携带同源重组修复相关基因突变的消化道肿瘤的临床特点

目的:探讨消化道肿瘤中同源重组修复相关基因(homologous recombination repair related gene，HRR)突变的发生情况及临床意义。方法:共92例消化道肿瘤患者，79例患者进行了血液标本HRR检测，53例患者进行了组织标本HRR检测，40例患者同时行血液和组织的HRR基因检测，收集患者基因检测结果及临床相关资料。结果:在79例患者血液标本检测中发现10例（12.6%）有临床意义HRR突变，在53例患者组织标本检测中发现9例（17.0%）有临床意义HRR突变。40例同时行血液和组织的HRR基因检测患者中常见的有临床意义HRR突变为CDK12突变4例（10.0%）、ATM突变3例（7.5%）、BRCA1突变2例（5.0%）。13例有临床意义HRR突变患者中常见共存突变为TP53突变10例（76.9%）、APC突变5例（38.5%）、PIK3CA突变4例（30.8%）。40例患者中13例患者血液和/或组织中有临床意义HRR突变，27例患者血液和组织中均无任何临床意义HRR突变且两组相比，有临床意义HRR突变组肿瘤突变负荷（tumor mutational burden，TMB）为6.17(2.24～11.52)，而未携带HRR突变组TMB为0.4(0～3.75)，差异有统计学意义（P＜0.05）。40例患者组织检测中7例HRR有临床意义的突变，33例无HRR突变，血液检测中10例HRR有临床意义的突变，30例无HRR突变，一致性检验的Kappa值为0.333（P=0.031）。结论:携带有临床意义HRR突变的消化道肿瘤患者TMB更高，血液和组织检测HRR突变有较好的一致性。     

The effects of a 0.12% chlorhexidine-digluconate-containing mouthrinse versus a placebo on plaque and gingival inflammation over a 3-month period

Abstract Several previous studies have evaluated the effects of 0.12% chlorhexidine digluconate (ChD) mouthrinses on plaque and gingival inflammation. However, previously, none have been based in general dental practices. The aim of this study was to evaluate the potential to conduct controlled periodontal clinical trials in co-operation with general dental practitioners (gdps). The project took place in 5 general dental practices in the South of England. 121 healthy subjects (24 at 4 sites and 25 at the 5th). aged 18-65 years, mean 35 ± 12) years participated in a double-blind, randomised study during which they received full mouth assessments for plaque and gingival bleeding at baseline, 6 and 12 weeks. 60 subjects were randomly asigned to use the 0.12% ChD mouth wash and 6i the placebo. The assessments were carried out by 5 gpds, who had previously achieved inter-examiner κ scores of 0.78–0.85 (mean 0.81) for the plaque index (PlI), and of 0.73–0.94 (mean 0.87) for a modified gingival index (mGI), and who maintained κ scores of 0.51–0.90 for PII and of 0.73–1.00 for mGI during the 12 months required to complete the study. 98 subjects (48 ChD and 50 placebo) completed the study. Even though the baseline levels of plaque and gingivitis were low, by week 12, mean whole mouth piaque score of the ChD mouthwash users had fallen from 1.33 at baseline to 0.96 and was significantly lower (p < 0.001) than for the placebo users, 1.31 at baseline to 1.13. Whole-mouth gingival bleeding score fell from 0.56 to 0.42 in the ChD mouthwash group but was unchanged (0.54–0.55) in the placebo group. A subsidiary data analysis which considered the effects at sites indicated that within these overall differences, the ChD users experienced almost 2× the reduction from plaque score 2 at baseline at proximal molar sites over a 12-week period (50.6% ChD versus 27.6% placebo). It was concluded that 0.12% ChD mouthwash reduced plaque accumulation fay 28% and gingival inflammation by 25% over a 12–week period, that it is feasible for a group of gdps to maintain high levels of inter–examiner consistency in the use of PlI and mGI, that it is also feasible to carry out such a multicentre study in general dental practice, and that the use of mean mouth scores per subject to analyse the effects of mouthrinses may well mask variations in response throughout the mouth.     

大学生自我和谐与社交焦虑的相关研究

目的探讨大学生的自我和谐与交往焦虑的特点和关系。方法采用自我和谐量表和交往焦虑量表对310名大学生进行调查。结果男生在自我灵活性和自我和谐上得分低于女生（P〈0．01），研究生在自我灵活性上得分低于本科生（P〈0．01），理科生在社交焦虑上得分低于文科生（P〈0．05）；高自我和谐组在社交焦虑上得分低于低自我和谐组（P〈0．05）；从总体上看，社交焦虑与自我与经验的不和谐、自我刻板性、总体的自我和谐均呈正相关（P〈0．01）。结论大学生的自我和谐和社交焦虑之间均存在相关，自我和谐对社交焦虑具有良好的预测作用。     

大学生时间管理倾向与自我和谐的关系

目的: 探讨大学生时间管理倾向与自我和谐的关系.方法: 运用青少年时间管理倾向量表和自我和谐量表对334名大学生进行施测,对大学生时间管理倾向与自我和谐各因素进行相关分析和多元逐步回归分析.结果: 334名大学生自我与经验的不和谐得分为51.9±8.6,自我灵活性得分24.6±6.3,自我刻板性得分25.0±4.1;自我与经验的不和谐与除时间价值感外的时间管理倾向(r=-0.31--0.39)、自我刻板性与时间管理倾向(r=-0.11--O.26)呈负相关;自我灵活性与时间管理倾向呈正相关(r=0.28-O.41).进一步回归分析表明,时间效能感是自我与经验的不和谐和自我刻板性的有效预测变量(R2=0.152,β=-0.390;R2:O.107,β=-0.259);时间效能感和时间价值感是自我灵活性的有效预测变量(R2=0.229,β:0.288、0.286).结论: 大学生时间管理倾向与自我和谐有一定程度的相关.     

北京地区精神分裂症患者家属情感表达测查报告

目的;探讨北京地区的住院精神分裂症患者家属情感表达方式及测查方法的实用性、测查工具应用的一致性。方法：经过训练的研究人员,采用费氏修订的ＣＦＩ－ＣＶ访谈提纲,对１７１例住院精神分裂症患者家庭的２８４位家属进行访谈和录音,并将录音打印成文字资料。     

Consistency of patient- and doctor-assessed cosmetic outcome after conservative treatment of breast cancer

The cosmetic results of the breast (144 patients)were analysed after segmental resection and axillary dissectionwith or without postoperative radiotherapy for early low-riskbreast cancers. Cosmetic results were assessed over time(3, 9, 18, 36, 48 months respectively) bythe patient and by the physician. Patients ratedthe overall cosmetic result good or excellent in92% of cases after 3 months. The proportionof good or excellent cosmetic results decreased overtime and after four years 89% of patientsclassified themselves in this category, whereas the physicianassessed the outcome as good or excellent in91% of cases after 3 months and 75%after 4 years. The inter-observer consistency between physicianand patient in assessing the cosmetic outcome was=0.42 at the beginning and decreasedover time (=0.07 after 4 years).The intra-observer variation over time was =0.53 for the patient and =0.32for the physician.Inter-observer consistency between patient and physician was moderateimmediately following treatment but decreased over time. Thefeeling of satisfaction of the patient was relativelystable whereas the opinion of the physician becamesomewhat more critical over time. Therefore the intra-observerconsistency over time was somewhat better for thepatient than for the physician.     

磁共振成像预测颅内肿瘤质地的研究进展

术前对颅内肿瘤质地的准确评估对于手术入路的选择以及预后的评估极为重要。目前,对颅内肿瘤质地的预测方法主要是通过磁共振成像。本文分别对磁共振常规序列、弥散序列、弹性序列及其他序列预测肿瘤质地研究相关的文献进行综述和分析。我们认为常规序列和弥散序列预测肿瘤质地的有效性尚存在争议;磁共振波谱、灌注加权成像及稳态进动平衡序列目前研究数据较少,不能得出有效的结论;弹性序列是目前预测肿瘤质地最有效的评价指标。     

吸入制剂人体药动学研究中关于给药的探讨

给药是药物临床试验中的关键环节，也是吸入制剂人体药动学研究中的难点之一。对吸入制剂给药环节中一些细节的把握可能直接影响制剂间生物等效性的建立，包括给药前准备、吸入技术培训、给药中及给药后处理等。本文将结合临床实践经验，针对吸入制剂人体药动学研究中的给药环节进行探讨并总结。     

Standardization of thromboelastography: a report from the TEG‐ROTEM working group

Summary. Laboratory evaluation of bleeding disorders has been performed with the standard clotting assays such as the PT and PTT for several decades. Our improved understanding of the process of blood coagulation has now revealed the important role played by the cellular elements such as platelets, monocytes and red blood cells. The need for a test that can assess clotting in a more ‘global’ manner, beyond the initiation of clot formation, has led to greater interest in assays such as thrombin generation and thromboelastography. Even though there are several publications using thromboelastography it remains a research tool as the methodology is not standardized. In an attempt to show reproducibility and consistency using thromboelastography, a group of investigators from different countries joined hands to form the TEG‐ROTEM Working Group. Two studies were performed using PRP and FVIII deficient plasma and an intrinsic pathway activator. This article summarizes the results of the first international effort at standardization of thromboelastography. Both of the instruments using this technology (TEG^® and ROTEM^®) were used. Nine laboratories from countries around the globe participated in this effort. The results showed a significant inter‐laboratory variance with CV’s greater than 10%. Although these results were not satisfactory, this has been the first effort to standardize this methodology and significant work remains to be done to improve reliability and reproducibility. These studies were performed on PRP and the results may be more reliable when preformed on whole blood samples. We believe that it is important to continue this work so that we may investigate the usefulness and potential applications of thromboelastography in the evaluation of bleeding and thrombosis.     

Effects of Clinical Experience and Explorer Type on Judged Crown Margin Acceptability

Purpose: This study was undertaken to simultaneously compare instrumentation type and operator characteristics in judgments of clinical acceptability of crowns exhibiting a controlled range of marginal gaps. The research was conducted in a laboratory setting and generalizability analysis was used as a statistical technique to identify the sources contributing to variation in the judgment outcome. Materials and Methods: A crown was seated on an ivorine tooth in a device that permitted continuous adjustment in intervals of 25 μm to produce known marginal gaps ranging from zero to 250 μm. Forty‐nine students and six faculty members used five types of explorers each to determine, by tactile examination, the point on the controlled increasing marginal gap where they would no longer regard the gap as clinically acceptable. Results: There were no differences across type of explorer. Operators with clinical experience had a threshold that rejected crowns at a smaller gap than did those operators without clinical experience (p= 0.007). Faculty members maintained a higher individual degree of consistency in their personal judgments than did students (p= 0.02); however, the inter‐operator consistency was significantly lower for faculty members than for students (p < 0.05). Conclusions: Differences among operators in a simulation of the decision regarding gaps in crowns accounted for 63% of the variance; type of explorer used in assisting this decision accounted for about half as much variance. Faculty members making such judgments exhibited high intra‐operator consistency but significantly lower inter‐operator consistency than did students. The study suggests that the internal standards dentists use for clinical decision making deserves further study as they may be as significant as the equipment used.