Purpose Hashimoto's thyroiditis (HT), a prevalent autoimmune disorder, primarily targets the thyroid gland. The influence of dietary factors, particularly unsaturated fatty acids, on HT remains underexplored. This study investigates the association between unsaturated fatty acids and HT prevalence using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. Methods A cross-sectional study involving 6944 participants (mean age 49.73 ± 17.71 years) was conducted. Demographic, lifestyle, dietary, and urinary characteristics were assessed. Logistic regression models were employed to control for potential confounders and to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for the association between unsaturated fatty acids and HT. Results The overall prevalence of HT was 11.82%. Individuals with HT were more likely to be older, female, married, non-smokers, drinkers, and have higher income. Dietary intakes of carbohydrates, sodium, energy, protein, polyunsaturated fatty acids (PUFAs), and monounsaturated fatty acids (MUFAs) were significantly lower in the HT group. Additionally, urinary cadmium concentrations were reduced in this group. After adjustments, higher intakes of PUFAs (OR 0.62, 95% CI 0.42-0.89) and a higher ratio of MUFAs to total fatty acids (OR 0.67, 95% CI 0.50-0.90) were associated with a lower risk of HT. Subgroup analyses indicated that these associations were particularly evident among females, individuals under 40 years of age, non-smokers, and alcohol consumers. A restricted cubic spline (RCS) model revealed a nonlinear relationship between PUFAs and HT (P-overall < 0.001, P-non-linear = 0.0127). Sensitivity analyses confirmed the robustness of these findings. Conclusion This study demonstrates that higher intake of unsaturated fatty acids, especially PUFAs and MUFAs, is associated with a reduced risk of HT. The identified nonlinear relationship between PUFAs and HT highlights the complex interplay of dietary factors in autoimmune thyroid diseases. Further research is warranted to elucidate the underlying mechanisms of these associations.

The common antibiotic oxytetracycline (OTC) is nowadays commonly found in natural aquatic environments. How-ever, the underlying mechanisms of low-dose OTC exposure and its neurotoxic effects on aquatic animals remain un-known. In this study, we exposed zebrafish larvae to environmental concentrations of OTC in early life and performed neurobehavioral, 16S rRNA gene sequencing, and transcriptomic analyses. OTC exposure resulted in hyperactivity of larvae and a significant reduction in the number of neurons in the midbrain. The expression levels of 15 genes related to neural function changed. Additionally, the composition of 65 genera of the gut microbiota of larvae was altered, which may be one of the reasons for the abnormal neural development. We further studied the long-term outcomes among adult fish long after cessation of OTC exposure. OTC treatment caused adult fish to be depressive and impulsive,symbolizing bipolar disorder. Adult fish exposed to OTC had significantly fewer neurons and their gut bacteria com-position did not recover 104 days after terminating OTC exposure. Finally, we analyzed the correlation between the gut microbiota of larvae, genes related to neural function, and metabolites of adult fish brain tissue. The results showed that the abundance of several members of the biome in larvae was related to the transcription levels of genes related to neural function, which were related to the metabolic levels in the adult brain. In conclusion, our study showed that early-life exposure to environmental concentrations of OTC can lead to persistent neurobehavioral abnormalities until adulthood through dysbiosis in the gut microbiota.

随着世界经济的快速增长及社会大众对医疗健康行业的重视，“医 + 旅”消费模式的市场逐年 壮大。本文以大型公立医院为研究对象，探讨大型公立医院在医疗旅游中的作用，分析大型公立医院开展 医疗旅游的优势、劣势、机遇和挑战，并提出大型公立医院开展医疗旅游的对策措施，为进一步完善医疗 旅游政策提供参考。

Purpose Epstein-Barr virus (EBV) infection has been shown to contribute to oncogenesis and often causes acute clinical manifestation of Infectious mononucleosis (IM). It is unknown whether IM could increase the risk of subsequent malignancies. We aimed to evaluate the association of IM caused by EBV (EBV-IM) with overall and subtypes of malignancy in a large population-based cohort study. Methods This study included 1,419,407 individuals born in Denmark between 1973 and 2016 identified from national registers and 23,057 individuals had IM. The 5,394 of them had confirmed EBV-IM and they were birth date- and sex- matched (1:63) to 1,396,350 non-IM individuals. Cox regression was used to examine the associations of EBV-IM with malignancy. Results Individuals with a history of confirmed EBV-IM had an 88% increased overall risk of malignancy (hazard ratio [HR]:1·88, 95% confidence interval [CI]: 1·42–2·49) and a five-fold risk of hematologic malignancies (HR 5·04, 95% CI: 3·07–8·25), compared to those without IM. Similar estimates were observed in the sibling analysis. The overall risk of malignancy was greater for EBV-IM with complications (HR 8·93, 95% CI: 3·35–23·81) than that for EBV-IM without complications (HR 1·35, 95% CI: 1·20–1·53). EBV-IM duration was related to increased risk of malignancy in a dose-response way. Notably, the significant elevated risk of overall malignancy was observed in the first two years after EBV-IM onset (rate ratio [RR] 4·44, 95% CI: 2·75–7·17) and attenuated thereafter. Conclusion EBV-IM was associated with an increased risk in malignancy, particularly hematologic malignancies and in the first two years following IM exposure. Our findings suggest an important time-window for early screening of the EBV-attributed malignancy.

目的:探讨国产与进口超声设备高端机型腹部图像质量的差距.方法:选取全国8个省及直辖市18家不同级别医院的受试者955例,每位受试者由同一名医师采用某一国产与某一进口超声设备各采集标准切面26张.根据国家及地区相关法规与行业标准,组织专家制定超声腹部图像质量评价标准,对采集到的超声图像数据进行李克特量表评分,5分为最佳,1分为最差.采用R语言进行数据分析,比较5个国产(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ)及6个进口超声设备高端机型(A、B、C、D、E、F)的腹部图像质量.结果:共采集腹部超声图像49660张.国产和进口超声设备腹部图像质量评分总体接近,差异无统计学意义.国产型号Ⅰ、Ⅳ表现相对较好,与评分最高的进口设备B之间无差异.国产型号Ⅱ及Ⅲ灰阶细节分辨力、彩色多普勒血流成像充盈度与平滑度、时间流速曲线中的低速血流敏感度较差.国产与进口超声设备腹部图像总体灰阶、彩色多普勒血流成像、时间流速曲线指标评分之间差异无统计学意义.结论:国产超声设备高端机型腹部图像质量较好,总体与进口设备之间无差异,得到超声评价专家的普遍认可.

目的 分析公立医院优势学科不同亚专科相同病种的住院费用影响因素,探索提高病种管理水平的策略.方法 以上海市某三级甲等综合医院骨科不同亚专科"取除骨折内固定装置"为例,以住院费用、日均住院费用为主要分析指标,通过多元回归分析探索主要指标与其他变量的关系.结果 在住院费用和日均住院费用多元回归模型中,亚专科、手术部位和手术数均有显著影响.结论 建议重视不同亚专科、不同手术部位病种管理的差异,搭建各亚专科交流的平台,探索合理缩短住院天数、管理提升与精细化管理的策略,以有效提升病种管理水平.

目的 分析2010-2018年长三角地区医疗服务效率,为促进各地优化卫生资源配置、提高卫生服务水平提供参考.方法 通过定性和定量相结合的研究方法,建立数据包络分析模型,对医疗服务效率进行统计描述和模型分析,并结合文献综述和专家访谈,阐释效率分析结果.结果 长三角地区各地医疗服务效率特征各异.上海市业务效率较高,浙江省业务效率发展快速,江苏省效率其次,安徽省较低.应将各地的医疗服务效率分析结果置于各自卫生发展的背景条件、资源禀赋和战略定位下进行分析.结论 在当前经济新常态、防控新型冠状病毒肺炎疫情的环境下,控制卫生费用的不合理增长显得更加迫切和必要.建议合理配置资源,提高医疗资源使用效率,进一步控制医疗费用上升.要强化政府在公立医院补偿机制中应该发挥的作用,鼓励和引导多元主体参与医疗服务提供,满足群众多层次、多样化的健康需求.此外,还应促进区域协同发展,推进区域健康一体化建设.

目的:分析上海市青浦区65岁以上老年人中医体质类型分布特点.方法:依据《中医体质分类判定标准》对上海市青浦区2016年1月至2017年12月参加健康体检的4258例65岁以上老人进行中医体质调查,结合体检基本数据进行统计分析.结果:本次研究共检出偏颇体质3547例(83.3％),以阴虚质(23.3％)、湿热质(21.7％)、痰湿质(16.8％)为主.不同性别、年龄、呼吸频率、视力损害、高血压患病与否的人群偏颇体质检出率比较,差异具有统计学意义(P＜0.05).多因素Logistic结果显示:女性偏颇体质是男性的1.3倍[95％ CI(1.10～1.53)],75 ～ 84岁是65～ 74岁的1.66倍[95％ CI(1.35 ～2.06)],高血压患病人群是未患人群的1.33倍[95％CI(1.12～1.57)],而呼吸频率正常人群是呼吸频率过缓人群的0.27倍[95％ CI(0.17～0.43)].结论:医疗机构应根据各类特征人群的体质特点,遵循中医体质规律,提供个体化中医药养生保健建议和健康干预.

Background:Research suggests that young working students are at higher risk for substance use. However, most studies have focused on students from middle-class families, with few investigations conducted on substance use by students from low-income families.Objective:To examine the associations between work experience and betel nut, alcohol, or tobacco (BAT) use among Taiwanese students from low-income families.Methods:The data for this cross-sectional study were derived from the fourth wave of the Taiwan Panel Study of Children and Youth survey which provides primary data on low-income families. A total of 3,350 low-income students aged 12-25 years old from middle school to university participated. The chi(2)test was performed to examine differences in sociodemographic characteristics and BAT use between employed and unemployed students. Multivariate logistic regression was used to examine the associations between work status, work intensity, monthly income, occupation, and BAT use.Results:Employed students displayed higher BAT use than those who were unemployed. Increased BAT use was also associated with higher work intensity (except for betel nut use), higher monthly income, and specific occupations (such as service or manual work).Conclusions:Employment is independently associated with a higher risk of BAT use among low-income Taiwanese students. Work intensity and specific occupational fields may offer insights into formulating relevant preventive measures for these students.

目的:讨论我国长三角地区卫生发展的问题并提出相关建议.方法:运用数据包络分析方法建立区域卫生发展效率比较模型,测算各地区卫生发展的技术效率和配置效率.结果:上海和浙江卫生发展的技术效率和配置效率较高,但存在资源配置不合理、资源过度扩张等现象;江苏卫生发展技术效率低于上海和浙江,但其社会办医富有活力;安徽卫生发展效率在长三角地区中相对落后.结论:推进分级诊疗是长三角地区面临的共同挑战;同时,先发地区应进一步发挥市场在卫生资源配置中的作用,后发地区应以卫生人才建设为突破口,合力形成长三角地区卫生一体化发展新局面.

非故意伤害是指无意识、无目的造成的伤害,主要包括车祸、跌落、烧烫伤、中毒等12种伤害类型[1-2].非故意伤害因常见、多发、致残率高、后遗症多和年轻人高发等特点,已成为日益突出的公共卫生问题[2-4].尤其是刚进入小学的儿童活泼好动,对各种新鲜、刺激、危险的事物充满好奇,然而伤害预防知识匮乏、对外界致伤因素警惕性较低、防范意识较差,加之脱离家长看护等原因,使得小学生成为极易发生非故意伤害的高危人群[5-6].

目的 为了分析评价多区域、多品牌的医用超声诊断仪设备,特别是关键部件超声探头的可靠性.方法 通过在全国多区域对某品牌医用超声诊断仪设备探头进行质量检测,进而对检测结果进行规律挖掘,分析不同区域该品牌探头的可靠性.结果 探头的指标不通过率随使用时间的增加有明显的增加趋势,具有统计学意义;不同地区探头指标通过率具有统计学意义,东北地区的指标不通过率偏高,而华北地区的指标不通过率偏低.不同地区探头使用时间的分布具有统计学意义,东北地区的整体使用时间更长,而华南较短.普通探头、特殊探头功能故障的比率随使用时间的增加而下降,透镜和外壳故障比率则随使用时间的增加而有明显的上升,结果具有统计学意义.结论 本文对超声探头质量检测的结果分析,探索了某品牌医用超声探头的在多区域的使用质量规律,为超声探头的可靠性分析提供的方向,为医院医学装备管理部门、临床使用部门等相关科室的决策提供参考.

目的 建立一套评价指标体系,用于不同生产厂商的PET-CT设备相关服务的客观准确评价.方法 参考相关标准,在多项前期工作的基础上,经多轮研讨与咨询,初步建立指标体系;采用德尔菲法进行专家咨询,最终确立指标体系及各级指标权重.结果 评价指标体系含企业服务、产品服务和客户服务3个一级指标和21个二级指标;专家咨询的专家积极系数100％,平均权威系数0.88,一级和二级指标的协调系数分别为0.945和0.588.结论 指标体系权威性、一致性、合理性、可操作性均较好,评价范围涵盖售前、售中、售后三个阶段,可从多个层面和维度对医疗设备的服务进行综合性评价.

还记得年少时初读《小王子》,我最不解的,是小王子为什么要决绝地离开玫瑰. 之后我年纪渐长,经历和目睹了无数初恋的挫败,便开始困惑,人生中最纯洁、最投入、最刻骨铭心的初恋,为什么总是如此脆弱? 小王子的出走,是因为玫瑰不够美吗?当然不是.在小王子眼中,玫瑰美得叫他“心动神摇”,并认定她是全宇宙最迷人的、独一无二的花儿. 是因为厌倦吗?也不见得.直到临走的一刻,小王子仍然在悉心照顾玫瑰,没有流露半分对玫瑰的不耐烦.

目的 以来自不同医疗机构、不同场强型号的具有市场代表性的磁共振设备作为研究对象,对其规范采集的垂体磁共振影像进行细致评价,横向比较各型号设备在垂体检查中的临床效果.方法 根据美国放射学会2013年颁布的MRI图像质量认证指南,在全国40余家医疗机构收集整理150例垂体磁共振扫描图像,对其5个常见序列进行临床图像质量Likert 5级评分;并将样本分为国产组与进口组,以及1.5 T组与3.0 T组,通过统计方法进行比较研究.结果 在1.5 T组别中,联影uMR560垂体磁共振图像质量优于GE HDx和奥泰Cen/ES且具有统计学差异;在3.0 T组别中,Siemens Verio表现较好,联影uMR770表现较弱,进口设备整体表现更好,该差异具有统计学意义.结论 在垂体MRI临床检查方面,1.5 T与3.0 T设备均能满足临床需求.1.5 T国产磁共振设备整体表现不逊于进口设备,而3.0 T磁共振设备与进口设备相比还存在一定差距.本研究以垂体磁共振图像质量评价研究为引,在医用磁共振临床图像质量评价与控制方面进行了一定探索,希望能为国产磁共振设备未来产品的定义和改进提供有价值的参考信息.

本文通过对国内通信领域内数据传输标准及其技术进行系统检索,阐述了数据传输标准中涉及的关键技术及其研究现状和发展趋势,通过对环保、水利和电力领域应用较为广泛和成熟领域的实践案例进行梳理,了解当前数据传输标准的研究和应用情况,以期为卫生监督领域中生活饮用水在线监测数据的传输标准的制定和实施提供借鉴和参考.

目的 了解该区住宿、沐浴和美容美发场所公共用品卫生状况和变化趋势,为卫生监管提供参考.方法 收集该区2012-2015年公共场所监测数据,运用SPSS 22.0进行统计分析.结果 公共用品大类之间的合格率有统计学差异(x2 =51.63,P＜0.005),多重比较显示布草、洁具、杯具和修脚工具间的合格率无统计学差异(P＞0.05/10=0.005),但前三类的合格率低于美容美发用具(P＜0.005);三类场所中仅美容美发场所的公共用品大类间的合格率有统计学差异(x2=85.91,P＜0.001);布草和洁具的整体合格率均呈上升的趋势(x趋2=39.01,P＜0.001;x趋2=26.43,P＜0.001),布草的合格率在三类场所中均呈上升趋势(x趋2=7.68,P＜0.006;x趋2 =22.98,P＜0.001;x趋2 =20.76,P＜0.001).结论 公共用品卫生状况不容乐观但呈现一定改善的趋势,仍需加强对部分公共用品进行卫生监测并强化监管措施.

喜欢《小王子》的读者应该记得,在书中第二十章,小王子来到地球后,偶然经过一座开满玫瑰的花园,见到里面的五千朵玫瑰,长得和B612行星上的那朵一模一样,于是惊觉他的玫瑰原来并非世间独一无二.他十分难过,并经历一场严重的身份危机.其后小王子遇上狐狸,得其启蒙,终于明白生命中最重要的事情,是通过驯服来建立独一无二的关系.

随着我国经济的快速发展,各领域设施设备的数量和种类不断增加.对各种设施设备进行分类和编码,实现对其精细化、科学化和信息化管理成为越来越紧迫的问题. 世界发达国家或组织,如日本(1920年)、国际劳工组织(1949年)、美国(约1956年)和苏联(约1960年)率先在信息分类、编码规则和标准化等方面进行了早期的探索和实践.而我国是从1979年才开始此项工作,颁布了一系列的国家标准并于1985年成立了信息分类编码研究所(现为中国标准化研究院下属信息分类编码领域),目前已经制定和发布的信息分类编码国家标准达上百个.

在2008年6月哈佛大学的毕业典礼上,该校校长福斯特在演讲中说,在过去一年中,学生跑来问她最多的问题是:为什么在我们中间,有那么多人毕业后选择了去华尔街工作?据统计,2007年进入职场的哈佛毕业生,有58％的男生和43％的女生,选择了财经金融界.