β-hCG、TGF-β和TβR-Ⅰ在卵巢上皮性癌中的表达及意义

目的:探讨人绒毛膜促性腺激素β亚单位(β-hCG)、转化生长因子β亚单位(TGF-β)及转化生长因子β亚单位受体Ⅰ (TβR-Ⅰ)在卵巢上皮性癌中的表达及临床意义.方法:选取2008年1月～2014年1月在石河子大学医学院第一附属医院以手术切除为初次治疗的卵巢上皮性癌石蜡标本60例、卵巢良性肿瘤组织标本40例和正常卵巢组织20例,采用免疫组化法检测β-hCG、TGF-β及TβR-Ⅰ的表达情况.结果:与卵巢良性肿瘤组织和正常卵巢组织相比,卵巢上皮性癌组织中β-hCG、TGF-β和TβR-Ⅰ的阳性表达率均明显升高,差异有统计学意义(P＜0.05);卵巢上皮性癌组织中β-hCG的阳性表达率与其手术病理分期及病理类型密切相关(P＜0.05),而TβR-Ⅰ及TGF-β的阳性表达率与病理类型密切相关(P＜0.05);β-hCG与TGF-β及TβR-Ⅰ的阳性表达率均呈负相关(r=-0.568,P＜0.01;r=-0.673,P＜0.01),TGF-β与TβR-Ⅰ的阳性表达率无相关性(r=0.128,P＞0.01).结论:β-hCG、TGF-β和TβR-Ⅰ对卵巢良性肿瘤和卵巢上皮性癌的鉴别诊断具有一定的临床意义.     

Health workforce governance: Processes,tools and actors towards a competent workforce for integrated health services delivery

A competent health workforce is a vital resource for health services delivery, dictating the extent to which services are capable of responding to health needs. In the context of the changing health landscape, an integrated approach to service provision has taken precedence. For this, strengthening health workforce competencies is an imperative, and doing so in practice hinges on the oversight and steering function of governance. To aid health system stewards in their governing role, this review seeks to provide an overview of processes, tools and actors for strengthening health workforce competencies. It draws from a purposive and multidisciplinary review of literature, expert opinion and country initiatives across the WHO European Region's 53 Member States. Through our analysis, we observe distinct yet complementary roles can be differentiated between health services delivery and the health system. This understanding is a necessary prerequisite to gain deeper insight into the specificities for strengthening health workforce competencies in order for governance to rightly create the institutional environment called for to foster alignment. Differentiating between the contribution of health services and the health system in the strengthening of health workforce competencies is an important distinction for achieving and sustaining health improvement goals.     

互联网预约检测的男男性行为者HIV、梅毒感染状况及相关因素分析

目的 了解通过互联网预约检测MSM的HIV、梅毒感染状况, 分析其相关影响因素。方法 对广州市2011－2012年通过互联网预约自愿前来进行HIV和梅毒抗体检测的MSM进行问卷调查和血清学检测, 内容包括研究对象的社会人口学、行为学资料及HIV/梅毒抗体检测结果, 采用logistic回归方法分析HIV/梅毒感染的相关影响因素。结果 共调查4 904名MSM, 平均年龄(28.77±7.24)岁, 大专及以上学历占70.3%;未婚占72.7%;HIV和梅毒抗体阳性检出率分别为8.7%(429/4 904)和4.4%(214/4 904), HIV合并梅毒感染率为1.2%(59/4 904)。约1/3调查对象最近一次与男性发生性行为时未使用安全套, 43.5%最近3个月与男性发生性行为不能坚持每次使用安全套。多因素logistic回归分析结果显示:文化程度低、职业(工人或农民)、最近3个月与男性发生性行为不能坚持使用安全套、既往是否做过HIV检测以及感染梅毒与HIV感染相关联;年龄(≥40岁)、文化程度低、最近3个月的男性性伴数(≥10个)及感染HIV与梅毒感染相关联。结论 基于互联网预约检测的MSM, 危险性行为发生率和HIV感染率较高, 既往HIV检测率较低。应加大应用互联网检测动员, 开发针对低文化、高年龄MSM的干预措施。     

Immunogenicity and safety of an E. coli-produced bivalent human papillomavirus (type 16 and 18) vaccine: A randomized controlled phase 2 clinical trial

BackgroundThis study aimed to investigate the dosage, immunogenicity and safety profile of a novel human papillomavirus (HPV) types 16 and 18 bivalent vaccine produced by E. coli.MethodsThis randomized, double-blinded, controlled phase 2 trial enrolled women aged 18–25 years in China. Totally 1600 eligible participants were randomized to receive 90 μg, 60 μg, or 30 μg of the recombinant HPV 16/18 bivalent vaccine or the control hepatitis B vaccine on a 0, 1 and 6 month schedule. The designated doses are the combined micrograms of HPV16 and 18 VLPs with dose ratio of 2:1. The immunogenicity of the vaccines was assessed by measuring anti-HPV 16 and 18 neutralizing antibodies and total IgG antibodies. Safety of the vaccine was assessed.ResultsAll but one of the seronegative participants who received 3 doses of the HPV vaccines seroconverted at month 7 for anti-HPV 16/18 neutralizing antibodies and IgG antibodies. For HPV 16, the geometric mean titers (GMTs) of the neutralizing antibodies were similar between the 60 μg (GMT = 10,548) and 90 μg (GMT = 12,505) HPV vaccine groups and were significantly higher than those in the 30 μg (GMT = 7596) group. For HPV 18, the GMTs of the neutralizing antibodies were similar among the 3 groups. The HPV vaccine was well tolerated. No vaccine-associated serious adverse events were identified.ConclusionThe prokaryotic-expressed HPV vaccine is safe and immunogenic in women aged 18–25 years. The 60 μg dosage formulation was selected for further investigation for efficacy.Clinical trials registration: NCT01356823.     

A model of health care provider decision making about HPV vaccination in adolescent males

IntroductionIn the U.S., HPV vaccination of adolescent males remains low, despite the recommendation for routine vaccination. Although research has highlighted that health care provider (HCP) recommendation is very influential in HPV vaccine uptake, research on this topic in the male population is lacking. Accordingly, we used a qualitative approach to identify HCP knowledge, attitudes, and behaviors regarding adolescent male HPV vaccination, one year, after routine vaccination of adolescent males was recommended.MethodA total of 20 U.S. pediatric HCPs participated in 20–30 min interviews about knowledge, attitudes, and practices regarding male HPV vaccination. Interviews were audio-recorded, transcribed and, analyzed using inductive content analysis.ResultsThe providers had been in practice for 1–35 years, 75% were female, and 75% were White. Opinions on HPV vaccination were shaped by knowledge/perception of the risks and benefits of vaccination. Although all providers frequently offered HPV vaccine to male patients, the strength and content of the offer varied greatly. Vaccination opinions determined what issues were emphasized in the vaccine offer (e.g., stressing herd immunity, discussing prevention of genital warts), while adolescent age influenced if and how they pitched their vaccine offer (e.g., HPV as a STI). Most providers agreed with the ACIP recommendations, however, several expressed that providers’ preexisting opinions might remain unchanged despite the recommendations. Consistent with the literature on determinants of HPV vaccination, providers believed that their own recommendation was a major factor in a family's decision to vaccinate. Barriers to vaccination included the “newness” and sexual nature of the vaccine, lack of insurance coverage, and the vaccine not being mandated.ConclusionsProviders’ opinions about, and approaches to offering, HPV vaccination to males were highly variable. Interventions designed to improve male HPV vaccination should focus on helping providers to routinely recommend the vaccine to all of their eligible patients, both males and females.     

Immunogenicity and safety of the new intradermal influenza vaccine in adults and elderly: A randomized phase 1/2 clinical trial

BackgroundRecent clinical evidence indicates that an intradermal (ID) delivery of vaccines confers superior immunogenicity as compared to a standard intramusclular or subcutaneous (SC) delivery.MethodsIn this exploratory study, 600 healthy adults were randomized to 6 study groups with subgroups of young adults (20–64 years old) and older adults (65 years and older). The subjects were either injected by a novel ID injection system with a single dose of 6, 9, or 15 μg HA or two doses (21 days apart) of 15 μg HA per strain or injected by an SC injection method with a single or two doses (21 days apart) of 15 μg HA per strain. Immunogenicity was assessed using hemagglutination inhibition (HAI) titer and microneutralization titer on Days 0, 10, 21, and 42. Solicited and unsolicited adverse events were recorded for 7 and 21 days post-vaccination, respectively.ResultsIn both young adults and older adults groups, the geometric titer (GMT) ratios of HAI in the ID 15 μg HA group were higher than those in the SC 15 μg HA group on both Day 10 and Day 21, while those in the ID 6 and ID 9 μg HA groups were comparable with those in the SC 15 μg HA group. The kinetics of GMTs of HAI suggested that the ID vaccine has the potential to induce the prompt immune response, which is rather hampered in older adults as seen in the SC vaccine groups. The injection-site AEs were generally mild and transient, and did not occur in a dose or dosage-dependent manner.ConclusionsThe results of this study clearly suggest that the immunologic profile of the ID vaccine is better than that of the SC vaccine, while the safety profile of the ID vaccine is similar to that of the SC vaccine. In this exploratory study with almost 100 subjects per each group, single or two-dose administration of the ID vaccine containing 15 μg HA was suggested to be an appropriate regimen in order to prevent influenza and to reduce the associated disease burden.Trial registrationJAPIC Clinical Trials Information (JapicCTI-132096).     

LCT及HR-HPV诊断宫颈病变的临床价值

目的探讨LCT和HR-HPV对宫颈病变的诊断价值。方法对20479例患者行LCT检查,LCT阳性者行HR-HPV检测及电子阴道镜下宫颈活检组织病理检查,以组织病理学结果作为诊断的金标准,比较LCT阳性结果、HR-HPV检测结果与阴道镜下宫颈活检病理结果的符合率。结果1)LCT结果为ASCUS、LSIL、ASCH、HSIL与阴道镜下宫颈活检病理结果的符合率分别为54.55%、62.65%)、88.24%、92.99%。其HR-HPV阳性率分别为71.64%、80.56%、88.24%、92.86%。差异有显著性(P<0.001)。2)HR-HPV阳性组与阴性组比较,高级别宫颈病变的检出率分别为48.14%、17.39%,经卡方检验,P<0.001,差异有显著性。结论高危型人乳头瘤病毒检测对于细胞学诊断为非典型鳞状细胞的患者有重要的分流价值。     

建立“全院共享、流程自动”的人力资源信息系统

信息化是医院人力资源管理发展的一种趋势。本文以某县级医院人力资源管理信息化实践为基础,提出借助商品化软件、内外网结合、全院共享的信息化思路,通过细致筛选软件产品、医院主导软件实施、运行中持续改进等具体做法,实现实施技术向医院的成功转移,捋顺薪酬管理流程,建立全院共享的人力资源信息系统。人事信息系统的建立提高人事信息的利用效率,为医院的管理决策提供有效支撑。本文总结建设思路和做法,为其他县级医院人力资源信息化建设提供借鉴。     

The Return of Actionable Variants Empirical (RAVE) Study,a Mayo Clinic Genomic Medicine Implementation Study: Design and Initial Results

Objectives

To identify clinically actionable genetic variants from targeted sequencing of 68 disease-related genes, estimate their penetrance, and assess the impact of disclosing results to participants and providers.