广东省绿头鸭场鸭乙肝病毒自然携带状况调查

目的　调查两个鸭场携带乙肝病毒(DHBV)状况。方法　在对广东省家养绿头鸭分布状况进行系统调查的基础上,对南海市和顺镇、里水镇两个绿头鸭场作了随机抽样调查,采集了雏鸭、青年鸭和种鸭的血标本共519份,应用斑点分子杂交(DotBlot)测定法观察绿头鸭乙型肝炎病毒(DHBV)自然携带率。结果　两鸭场绿头鸭的DHBV自然携带率为36.0%(187/519),其95%可信限为31.0%～44.0%。不同鸭龄组绿头鸭DHBV自然携带比较,两鸭场同日龄绿头鸭DHBV自然携带率比较,绿头鸭DHBV自然携带率的性别比较,差异均无显著意义。不同鸭龄的绿头鸭DHBV-DNA含量定量分析(A值),差异有非常显著性(P＜0.01),其含量由高到低顺序为雏鸭＞种鸭＞青年鸭,和顺鸭场的绿头鸭DHBV-DNA含量高于里水鸭场。结论　两鸭场绿头鸭携带的DHBV可能源于不同的亚株。     

Natural language processing and entrustable professional activity text feedback in surgery: A machine learning model of resident autonomy

BackgroundEntrustable Professional Activities (EPAs) contain narrative ‘entrustment roadmaps’ designed to describe specific behaviors associated with different entrustment levels. However, these roadmaps were created using expert committee consensus, with little data available for guidance. Analysis of actual EPA assessment narrative comments using natural language processing may enhance our understanding of resident entrustment in actual practice.MethodsAll text comments associated with EPA microassessments at a single institution were combined. EPA—entrustment level pairs (e.g. Gallbladder Disease—Level 1) were identified as documents. Latent Dirichlet Allocation (LDA), a common machine learning algorithm, was used to identify latent topics in the documents associated with a single EPA. These topics were then reviewed for interpretability by human raters.ResultsOver 18 months, 1015 faculty EPA microassessments were collected from 64 faculty for 80 residents. LDA analysis identified topics that mapped 1:1 to EPA entrustment levels (Gammas >0.99). These LDA topics appeared to trend coherently with entrustment levels (words demonstrating high entrustment were consistently found in high entrustment topics, word demonstrating low entrustment were found in low entrustment topics).ConclusionsLDA is capable of identifying topics relevant to progressive surgical entrustment and autonomy in EPA comments. These topics provide insight into key behaviors that drive different level of resident autonomy and may allow for data-driven revision of EPA entrustment maps.     

腹部无辅助切口经阴道取标本的全机器人远端胃切除术(GC-NOSES Ⅳ式)

目的经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)具有美观、腹壁损伤小、术后疼痛轻等优势,笔者旨在探究机器人(Da Vinci Xi)在胃癌NOSES中的手术技巧及应用要点。方法选取南昌大学第一附属医院普外科1例胃癌病例,简介使用Da Vinci Xi手术机器人系统进行腹部无辅助切口经阴道取标本的远端胃切除术的手术步骤。结果手术顺利完成,术中及术后无并发症。结论经腹部无辅助切口经阴道取标本的远端胃切除术是安全、可行的,机器人的应用为手术的进行创造了极大的便利。     

Robotic transanal total mesorectal excision: Is the future now?

Total mesorectal excision (TME) is the standard surgical treatment for the curative radical resection of rectal cancers. Minimally invasive TME has been gaining ground favored by the continuous technological advancements. New procedures, such as transanal TME (TaTME), have been introduced to overcome some technical limitations, especially in low rectal tumors, obese patients, and/or narrow pelvis. The earliest TaTME reports showed promising results when compared with the conventional laparoscopic TME. However, recent publications raised concerns regarding the high rates of anastomotic leaks or local recurrences observed in national series. Robotic TaTME (R-TaTME) has been proposed as a novel technique incorporating the potential benefits of a perineal dissection together with precise control of the distal margins, and also offers all those advantages provided by the robotic technology in terms of improved precision and dexterity. Encouraging short-term results have been reported for R-TaTME, but further studies are needed to assess the real role of the new technique in the long-term oncological or functional outcomes. The present review aims to provide a general overview of R-TaTME by analyzing the body of the available literature, with a special focus on the potential benefits, harms, and future perspectives for this novel approach.     

四川省自然灾害多发地区居民灾害健康知识行为现状及影响因素分析

目的 调查灾害多发地区居民健康知识和行为现状及其影响因素,为进一步开展针对性健康教育提供科学依据。 方法 对四川省什邡市、泸县和越西县的居民进行问卷调查。 结果 本研究共调查1600人,健康知识方面,呼吸道传染病知识知晓率为9.4%,消化道传染病知识知晓率为16.2%,急救电话知晓率为66.6%;地震室外安全做法知晓率为91.9%,地震室内安全做法知晓率为57. 6%,洪水逃生技巧知晓率为43.6%。健康行为方面,55.1%的居民从不会喝生水,54.9%的居民能掌握正确的洗手方式,86.4%的居民会在做菜时将生熟分开。Logistic回归分析结果显示,健康知识知晓率与民族(OR=0.240, 95% CI=0.146~0.396)、文化程度(OR=1.179, 95% CI=1.049~1.326)相关,健康行为形成率与地区(OR=1.266, 95% CI=1.020~1.570)、民族(OR=0.244, 95% CI=0.148~0.401)、文化程度(OR=1.388, 95% CI=1.243~1.551)、家庭总收入(OR=1.172, 95% CI=1.034~1.329)相关。结论 四川省居民自然灾害健康知识认知和健康行为形成存在问题,应广泛开展健康宣教活动,提高居民自救互救能力和防灾减灾意识,减少健康风险。     

孕妇外周血NKT细胞水平与妊娠期肝内胆汁淤积症发病及病情关系

目的:探究孕妇外周血自然杀伤T(NTK)细胞水平与妊娠期肝内胆汁淤积症(ICP)发病及病情严重程度相关性。方法:选择2016年3月1日-2018年3月1日本院就诊的ICP患者52例(ICP患者组),根据ICP严重程度分为轻度ICP组(n=28)和重度ICP组(n=24),同时随机选择孕周相当的健康产前检查孕妇52例(健康孕妇组),比较各组外周血单个核细胞(PBMC)中NKT细胞水平,分析NKT细胞水平与ICP发生发展相关性。结果:ICP患者组外周血PBMC中NKT细胞含量高于健康孕妇组(P<0.05)。对ICP患者组和健康孕妇组外周血PBMC给予不同刺激物培养后,均显示出NKT细胞含量在正常组与空白组无差异(P>0.05),而在植物血凝素(PHA)组、ICP组、正常组依次降低(P<0.05)。重度ICP组外周血PBMC中NKT细胞含量高于轻度ICP组(P<0.05),NKT细胞含量与ICP病情严重程度呈正相关关系(P<0.05)。结论:ICP发生及进展与孕妇外周血NKT细胞水平呈正相关关系,监测NKT细胞水平可为诊断ICP提供新思路。     

五种免疫相关性心血管疾病的免疫学研究

对扩张型心肌病、风湿性心脏病，原发性高血压，冠心病及肥厚型心肌病进行外周血清可溶性白细胞介素２受体，Ｔ淋巴细胞亚群及自然杀伤细胞活性的检测，并与健康对照组比较，结果显示：ＤＣＭ组，ＲＨＤ组及ＥＨＴ组的ｓＩＬ－２Ｒ明显高于ＮＣ组，而ＤＣＭ、ＲＨＤ风湿活动组的ＮＫ活性低于ＮＣ组，ＥＨＴ组ＮＫ活性高于ＮＣ组。     

Identification of natural antibodies to interleukin-18 in the sera of normal humans and three nonhuman primate species

Natural antibodies to cytokines can be found in the sera of normal healthy individuals in the absence of specific immunostimulation. However, the function, impact, and purpose of natural antibody development have yet to be fully elucidated. Interleukin (IL)-18 is a cytokine that exerts proinflammatory activities and induces natural killer (NK) cell activity. Recombinant human IL-18 (rHuIL-18) is currently in development as a cancer immunotherapy. In this study, the presence of natural antibodies to IL-18 in the sera of normal humans and three nonhuman primate species was evaluated by electrochemiluminescence immunoassay (ECLIA). Of the human sera tested, 6 of 47 samples were positive for natural antibodies to IL-18. Of the nonhuman primate sera tested, 22 of 80 cynomolgus monkey samples, 4 of 31 rhesus monkey samples, and 2 of 20 chimpanzee samples were positive for natural antibodies to IL-18. Natural anti-IL-18 antibodies were neutralizing in 5 of 22 cynomolgus and 2 of 4 rhesus sera. None of the chimpanzee or human sera were able to neutralize IL-18 induction of interferon (IFN)-gamma in vitro. In vivo activity of rHuIL-18 was compared in IL-18 natural antibody-positive and -negative cynomolgus monkeys. The presence of natural antibodies to IL-18 did not alter rHuIL-18 systemic exposure levels, induction of neopterin, or induction of treatment-induced antibodies following intravenous administration of rHuIL-18. In conclusion, our data indicate that, as has been found with other cytokines, natural anti-IL-18 antibodies are relatively common. Moreover, natural anti-IL-18 antibodies do not appear to influence rHuIL-18 activity in vivo and are not predictive of a heightened immune response, suggesting that natural anti-IL-18 antibodies do not impact IL-18 therapy. Finally, our data suggest that the ability to detect natural anti-cytokine antibodies may be a useful measure of the adequacy of an assay for deployment in clinical trials.