全科医生内隐胜任力量表的编制及应用研究

背景 全科医生是基层医疗服务的“主力军”,现有关于全科医生胜任力的研究大部分强调应着力提升全科医生的知识和技能水平,忽略了全科医生内隐素质的重要性。目前我国仍缺乏评估全科医生内隐胜任力的有效工具,开发全科医生内隐胜任力量表（GPICRS）对于提高基层医疗服务质量具有重要意义。目的 编制GPICRS,并对其进行评价,旨在为提升全科医生胜任力提供一定的参考。方法 在文献分析和行为事件访谈的基础上,形成初始版量表。于2021年9—12月,采用随机抽样法,从全国选取380例全科医生为研究对象,采用初始版GPICRS对其进行调查,通过项目净化、探索性因子分析、验证性因子分析、信效度分析验证量表的合理性,基于加权平均法评价全科医生的内隐胜任力水平,比较不同特征全科医生的GPICRS平均总得分及各维度得分。结果 共回收有效问卷335份（88.2%）。GPICRS由工作动机、自我效能感、医学人文关怀和医学职业素养4个维度14个条目构成。探索性因子分析结果显示,KMO值为0.737,Bartlett’s球形检验χ2=592.715、P<0.001,表明数据适合进行因子分析;按特征根>1.00...     

细菌性肝脓肿患者发生血小板减少影响因素研究

背景细菌性肝脓肿(PLA)是临床常见的内脏器官感染性疾病,既往PLA发生血小板减少的临床研究较少。目的 分析PLA患者发生血小板减少的流行病学和临床特征,并探讨发生血小板减少的影响因素。方法 纳入北京大学人民医院2011年1月至2020年12月161例因PLA住院的患者为研究对象。收集患者资料,包括年龄、性别、体质指数(BMI)、发病症状(发热、腹痛、恶心、呕吐)、既往病史信息(高血压、糖尿病、冠心病、肝胆疾病、恶性肿瘤);收集患者入院时辅助检查结果,包括白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值(ALC)、单核细胞绝对值、血红蛋白、C反应蛋白(CRP)、降钙素原(PCT)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBiL)、尿素氮(BUN)、肌酐(Scr)、白蛋白(ALB)、凝血酶原时间(PT)、活化部分凝血活酶时间、纤维蛋白原、D-二聚体(D-Dimer)、血小板计数(PLT);收集患者肝脓肿影像学检查(腹部CT或超声)结果(是否多个脓肿)、病原学检查结果(血培养、培养出肺炎克雷伯菌比例);收集患者的并发症情况及预后情况。根据外周血PLT是否<1...     

芪苈强心胶囊联合尼可地尔对射血分数保留性心力衰竭患者心功能及细胞因子的影响

目的 探讨芪苈强心胶囊联合尼可地尔对射血分数保留性心力衰竭患者心功能及细胞因子的影响。方法 连续入选2019年10月至2020年10月诊断为射血分数保留性心力衰竭的患者共90例,随机分为观察组(45例)与对照组(45例)。对照组给予常规抗心力衰竭药物加芪苈强心胶囊治疗,观察组在对照组治疗基础上,加用尼可地尔治疗。比较两组患者一般临床资料、细胞因子水平、心功能各项指标。随访1年患者心功能情况、细胞因子水平以及不良心脑血管事件(MACCEs)发生情况。结果 两组患者接受治疗1年后脑钠肽(BNP)、左室舒张末期内径、白细胞介素(IL)-1β、IL-6、肿瘤坏死因子-α(TNF-α)均降低,射血分数(EF)值较治疗前升高,差异有统计学意义(P<0.05)。组间对比发现,两组患者入院时基础BNP、细胞因子、超声心能指标(LVEF、左室舒张末期内径、左房内径)差异无统计学意义(P>0.05);接受治疗1年后观察组IL-1β、IL-6、TNF-α、BNP、左室舒张末期内径低于对照组,EF值高于对照组,差异有统计学意义(P<0.05)。随访1年对照组共有7例发生终点事件,观察组共有4...     

Respiratory distress syndrome in second-born versus first-born twins. A matched case-control analysis

The well-known increased risk of the respiratory distress syndrome in a twin born second as compared with the twin born first is usually attributed to the second twin's predisposition to depression at birth ("asphyxia"). We analyzed the etiologic roles of birth order, presentation, and depression at birth in the development of the respiratory distress syndrome in matched case-control populations drawn from 221 preterm twin pairs. Among the 39 twin pairs discordant for respiratory distress syndrome, the second twin was the affected member in 31 pairs. Second birth order was the only independent risk factor, but only in vaginal deliveries (matched odds ratio, 14.2; 95 percent confidence interval, 2.5 to 81.1). Second twins delivered abdominally did not have an increased risk relative to first twins (odds ratio, 0.9; confidence interval, 0 to 17.8). When depression at birth was evaluated as an outcome variable, malpresentation, rather than birth order, was the major risk factor (independent matched odds ratios of 2.7 [confidence interval, 1.0 to 7.5] and 1.3 [0.7 to 2.5], respectively). Thus, second twins' increased risk of respiratory distress syndrome cannot be explained by a predisposition to depression at birth; a more important factor may be that second twins do not benefit from the salutary effects of labor to the same extent as first twins.     

Advantages of branched peptides in serodiagnosis. Detection of HIV-specific antibodies and the use of glycine spacers to increase sensitivity.

The reactivities of antibodies with branched and monomeric peptides were compared in ELISA assays. We found that lower amounts of antibodies could be detected with branched peptides than with monomeric peptides. This was observed with a monoclonal antibody and with antibodies in the sera of various HIV-positive individuals. To investigate the physical aspects of branched peptides important for the observed increase in sensitivity, glycine spacers of different lengths were introduced between the branched lysine core and the epitope reacting with the monoclonal antibody. The effect of the number of glycine residues, both on the sensitivity of antibody detection and on the amount of branched peptide needed to produce a given signal, was studied and the optimum was found at 4-5 residues. We discuss the basis for these findings and conclude that the routine use of branched peptides for serodiagnosis will give both greater sensitivity and appreciable cost savings.     

Serologic analysis of white-tailed deer sera for antibodies to Borrelia burgdorferi by enzyme-linked immunosorbent assay and western immunoblotting.

White-tailed deer serum samples were collected in the Minneapolis-St. Paul, Minn., metropolitan area during the fall and winter months from 1989 to 1992 and analyzed for antibodies to Borrelia burgdorferi, the etiologic agent of Lyme borreliosis. Ninety-eight percent of the serum samples were collected from regions where currently the vector tick, Ixodes dammini, is nonexistent. Antibodies to B. burgdorferi were detected in 2.2% of 508 samples by enzyme-linked immunosorbent assay, and their presence was confirmed by Western immunoblot analysis. Western immunoblotting yielded mean numbers of reactive bands of 0.1 and 6.0 for samples that were negative and positive for antibodies by enzyme-linked immunosorbent assay, respectively. The molecular weights of the antigens in many of the reactive bands from positive samples were similar to the molecular weights of antigens reactive with samples from humans with Lyme borreliosis. An antibody response to the major outer surface proteins A and B was not detected. Serologic analysis of deer sera may provide a valuable method for surveillance programs designed to monitor the spread of B. burgdorferi in nature.     

CD44+/CD24-细胞在乳腺癌组织及细胞系中的数量与分布

Objective To study the distribution and quantity of CD44VCD24- cells in breast cancer tissue and the cell lines,and as well as its correlation with the expression of various breast cancer markers and molecular subtyping of breast carcinoma.Methods The expression of CD44 / CD24,estrogen receptor,progesterone receptor,HER2,human estrogen-induced protein PS2,bcl-2 and nm23 in 60 cases of invasive ductal carcinoma of breast were studied by either single or double immunohistochemical staining.The co-expression of CD44 and CD24 in 3 breast cancer cell lines (MCF-7,MDA-MB-468,and MDA-MB- 231) was also examined.Results The quantity and distribution of CD44 + /CD24- cells varied greatly and no specific patterns were identified.The percentage of CD44 + /CD24- in breast cancer was 65%.The amount of CD44+/CD24- cells did not correlate with the age of patients,lymph node metastasis,tumor　 size,molecular subtypes and expression of various breast cancer markers in breast carcinoma.The proportion of CD44+/CD24- cells in MCF-7,MDA-MB-468,and MDA-MB-231 cell lines was < 1%,5% and > 80% ,respectively.Conclusions CD44+ /CD24- cells are demonstrated in certain breast cancer tissues and cell lines.However,there is no relationship obtained between the quantity or the distribution of these cells and the molecular subtyping or the clinicopathologic parameters in breast cancer.     

抗人DR5单抗-阿霉素交联物的制备及其细胞毒作用

目的：介绍抗人DR5单抗YM366EC-阿霉素结合物的制备及其细胞毒作用,以探讨YM366EC作为内源性导向载体的可能性。方法：采用氧化葡聚糖（Dex）T-40作为中介载体,联结抗人DR5YM366EC与阿霉素（ADR）制备交联物366EC-Dex-ADR,交联物中ADR与366EC的克分子比为71：1。经ELISA测定交联物的抗体活性大部分保持。MTT法体外测定其细胞毒性。结果：交联物对表达DR5受体的肿瘤细胞处理24小时的IC50是游离ADM的5倍,并且和肿瘤细胞DR5受体表达相关。结论：YM366EC具有良好的导向作用,结合物对肿瘤细胞有选择性杀伤作用。     

Analysis of Electromagnetic Exposure in Wireless Power Transfer System for Endoscopic Micro-robot

A wireless power transfer system for endoscopic micro-robot operating at 36 kHz is presented in this paper. The issue of patient＇ s health and safety regarding exposure to the electromagnetic field is addressed. The specific absorption rate and current density can be used to investigate the electromagnetic influences on the biological tissues surrounded by the wireless power launching coil. In view of this purpose, the limited close-ound solenoid electromagnetic model is built, the relationship between the electric intensity and the specific absorption rate and current density is deduced, and the simulation experiments are done. Experimental results show that the values of SAR and current density related to different tissue catalogs are all very small and do not exceed their own limits respectively when the resonance frequency of operation is 36 kHz.