微小RNA在结肠癌组织中的表达及其临床意义

目的 研究结肠癌组织与对应正常结肠组织微小RNA(miRNA)的表达特征及其在结肠癌诊断中的意义.方法 取天津市肿瘤医院2004至2007年手术切除的15例晚期结肠癌组织标本及其癌旁正常组织标本.通过定量PCR(qRT-PCR)法检测6例结肠癌及其癌旁正常结肠组织的手术标本中200种miRNA的表达情况,应用问题分析(PAM)法对其他9例结肠癌组织及其癌旁正常结肠组织进行定性判断(癌和非癌).结果 6例结肠癌及其癌旁正常结肠组织中存在132种miRNA,其中47种miRNA在结肠癌发生过程中表达量显著下降(＜0.66).应用PAM法对9对结肠癌组织/远端正常结肠组织进行定性判断的结果与病理切片诊断结果基本一致(吻合度准确率11/12).结论 miRNA与结肠癌的发生发展有密切的联系,有可能成为一个有效的肿瘤标志物以进行结肠癌的早期预测和诊断.     

Guidance for community‐based caregivers in assisting people with moderate to severe traumatic brain injury with transfers and manual handling: evidence and key stakeholder perspectives

Adults with moderate to severe traumatic brain injury (TBI) rely on assistance from paid and unpaid caregivers upon return to the community. An inability to move independently makes these adults highly dependent on caregivers for transfers and manual handling tasks. Evidence‐based guidelines are therefore important to ensure that caregivers and people in the community are protected and that practices are standard and consistent. This study commenced with a rapid review of evidence‐based recommendations between 2000 and 2015 pertaining to transfers and manual handling in people with TBI; and ended with a structured stakeholder dialogue that reflected upon this evidence and gathered perspectives on how to address key issues in community‐based manual handling following TBI. Three relevant guidelines were identified, providing nine recommendations encompassing assessment of the person's ability to assist caregivers, manual handling and appropriate equipment use. Due to the low number of recommendations and low level of supporting evidence, these recommendations alone could not provide comprehensive guidance. Three systematic reviews and two primary studies were also identified, and these suggest that comprehensive training programmes in transfers and manual handling tasks are effective. Further to this, a structured stakeholder dialogue was conducted, which revealed six major themes – (i) comprehensive risk assessment, (ii) presence of two caregivers, (iii) provision of training, (iv) home environment modification, (v) equipment, and (vi) policy implementation context. Recommendations for health professionals include providing information packs to caregivers, risk assessment and mitigation for those at high risk, and strategies to prevent and minimise injury in caregivers. Development of comprehensive guidance for caregivers in transfers and manual handling in people with moderate to severe TBI living in the community is a hidden but important priority.     

停用宫内节育器后育龄妇女妊娠率的双向性队列研究

目的：探讨使用宫内节育器（IUD）对女性生育能力的影响。方法：采用双向性队列研究方法,以生育一孩的妇女采用IUD避孕对象作为观察队列（1 361例）,同期使用避孕套妇女作为对照队列（1 307例）,于2016年7月1日—2017年9月30日随访观察停用避孕措施后1年内的妊娠情况,计算1年累积妊娠率,采用Cox比例风险模型进行多因素分析。结果：IUD组和对照组停用措施后妊娠者平均受孕时间分别为（144.1±96.86）d和（122.5±91.33）d,差异有统计学意义（P＜0.05）。IUD组累积妊娠率低于对照组,差异有统计学意义（P＜0.05）。使用IUD时间小于5年者停用后1年累积妊娠率是停用避孕套者的0.866倍（95%CI：0.788～0.952）。多因素Cox回归分析显示,与使用避孕套妇女相比,使用高铜IUD妇女停用后对妊娠有影响（HR=0.826,95%CI：0.720～0.947）。结论：使用高铜IUD者1年累积妊娠率较使用避孕套者低,受孕时间延长,对于使用高铜IUD者如近期有再生育计划,建议及早取出IUD以做好生育准备。     

舰艇部队军事训练伤分布特点与干预效果研究

目的：查明海军舰艇部队特殊军事训练伤的发生率和分布特征，以及施加干预措施后军事训练伤发生率的变化。方法：以整群抽样方式选取海军某舰艇部队官兵1648人，对全年军事训练伤进行前瞻性流行病学调查；以每个参试支队各抽2艘舰艇为干预试验单位，设同期对照组和历史对照组。结果：全年军事训练伤累积发生率为14．62％，时间分布以7月份为高峰；46．53％的伤者为机电部门人员；损伤部位以下肢为主，占32．64％；受伤类型以急性创伤性损伤为主；干预试验的军事训练伤发生率为8．96％，低于同期对照组(12．21％，P＜0、05)和历史对照组(14．62％，P＜0．01)。结论：舰艇部队军事训练伤发生情况与其它军兵种有较大的区别。施加干预措施可显著降低舰艇部队的军事训练伤。     

Building an online community to promote communication and collaborative learning between health professionals and young people who self‐harm: an exploratory study

Background

Online communities are known to break down barriers between supposed experts and non‐experts and to promote collaborative learning and ‘radical trust’ among members. Young people who self‐harm report difficulties in communicating with health professionals, and vice versa.

Aim

We sought to bring these two groups together online to see how well they could communicate with each other about self‐harm and its management, and whether they could agree on what constituted safe and relevant advice.

Methods

We allocated 77 young people aged 16–25 with experience of self‐harm and 18 recently/nearly qualified professionals in relevant health‐care disciplines to three separate Internet discussion forums. The forums contained different proportions of professionals to young people (none; 25%; 50% respectively) to allow us to observe the effect of the professionals on online interaction.

Results

The young people were keen to share their lived experience of self‐harm and its management with health professionals. They engaged in lively discussion and supported one another during emotional crises. Despite registering to take part, health professionals did not actively participate in the forums. Reported barriers included lack of confidence and concerns relating to workload, private–professional boundaries, role clarity, duty of care and accountability. In their absence, the young people built a vibrant lay community, supported by site moderators.

Conclusions

Health professionals may not yet be ready to engage with young people who self‐harm and to exchange knowledge and experience in an anonymous online setting. Further work is needed to understand and overcome their insecurities.     

产妇血清叶酸水平对新生儿出生特征的影响

目的:探讨产妇血清叶酸水平对新生儿血清叶酸、身长、体质量和头围的影响.方法:对80名产妇进行回顾性健康问卷调查;采用顺磁性颗粒化学发光免疫法测定血清叶酸水平;采用卧式身长计和头围尺分别测量新生儿身高和头围;电子秤称量新生儿体质量.结果:母体血清叶酸水平为(2.27±2.14)μg/,L,新生儿脐带血血清叶酸水平为(7....     

C57-TgN(HBVadr2.0)SMMU小鼠血清和肝组织中HBsAg的表达模式分析

目的:分析C57-TgN(HBVadr2.0)SMMU"3号"品系转基因小鼠的月龄、性别和遗传背景与其血清和肝组织中HBsAg表达模式的关系.方法:采用血清ELISA检测和免疫组织化学的方法检测转基因小鼠血清和肝组织中HBsAg的表达,统计学方法分析转基因小鼠血清和肝组织中HBsAg的表达与小鼠的月龄、性别、遗传背景的相关性.结果:转基因小鼠在出生后1～3个月时,血清中HBsAg的表达较低或甚至不表达,8个月龄左右时最高,此后逐渐降低,但肝组织中HBsAg的表达相对稳定在较高水平,能真实反映转基因小鼠中HBsAg的表达.雄性小鼠血清和肝组织中HBsAg的表达量高于雌性小鼠(P＜0.05).转基因小鼠与C57BL/6品系、DAB品系和129s品系正常小鼠交配后的子代,其血清和肝组织中HBsAg表达量均未发生变化.血清阳性的小鼠中肝组织HBsAg阳性率为94.05%,两者呈正相关关系(r=0.257,P＜0.01).结论:C57-TgN(HBVadr2.0)SMMU"3号"品系转基因小鼠血清和肝组织中HBsAg的表达具有发育调节和性别差异.     

小肠间质瘤20例诊治分析

目的　总结小肠间质瘤诊断和治疗经验。方法　对1993—2 0 0 4年收治的2 0例小肠间质瘤的临床资料进行回顾性分析。结果　临床表现为黑便、果酱样血便14例、头晕9例、贫血3例,伴腹部疼痛11例,发病时间2个月至7年。确诊方式:剖腹探查12例,腹腔镜探查6例,小肠镜检查2例;手术方式:小肠间质瘤切除18例,胰十二指肠切除术1例,肿瘤无法切除行保守治疗1例。随访6个月至9年,除1例死于脑干出血、2例长期服用甲磺酸伊马替尼(Gleevec)症状部分缓解外,其余17例均健在,间质瘤无复发。结论　小肠间质瘤预后较好,但对不明原因的消化道出血应及早探查,以避免误诊;Gleevec对晚期小肠间质瘤有较好疗效     

空回肠间质瘤13例诊治分析

目的　探讨空回肠间质瘤的诊断和治疗经验。方法　对我院 1993年 10月～ 2 0 0 4年 1月收治的有完整资料的 13例空回肠间质瘤病例进行回顾性分析 ,本组患者均经术后病理和免疫组化证实。结果　本组患者主要临床表现为消化道出血、腹痛。发病至确诊时间 2个月至 7年。剖腹探查确诊 7例 ,腹腔镜腹腔探查确诊 4例 ,术前确诊的仅 2例。随访 2个月至 9年 ,除 1例死于其它疾患外 ,余 12例均健在 ,无空回肠间质瘤复发病例发现。结论　小肠间质瘤预后甚好 ,但本病缺乏特征性的临床表现及有效的诊断手段 ,易致长期延误诊治 ;对长期不明原因的消化道出血患者 ,及早行剖腹探查或腹腔镜腹腔探查是避免小肠间质瘤长期延误诊治 ,改善患者预后的关键     

正电子放射性药物自动分装注射系统的设计与测试

目的 设计研发新型正电子放射性药物自动分装注射系统,以实现精准药物活度注射,简化注射流程,降低职业照射。方法 选择钨合金作为屏蔽材料,采用基于单片机控制步进电机驱动技术,设计机械驱动模块、管路系统、控制软件。制作设备及相关配套装置。测量防护效能和性能。结果 自动分装注射放射性药物时间约60 s,设备50次稳定性测试空白试验的成功率100%。系统整体注射活度的分装误差≤3%;设备箱体屏蔽40 mmPb,台面屏蔽60 mmPb,隔离防护屏蔽15 mmPb,内置钨合金原液罐50 mmPb。距离运行中设备30 cm处平均剂量率为1.44 μSv/h。操作人员肢端辐射剂量较使用注射器防护套注射操作降低99%以上。结论 自动分装注射系统操作简便,分装精度高,重复性好,防护安全,达到设计功能和放射防护要求。