人乳头瘤病毒在宫颈癌前病变诊断中的意义

目的用人乳头瘤病毒杂交捕获法（hc2 HPV DNA）监测宫颈癌前病变,提高诊断率。方法hc2 HPV DNA和TCT两种方法并用检测1231例宫颈外口及颈管脱落细胞。结果1231例样本中,HPV感染率34．0％,而21～40岁年龄段略高于其他年龄段;宫颈鳞状上皮正常HPV感染率23．2％。在细胞学诊断为ASC-us、ASC-h、LSIL和HSIL组中,HPV感染率依次为50．0％、58．8％、76．7％和93．3％。TCT检测：正常＋炎症1077例;asc-us 32例;ASC-h 34例;LSIL 73例,HSIL 15例。ASC-us、ASC-h、LSIL和HSIL检出率分别为2．6％、2．8％、5．9％和1．2％。统计学检验表明：HPV感染与细胞形态和结构的异常具有高度相关性（P〈0．01）。结论在宫颈鳞状上皮正常时HPV感染率最低,重度炎症时HPV感染率出现增高的趋势;当细胞形态和结构出现异常时,HPV的感染率明显增加,即HSIL〉15IL〉ASC-h〉ASC-us〉正常＋炎症。     

新辅助放化疗在中晚期低位直肠癌全直肠系膜切除术的作用

目的:探讨2种新辅助放化疗(NCR)在中晚期直肠癌全直肠系膜切除术的作用。方法:78例T3、T4期低位直肠癌随机分为两组,每组39例。全部给予放疗,每次2Gy,总剂量45～50Gy,每周5次。A组同时辅以5-氟尿嘧碇(F-FU)、亚叶酸钙治疗(LV),B组同时辅以希罗达(Xeloda)治疗。放疗结束休息6周后进行手术。手术均按全直肠系膜切除术操作规范进行。结果:全部病人按计划完成NCR,其中11例肿瘤完全消失,未行手术。67例施行了根治性切除术,65例为保肛手术。2例为腹会阴切除术。病理结果显示10例肿瘤消失(TO)。总的肿瘤消失为21例。T2No13例,T3No26例,T2-3No18例,无T4期。共52例(66.67%)达到降期(down staging)。全组随访6～42个月。无局部复发,4例肺转移,总复发率5.13%,无死亡,无瘤生存和无复发生存率均为94.87%。结论:NCR与全直肠系膜切除术操作规范相结合有效地达到肿瘤降期的目的,肿瘤缩小,切除率和保肛率均明显增加,降低了复发的风险。     

超声吸引刀联合双极电凝与射频凝血器肝切除术的临床比较

目的探讨超声吸引刀(cut-ultrasound aspiration,CUSA)联合双极电凝与射频凝血器(radiofrequency coagulation device,RFA)行肝切除术的临床应用效果。方法回顾性分析我院2012年1月至2013年12月期间肝胆外科治疗的108例肝切除术患者的临床资料,根据术中采用断肝方式不同分为两组:射频凝血器组(RFA组)55例和超声吸引刀联合双极电凝组(CUSA组)53例。比较两组肝门阻断率、手术时间、术中出血量、输血率、术后肝功能、术后并发症发生率、术后住院时间的差异,进行分析评价。结果两组患者围术期均无死亡病例;射频凝血器切肝肝断面形成1.5~2 cm的消融凝固带,而超声吸引刀联合双极电凝切肝肝断面损伤厚约0.5 cm肝组织。与CUSA组比较,射频凝血器组肝门阻断率低、手术时间短、术中出血少、输血率低(P<0.05)。两组术后肝功能、并发症发生率、术后住院时间差异无统计学意义(P>0.05)。结论应用射频凝血器与超声吸引刀联合双极电凝行肝脏切除都是安全有效的,可根据各自优缺点选择应用。     

丙型肝炎病毒感染对肾移植术后影响的临床研究

OBJECTIVE: To study the influence of hepatitis C virus (HCV) infection on the clinical outcome of kidney transplantation. METHODS: The recipient/graft survival, the incidence of acute/chronic rejection and cause of death in 86 HCV-infected recipients of renal transplantation were compared with those in another 86 recipients without HCV infection. RESULTS: HCV-infected recipients had significantly shorter 5-year survival (74.4%) than those without HCV infection (87.2%, P<0.01). The 1-year (94.2%/90.7% vs 96.8%/96.0%) and 3-year recipient/graft survival rates (88.4%/79.1% vs 90.7%/87.2%), the incidence of acute/chronic rejection (31.3% vs 21.2%, and 12.5% vs 6.5%) and the 5-year graft survival (73.3%/81.4%) were comparable between the two groups (P>0.05). Hepatic disease was identified as the primary cause of mortality. CONCLUSIONS: HCV infection may affect the long-term survival of the recipients with kidney transplantation, and therefore should be considered as a relative contraindication of kidney transplantation.     

2006年天津市精神科住院服务现状分析

目的了解天津市精神科住院服务现况。方法现况调查。使用天津市医疗机构精神卫生服务状况调查问卷调查天津市18个区县365家医疗机构2006年精神科床位的分布情况以及精神科住院服务的利用情况。结果 2006年天津市有21家医疗机构提供精神科住院服务,共拥有精神科医生497人,精神科护士876人,精神科床位4281张,按人口密度计算分别为4.76人/10万人、8.4人/10万人、4.11张/万人。全年总住院人次10449人次。精神卫生资源主要分布在中心城区、精神专科医院、三级医院,住院服务的利用主要在中心城区和精神专科医院。结论天津市精神科住院服务资源水平相对较高,但是精神科床位在全市的分布不均衡。     

Effectiveness of E-SBIRT intervention in community healthcare institution in China: study proposal for a randomised controlled trial

BackgroundMany studies have demonstrated the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) in addressing substance use problem. However, owing to the shortage of counsellors, it has not been widely used in China. With the development of smart medicine, we developed a web-based electronic SBIRT (E-SBIRT) program and explored the effectiveness of E-SBIRT in reducing substance use in China.MethodsA randomised controlled trial will be conducted in primary healthcare institutions. Four primary healthcare institutions will be selected and randomly divided into an intervention group and a control group (each institution will recruit 60 participants, and in total, 240 participants will be recruited). The control group will get a pamphlet of drug abuse prevention, and the intervention group will get the E-SBIRT intervention and the pamphlet. Both groups will receive baseline and follow-up assessment at 1 and 3 months after the intervention. The primary outcome is the change in scores on the Alcohol, Smoking and Substance Use Involvement Screening Test, and the secondary outcomes include changes in motivation, depression, anxiety, positive/negative emotion, self-esteem, addiction knowledge and addiction severity index.ConclusionsIf the ‘E-SBIRT’ program is found to be effective, it will be an accessible, affordable and widely implementable intervention to help participants at moderate risk of substance use to reduce their consumption. The potential benefit is to provide early intervention to high-risk patients in time and reduce the harmful consequences to individuals and society.Trial registration number{"type":"clinical-trial","attrs":{"text":"NCT03452241","term_id":"NCT03452241"}}NCT03452241.     

青少年抑郁症患者自杀行为的影响因素研究

目的 探讨家庭及其他因素对青少年抑郁症患者自杀行为的影响。方法 选取于 2020 年6 月至 2021 年 12 月在荆门市第二人民医院儿童青少年心理科住院的 126 例青少年抑郁症患者进行横断面调查,根据近 6 个月内是否有自杀行为分为自杀组（n=76）及非自杀组（n=50）。采用一般情况调查表、患者健康问卷抑郁症状群量表（PHQ-9）、自杀意念自评量表（SIOSS）、家庭亲密度与适应性评定量表（FACES Ⅱ-CV）对两组患者的一般资料、抑郁程度、自杀意念、家庭分型进行比较。采用 Spearman 相关分析患者自杀行为与一般资料、PHQ-9、SIOSS、FACES Ⅱ-CV 评分的相关性。采用二元 Logistic 回归模型对患者自杀行为的影响因素进行分析。结果 自杀组饮酒者占 40.8%（31/76）,有精神疾病家族史者占 27.6%（21/76）,分别高于非自杀组的 20.0%（10/50）、12.0%（6/50）,差异有统计学意义（P＜ 0.05）。自杀组患者 PHQ-9 评分、SIOSS 总分、绝望因子评分及睡眠因子评分高于非自杀组［19.0（15.0,21.8）分比 15.0（10.8,19.0）分、15.0（14.0,16.8）分比 13.0（11.0,15.0）分、12.0（10.3,12.0）分比 10.0（7.8,12.0）分、3.0（2.0,3.0）分比 2.0（1.0,3.0）分］,家庭亲密度评分低于非自杀组［50.5（43.3,57.0）分比 57.5（48.8,65.5）分］,差异均有统计学意义（P＜ 0.05）。自杀组患者中极端型家庭占 67.1%（51/76）,高于非自杀组的 44.0%（22/50）,差异有统计学意义（P＜ 0.05）。患者自杀行为与家庭亲密度呈负相关（r=-0.224,P＜0.05）,与 PHQ-9 评分、SIOSS 总分、绝望因子评分、睡眠因子评分、饮酒、有精神疾病家族史呈正相关（r=0.346、0.373、0.361、0.324、0.206、0.217、0.186;P＜ 0.05）。二元 Logistic 回归分析显示,饮酒（OR=3.066,95%CI=1.184～7.941）、家 庭 适 应 性 高（OR=1.126,95%CI=1.034～1.227）、PHQ-9 评 分 高（OR=1.197,95%CI=1.087～1.317）是青少年抑郁症患者自杀行为的危险因素（P＜ 0.05）,家庭亲密度高是自杀行为的保护因素（OR=0.878,95%CI=0.813～0.948）。结论 青少年抑郁症患者自杀行为发生率较高,家庭分型更多见于“僵硬 - 松散”的极端型家庭,有饮酒行为、严重抑郁、家庭关系不良者更容易自杀     

Artifact removal in the context of group ICA: A comparison of single‐subject and group approaches

Independent component analysis (ICA) has been widely applied to identify intrinsic brain networks from fMRI data. Group ICA computes group‐level components from all data and subsequently estimates individual‐level components to recapture intersubject variability. However, the best approach to handle artifacts, which may vary widely among subjects, is not yet clear. In this work, we study and compare two ICA approaches for artifacts removal. One approach, recommended in recent work by the Human Connectome Project, first performs ICA on individual subject data to remove artifacts, and then applies a group ICA on the cleaned data from all subjects. We refer to this approach as Individual ICA based artifacts Removal Plus Group ICA (IRPG). A second proposed approach, called Group Information Guided ICA (GIG‐ICA), performs ICA on group data, then removes the group‐level artifact components, and finally performs subject‐specific ICAs using the group‐level non‐artifact components as spatial references. We used simulations to evaluate the two approaches with respect to the effects of data quality, data quantity, variable number of sources among subjects, and spatially unique artifacts. Resting‐state test–retest datasets were also employed to investigate the reliability of functional networks. Results from simulations demonstrate GIG‐ICA has greater performance compared with IRPG, even in the case when single‐subject artifacts removal is perfect and when individual subjects have spatially unique artifacts. Experiments using test–retest data suggest that GIG‐ICA provides more reliable functional networks. Based on high estimation accuracy, ease of implementation, and high reliability of functional networks, we find GIG‐ICA to be a promising approach. Hum Brain Mapp 37:1005–1025, 2016. © 2015 Wiley Periodicals, Inc .