农村青少年不同时期家庭逆境与精神病理症状的关联

目的探讨家庭逆境致精神病理症状结局的累积性与关键期效应,为预防与干预逆境伤害提供依据。方法2017年12月,采用方便抽样的方法选取安徽省阜阳地区2所农村学校的710名青少年。采用《童年期不良经历问卷》评估家庭逆境,《MacArthur健康与行为问卷》评价内化症状和外化症状。采用多元线性回归分析家庭逆境发生时间与数量和精神病理症状的关联。结果持续家庭逆境组与内化症状、外化症状增加均有相关性[β值(95%CI)分别为0.35(0.15~0.54),0.16(0.01~0.32)]。家庭逆境数量为2和≥3与内化症状[β值(95%CI)分别为0.20(0.04~0.36),0.42(0.24~0.60)]、外化症状[β值(95%CI)分别为0.14(0.01~0.26),0.23(0.09~0.37)]增加有关。在仅童年期家庭逆境中,家庭逆境数量为2和≥3的内化症状[β值(95%CI)分别为0.23(0.06~0.41),0.34(0.11~0.58)]、外化症状[β值(95%CI)分别为0.17(0.02~0.31),0.21(0.02~0.39)]的风险增高。在持续家庭逆境组中,逆境数量≥3与内化症状、外化症状相关[(β值(95%CI)分别为0.56(0.31~0.82),0.24(0.02~0.45)]。仅青春期家庭逆境与精神病理症状无关。结论家庭逆境的多次发生可增加精神病理症状风险,童年期可能是家庭逆境致精神病理症状的关键期。     

海洛因依赖者的个性心理特征及其对复吸的影响分析

目的了解自愿戒毒的海洛因依赖者的个性心理特征及其对脱毒后复吸的影响。方法使用MMPI对30例自愿戒毒的海洛因依赖者和30例未对任何药物成瘾的正常人的个性心理特征进行对照分析，明确海洛因依赖者个性心理特征，在此基础上找出个性心理特征与复吸原因的联系。结果海洛因依赖者在MMPI各量表中诈病(F)，精神病态(Pd)，疑病症(Hs)，偏执狂(Pa)，精神分裂(Sc)等量袁与对照组有明显的差异，且这些差异与脱毒者复吸原因有着直接的关系。结论海洛因依赖者的个性心理特征为明显的反社会行为和社会适应障碍，对自己健康过分关注，缺乏对社会环境的归属感，易将自己的问题合理化而归因于剐人，并由这种心理特征增加了复吸率。     

空肠弯曲菌HSP43诱导自身免疫机理──分子模拟和抗原优势

我们曾发现空肠弯曲菌４３ｋＤ热休克蛋白（ＨＳＰ４３）能诱导小鼠产生自身免疫应答，本文则进一步分析了这种诱导作用的机理。二株针对ＨＳＰ６０保守区序列的单克隆抗体ＩＩＨ９和ＭＬ－３０不但能结合人及小鼠细胞中ＨＳＰ６０家族成员，而且也能结合ＨＳＰ４３，表明ＨＳＰ４３、人及小鼠ＨＳＰ６０三者均属同一家族成员，具有序列上的高度同源性。小鼠用空肠弯曲菌免疫后出现了针对１０种菌体蛋白的抗体，其中最早被诱导的抗体是针对ＨＳＰ４３的，并且该种抗体在随后８０ｄ观察期间内保持了较高活性，表明ＨＳＰ４３是优势抗原。本文结果提示，ＨＳＰ４３较易被免疫系统识别而产生应答，通过和宿主ＨＳＰ６０高度序列同源性而可能呈现分子模拟，从而诱导自身免疫损伤。     

甘肃省某大型公立医院医疗纠纷发生原因探析△

目的：探析甘肃省某大型公立医院医疗纠纷发生的原因,并识别表面原因、过度原因及根本原因,针对性提出综合防治建议,以促进医院全面和谐发展。方法：对2015-2019年该院440例医疗纠纷案例进行历史追踪,结合访谈法深入分析其发生原因,并运用冰山分析法进行分类。结果：该院医疗纠纷发生的表面原因有3项：医疗费用过高、发生并发症、过度检查和治疗;过渡原因有9项：医患沟通不到位,不充分、就诊流程不合理、患者隐私保护不到位、诊疗行为不规范和违反常规操作、手术不当、患者期望值过高难以满足、存在心理疾病、用药不当和用药不规范、有创治疗未履行知情同意义务;根本原因有4项：诊疗能力不足及技术水平不高、服务态度差、责任意识差、管理制度落实不到位。结论：医疗机构在制定医疗纠纷的防范措施时,要从根本原因入手,从根本上解决问题。因此,在日常诊疗工作中要持续强化临床技能操作,加强医德医风建设,强化医务人员责任意识和专业服务意识,落实医疗管理制度,以最大限度地降低医疗纠纷发生率。     

A nationwide post-marketing survey of knowledge,attitude and practice toward human papillomavirus vaccine in general population: Implications for vaccine roll-out in mainland China

BackgroundHuman papillomavirus (HPV) vaccine has been increasingly discussed in mainland China since its first approval in 2016. To date, nearly all studies assessing HPV vaccine perceptions and attitudes were implemented during pre-licensure period. Therefore, the nationwide post-marketing survey was conducted to update knowledge, attitudes and practice on HPV vaccine among general population in mainland China.MethodsParticipants aged 18–45 years living in mainland China were recruited in April 2019 by multi-stage non-randomized sampling. Sociodemographic factors, HPV and HPV vaccine related awareness, knowledge, attitudes, vaccine uptake and potential obstacles were assessed in questionnaires. Bivariate analysis and multivariate regression were used to identify disparity among subgroups with different sociodemographic characteristics.Results4,000 women (32.1 ± 7.81y) and 1,000 men (31.8 ± 7.96y) were included in final analysis. Less than one third of participants had heard of HPV (female: 31%; male: 22%) and HPV vaccine (female: 34%; male: 23%). Knowledge score was also unfavorable on HPV (female: 3 out of 13; male: 1.8 out of 13) and HPV vaccine (female: 3 out of 6; male: 2 out of 5). Only 3% females had been vaccinated three years after HPV licensure in China, although willingness to get vaccinated among those unvaccinated were high (mean willingness score ± SD: female: 3.3 ± 0.97; male: 3.0 ± 0.98). Industry of employment and household income were the major factors related to awareness and knowledge of vaccine, whereas HPV and HPV vaccine awareness were key influential factors for willingness. The main obstacles of vaccination were safety concerns, lack of knowledge, and high price of HPV vaccines.ConclusionsFindings highlight a lack of vaccine awareness, knowledge, and poor uptake in mainland China and underscore the necessity of health education campaigns. The identified priority groups, contents to be delivered and practical obstacles could furthermore provide insight into health education to reduce disparities and accelerate HPV vaccine roll-out in China.     

0.15％左旋布比卡因用于子宫全切术后硬膜外自控镇痛的临床观察

目的:比较0.15%左旋布比卡因和布比卡因用于经腹子宫全切术后患者自控硬膜外镇痛(PCEA)的临床效应.方法:择期经腹子宫全切术患者60例随机分成左旋布比卡因组(L组,n=30)和布比卡因组(B组,n=30)进行PCEA,观察患者24h镇痛效果、运动阻滞情况及不良反应.结果:两组视觉模拟评分(VAS)、舒适评级(BCS)相似,而24h硬膜外用药量、24h按压次数/实际有效进药次数(D/D)比值及PCA按压次数B组＞L组(P＜0 05);术后运动阻滞完全恢复时间,术后4h、8h、12h运动恢复分级两组差异无显著性;低血压发生率L组明显低于B组,差异有显著性(P＜0.05).结论:0.15%左旋布比卡因用于PCEA能达到满意镇痛效应,并减少局麻药及芬太尼用量,术后不良反应较少,安全性高;运动神经阻滞与布比卡因相同,作用时间较长.     

Methuselah‐like genes affect development,stress resistance,lifespan and reproduction in Tribolium castaneum

Methuselah (Mth) is associated with lifespan, stress resistance and reproduction in Drosophila melanogaster, but Mth is not present in nondrosophiline insects. A number of methuselah‐likes (mthls) have been identified in nondrosophiline insects, but it is unknown whether the functions of mth are shared by mthls or are divergent from them. Five mthls have been identified in Tribolium castaneum. Although they have different developmental expression patterns, they all enhance resistance to starvation. Only mthl1 and mthl2 enhance resistance to high temperature, whereas mthl4 and mthl5 negatively regulate oxidative stress in T. castaneum. Unlike in the fly with mth mutation, knockdown of mthls, except mthl3, shortens the lifespan of T. castaneum. Moreover, mthl1 and mthl2 are critical for Tribolium development. mthl1 plays important roles in larval and pupal development and adult eclosion, while mthl2 is required for eclosion. Moreover, mthl1 and mthl2 silencing reduces the fertility of T. castaneum, and mthl1 and mthl4 are also essential for embryo development. In conclusion, mthls have a significant effect on insect development, lifespan, stress resistance and reproduction. These results provide experimental evidence for functional divergence among mthls/mth and clues for the signal transduction of Mthls.     

筋骨活血汤治疗骨折急性疼痛患者的疗效及对炎性反应递质水平的影响

目的:探讨筋骨活血汤治疗骨折急性疼痛患者的疗效及对炎性反应递质水平的影响。方法:选取2015年4月至2018年5月琼海市中医院收治的骨折急性疼痛患者128例作为研究对象,按随机数字表法分为观察组和对照组,每组64例。入院后2组患者均进行相应的外科手术治疗,术后对照组采用布洛芬治疗,观察组采用筋骨活血汤治疗,2组均连续治疗4周。比较2组患者治疗后临床疗效,治疗前后中医症状改善情况,致痛因子水平,炎性反应递质水平及休息时、活动时、按压时疼痛程度。结果:治疗后观察组总有效率为93. 75%,明显高于对照组的81. 25%,差异有统计学意义(P 0. 05)。与治疗前比较,治疗后2组患者肿胀、红肿、疼痛、活动障碍评分均明显降低,且观察组明显低于对照组,差异有统计学意义(P 0. 05)。与治疗前比较,治疗后2组患者休息时、活动时及按压时视觉模拟评分法(VAS)评分均明显降低,且观察组明显低于对照组,差异有统计学意义(P 0. 05)。与治疗前比较,治疗后2组患者血浆前列腺素E2(PGE2)、缓激肽(BME)及血清白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平均明显降低,且观察组明显低于对照组,差异有统计学意义(P 0. 05)。结论:筋骨活血汤可降低骨折急性疼痛患者炎性反应递质水平,减轻肿胀、红肿等症状,缓解疼痛,改善骨折部位活动障碍,临床疗效优于布洛芬。     

Heparinized PCL/keratin mats for vascular tissue engineering scaffold with potential of catalytic nitric oxide generation

Abstract

Heparins are capable of improving blood compatibility, enhancing HUVEC viability, while inhibiting HUASMC proliferation. Combination of biodegradable poly(ε-caprolactone) (PCL) with keratin and heparins would provide an anticoagulant and endothelialization supporting environment for vascular tissue engineering. Herein, PCL and keratin were first coelectrospun and then covalently conjugated with heparins. The resulting mats were surface-characterized by ATR-FTIR, SEM, WCA, and XPS. Cell viability data showed that the heparinized PCL/keratin mats could motivate the adhesion and growth of HUVEC, while inhibit HUASMC proliferation. In addition, these mats could prolong blood clotting time and reduce platelet adhesion as well as no erythrolysis. Interestingly, these mats could catalyze the NO donor in blood to release NO, which could enhance endothelial cell growth, while decrease smooth muscle cell proliferation and platelet adhesion. In summary, the heparinized mats would be a good candidate as a scaffold for vascular tissue engineering. This study is novel in that we prepared a type of heparinized tissue scaffold that could catalyze the NO donor to release NO to regulate endothelialization without angiogenesis and thrombus formation.