血清胃蛋白酶原和胃泌素-17在胃癌筛查中的应用

目的探讨血清胃蛋白酶原(PG)和胃泌素-17(G-17)联合检测在胃癌筛查中的价值。方法选择该院胃癌患者(胃癌组)和非胃癌患者(非胃癌组)各25例为研究对象,采用全自动化学发光分析法对研究对象血清PG和G-17水平进行检测。采用SPSS19.0统计学软件对胃癌组和非胃癌组PG及G-17水平进行比较。结果胃癌组血清PGⅠ水平和PGⅠ与PGⅡ的比值(PGR)明显低于非胃癌组,差异有统计学意义(P0.05);胃癌组血清PGⅡ、G-17水平明显高于非胃癌组,差异有统计学意义(P0.01);血清PGⅠ、PGⅡ、G-17联合检测对胃癌诊断的灵敏度为96%。结论血清PG和G-17水平对胃癌诊断的灵敏度高,可广泛应用于临床胃癌的筛查。     

血清PG G-17检测结合窄带成像放大内镜对早期胃癌的诊断价值

目的探讨血清PG、G-17结合窄带成像放大内镜对早期胃癌的诊断价值。方法选择2017年1月至2020年4月因上腹不适等上消化道症状就诊的患者573例,同期进行普通白光胃镜检查及胃黏膜组织活检,根据病检结果分为A组(非萎缩性胃炎组)、B组(胃癌癌前病变组)和C组(早期胃癌组)。比较各组血清PGⅠ、PGⅡ和G-17水平,利用ROC曲线分析PGⅠ、G-17单独或联合检测对早期胃癌的诊断价值。结果573例患者均进行了白光内镜检查,218例行NBI+ME精查,其中92例行靶向活检,126例行BSD术,其中A组387例、B组123例、C组63例。与A组比较,B组和C组PGⅠ、PGR水平较低,G-17水平较高,差异有统计学意义(P<0.05);与B组比较,C组PGⅠ、PGR水平较低,G-17水平较高,差异有统计学意义(P<0.05)。以血清PGⅠ<70.1μg/L且血清G-17>14.1 pmol/L为标准,诊断早期胃癌的敏感度和特异度分别为85.7%和96.5%,联合诊断敏感度和特异度均高于单独诊断(P<0.05);三组血清学指标异常检出率分别为1.3%、7.3%和88.9%,B组、C组血清学指标异常检出率均高于A组(P<0.05),C组血清学指标异常检出率高于B组(P<0.05)。结论PGⅠ降低、G-17升高提示胃癌癌前病变、早期胃癌的高风险,PGⅠ与G-17联合检测结合白光内镜、NBI+ME精查、靶向活检及诊断性ESD可进一步提高诊断准确性。     

血清胃蛋白酶原和胃泌素-17检测在胃癌筛查中的应用

目的研究不同胃疾病患者的血清中胃蛋白酶原Ⅰ(PGⅠ)、PGⅡ、胃泌素-17(G-17)水平变化,探讨血清PG和G-17检测对胃癌的诊断价值。方法选取胃癌患者158例(胃癌组)、慢性萎缩性胃炎患者56例(慢性萎缩性胃炎组)、慢性浅表性胃炎患者53例(慢性浅表性胃炎组)、健康体检者85例(对照组)。采用化学发光免疫法测定所有研究对象血清中的PGⅠ、PGⅡ、G-17水平,并计算PGⅠ/PGⅡ(PGR)值。结果慢性萎缩性胃炎组、胃癌组的PGI和PGR水平明显低于对照组和慢性浅表性胃炎组,差异有统计学意义(P0.05);血清PGⅠ和PGR水平与胃癌的分期和病变部位有关,差异有统计学意义(P0.05);受试者工作特征曲线(ROC曲线)显示筛选和诊断胃癌PGⅠ和PGR的最佳临界值PGⅠ为69.6ng/mL,PGR为2.9,而慢性萎缩性胃炎组或胃癌组患者中,多灶性病变时血清G-17的水平明显低于胃体和胃窦病变,差异有统计学意义(P0.05)。结论血清PG和G-17的水平变化与胃黏膜病变密切相关,低水平的血清PGⅠ、PGR可作为筛查和早期诊断胃癌的重要手段。     

胃癌患者及其化疗后胃蛋白酶原与胃泌素变化的临床意义

目的探讨胃癌患者及其化疗后血清胃蛋白酶原、胃泌素的变化。方法选择北京友谊医院418例胃癌患者纳入研究。用免疫放射法测定了其血清胃泌素17(G-17)、血胃蛋白酶原Ⅰ(PGⅠ)及胃蛋白酶原Ⅱ(PGⅡ)并计算PGⅠ/PGⅡ的比值即PGR。其中,279例进展期胃癌化疗患者,比较化疗前后血清PGⅠ、PGR及G-17水平。同时纳入100例正常对照者和100例萎缩性胃炎患者,观察血清PGⅠ、PGR及G-17水平。结果①正常对照组血清PGⅠ、PGR、G-17值分别为149.76±57.45μg/L、10.11±2.30、29.56±12.03 pg/ml,萎缩性胃炎组为115.72±40.87μg/L、7.09±2.02、37.62±15.05 pg/ml,胃癌组为76.75±20.88μg/L、3.90±1.81、54.59±18.77 pg/ml。与正常对照组相比,萎缩性胃炎患者血清PGⅠ、PGR降低,G-17水平升高(P0.05),胃癌患者血清PGⅠ、PGR进一步明显降低,G-17水平显著升高(P0.01)。②早期胃癌组PGⅠ、PGR、G-17分别为80.11±21.18μg/L、4.39±2.95、48.11±16.99pg/ml,进展期胃癌组PGⅠ、PGR、G-17分别为59.74±11.78μg/L、2.79±0.99、58.88±19.0 pg/ml,与早期胃癌组相比,进展期胃癌患者血清PGⅠ、PGR降低,G-17水平显著升高(P0.05)。③进展期胃癌组化疗前PGⅠ、PGR、G-17分别为59.74±11.78μg/L、2.79±0.99、58.88±19.02 pg/ml,化疗后病情出现进展组分别为26.23±17.73μg/L、1.09±0.49、76.89±32.19 pg/ml,患者在化疗后病情出现进展时PGⅠ、PGR进一步降低,G-17升高(P0.05)。④以上各组PGⅡ水平变化均无统计学意义(P0.05)。结论胃癌患者化疗后PGⅠ水平下降提示应行进一步胃镜检查。胃癌患者化疗过程中测定PGⅠ、G-17水平可起到监测患者病情的作用。     

胃蛋白酶原、胃泌素-17和幽门螺杆菌对萎缩性胃炎的诊断价值

目的探讨血清胃蛋白酶原(PG)Ⅰ、PGⅡ、PGⅠ/PGⅡ比值(PGR)、胃泌素-17(G-17)和幽门螺杆菌(Hp)对萎缩性胃炎的早期诊断价值。方法选取2016年12月至2018年6月来武汉科技大学附属孝感医院消化内科和胃肠外科就诊的660例萎缩性胃炎患者纳入研究组,根据胃镜结果和病理诊断结果分为轻度组(236例)、中度组(323例)和重度组(101例),选择同期50例怀疑胃炎到该院进行进一步检测,最终排除胃部疾病者纳入对照组。收集所有研究对象空腹血清标本,采用ELISA检测血清中PGⅠ、PGⅡ、G-17水平,并计算PGR,采用胶体金法检测Hp。结果随着胃黏膜萎缩程度加重,PGⅠ和PGR水平逐渐降低,PGⅡ和G-17水平逐渐升高。轻度组、中度组、重度组与对照组比较,PGⅠ、PGR和G-17水平均明显降低,PGⅡ水平及Hp阳性率均明显升高,差异均有统计学意义(P0.05)。根据受试者工作特征曲线,PGⅠ、PGⅡ、PGR、G-17诊断萎缩性胃炎的最佳临界值分别为82.365μg/L、9.958μg/L、10.395、9.624pmol/L。结论检测血清PGⅠ、PGⅡ、G-17和Hp在萎缩性胃炎中有较高的诊断价值,对防止癌前病变具有重要临床意义。     

血清PG、G17及Hp对胃癌的筛查效果研究

目的探讨血清胃蛋白酶原(PG)、胃泌素17(G17)及幽门螺杆菌(Hp)对胃癌的筛查效果。方法选取2015年1月至2018年1月锦州市妇婴医院210例早期胃癌患者作为观察组,另选取同期该院健康体检者205例作为健康对照组。采用乳胶增强免疫比浊法检测两组受试者血清PGⅠ和PGⅡ水平,采用酶联免疫吸附试验检测血清G17水平,采用~(13)C尿素呼气试验定性检测血清中Hp阳性结果。观察两组受试者血清PGⅠ、PGⅡ、G17、PGⅠ/PGⅡ(PGR)水平及Hp阳性率,以及Hp阳性和Hp阴性受试者血清PGⅠ、PGⅡ、G17及PGR水平。结果观察组血清PGⅠ、PGR水平低于健康对照组,血清PGⅡ、G17水平高于健康对照组,差异均有统计学意义(P0.05)。观察组血清Hp阳性率明显高于健康对照组,差异有统计学意义(P0.05)。Hp阳性受试者血清PGⅡ、G17水平明显高于Hp阴性受试者,Hp阳性受试者血清PGⅠ、PGR水平明显低于Hp阴性受试者,差异均有统计学意义(P0.05)。结论血清PG、G17及Hp检测对于早期胃癌筛选有重要意义。     

联合检测血清胃蛋白酶原、胃泌素17和糖类抗原72-4在胃癌中的诊断价值

目的探讨血清胃蛋白酶原(PG)、胃泌素17(G-17)和糖类抗原72-4(CA72-4)的联合检测对胃癌诊断的临床价值。方法选取2014年8月至2016年2月门诊及住院经胃镜检查及病理确诊且未经治疗患者126例作为研究对象,并选取24例为在本院体检、无肝肾疾病、急慢性消化道疾病和其他慢性病、胃镜检查无异常者作为健康对照组,用酶联免疫吸附试验(ELISA)检测其血清PG、G-17水平,电化学发光法检测血清CA72-4水平,并计算PGR(PGⅠ/PGⅡ)值。比较胃癌组与健康对照组的结果差异,并用受试者工作特征曲线(ROC曲线)计算各指标的灵敏度和特异度。结果与健康对照组和其他疾病组相比,胃癌组的PGⅠ、PGⅡ、PGⅠ/PGⅡ、G-17和CA72-4均差异有统计学意义(P0.05),其中PGⅠ/PGⅡ的灵敏度最高,分别为70.2%和73.4%,3项联合检测的灵敏度和特异度为91.7%和89.3%。结论 PGⅠ/PGⅡ、G-17和CA72-4的联合检测可以提高胃癌检测的灵敏度和特异度。     

血清胃蛋白酶原与胃泌素-17在萎缩性胃炎筛查中的应用价值

目的探讨血清胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)水平、PGⅠ/PGⅡ(PGR)比值和胃泌素-17(G-17)水平在萎缩性胃炎筛查中的价值。方法选择2014年1月至2015年12月因消化道症状做胃镜检查的门诊及住院患者120例,根据组织活检结果,将受检者分为非萎缩性胃炎组和萎缩性胃炎组,每组60例。比较两组组血清PGⅠ、PGⅡ水平、PGR和G-17,采用组织学方法检测幽门螺杆菌(Hp)感染情况。结果与对照组比较,萎缩性胃炎组患者血清PGⅠ、PGR比值下降,G-17轻度升高。萎缩性胃炎组Hp感染率为46.67%,Hp阳性者的PGR比值下降。结论血清PGⅠ、PGR和G-17对于萎缩性胃炎的筛查有重要的临床价值。幽门螺杆菌感染与PG的变化有一定关系。     

早期胃癌血清PGR、IgG抗体、G-17表达与新型胃癌风险评分系统及预后的关系

目的 探讨早期胃癌血清胃蛋白原Ⅰ/胃蛋白原Ⅱ比值(PGR)、幽门螺旋杆菌(Hp)IgG抗体、胃泌素-17(G-17)表达与新型胃癌风险评分系统及预后的关系。方法 选取2019年11月至2020年12月该院146例早期胃癌患者,均接受胃癌根治术。术后12个月采用电话或上门形式随访预后,统计一般资料、血清PGR、Hp IgG抗体、G-17表达及新型胃癌风险评分系统得分,Spearman相关性分析血清各指标与新型胃癌风险评分系统相关性,采用Cox向前逐步回归法分析胃癌预后影响因素。结果 (1)术后12个月随访,复发率为28.78%(40/139)。复发组PGR低于未复发组,Hp IgG抗体阳性率、G-17水平及新型胃癌风险评分系统得分均高于未复发组(P<0.05);(2)复发组低风险患者PGR高于中风险、高风险患者,且中风险患者PGR高于高风险患者(P<0.05);复发组低风险患者G-17及Hp IgG抗体阳性率均低于中风险、高风险患者,且中风险患者G-17及Hp IgG抗体阳性率均低于高风险患者(P<0.05);(3)Spearman相关性分析结果显示,血清PGR与新型胃...     

胃癌患者及其化疗后胃蛋白酶原与胃泌素变化的临床意义简

目的 探讨胃癌患者及其化疗后血清胃蛋白酶原、胃泌素的变化.方法 选择北京友谊医院418例胃癌患者纳入研究.用免疫放射法测定了其血清胃泌素17（G-17）、血胃蛋白酶原Ⅰ（PGⅠ）及胃蛋白酶原Ⅱ（PGⅡ）并计算PGⅠ/PGⅡ的比值即PGR.其中,279例进展期胃癌化疗患者,比较化疗前后血清PGⅠ、PGR及G-17水平.同时纳入100例正常对照者和100例萎缩性胃炎患者,观察血清PGⅠ、PGR及G-17水平.结果 ①正常对照组血清PGⅠ、PGR、G-17值分别为149.76±57.45 μg/L、10.11±2.30、29.56±12.03 pg/ml,萎缩性胃炎组为115.72±40.87 μg/L、7.09±2.02、37.62±15.05 pg/ml,胃癌组为76.75±20.88 μg/L、3.90±1.81、54.59±18.77 pg/ml.与正常对照组相比,萎缩性胃炎患者血清PGⅠ、PGR降低,G-17水平升高（P〈0.05）,胃癌患者血清PGⅠ、PGR进一步明显降低,G-17水平显著升高（P〈0.01）.②早期胃癌组PGⅠ、PGR、G-17分别为80.11±21.18 μg/L、4.39±2.95、48.11±16.99 pg/ml,进展期胃癌组PGⅠ、PGR、G-17分别为59.74±11.78 μg/L、2.79±0.99、58.88±19.0 pg/ml,与早期胃癌组相比,进展期胃癌患者血清PGⅠ、PGR降低,G-17水平显著升高（P〈0.05）.③进展期胃癌组化疗前 PGⅠ、PGR、G-17分别为59.74±11.78 μg/L、2.79±0.99、58.88±19.02 pg/ml,化疗后病情出现进展组分别为26.23±17.73 μg/L、1.09±0.49、76.89±32.19 pg/ml,患者在化疗后病情出现进展时PGⅠ、PGR进一步降低,G-17升高（P〈0.05）.④以上各组PGⅡ水平变化均无统计学意义（P〉0.05）.结论 胃癌患者化疗后PGⅠ水平下降提示应行进一步胃镜检查.胃癌患者化疗过程中测定PGⅠ、G-17水平可起到监测患者病情的作用.     

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。     

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。     

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。     

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。     

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。     

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.     

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.     

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.     

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.

     

CT血管成像在腹盆腔肿瘤诊治中的临床应用及进展

腹部肿瘤较为常见,来源广泛,部分肿瘤的形态学表现缺乏特征性、位置变化较大,给诊断带来一定的困难。腹盆腔原发性肿瘤的血供一般来自起源器官或起源组织,肿瘤的生长方式及形态的不同,肿瘤血管的影像表现也不尽相同。随着CT技术的发展,腹部CT血管成像(Computed Tomography Angiography,CTA)已成为一种显示腹盆腔肿瘤供血动脉及肿瘤血管的重要检查方法,对于肿瘤的早期定位及定性诊断、肿瘤分期、治疗方式的选择、预后生存率的判断都有着举足轻重的价值。