猪嵴病毒福建株全基因克隆及序列分析

目的为研究猪嵴病毒（porcinekobuvirus,PKV）福建株的基因组结构特征。材料与方法根据猪嵴病毒基因组特征设计特异性朝物,运用RT—PCR方法,对猪嵴病毒福建株进行全基因克隆,并运用RACE方法对猪嵴病毒福建株的5,和3’末端进行扩增。结果与结论所获得的猪嵴病毒福建株基因组全长为8210bp,其5’末端长度为576bp·3’末端长度为167bp,编码一个大的多聚蛋白,长度为7467bp,编码2488个氨基酸。其多聚蛋白核苷酸同源性和我国猪嵴病毒分离株cH／HNxx-4／2012（GenBank登录号JX401523）同源性最高,均为89．2％,和匈牙利猪嵴病毒分离株swine／S—1-HUN／2007／Hungary（GenBank登录号（GenBank登录号EU787450）同源性最低,达87．6％。     

鲁北地区子宫内膜癌发病因素病例对照研究

目的：了解子宫内膜癌发病情况及相关因素,为临床进行预防及治疗提供依据。方法：采用病例-对照流行病学分析方法,对鲁北地区6所三级医院2006-05-01-2011-10-01病理确诊的289例子宫内膜癌患者及174例对照进行统一问卷调查;采用单因素和多因素的Logistic回归分析,以OR和95%可信区间为评价指标,分析与子宫内膜癌有关联的危险性因素。结果：鲁北地区子宫内膜癌患者289例,其中子宫内膜样腺癌259例（90%）;非子宫内膜样腺癌（浆液性腺癌,透明细胞癌等）30例（10%）。Ⅰ期患者219例（76%）,Ⅱ期患者29例（10%）,Ⅲ~Ⅳ期患者共41例（14%）。子宫内膜癌的发病年龄为25~78岁,平均发病年龄为55.41岁,58~61岁为发病高峰。已绝经妇女占62%。单因素分析结果表明,高血压（OR=3.67,χ2=33.70,P=0.00）、糖尿病（OR=1.92,χ2=4.13,P=0.04）、肥胖（OR=4.63,χ2=50.62,P=0.00）、饮用茉莉花茶史（OR=2.63,χ2=19.84,P=0.00）、重体力劳动（OR=1.82,χ2=9.28,P=0.00）、月经不规律（OR=12.68,χ2=107.20,P=0.00）、口服中草药调经（OR=15.21,χ2=68.82,P=0.00）、绝经年龄（OR=1.10,χ2=11.56,P=0.00）、未产（OR=19.07,χ2=15.84,P=0.00）和一级亲属恶性肿瘤家族史（OR=2.91,χ2=12.22,P=0.00）等可增加子宫内膜癌发病风险;使用宫内节育器（intrauterine device,IUD）可降低子宫内膜癌发病风险,OR=0.29,χ2=37.21,P=0.00。多因素Logistic回归分析结果表明,高血压（OR=3.69,95%CI：1.89~7.22）、肥胖（OR=3.06,95%CI：1.62~5.75）、月经不规律（OR=4.53,95%CI：2.13~9.60）、口服中草药调经（OR=9.31,95%CI：2.91~29.76）、绝经年龄晚（OR=1.13,95%CI：1.06~1.20）和一级亲属恶性肿瘤家族史（OR=5.20,95%CI：2.13~12.73）是内膜癌发病的危险因素;使用IUD是内膜癌的保护性因素,OR=0.84,95%CI：0.79~0.88。结论：高血压、肥胖和绝经年龄等因素可影响子宫内膜癌的发生,应针对相关危险因素采取相应的预防措施。     

能谱CT虚拟平扫在肾癌中的应用

目的：探讨能谱CT虚拟平扫(VNC)替代常规平扫在肾癌中的临床应用价值。方法回顾分析32例经病理证实为肾癌的患者影像资料,均行能谱CT常规平扫及动脉期、静脉期能谱成像(GSI),采用MSI软件生成动脉期VNC和静脉期VNC图像。分别测量3组图像(常规平扫、动脉期VNC、静脉期VNC)肾脏病灶的CT值、病灶-正常肾脏的对比噪声比(CNR),同层面病灶的长径、橫径,采用单因素方差分析;由2位放射科医师对3组图像分别行5分制图像质量主观评分,3分制影像学征象主观评分,对2位医师评价结果的一致性行Kappa 检验,对3组图像的图像质量主观评分行单因素方差分析。结果2位医师对3组图像评价结果的一致性较好(Kappa 值均>0.700);3组图像间图像质量主观评分无统计学差异(P>0.05);影像学征象主观评分动脉期 VNC为2.88±0.34,静脉期VNC为2.84±0.37,均可接受。3组图像的CNR分别为0.52±0.11、0.72±0.16、0.69±0.12,动脉期VNC、静脉期 VNC的对比噪声比(CNR)均高于常规平扫,有统计学差异(P<0.05)。3组图像同层面病灶的长径和横径无统计学差异(P>0.05)。3组图像肾脏病灶的CT值分别为(30.04±4.09)HU、(32.69±4.07)HU、(32.56±3.52)HU,有统计学差异(P<0.05),常规平扫病灶的CT值低于动脉期 VNC和静脉期 VNC,但差值均在5 HU内。结论在肾癌检查中 VNC能替代常规平扫,可减少患者的扫描次数,降低辐射剂量。     

Impact of bowel obstruction at the time of initial presentation in women with ovarian cancer

Objective  To determine whether the presence of bowel obstruction at the time of initial presentation has any prognostic significance in these women.
Design  Retrospective cohort study.
Setting  Dedicated gynaecological oncology service of a large tertiary institution.
Population  Women who had a bowel obstruction as part of their initial presentation of ovarian cancer were identified between 1995 and 2007. Each woman was matched with four control women (with disease but no obstruction).
Methods  Women with disease were compared with controls to determine the impact, if any, of bowel obstruction at presentation. Several prognostic variables including bowel obstruction were also evaluated in a Cox proportional hazard model.
Main outcome measures  Progression-free survival (PFS) and overall survival (OS).
Results  Forty-eight women with disease and 192 controls were identified during the study period. The median follow-up period was 19 months among women with disease versus 20 months in controls. No differences were seen in demographics and clinical characteristics of the women. Optimal cytoreduction rate was similar between the two groups (75% versus 78%, P  = 0.7). Patients with bowel obstruction had a shorter PFS and OS compared with controls [19 months versus 21 months ( P  = 0.01) and 22 versus 35 months ( P  = 0.008)], respectively. Bowel obstruction at presentation was an independent prognostic variable with a hazard ratio of 1.5 ( P  = 0.009). Other prognostic variables were age, stage and extent of surgical cytoreduction.
Conclusions  Bowel obstruction at the time of initial presentation is an adverse prognostic factor in women with ovarian cancer.     

荔湾区2010～2013年艾滋病自愿咨询检测结果及影响因素分析

目的探讨艾滋病自愿咨询人群血清学检测结果及其影响因素,为荔湾区今后更好的开展VCT服务提供依据。方法以2010~2013年在荔湾区各VCT门诊接受VCT服务并登记上报的求询者作为研究对象,按照《全国艾滋病检测技术规范(2009)》要求开展HIV抗体初筛检测,阳性标本合做梅毒、丙肝、乙肝检测。采用非条件Logistic回归分析影响艾滋病自愿咨询人群艾滋病感染的相关因素。结果共调查艾滋病自愿咨询检测者6 423人,其中男性2 787人,占43.4%,女性3 636人,占56.6%;年龄集中在(32.4±10.8)岁。HIV抗体阳性98例,占1.5%,其中1例同时呈HIV、梅毒、丙肝、乙肝阳性,合并四重感染率为1%;HIV、丙肝合并感染者有42例,双重感染率为42.9%;HIV、梅毒合并感染有20例,双重感染率为20.4%;HIV、乙肝合并感染有8例,双重感染率为8.16%。经Logistic回归分析显示:对艾滋病自愿咨询检测人群艾滋病感染的影响因素是年龄、职业和人群特征。年龄段在21~60岁,吸毒者、同性恋、阳性配偶者为艾滋病感染的风险人群。结论政府组织与各部门共同担责,改进并完善自愿咨询检测服务,加强对艾滋病感染风险人群检测,向"零"艾滋迈进。     

Nitric oxide synthase activity and localization do not change in uterus and placenta during human parturition

Animal studies have suggested that nitric oxide, a smooth muscle relaxant, is a fundamental mediator in the initiation of parturition. The purpose of this study was to test the hypothesis that the onset of human labour is associated with a reduction in the activity of the enzyme nitric oxide synthase (NOS), within the uterus. Samples of myometrium, placenta, decidua and fetal membranes were collected during Caesarean section from 11 women before and 11 women after the onset of labour at term. Immunocytochemistry was used to localize each of the three isoforms of NOS (endothelial NOS, brain NOS, and inducible NOS) in each of these tissues and the intensity of staining was qualitatively assessed. NOS enzyme activity was determined in homogenates of frozen myometrium, placenta and fetal membranes (with attached decidua), by measuring conversion of radio-labelled L-arginine to L-citrulline. Each of the three isoforms of NOS was localized in each of the tissues. We found no difference in either the expression or enzyme activity of NOS in myometrium, placenta or fetal membranes before and during labour at term. These results suggest that, in contrast to animal studies, a decrease in NOS enzyme activity may not be involved in the onset of parturition at term in the human.      

Outcome in children from cryopreserved embryos

A cohort of 91 children from cryopreserved embryos and 83 control children who were conceived normally had their development assessed using the Griffiths's scales of mental development. The controls (81 singletons and two twins) of a similar age, sex, and social class were selected from siblings, cousins, and peers of the cryopreserved embryo group (68 singleton, 20 twins, and three triplets). Children from cryopreserved embryos had a lower mean birth weight and mean gestational age and a higher proportion were born by caesarean section. One child from the cryopreserved embryo group had Down's syndrome, three had squints, and four had conductive hearing loss while in the control children, six had squints, and nine had conductive hearing loss. In both groups, including the child with Down's syndrome, the mean Griffiths's quotient was greater than the standard 100. In the children from cryopreserved embryos, the singleton and multiple birth subgroups had statistically similar assessment results. The mean (SD) Griffiths's quotient was 105.69 (13.55) in children from cryopreserved embryos and 108.18 (9.80) in controls at a chronological age of 25.08 (12.86) and 29.19 (14.65) months respectively. Overall, the development in children from cryopreserved embryos did not cause concern though formal testing had highlighted small differences compared with other children conceived normally and of a similar social class.     

非手术与桡骨短缩术治疗Kiebock氏病的疗效比较

非手术与桡骨短缩术治疗Kiebock氏病的疗效比较@J Salm on @JK Stam ley @IA T rail @范少勇$江西中医学院!南昌330006     

Initial evaluation of congenital hypothyroidism: a survey of general paediatricians in East Anglia

The practice of general paediatricians in the initial evaluation of congenital hypothyroidism (CHT) was assessed. This was performed by a questionnaire survey of paediatricians in East Anglia of whom 84% responded. Nineteen of 25 clinicians based in seven district hospitals managed children with CHT. The median number of children in the care of each clinician was 4 (range 1-17) and the median number of children attending each hospital was 12 (range 5-23). All except one clinician arranged to confirm the diagnosis with a serum thyroid stimulating hormone concentration and free or total thyroxine. There was variation of opinion on the value of serum triiodothyronine and free triiodothyronine measurements, antibody screening, knee radiographs, and thyroid isotope scans. One clinician sought advice when notified of new children and two expressed the need for an investigation protocol. These findings indicate that most general paediatricians in East Anglia manage only a few children with CHT; the initial diagnosis is appropriately confirmed but they are uncertain about the value of other investigations.