Hormone receptors,Her-2/neu and chromosomal aberrations in breast cancer

Background: There is a great deal of disparity in the incidence of breast cancer in rural and urban India on one hand and between India and Western population on the other.     

犯罪青少年家庭教养方式的特征

目的:分析犯罪青少年家庭教养方式与正常青少年群体父母教养方式的差异,以及犯罪青少年父母教养方式的一致性问题。方法:于2004-11/2005-02以某省少年教养管理所在册的少教学员86名作为观察组,同期随机抽取初中和高中在校学生86名作为对照组。采用父母教养方式评价量表和自编一般家庭情况问卷对两组被试评分进行比较。父母教养方式量表包括父亲和母亲两个量表。父亲教养方式包括6个因子:情感温暖、理解,惩罚、严厉,过分干涉,偏爱被试,拒绝、否认,过度保护。母亲教养方式包括5个因子:情感温暖、理解,过分干涉、过度保护,拒绝、否认,惩罚、严厉,偏爱被试。测试包括从不、偶尔、经常、总是4个等级(分数越高表明父母教养方式各方面越突出)。结果:共发放问卷200份,回收有效问卷172份。①观察组父亲教养方式中情感温暖与理解、过分干涉评分低于对照组[(44.86±9.61),(51.41±8.25)分;(22.21±6.97),(33.30±3.49)分,P均<0.01],惩罚严厉、偏爱被试等评分高于对照组[(21.48±7.64),(14.21±4.74)分;(11.74±3.87),(8.56±4.29)分,P均<0.01];观察组母亲教养方式中情感温暖与理解评分低于对照组[(42.98±11.84),(52.97±9.05)分,P<0.01],拒绝否认、过分干涉与保护、惩罚严厉等评分高于对照组[(14.41±5.10),(9.02±2.84)分;(37.40±8.91),(33.97±5.90)分;(14.48±4.80),(12.94±3.45)分,P<0.01,P<0.05]。②观察组父母教养方式在偏爱被试、过度干涉保护、惩罚严厉以及拒绝否认贬低等方面存在严重分歧[(12.03±3.99),(9.50±3.68)分;(21.85±6.82),(37.78±8.3)分;(21.12±7.59),(14.44±5.03)分;(9.68±2.87),(14.26±4.91)分,P均<0.01]。对照组父母在情感温暖理解、过度干涉保护、惩罚严厉等方面存在分歧[(52.00±8.31),(53.08±9.18)分;(33.27±3.41),(34.77±6.12)分;(14.21±5.03),(13.22±3.82)分,P<0.05,P<0.01]。结论:犯罪青少年的父母教养方式存在3个明显不足,即缺少情感温暖、沟通和理解;极端化;父母教养方式严重分歧。母亲的过分干涉保护可能是青少年犯罪的一个重要相关因素。     

经皮电神经刺激在脑卒中康复中的应用：时尚与事实

经皮电神经刺激（TENS）对疼痛的治疗 经皮电神经刺激（transcutaneouselectricalnervestimulation，TENS）是一种外周神经刺激，自1967年开始成功地用于缓解疼痛的治疗，至今已有40年.其理论基础源于1965年Melza-ck等提出的著名的闸门控制学说。基于当时的实验基础，研究者们认为脊髓背侧角的胶质细胞是通过闸门控制系统工作，这些细胞在传人纤维终止于脊髓背侧角的第一级传入神经元之前起着调节作用。一级传入神经元通过前外侧系统调节大脑对疼痛的辨别和感受。触摸、挤压和振动刺激粗的有髓鞘纤维（如A-α、A-β纤维），后者作用于小的伤害性传人纤维，增强了背侧角神经元细胞终止前的突触前抑制，以减少传入神经元对大脑的刺激，从而达到减轻疼痛的目的。相反，小直径纤维，包括有髓鞘和无髓鞘（如A-γ和C纤维）则会在以上水平上减弱突触前抑制，从而加重疼痛。     

自体骨髓干细胞移植治疗急性心肌梗死围手术期并发症分析

目的：分析自体骨髓干细胞经冠脉移植治疗急性心肌梗死患者围手术期并发症情况。方法：抽取2004—09／2006—12唐山工人医院收治的急性心肌梗死患者40例，均行经皮冠状动脉介入治疗＋标准药物治疗＋经冠脉注入自体骨髓单个核细胞治疗，实验方案经医院伦理委员会批准，并获得患者知情同意，术前及术后根据临床需要给予标准药物治疗。于患者双侧髂后上棘穿刺，抽取骨髓，滤筛去除脂肪颗粒及骨渣，共采集100-120mL，经密度梯度离心获得骨髓单个核细胞悬液12～15mL，室温下保存少于4h。两侧冠脉造影，左前降支植入支架后，将导丝放置于原病变远端，沿导丝将over the wire球囊置入支架内，将分离的骨髓单个核细胞悬液经over the wire球囊导管中心腔内注入梗死相关动脉血管远端，每次注射4．0～5．0mL，抽空球囊间歇2min后再次同法注射，反复共3次。结果：40例行骨髓单个核细胞冠脉移植的心肌梗死患者均进入结果分析。围手术期各种并发症共34例次，其中血管并发症发生率20％，胸痛17．5％，心律失常15％，低血压12．5％，心功能障碍10％，迷走神经反射7．5％，低血糖反应2．5％。结论：随着冠状动脉介入治疗技术的开展和操作的规范，手术成功率逐步提高，但仍然会在围手术期出现各种并发症及突发事件。提示应严密观察病情，有针对性地采取预防措施和正确的应急处置，从而减少干细胞移植手术的风险。     

颈椎类风湿性关节炎患者的影像学分期及其功能评估

目的:探讨临床和影像学分期及评估对指导颈椎类风湿性关节炎患者治疗的意义。方法:选择1995-01/2004-07解放军第98医院住院治疗累及颈椎的类风湿性关节炎患者21例,平均病程8.0年。①所有患者常规摄颈椎或颅颈部正侧位、屈/伸侧位片及开口位片和枕颈部CT平扫,疑神经损伤者行MRI检查。②临床和影像学分期显示Ⅱ期(中度进展期)5例和Ⅲ期(重度进展期)16例;神经系统评估按Ranawat等标准(级别越高,神经损害越重)示Ⅰ级4例,Ⅱ级11例、ⅢA级4例、ⅢB级2例。③21例患者行甲氨蝶呤 其他DMARDs的联合治疗,Ranawa分级Ⅰ级4例行颈围外固定,11例Ⅱ级患者行枕颌吊带牵引,Ⅲ级6例手术行后路寰枢或枕颈融合治疗。④出院和随访时行临床疗效评估。结果:21例均进入结果分析。①影像学结果显示前向寰枢椎半脱位最常见,有16例,与侵蚀性骨破坏累及寰枢、寰齿、寰枢关节有关。②平均随访5.6年,21例中缓解2例,显效12例,有效4例,无效3例。③6例手术患者的齿突周围血管翳在随访中较术前明显减小。结论:对颈椎类风湿性关节炎患者可成功行临床和和影像学分期及评估,根据评估结果指导临床治疗效果满意。提示为防止枕颈部脊髓压迫,宜对此类患者行常规、定期的临床和影像学随访。     

Malnutrition,Critical Illness Survivors,and Postdischarge Outcomes: A Cohort Study

Background: We hypothesized that preexisting malnutrition in patients who survived critical care would be associated with adverse outcomes following hospital discharge. Methods: We performed an observational cohort study in 1 academic medical center in Boston. We studied 23,575 patients, aged ≥18 years, who received critical care between 2004 and 2011 and survived hospitalization. Results: The exposure of interest was malnutrition determined at intensive care unit (ICU) admission by a registered dietitian using clinical judgment and on data related to unintentional weight loss, inadequate nutrient intake, and wasting of muscle mass and/or subcutaneous fat. The primary outcome was 90‐day postdischarge mortality. Secondary outcome was unplanned 30‐day hospital readmission. Adjusted odds ratios were estimated by logistic regression models adjusted for age, race, sex, Deyo‐Charlson Index, surgical ICU, sepsis, and acute organ failure. In the cohort, the absolute risk of 90‐day postdischarge mortality was 5.9%, 11.7%, 15.8%, and 21.9% in patients without malnutrition, those at risk of malnutrition, nonspecific malnutrition, and protein‐energy malnutrition, respectively. The odds of 90‐day postdischarge mortality in patients at risk of malnutrition, nonspecific malnutrition, and protein‐energy malnutrition fully adjusted were 1.77 (95% confidence interval [CI], 1.23–2.54), 2.51 (95% CI, 1.36–4.62), and 3.72 (95% CI, 2.16–6.39), respectively, relative to patients without malnutrition. Furthermore, the presence of malnutrition is a significant predictor of the odds of unplanned 30‐day hospital readmission. Conclusions: In patients treated with critical care who survive hospitalization, preexisting malnutrition is a robust predictor of subsequent mortality and unplanned hospital readmission.     

Web-based Health Information Seeking and eHealth Literacy among Patients Living with Chronic Obstructive Pulmonary Disease (COPD)

Many people living with Chronic Obstructive Pulmonary Disease (COPD) have low general health literacy; however, there is little information available on these patients’ eHealth literacy, or their ability to seek, find, understand, and appraise online health information and apply this knowledge to address or solve disease-related health concerns. A nationally representative sample of patients registered in the COPD Foundation’s National Research Registry (N = 1,270) was invited to complete a web-based survey to assess socio-demographic (age, gender, marital status, education), health status (generic and lung-specific health-related quality of life), and socio-cognitive (social support, self-efficacy, COPD knowledge) predictors of eHealth literacy, measured using the 8-item eHealth literacy scale (eHEALS). Over 50% of the respondents (n = 176) were female (n = 89), with a mean age of 66.19 (SD = 9.47). Overall, participants reported moderate levels of eHealth literacy, with more than 70% feeling confident in their ability to find helpful health resources on the Internet. However, respondents were much less confident in their ability to distinguish between high- and low-quality sources of web-based health information. Very severe versus less severe COPD (β = 4.15), lower lung-specific health-related quality of life (β = ?0.19), and greater COPD knowledge (β = 0.62) were significantly associated with higher eHealth literacy. Higher COPD knowledge was also significantly associated with greater knowledge (ρ = 0.24, p = .001) and use (ρ = 0.24, p = .001) of web-based health resources. Findings emphasize the importance of integrating skill-building activities into comprehensive patient education programs that enable patients with severe cases of COPD to identify high-quality sources of web-based health information. Additional research is needed to understand how new social technologies can be used to help medically underserved COPD patients benefit from web-based self-management support resources.     

Production of IL-12, IL-23 and IL-27p28 by bone marrow-derived conventional dendritic cells rather than macrophages after LPS/TLR4-dependent induction by Salmonella Enteritidis

Induction of the interleukin-12 (IL-12) cytokine family comprising IL-12, IL-23, IL-27, and IL-12p40 by intracellular pathogens is required for orchestration of cell-mediated immune responses. Macrophages (MPhi) have been shown to be a source of IL-12 following TLR4-dependent activation by Salmonella (S.). In this study another antigen-presenting cell type, the conventional dendritic cell (cDC), was analyzed and its cytokine responses compared with those of MPhi. We generated bone marrow-derived conventional dendritic cells (BMDC) and macrophages (BMMPhi) by incubating murine bone marrow cells with supernatants containing granulocyte/macrophage colony-stimulating factor (GM-CSF) or macrophage colony-stimulating factor (M-CSF), respectively. Stimulation of BMDC and BMMPhi with S. enterica serovar Enteritidis (SE) or LPS resulted in the release of IL-12 and IL-23 by BMDC but not by BMMPhi. Furthermore, BMDC secreted approx. 20-fold more IL-12p40 and IL-27p28 than BMMPhi. However, BMDC and BMMPhi produced similar levels of IL-10. Using BMDC originating from wild-type (wt), TLR2(def) and TLR4(def) mice, we show that in BMDC the induction of IL-12, IL-23, and IL-27p28 by SE is dependent on TLR4, whereas low-level production of p40 is also mediated by pattern recognition receptors (PRR) other than TLR4. Interestingly, LPS- and SE-provoked responses of BMDC were remarkably similar indicating that LPS is the primary danger molecule of SE. Taken together, our results point to cDC rather than MPhi as the major producers of the IL-12 family members during in vitro infection with SE. The mechanisms of recognition of SE, however, appear to be the same for cDC and MPhi.