Background: In the case of large heterogeneity, the data combination of randomized controlled trials will lead to the decrease of the reliability of systematic review and meta analysis, so we conducted the present study. Objectives: To explore sources of heterogeneity in studies on Tai Chi Chuan (TCC) as a complementary and alternative method for managing the overall quality of life of postoperative breast cancer patients. Methods: Randomized controlled trials were searched for in PubMed, EMBASE, Web of Science and the Cochrane Library through August 2017. The Cochrane Handbook 5.2 standards and Stata software version 10.0 were adopted for evaluating the quality of the included studies and the data was analyzed on overall quality of life of TCC. A separate univariate meta-regression analysis was performed on the study duration, sample size, cancer staging, prior breast cancer treatment, different types of TCC intervention group, different types of control group, intervention duration, mean age, and ethnicity to detect important factors leading to heterogeneity. Results: Significant heterogeneity was present in the included studies that used TCC to improve the overall quality of life of postoperative breast cancer patients from the retrieved literature (P < 0.05). The univariate meta-regression analysis indicated that the source of heterogeneity was not apparent in the analyzed factors within or between studies. Conclusions: A normative approach in studies evaluating the use of TCC for improving the overall quality of life of postoperative breast cancer patients was not sufficiently explored in the existing randomized controlled trials (RCTs). An insufficient number of RCTs in this field may be the reason that the effect size had unclear clinical significance. The existing evidence provided limited judgment on sources of heterogeneity between studies evaluating the use of TCC for improving overall quality of life in postoperative breast cancer patients.

目的 系统评价太极拳辅助治疗乳腺癌术后不良反应的临床疗效.方法 计算机检索中英文数据库和相关学术组织网站,按Cochrane系统评价方法对纳入研究进行质量评价和资料提取,采用Stata软件进行Meta分析.结果 共纳入1979例患者12个RCT.与对照组相比,太极拳能明显减轻乳腺癌术后患者握力强度、屈肘功能、肘关节伸直度、肘关节旋转度、横向内收功能,并能明显改善体重指数,对疼痛、白介素、胰岛素样生长因子-1和生活质量结局指标作用不明显.结论 太极拳能短期改善肌肉强度、灵活性和降低体重指数.由于纳入研究质量存在异质性、结局指标主观性强、例数有限且随访期短,因此开展高质量、大样本、多中心的随机对照试验对太极拳远期疗效的评价非常必要.

轻度认知功能障碍（ MCI ）患者以每年10％～15％的速度发展为阿尔茨海默病（ AD ），是正常老人发生AD的10倍。研究者们一直关注的是MCI的认知功能，如记忆力、智能和语言能力，忽略了MCI的行为和心理症状。直到1996年，国际老年精神病学会（ IPA）制定了一个新的疾病现象学术语即痴呆的行为和心理症状（ BPSD）。 BPSD是MCI常见的症状，包括抑郁、焦虑、精神病性症状、漫游、激越行为和睡眠障碍等。 MCI至今无公认的筛选及临床诊断标准，目前多采用美国 Petersen等〔1，2〕提出的MCI诊断标准，因为其相对比较准确，操作性较强：①排除痴呆和其他可引起脑功能障碍的疾病状态；②记忆力下降（有家属或知情者证实）；③量表评价：总体衰退量表（GDS）2～3级，临床痴呆量表（CDR）0.5，记忆测试结果比年龄、受教育程度匹配的对照组低1.5s以下，且简易精神状态问卷（ MMSE）至少24分，或者Mattis痴呆评定量表（ MDRS）分值至少123分、一般生活功能保存；④不符合痴呆诊断标准〔3〕。

The cognitive level mostly depends on the Meta-Cognitive level. As far as bilingual medical teaching is concerned, what it should keep in mind is that effect of transfer on medical teaching is deeply embedded in Meta-Cognitive strategies and Cultural background. The article study the utility of cognitive movement from Meta-Cognitive strategies in bilingual medical teaching with the scope of our country where the universities and colleges perform bilingual medical teaching in English-to-Chinese.

内隐自尊是自发的、自动的、无意识地自我评价系统。临终关怀系统与临终个体的心理健康、生活幸福感密切相关，人文社会科学已渗透临终关怀研究领域。通过回顾临终关怀与内隐自尊系统的社会表征及研究的现状，并从中揭示出临终关怀与内隐自尊的修复可能的机制及意义。

认知储备是一种能力假设,即在成年人的大脑足以引起临床痴呆的病损时维持最优化的一种能力.个体的教育程度、职业、智力、健康等都能反映其认知储备能力.认知储备假设预测具有较高的认知能力将降低痴呆症的罹患风险因素,这些因素包括对成人认知能力的重要影响如饮食均衡、提供高品质的教育、职业的复杂性、稳定的社会关系及炎症反应、氧化应激、细胞凋亡及认知老化的神经病理.从这些方面看,认知储备对临床老化的影响可以理解为多个积极和消极的因素对老化认知功能保留的净结果.

现代生物-心理-社会医学模式认为,几乎每一种疾病都是生物、心理、社会因素作用的结果,因而对不孕症的研究也不应仅限于生物因素.本综述的目的在于从国外心理、社会因素对不孕妇女心理干预病例研究,探讨不孕妇女存在的社会心理问题的现状和心理干预的最新进展,以便为我国不孕妇女心理治疗提供理论依据.

DPC4/Smad4 is a tumor suppressor gene identified recently,and the peptide encoded by DPC4/Smad4 gene is a cytoplasmic mediator fellowed the binding between the ligand and receptor in TGF-β signaling pathway.The downstream target genes regulated by DPC4/Smad4 are p21 WAF1,uPA,PAI-1,VEGF and TSP-1.TGF-β signaling transcription pathway including the ligand,receptor,cytoplasmic signaling transcription factor DPC4/Smad4 and the downstream target gene forms a growth inhibition regulation of tumor,and any abnormality of the elements can cause disorder in the pathway leading to tumorigenesis.

为探讨TGF-β1信号通路异常和DNA含量在直肠癌恶性演进过程中的关系与预后的意义,应用免疫组化检测正常直肠黏膜、直肠腺上皮不典型增生、直肠癌中TGF-β1,TβRⅡ,Smad4,VEGF蛋白的表达;核酸Feulgen染色测定直肠癌DNA含量.TGF-β1在低分化(72.4%)、中分化(73.9%)和高分化组(70.0%)中的阳性表达明显高于不典型增生组(23.1%)(P＜0.05),且与淋巴结侵犯、TNM分期明显相关.TβRⅡ在正常直肠黏膜(70.0%)及不典型增生组(69.2%)中的阳性表达明显高于低分化(14.8%)、中分化(13.5%)、高分化组(11.1%)(P＜0.05).73.9%低分化、72.2%中分化腺癌有Smad4的缺失表达,与高分化(35.0%)、不典型增生组(23.1%)及正常直肠黏膜(25.0%)的缺失表达相比有显著性差异(P＜0.05).VEGF在低分化(66.6%)和中分化组(65.2%)中的阳性表达明显高于高分化(25.0%)及不典型增生组(23.0%)(P＜0.05),且与腹水明显相关.DI值与直肠癌淋巴结转移相关,TNM分期中DI值Ⅳ期＞Ⅲ期＞Ⅱ期＞Ⅰ期,Ⅳ期、Ⅲ期和Ⅱ期、Ⅰ期差异有统计学意义(P＜0.05).TGF-β1与VEGF的表达(x2=5.94,r=0.364)、Smad4和TβRⅡ的表达(x2=4.14,r=0.256)均呈正相关,Smad4与VEGF的表达(x2=4.68,r=-0.322)呈负相关.Kaplan-Meier曲线显示TGF-β1,VEGF的阳性表达组与Smad4,TβRⅡ的阴性表达组的预后较正常对照组差.Cox回归分析显示TGF-β1和Smad4与预后相关,Smad4对预后是保护性因素,TGF-β1对预后风险最大.TGF-β1信号通路的关键元件的异常和直肠癌的高增殖活性与直肠癌恶性演进及预后密切相关.

OBJECTIVE:To evaluate the relationship between inactivation of TGF β 1 signaling pathway and pathogenesis of rectal cancer.METHODS:Twenty specimens of normal rectal adenoepithelium,thirteen specimens of rectal atypical hyperplasia and sixty specimens of different differentiated rectal cancers were tested by immunohistochemical techniques for expression of TGF β 1,TβRⅡ,Smad4 and VEGF.RESULTS:The expression of TGF β 1 was significantly higher in poorly differentiated adenocarcinoma (13/18),medium differentiated adenocarcinoma(17/23) and well differentiated adenocarcinoma (11/20) than that in group of atypical hyperplasia (21 5%), P 0 05,and had a significant relevance with regional node metastasis, P 0 01.The positive staining of TβRⅡ was higher in groups of normal rectal adenoepithelium(15/20) and atypical hyperplasia (7/13) than that was in poorly differentiated adenocarcinoma (3/18), medium differentiated adenocarcinoma (4/23) and well differentiated adenocarcinoma (4/20), P 0 05.The loss expressions of Smad4 in groups of of poorly and medium differentiated adenocarcinoma were observed in (13/18) and (16/23),respectively,and were significant higher than those were in groups of well differentiated adenocarcinoma (7/20),atypical hyperplasia (4/13) and normal rectal adenoepithelium (6/20), P 0 05.The expression of VEGF was significant higher in groups of poorly differentiated adenocarcinoma (12/18) and medium differentiated adenocarcinoma (16/23) than that was in well differentiated adenocarcinoma (5/20) and atypical hyperplasia (3/13), P 0 05.Expressions of TGF β 1 and VEGF were positively correlated,expressions of Smad4 and TβRⅡ were positively correlated and expressions of Smad4 and VEGF were negatively correlated.Kaplan Meier analyses revealed an impact on survival by TGF β 1,TβRⅡ,Smad4 and VEGF.CONCLUSIONS:The abnormal TGF β 1 signaling pathway and pathogenesis of rectal cancer are positively correlated.

双峰驼诱导排卵因子(OIF)的靶器官位于垂体,当OIF进入垂体后,引起组织学和生化反应导致促黄体素(LH)的分泌,其组织学改变与外观形态一致,表现为分泌细胞变形与位移.

应用同位素示踪技术,将公驼精清内的诱导排卵活性蛋白(OIP)经125I标记后输入母驼阴道.示踪结果证明,OIP经阴道前端主动吸收,很快进入血液循环,其代谢动力学属于一级吸收二室开放模型,吸收速度常数(ka)为0.067@min-1,吸收半衰期10.24 min,于23 min达峰浓度(Cmax)5.15μg@ml-1,清除半衰期(t1/2k)较长为72.6h;从DEAE-DE52柱上洗脱的活性蛋白吸收后,不经过脊髓和卵巢反馈通路,而是经血液循环直达脑髅内的靶器官垂体,从而引起母驼释放促黄体素(LH),至峰值出现,诱导母驼排卵.

从公驼精清内经DEAE-DE52柱上分离的诱导排卵活性蛋白(Ovulation- inducing bioactive protein, OIP)应用125I标记后输入母驼阴道,通过血液循环到达垂体.经测定,OIP遍布母驼体内各脏器,其中以垂体、肝脏、心脏、舌肌等浓度较高,而在眼角膜、耳尖部以及被毛中含量很少.消除半衰期长达72.6 h,其代谢主要经肝胆系统排泄,也有部分活性蛋白通过泌尿、生殖道排泄.

为建立一种高效碘标双峰驼诱导排卵活性蛋白方法,从传统的氯胺-T开始,应用Iodogen方法,最终选择N-溴代琥珀酰亚胺(NBS)为氧化剂,取得了满意的结果.标记率随NBS的用量增加而提高,在55%～86%之间;比活度0.56～1.23 MBq/μg;体外稳定期约70小时,上述研究结果表明,NBS法可以高效碘标记OIP,可用于大剂量125I的示踪,为研究双峰驼的排卵机理铺平了道路.