角色转换视角下产后抑郁发生发展模型的解释性案例研究

背景产后抑郁(PPD)是全球产后女性常发生的健康问题之一,也是女性生育期最具致残性的疾病,会对母婴身心健康及其家庭产生不良影响。目的分析产妇出现PPD症状的原因,以验证或修订前期理论假设“角色转换视角下PPD发生发展的自我-人际模型”,为构建有效的PPD预防干预方案提供干预靶点。方法采用解释性案例研究的方法,基于前期理论假设,采用理论抽样法,并遵循“复制法则”,选取2022年11月—2023年1月在复旦大学附属妇产科医院产后康复门诊进行产后常规检查的15名经历过PPD症状的产妇作为案例,对其进行面对面、半结构式个人深入访谈,运用Max QDA 2022质性资料分析软件协助整理文本信息,采用建构性解释的分析方法,将每个案例结果与预设的理论假设进行比较分析。结果本研究中产妇PPD症状的发生原因未超出前期理论假设中的自我和人际方面,可进一步归纳为“不能照顾好自己”“不能照顾好婴儿”“不能处理好与配偶的关系”及“不能处理好与重要他人的关系”4个方面的压力因素。结论前期理论假设“角色转换视角下PPD发生发展的自我-人际模型”得到了验证与具化,鉴于此,未来开发PPD预防干预方案可将其中的4个方面的压力因素作为干预靶点,从而预防PPD的发生。

Alexa,let's train now!——A systematic review and classification approach to digital and home-based physical training interventions aiming to support healthy cognitive aging

Background:There is mounting evidence that regular physical activity is an important prerequisite for healthy cognitive aging.Consequently,the finding that almost one-third of the adult population does not reach the recommended level of regular physical activity calls for further public health actions.In this context,digital and home-based physical training interventions might be a promising alternative to center-based intervention programs.Thus,this systematic review aimed to summarize the current state of the literature on the effects of digital and home-based physical training interventions on adult cognitive performance.Methods:In this pre-registered systematic review(PROSPERO;ID:CRD42022320031),5 electronic databases(PubMed,Web of Science,Psyclnfo,SPORTDiscus,and Cochrane Library)were searched by 2 independent researchers(FH and PT)to identify eligible studies investigating the effects of digital and home-based physical training interventions on cognitive performance in adults.The systematic literature search yielded 8258 records(extra17 records from other sources),of which 27 controlled trials were considered relevant.Two reviewers(FH and PT)independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise(TESTEX scale).Results:Of the 27 reviewed studies,15 reported positive effects on cognitive and motor-cognitive outcomes(i.e.,performance improvements in measures of executive functions,working memory,and choice stepping reaction test),and a considerable heterogeneity concerning study-related,population-related,and intervention-related characteristics was noticed.A more detailed analysis suggests that,in particular,interventions using online classes and technology-based exercise devices(i.e.,step-based exergames)can improve cognitive performance in healthy older adults.Approximately one-half of the reviewed studies were rated as having a high risk of bias with respect to completion adherence(≤85%)and monitoring of the level of regular physical activity in the control group.Conclusion:The current state of evidence concerning the effectiveness of digital and home-based physical training interventions is mixed overall,though there is limited evidence that specific types of digital and home-based physical training interventions(e.g.,online classes and step-based exergames)can be an effective strategy for improving cognitive performance in older adults.However,due to the limited number of available studies,future high-quality studies are needed to buttress this assumption empirically and to allow for more solid and nuanced conclusions.

Dynamic gut microbiome-metabolome in cationic bovine serum albumin induced experimental immune-complex glomerulonephritis and effect of losartan and mycophenolate mofetil on microbiota modulation

Dynamic changes in gut dysbiosis and metabolomic dysregulation are associated with immune-complex glomerulonephritis(ICGN).However,an in-depth study on this topic is currently lacking.Herein,we report an ICGN model to address this gap.ICGN was induced via the intravenous injection of cationized bovine serum albumin(c-BSA)into Sprague-Dawley(SD)rats for two weeks,after which mycophenolate mofetil(MMF)and losartan were administered orally.Two and six weeks after ICGN establishment,fecal samples were collected and 16S ribosomal DNA(rDNA)sequencing and untargeted metabolomic were conducted.Fecal microbiota transplantation(FMT)was conducted to determine whether gut normali-zation caused by MMF and losartan contributed to their renal protective effects.A gradual decline in microbial diversity and richness was accompanied by a loss of renal function.Approximately 18 genera were found to have significantly different relative abundances between the early and later stages,and Marvinbryantia and Allobaculum were markedly upregulated in both stages.Untargeted metabolomics indicated that the tryptophan metabolism was enhanced in ICGN,characterized by the overproduction of indole and kynurenic acid,while the serotonin pathway was reduced.Administration of losartan and MMF ameliorated microbial dysbiosis and reduced the accumulation of indoxyl conjugates in feces.FMT using feces from animals administered MMF and losartan improved gut dysbiosis by decreasing the Firmicutes/Bacteroidetes(F/B)ratio but did not improve renal function.These findings indicate that ICGN induces serous gut dysbiosis,wherein an altered tryptophan metabolism may contribute to its pro-gression.MMF and losartan significantly reversed the gut microbial and metabolomic dysbiosis,which partially contributed to their renoprotective effects.

Heuristic Estimation of the Vacuum Energy Density of the Universe: Part II-Analysis Based on Frequency Domain Electromagnetic Radiation

In Part I of this paper, an inequality satisfied by the vacuum energy density of the universe was derived using an indirect and heuristic procedure. The derivation is based on a proposed thought experiment, according to which an electron is accelerated to a constant and relativistic speed at a distance L from a perfectly conducting plane. The charge of the electron was represented by a spherical charge distribution located within the Compton wavelength of the electron. Subsequently, the electron is incident on the perfect conductor giving rise to transition radiation. The energy associated with the transition radiation depends on the parameter L. It was shown that an inequality satisfied by the vacuum energy density will emerge when the length L is pushed to cosmological dimensions and the product of the radiated energy, and the time duration of emission is constrained by Heisenberg’s uncertainty principle. In this paper, a similar analysis is conducted with a chain of electrons oscillating sinusoidally and located above a conducting plane. In the thought experiment presented in this paper, the behavior of the energy radiated by the chain of oscillating electrons is studied in the frequency domain as a function of the length L of the chain. It is shown that when the length L is pushed to cosmological dimensions and the energy radiated within a single burst of duration of half a period of oscillation is constrained by the fact that electromagnetic energy consists of photons, an inequality satisfied by the vacuum energy density emerges as a result. The derived inequality is given by where is the vacuum energy density. This result is consistent with the measured value of the vacuum energy density, which is 5.38 × 10-10 J/m. The result obtained here is in better agreement with experimental data than the one obtained in Part I of this paper with time domain radiation.

中国的恶性肿瘤:从第1次全国死亡调查到最新的国家癌症登记,中国癌症地图变迁带来的启示

背景与目的在过去的40年里,中国共开展了3次全国范围的死因调查,并逐步建立了癌症登记制度。为了更好地了解中国的癌症疾病负担及其预防策略,本研究分析了40年来的恶性肿瘤的死亡情况,并梳理了已或待实施的恶性肿瘤的预防策略。方法基于1973–1975年、1990–1992年、2004–2005年3次全国死因调查的数据及我国国家癌症登记中心公布的最新癌症登记数据,本研究描述了中国主要恶性肿瘤的死亡率及其时空变化。根据Segi’s世界标准人口计算年龄标准化死亡率后,比较各死亡率的数据。通过在地图上标记主要恶性肿瘤的高发地区,探讨其地理分布特征及变化。结果1973–2016年,我国胃癌、食管癌、宫颈癌的死亡率明显下降,而肺癌、结直肠癌、女性乳腺癌的死亡率逐渐上升。自2004年以来,肝癌的死亡率略微下降。在过去的20年里,肺癌和肝癌已经成为我国恶性肿瘤的两大主要死因。3次全国死因调查显示,城市和农村地区的主要恶性肿瘤的死因模式相似。但是,城市地区的食管癌和胃癌死亡率均低于农村地区。1973–1975年,农村地区五大主要恶性肿瘤死因的死亡率与同时期小城市地区相似。此外,2016年农村地区的五大主要恶性肿瘤的死因的死亡率也与2004–2005年城市地区接近。胃癌、食管癌和肝癌呈现出区域聚集性高发。自1990年至2016年,尽管这些恶性肿瘤的大多数高发地区的死亡率有所下降,但仍高于同期全国平均水平。结论进一步强化我国的初级公共卫生体系,特别是在农村地区,可能是减轻我国恶性肿瘤负担的关键一步。

成年人慢性肾脏病患者感染新型冠状病毒治疗药物选择——基于循证医学证据

慢性肾脏病(CKD)以尿检异常或肾功能进行性下降为特征。CKD患者因肾功能受损、长期使用影响免疫系统的药物或合并基础疾病较多,较正常人群更容易感染新型冠状病毒(COVID-19),且感染后重症转化率及死亡率更高。对于CKD合并COVID-19感染的治疗,合理用药尤为重要。为此,本文通过整合目前治疗COVID-19相关药物的最新研究证据,包括抗病毒药物、抗炎药物、抗血栓药物、康复者恢复期血浆与中和单克隆抗体,以及呼吸系统疾病常用对症治疗药物(如解热、止咳化痰及抗过敏药物等),突出在不同肾功能水平的调整用药方案,总结在CKD患者中使用相关药物的特殊考虑要点,以期供临床专业人员参考,辅助临床决策和合理用药,保障临床疗效与安全性。

血管周细胞在表达PDGF-B的实体瘤中诱发造血

背景与目的肿瘤组织持续生长需要红细胞充分供氧。在各类病理生理情况下,成年哺乳动物可在主要造血器官骨髓之外发生髓外造血。然而,肿瘤组织能否造血是完全未知的。大量证据表明,在肿瘤微环境中,血管周细胞保留了祖细胞特性,可分化成其他细胞类型。在此,我们探究了肿瘤组织内周细胞是否能调节造血及其作用机制。方法使用鼠源周细胞进行全基因组表达谱分析以测试周细胞是否可向红细胞分化。使用NG2-CreERT2:R26R-tdTomato小鼠对血管周细胞进行在体遗传示踪。使用流式细胞术、单细胞测序和集落形成实验对分选细胞进行鉴定。使用定量聚合酶链反应(quantitative polymerase chain reactionq,PCR)、酶联免疫吸附实验(enzyme-linked immunosorbent assay,ELISA)、细胞磁珠分选和免疫染色检查红细胞生成素(erythropoietin,EPO)的表达。构建骨髓移植小鼠模型以研究骨髓对肿瘤红细胞生成的影响。结果表达谱显示,在PDGF-B处理后,NG2+周细胞表现出造血干祖样特征,并向红系谱系分化。同时,PDGF-B可靶向癌症相关成纤维细胞以产生促红细胞生成的关键激素EPO。通过遗传示踪及流式分析,我们定义了NG2+细胞衍生的造血亚群。进一步的单细胞测序和集落形成实验结果显示,在PDGF-B刺激下,肿瘤中的NG2+细胞形成了与典型的骨髓造血干细胞不同的红系祖细胞。结论本研究提出了肿瘤组织内造血的新概念,并阐明肿瘤周细胞分化为红细胞的分子机制。靶向肿瘤造血作为一种新的治疗理念,可能对肿瘤治疗产生深远影响。

Heuristic Estimation of the Vacuum Energy Density of the Universe: Part I—Analysis Based on Time Domain Electromagnetic Radiation

In this paper, an inequality satisfied by the vacuum energy density of the universe is derived using an indirect and heuristic procedure. The derivation is based on a proposed thought experiment, according to which an electron is accelerated to a constant and relativistic speed at a distance L from a perfectly conducting plane. The charge of the electron is represented by a spherical charge distribution located within the Compton wavelength of the electron. Subsequently, the electron is incident on the perfect conductor giving rise to transition radiation. The energy associated with the transition radiation depends on the parameter L. It is shown that an inequality satisfied by the vacuum energy density will emerge when the length L is pushed to cosmological dimensions and the product of the radiated energy and the time duration of emission are constrained by Heisenberg’s uncertainty principle. The inequality derived is given by ρΛ ≤ 9.9×10-9J/m3 where ρΛ is the vacuum energy density. This result is consistent with the measured value of the vacuum energy density, which is 0.538 × 10-9J/m. Since there is a direct relationship between the vacuum energy density and the Einstein’s cosmological constant, the inequality can be converted directly to that of the cosmological constant.

Hints of the Photonic Nature of the Electromagnetic Fields in Classical Electrodynamics

Several recent publications show that the electromagnetic radiation generated by transmitting antennas satisfy the following universal conditions: The time domain radiation fields satisfy the condition A ≥ h/4π ⇒q ≥ e where A is the action of the radiation field, which is defined as the product of the radiated energy and the duration of the radiation, h is the Planck constant, e is the electronic charge and q is the charge associated with the radiating system. The frequency domain radiation fields satisfy the condition U ≥ hv ⇒q ≥ e where U is the energy radiated in a single burst of radiation of duration T/2 and v is the frequency of oscillation. The goal of this paper is to show that these conditions, which indeed are expressions of the photonic nature of the electromagnetic fields, are satisfied not only by the radiation fields generated by physical antennas but also by the radiation fields generated by accelerating or decelerating electric charges. The results presented here together with the results obtained in previous studies show that hints of the photonic nature of the electromagnetic radiation remain hidden in the field equations of classical electrodynamics, and they become apparent when the dimension of the radiating system is pushed to the extreme limits as allowed by nature.

Stair climbing,genetic predisposition,and the risk of incident type 2 diabetes:A large population-based prospective cohort study

Background:Cross-sectional evidence and small-scale trials suggest positive effects of stair climbing on cardiometabolic disease and glucose regulation.However,few studies have examined the long-term association between stair climbing and the incidence of type 2 diabetes(T2D).We aimed to prospectively evaluate the association of stair climbing with T2D and assess modifications by genetic predisposition to T2D.Methods:We included 451,699 adults(mean age=56.3±8.1 years,mean±SD;55.2%females)without T2D at baseline in the UK Biobank and followed up to March 31,2021.Stair climbing information was collected through the touchscreen questionnaire.Genetic risk score for T2D consisted of 424 single nucleotide polymorphisms.Results:During a median follow up of 12.1 years,14,896 T2D cases were documented.Compared with participants who reported no stair climbing,those who climbed stairs regularly had a lower risk of incident T2D(10-50 steps/day:hazard ratio(HR)=0.95,95%confidence interval(95%CI):0.89-1.00;60-100 steps/day:HR=0.92,95%CI:0.87-0.98;110-150 steps/day:HR=0.86,95%CI:0.80-0.91;>150 steps/day:HR=0.93,95%CI:0.87-0.99,p for trend=0.0007).We observed a significant interaction between stair climbing and genetic risk score on the subsequent T2D risk(p for interaction=0.0004),where the risk of T2D showed a downward trend in subjects with low genetic risk and those who reported stair climbing activity of 110-150 steps/day appeared to have the lowest overall T2D risk among those with intermediate to high genetic risk.Conclusion:A higher number of stairs climbed at home was associated with lower T2D incidence risk,especially among individuals with a low genetic predisposition to T2D.These findings highlight that stair climbing,as incidental physical activity,offers a simple and low-cost complement to public health interventions for T2D prevention.

结直肠癌TK、PCNA表达的研究

目的 通过对结直肠癌及腺瘤中TK和PCNA的表达 ,探讨其对结直肠癌的治疗、预后所起作用。方法 采用免疫组织化学SABC法 ,检测 54例结直肠癌及 2 0例结直肠腺瘤中TK及PCNA的表达。结果 本研究结果表明结直肠癌中TK及PCNA的阳性表达率均比结直肠腺瘤高(P <0 0 5) ,结直肠癌中TK阳性表达率 ( 64 8% )虽略比PCNA ( 51 9% )高 ,但差异无显性 (P >0 0 5)。结论 TK不仅同PCNA一样 ,可作细胞增殖的指标 ,还因其参与DNA合成及细胞间“旁观者效应”等原因 ,从而给临床提供治疗及预后方面的有价值的参考。

河北汉族人群NAT2基因多态性分析

目的 了解河北汉族人群中氮乙酰基转移酶 2 (NAT2 )基因分布。方法 采用聚合酶链式反应 限制性内切酶片段长度多态性 (PCR RFLP)方法检测 2 37名河北籍健康汉族人的NAT2基因型。结果 在河北健康汉族人群中 ,NAT2各种等位基因频率分别为Wt =0 .4 874 ,M1=0 .0 5 0 6 ,M2 =0 .15 6 1,M3=0 .30 5 9,M4 =0。快速乙酰化基因型 16 9例 (71.31% ) ,其中纯合的个体 6 2例 (2 6 .16 % ) ,杂合个体 10 7例 (4 5 .15 % ) ,并以Wt/M 3为主 (6 9例 ) ,占样本的 2 9.11% ;慢速乙酰化基因型 6 8例 ,占 2 8.6 9% ,其中纯合的个体 2 4例 (10 .13% ) ,杂合个体 4 4例 (18.5 7% ) ,并以M2 /M3基因型为主 ,共 31例 ,占样本的 13.0 8%。该结果经Hardy Weinberg吻合度检验符合Hardy Weinberg定律 ,χ2=7.2 5 33,υ=8,P>0 .0 5。结论 在河北省汉族人群NAT2突变基因中 ,以M3为主 ,但主要以Wt/M3形式存在 ,M1突变最少 ,未发现M4。这可能是该地区慢速乙酰化基因型较少的原因之一。

靶向抑制存活素基因对大肠癌细胞SW80侵袭和转移的实验研究

目的构建靶向存活素(survivin)基因的短发夹干扰RNA(shRNA)表达载体,导入人大肠癌细胞SW480中,研究靶向抑制survivin基因对SW480细胞侵袭和转移的影响。方法根据siRNA设计原则,在survivin序列中选取设计含19个核苷酸(19nt)的靶序列,间以9个核苷酸的茎环序列,两端分别加上对应的酶切位点,形成shRNA的DNA模板并克隆到shRNA表达载体pRNAT-U6.1/Neo中,获得靶向抑制survivin基因的sihNA表达载体pRNAT-U6.1/Neo-survivin;采用Lipofectamine2000TM转染试剂将干扰质粒pRNAT-U6.1/Neo-survivin导入到大肠癌细胞SW480中;用Westernblotting从蛋白水平检测干扰效果;分别采用肿瘤侵袭粘附实验和明胶酶谱分析法检测pRNAT-U6.1/Neo-survivin对SW480细胞的侵袭和转移潜能的影响。结果Survivin基因的蛋白表达均得到显著抑制;沉默SW480的survivin基因可以显著抑制SW480细胞的侵袭和转移潜能,而且survivin基因表达被抑制后,SW480细胞分泌基质金属蛋白酶明显减少。结论Survivin基因可能在SW480的侵袭和转移潜能中起重要作用,沉默SW480的survivin基因可以显著抑制其侵袭、转移和基质金属蛋白酶分泌,因而survivin影响SW480的侵袭和转移可能与调控基质金属蛋白酶分泌密切相关。

山东、宁夏农村地区县、乡、村医疗机构药品合理使用分析

目的:了解山东、宁夏《新型农村合作医疗基本药物目录》使用后农村地区的药品合理使用现状。方法:处方抽查、居民问卷调查相结合,共抽查处方3000份,调查居民3288户。结果:"大处方"、抗生素及注射剂滥用等不合理用药现象仍普遍存在,乡村医疗机构更为严重。结论:基本药物目录的推行需配套医生业务素质、合理用药意识的提高及对居民药品知识的宣传等才能真正改善合理用药状况。

山东、宁夏两省部分农村地区居民家庭自备药的现状研究

了解其家庭自备药的储备情况,及时发现问题,确保安全有效的用药。方法:采用分层随机抽样的方法抽取样本,用SPSS软件对指标进行相应的统计分析。结果:多数家庭备有中成药、抗生素类、解热止痛类及非甾体抗炎镇痛药;山东、宁夏两省分别有45.2%和43.5%的自备药品为处方药;居民药品知识匮乏;山东、宁夏分别有3.7%和1.0%的被调查居民经常外借药品,12%和32.7%偶尔外借药品给他人。结论:山东、宁夏两省农村家庭中抗生素和中成药均有较高的储备率,且自备药品中近半数为处方药,有必要进一步完善家庭自备药的管理。

微量Aβ_(1-40)诱导的α3、α7烟碱型乙酰胆碱能受体的低表达(一种老年性痴呆细胞模型)

目的 探讨老年痴呆症 ( AD)患者大脑中 ,大量神经元烟碱型胆碱能受体 ( n ACh Rs)丢失是否与 β-淀粉样多肽 ( Aβ)沉淀的关系及其影响 n ACh Rs表达的机制 ,建立一种老年性痴呆早期研究离体模型。方法 采用MTT、Annexin- V、配体结合实验以及 Western Blot、RPA法 ,观察 PC12细胞在 Aβ侵害早期 ,细胞损伤机制。结果 显示用纳摩尔浓度 Aβ1 - 40 能明显降低 PC12细胞 [1 2 5I]α- Bungarotoxin和 [3H]Epibatidine结合位点数量 ,引起 α3、α7和 β2亚单位蛋白和 α3、α7m RNA水平的下降 ,但不诱导凋亡 ,却明显抑制 MTT。结论 Aβ引起的 n ACh Rs生物合成降低 ,可能部分归因于细胞内在信号传导系统。本研究提示 ,在 AD病程早期大量 Aβ纤维形成之前 ,Aβ可直接引起 n Ach Rs退行性改变。应用药物修复 n ACh Rs,干预 Aβ对 n ACh R,尤其是对 α7n ACh R的毒性作用是预防和治疗

PAK1基因对大肠癌细胞体外侵袭能力的影响

目的研究p21-activated kinase-1(PAK1)基因对大肠癌细胞系体外侵袭能力的影响。方法把重组p21活化蛋白激酶1质粒用脂质体转染大肠癌SW480细胞,同时设立空白对照组和空载体对照组。于转染后48h采用免疫印迹方法检测PAK1的蛋白表达水平,Boyden小室模型检测大肠癌细胞SW480在转染重组PAK1基因质粒后侵袭能力的变化。结果SW480细胞转染p21活化蛋白激酶1重组质粒后,与空白对照和空载体对照相比,PAK1蛋白水平明显增加,细胞的体外侵袭能力增强。结论转染pPAK1重组质粒能够有效上调PAK1基因,增强大肠癌细胞系体外侵袭潜能,提示PAK1基因高表达可能与大肠癌细胞的侵袭和转移等生物学行为相关。

社会资本与健康公平关系的实证研究

目的:探讨社会资本对我国城市居民健康公平的影响。方法:分析方法包括单因素和logistic回归分析。主要测量指标包括自评健康指标和因子分析得到的5个社会资本因子。结果:邻里关系、互惠与社会支持高分组的人群自评健康差的概率只有低分组的1.37倍和1.32倍。但是引入社会资本变量后,贫困对自评健康的影响并没有很明显的减少。结论:在消除贫困所带来的影响的前提下,推动贫困人口社会资本的发展,对健康公平的改善会更有意义。

铁引起的早期PC12细胞nAchRs缺失及抗氧化剂的干预

目的 探讨铁对nAchRs表达的影响机制和可能的干预途径。方法 用Annexin Ⅴ、配体结合、Western印迹、RPA等方法 ,观察铁侵害早期PC1 2细胞损伤机制及抗氧化剂的保护作用。结果 FeSO4 在低浓度 (1～ 1 0 0 μM )引起PC1 2细胞膜脂质过氧化和细胞毒性作用并呈剂量依赖性增加 ,但不引起凋亡和坏死。该浓度范围可降低〔1 2 5I〕α BTX结合位点 ,α3、α7受体亚单位蛋白及α7亚单位mRNA水平 ,但预先用抗氧化剂处理 ,可干预铁对〔1 2 5I〕α BTX和〔3H〕Epibatidine亲和力的影响。结论 铁诱导的脂质过氧化能减少〔1 2 5I〕α BTX结合位点 ,选择性抑制nAchRs亚单位在蛋白质、mRNA水平表达 ,铁对nAchRs的损伤可早于凋亡和坏死的发生 ,可能是AD患者病程早期nAchRs缺失的一个机制。