遗传性非息肉病性大肠癌30例临床病理特点与诊治分析

目的：探讨遗传性非息肉病性大肠癌（hereditary nonpolyposis colorectal cancer,HNPCC）的临床病理及分子病理特征,提高对该病的认识和诊疗水平。方法：回顾性分析中南大学湘雅医院普通外科诊治的30例HNPCC病人,以同期在该院治疗的散发性结直肠癌25例为对照组。比较其发病年龄、肿瘤部位、病理类型、治疗方法及预后。采用免疫组织化学检测两组病人错配修复基因（mismatch repair genes,MMR）MLH1和 MSH2 表达缺失率。结果：与对照组相比,HNPCC组的发病年龄早,近段大肠癌比例高,易于合并多发癌,肿瘤高分化类型所占比例高（P＜0.05）。MLH1和 MSH2 表达缺失率高于对照组（P＜0.05）。HNPCC组中1/3的病人接受了大肠次全切除术,预后与散发大肠癌相当（P＞0.05）。结论：HNPCC具有发病早,易合并多发癌的特点,结合MMR的检测可提高诊断的准确率。彻底手术和密切随访可取得好的效果。     

Long-term effect of pharyngeal flap surgery on craniofacial and nasopharyngeal morphology in patients with cleft palate

The craniofacial morphology of 48 consecutive adult males with isolated cleft palate was studied by means of lateral cephalograms at the mean age of 18.8 years. Twelve of the patients had received pharyngeal flap surgery between 4 and 12 years of age (mean age 6 years) to improve speech. No significant differences were noticed in craniofacial cephalometric relations between the patients who had not had velopharyngeal flap surgery (VPF-) and those who had (VPF+), although the latter showed a tendency toward a more vertical growth direction. In the pharynx, the VPF+ group showed larger sagittal depths of nasopharyngeal airway but smaller depths of oropharyngeal airway. The differences were significant at the levels of the upper nasopharynx and lower oropharynx. According to the hospital records, none of the patients demonstrated persistent airway obstruction. Cephalometry may be useful in evaluating the changes in pharyngeal airway dimensions that may be related to velopharyngeal flap surgery.     

信息-动机-行为技巧模型在抑郁症患儿父母健康教育中的应用效果研究

背景　青少年抑郁症常症状不典型,患儿、患儿家属及社会对该病认识普遍不足,难以正确意识疾病危害,即便青少年想要接受治疗,也常受到家属的阻挠,导致无法规范治疗。目的　探究信息-动机-行为技巧模型在抑郁症患儿父母健康教育中的应用效果。方法　选取2018年6-12月在南昌大学第二附属医院心身医学科治疗的90例抑郁症患儿的父母为研究对象。采用随机数字表法将其分为A组（接受常规健康宣教）和B组（接受信息-动机-行为技巧模型指导下健康教育）,各45例。于基线时和干预12周后采用焦虑自评量表、抑郁自评量表、自我感受负担量表调查两组患儿父母负性情绪和自我感受负担,于干预12周后采用自行设计的调查表调查两组患儿父母抑郁症疾病知识掌握情况。结果　基线时,两组焦虑自评量表、抑郁自评量表标准分比较,差异均无统计学意义（P>0.05）;干预12周后,B组焦虑自评量表、抑郁自评量表标准分均低于A组（P<0.05）。两组干预12周后焦虑自评量表、抑郁自评量表标准分均低于基线时（P<0.05）。基线时,两组患儿父母照护体力负担、经济负担、情感负担、家庭负担、社会负担、心理负担得分比较,差异均无统计学意义（P>0.05）;干预12周后,B组患儿父母照护体力负担、经济负担、情感负担、家庭负担、社会负担、心理负担得分均低于A组（P<0.05）。两组干预12周后照护体力负担、经济负担、情感负担、家庭负担、社会负担、心理负担得分均低于基线时（P<0.05）。干预12周后,B组患儿父母疾病知识、家庭管理技术和复诊要求得分均高于A组（P<0.05）。结论　信息-动机-行为技巧模型指导下健康教育能够改善患儿父母负性情绪,减轻其自我感受负担,极大促进患儿父母掌握抑郁症疾病知识,提升抑郁症患儿父母管理技能,优化抑郁症患儿家庭管理方案,有更高的复诊意愿。     

Amplification of fgfr4 gene in human breast and gynecological cancers

We have investigated gene amplification of fibroblast growth factor receptor-4 (FGFR4) gene in 30 primary breast tumor samples and 15 gynecological tumor samples. Ten percent of the breast tumors showed 2- to 4-fold amplification. Amplification was found more frequently in estrogen- and progesterone-receptor-positive tumors and in tumors with high lymph-node involvement. Breast tumor samples were also analyzed for the amplification of fgfr3 and erbB2 genes and the chromosome I Iq 13 located genes hst I Iint2lbci1 /sea. erbB2 gene was amplified 2- to 13-fold in 13% of the cases, but no amplification of int2/hst I/be/1/sea amplicon was found. Gynecological tumors were also analyzed for the amplification of fgfr4 and fgfr3 genes and for int2 and hst I oncogenes. Eleven of the 15 gynecological tumors were ovarian neoplasms including 2 benign tumors; the remainder comprised I ovarian metastasis of breast cancer; I endometrial cancer; I uterine leiomyosarcoma and I carcinosarcoma of the fallopian tube. In gynecological tumors, fgfr4 gene was found to be amplified in 2 ovarian tumors. Amplification of hst I was found in I benign ovarian tumor. Thus, the fgfr4 gene may be involved in breast and ovarian tumorigenesis.     

防护剂量监测质量控制的初步工作

为了加强防护剂量监测中的质量控制工作,我们建立了一个用于此目的的剂量学实验室.在X线防护监划、医用诊断X线工作人员剂量与效应研究及医疗照射研究等项工作中,已用这个实验室的条件开展了X线防护仪器的统一刻度,以及个人剂量监测方法比对等项实验工作.本文主要介绍这个实验室的基本条件以及第～次X线防护仪器统一刻度和个人剂量监测方法比对的主要结果.     

Genetic variants of apolipoprotein B: relation to serum lipid levels and coronary artery disease among the Finns.

The genetic variation of apolipoprotein B has been studied extensively in Finns with the aid of protein and DNA polymorphisms. Population association studies confirmed significant associations between the XbaI polymorphism of the apolipoprotein B gene and elevated serum cholesterol levels, and dietary studies suggested that the XbaI and ins/del polymorphisms might modify the serum lipid response to dietary fat intake. Studies comparing patients and controls, however, did not confirm previous studies suggesting that the multi-allelic variation at the 3'VNTR region of the apolipoprotein B gene was associated with coronary artery disease. The results suggest that the apolipoprotein B gene is involved in the regulation of serum lipid levels. A yet unknown mutation in linkage disequilibrium with the XbaI site may contribute to this regulation.     

A Qualitative Study of the Difficulties of Smoking Cessation; Health Care Professionals'' and Smokers'' Pints of View

AbstractObjective: To obtain a deeper understanding of smokers' feelings and to establish co-operative networking groups,the opinions about smoking cessation of health careprofessionals and smokers were studied.Design: Focus group discussions were held in order to gainideas and tools to be used in smoking cessation work, inparticular in network groups. Two focus group discussions forhealth care professionals (n = 7) and one focus groupdiscussion for ex-smokers/smokers (n = 3) were held.Results: The study suggests that problems exist in smokingcessation work among health care professionals. The mainissues among the health care professionals were lack ofmotivation and consistency of approach. Informationconcerning the health risk related to smoking no longerreaches people. New ways of health promotion are desired.Smokers feel that lack of positive support and nicotinedependence are the main problems in their attempts to quit.Conclusions: Society and smokers have the same goal:smoking cessation. However, both parties do not seem toagree on ways of achieving this goal. A local network amonghealth care professionals could motivate and give rise to newmethods of smoking cessation counselling. Positive supportand nicotine replacement therapy could significantlyimprove smokers' success rates. Trained personnel havebetter opportunities for meeting smokers and that is whycessation should be part of the core curriculum and basictraining for health care professionals.     

Antibodies to synthetic peptides from Epstein-Barr nuclear antigen-1 in sera of patients with early rheumatoid arthritis and in preillness sera

We studied IgG antibody levels to synthetic peptides (p62, E11 and E3) from Epstein-Barr nuclear antigen-1 (EBNA-1) protein sequence in sera of patients with rheumatoid arthritis (RA), in pre-RA and in rheumatoid factor (RF) positive non-RA sera from Finland. Anti-E11 and anti-E3 antibody levels were significantly elevated in RA sera, compared with both RF negative and RF positive nonrheumatoid controls. The concentrations of anti-E11 and anti-E3 antibodies in the preillness sera were lower than those in RA sera. Eight-year followup samples of patients with RA had slightly decreased levels of anti-E3 and anti-E11 antibodies compared with samples taken within 6 months of the disease onset. Anti-p62 antibody levels did not differ significantly between any of the groups studied. Thus, elevated levels of antibodies to 2 of the glycine containing EBNA-1 peptides were associated with clinical RA.     

Effect of polydextrose on intestinal microbes and immune functions in pigs

Dietary fibre has been proposed to decrease risk for colon cancer by altering the composition of intestinal microbes or their activity. In the present study, the changes in intestinal microbiota and its activity, and immunological characteristics, such as cyclo-oxygenase (COX)-2 gene expression in mucosa, in pigs fed with a high-energy-density diet, with and without supplementation of a soluble fibre (polydextrose; PDX) (30 g/d) were assessed in different intestinal compartments. PDX was gradually fermented throughout the intestine, and was still present in the distal colon. Irrespective of the diet throughout the intestine, of the four microbial groups determined by fluorescent in situ hybridisation, lactobacilli were found to be dominating, followed by clostridia and Bacteroides. Bifidobacteria represented a minority of the total intestinal microbiota. The numbers of bacteria increased approximately ten-fold from the distal small intestine to the distal colon. Concomitantly, also concentrations of SCFA and biogenic amines increased in the large intestine. In contrast, concentrations of luminal IgA decreased distally but the expression of mucosal COX-2 had a tendency to increase in the mucosa towards the distal colon. Addition of PDX to the diet significantly changed the fermentation endproducts, especially in the distal colon, whereas effects on bacterial composition were rather minor. There was a reduction in concentrations of SCFA and tryptamine, and an increase in concentrations of spermidine in the colon upon PDX supplementation. Furthermore, PDX tended to decrease the expression of mucosal COX-2, therefore possibly reducing the risk of developing colon cancer-promoting conditions in the distal intestine.     

乳腺癌改良根治术后容积调强弧形治疗与调强放疗剂量比较的Meta分析

目的 比较乳腺癌改良根治术后容积调强弧形治疗(VMAT)与调强放疗(IMRT)对计划靶区(PTV)和危及器官(OAR)的剂量学差异,为临床提供循证学依据。方法 根据纳入和排除标准,计算机检索PubMed、Cochrane Library、FMRS、中国知网、万方数据库及维普全文期刊数据库,筛选所有乳腺癌改良根治术后VMAT与IMRT剂量学比较的文献纳入研究。检索时间从建库至 2020年3月。应用Stata14.0软件进行Meta分析。结果 13项研究的 281例纳入Meta分析。与IMRT计划相比,VMAT计划明显提高PTV剂量 (D95%,P<0.001),明显改善PTV剂量均匀性(P<0.001)和适形性(P=0.004)。VMAT计划较IMRT计划有效降低患侧 肺V20Gy (P=0.027)和健侧 肺V10Gy (P=0.003);而患侧肺 Dmean、V5Gy、V10Gy、V30Gy,健侧肺 Dmean、V5Gy,心脏 Dmean、V10Gy、V30Gy两组计划均相近(均 P>0.05)。IMRT计划较VMAT计划降低心 脏V5Gy (P=0.001),但对心 脏V5Gy纳入文献进行敏感性分析,显示结果稳定性较差。VMAT计划比IMRT计划明显减少治疗时间(P<0.001)和机器跳数(P<0.001)。结论 乳腺癌改良根治术后放疗中VMAT比IMRT在靶区剂量覆盖、均匀性和适形性,对患侧肺和健侧肺保护,以及治疗效率方面均更具剂量学优势。