慢性咽喉炎患者健康教育需求调查及对策

目的 了解慢性咽喉炎患者对健康教育知识、方法的需求,引导患者建立健康生活行为方式,有效地减轻慢性咽喉炎的症状和避免复发.方法 自行设计问卷,对我院耳鼻喉科门诊100例慢性咽喉炎患者进行调查.结果 患者现有的相关知识较为贫乏,但他们对慢性咽喉炎的发病原因、诱发因素与治疗方法、效果及自身病情、用药方法等诸多问题都十分关注,并且都迫切希望能得到医护人员的讲解,告知和指导其健康行为.结论 采用多形式施教,加强对慢性咽喉炎患者的健康教育,对提高患者对疾病以及相关知识的认知水平,促进培养良好的健康行为,减轻疾病症状和避免复发有重要意义.     

新型农村合作医疗中政府职责定位及对策分析——基于公共物品理论视角

运用公共物品理论对新型农村合作医疗的公共物品属性及政府的职责进行界定,通过分析认为,新型农村合作医疗属于准公共物品,政府在供给上负有不可推卸的责任。然而,新型农村合作医疗试点过程中,由于政府职责缺位产生了诸多问题,针对这些问题进行分析,并提出相应解决问题的对策。     

番茄红素对环孢素所致大鼠肾毒性的保护作用

目的:研究番茄红素(lycopene,LP)对环孢素(cyclosporine,CsA)所致肾功能衰竭的保护作用及机制。方法:雄性SD大鼠po给予溶媒或LP(10mg/kg)6d后,再联合给予0.9%氯化钠注射液或CsA(50mg/kg)14d,观察大鼠肾功能与肾脏组织的结构改变。结果:连续14d给予CsA可致大鼠体重下降,血清肌酐(creatinine,Crea)和尿素氮(blood urea nitrogen,BUN)水平显著升高、肌酐清除率(creatinine clearance,Ccr)和肾脏抗氧化活性下降,肾脏组织出现大量细胞排列紊乱和小管萎缩。提前给予LP可以有效增加肾脏抗氧化能力,逆转CsA所致的大鼠体重下降和肾功能衰竭,降低大鼠血清Crea和BUN而提高体内Ccr;组织病理学检测也证实LP可有效的拮抗CsA引起的肾小管变性萎缩。结论:LP能有效拮抗CsA所致的大鼠肾功能衰竭,其作用与LP可以增强CsA大鼠抗氧化能力有关。     

大鼠Ⅲ度烫伤后异体、自体皮混合移植局部透明质酸含量的变化

目的 探讨混合移植皮片中细胞外间质的变化。方法 采用放射免疫方法测定了大鼠Ⅲ度烫伤后混合移植(异体皮打洞嵌植自体皮片)后3、5、7、14、21、28d自体皮区和异体皮区透明质酸的含量变化。结果 移植后自体皮区和异体皮区透明质酸含量变化均是先下降后上升，但自体皮区升高早于异体皮区，在移植后第14天(嵌植第12天)即开始显升高，至28d仍显高于正常对照，而异体皮区在移植后第21天才显升高，升高幅度也无自体皮区明显。结论 在植皮同时适当外用透明质酸可能更有利于移植皮区的愈合和重建。     

Using the initial vector from surface electrocardiogram to distinguish the site of outflow tract tachycardia

BACKGROUND: The purpose of this study is to determine whether initial vector force might best distinguish tachycardias arising from the right ventricular (RV) outflow tract (OT) versus aortic sinus cusps (ASCs). METHODS: Among 45 patients with OT tachycardia, we measured the time from the earliest QRS onset in any lead to local onset and to the first QRS peak/nadir in each surface leads during VT. We compared the earliest phase differences among patients with foci in RVOT (n = 32) and in ASCs (n = 13) (determined by ablation), using unpaired t-tests. We determined the optimum cut-points by analyzing the receiver-operator characteristics curves, and derived an algorithm to discriminate ASC from RVOT foci. RESULTS: Compared with an RVOT focus, origin in the ASC was associated with lower likelihood that the earliest lead of QRS activation was V2 (4/13 [12%] vs 29/32 [88%], P = 0.0001), later initial peak/nadir in III (110 +/- 19 vs 93 +/- 16 ms, P = 0.0026) and V2 (75 +/- 26 vs 42 +/- 19 ms, P < 0.0001). After determining the optimum cut-points for each, we found that the presence of any one of these findings discriminated well between RVOT and ASC foci (sensitivity 92%, specificity 88%, positive predictive value 75%, and negative predictive value 97%). The sensitivity and specificity using standard ECG criteria were inferior to the vector approach. CONCLUSIONS: The ECG phase differences during VT can distinguish the origin of OT-VT. Earliest onset or first peak/nadir in V2 and early initial peak/nadir in the inferior leads suggest a RVOT focus.     

用于肿瘤调强放射治疗影像分析与转换的深度学习方法

癌症已成为严重威胁人类健康的主要公共卫生问题。60%~70%的癌症患者需要进行放射治疗。调强放疗是当前主要的临床放疗技术。对近几年基于深度学习的影像分析与转换方法在肿瘤调强放疗计划中的应用进展及关键技术进行综述,包括计算机断层扫描(CT)、锥形束CT(CBCT)、磁共振成像(MRI)、正电子发射断层扫描(PET)引导的肿瘤调强放疗技术应用现状与发展趋势,肿瘤CT/CBCT/MRI/PET影像放疗靶区分割、影像配准以及转换深度卷积神经网络、生成对抗网络的有监督或无监督学习方法,并对未来的研究方向进行展望。     

Characterization of LY2775240, a selective phosphodiesterase‐4 inhibitor,in nonclinical models and in healthy subjects

AbstractLY2775240 is a highly selective, potent and orally‐administered inhibitor of phosphodiesterase 4 (PDE4), and is being investigated as a treatment option for inflammatory disorders, such as psoriasis. LY2775240 was investigated in rodent and rhesus monkey nonclinical models. Treatment with LY2775240 led to significant reductions in TNFα production, a marker of PDE4 engagement upon immune activation, in both nonclinical models. In the first part of a 2‐part first‐in‐human randomized study, a wide dose range of LY2775240 was safely evaluated and found to be well‐tolerated with common adverse events (AEs) of nausea, diarrhea, and headache. No serious AEs were reported. The pharmacokinetic profile of LY2775240 was well‐characterized, with a half‐life that can support once‐a‐day dosing. An ex vivo pharmacodynamic (PD) assay demonstrated dose‐dependent PDE4 target engagement as assessed by reduction in TNFα production. A 20 mg dose of LY2775240 led to near‐maximal TNFα inhibition in this PD assay in the first part of the study and was selected for comparison with the clinical dose of apremilast (30 mg) in the crossover, second part of this study. The 20 mg dose of LY2775240 demonstrated sustained maximal (50%–80%) inhibition of TNFα over all timepoints over the 24‐h duration. The comparator apremilast achieved peak inhibition of ~ 50% at only 4 h postdose with a return to about 10% inhibition within 12 h of dosing. In summary, the nonclinical data and safety, tolerability, and PK/PD data in healthy subjects supports further investigation of LY2775240 in inflammatory indications. Study Highlights

• WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?

Phosphodiesterase 4 (PDE4) inhibitors, such as apremilast, are currently approved to treat autoimmune disorders, such as psoriasis. LY2775240 is an oral PDE4 inhibitor being developed for treatment of a variety of inflammatory disorders. The degree of enzymatic inhibition achieved by PDE4 inhibitors clinically is poorly understood.

• WHAT QUESTION DID THIS STUDY ADDRESS?

This study investigated single ascending doses of LY2775240, a highly selective oral PDE4 inhibitor, in healthy subjects. LY2775240 was well‐tolerated over the dose range evaluated, and pharmacokinetic/pharmacodynamic (PD) profiles were well‐characterized.

• WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE?

This study evaluated different doses of LY2775240 and subsequently compared a selected LY2775240 dose with the clinical dose of apremilast with an ex vivo assay. This information builds a connection between target engagement and clinical efficacy.

• HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?

This is the first report of an ex vivo PD assay that has been systematically implemented in a PDE4 inhibitor Phase 1 study. Early investigation of exposure‐response relationships versus a comparator can support evaluation of clinically meaningful doses of investigational agents.     

50岁及以上人群生活质量与体力活动的关联研究

目的 探讨上海市≥50岁人群体力活动水平和生活质量之间的关系。方法 2009年10月至2010年6月使用多阶段随机整群抽样方法抽取上海市5个区8 872名≥50岁的中老年人,使用全球体力活动问卷和WHO生活质量量表8项版（WHOQoL-8）评估体力活动水平和生活质量,并获取社会人口学及健康、社会参与等信息,采用两水平（个体层面和社区层面）线性模型分析不同年龄段的中老年人群其体力活动水平与幸福感的关系。结果 共纳入有效样本8 454份,年龄为（63.16±9.74）岁,体力活动水平较低的人群占59.95%,中等体力活动水平的人群比例为28.00%,高体力活动水平者仅占12.05%。WHOQoL-8生活质量得分为43.91±0.69,体力活动水平越高,WHOQoL-8得分越低,生活质量越好（P=0.00）。在控制社会经济因素和健康状况、社会参与等混杂因素后,对<80岁各个年龄段的中老年人群而言,体力活动水平的增高对提高生活质量具有显著作用（P<0.05）,然而对≥80岁的高龄人群,和低水平体力活动相比,中水平和高水平的体力活动对提升生活质量不具备有意义的影响,P值分别为0.06及0.47。结论 上海市≥50岁且<80岁的人群中,较高的体力活动水平与较好的生活质量相关。     

阴式子宫次全切除术的临床应用

目的 探讨非脱垂、良性病变的子宫实施保留宫颈的阴式子宫次全切除术的可行性和安全性.方法 对要求保留宫颈的86例非脱垂、良性子宫病变患者实施阴式子宫次全切除术,并选择同期90例经腹次全子宫切除术患者作为对照,比较两组患者平均手术时间、术中出血量、术后肛门排气恢复时间、术后病率、术后住院时间.结果 86例阴式子宫次全切除术患者中除2例借助腹腔镜分离盆腔粘连后完成阴式手术外,其余均获成功.两组比较,平均手术时间、术中出血量及术后住院时间的差异均无统计学意义（均P〉0.05）,而肛门排气时间明显缩短（P〈0.01）,术后病率亦明显下降（P〈0.05）.结论 对非脱垂子宫、良性病变子宫（小于孕12周）者,严格掌握适应证实施阴式子宫次全切除术是相对安全、可行的,借助腹腔镜可扩大手术适应证.