415例HBV感染的不同血清学指标组合的HBV—DNA的检测

目的 了解HBV感染的不同血清学指标组合的HBV－DNA阳性情况。方法 对415份血清同时行ELISA方法测定HBV－M及普通PCR法检测HBV－DNA。结果 HBsAg( )组HBV－DNA阳性率为77．8％（270，347），HBsAg(-)组HBV－DNA阳性率19．1％（13／68），二者差别显著（P＜0．001）。其中153例HBsAg( )HBeAg( )抗HBc( )血清，HBV－DNA全部阳性，阳性率为100％，HBsAg（ ）抗HBe( ）抗HBc( )组血清HBV－DNA阳性率为66．9％（79／118），HBsAg( )抗HBc( )组血清HBV－DNA阳性率为50％（38／76），抗HBs( )组为18％（9／50），9例抗HBs( )抗HBe（＋）抗HBc( )血清中2例HBV－DNA阳性，2例抗HBs( )抗HBc( ）血清中1例HBV－DNA阳性，4例单一抗HBc( )血清中1例HBV－DNA阳性。结论 单凭HBsAg或HBeAg是否阳性来判断肝脏中HBV复制及有无传染性是不够的，易造成部分慢性乙型病毒性肝炎的漏诊，对HBsAg阴性无论抗HBs是否阳性，只要有HBV感染后的任何血清学依据，都应进一步检测血清HBV－DNA作为诊断乙型肝炎的第二步筛选，有条件时肝活检加以证实。     

768例乙型肝炎血清标志物和HBV-DNA载量相关性分析

目的：探讨HBV-DNA载量与乙型肝炎血清标志物之间的相关性。方法：采用实时荧光定量PCR法检测HBV-DNA载量,化学发光法检测HBsAg、抗HBs、HBeAg、抗HBe、抗HBc五项乙型肝炎血清标志物。结果：在768份血清标本中,HBsAg、HBeAg、抗HBc阳性组HBV-DNA阳性率为98.70%,HBsAg、抗HBe、抗HBc阳性组HBV-DNA阳性率为66.02%,HBsAg阳性组HBV-DNA阳性率为43.75%,抗HBs、抗HBe、抗HBc阳性组HBV-DNA阳性率为10.00%,抗HBs、抗HBc阳性组、抗HBs阳性组及五项乙型肝炎血清标志物全阴组HBV-DNA阳性率为0。结论：不同组的乙型肝炎患者HBV-DNA载量阳性率不同,HBV-DNA载量与乙型肝炎血清标志物之间存在相关性。采用实时荧光定量PCR法检测HBV-DNA载量是反映HBV复制的可靠指标,结合乙型肝炎血清标志物可以帮助临床了解HBV在体内复制的状况,并为临床评价抗HBV治疗效果提供可靠依据。     

乙型肝炎核心抗体阳性与阴性慢性乙型肝炎患者血清可溶性白介素2受体检测

目的　分析比较慢性乙型肝炎核心抗体 (抗 HBc)阳性的患者和抗 HBc阴性的患者血清中可溶性白细胞介素 2受体 (sIL 2R)和乙型肝炎病毒DNA(HBV DNA)含量的变化及意义。方法　将 10 0例诊断为慢性乙型肝炎肝者分为两组 ,A组为 5 0例 ,HBsAg阳性、HBeAg阳性和抗 HBc阳性 ,B组为 5 0例 ,HBsAg阳性 ,HBeAg阳性和抗 HBc阴性。另选 30例健康体检者 ,HBV标志均为阴性 ,作为对照组。sIL 2R采用双抗体夹心间接酶联免疫吸附测定法 ,HBV DNA采用荧光定量聚合酶链法 ,丙氨酸转氨酶 (ALT)采用赖氏法。结果　乙型肝炎表面抗原 (HBsAg)阳性、乙型肝炎e抗原 (HBeAg)阳性、抗 HBc阳性组血清中sIL 2R和ALT水平均明显高于HBsAg阳性、HBeAg阳性、抗 HBc阴性组 ,P <0 .0 5 ,与正常对照组比较 ,P <0 .0 5 ,且年龄偏向于青少年段 ,但比较HBV DNA含量在两组患者差异无统计学意义 (P >0 .0 5 ) ,HBsAg阳性、HBeAg阳性、抗 HBc阴性组sIL 2R水平亦高于正常对照组 P <0 .0 5。结论　以上结果表明抗 HBc阴性的慢性乙型肝炎患者机体的免疫系统处于一种免疫耐受的状态 ,而sIL 2R可作为肝炎患者免疫状态的监测指标而用于机体免疫状态的分析     

乙型肝炎病毒核酸定量与血清标志物模式及肝功能的关系探讨

目的探讨乙型肝炎患者病毒核酸定量检测与血清标志物模式(HBV-M)及肝功能的关系.方法 315例乙型肝炎患者血清分别用酶联免疫吸附试验(ELISA)、荧光定量聚合酶链反应(FQ-PCR)检测HBV-M、HBV DNA含量,并对其中115例慢性乙型肝炎(CHB)患者的丙氨酸氨基转移酶(ALT)水平作统计分析.结果血清HBV DNA含量与HBV-M有关,模式Ⅰ(HBsAg阳性+HBeAg阳性+抗HBc阳性)与HBeAg阴性的各种模式比较,模式Ⅱ(HBsAg阳性+抗HBc阳性)、Ⅲ(HBsAg阳性+抗HBe阳性+抗HBc阳性)与HBsAg阴性的各种模式比较,差异有显著性(P<0.01).对于CHB患者,随着病毒在体内的活动,血清HBV DNA含量和ALT水平相应升高.结论 HBeAg与HBV DNA含量明显相关;HBeAg阴性或HBeAg/抗-HBe血清转换,不表示病毒停止复制;CHB患者肝功能状态与血清HBV DNA含量有关.     

乙型肝炎表面抗原和表面抗体同时阳性患者随访分析

目的：分析乙型肝炎表面抗原（HBsAg）和乙型肝炎表面抗体（抗-HBs）同时阳性的乙型肝炎病毒（HBV ）感染者病毒学特征动态变化。方法对53例 HBsAg和抗-HBs同时阳性患者进行平均13．5个月的随访,检测随访前后血清 HBV标志物,并对 HBV DNA进行定量检测及丙氨酸氨基转移酶（ALT）检测,分析其病毒学特征变化特点。结果53例患者随访期间,4例（7．55％）HBsAg转为阴性,13例（24．53％）抗-HBs转为阴性,而36例（67．92％）HBsAg和抗-HBs仍同时为阳性。随访后患者血清 HBsAg与抗-HBs水平、乙型肝炎e抗原（HBeAg ）阳性率及ALT水平与随访前相比差异无统计学意义（P＞0．05）,随访后 HBV DNA水平（3．44±1．60log10）IU/mL较随访前（3．00±1．36）log10 IU/mL降低,差异有统计学意义（P＜0．05）。结论大多数 HBsAg与抗-HBs同时阳性的HBV感染者抗原与抗体可长期存在,HBsAg及HBV DNA水平较低、HBeAg阴性患者更易发生HBsAg转阴。     

全血乙型肝炎病毒定量检测方法的初步研究

目的探讨聚合酶链反应(PCR)检测全血中乙型肝炎病毒(HBV)DNA含量及临床应用价值.方法取20μl血清裂解液提取HBV DNA、和取同样量的全血经不同裂解液提取血液中血清及白细胞内总HBV DNA,同时经PCR检测.对78份乙型肝炎表面抗原(HBsAg)阳性患者两种取材方法检测HBV DNA含量进行比较.结果检测HBV DNA的最低检测限为1×103拷贝/ml,29份乙型肝炎表面抗原(HBsAg)、乙型肝炎e抗原(HBeAg)和抗乙型肝炎核心抗体(抗HBc)均为阳性患者全血检测HBV DNA阳性率为100%,血清阳性率为100%,P＞0.05;37份HBsAg、抗乙型肝炎e抗体(抗HBe)和抗HBc均为阳性患者全血检测HBV DNA阳性率为97.30%,血清阳性率为48.65%,P＜0.01;12份HBsAg和抗HBc均为阳性患者全血检测HBV DNA阳性率为91.67%,血清阳性率为25%,P＜0.01;20份非乙型肝炎患者血清均为阴性.血清HBVDNA阳性多数是ALT升高患者,其拷贝数均小于全血测定的拷贝数.结论全血检测HBV DNA阳性率高,避免血液中白细胞内HBV漏检,它能准确地反应血液HBV含量,更好地为临床治疗效果作监测.     

血清中乙型肝炎病毒定量与免疫标志物及谷丙转氨酶之间的关系探讨

目的 探讨血清中乙型肝炎病毒定量（HBV DNA）与免疫标志物（HBV-M）及谷丙转氨酶（ALT）的关系.方法 用Tag酶荧光定量PCR法、ELISA法、丙氨酸氨基转移酶法分别检测HBV DNA、HBV-M和ALT.结果 HBsAg阳性者,HBV DNA阳性率61.9%;HBsAg阴性者中HBV DNA阳性率1.7%;HBsAg、HBeAg、和/或抗HBc阳性者,HBV DNA阳性率99%,其中载量〉106为91%;HBsAg、抗HBe、抗HBc阳性者,HBV DNA阳性率38.3%,其中〉106为9%;其它HBV-M模式下,HBV DNA阳性率1.3%～18.3%;HBV-M全阴模式下,HBV DNA 阳性率1.3%;HBV DNA阳性者ALT升高,与阴性组间有非常显著差异（P〈0.01）,HBV阳性而病毒载量不同的两组间,ALT值无显著差异（P〉0.05）.结论 HBsAg阴性者,HBV DNA也可阳性.HBeAg的阴转不能说明是病毒复制的静息与好转,有些HBeAg/抗HBe的转换后,HBV DNA〉106.ALT的升高常伴有HBV DNA阳性,HBV DNA阳性者不一定ALT升高,且ALT的升高程度不与HBV DNA值正相关.     

乙型肝炎患者HBeAg、前-S1抗原、核心抗体-IgM与ALT升高的比较

目的研究乙型肝炎患者在表面抗原（HBsAg）阳性情况下，检测乙肝e抗原（HBeAg）、前S1抗原（Pre-S1Ag）、核心抗体-IgM（抗HBc—IgM）与谷丙转氨酶（ALT）升高的关系及对肝功能的影响。方法对185例乙肝HBsAg阳性患者的HBeAg、Pre-S1Ag、抗HBc—IgM及ALT进行检测，并对其阳性率及相互关系进行分析比较。结果HBeAg阳性时，ALT升高占45％；Pre-S1Ag阳性时，ALT升高占29％；抗HBc—IgM阳性时，ALT升高占96％。结论对于乙肝感染者，只检测“两对半”是不够的，补充Pre-S1Ag、抗HBc-IgM检测十分必要，它们对乙肝病毒感染者的早期诊断、病毒分别、疗效观察、预后估计以及对肝功能的损伤程度等可起到重要的提示作用。     

兰州地区慢性HBV感染者HBV DNA载量与ALT、HBV-M的相关性研究

目的探讨兰州地区慢性乙型肝炎病毒（HBV）感染者血清HBV DNA载量与HBV血清学标志物（HBV-M）、丙氨酸氨基转移酶（ALT）的关系。方法收集兰州地区724例慢性HBV感染者,均于清晨空腹抽取10mL静脉血,采用荧光定量PCR技术检测HBV DNA载量;采用化学发光免疫分析（CLIA）技术检测HBV表面抗原（HBsAg）、抗HBV表面抗体（HBsAb）、HBV e抗原（HBeAg）、抗HBV e抗体（HBeAb）、抗HBV核心抗体（HBcAb）;采用AU680全自动生化分析仪检测ALT浓度。结果 724例慢性HBV感染者HBeAg阳性238例（32.87%）,HBeAg阴性486例（67.13%）,HBV DNA阳性469例（64.78%）,HBV DNA阴性255例（35.22%）。慢性乙型肝炎患者中,HBeAg阳性慢性乙型肝炎患者血清HBV DNA载量、HBeAg、HBcAg及ALT水平最高,而其HBeAb水平最低。慢性乙型肝炎患者血清HBeAg水平与HBV DNA载量呈明显正相关（r=0.463,P=0.000）,HBeAb与HBV DNA载量呈明显负相关（r=-0.227,P=0.001）,HBcAb水平变化与HBV DNA载量变化无相关性（r=-0.062,P=0.366）,HBV DNA载量与ALT呈明显正相关（r=0.138,P=0.028）,ALT水平与HBeAg水平呈明显正相关（r=0.200,P〈0.01）,ALT水平与HBeAb水平呈明显负相关（r=-0.156,P=0.001）,ALT水平与HBcAb水平无明显相关性（r=-0.017,P=0.715）。结论兰州地区慢性HBV感染者HBV DNA载量、HBeAg和ALT三者呈明显正相关,HBeAb与HBV DNA载量、ALT水平呈负相关。     

乙型肝炎患者血清中前 S1蛋白与 H BeA g 及 H B V‐D N A之间的相关性和临床价值

目的探讨乙型肝炎患者血清中前S1蛋白与乙型肝炎e抗原(HBeAg )及乙型肝炎病毒核酸(HBV‐DNA )之间的相关性和临床价值.方法将520例标本分成4组模式,另外选取35例健康者作为健康对照组,采用酶联免疫吸附试验测定法检测前S1蛋白和 HBeAg ,核酸扩增荧光定量法检测 HBV‐DNA.结果A组230例患者为乙型肝炎表面抗原(HBsAg)、HBeAg、乙型肝炎核心抗体(抗‐HBc)均阳性,B组208例患者为 HBsAg、乙型肝炎e抗体(抗‐HBe)、抗‐HBc均阳性,C组65例患者 HBsAg、抗‐HBc均阳性,D组17例患者为其他模式.A、B、C、D 4组的HBV‐DNA阳性检测率分别为82.6%、57.7%、15.4%和5.9%,321例 HBV‐DNA阳性患者中前S1蛋白阳性检出率53.6%,HBeAg阳性率45.2%.结论前S1蛋白与HBeAg阳性反应病毒复制,而HBV‐DNA阳性更能灵敏地反应乙型肝炎病毒的复制情况,对病情的监测及治疗有重要的意义.     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。