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This study investigated possible predictors of residual islet β-cell function (RBF) in young patients with newly diagnosed type 1 diabetes (T1D).After analyzing RBF in 443 patients with T1D according to age at diagnosis and disease duration, 110 were followed-up over 18-60 months. A nomogram was developed by logistic regression to explore factors associated with long-term RBF.Of the 443 T1D patients (mean [±SD] age 20.28 ± 5.50 years; mean [±SD] diabetes duration 28.5 ± 14.6 months), RBF was preserved in 64.3%. Independent predictors for poor RBF outcome among the 110 patients in the follow-up cohort were age at onset (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.73-0.92; P 0.001), high-risk human leukocyte antigen (HLA) status (OR 4.73; CI 1.28-17.52; P = 0.020), female sex (OR 3.39; CI 1.03-11.22; P = 0.045), and a history of diabetic ketoacidosis (DKA; OR 8.71; CI 2.31-32.83; P 0.001). Baseline glutamic acid decarboxylase (GAD) antibody, family history of diabetes, body mass index, insulin dosage, and C-peptide and HbA1c levels were not associated with poor RBF outcome. Intensive glycemic control after T1D diagnosis may improve RBF within a mean (±SD) follow-up of 35.1 ± 13.8 months. The calibration plot for the probability of 2-, 3-, and 4-year RBF showed optimal agreement between nomogram-predicted and actual observed probabilities.Younger age of onset, female sex, higher HLA risk status, and a history of DKA were the main factors predicting long-term poor preserved β-cell function. Glycemic control could improve RBF during the course of diabetes. The nomogram provides an individualized risk estimate of RBF in patients with newly diagnosed T1D within Chinese Han populations.摘要: 目的 探讨影响初发年轻1型糖尿病(type 1 diabetes, T1D)患者病程进展后残余胰岛功能(Residual β-cell Function, RBF)的预测因素。 方法 对443例T1D患者按诊断年龄、病程进行RBF分析后，入选110例患者进行18-60个月的临床随访研究。基于Logistic回归分析建立Nomogram模型，预测长期RBF的相关因素。 结果 443例T1D患者平均年龄20.28±5.50岁，平均病程28.5±14.6个月，保留RBF者占64.3%。在110例患者的随访研究中，低RBF的独立预测因素有:起病年龄(岁)(OR=0.82，95% CI: 0.73-0.92，P0.001)、HLA高危表型(OR=4.73, 95%CI:1.28-17.52，P=0.020)、女性(OR=3.39，95%CI: 1.03-11.22，P=0.045)以及酮症酸中毒起病史(OR=8.71，95%CI: 2.31-32.83，P=0.001)。而基线的谷氨酸脱羧酶抗体、糖尿病家族史、体重指数、胰岛素用量、C肽和糖化血红蛋白水平与RBF预后不良无关。在平均35.1±13.8个月的随访中，强化血糖控制可改善RBF。2、3、4年的Calibration曲线显示,Nomogram预测概率和实际观测概率间吻合度较高。 结论 起病年龄小、女性、HLA的高危表型、DKA起病史是较长病程后低RBF的影响因素，病程中的血糖控制可以提升RBF。Nomogram预测模型提供了汉族人群中初发T1D患者RBF的个体化风险评估。.

To investigate the factors affecting the quality of life among adults with comorbid serious mental illness and chronic diseases.Descriptive, cross-sectional study design.In total, 204 patients with serious mental illness were recruited from two hospitals. Self-reported data were collected using the Brief Psychiatric Rating Scale, Internalised Stigma of Mental Illness, Patient Activation Measure and brief version of the World Health Organization Quality of Life Instrument. Data were collected between July 2018 - January 2019. The structural equation model was applied to examine the associations among the study variables.Internalized stigma (β = -0.479, p = .002) had the greatest direct effect on quality of life, followed by patient activation (β = 0.238, p = .002), severity of comorbidities (β = -0.207, p = .002) and psychiatric symptoms (β = -0.186, p = .006). In addition, psychiatric symptoms directly influenced the severity of comorbidities, which in turn directly influenced internalized stigma and then in turn directly influenced patient activation and ultimately influenced quality of life.The relationship between internalized stigma and quality of life is significantly mediated by patient activation. This finding provides a theoretical basis for developing patient activation interventions for patients with comorbid mental and chronic diseases, which potentially improve the quality of life of this population.Multiple comorbidities cause impaired quality of life in patients with serious mental illnesses. We found that patient activation plays an important role in the management of chronic diseases for achieving more favourable quality of life, but this is negatively affected by internalized stigma. These findings can help mental health professionals develop tailored intervention strategies to enhance quality of life by promoting patient activation and reducing internalized stigma, psychiatric symptoms, and comorbidity severity in patients with comorbid serious mental illnesses and chronic diseases.目的: 探讨影响成年严重精神病兼慢性病患者生活质量的因素。 设计: 描述性横断面研究设计。 方法: 两所医院共计招募204名严重精神疾病患者。可通过简明精神病评定量表、精神病患者病耻感评估量表、患者激活措施和世界卫生组织生活质量量表的简要版本收集自我报告数据。数据收集时间为2018年7月至2019年1月。结构方程模型可用于检验不同变量之间的相关性。 结果: 内耻感 (β = −0.479, p = .002) 对生活质量的直接影响最大, 其次是患者激活度(β = 0.238, p = .002) 、并存病严重程度(β = −0.207, p = .002) 和精神症状 (β = −0.186, p = .006) 。此外, 精神症状直接影响并存病严重程度, 进而影响内耻感和患者的积极性, 最终影响其生活质量。 结论: 内耻感和生活质量的相关性可通过患者激活度来确定。这一发现为针对精神疾病兼慢性疾病患者的激活干预措施的开发提供理论基础, 可帮助改善相关人群的生活质量。 影响: 多种并存病可能导致严重精神疾病患者的生活质量下降。我们发现, 患者激活度在慢性病的治疗中起着重要的作用, 帮助提高患者的生活质量, 然而, 其可能受到内耻感的负面影响。此类发现可以帮助精神卫生专业人员制定针对性的干预策略, 提高患者的积极性, 减少严重精神疾病兼慢性病患者的内耻感、精神症状和并存病严重程度, 提高其生活质量。.

To assess the effects of upright positions on maternal outcomes for women without epidural analgesia in comparison with recumbent positions during the second stage of labour.Upright positions have many physiological advantages. The underlying benefits and risks of upright positions during the second stage of labour have been reported in many studies but the results are divergent.A meta-analysis of randomized controlled trials.The Cochrane Library, PubMed, Embase, CINAHL and ProQuest databases were systematically searched from inception to 17 June 2019.We conducted the quality appraisal using the Cochrane Collaboration's tool and performed meta-analyses using the Review Manager 5.3 software. The primary outcomes were instrumental vaginal delivery and the duration of the second stage of labour.Overall, 12 studies including 4,314 women were included. Upright positions significantly decreased the rate of instrumental vaginal delivery (risk ratio [RR] = 0.74, 95% CI 0.59-0.93), shortened the active pushing phase (mean difference [MD] = -8.16 min, 95% CI -16.29 to -0.02), decreased the rate of severe perineal trauma (RR = 0.35, 95% CI 0.14-0.87) and episiotomy (RR = 0.52, 95% CI 0.29-0.92), but significantly increased the rate of second-degree perineal trauma (RR = 1.45, 95% CI 1.10-1.90). However, there was no significant difference in the duration of the second stage of labour or postpartum haemorrhage.Upright positions are beneficial for improving maternal outcomes. Several results should be considered with caution. Researchers need to clarify the definition of upright positions and conduct large, robust studies in the future to provide stronger evidence.This meta-analysis explores a crucial issue in intrapartum care and clarifies the benefits and possible risks of upright positions in the second stage of labour. Midwives and obstetricians are encouraged to apply upright positions depending on women's preferences and labour progress but should take measures to prevent perineal trauma.目的: 评估在第二产程中,与卧位相比,直立体位对未使用硬膜外镇痛的产妇的预后的影响。 背景: 从生理角度讲,直立体位具有许多优势。许多研究报告了第二产程期间直立体位的基本益处和风险,但结果却不尽相同。 设计: 随机对照试验的荟萃分析。 数据来源: 从各数据库成立至2019年6月17日,对Cochrane Library、PubMed、Embase、CINAHL和ProQuest等数据库进行了系统化检索。 审查方法: 使用科克伦协作网的工具进行质量评价,并使用Review Manager 5.3软件进行荟萃分析。主要预后指标是器械性阴道分娩和第二产程的持续时间。 结果: 总的来说,包括了12项研究,涉及4314名妇女。直立体位显著降低了器械性阴道分娩率(风险比[RR]=0.74,95%置信区间0.59-0.93),缩短了主动推宫阶段(平均差 [MD]=−8.16分钟, 95%置信区间−16.29 to −0.02),降低了严重会阴创伤发生率(RR=0.35, 95%置信区间0.14-0.87)和会阴切开术(RR=0.52, 95%置信区间0.29-0.92),但显著增加了二度会阴创伤的发生率(RR=1.45, 95%置信区间.10-1.90)。但在第二产程的持续时间或产后出血方面没有显著差异。 结论: 直立位有利于改善孕产妇预后。有几项结果应予以谨慎考虑。研究人员需要明确直立体位的定义,并在未来进行大规模、稳健的研究,以提供更有力的证据。 影响: 本荟萃分析探讨了产时护理中的一个关键问题,并阐明了直立体位在第二产程中的益处和可能存在的风险。鼓励助产士和产科医生根据产妇的喜好和产程进展采用直立体位,但应采取措施防止会阴创伤。.

Type 2 diabetes is increasingly diagnosed at a younger age worldwide and in China. Limited data are available regarding the association between age at diabetes diagnosis and risks of albuminuria. This study sought to examine the independent effect of age at diagnosis of type 2 diabetes on the risk of albuminuria.We used data from a nationwide multicenter study with 207 961 participants in mainland China. Age, sex, and study site were matched for 31 366 screen-detected type 2 diabetes cases and 31 366 normal controls. Age, sex, study site, and diabetes duration were matched for 7490 self-reported type 2 diabetes cases and 7490 normal controls. Risks of having albuminuria in matched type 2 diabetes vs controls were examined using multivariable logistic regression analysis in strata of age at diabetes diagnosis.Although the absolute rate of albuminuria is higher in older adults, the odds ratio of albuminuria in type 2 diabetes vs matched controls decreased with increasing age at diagnosis. For participants with diabetes diagnosed at an age of50, 50 to 59, 60 to 69, or ≥70 years, the multivariable adjusted risk of albuminuria increased by 81%, 60%, 45%, and 33% for screen-detected diabetes, and 135%, 121%, 90%, and 58% for self-reported diabetes compared with their normal controls, respectively.A younger age at diagnosis of type 2 diabetes is associated with a more significantly elevated risk of albuminuria than an older age at diagnosis in Chinese adults.背景: 2型糖尿病的诊断年龄在全球及中国呈年轻化的趋势。目前较少研究糖尿病诊断年龄与白蛋白尿患病风险的相关性。本研究拟探讨糖尿病诊断年龄是否为白蛋白尿风险相关的独立危险因素。 方法: 我们使用了来自中国大陆207961名研究对象的全国多中心研究数据。从年龄、性别和研究中心匹配的非糖尿病人群中随机选择正常对照, 另外对已诊断糖尿病患者的病程进行匹配, 最终共有31366 名新诊断2型糖尿病患者和 31366名正常对照, 及7490名已诊断2型糖尿病和7490名正常对照纳入分析。使用多元Logistic回归分析在不同糖尿病诊断年龄层中2型糖尿病患者与正常对照患白蛋白尿的风险。 结果: 虽然年龄越大, 白蛋白尿患病风险越高, 但是2型糖尿病患者与正常对照组白蛋白尿的比值比随着诊断年龄的增加而降低。与正常对照组相比, 年龄50、50-59、60-69 或≥70 岁诊断为糖尿病的患者经过多变量校正后白蛋白尿风险仍然增加, 新诊断糖尿病分别增加了 81%、60%、45% 和 33%, 已诊断糖尿病分别增加了 135%、121%、90% 和 58%。 结论: 在中国成人中, 2型糖尿病诊断年龄越低, 其白蛋白尿风险升高越明显。.

To explain the differences in organ donation consent outcomes of a new nursing role (Specialist Requesters) derived from the United States (US) compared with the existing nursing role (Specialist Nurses in Organ Donation).Thirty-month observational qualitative process evaluation: Implementation theory-informed analysis.Qualitative content analysis of free text describing challenges, processes and practice from 996 bespoke routinely collected potential organ donor 'approach forms' from two regions: one where there was no difference, and one with an observed difference in consent outcomes.Region A consent rate: Specialist Requester 75.8%, Specialist Nurse in Organ Donation71.8%. Region B consent rate: Specialist Requester 71.4%, Specialist Nurse in Organ Donation 82%. Region A Specialist Requesters turned the family position from no or uncertain to support organ donation in 73% of cases, compared with 27.4% in Region B. Two Specialist Requesters in Region A were highly effective. Region B experienced problems with intervention fidelity and implementation.The benefits of the Specialist Requester role remain unclear. Positive differences in consent rates achieved by Specialist Requesters in the originator region reduced over time and have yet to be successfully replicated in other regions.The impact of Specialist Requesters on consent outcomes varied across regions and it was not known why. Specialist Requesters in Region A were better at getting family member(s) to support organ donation. In Region B, Specialist Nurse in Organ Donation consent rates were higher and problems with intervention fidelity were identified (recruitment, staffing, less experience). Policy makers need to understand it is not just a matter of waiting for the Specialist Requester intervention to work. Ongoing training and recruiting the right people with the right skills need to be addressed and consistently reviewed.目的: 说明美国新型护理职位(专寻家)与现存护理职位(器官捐献专业护士)在获取器官捐赠许可成效方面的不同点。 设计: 进行定性观测并对流程进行评估:采用理论依据分析法 方法: 定期搜集两个不同区域内与潜在器官捐赠者“建立联系的方式”,从中获取描述挑战、流程及实施方法的自由文本,并对其进行定性内容分析:一区域的捐赠许可成效并无不同;而另一区域大有不同。 结果: 区域A许可率:专寻家为75.8%,器官捐献专业护士为71.8%。 区域B许可率:专寻家为71.4%,器官捐献专业护士为82%。 区域A中的专寻家在73%项案例中将家庭状况项勾选内容由“否”更为“不确定”,从而支持器官捐赠,而区域B中,这一数字是27.4%。结果是,区域A中的两名专寻家工作效率极高;而区域B中的则有维持干预保真度及实施方面的问题。 结论: 专寻家一职所带来的效益仍未知。发起人地区的专寻家给许可率方面带来的增长日渐减少,但其他区域尚未有此迹象。 影响: 专寻家对捐赠许可成效的影响视区域而有不同,其原因未知。在区域A,专寻家更擅长让家庭成员支持器官捐献。而在区域B,专业护士达成了更高器官捐献许可率,并且干预保真度方面的问题(职工招聘及安置不当、工作经验不足)也得到了鉴定。政策制定者们需要知道的是,器官捐献并不只意味着等着专寻家调停成功就足够了。现在需要长期提供训练项目,招收对口的技术型职员,并统一进行审查。.

A review of literature was performed, focused on the etiopathogenesis of aggressive posterior retinopathy of prematurity (APROP), the characteristic and atypical clinical features, management strategies, anatomical and visual outcomes. Characteristically APROP has zone I/posterior zone II involvement with prominent plus disease, featureless junction, large vascular loops, flat extra-retinal fibrovascular proliferation, and a rapidly progressive course. The risk factors for APROP are extreme prematurity (birth weight ≤1000 gram and/or gestational age ≤28 weeks), dysregulated oxygen supplementation, intrauterine growth retardation, sepsis, and thrombocytopenia. The uncommon presentations include small zone I disease, a hybrid disease with additional ridge tissue, and APROP in bigger babies with birth weight greater than 1500 g. Laser photocoagulation role is limited by the resultant visual field loss and high refractive error. Although anti-vascular endothelial growth factor injection allows peripheral retinal vascularization; reactivation of disease, systemic absorption of the drug and long-term safety are the chief concerns. Early vitrectomy is required when tractional retinal detachment develops. The visual outcome depends upon the morphology and vascular development of the macula. With the limited yet emerging new understanding of the pathophysiology, a multifaceted rational and individualized treatment strategy is suggested for APROP. Best practices in neonatal intensive care may prevent the occurrence of APROP. Further studies need to be performed for the prevention and safe, effective management of APROP.摘要: 急性进展性后极部早产儿视网膜病变的最新文献综述摘要:本文回顾了相关文献, 着重讨论急性进展性后极部早产儿视网膜病变 (aggressive posterior retinopathy of prematurity, APROP) 的发病机制、临床特征、非典型临床特征、治疗策略、解剖及视力的临床结局。APROP的特征性表现为视网膜I区/ 后极部II区受累并且伴有显著的附加病变: 无特征性粘连、大血管袢、平的重度视网膜纤维血管增殖以及病程进展迅速。APROP的危险因素为极度早产儿 (出生体重≤1000克和/或孕周28周) 、吸氧治疗管理不佳、宫内发育迟缓、败血症和血小板减少症。不常见的临床表现包括小范围I区病变、带有额外脊状组织的融合病变, 以及出生体重大于1500克的较大婴儿的APROP。激光光凝由于会导致视野缺损和严重的屈光不正而应用受限。虽然玻璃体内抗血管内皮生长因子注射可导致周边视网膜血管化, 但疾病再度活跃、药物的全身吸收以及长期安全性是主要考虑的因素。当牵拉性视网膜脱离发生时, 需要及早行玻璃体切除术。视力结局取决于黄斑形态和血管的发育。随着我们对APROP病理生理学虽然有限但不断深入的认识, 全面且合理的个体化治疗策略已经提出。最佳的新生儿重症监护可预防APROP发生。为了预防、安全、有效地管理APROP, 需要进行进一步的研究.

X-linked retinoschisis (XLRS) is a leading cause of hereditary juvenile macular degeneration in males resulting in significant vision impairment. Outcome measures to monitor disease progression or therapeutic interventions have evolved with technology. A systematic review was undertaken to evaluate outcome measures for XLRS. Inclusion criteria were all publications examining outcome measures for natural history studies or following an interventional approach for patients with XLRS. Studies which did not present follow-up data were excluded. We searched medical databases including CENTRAL, Ovid Medline, pre-Medline and ahead of Print up to February 2019. Two authors independently assessed the risk of bias. Twelve studies meet the inclusion criteria with four prospective and eight retrospective case series. Five series were natural history observational studies and seven were interventional series using either topical or systemic carbonic anhydrase inhibitors. Visual acuity (VA) declined very slowly in the natural history studies equivalent to 0.22-0.5 letters per year. Five of the six interventional studies showed an improvement in VA and four a reduction in spectral domain optical coherence tomography (SD-OCT) parameters for central macular thickness (CMT). The full-field electroretinogram identified the 30-Hz latency as a further parameter to monitor function. VA was the measure most likely to show a statistically significant outcome. How functionally meaningful this is, requires further evaluation. CMT SD-OCT outcomes are variable depending on cystic changes. More refined measures are required to better correlate structure with function.摘要: X连锁视网膜劈裂症 (X-linked retinoschisis, XLRS) 是一种男性遗传性青少年黄斑变性并可造成视力严重损害的疾病。监测疾病进展或治疗干预的临床指标随技术的发展而进步。本文对XLRS的临床预后指标进行了系统回顾。本文纳入了所有发表的, 针对XLRS的自然病程进行研究或对患者进行干预研究的文章, 并排除无随访数据的研究。我们检索了CENTRAL、Ovid Medline、pre-Medline医疗数据库, 搜索截至2019年2月前发表或预发表的文章。由两位作者独立评估偏倚风险。共有12项研究符合纳入标准, 其中4项为前瞻性研究, 8项为回顾性研究。5项为自然病程观察性研究, 7项为局部或全身应用碳酸酐酶抑制剂干预治疗。在自然病程研究中, 视力下降非常缓慢, 相当于每年下降0.22-0.5 个字母。六项干预性研究中有五项显示视力改善, 四项SD检查(spectral domain optical coherence tomography, SD-OCT)显示黄斑中心厚度降低。全视野视网膜电流图将30Hz刺激下的潜伏期作为进一步功能监测的参数。视力是最有可能显示统计学意义的预后指标, 在功能检测的意义方面, 还需要进一步评估。黄斑中心厚度的SD-OCT结果取决于囊腔的改变程度。现需要更精细的、能够更好地结合结构与功能的监测指标的预后评估方法。.

To evaluate the effectiveness of a mobile health (mHealth) application, based on self-regulation theory, on patients' knowledge of wound care, skills in changing dressings and anxiety.A prospective randomized controlled trial.Seventy patients (or family members) at a 1,500-bed university hospital in Taiwan were randomized into an experimental (N = 35) or control group (N = 35) from March to December 2016. The experimental group used a mHealth application for wound care; the control group received verbal instructions and a booklet. Instruments to collect data were a wound care knowledge scale, wound care skills scale, State-Trait Anxiety Inventory, and a digital heart variability device. Data were collected at baseline, after three additional demonstrations and before discharge. The generalized estimating equation was used for statistical analysis.The experimental group showed significantly higher levels of wound care knowledge, improved wound care skills, lower levels of state anxiety, and lower heart rate variability than the control group after baseline data collection.Results support hat a mHealth application may be effective in health education. Clinicians can use the results to promote patients' wound care knowledge, enhance their wound care skills, and reduce anxiety related to dressing changes.Lack of wound care knowledge and skills can affect the willingness and ability to perform effective wound dressing changes, producing anxiety and having an impact on a patient's self-care after hospital discharge. mHealth applications (apps) have the potential to deliver health information in targeted and tailored ways that strengthen the self-management of diseases. mHealth app can increase wound care knowledge, improve care skills, and reduce anxiety related to wound care. mHealth app effectively supports self-monitoring of the wound healing process, self-judgement of the wound condition, and self-reaction of wound care accuracy. mHealth app provides step-by-step visual tutorials on wound care that allow patients and family caregivers to take pictures of the wounds and monitor the wound healing process. mHealth app for wound care knowledge is an effective and individualized method for learning.This study was registered by U.S. National Library of Medicine, ClinicalTrials.gov (ID: NCT03683303).目的: 基于自我调节理论,评估移动医疗(mHealth)应用程序对患者伤口护理知识、换药技能和焦虑程度的作用。 设计: 一项前瞻性随机对照试验 方法: 2016年3月至2016年12月,台湾一所拥有1,500张床位的大学附属医院的70名患者(或家属)被随机分为实验组(N = 35)或对照组(N = 35)。实验组使用移动医疗(mHealth)应用程序申请进行伤口护理;对照组收到口头指示和小册子。数据采集工具包括伤口护理知识量表、伤口护理技能量表、状态特质焦虑问卷和数字式心率变异装置。数据收集时间点是治疗前的基础值、三次额外演示后和出院前。采用广义估计方程进行统计分析。 结果: 在进行基础数据收集之后,实验组的伤口护理知识水平、伤口护理技能改善情况、状态特质焦虑水平和心率变异性均显著高于对照组。 结论: 研究结果支持移动医疗(mHealth)应用程序在健康教育中的有效性。临床医生可利用这些结果来加强患者的伤口护理知识,提高他们的伤口护理技能,降低与换药相关的焦虑。 影响: 缺乏伤口护理知识和技能会影响患者进行有效伤口换药的意愿和能力,使患者产生焦虑,并影响患者出院后的自我护理。移动医疗(mHealth)应用程序(apps)有可能提供具有针对性的定制化健康信息,从而加强患者对疾病的自我管理。移动医疗(mHealth)应用程序可以增加患者的伤口护理知识,提高护理技能,降低与伤口护理相关的焦虑。移动医疗(mHealth)应用程序可有效支持伤口愈合过程的自我监控、伤口状况的自我判断以及伤口护理准确性的自我反应。移动医疗(mHealth)应用程序可提供有关伤口护理的分步式可视化教程,允许患者和家庭护理提供者拍摄伤口照片并监控伤口愈合过程。移动医疗(mHealth)伤口护理知识应用程序是一种有效的个性化学习方法。 临床试验: 该研究在美国国立医学图书馆ClinicalTrials.gov注册(编号:NCT03683303)。.

肾脏纤维化是多种慢性肾病发展到一定阶段常见的病理改变，是一种进行性的几乎不可能的损伤过程，最终会引发肾脏功能损伤并引发肾衰竭。上皮间充质转分化(EMT)是一种在病理状态下上皮细胞改变表型，细胞间粘附因子表达减少，成纤维特征性细胞因子表达增加，细胞逐渐向成纤维细胞转变的进程。EMT过程在肾间质纤维化中起到重要调控作用。水通道蛋白是肾脏中高度表达的负责水分转运的膜蛋白，当肾脏纤维化发生时，水通道蛋白的表达将发生变化，对肾脏疾病的发生与调控起到重要作用。本文综述了多种水通道蛋白在肾脏纤维化疾病中的作用及机制，并对水通道蛋白作为潜在靶点调控纤维化中的EMT过程进行了一定展望。 Renal fibrosis is a common pathological characteristic that usually appears during the process of chronic kidney diseases (CKD), which is a kind of progressive damage and almost irreversible. Renal fibrosis induces kidney dysfunction and finally causes renal failure. Epithelial Mesenchymal Transition (EMT) is a pathological process that the epithelial cells lose their original characteristic and express the feature of fibroblast. Renal epithelial mesenchymal transition plays a critical role in renal fibrosis and regulates the process of renal fibrosis. Aquaporin (AQP) is a kind of water channel protein that highly expressed in kidney, which is involved in water transport and the formation of osmotic pressure in kidney. The expression of AQPs changes when renal fibrosis occurs. Many renal diseases cause imbalance of water transport, so AQPs in kidney may take part in the regulation of various renal diseases, especially renal fibrosis. This article reviews the function and mechanism between various kinds of AQPs and renal fibrosis. At last, we make an outlook on AQPs as the potential target of the EMT process in renal fibrosis.

当前在医疗信息化的推动下，人们开始从诊疗流程出发研究医疗信息的采集。本文对传统型、研究型和新型门诊诊疗流程进行分析，对三种形式下的门诊诊疗流程做了对比研究，从数据利用以及人性化服务角度出发设计出一套通用门诊信息采集系统，为未来智慧型医院的发展打下良好基础。 Driven by the medical informatization, people start to research the information gathering according to the clinical and medical information flow. By analyzing and comparing the traditional, re-search-based and new clinic diagnosis and treatment processes, from the perspective of data uti-lization and humanized service, this article is to design a set of general outpatient information ga-thering systems, for the future development of intelligence hospitals.

本文对一例全身多发软组织肿瘤患者的发病及诊治过程进行报道。 This paper reports on the diagnosis and treatment of patients with multiple soft tissue tumors.

摘要: 次级花粉呈现是植物提高花粉输出和接受的效率与准确性以及促进异交的一种繁殖策略。新疆党参 (Codonopsis clematidea)具有典型的次级花粉呈现特性。本文采用野外观测、授粉实验与室内显微观测等方法, 对 该物种的花部综合征及其次级花粉呈现过程进行了详细观测, 并对这些特征的适应意义进行了探讨。结果表明: 新疆党参钟状下垂的蓝色花冠及黑黄色蜜腺, 不仅避免了雨水冲刷雌雄蕊、稀释花蜜以及风移出花粉等不利影响, 还增加了对传粉者的吸引, 延长了花粉活力及柱头可授性持续时间。次级花粉呈现属于亚顶端花柱呈现者, 呈现 机制为沉积机制。该特性限制了单个传粉者带走的花粉量, 延长了花粉呈现时间, 使更多传粉者参与传粉过程, 增 加了雄性适合度。其雄性先熟及雌雄蕊空间位置变化, 避免了雌雄功能干扰, 为传粉者取食花蜜、输出花粉以及 柱头接受异源花粉提供了通道和机会。其泛化传粉系统的主要传粉昆虫为林野熊蜂(Bombus silvarum)、草地熊蜂 (B. paradoxus)和树长黄胡蜂(Dolichovespula sylvestris), 其较长的单花花期(6 d左右), 昆虫访花高峰期与花粉活力 最高时期及柱头最佳授粉期相吻合, 以及较大的泌蜜量、较高的花蜜糖浓度和较长的泌蜜时间等特征, 可提高传 粉者的访花频率, 增加成功传粉的机会和传粉效率。在气候多变的天山山区, 该物种特殊的花部综合征和次级花

肾母细胞瘤(Wilms’ Tumor)是儿童最常见的肾脏肿瘤，占儿童全部肿瘤的6%~7%。而在成人，肾母细胞瘤的发生极为罕见，进展迅速；且同儿童肾母细胞瘤患者相比，成人肾母细胞瘤患者的预后更差。迄今，关于成人肾母细胞瘤的治疗仍在进一步完善当中。本文报道一例33岁成年男性巨大肾母细胞瘤患者术后复发及肺转移的治疗过程，探讨了当前的治疗进展，并对疾病的治疗过程进行了回顾性的分析。 Wilms’ tumor (nephroblastoma) is the most common renal tumor that occurs in children, accounting for 6% to 7% of all childhood tumors. However, it is extremely rare in adults, and the clinical course of adult Wilms’ tumor is very aggressive. In addition, adult Wilms’ tumor has a worse prognosis compared with Wilms’ tumor that occurs in children. To date, there are no defined treatment protocols for adults. Here, we report the treatment course for recurrence and lung metastasis of giant adult Wilms’ tumor in a case of 33-year-old male, review the literatures for the treatment outcome and discuss the treatment course of this case retrospectively.

目的：探讨外耳道腺样囊性癌的临床及病理特点，以提高诊断和治疗水平。方法：回顾性分析1例外耳道腺样囊性癌患者自首诊8年来连续的临床表现，病程进展，治疗及随访结果。结果：患者术后随访半年无复发。结论：外耳道腺样囊性癌生长缓慢，可长期带瘤生存但远期预后不佳，首次治疗应该采用扩大根治性手术，术后结合临床病理分期辅以放射治疗以提高治愈率。 Objective: To detect the clinical and pathological features of the adenoid cystic carcinoma of external audi-tory canal, and to improve its diagnosis and treatment level. Method: A retrospective analysis has been performed on patients with ACCEAC by their clinical manifestation, the therapy and follow-up results since 8 years ago as well as the combination with there view of related literature. Result: Patients without recurrence of postoperative follow-up of six months. Conclusion: Adenoid cystic carcinoma of external auditory canal, which is rarely seen in clinic, is not easy to exact diagnosis in early stage. It progresses slowly and tends to invade parotid and even intracranial cavity. It also has the tendency of recurrence and pulmonary metastasis. So, it’s necessary to do both aggressive surgery and postoperative irradiation. The long term follow-up indicates that the tumor has a poor prognosis.

为解决传统Dyson成像光谱系统结构过于紧凑而难于实际应用的缺点，通过减薄半球透镜厚度和偏置狭缝位置的办法，将狭缝、像面与半球透镜之间拉开了足够的轴上距离和垂轴距离；结合光程进行分析，获得了改进后Dyson系统的消像散条件；在半球透镜和凹面光栅之间增加两个球面透镜，对轴上距离带来的额外球差和色差进行校正.结合改进的Dyson成像光谱仪和Schwarzschild双反射镜系统，设计了宽波段、小 F 数高光谱成像仪光学系统.对一工作波段为320~1 000 nm的实例设计结果进行分析可知， F 数为1.8的全系统像差得到充分校正，全视场全波段调制传递函数值在0.5以上，光谱分辨率达到3.6 nm.该系统可用于沿海环境的高光谱观测.

Suboptimal care contributes to perinatal mortality rates. Quality-of-care audits can be used to identify and change suboptimal care, but it is not known if such audits have reduced perinatal mortality in South Africa.We investigated perinatal mortality trends in health facilities that had completed at least five years of quality-of-care audits. In a subset of facilities that began audits from 2006, we analysed modifiable factors that may have contributed to perinatal deaths.Since the 1990s, the perinatal problem identification programme has performed quality-of-care audits in South Africa to record perinatal deaths, identify modifiable factors and motivate change.Five years of continuous audits were available for 163 facilities. Perinatal mortality rates decreased in 48 facilities (29%) and increased in 52 (32%). Among the subset of facilities that began audits in 2006, there was a decrease in perinatal mortality of 30% (16/54) but an increase in 35% (19/54). Facilities with increasing perinatal mortality were more likely to identify the following contributing factors: patient delay in seeking help when a baby was ill (odds ratio, OR: 4.67; 95% confidence interval, CI: 1.99-10.97); lack of use of antenatal steroids (OR: 9.57; 95% CI: 2.97-30.81); lack of nursing personnel (OR: 2.67; 95% CI: 1.34-5.33); fetal distress not detected antepartum when the fetus is monitored (OR: 2.92; 95% CI: 1.47-5.8) and poor progress in labour with incorrect interpretation of the partogram (OR: 2.77; 95% CI: 1.43-5.34).Quality-of-care audits were not shown to improve perinatal mortality in this study.Des soins sous-optimaux contribuent à des taux élevés de mortalité périnatale. Les contrôles de la qualité des soins peuvent permettre de déterminer si des soins sont sous-optimaux et de les modifier, mais il reste à savoir si ce type de contrôle a permis de réduire la mortalité périnatale en Afrique du Sud.Nous avons examiné les tendances en termes de mortalité périnatale dans des établissements de santé qui avaient réalisé des contrôles de la qualité des soins sur au moins cinq ans. Dans un sous-groupe d'établissements ayant commencé ces contrôles dès 2006, nous avons analysé les facteurs modifiables qui pourraient avoir eu un effet sur la mortalité périnatale.Depuis les années 1990, dans le cadre du programme d'identification des problèmes périnataux (PPIP), des contrôles de la qualité des soins ont été réalisés en Afrique du Sud afin d'enregistrer les décès périnataux, de déterminer les facteurs modifiables et de favoriser des changements.Des contrôles en continu sur cinq ans avaient été réalisés dans 163 établissements. Le taux de mortalité périnatale avait diminué dans 48 établissements (29 %) et augmenté dans 52 (32 %). Concernant le sous-groupe des établissements qui avaient commencé le contrôle en 2006, on a observé une diminution de la mortalité périnatale dans 30 % d'entre eux (16/54) mais une augmentation dans 35 % de ces établissements (19/54). Dans les établissements qui affichaient une augmentation du taux de mortalité périnatale, les facteurs suivants étaient plus fréquemment identifiés : consultation tardive des patients lorsqu'un enfant était malade (rapport des cotes, RC : 4,67 ; intervalle de confiance de 95 %, IC : 1,99–10,97) ; non-administration prénatale de stéroïdes (RC : 9,57 ; IC de 95 % : 2,97–30,81) ; manque de personnel infirmier (RC : 2,67 ; IC de 95 % : 1,34–5,33) ; souffrance fœtale non détectée ante partum lors de la surveillance du fœtus (RC : 2,92 ; IC de 95 % : 1,47–5,8) et mauvaise progression du travail, avec une interprétation incorrecte du partogramme (RC : 2,77 ; IC de 95 % : 1,43-5,34).Cette étude n'a pas montré que le contrôle de la qualité des soins permettait de réduire la mortalité périnatale.El cuidado por debajo del nivel óptimo contribuye a las tasas de mortalidad perinatal. Las verificaciones de la calidad de la asistencia se puede utilizar para identificar y cambiar el cuidado por debajo del nivel óptimo, pero no se sabe si tales verificaciones han reducido la mortalidad perinatal en Sudáfrica.Se investigaron las tendencias de mortalidad perinatal en centros de salud que habían completado por lo menos cinco años de verificaciones de la calidad de la asistencia. En un subgrupo de centros que empezaron las verificaciones en 2006, se analizaron los factores modificables que podrían haber contribuido a las muertes perinatales.Desde la década de 1990, el programa de identificación del problema perinatal ha realizado verificaciones de la calidad de la asistencia en Sudáfrica para registrar las muertes perinatales, identificar los factores modificables y estimular el cambio.Cinco años de verificaciones continuas estuvieron disponibles para 163 centros. Las tasas de mortalidad perinatal disminuyeron en 48 centros (28%) y aumentaron en 52 (32%). En el subgrupo de centros que empezó la verificación en 2006, hubo una disminución en la mortalidad perinatal del 30% (16/54), pero un aumento del 35% (19/54). Los centros con una mortalidad perinatal en aumento tenían una mayor probabilidad de identificar los siguientes factores: retraso de los pacientes en la búsqueda de ayuda cuando un niño enfermaba (cociente de posibilidades, CP: 4,67; intervalo de confianza, IC, del 95%: 1,99–10,97); falta de uso de asteroides prenatales (CP: 9,57 (IC del 95%: 2,97–30,81); falta de personal de enfermería (CP: 2,67 (IC del 95%: 1,34–5,33); septicemia neonatal no identificada antes del parto durante el control del feto (CP: 2,92 (IC del 95%: 1,47–5,8) y escasos progresos en el parto con una interpretación incorrecta del partograma (CP: 2,77 (IC del 95%: 1,43–5,34).Las verificaciones de la calidad de la asistencia no ha mostrado mejoras en la mortalidad perinatal en este estudio.تسهم الرعاية التي تكون دون المستوى في زيادة معدلات الوفيات المحيطة بالولادةقمنا باستقصاء نزعات الوفيات المحيطة بالولادة في المرافق الصحية التي أكملت خمس سنوات على الأقل من تنفيذ مراجعات جودة الرعاية. في مجموعة ثانوية من المرافق التي بدأت في تنفيذ عمليات المراجعة منذ عام 2006، قمنا بتحليل العوامل القابلة للتعديل التي ربما تكون قد ساهمت في الوفيات المحيطة بالولادة.منذ التسعينيات، قام برنامج تحديد المشكلة المحيطة بالولادة بتنفيذ عمليات مراجعة جودة الرعاية في جنوب أفريقيا لتسجيل الوفيات المحيطة بالولادة، وتحديد العوامل القابلة للتعديل، وتحفيز التغيير.توفرت خمس سنوات من المراجعات المستمرة لعدد 163 مِرفقًا. انخفضت معدلات الوفيات المحيطة بالولادة في 48 مرفقًا (‏‏29٪) وارتفعت المعدلات في 52 مرفقًا (‏‏32٪). من بين المجموعة الثانوية من المرافق التي بدأت في تنفيذ المراجعات في عام 2006، كان هناك انخفاض في معدل الوفيات المحيطة بالولادة بنسبة بلغت 30٪ (16/54)، ولكن كان هناك زيادة بنسبة تبلغ 35‏٪ (19/54). كانت المرافق التي تعاني من معدلات متزايدة للوفيات المحيطة بالولادة، أكثر أرجحية لتحديد العوامل المساهمة التالية: تأخر المريض في طلب المساعدة عندما كان الطفل مريضًا (نسبة الاحتمال: 4.67؛ بنسبة أرجحية مقدارها ‏95‏%: 1.99 إلى 10.97)؛ الافتقار لاستخدام الستيرويدات في الفترة السابقة للولادة (نسبة الاحتمال: 9.57؛ بنسبة أرجحية مقدارها ‏95%: 2.97 إلى 30.81)؛ قلة أعداد العاملين في مجال التمريض (نسبة الاحتمال: 2.67؛ بنسبة أرجحية مقدارها 95%: 1.34 إلى 5.33)؛ لم يتم اكتشاف المشكلات الجنينية في الفترة السابقة للولادة عندما يتم رصد الجنين (نسبة الاحتمال: 2.92؛ بنسبة أرجحية مقدارها ‏95%: 1.47 إلى 5.8) والتقدم الضعيف في المخاض، إلى جانب التفسير الخاطئ لمخطط الولادة (نسبة الاحتمال: 2.77؛ بنسبة أرجحية مقدارها ‏95%: 1.43 إلى 5.34).لم يتضح تأثير لمراجعات جودة العناية في تحسين معدلات الوفيات المحيطة بالولادة في هذه الدراسة.医疗情况不理想是导致围产儿死亡率上升的因素。医疗质量审核可用于确定并改变不理想的医疗情况，但是目前尚不清楚该种审核是否能降低南非境内的围产儿死亡率。.我们在已经完成医疗质量审核至少长达五年的医疗机构中调查了围产儿的死亡率变化趋势。针对从 2006 年开始审核的一部分机构，我们分析了造成围产儿死亡的可变因素。.自二十世纪九十年代以来，围产儿问题确定计划已在南非开展医疗质量审核，记录围产儿死亡情况，确定可变因素并促进改变。.五年来持续为 163 家机构提供审核。48 家机构 (29%) 的围产儿死亡率下降，52 家机构 (32%) 的围产儿死亡率上升。在从 2006 年开始审核的一些机构中，30% (16/54) 的机构出现围产儿死亡率下降，但是 35% (19/54) 的机构却出现围产儿死亡率上升。围产儿死亡率上升的机构更有可能与以下确定的诱发因素有关：婴儿生病时，患者就医延迟（比值比，OR：4.67；95% 置信区间，CI：1.99–10.97）；没有使用产前类固醇 (OR:9.57；95% CI：2.97–30.81)；缺乏护理人员 (OR:2.67；95% CI：1.34–5.33)；没有在产前对胎儿进行监护时检测出胎儿困厄的情况 (OR:2.92; 95% CI:1.47–5.8)；以及产程进展缓慢，工作人员无法正确判读产程图 (OR:2.77; 95% CI: 1.43–5.34)。.医疗质量审核尚未在本研究中表明围产儿死亡率情况得到改善的结果。.Недостаточный уровень медицинской помощи способствует росту показателей перинатальной смертности. Аудит качества медицинской помощи можно использовать для выявления недостаточного медицинского ухода и возможного изменения сложившейся ситуации. Тем не менее эффективность такого аудита для уменьшения уровня перинатальной смертности в Южной Африке неизвестна.Были исследованы тенденции в отношении перинатальной смертности в тех учреждениях здравоохранения, которые проводили аудит качества медицинской помощи по меньшей мере в течение пяти лет. В подгруппе учреждений, начавших аудит с 2006 года, были проанализированы модифицируемые факторы, которые могли вносить вклад в показатели перинатальной смертности.В Южной Африке с 90-х годов ХХ века проводится аудит качества медицинской помощи по программе идентификации перинатальных проблем с целью учета уровня перинатальной смертности, выявления модифицируемых факторов и стимулирования изменений.Были получены результаты непрерывного пятилетнего аудита из 163 учреждений. Показатели перинатальной смертности снизились в 48 учреждениях (29 %) и выросли в 52 (32 %). Среди подгруппы учреждений, которые приступили к аудиту в 2006 году, снижение перинатальной смертности выявлено в 30 % случаев (16 из 54 учреждений), однако в 35 % (19 из 54 учреждений) выявлен рост. В тех учреждениях, где отмечался рост перинатальной смертности, с большей вероятностью выявлялись следующие факторы: задержка с обращением за помощью со стороны пациентов, когда ребенок заболел (отношение шансов, ОШ: 4,67; 95 % доверительный интервал, ДИ: 1,99–10,97); недостаточное использование стероидов в антенатальном периоде (ОШ: 9,57; 95 % ДИ: 2,97–30,81); нехватка младшего медицинского персонала (ОШ: 2,67; 95 % ДИ: 1,34–5,33); невыявленное при дородовом мониторинге угнетенное состояние плода (ОШ: 2,92; 95 % ДИ: 1,47–5,8); плохая динамика родов с неверной интерпретацией партограммы (ОШ: 2,77; 95 % ДИ: 1,43–5,34).По результатам данного исследования аудит качества медицинской помощи не привел к улучшению показателей перинатальной смертности.

China's National Methadone Maintenance Treatment Programme (MMT) has expanded from eight clinics serving approximately 1000 clients to 738 clinics that have served more than 340 000 clients cumulatively in only 8 years. This has created an enormous demand for trained providers.Human resource development and capacity building efforts have been conducted in China's National MMT Programme to create a supply of providers trained in administering MMT for opioid dependence.From 2004 to 2007, China's National MMT Programme faced several problems: inappropriately low methadone doses, poor compliance, high concurrent drug use and high drop-out rates among clients, and little experience, little training and high turnover rates among providers.Training programmes for individual providers and their trainers were redeveloped and expanded in 2008. Although programme performance metrics show an increase in patients' annual mean duration in treatment (93 days in 2004 versus 238 days in 2011), the increase in their mean daily methadone dose (from 47.2 mg in 2004 to 58.6 mg in 2011) is modest.Some of the problems that can arise during the development, launch and scale-up of a major national public health effort, such as China's National MMT Programme, cannot be foreseen. Key to the programme's success so far have been the strong commitment on the part of China's government and the optimism and pragmatism of programme managers. Human resources development and capacity-building during scale-up have contributed to improved service quality in MMT treatment clinics and are critical to long-term success.Le programme national chinois de traitement de maintien à la méthadone est passé de 8 hôpitaux traitant environ 1 000 patients à 738 cliniques qui ont suivi plus de 340 000 patients au total en seulement 8 ans. Cela a généré une énorme demande en prestataires expérimentés.Le développement des ressources humaines et des efforts de renforcement des compétences ont été menés par le programme national chinois de traitement de maintien à la méthadone (TMM) afin de proposer des prestataires formés à la gestion du TMM en termes de dépendance aux opiacés.De 2004 à 2007, le programme national chinois de TMM s'est heurté à divers problèmes: doses de méthadone inadéquatement faibles, observance médiocre, importante consommation simultanée de drogues et taux d'abandon élevés chez les patients, faible expérience et taux de renouvellement élevé des prestataires.Des programmes de formation pour les prestataires et leurs formateurs ont été élaborés et développés en 2008. Bien que des mesures de performance du programme montrent une augmentation de la durée moyenne annuelle du traitement des patients (93 jours en 2004 pour 238 jours en 2011), l'augmentation de leur dose quotidienne moyenne de méthadone est modeste (de 47,2 mg en 2004 à 58,6 mg en 2011).Certains problèmes qui peuvent survenir lors du développement, du lancement et de l'application à grande échelle d'un effort national majeur dans le domaine de la santé publique, tel que le programme national chinois du traitement de maintien à la méthadone, ne peuvent être prévus. À ce jour, les clés du succès du programme sont l'engagement marqué de la part du gouvernement chinois ainsi que l'optimisme et le pragmatisme des responsables du programme. Le développement des ressources humaines et le renforcement des compétences lors du développement à grande échelle ont contribué à une amélioration de la qualité du service dans les cliniques de TMM et sont essentiels pour une réussite à long terme.El Programa Nacional para el Tratamiento de Mantenimiento con Metadona de China ha pasado de tener ocho clínicas que atendían a aproximadamente 1000 clientes a 738 clínicas con un total acumulado de más de 340 000 clientes atendidos en sólo ocho años, lo que ha creado una demanda enorme de proveedores de servicios cualificados.Los esfuerzos para el desarrollo de los recursos humanos y la creación de capacidad adecuada han llevado al Programa Nacional para el TMM de China a crear un programa para aportar proveedores cualificados capaces de administrar el tratamiento de mantenimiento con metadona (TMM) para la dependencia de opiáceos.Desde el año 2004 hasta el 2007, el Programa Nacional para el TMM chino tuvo que hacer frente a numerosos problemas: dosis inadecuadamente bajas de metadona, cumplimiento deficiente del programa, elevado uso simultáneo de drogas, tasas altas de abandono entre los clientes, falta de experiencia y de formación, así como índices elevados de rotación entre los proveedores de servicios.En el año 2008 se volvieron a diseñar y se aumentaron los programas de formación para los proveedores individuales, así como para sus instructores. Aunque las mediciones del rendimiento del programa muestran un aumento de la duración media anual del tratamiento de los pacientes (93 días en 2004 frente a 238 días en 2011), el aumento de la dosis diaria de metadona (de 47,2 mg en 2004 a 58,6 mg en 2011) resulta moderado.No es posible prever todos los problemas que pueden surgir durante el desarrollo, el lanzamiento y la expansión de un esfuerzo de tal relevancia en materia de salud pública nacional como es el Programa chino para el Tratamiento de Mantenimiento con Metadona. Las claves para el éxito del programa han sido, hasta ahora, el fuerte compromiso por parte del gobierno chino, así como el optimismo y el pragmatismo de los gestores del programa. El desarrollo de los recursos humanos y la creación de capacidad durante su proceso de expansión han contribuido a mejorar la calidad del servicio en las clínicas de TMM y son fundamentales para el éxito a largo plazo.توسع البرنامج الوطني الصيني للعلاج الصياني بالميثادون من ثماني عيادات تخدم 1000 عميل إلى 738 عيادة خدمت أكثر من 340000 عميل على نحو تراكمي خلال 8 سنوات فقط. وهو ما أسفر عن طلب هائل على مقدمي الخدمة المدربين.تم القيام بجهود تنمية الموارد البشرية وبناء القدرات في البرنامج الوطني الصيني للعلاج الصياني بالميثادون لتهيئة الإمداد بمقدمي خدمة مدربين على إدارة العلاج الصياني بالميثادون (MMT) المعتمد على المواد الأفيونية المفعول.في الفترة من 2004 إلى 2007، واجه البرنامج الوطني الصيني للعلاج الصياني بالميثادون عدة مشكلات، هي: انخفاض جرعات الميثادون على نحو غير ملائم، وضعف الامتثال، وزيادة الاستخدام المتزامن للأدوية وزيادة معدلات التسرب بين العملاء، وقلة الخبرة، وقلة التدريب وزيادة معدلات التنقل بين مقدمي الخدمة.تم إعادة تطوير برامج التدريب لمقدمي الخدمة الفرديين ومدربيهم وتوسيعها في عام 2008. وعلى الرغم من أنه يتضح من قياسات أداء البرامج وجود زيادة في متوسط المدة السنوية للمرضى في العلاج (93 يوماً في 2004 مقابل 238 يوماً في 2011)، فإن الزيادة في متوسط جرعة الميثادون اليومية (من 47.2 مليغرام في 2004 إلى 58.6 مليغرام في 2011) متواضعة.لا يمكن التكهن ببعض المشكلات التي يمكن أن تنشأ أثناء تنفيذ جهد وطني رئيسي في مجال الصحة العمومية وإطلاقه وزيادته، مثل البرنامج الوطني الصيني للعلاج الصياني بالميثادون. ولايزال الالتزام القوي من جانب الحكومة الصينية والتفاؤل والطابع العملي لدى مديري البرنامج حتى الآن عوامل رئيسية في نجاح البرنامج. وأسهمت تنمية الموارد البشرية وبناء القدرات، أثناء الزيادة في خدمات العلاج الصياني بالميثادون، في تحسين نوعية الخدمة في عيادات العلاج الصياني بالميثادون كما أن لهما أهمية بالغة في تحقيق النجاح على الأمد الطويل.中国的国家美沙酮维持治疗（MMT）方案不断扩大，仅在8 年时间内就从服务约千名患者的八个诊所发展到累计服务超过34 万名患者的738 个诊所。这产生了对经过培训的医疗服务人员的巨大需求。中国的国家MMT方案已经在开展人力资源开发和能力建设工作，以此输送经过培训的医疗服务人员，管理针对阿片类药物依赖的MMT。从2004 年到2007 年，中国的国家MMT方案面临着几个问题：美沙酮剂量畸低、依从性差、合并用药多、患者脱失率高以及医疗服务人员经验少、接受的培训很少、离职率高。2008 年，各个医疗服务人员及其培训师的培训方案得到重建和扩大。尽管方案效果指标显示，患者治疗的年平均时间增加（2004 年93 天，2011 年238 天），而平均每日美沙酮剂量的增加（从2004 年的47.2 毫克增加至2011 年的58.6 毫克）适度。在开发、启动和推广国家重大公共卫生工作（如中国的国家美沙酮维持治疗方案）中可能出现的一些问题无法预见。到目前为止，保证方案成功的关键一直都在于中国政府强有力的承诺以及方案管理者的乐观精神和务实态度。在推广过程中，进行人力资源开发和能力建设有助于提高MMT治疗诊所的服务质量，对取得长期成功非常关键。Национальная программа Китая по метадоновой поддерживающей терапии была расширена с восьми клиник, обслуживающих приблизительно одну тысячу пациентов, до 738 клиник, которые в совокупности обслужили более 340 000 пациентов только за восемь лет. Это привело к огромной потребности в квалифицированных специалистах.В рамках Национальной программы Китая по метадоновой поддерживающей терапии были предприняты усилия по развитию кадровых ресурсов и созданию потенциала для обеспечения специалистами, обученными назначению метадоновой поддерживающей терапии (МПТ) для лечения опиоидной зависимости.С 2004 по 2007 гг. Национальная программа Китая по МПТ столкнулась с несколькими проблемами, такими как: нецелесообразно низкие дозы метадона, несоблюдение режима терапии, одновременное широкое использование лекарственных препаратов и высокий процент отсеявшихся пациентов, а также небольшой опыт, недостаточное обучение и большая текучесть специалистов.Обучающие программы для отдельных специалистов и их инструкторов были переработаны и расширены в 2008 году. Несмотря на то, что показатели выполнения программы указывают на увеличение средней годовой длительности лечения пациентов (93 дня в 2004 году по сравнению с 238 днями в 2011 году), увеличение средней ежедневной дозы метадона пациентов (с 47,2 мг в 2004 году до 58,6 мг в 2011 году) является незначительным.Некоторые проблемы, которые могут возникнуть во время разработки, запуска и развития больших программ общественного здравоохранения подобно Национальной программе Китая по метадоновой поддерживающей терапии, невозможно предусмотреть. До сих пор ключевым фактором успешности программы были глубокая приверженность со стороны китайского правительства, оптимизм и прагматизм руководителей программы. Развитие кадровых ресурсов и создание потенциала во время расширения программы способствовали улучшению качества обслуживания в клиниках, проводящих МПТ, и являются важными для обеспечения долговременного успеха.

目的 运用功能磁共振成像对脑卒中后及康复过程进行观察，分析相应脑内运动功能区激活的变化情况，对不同运动模式下皮质功能再塑的表现进行探讨。方法 选取本院2012年7月～2013年7月收治的30例脑卒中患者，在发病后一周开始连续两个月的康复治疗。运用Brunnstrom分级、Caroll上肢功能量表对患者康复前和康复后1、2个月的手功能进行评价。使用血氧水平依赖法观察康复病人经镜像治疗后血氧水平的变化。采用GE MR/iHSpeed 1.5磁共振扫描机进行成像功能激发检查。患者用病手执行随意运动、简单运动等，获得脑功能激发图像后，对脑内相关功能区的激活情况进行观察。结果 患者康复前Brunnstrom分级均为III级，Caroll平均分为(3.5±1.3)分；康复治疗后1个月Brunnstrom分级为III级或IV级，Caroll平均分为（35.2±2.6）分；康复治疗后2个月Brunnstrom分级为IV级或V级，Caroll平均分为（85.6±4.6）分。结论 功能磁共振分析镜像可对脑卒中偏瘫患者康复前后大脑再塑变化进行全面地反映，可作为康复治疗的依据，值得临床推广使用。

This study aims to describe the creation process of standard procedures to make possible multicentre studies related to emotional aspects of thalassaemic patients, their families and caregivers, and the pilot phase of the routine implementation. The objectives defined to perform this goal are: i) develop routines to assess and manage/treat emotional issues, ii) adjust the ABRASTA - Brazilian Association of Thalassaemia computer system to the input of collected data and its compilation, iii) conduct a pilot implementation of the routines, iv) discuss the whole process and propose next steps. Forty patients were assisted following the above mentioned routines of psychological evaluation, follow-up assistance and management of specific emotional issues. Conclusions are that the routines are adequate to enable multicenter research to compare findings and develop specific interventions to Thalassaemia patients, their families and caregivers, information gathered through them is an important means of supporting medical doctors and other members of the professional team, both in the therapeutic planning and in the communication process with patients and families, finally, considering the nature of the information, psychologists and psychiatrists are the most indicated professionals to perform the assessment and the interventions related to emotional issues, due to their professional background, training and specific skills that allow a free and candid communication with the patients and their families.&nbsp, 本研究旨在描述标准程序的创造过程，来进行关于地中海贫血患者、其家属和照顾者情感方面可能的多中心研究；以及例程实施的试点阶段。 为实现此目的而定下的目标有： 1）制定例程评估和管理/处理情感问题；2）调整巴西地中海贫血病协会（ABRASTA）计算机系统， 输入收集到的数据并对其进行编辑；3）对例程进行试点实施；4）讨论整个过程并提出下一步行动。 遵照上述特殊情感问题的心理评估、随访协助和管理的例程，曾协助过四十名患者。 结论为该例程足以确保多中心研究，以比较结果和为地中海贫血患者、其家属和照顾者制定具体的干预措施；通过他们收集的信息是支持治疗医生和专业团队的其他成员的重要途径，这些支持体现在治疗计划、以及和患者及其家属交流的过程中；最后，考虑到这些信息的性质，心理专家和精神病专家是最明显的专业人士来进行的有关情感问题的评估和干预，因为他们具备专业背景、专业训练和特殊技能，这些使得他们能够和患者及其家属进行自由和真正的交流。