团队项目教学法在《社区护理学》实验教学中的应用

团队项目教学法源于20世纪80年代的美国,是一种以学生为中心的新型教学方法,打破以教师讲授为主的传统教学方法,旨在培养学生的团队合作能力和沟通能力,在国外会计学专业中被广泛采用[1]。"90"后护理本科生多为独生子女,缺乏与他人沟通合作、共同完成任务的能力。社区护理是团队合作性     

视网膜母细胞瘤组织中DNA甲基转移酶1、DNA甲基转移酶3a、3b的表达

目的 观察视网膜母细胞瘤(RB)组织中DNA甲基转移酶(DNMT)1、DNMT3a和DN MT3b的表达.方法 62例RB肿瘤组织标本及6例正常视网膜组织标本纳入研究.其中,低分化组织标本17例,高分化组织标本45例；侵袭性肿瘤16例,非侵袭性肿瘤46例.采用免疫组织化学染色方法检测RB肿瘤组织标本中DNMT1、DNMT3a、DNMT3b的表达.以细胞核棕色染色为阳性表达,蓝色为阴性表达.以DNMT1、DNMT3a及DNMT3b阳性细胞分别≥65％、60％及40％为DNMT1、DNMT3a、DNMT3b高表达,≥1％但＜65％、60％及40％为低表达.同时分析DNMT1、DNMT3a、DNMT3b表达和MIB-1标记指数之间的相关性.结果 光学显微镜观察发现,正常视网膜组织中DNMT1、DNMT3a和DNMT3b均为阴性表达.肿瘤视网膜组织中均可见DNMT1、DNMT3a和DNMT3b表达,其阳性表达率分别为100％、98％、92％.高低分化组织标本比较,DNMT1、DNMT3a高表达率(x2=12.57、10.54)及阳性细胞计数(U=179、198)间差异均有统计学意义(P＜0.05)；DNMT3b高表达率(x2=1.5)和阳性细胞计数(U=307)间差异均无统计学意义(P＞0.05).侵袭性及非侵袭性肿瘤组织标本比较,DNMT1高表达率(x2=4.72)及阳性细胞计数(U=236)间差异均有统计学意义(P＜0.05)；DNMT3a、DNMT3b高表达率(x2=3.53、0.84)及阳性细胞计数(U=338、257)间差异均无统计学意义(P＞0.05).相关性分析结果显示,MIB-1标记指数与RB肿瘤组织中DNMT1、DNMT3a及DNMT3b表达呈正相关(R2=0.554、0.376、0.219,P＜0.05).结论 RB肿瘤视网膜组织中DNMT1、DNMT3a和DNMT3b均呈高表达.     

The Effects of Connectedness on Health-Promoting and Health-Compromising Behaviors in Adolescents: Evidence from a Statewide Survey

Using a social ecological perspective, we examined the effects of connectedness in multiple domains on health-promoting and health-compromising behaviors among Asian American (AA), Pacific Islander (PI), and Caucasian/White American (WA) adolescents in California. After adjusting for age, gender, and socioeconomic status, the following consistent results emerged across the three ethnic groups: (a) community connectedness increased the odds of physical activity; (b) internal, family, and school connectedness decreased, whereas friend connectedness increased, the odds of substance use; and (c) internal and family connectedness decreased the odds of violent behavior. We also found specific ethnic variations pertaining to the effects of connectedness. Friend connectedness increased the odds of violent behavior for AAs and WAs, but not for PIs. Meanwhile, community connectedness increased the odds of substance use and violent behavior for AAs and PIs, but decreased the odds of these behaviors for WAs. Findings for healthy dietary behavior were inconsistent across ethnic groups and connectedness domains. Our overall findings suggest that the effects of connectedness were more salient for health-compromising behaviors than for health-promoting behaviors. Health prevention and intervention efforts in adolescents could target the role of their connectedness to their multiple social domains.     

儿童青少年1型糖尿病患儿的压力和应对方式对其疾病自我管理的影响

目的 探讨人口学、疾病相关特征、压力、应对方式对儿童青少年1型糖尿病患儿疾病自我管理水平的影响。方法 采用横断面调查研究设计，纳入149名儿童青少年1型糖尿病患儿（8~20岁）。采用一般资料收集表、儿童青少年1型糖尿病自我管理量表、压力知觉量表、青少年应对方式量表进行调查。结果 149例患儿中，37例（24.8%）患儿处于高压力水平。与学龄期患儿相比，青春期患儿压力水平更高，且更多地采用消极应对方式（P < 0.05）。多元线性回归分析结果显示，母亲教育水平为高中及以上患儿以及低压力水平、面对压力采取积极应对的患儿，其糖尿病自我管理水平较高（P < 0.05）。结论 近四分之一的儿童青少年1型糖尿病患儿处于高压力水平。医护人员在对儿童青少年患儿进行糖尿病自我管理教育时，重点人群应放在母亲教育水平为初中及以下水平的家庭；策略方面，应以减压为目标，引导患儿更多地采取积极应对方式缓解压力。     

宫颈癌65例漏诊病例分析

目的　探讨宫颈癌漏诊的原因及特点，提高首诊诊断率。 方法　回顾性分析四川大学华西第二医院2009 年 1 月－ 2011 年 3 月收治的外院漏诊的 65 例宫颈癌患者。 结果　漏诊的 65 例中有 51 例误诊为宫颈糜烂，其中仅 13 例首诊曾行细胞学筛查，16 例行阴道镜检查及活检，总平均年龄仅 39 岁，农村居民 54 例。 结论　各地区应加强宫颈癌筛查意识，采取相应措施及适合的筛查方式提高宫颈癌筛查率，减少漏诊。     

The diagnostic and prognostic value of MRP8/MRP14 in intrahepatic cholangiocarcinoma

Myeloid-related protein 8 (MRP8) and 14 (MRP14) are abundantly expressed in several kinds of benign and malignant tumors. However, little is known about their clinicopathological significance in intrahepatic cholangiocarcinoma (ICC), biliary intraepithelial neoplasia (BilIN), intraductal papillary neoplasm of bile duct (IPNB), or inflammatory hepatic biliary ducts epithelium (IHBD). This study aimed to investigate the diagnostic and prognostic values of MRP8 and MRP14 as new biomarkers for ICC. We examined MRP8 and MRP14 expression levels by immunohistochemistry in IHBD (n = 15), BilIN (BilIN1 = 24, BilIN2 = 9, BilIN3 = 5), IPNB (n = 18) and ICC (n = 416). The differential diagnostic and prognosis values were also evaluated. The results showed that the ratio of tumor-infiltrating MRP8 and MRP14 positive immune cells, relative to biliary epithelial cells, was significantly increased in ICC tissues compared with nonmalignant tissues, including IHBD, BilIN1, BilIN2, BilIN3, and IPNB (P value < 0.05). In addition, over-expression levels of MRP8 and MRP14 were correlated with overall survival (OS) and time to recurrence (TTR) by univariate analysis; MRP8/MRP14 combination was an independent prognostic factor for OS and TTR. MRP8 and MRP14 expression might help to identify the benign bile duct diseases from ICC, as high expression of MRP8 and MRP14 suggests a poor prognosis after surgical resection.