Adolescents’ perspectives on a school-based physical activity intervention:A mixed method study

Purpose'. To examine adolescent experiences and perspectives of the GoActive intervention (ISRCTN31583496) using mixed methods processevaluation to determine satisfaction with intervention components and interpret a*dolescents experiences of the intervention process in order toprovide insights for future intervention design.Methods'. Participants (n = 1542;13.2 土 0.4 years, mean 土 SD) provided questionnaire data at baseline (shyness, activity level) and post-intervention(intervention acceptability, satisfaction with components). Between-group differences (boys vs. girls and shy/inactive vs. others) weretested with linear regression models, accounting for school clustering. Data from 16 individual interviews (shy/inactive) and 11 focus groupswith 48 participants (mean = 4;range 2—7) were thematically coded. Qualitative and quantitative data were merged in an integrative mixedmethods convergence matrix, which denoted convergence and dissonance across datasets.Results'. Effect sizes for quantitative results were small and may not represent substantial between-group differences. Boys (vs. girls) preferredclass-based sessions (0 = 0.2, 95% confidence interval (CI): 0.1—0.3);qualitative data suggested that this was because boys preferred competition,which was supported quantitatively (0 = 0.2, 95%CI: 0.1-0.3). Shy/inactive students did not enjoy the competition (0 = -0.3, 95%CI:—0.5 to —0.1). Boys enjoyed trying new activities more (0 = 0.1, 95%CI: 0.1 -0.2);qualitative data indicated a desire to try new activities acrossall subgroups but identified barriers to choosing unfamiliar activities with self-imposed choice restriction leading to boredom. Qualitative datahighlighted critique of mentorship;adolescents liked the idea, but older mentors did not meet expectations.Conclusion. We interpreted adolescent perspectives of intervention components and implementation to provide insights into future complexinterventions aimed at increasing young people's physical activity in school-based settings. The intervention component mentorship was liked inprinciple, but implementation issues undesirably impacted satisfaction;competition was disliked by girls and shy/inactive students. The resultshighlight the importance of considering gender differences in preference of competition and extensive mentorship training.

肝移植后肿瘤淋巴细胞的浸润和肝细胞癌的复发

Background/Aims:Liver transplantation is an effective treatment for highly selected patients with hepatocellular carcinoma(HCC) ,but tumour recurrence remains an important cause of mortality.There are few data on the relation between the recurrence of HCC and lymphocytic infiltration following liver transplantation.Methods:The tumour CD4+,CD8+,CD25+ and Foxp3+ lymphocyte infiltrate was assessed by immunohistochemistry in explant tissue of 69 patients who underwent liver transplantation for HCC between 1985 and 2001.The data were analysed according to HCC recurrence and factors known to be associated with outcome.Results:Tumour size(Hazard ratio(95% CI:1.19(1.02,1.39) ,P = 0.03) ) ,vascular invasion(P = 0.02) ,lymphocyte infiltration(P = 0.02) and CD4 ∶ CD8 ratio(P = 0.001) were identified as significant univariate predictors of tumour recurrence.On multivariate analysis CD4 ∶ 8 ratio(P = 0.001) ,vascular invasion(P = 0.01) ,tumour size(P = 0.06) and reduced lymphocyte infiltration(P = 0.03) were significant independent predictors of recurrence.The presence of Foxp3+ T-lymphocytes was not predictive of recurrence,but was associated with vascular invasion(FE = 9.02,P = 0.04) .Conclusions:The data support the hypothesis that immune responses are important in HCC and that the phenotype of infiltrating lymphocytes is informative regarding prognosis.

英国剑桥郡外卖食品店暴露与外卖食品消费和体重的相关性：横断面人群研究

目的 调查家庭、工作和交通路线环境中的外卖食品店暴露、外卖食品消费与体重的相关性。设计 横断面人群研究，使用每个研究对象的饮食和体重数据，以及食品环境暴露的客观指标。

血管性认知损害诊断的进一步规范化：血管性认知损害分类共识研究组指南

引言血管性认知损害（vascular cognitive impairment,VCI）诊断共识的缺乏（体现为多种不同评估方案的使用）,妨碍了对其理解和治疗的推进.多个国家的大量临床医生和研究人员参与了2个阶段血管性认知损害分类共识研究（Vascular Impairment of Cognition Classification Consensus Study,VICCCS）,旨在就VCI的诊断原则（VICCCS-1）和诊断方案（VICCCS-2）达成一致意见.本文提供了VICCCS-2的相关内容.方法使用VICCCS-1达成的原则和已发表的诊断指南作为在线德尔菲（Delphi）调查的参考基点,以期对VCI的临床诊断达成共识.结果共进行了6轮调查,每轮有65～79名专家参与,他们就VICCCS修订的轻度和重度VCI的诊断指南达成共识,并肯定了美国国立神经疾病与卒中研究所-加拿大卒中网（National Institute of Neurological Disorders and Stroke–Canadian Stroke Network,NINDS-CSN）发布的神经心理学评估方案和对影像学检查的推荐意见.讨论VICCCS-2建议规范化应用NINDS-CSN推荐的神经心理学和影像学评估方案诊断VCI,以促进研究协作.

医学院校应该放宽录取标准吗?

Drew Tarmey说:"我们需要招收更多医学生,且无需要求高中水平考试(A level,英国学生的大学入学考试)的化学成绩,这将有助于建立一个更合理且多样化的医疗人才队伍"。但Diana Wood、Mark Lillicrap和Holly Canuto认为学习化学有助于医学知识的学习,因此在改变录取标准之前仍需进一步论证。

Epitope mapping on Wegener's granulomatosis autoantigen proteinase 3

Abstract:Objective To map the epitopes on Wegener's granulomatosis autoantigen proteinase 3.Methods Antigenicity of proteinase 3 was studied with Western blot analysis in which proteinase 3 was prepared under reducing and non-reducing conditions. Two anti-proteinase 3 monoclonal antibodies, HZ1F12 and HZ1H3, were used to inhibit each other and to inhibit 22 anti-proteinase 3 positive sera from patients with Wegener's granulomatosis in competitive inhibition enzyme-linked immunosorbent assays (ELISA) and Western blot analysis. Results All monoclonal antibodies and patient sera recognized proteinase 3 under non-reducing conditions in Western blot analysis. HZ1F12 was inhibited 74% by HZ1H3. 10/22 (46%) sera were completely or partially inhibited by HZ1F12; 9/22 (41%) sera were partially inhibited by HZ1H3; and 6/22 (27%) were inhibited by both monoclonal antibodies. In inhibition Western blot analysis, the binding of patient sera to proteinase 3 could be inhibited by HZ1F12. Conclusions The epitopes of Wegener's granulomatosis autoantigen were conformational. Anti-proteinase 3 monoclonal HZ1F12 and HZ1H3 recognized similar or overlapping epitopes on the proteinase 3 molecule. Epitopes of proteinase 3 recognized by anti-proteinase 3 positive sera were not restricted.

辣食摄入与病死率——吃辣椒有益健康吗？可能有益，但证据只是初步的

饮食和营养一直被认为是影响人体健康和寿命的重要因素。由于人类饮食的多样性和复杂性，确定对健康和病死率有直接效应的饮食成分一直面临很大的挑战。目前普遍的共识是，预防慢性病主要得益于健康的饮食模式，包括摄人足够量的水果、蔬菜、全谷类、坚果、种子、纤维和鱼类，少摄人红肉和加工肉、含糖饮料和盐。除此之外，研究者也有兴趣在通常的饮食中发现其他功能性食物的成分。辛辣调味料就是其中一个例子，也是吕筠及其研究团队发表的这篇文章所关注的主题（见本期第27页；doi：10．1136／bmj．h3942）。

预防和管理2型糖尿病的饮食和营养干预策略

Nita G Forouhi和同事们认为,我们可以找到预防、管理和可能缓解2型糖尿病的饮食方法基本要点。饮食因素在2型糖尿病的预防和管理中至关重要。尽管在制定循证饮食指南方面取得了进展,但争议和困惑依然存在。在本文中,我们研究了现有证据,确定2型糖尿病饮食指南中哪些领域取得了共识,哪些还存在不确定性或争议。

预测结直肠癌患者的生存率新的模型有帮助，但不应单独使用

以临床和人口学特点相结合为基础，预估个体假定结局的概率。愈来愈多的风险预测模型有望支持患者和医生做决策。在一篇链接文章（doi：10．1136／bmj．j2497）中，Hippisley．Cox和Coupland应用英国初级保健数据库建立已诊断结直肠癌的男、女性患者其生存预估模型。然后他们在相同数据库中的患者分离群及英格兰公共健康癌症登记库进行验证。