HPV检测原发灶不明颈淋巴结转移癌的诊断作用初探(附6例报告)

目的 初步探讨HPV检测在诊断原发灶不明的颈淋巴结转移性鳞癌中的价值。方法 收集复旦大学附属肿瘤医院6例首诊为原发灶不明的颈淋巴结转移性鳞癌,最终确诊为HPV相关口咽鳞癌,分析确诊过程。结果 首诊时6例患者均被确诊为颈淋巴结转移性鳞癌,且p16表达阳性和HPV-16亚型阳性,而EBER表达阴性。经全面检查均未发现明显的原发病灶。随后对其中4例予同侧扁桃体盲检(2例)和切除(2例),病理均证实为扁桃体鳞癌。另2例分别在随访第149天、545天MRI检查发现同侧口咽侧壁和舌根增厚伴强化,经活检分别证实为扁桃体鳞癌、舌根鳞癌。结论 对于原发灶不明的HPV阳性颈淋巴结转移性鳞癌,应高度怀疑原发病灶来源于口咽部位的可能性,特别是扁桃体和舌根部位。     

Gini系数和泰尔指数在山东省妇幼保健卫生人力资源配置公平性中的应用研究

目的探讨山东省妇幼保健机构卫生人力资源配置公平性,为妇幼保健人员的合理配置提供决策依据。方法对山东省2015-2017年妇幼保健机构卫生人力资源现况开展问卷调查。综合运用卫生资源密度指数指标(HRDI)、基尼系数及泰尔指数等方法,分别从人口、地理两个维度分析卫生人力资源配置的公平性。结果2015-2017年,山东省妇幼保健机构卫生人力总量呈逐年上升趋势。各地市相比,3年间HRDI最高的均为枣庄市,最低的为滨州市,两市相差近6倍。东营市、滨州市和菏泽市的HRDI远低于全省平均水平。基于人口维度,山东省妇幼保健人力资源基尼系数3年间均维持在0.20左右。东部和西部地区的基尼系数均<0.20,中部地区的基尼系数0.20~0.30。泰尔指数组内差异贡献率均高于80%。基于地理面积维度,基尼系数3年间均维持在0.25左右,西部地区的基尼系数均<0.20,东、中部地区的基尼系数0.20~0.30。泰尔指数组内差异贡献率均高于90%。结论山东省妇幼保健机构卫生人力配置公平性总体较好,人口公平性优于地理面积公平性。在下一步配置中在考虑人口因素的同时,要兼顾地理面积因素。     

Consensus summary report for CEPI/BC March 12–13, 2020 meeting: Assessment of risk of disease enhancement with COVID-19 vaccines

A novel coronavirus (CoV), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in late 2019 in Wuhan, China and has since spread as a global pandemic. Safe and effective vaccines are thus urgently needed to reduce the significant morbidity and mortality of Coronavirus Disease 2019 (COVID-19) disease and ease the major economic impact. There has been an unprecedented rapid response by vaccine developers with now over one hundred vaccine candidates in development and at least six having reached clinical trials. However, a major challenge during rapid development is to avoid safety issues both by thoughtful vaccine design and by thorough evaluation in a timely manner. A syndrome of “disease enhancement” has been reported in the past for a few viral vaccines where those immunized suffered increased severity or death when they later encountered the virus or were found to have an increased frequency of infection. Animal models allowed scientists to determine the underlying mechanism for the former in the case of Respiratory syncytial virus (RSV) vaccine and have been utilized to design and screen new RSV vaccine candidates. Because some Middle East respiratory syndrome (MERS) and SARS-CoV-1 vaccines have shown evidence of disease enhancement in some animal models, this is a particular concern for SARS-CoV-2 vaccines. To address this challenge, the Coalition for Epidemic Preparedness Innovations (CEPI) and the Brighton Collaboration (BC) Safety Platform for Emergency vACcines (SPEAC) convened a scientific working meeting on March 12 and 13, 2020 of experts in the field of vaccine immunology and coronaviruses to consider what vaccine designs could reduce safety concerns and how animal models and immunological assessments in early clinical trials can help to assess the risk. This report summarizes the evidence presented and provides considerations for safety assessment of COVID-19 vaccine candidates in accelerated vaccine development.     

Undergraduate medical students. Simulation-based activity to conduct the informed consent process for health research studies

IntroductionTraining through medical simulation allows for continuous learning under controlled conditions. Simulation-based training activities can be used simultaneously with other educational strategies to strengthen the attitudinal skills needed to develop an informed consent process in the context of health research.ObjectiveTo facilitate learning in undergraduate medicine students, and to evaluate their competences to carry out an informed consent process in a scenario that resembles reality.Materials and methodsIn this semi-longitudinal study, a simulation-based activity was conducted with 136 medical students of the fourth (Group A) and fifth year (Group B) of the Marist University of Mérida, in southern Mexico.ResultsThe mean score for both groups was 72.48 ± 1.05 (95% CI = 70.4–74.5); 86.2 ± 0.96 (95% CI = 84.2–88.0); and 77.7 ± 0.72 (95% CI = 76.3–79.1), in the pre-test, the simulation and the post-test, respectively. The students of group A self-evaluated their performance with 3.93/5.00, and those of Group B, 4.04/5.00.DiscussionThis study showed that Group A students did not score lower on simulation-based activity when compared to students in Group B, suggesting that before the fifth year of undergraduate medical education, students could properly develop an informed consent-process for health research if they receive early education about medical ethics and research bioethics. Issues related to bioethics in human health research can be included as soon as medical students initiate research methodology courses.     

The effect of Yakson and Gentle Human Touch methods on pain and physiological parameters in preterm infants during heel lancing

BackgroundVarious non-pharmacologic methods are used to alleviate pain in preterm infants who spend their first days in neonatal intensive care units (NICU) because they are exposed to numerous painful interventions.ObjectiveTo determine the effects of Yakson and Gentle Human Touch (GHT) methods on pain and physiologic parameters during heel lancing procedures in preterm infants.Design and methodsThis was a randomised controlled trial. The study was conducted in a NICU between June 2018 and June 2019. A total of 90 preterm infants were divided into three groups: 30 infants in the Yakson group, 30 infants in the GHT group, and 30 infants in the control group. All preterm infants were randomly divided into groups. Pain responses were evaluated using the Neonatal Infant Pain Scale.ResultsIt was found that pain scores and heart rates were significantly lower during and after heel lancing in preterm infants in the Yakson and GHT groups than in the control group, the difference was statistically significant (p < .001).Practical implicationsYakson and GHT applied to preterm infants during heel lancing has positive effects on pain and physiologic parameters.     

利用规律间隔成簇短回文重复序列/相关蛋白9系统敲减α2δ1对人肝癌细胞系Hep-12干性的影响

目的 通过规律间隔成簇短回文重复序列/相关蛋白9(CRISPR/Cas9)系统敲减人肝癌细胞系Hep12中电压依赖性钙离子通道 α2δ1的表达，观察α2δ1敲减后对肝癌细胞干性的影响。方法 设计3对靶向α2δ1的向导 (sgRNA)，长度为20 bp，构建到lenti CRISPRv2-puro载体上，然后在体外检测sgRNA切割活性，利用慢病毒包装系统包装含有sgRNA的重组质粒，将包装好的病毒感染Hep-12细胞，2 d后加入嘌呤霉素筛选。利用Western blotting验证α2δ1的敲减效果和干性相关基因的表达。通过成球实验检测其体外自我更新能力的变化。结果 测序结果显示，sgRNA成功插入载体质粒；体外切割实验显示，3条sgRNA均有切割活性；Western blotting结果显示，α2δ1基因的表达显著降低，干性相关基因B细胞特异性莫洛尼白血病病毒插入位点1(BMI1)和Nanog的表达显著被抑制；无血清培养基成球实验结果表明，敲减α2δ1导致Hep-12细胞的体外自我更新能力减弱。结论 利用CRISPR/Cas9技术成功构建敲除α2δ1基因的Hep-12细胞系；敲除α2δ1基因后能抑制Hep-12细胞肿瘤干细胞样特性。     

微课在胸腔外科临床教学中的应用及效果

传统的胸腔外科教学存在课堂教学课时分配有限、病种较多而课堂教学难以全面覆盖、实践教学水平参差不齐、"大教材"更新难以同步等诸多问题。空军军医大学第二附属医院胸腔外科将微课教学逐渐应用于胸外科教学工作的各个层面当中，如本科生辅助课堂教学及临床技能培训、基层及进修医生培训、研究生教育等，取得了良好的教学效果。     

Dynamic Indicators That Impact the Outcomes of Thoracic Endovascular Aortic Repair in Complicated Type B Aortic Dissection

PurposeTo investigate dynamic variables obtained from retrospective computed tomography angiography for ability to predict thoracic endovascular aortic repair (TEVAR) outcomes in patients with complicated type B aortic dissection (cTBAD).Materials and MethodsSeventy-nine patients with cTBAD who received TEVAR from March 2009 to June 2018 were retrospectively enrolled. Relative true lumen area (r-TLA) was computed at the level of tracheal bifurcation every 5% of all R-R intervals. Parameters that reflect the state of intimal motion were evaluated, including difference between maximum and minimum r-TLA (D-TLA) and true lumen collapse. The endpoints comprised early (≤ 30 days) and late (> 30 days) outcomes after intervention.ResultsOverall early mortality rate was 13.9% (11/79), and early adverse events rate was 24.1% (19/79). Patients who received TEVAR within 2 days of symptom onset demonstrated the worst outcomes. A longer time of r-TLA < 25% in 1 cardiac cycle (P = .049) and larger D-TLA (P < .001) were correlated to an increased early death. In addition, D-TLA was an independent predictor of early mortality. Area under the curve of D-TLA was 0.849 (95% confidence interval 0.730–0.967) for predicting early mortality and 0.742 (95% CI 0.611–0.873) for predicting early adverse events. Survival and event-free survival rates during follow-up were decreased in the D-TLA > 21.5% group compared with the D-TLA ≤ 21.5% group (all P < .001).ConclusionsLarger D-TLA is correlated with worse postoperative outcomes and might be a crucial parameter for future risk stratification in patients with cTBAD.