国内外“两癌”筛查服务利用与提供的研究进展

文章利用PubMed、CNKI等国内外数据库,检索宫颈癌与乳腺癌筛查服务与利用方面的相关文献,整理归纳与比较分析发现,国外研究以社会心理学、行为学等健康信念理论为研究框架,强调社会心理、行为因素、社会资本对供需双方“两癌”筛查服务利用与提供的影响,并以此设计相应的干预策略,但是以供方视角分析筛查服务提供影响因素的研究偏少。国内的研究以需方参与筛查服务的影响因素分析为主,但是大部分研究缺少必要的理论基础,缺少对供方组织和个体层面的系统研究。国内研究者应加强对供方“两癌”筛查服务提供意愿与行为的影响因素分析,建立适合我国城乡妇女“两癌”筛查依从行为解释和干预的理论模型,积极开发提高城乡妇女参与“两癌”筛查依从行为的综合干预方案。     

当前呼吸内科临床实习中的问题与对策

临床实习是将医学生培养成为临床医生最重要的环节之一。但现阶段医学生在呼吸内科的临床实习中面临着一些问题,如实习管理松懈、带教老师轻视教学、医学实习生面临“考研”、“择业”压力忽视呼吸内科实习,以及呼吸内科学科自身的一些原因等。文章分析了影响当前呼吸内科实习质量“教”与“学”的多方面因素,提出解决呼吸内科临床实习的一些建议。     

Timing the Use of Breast Cancer Risk Information in Biopsy Decision‐Making

Available clinical evidence is inconclusive on whether radiologists should use the patient risk profile information when interpreting mammograms. On the one hand, risk profile information is informative and can improve radiologists’ performance, but on the other hand, it may impair their judgment by introducing biases in mammography interpretation. Therefore, it is important to assess whether and when profile information use translates into improved outcomes. We model the use of profile information in mammography, using a decision theoretic approach and explore the value of profile information using three process design choices: mammography only, unbiased, and biased reading. We estimate the parameters of our model using clinical data and find that using profile information along with the mammography information can achieve a better performance than not using the profile information. However, the better performance is contingent on the weight assigned to the profile information as well as the extent of bias due to profile information. Translating our findings into clinical practice would require properly designed experiments aiming to quantify the effect of the timing and the use of profile information on performance while accounting for radiologist and patient characteristics. When conducting an experiment is not feasible, a uniform operational sequence for interpreting mammograms and related guidelines may be a useful starting point to improve the quality of mammography operations.     

Using a grey relational analysis in an improved Grunow–Finke assessment tool to detect unnatural epidemics

The Grunow–Finke epidemiological assessment tool (GFT) has several limitations in its ability to differentiate between natural and man-made epidemics. Our study aimed to improve the GFT and analyze historical epidemics to validate the model. Using a gray relational analysis (GRA), we improved the GFT by revising the existing standards and adding five new standards. We then removed the artificial weights and final decision threshold. Finally, by using typically unnatural epidemic events as references, we used the GRA to calculate the unnatural probability and obtain assessment results. Using the advanced tool, we conducted retrospective and case analyses to test its performance. In the validation set of 13 historical epidemics, unnatural and natural epidemics were divided into two categories near the unnatural probability of 45%, showing evident differences (p < 0.01) and an assessment accuracy close to 100%. The unnatural probabilities of the Ebola virus disease of 2013 and Middle East Respiratory Syndrome of 2012 were 30.6% and 36.1%, respectively. Our advanced epidemic assessment tool improved the accuracy of the original GFT from approximately 55% to approximately 100% and reduced the impact of human factors on these outcomes effectively.     

TWIST基因和蛋白与宫颈癌发生发展关系的研究

目的:检测TWIST基因在宫颈癌组织和宫颈正常组织中的表达,探讨其与宫颈癌发生?发展的相关性及在宫颈癌诊疗中的意义?方法:收集56例宫颈癌组织和35例宫颈正常组织,用实时定量PCR检测TWIST mRNA的表达;用Western blot检测TWIST蛋白的表达,并分析TWIST mRNA在宫颈癌中的表达水平与临床病理因素及高危型HPV病毒载量相关性?结果:实时定量PCR结果显示宫颈癌组织中TWIST mRNA表达高于宫颈正常组织,差异具有统计学意义(P < 0.01);Western blot在蛋白质水平上证实了这一点(P < 0.01)?宫颈癌组织中TWIST的表达与淋巴结转移相关(P = 0.022),但与年龄?FIGO分期?肿瘤大小?病理类型?肿瘤分化程度无关(P均> 0.05),Logistic回归分析显示,高水平的TWIST mRNA表达是淋巴结转移的独立危险因子(P < 0.05)?而TWIST基因的相对表达水平与高危型HPV病毒载量无相关性(r = 0.205,P > 0.05)?结论:宫颈癌组织中TWIST的表达上调,且与是否有淋巴结转移相关,TWIST的表达可能对宫颈癌的发生?发展及转移有重要作用?     

单中心食管胃结合部腺癌发病情况11年变化趋势

目的:研究食管胃结合部腺癌(adenocarcinoma of the esophagogastric junction,AEG)发病情况的变化趋势?方法:回顾分析2001年1月~2011年12月南京医科大学第一附属医院收治的4 685例胃癌病例,其中AEG1 824例,非食管胃结合部腺癌(non-esophagogastric junction adenocarcinoma,NEGA)2 861例?研究AEG在胃癌中所占比例变化趋势?早期食管胃结合部腺癌(early adenocarcinoma of esophagogastric junction,EAEG)检出率变化趋势?AEG 性别年龄分布及比较AEG和NEGA患者发病年龄和性别比的差异?结果:该中心11年来AEG在胃癌中所占比例无明显变化;2007~2011年EAEG的检出率为12.23%(135/1 104),2001~2006年为8.47%(61/720),前者显著高于后者(P = 0.013);AEG患者平均发病年龄以及男女性别比均显著高于NEGA患者[(62.7 ± 9.5)岁 vs (59.1 ± 12.7)岁,P < 0.001;1 434∶390 vs 1 990∶871,P < 0.001)]?结论:AEG在胃癌中所占比例无明显增高;近5年EAEG检出率显著增高;AEG好发于男性老年患者?     

Statistical inference for Cox proportional hazards models with a diverging number of covariates

For statistical inference on regression models with a diverging number of covariates, the existing literature typically makes sparsity assumptions on the inverse of the Fisher information matrix. Such assumptions, however, are often violated under Cox proportion hazards models, leading to biased estimates with under-coverage confidence intervals. We propose a modified debiased lasso method, which solves a series of quadratic programming problems to approximate the inverse information matrix without posing sparse matrix assumptions. We establish asymptotic results for the estimated regression coefficients when the dimension of covariates diverges with the sample size. As demonstrated by extensive simulations, our proposed method provides consistent estimates and confidence intervals with nominal coverage probabilities. The utility of the method is further demonstrated by assessing the effects of genetic markers on patients' overall survival with the Boston Lung Cancer Survival Cohort, a large-scale epidemiology study investigating mechanisms underlying the lung cancer.