果糖及葡萄糖对精子运动能力存活率及顶体酶活性的影响

目的探讨果糖及葡萄糖对人类精子运动能力、存活率及顶体酶活性的影响。方法选取2008年7月~2009年1月在浙江省舟山市妇幼保健院生殖中心接受精液质量检查的男性患者312人,经精液常规分析符合《人类精液及精子-宫颈黏液相互作用实验室检验手册》规定的正常标准者;以无糖的人类输卵管液(HTF)为对照组(n=312),添加果糖成分的研究组1(n=312),添加葡萄糖成分的研究组2(n=312),观察不同配方精子培养液培养前、培养24,48,72 h后对精子运动能力、存活率及顶体酶活性的影响。统计学处理采用SPSS 10.0统计学软件,数据均衡性检验后用t检验或单因素方差分析方法 ,P0.05为差异有统计学意义。结果与对照组相比,培养前各项指标差异无统计学意义;培养24,48 h及72 h后,研究组精子的各项指标明显较好(P0.05)。两研究组之间相比,培养前及培养24h的各项指标差异无统计学意义;但培养48 h及72 h后,研究组1的各项指标都优于研究组2,但差异无统计学意义。结论精子培养液内添加糖分是必须的,在精子培养24 h之前,添加果糖和添加葡萄糖对精子的运动能力、存活率及顶体酶活性没有明显差别,但培养超过24 h后,以果糖作为精子能量供应物质优于葡萄糖。     

Perceived benefits experienced in support groups for Chinese families of children with disabilities

Parent support groups have been considered an important channel for families of children with disabilities who seek support and resources. Given the view of family privacy in many diverse cultures, it is unknown whether or not parents from diverse backgrounds can receive the same benefits as parents from the dominant culture. The purpose of this qualitative study was to examine what influenced 15 Chinese parents of children with disabilities in their decisions to participate in support groups and to investigate their perceive benefits of being in support groups. Results suggested that Chinese parents wanted to meet and share knowledge with other Chinese families of children with disabilities due to cultural and language challenges they experienced. Their support group participation led them to develop a sense of belonging and to feel confident and empowered when handling issues regarding their children with disabilities. Implications for future research are discussed.     

Stereomicroscopic and histological examination of bovine embryos following extended in vitro culture

Attempts to support survival of mammalian embryos after hatching have met with limited success, although some mouse studies have reported growth at the post-implantation stage. The aim of the present research was to establish and characterise an in vitro culture system that could support extended growth and differentiation of bovine embryos. Abattoir-derived oocytes were matured and fertilised in vitro. Presumptive zygotes were cultured in modified synthetic oviduct fluid (SOFaaci) medium supplemented with 5% cow serum (CS). On Day 9, single hatched blastocysts (n = 160) were randomly allocated to SOFaaci supplemented with either 5% bovine serum albumin, 5% CS, 5% fetal calf serum (FCS) or SOF only and cultured on a collagen gel substrate for up to 45 days. Embryos were evaluated at various time-points until complete disaggregation or the total disappearance of embryonic cells. Blastocyst viability post hatching was severely compromised in protein-free SOFaaci medium. Addition of FCS generated increased embryonic growth for the longest time period (Day 45) when compared to the other groups. Long-term survival of embryonic cells was observed stereomicroscopically by the proliferation and development of three-dimensional tubular structures to 85% confluence in culture. Haematoxylin and eosin staining of morphological structures obtained from all treatment groups revealed embryos displaying trophoblast, inner cell mass and hypoblast development to varying degrees. Regardless of treatment, extended in vitro culture did not result in development comparable with that described for in vivo embryos. In the present work, however, there was evidence of extended culture of bovine embryos beyond that achieved previously. However, further research is required to identify the exact requirements for extended in vitro culture for bovine embryos.     

Receiving social support online: implications for health education.

Online support groups are expanding as the general public becomes more comfortable using computer-mediated communication technology. These support groups have certain benefits for users who may not be able to or do not have the desire to attend face-to-face sessions. Online support groups also present challenges when compared to traditional face-to-face group communication. Communication difficulties may arise resulting from lack of visual and aural cues found in traditional face-to-face communication. Online support groups have emerged within health care as a result of the need individuals have to know more about health conditions they are confronting. The proliferation of these online communities may provide an opportunity for health educators to reach target populations with specific messages. This paper reviews the development of health-related online support groups, examines research conducted within these communities, compares their utility with traditional support groups and discusses the implications of these groups for health education.     

The focus group method: insights from focus group interviews on sexual health with adolescents

This article concerns the manner in which group interaction during focus groups impacted upon the data generated in a study of adolescent sexual health. Twenty-nine group interviews were conducted with secondary school pupils in Ireland, and data were subjected to a qualitative analysis. In exploring the relationship between method and theory generation, we begin by focusing on the ethnographic potential within group interviews. We propose that at times during the interviews, episodes of acting-out, or presenting a particular image in the presence of others, can be highly revealing in attempting to understand the normative rules embedded in the culture from which participants are drawn. However, we highlight a specific problem with distinguishing which parts of the group interview are a valid representation of group processes and which parts accurately reflect individuals' retrospective experiences of reality. We also note that at various points in the interview, focus groups have the potential to reveal participants' vulnerabilities. In addition, group members themselves can challenge one another on how aspects of their sub-culture are represented within the focus group, in a way that is normally beyond reach within individual interviews. The formation and composition of focus groups, particularly through the clustering of like-minded individuals, can affect the dominant views being expressed within specific groups. While focus groups have been noted to have an educational and transformative potential, we caution that they may also be a source of inaccurate information, placing participants at risk. Finally, the opportunities that focus groups offer in enabling researchers to cross-check the trustworthiness of data using a post-interview questionnaire are considered. We conclude by arguing that although far from flawless, focus groups are a valuable method for gathering data about health issues.     

An educational intervention to enhance nurse leaders' perceptions of patient safety culture

OBJECTIVE: To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture. STUDY SETTING: Three hundred and fifty-six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi-site teaching hospitals (study and control). STUDY DESIGN: A prospective evaluation of a patient safety training intervention using a quasi-experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6-month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop. EXTRACTION METHODS: Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated-measures analysis of variance and paired t-tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture. PRINCIPAL FINDINGS: A statistically significant improvement in one of three safety culture measures was shown for the study group (p<.001) and a significant decline was seen on one of the safety culture measures for the control group (p<.05). Leadership support for improvement was found to explain significant amounts of variance in all three patient safety culture measures; workshop attendance explained significant amounts of variance in one of the three safety culture measures. The total R(2) for the three full hierarchical regression models ranged from 0.338 and 0.554. CONCLUSIONS: Sensitively delivered training initiatives for nurse leaders can help to foster a safety culture. Organizational leadership support for improvement is, however, also critical for fostering a culture of safety. Together, training interventions and leadership support may have the most significant impact on patient safety culture.     

Running a group

Self-help groups, e.g. for breast-feeding support or postnatal depression, can be an effective resource for clients. They can also be an effective use of professionals'time in primary care. A health visitor offers practical suggestions for starting and guiding a new group, including the need for professionals to think creatively and flexibly about group structures. The advice is to keep these simple, audit regularly and allow the groups to evolve.     

VEGF转染VEC促进移植皮瓣血管化的实验研究

目的探讨VEGF165基因转染血管内皮细胞促进移植皮瓣血管化的可行性,提高皮瓣存活率。方法利用脂质体介导pIRES2-EGFP/VEGF165质粒体外转染VEC。27只SD大鼠随机分为3组,转染组和内皮细胞组大鼠缺血皮瓣内分别加入1ml浓度为1×106个/亳升的含有转染质粒pIRES2-EGFP/VEGF165血管内皮细胞和未转染正常血管内皮细胞的DMEM培养基,对照组注射相同量DMEM培养基。皮瓣早期断蒂,观察皮瓣的皮瓣存活率、HE染色和CD34免疫组化染色观察血管生成情况,计算微血管密度。结果VEGF165基因转染VEC、单纯的VECC移植大鼠缺血皮瓣后,与对照组的皮瓣存活率分别为98.6%±3.9%、83.2%±3.5%、42.5%±2.1%,差异有统计学意义(p<0.05)。术后第7d时三组皮瓣中点处的毛细血管密度分别为(60.4±6.5)个/毫米2、(58.2±6.3)个/毫米2、(17.8±1.7)个/毫米2;第14d时毛细血管密度分别为(91.9±7.1)个/毫米2、(74.4±6.8)个/毫米2、(28.6±3.7)个/毫米2。结论VEGF165转染血管内皮细胞可以可促进缺血皮瓣的血管新生,提高存活率。     

同步放化疗与放疗对早期子宫颈癌手术患者生存率的影响

目的 探讨对于早期宫颈癌患者采用同步放化疗以及单独放疗的治疗方案的临床疗效差异,为早期宫颈癌的治疗提供依据.方法 对我院自2004年6月至2008年6月期间收治的86例子宫颈癌患者的临床资料进行总结分析.将其分为两组,对照组34例患者采用单独放射治疗手段,研究组52例患者采用同步放射治疗联合化学治疗方案.制定疗效判定标准,对比两组患者治疗后的临床疗效.并对患者进行为期5年的随访,统计患者在治疗后的5年内生存、复发、肿瘤转移等情况,采用SPSS 17.0对数据进行统计学分析.结果 两组患者在治疗后的短期时间内,总有效率均为100％,无显著差异（P＞0.05）,但缓解率与部分缓解率有显著差异（P＜0.01）;5年随访期内,对照组患者9例死亡,25例存活,其中无进展生存患者4例,肿瘤向远传转移患者2例,复发患者6例,13例患者生存质量较好;研究组患者4例死亡,48例存活,其中无进展生存患者5例,肿瘤向远传转移患者2例,复发患者5例,36例患者生存质量较好.两组患者5年生存率有显著差异（P＜0.01）.结论 当患者手术时并未完全清除病灶的情况下,放疗效果无法对患者的5年生存率有较为显著的提高,但同步放化疗可以达到理想的临床治疗效果.具有不良预后的宫颈癌患者在手术后无论接受同步放化疗或单独放射治疗,都具有一定的临床效果,提高其生存概率以及患者的生活质量.肿瘤往远处进行转移是治疗无法达到预期效果的主要原因.     

氨基酸对热暴露果蝇生存能力的影响

为研究氨基酸对热暴露果蝇生存能力的影响 ,筛选对热损伤有防护能力的有效氨基酸。选取黑腹果蝇 (Drosophilamelanogaster) ,野生型Oregonk品系 ,在 2 5℃普通培养基中生长、繁殖 ;收集 1 0h内在基础培养基羽化的成虫 ,区分雌雄 ,分为对照组及实验组 ,基础培养基适应 2 5～ 3天后 ,将实验组移入添加氨基酸的培养基 ,对照组继续在基础培养基 2 5℃饲养。实验组果蝇在 36 5℃热环境饲养 ,1 0h后每隔 2h计数果蝇死亡数 ,直到果蝇全部死亡。共计筛选了 1 8种氨基酸 ,其中果蝇在添加了 5种氨基酸的培养基中热暴露平均存活时间明显高于对照组 ,这 5种氨基酸是谷氨酰胺、苯丙氨酸、酪氨酸、谷氨酸和精氨酸 ;其它 1 3种氨基酸没有明显延长热暴露果蝇生存时间的效果。提示谷氨酰胺、苯丙氨酸、酪氨酸、谷氨酸和精氨酸可以延长热暴露果蝇生存时间 ,但不存在剂量 -反应关系     

晚期胰腺痛减黄术后化疗加肠外营养支持的随机对照研究

目的探讨营养支持在晚期胰腺癌姑息减黄术后化疗病人中的作用，及对病人的营养、免疫、生活质量及肿瘤疗效的影响。 方法1996年1月至1999年1月，对有病理学诊断和术中临床分期的40例姑息减黄术后的进展期胰腺癌病人进行随机分组，。术后给予联合化疗(FCMP／A)，或加用干扰素γ。联合化疗方案5氟尿嘧啶300～400mg／m2，甲酰四氢叶酸钙200mg／次，24小时持续静脉滴注，分别在3、5、10、12天给予，丝裂霉素4～6mg／m2、顺铂或表阿霉素20～30mg／m2第一天静注。以上药物可根据病人化疗中反应情况适当调整。每21天为1周期，间歇1周重复，完成至少2个周期。干扰素γ300万IU／天，每周3次，共6周。评定疗效标准按WHO实体瘤疗效标准分为CR(完全缓解)、PR(部分缓解)、NC(无变化)、PD(进展)。40例病人随机分为治疗组和对照组，治疗组为联合化疗加营养支持，共20例，其中男12例，女8例，中位年龄57．8(43～69)岁。对照组为联合化疗加常规治疗，共20例，其中男13例，女7例，中位年龄58．2(45～69)岁。肠外营养方案每日静脉供给非蛋白(NPC)热量20Kcal·k8-1·d-1，热氮比125Kcal·kg-1·d-1，糖脂比64，治疗组接受肠外营养平均11．5天(8～15天)。检验两组病人的营养、免疫状态，生活质量及化疗效果。 结果治疗组的前白蛋白，转铁蛋白，视黄醇结合蛋白，外周淋巴细胞总数，自然杀伤细胞活性，白介素-2受体阳性细胞，生活质量评分，化疗药物毒性作用消失时间和生存时间均不同程度的优于对照组(P<0．05或P<0．01)。非随机性对照使用干扰素未发现差异(P>0．05)。 结论对进展期胰腺癌姑息减黄术后的病人进行联合化疗，同时给予合理的营养支持能够提高营养、免疫水平，改善生活质量，延长生存时间，提高化疗效果。但是病人未能达到长期的无瘤生存。     

"Cutting" on cancer: attitudes about cancer spread and surgery among primary care patients in the U.S.A

Many underserved groups in the United States experience disparities in cancer survival. Part of the disparity may be due to differences in treatment or treatment uptake. Previous studies uncovered patient beliefs that surgery could cause cancer to spread and have suggested that this belief may affect uptake of cancer treatment. We explored patients’ explanations about surgical treatment of cancer and cancer spread, as well as the perceived impact on decision-making among primary care patients from an underserved area. Focus groups and interviews were conducted with patients (n = 42) at a primary care federally qualified health center in 2006 and 2007. Focus groups/interviews were semi-structured and were audio-taped and transcribed. An inductive text analysis with multiple coders was used to analyze the data and extract themes. We found that nearly all respondents had heard that surgery (“cutting”) and exposing cancer to the air would hasten cancer spread and result in worse outcomes. Most participants expressed agreement with this belief. Many participants said this concern would influence their decision about whether to have surgery and/or reported that a family member had refused surgery for this reason. A smaller group of respondents disagreed with this belief and offered experiential evidence to the contrary or hypotheses about its origination. The idea that “cutting” and “air” during surgery can cause cancer to spread may be more prevalent among patients than suspected, based on this sample of predominantly African American patients. While we were unable to disentangle the ideas about “cutting” from those about “exposure to air”, this set of beliefs, when held strongly, can negatively influence patients’ or family members’ decisions to seek surgical care and, if it is more prevalent in underserved groups, may contribute to cancer disparities.     

What do cancer support groups provide which other supportive relationships do not? The experience of peer support groups for people with cancer

This qualitative study examined the questions of what cancer support groups provide that other supportive relationships do not, and what the self perceived consequences are of support group attendance. Nine representative Australian cancer peer support groups, consisting of a total of 93 interviewees, 75 women, and 18 men, with a mean age of 62, took part in participant observation and focus group interviews, with the data analysed using positioning theory. Support groups were positioned by participants as providing a unique sense of community, unconditional acceptance, and information about cancer and its treatment, in contrast to the isolation, rejection, and lack of knowledge about cancer frequently experienced outside the group. Groups were also positioned as occasionally emotionally challenging, in contrast to the experience of normalising support from family and friends. Increased empowerment and agency were positioned as the most significant consequences of group support, consisting of increased confidence and a sense of control in relation to self, living with cancer, and interactions with others, in particular the medical profession. The support group was also positioned as facilitating positive relationships with family and friends because of relieving their burden of care, by providing a safe space for the expression of emotion. No difference was found between professionally led and peer led support groups, suggesting that it is not the professional background of the leader which is of importance, but whether the group provides a supportive environment, mutuality, and a sense of belonging, and whether it meets the perceived needs of those attending. It is suggested that future research should examine the construction and experience of social support in those who drop out of, or who do not attend, cancer support groups, in order to provide further insight into the contrast between social support within groups and support in other contexts.     

Evaluating the survival of cancer cases detected by screening

Early detection of cancer by screening advances the date of diagnosis, but may or may not affect survival. To assess the survival benefit associated with early detection, one must estimate the distribution of time survived post lead-time, that is, after the unknown date when clinical diagnosis would have occurred in the absence of screening. One can then compare the adjusted survival of screen-detected cancer cases to other groups of cases not diagnosed by screening. This paper describes a model for the survival of screen-detected cases, with a hazard function that depends on an individual's lead time, the duration of preclinical disease, and the time since diagnosis. The model is fitted to the ten year survival data from the 132 screen-detected cases of breast cancer in the well-known HIP (Health Insurance Plan of Greater New York) study. Comparison with the survival of several groups of cancer cases not detected by screening (interval cases arising clinically in persons previously screened, cases among persons who refuse screening, and cases among randomized controls not offered screening) yields various estimates of benefit. Use of the interval cases for comparison gives an estimate of about 21 breast cancer deaths prevented among 20,166 women screened in the HIP study; use of the data from the randomized controls gives an estimate of about 25 prevented deaths. The former estimate derives from the screened group of women only, and so the same method of evaluation may also be applied to community screening programmes and other situations that do not entail randomization.     

Identifying perceived needs among nurses in providing their patients with smoking cessation support in a Japanese hospital results from focus group interviews

OBJECTIVE: To identify perceived needs among nurses in providing their patients with smoking cessation support in a Japanese hospital. SUBJECTS: Thirty-three female nurses who were interested in providing their patients with smoking cessation support in the hospital setting participated in focus group interviews. They conducted six focus group interviews segmented by age, working conditions (e.g., outpatient or inpatient sections) and occupational class (e.g., administrative post or not). DESIGN: An experienced researcher moderated two focus groups and another researcher who received training moderated four focus groups. At least two observers hand-recorded participants' conversations in each group and all groups were also tape-recorded. Moderators and observers analyzed the focus group data together. RESULTS: We found that smoking cessation counseling or health education on effects of smoking to be rarely conducted in the hospital. The study participants ordinarily just told patients to stop smoking. They mentioned several barriers to conducting smoking cessation support and suggested a number of ideas to promote this aim in the hospital. CONCLUSIONS: The focus group interview is an effective means to determine the needs and interests of Japanese health professionals. Nurses have many opinions and insights for supporting smoking patients. To introduce a smoking cessation program into hospitals, there are various problems that should be solved. First, nurses and other health professionals should have accurate knowledge, positive attitudes and appropriate skills for smoking cessation support. Second, smoking cessation support should be programmed as part of treatment or nursing. Third, healthcare professionals, especially doctors, should collaborate in supporting patients to stop smoking. Fourth, the hospital environment should be modified to promote smoking cessation. Finally, hospitals should develop a consensus among all staff about the importance of smoking cessation support and smoking control activities. As the result, multidimensional strategies are needed to effectively promote smoking cessation support in the hospital setting.     

Online Support Groups: The Good,the Bad,and the Motivated

Online support groups exist for a multitude of health conditions. Group participants tend to have unmet needs for emotional or psychological support, socialization, information, or validation. There are advantages to online support communities that cannot be found in face-to-face groups, but there are numerous disadvantages as well. This article reviews the motivations for participating in an online support group, lists the pros and cons of online communities, and offers a glimpse into experiences of a few group participants.     

Cystic fibrosis

Cystic fibrosis represents a major health problem in developed countries. Although its distribution is worldwide, in most developing countries there is little awareness of its prevalence and little opportunity to provide treatment. The improvements in survival of cystic fibrosis patients in developed countries over the past two decades have brought mean life expectancy to 20 years or more, and many adult patients with cystic fibrosis at present are fully integrated in society and have an acceptable lifestyle. Improvements in standard of living, general health, diet, surgical and medical care, including nutritional support, pancreatic enzyme supplementation and antibiotic therapy have all contributed to extended survival of patients and improved quality of life. The role of the community is important in providing support for cystic fibrosis patients and their families. Cystic fibrosis organizations, and mutual-help parent groups play a vital part in educating the public about the disease, disseminating information, and supporting research.     

Peer Reviewed: Adapting Evidence-Based Strategies to Increase Physical Activity Among African Americans, Hispanics, Hmong, and Native Hawaiians: A Social Marketing Approach

Introduction

Using a social marketing approach, we studied how best to adapt proven, evidence-based strategies to increase physical activity for use with underserved racial or ethnic groups.

Methods

We conducted focus groups with low-income Hispanic women in Texas, Hmong parents and their children in California, low-income African American women and men in the Mississippi Delta, and Native Hawaiian college students in Hawaii. We also interviewed key leaders of these communities. Topics of discussion were participants'' perceptions about 1) the benefits of engaging in physical activity, 2) the proposed evidence-based strategies for increasing each community''s level of physical activity, and 3) the benefits and barriers to following the proposed interventions for increasing physical activity. A total of 292 individuals participated in the study.

Results

All groups considered that being physically active was part of their culture, and participants found culturally relevant suggestions for physical activities appealing. Overwhelmingly, strategies that aimed to create or improve social support and increase access to physical activity venues received the most positive feedback from all groups. Barriers to physical activity were not culturally specific; they are common to all underserved people (lack of time, transportation, access, neighborhood safety, or economic resources).

Conclusion

Results indicate that evidence-based strategies to increase physical activity need to be adapted for cultural relevance for each racial or ethnic group. Our research shows that members of four underserved populations are likely to respond to strategies that increase social support for physical activity and improve access to venues where they can be physically active. Further research is needed to test how to implement such strategies in ways that are embraced by community members.