day p.o.). The absolute neutrophil count gradually increased, but Hb and platelets were not improved. The intravenous administration of recombinant human erythropoietin (100 U/kg three times a week) was started, and the reticulocyte count reached 20000/l on day 12. The platelets increased to 81000/l after 16 months of combined administration of recombinant human granulocyte-colony stimulating factor, recombinant human erythropoietin and cyclosporin A. After 20 months of combined administration, the haematological results were: Hb, 13.1 g/dl; platelets 80000/l: WBC, 9500/l with 40% neutrophils. After recombinant human granulocyte-colony stimulating factor treatment, the myeloid elements of the bone marrow and the number of granulocyte-macrophage colony forming units increased. Bone marrow erythropoiesis and erythroid colonies also increased after recombinant human erythropoietin administration. The clinical course suggested a beneficial effect of haemopoietic growth factors and cyclosporin A in post-hepatitic aplastic anaemia.     

Short-term and long-term results after early treatment with the castillo morales stimulating plate

The present study is divided into 2 parts: The first explains the concept of stimulating plate therapy at the Muenster Clinic and the second presents a longitudinal study of mouth and tongue posture in trisomy 21 children treated with this concept.47 children underwent a pre-treatment examination (Rec1), and 38 attended a first follow-up examination (Rec2) after an average of 4 months of stimulating plate treatment. The second follow-up examination (Rec3) was on average 53 months after the end of treatment and covered 18 patients. Data acquisition was based on standardized parent questionnaires and standardized clinical examination records. Rec2 showed in part a highly significant improvement in orofacial appearance. These results were confirmed by the parent interview, according to which the mouth and tongue posture improved in 76.3% of the children during the time they were wearing the plate. Even when the plate was not in place, the result remained stable in 65.8% of the patients. Up to Rec3, further improvement was recorded in some results. The symptoms: mouth mostly wide open and tongue mostly protruding way over lips were reduced. The number of children whose tongue was mostly in the oral cavity increased correspondingly.At Rec3, the parents also rated the mouth posture in 88.9% and the tongue posture in 77.7% of the children as stable or further improved.It can be concluded from the results of this study that stimulating plate treatment in combination with physiotherapy provides a long-term improvement in the mouth and tongue posture of children with Down's syndrome.     

卵巢癌抗独特型抗体/hGM-CSF融合蛋白质对体外免疫细胞的刺激作用

目的：探讨卵巢癌抗独特型单链抗体６Ｂ１１ｓｃＦｖ／ｈＧＭＣＳＦ融合蛋白质（６Ｂ１１ＧＭ）作为肿瘤疫苗的可能性。方法：采用体外Ｔ细胞增殖试验,对６Ｂ１１ＧＭ刺激Ｔ细胞的能力进行测定,并用流式细胞仪对Ｔ细胞表型及ＡＰＣＭＨＣⅡ表达情况进行测定,测定了外周血单个核细胞经６Ｂ１１ＧＭ激活后对卵巢癌细胞系的非ＭＨＣ限制的杀伤活性。结果：６Ｂ１１ＧＭ及６Ｂ１１均能引起特异的Ｔ细胞增殖,但６Ｂ１１ＧＭ组的增殖明显高于６Ｂ１１组,以ＣＤ４＋增殖为主。６Ｂ１１ＧＭ能明显增加抗原提呈细胞（ａｎｔｉｇｅｎｐｒｅｓｅｎｔｉｎｇｃｅｌ,ＡＰＣ）的ＭＨＣⅡ表达,使ＡＰＣ更有效地摄取抗原,激活非ＭＨＣ限制的杀伤活性。结论：６Ｂ１１ＧＭ能引起细胞免疫反应,作为疫苗具有良好的前景