激素与去卵巢诱导大鼠骨质疏松症的差异及其分子机制探讨

目的 比较激素及去卵巢对大鼠骨量、骨转换指标、雌激素水平、骨髓细胞成脂分化水平的影响,并探讨两种模型可能的分子机制。方法 3月龄雌性SD大鼠36只,随机分为空白组、甲强龙组（MP组）、去卵巢组（OVX组）。3组大鼠于8w后处死,测量体重及子宫、肾上腺重量;双能X线骨密度仪测量左股骨BMD、BMC、BA;ELISA法测量血清PINP、β-CTX及雌激素水平;油红“O”染色观察右股骨骨髓间充质干细胞（BMSCs）成脂情况。RT-PCR检测左胫骨Runx2、Col1α1、MMP9 mRNA表达。结果 术后8w,MP组体重显著低于空白组及OVX组,OVX组体重明显高于空白组（P<0.05）。MP组BMC、BMD、BA及OVX组BMC、BMD均较空白组明显降低,且MP组BMC、BMD、BA明显低于OVX组（P<0.05）。两组血清PINP、β-CTX均较空白组显著升高,且MP组明显高于OVX组,两组雌激素水平均显著低于空白组（P<0.05）。两组骨髓脂滴均较空白组增多,骨组织Runx2 mRNA表达均较空白组显著下调（P<0.05）,Col1α1、MMP9 mRNA表达较空白组高,但比较差异无统计学意义。结论 激素及去卵巢均可诱导大鼠高转换型骨质疏松症,以激素导致的骨量丢失更严重,且两者均可下调大鼠血清雌激素水平、促进骨髓细胞成脂分化,其机制可能均与调控骨组织Runx2 mRNA表达水平密切相关。     

山东省1970-2013年恶性肿瘤死亡率变化趋势及差别分解

目的 探讨1970-2013年山东省恶性肿瘤死亡率的变化趋势和影响因素,为制定癌症防控规划和措施提供依据。方法 恶性肿瘤死亡率数据取自山东省死亡登记系统和3次全国死因回顾调查数据。利用死亡率和年龄标化死亡率等指标描述不同年代恶性肿瘤总死亡和主要肿瘤死亡水平的变化趋势,采用死亡率差别分解法计算死亡率变化中人口因素和非人口因素的贡献值。结果 1970-2013年山东省恶性肿瘤粗死亡率呈升高趋势,标化死亡率先升高后降低。恶性肿瘤死亡在全死因中的构成也是先升高后降低。人口因素和非人口因素共同导致粗死亡率的升高,人口因素所占的比重逐渐增加,甚至超过了非人口因素,导致2011-2013年恶性肿瘤年龄标化死亡率较2004-2005年降低。主要恶性肿瘤死因顺位变化较大,肺癌由第5位上升至第1位,2011-2013年较1970-1974年上升了6.81倍。胃癌死亡顺位从第1位降至第3位,食道癌从第2位降至第4位。经1964年中国标准人口调整后,肺癌死亡率仍呈快速升高趋势,而食管癌的调整率却逐渐下降。宫颈癌的粗死亡率和标化死亡率均呈快速下降趋势,2011-2013年较1970-1974年分别下降了87.00%和93.00%。结论 恶性肿瘤仍然是威胁山东省居民的重大疾病,不同恶性肿瘤的变化趋势不一致,应针对不同恶性肿瘤的病因和危险因素积极开展防控工作。     

The effectiveness of group exercise for improving activity and participation in adult stroke survivors: a systematic review

BackgroundFollowing post stroke rehabilitation, group exercise interventions can be used to continue improving cardiovascular fitness, activity levels, balance, gait, movement efficiency, and strengthening. However, little is known of the effectiveness of group exercise for improving activity and participation in stroke survivors.ObjectivesThis review aims to assess the effectiveness of group exercise for improving activity and participation in adult stroke survivors.Data sourcesDatabases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library.Study eligibility criteriaRandomised controlled trials (RCTs) of group exercise using validated outcome measures of activity and participation for post stroke rehabilitation. Two independent reviewers assessed all abstracts, extracted data, conducted a narrative synthesis and assessed the quality of all included articles. The Cochrane Risk of Bias Tool assessed methodological quality and included outcome measure quality was assessed.Results14 RCTs were included (n = 624 chronic stroke survivors collectively). Studies ranged between 12 and 243 stroke participants with an average of left:right hemisphere lesions of 32:39 and average age was 66.7 years. Although intervention and control groups improved, no significant difference between group differences were evident.Conclusionand implications of key findings: The review found improvements are short-term and less evident at long-term follow up with little improvements in participation after 6 months. However, this review was limited to the standard of intervention reporting. Further research should consider consistency in measuring underpinning mechanisms of group exercise interventions, which may explain the lack of activity changes in long-term follow-up.
Systematic review registration number PROSPEROCRD42017078917.     

住院患者分级护理情况调查分析

目的：通过分析医生对患者下达护理级别医嘱和护理人员运用ADL量表的护理分级实施级别护理情况,对目前分级护理制定存在的缺陷进行分析。方法：以4个病区800例Ⅰ～Ⅲ级护理级别的住院患者为研究对象,分别对医生、护士确定的分级护理结果进行统计分析。结果：医护对住院患者分级护理制定存在差异。结论：医护双方对分级护理的制定均存在局限性,建议采用医护合作模式确定护理级别,确保医疗安全及护理质量     

英汉差异对英语写作的影响

分析了英汉差异对写作的影响,指出在英语写作教学中应重视启发学生比较汉英之间的主要区别,帮助学生有意识地克服母语负迁移的影响。     

Self and other in global bioethics: critical hermeneutics and the example of different death concepts

Our approach to global bioethics will depend, among other things, on how we answer the questions whether global bioethics is possible and whether it, if it is possible, is desirable. Our approach to global bioethics will also vary depending on whether we believe that the required bioethical deliberation should take as its principal point of departure that which we have in common or that which we have in common and that on which we differ. The aim of this article is to elaborate a theoretical underpinning for a bioethics that acknowledges the diversity of traditions and experiences without leading to relativism. The theoretical underpinning will be elaborated through an exploration of the concepts of sameness, otherness, self and other, and through a discussion of the conditions for understanding and critical reflection. Furthermore, the article discusses whether the principle of respect for the other as both the same and different can function as the normative core of this global bioethics. The article also discusses the New Jersey Death Definition Law and the Japanese Transplantation Law. These laws are helpful in order to highlight possible implications of the principle of respect for the other as both the same and different. Both of these laws open the door to more than one concept of death within one and the same legal system. Both of them relate preference for a particular concept of death to religious and/or cultural beliefs.

良性前列腺增生患者对中文版国际前列腺症状评分理解能力的调查

目的了解不同文化背景条件下的良性前列腺增生（BPH）患者对中文版国际前列腺症状评分（IPSS）理解能力的准确性。方法自2008年9月至10月间,对我院门诊及病房104例BPH患者进行中文版IPSS问卷调查,患者的年龄是58．90±15．41岁。分别按照其文化层次分为文盲组32例,年龄53．94±18．03岁,小学组23例,年龄61．87±15．15岁,中学组27例,年龄60．93±13．84岁,大学组22例,年龄60．55±12．31岁。首先,在门诊的候诊厅中让BPH的患者根据自己对调查表的理解力自评。然后,有一位泌尿外科医生对其每项条款进行解释,再结合患者的情况及病史做出评价,住院病人在病房调查方法同上。分析两种评分间结果的差异性。结果文盲组中第4项评分在两种评分间差异有显著性意义（P〈0．05）,但总分数在两种评分间比较的P=0．050。小学组中各项及总分数在两种评分之间差异无显著性意义（P〉0．05）。中学组及大学组中各项评分及总分数在两种评分之间差异无显著性意义（P〉0．05）。结论不同文化背景下患者对中文版IPSS的理解力同医生间差异无统计学意义,且文化层次越高理解的准确性越高。     

不同人口学特征的针灸科门诊患者对针刺刺激接受程度差异的比较研究

目的探讨不同人口学特征的针灸科门诊患者对针刺刺激接受程度之间的差异。方法采取整群抽样的方式选取1000例患者,通过自行设计的问卷,对患者的人口学资料及其针刺接受程度进行调查分析。结果不同性别、年龄及职业的患者对针刺刺激接受程度存在统计学差异(P0.01),中老年男性及已产女性和偏体力劳动者完全能够接受针刺刺激的比例较大。结论不同人口学资料特征的患者对针刺刺激接受程度不同,建议临床工作时,应根据患者的个体特征施治,以减轻患者针刺时的不适感,提高针灸临床认同度。     

Impact of VKORC1 gene polymorphism on interindividual and interethnic warfarin dosage requirement— A systematic review and meta analysis

Introduction

Warfarin is the most widely used oral anticoagulant. It has been suggested that anticoagulation effect of warfarin is significantly associated with the polymorphism of certain genes, including Cytochrome P450 complex subunit 2C9 (CYP2C9), Vitamin K Epoxide Reductase Complex Subunit 1 (VKORC1), Gamma-Glutamyl Carboxylase (GGCX) and Apolipoprotein E (APOE) etc. The purpose of the present study was to conduct a systemic review and meta-analysis to investigate the relationship between mean daily warfarin dose (MDWD) and VKORC1 single nucleotide polymorphisms (SNPs).

Materials and Methods

Inclusion and exclusion criteria were made, and the studies between 2004 and present were searched. References were examined, and experts were consulted for additional information. Data were extracted. Revman 4.2.10 software was applied to analyze the relationship between MDWD and VKORC1 SNPs.

Results

Total 19 studies were included in the meta-analysis. The frequencies of 1173TT and − 1639 AA in Asian patients were higher than those in Caucasian and African populations. Patients with VKORC1 1173 CT and 1173 CC required 44% [95% Confidence Interval (CI); 32%, 56%] and 97% [73%, 122%] higher MDWD than 1173 TT carriers, − 1639GA and − 1639GG carriers required 52% [41%, 64%] and 102% [85%, 118%] higher MDWD than − 1639AA carriers, 3730GA and 3730AA carriers required 27% [3%, 58%] and 52% [3%, 109%] higher MDWD than 3730GG carriers. In addition, 1173C, − 1639 G and 3730 A carriers required 63% [44%, 82%], 61% [49%, 73%] and 32% [4%, 59%] higher MDWD than 1173TT, − 1639 AA and 3730GG, respectively. Sensitive analyses demonstrated that the impacts of gene polymorphism on warfarin dosage requirement were significantly different between Caucasian and Asian population, and the results of meta-analyses were stable and reliable.

Conclusion

This is the first meta-analysis about the impact of VKORC1 gene polymorphism on warfarin dose requirement. Our studies showed that gene polymorphisms of VKORC1 significantly associated with the variation of interindividual warfarin dose requirement variation, and the effects are different in ethnicities.     

脑瘫精细运动功能测试量表在偏瘫型患儿中需要重新建立评估标准与程序

目的 分析脑瘫精细运动功能测试量表(FMFM)在偏瘫和非偏瘫型脑瘫间的项目功能差异(DIF)。方法 收集2001至2018年复旦大学附属儿科医院康复中心及其医联体儿童康复协作网诊断为脑瘫并行FMFM评估的患儿,从FMFM评估数据中提取偏瘫患儿对侧数据,随机选择30%样本作为DIF的焦点组样本;根据整体样本中非偏瘫型与偏瘫型的比例确定采用随机分层匹配对照组样本。采用Conquest软件把两组合并数据样本分别与FMFM中B~E区的全部56个项目以及经项目内容分析后划分出的30个单手项目和26个双手项目进行Rasch分析,以内聚拟合度(Infit)的均方来确定FMFM的单维性,标准为MnSq在0.6～1.4,并对全部56项、单双手项目组进行项目功能差异分析。结果 1 556例脑瘫患儿的3 442次FMFM评估作为整体样本和数据,焦点组198个和对照组792个FMFM评估数据进入本文分析,单独样本配对检验显示两组FMFM分值[112(96,146) vs 113(95,145)]差异无统计学意义。经过3轮项目内容分析,30个归入单手项目,26个归为双手项目。全部56个项目的难度尺度对数值之差的绝对值>0.5分别有41个(73.2%),30个单手和26个双手项目的难度尺度对数值之差的绝对值>0.5分别有23个(76.7%)和9个(34.6%)。结论 FMFM全部56个操作项目在偏瘫和非偏瘫型脑瘫间存在DIF,在单手项目中尤其显著,为了更为精准地评价偏瘫儿童的精细运动功能,需要重新建立评估标准与程序。