Ontario, Canada: using networks to integrate palliative care province-wide

Ontario, a Canadian province, identified the lack of coordination, integration, and consistency of end-of-life care services as barriers to quality palliative care. To address these barriers, various governmental, organizational, and community-level initiatives were implemented. The Ministry of Health and Long-Term Care enacted an End-of-Life Care Strategy in 2005 aimed at shifting care from acute settings to appropriate alternate settings of care; enhancing client-centered and interdisciplinary service capacity; and improving access, coordination, and consistency of services. Crucial to accomplishing the strategy was the establishment of End-of-Life Networks within health care planning regions. The networks were instrumental in developing end-of-life care service delivery models in the various regions, bringing key stakeholders together toward a common vision, and building strong collaborations across providers and settings. Cancer Care Ontario, an organization dedicated to improving cancer care at the regional and provincial levels, also leads improvements in palliative care through the implementation of a palliative strategy for cancer patients aimed at improved measurement of quality indicators, increased use of evidence and standards, and increased efficiency and access to care. A regional network of organizations in Southeastern Ontario created a quality improvement project, the Palliative Care Integration Project (PCIP), which disseminated common symptom assessment tools, collaborative care plans, and evidence-based guidelines across the continuum of care. The PCIP was embraced by key stakeholders across the province as a model intervention to better coordinate, integrate, and standardize palliative care service delivery, and is currently being spread across all regions of the province.     

暴露唐山大地震6个月胎儿成年后的分裂样人格特征

目的:评估暴露与未暴露于唐山大地震的6个月胎儿成年后发展为分裂样人格的可能性。方法:①被试对象为来自于唐山地区的14所高中学校的所有18周岁的高中三级学生。剔除1976年地震时母亲不在唐山地区居住的学生。设出生于1976-07-28/1977-04-28学生604人为暴露组,1977-07-28/1978-04-28出生的学生601人为对照组。为确保两组在接受评估时的年龄相同暴露组和对照组的测试时间分别为1995-12和1996-12。接受调查的学生均对本调查目的知情同意。②采用Raine分裂样人格问卷作为分裂性人格特征的测量工具。该问卷包括22项"是""否"的选择题,由此产生总分及3个因子分:认知因子、人际关系因子、紊乱因子,该量表评分越高(0￣20分),分裂样人格的可能性越大。③两组的测验结果比较采用t检验。结果:暴露组有603人和对照组598人完成Raine分裂样人格问卷的评定数据,获得有效报告,并进入结果分析。①两组妊娠6个月胎儿Raine分裂样人格问卷评分比较:暴露组妊娠6个月胎儿Raine分裂样人格问卷总分和认知因子分分别为(9.1±4.6)和(13.4±2.1)分,明显高于对照组[(7.6±3.6),(2.7±1.6)分,t=2.04,2.00,P<0.05],人际关系缺陷因子和紊乱因子比较,差异不明显(P>0.05)。②两组妊娠第6个月不同周数胎儿的Raine分裂样人格问卷总分和因子分比较:暴露组妊娠第23周胎儿的Raine分裂样人格问卷总分明显高于对照组(t=2.1,P<0.05),认知因子分有高于对照组的倾向,但差异不明显(P>0.05),紊乱因子分明显高于对照组(t=2.3,P<0.05)。两组妊娠第21,22,24周胎儿Raine分裂样人格问卷评分差异不明显(P>0.10)。结论:暴露于唐山大地震的6个月胎儿成年后发展为分裂样人格的可能性更大。     

骨髓间质干细胞移植治疗大鼠急性心肌梗死的病理学观察

目的:观察急性心肌梗死大鼠行骨髓间质干细胞移植后受损心肌组织的病理形态学变化。方法:实验于2004-01/2005-06在上海胸科医院完成。选取健康成年雌性SD大鼠40只,随机数字表法分为骨髓间质干细胞注射组、模型对照组,20只/组。①两组大鼠均建立心肌梗死模型。造模0.5h后,骨髓间质干细胞注射组于结扎点下方缺血区域组织注射Dill标记的骨髓间质干细胞3×106个,模型对照组心肌缺血区域注射100μL生理盐水。②造模后4～6周处死两组大鼠,取出心脏,剪除双侧心房及右心室,沿左心室长轴由心尖到底部做3mm厚切片,镜下观察心肌梗死区域病理组织学表现。③选择心肌梗死表现明显的蜡块切片,行酸性复红染色,用LeicaQWin多媒体彩色病理图文分析软件进行图像分析,自动测量出切片中心肌梗死组织占总面积的百分比。免疫组化检测梗死心肌血管内皮生长因子和FactorⅧ蛋白因子的表达情况。结果:40只大鼠均进入结果分析。①梗死心肌的病理形态学观察:光镜下两组均可见大小不等的心肌梗死灶,梗死心肌区域细胞肿胀坏死,严重缺血坏死区出现心肌溶解。但骨髓间质干细胞注射组上述改变明显弱于模型对照组,其心肌梗死中层可见条索状的梗死灶及纤维瘢痕灶,并且有残存的心肌呈岛状散在分布,纤维瘢痕区域心肌细胞、微血管和毛细血管数量均明显增加,侧支循环丰富。另外,骨髓间质干细胞移植组于造模初期4只大鼠心内膜面有灶性软骨生成,向心室腔突起。②梗死心肌面积百分率的检测:骨髓间质干细胞注射组梗死心肌面积百分率明显低于模型对照组[(3.69±0.48)%,(19.20±1.77)%,t=7.621～10.820,P=0.001]。③梗死心肌血管内皮生长因子和FactorⅧ免疫组化检测:骨髓间质干细胞注射组血管内皮生长因子、FactorⅧ呈阳性表达,模型对照组未检测到血管内皮生长因子和FactorⅧ。结论:骨髓间质干细胞在大鼠心脏内可以转化为血管内皮细胞或分泌血管内皮生长因子,是治疗缺血性心血管疾病理想的细胞来源。心内膜面有灶性软骨生成可能是由于注射细胞时进针太深,警示注意骨髓间质干细胞移植的副反应。     

Effect of incubation with different concentrations and durations of FSH for in-vitro maturation of murine oocytes

The purpose of the study was to evaluate whether a lower concentration of FSH or 2-h incubation with FSH would improve the outcome of in-vitro maturation of oocytes. The immature oocytes were obtained from FVB mice, and were allocated to four groups and incubated in the maturation media for 24 h. The maturation media were supplemented with 10 mIU/ml FSH for 24 h (group 1), 10 mIU/ml FSH for 2 h (group 2), 75 mIU/ml FSH for 24 h (group 3) or 75 mIU/ml FSH for 2 h (group 4). In each group, half of the in-vitro-matured oocytes were fertilized and cultured to blastocysts and the remaining matured oocytes were analysed for growth differentiation factor (GDF)-9 and bone morphogenetic protein (BMP)-15 mRNA to assess the oocyte quality. The maturation rates and oocyte BMP-15 mRNA concentrations were similar among the four groups. The GDF-9 mRNA concentrations were similar in group 2 and group 4. The fertilization and blastocyst rates were higher in groups 2 and 4 than in groups 1 and 3. It is concluded that 2-h incubation with FSH is better than 24-h incubation in terms of the fertilization rate and blastocyst development.