BACKGROUND & AIMS: PURPOSE:The middle school years are peak years for substance use initiation. The current study assessed the impact of peer influence on both initiation and escalation of cigarette, alcohol, and marijuana use among sixth, seventh, and eighth graders. METHODS:Youth (n = 974; 45% male) were surveyed twice over an academic year and reported on their personal substance use and their perception of peer substance use. The sample ranged in age from 10 to 15 years at Time 1 (M age = 11.95) and was 44% White, 26% Latino, 7% Asian American/Pacific Islander, 4% African American, and 14% mixed ethnic origin. RESULTS:Hierarchical regressions examined whether personal and perceived peer substance use predicted later substance involvement, and logistic regressions assessed whether Time 1 perceived peer and personal use of other substances discriminated between initiates and noninitiates. After controlling for personal substance use, perceived peer alcohol use predicted both increased alcohol and marijuana use, and perceived peer marijuana use predicted increased alcohol use. Only perceived peer alcohol use was associated with initiation of alcohol, and both perceived peer alcohol and marijuana use predicted onset of marijuana use. CONCLUSIONS:Results highlight the importance of perceived peer use in predicting both onset and escalation of use and suggest utilizing a multifaceted prevention approach that targets multiple substances.

背景与目标：

BACKGROUND & AIMS: CONTEXT:Concern has been raised about the safety of assisted reproduction techniques for the offspring. OBJECTIVES:The objective of the study was to investigate postnatal growth and growth factors in children born after intra-cytoplasmatic sperm injection (ICSI) and in vitro fertilization (IVF). DESIGN:The study had two cohorts: a population-based longitudinal infant cohort 0-36 months [236 ICSI, 173 IVF, 1530 naturally conceived (NC)], and a cross-sectional child cohort at 5 yr (68 ICSI, 67 IVF, 70 NC). INTERVENTION:Anthropometrical measurements were made at birth, 3, 18, 36 (infant cohort), and 60 months (child cohort), and blood samples were collected at 3 or 60 months. MAIN OUTCOME MEASURES:Serum IGF-I, IGFBP-3, height, weight, head and abdominal circumference, body mass index, and fat folds were the main outcome measures. RESULTS:Anthropometrical measurements showed no significant differences between ICSI and IVF children and controls in either cohort. However, singleton ICSI girls [3.4 (0.6) kg, P = 0.008] had a slightly lower birth weight than IVF [3.5 (0.5) kg] and NC girls [3.5 (0.5) kg]. Birth weights of singleton boys [3.6 (0.5) kg], twin boys [2.6 (0.6) kg], and twin girls [2.4 (0.5) kg] did not differ between types of conception. In the infant cohort in 3-month-old singletons, serum IGF-I was lower in ICSI [78 (26) ng/ml] than NC boys [94 (27) ng/ml, P < 0.001] and IVF [74 (34) ng/ml], compared with NC girls [93 (43) ng/ml, P = 0.011]. ICSI children were also smaller than their target height (sd score) at 3 yr of age [mean -0.91 (1.2)], compared with NC children [-0.61 (0.9), P = 0.033]. In the child cohort, target height attainment (sd score) and growth factors did not differ among the three groups. CONCLUSIONS:The overall growth pattern of ICSI and IVF children in both cohorts was normal. Our findings of subtle differences in target height attainment and serum IGF-I levels between infants born after assisted reproduction techniques and controls may not be clinically significant. However, these observations indicate that further systematic follow-up of growth and puberty in these children is needed.

背景与目标：

BACKGROUND & AIMS: PURPOSE:Although splenectomy plays an important role in the management of patients with liver cirrhosis, the optimal technique, open surgery, total laparoscopic surgery or hand-assisted laparoscopic surgery (HALS), has not yet been defined. The present study evaluated the outcomes of HALS splenectomy for cirrhotic patients. METHODS:A total of 28 consecutive patients with cirrhosis that underwent HALS splenectomy were enrolled into this study. The preoperative laboratory and morphometric data, intraoperative variables and postoperative outcomes were reviewed from the hospital charts. RESULTS:The postoperative platelet count was remarkably elevated in all cases. A re-operation was required in 1 patient complicated with postoperative hemorrhage. Enhanced CT on POD 7 revealed a high incidence of portal or splenic vein thrombosis (PSVT; 22 patients, 78.6 %). PSVT was significantly associated with higher serum bilirubin, higher indocyanine green retention value at 15 min (ICG R-15), and larger splenic vein diameter. CONCLUSION:HALS splenectomy was a very feasible and appropriate procedure for cirrhotic patients with hypersplenism. PSVT was a frequent complication and large splenic vein diameter, high serum bilirubin, and high ICG R-15 were found to be significant risk factors for PSVT after HALS splenectomy in cirrhotic patients.

背景与目标：

BACKGROUND & AIMS: :Improvements in health care are slow, in part because doctors and nurses lack skills in quality improvement, patient safety, and interprofessional teamwork. This article reports on the Retooling for Quality and Safety initiative of the Josiah Macy Jr. Foundation and the Institute for Healthcare Improvement, which sought to integrate improvement and patient safety into medical and nursing school curricula. In one academic year, 2009-10, the initiative supported new learning activities (87 percent of which were interprofessional, involving both medical and nursing students) in classrooms, simulation centers, and clinical care settings that involved 1,374 student encounters at six universities. The work generated insights-described in this article-into which learning goals require interprofessional education; how to create clinically based improvement learning for all students; and how to demonstrate the effects on students' behavior, organizational practice, and benefits to patients. A commonly encountered limiting factor for the programs was the lack of a critical mass of clinically based faculty members who were ready to teach about the improvement of care. What's more, the paucity of robust evaluation strategies for such programs suggests a future research agenda that deserves to be funded.

背景与目标： : 医疗保健的改善缓慢，部分原因是医生和护士缺乏质量改进，患者安全和专业团队合作方面的技能。本文报道了Josiah Macy Jr的质量和安全重组计划。基金会和医疗保健改善研究所，试图将改善和患者安全纳入医疗和护理学校课程。在2009-10的一个学年中，该计划支持了教室，模拟中心和临床护理环境中的新学习活动 (其中87% 是跨专业的，涉及医学和护理学生)，涉及六所大学的1,374学生相遇。这项工作产生了见解-在本文中描述-学习目标需要跨专业教育; 如何为所有学生创建基于临床的改进学习; 以及如何证明对学生行为，组织实践和对患者的利益的影响。该计划通常遇到的限制因素是缺乏足够数量的临床教职员工，他们准备教授有关改善护理的知识。更重要的是，缺乏针对此类计划的强大评估策略，这表明未来的研究议程值得资助。

BACKGROUND & AIMS: PURPOSE:The incidence of poor ovarian response in controlled ovarian stimulation (COH) has been reported in 9-24 % of IVF-ET cycles. Growth hormone augments the effect of gonadotropin on granulosa and theca cells, and plays an essential role in ovarian function, including follicular development, estrogen synthesis and oocyte maturation. The aim of this study was to assess IVF-ET cycle outcome after the addition of growth hormone in antagonist protocol in poor responders. MATERIALS AND METHODS:Eighty-two poor responder patients selected for ART enrolled the study and were randomly divided into two groups. Group I (GH/HMG/GnRHant group, n = 40) received growth hormone/gonadotropin/GnRH antagonist protocol and group II (HMG/GnRHant group, n = 42) received gonadotropin/GnRH antagonist protocol. RESULTS:The number of retrieved oocytes was significantly higher in GH/HMG/GnRHant group than HMG/GnRHant group, 6.10 ± 2.90 vs. 4.80 ± 2.40 (p = 0.035) and the number of obtained embryos was also significantly higher in GH/HMG/GnRHant group than HMG/GnRHant group, 3.7 ± 2.89 as compared to 2.7 ± 1.29 (p = 0.018). There were no significant differences between groups regarding implantation, and chemical and clinical pregnancy rates. CONCLUSION:Our study showed that co-treatment with growth hormone in antagonist protocol in patients with a history of poor response in previous IVF-ET cycles did not increase pregnancy rates.

背景与目标：

BACKGROUND & AIMS: :Psychiatrists and psychotherapists in the US (1970s to 1985) and Switzerland (1988-1993) used MDMA legally as a prescription drug, to enhance the effectiveness of psychotherapy. Early reports suggest that it is useful in treating trauma-related disorders. Recently, the first completed pilot study of MDMA-assisted psychotherapy for PTSD yielded encouraging results. Designed to test the safety and efficacy of MDMA-assisted psychotherapy in patients with treatment-resistant PTSD; our randomized, double-blind, active-placebo controlled trial enrolled 12 patients for treatment with either low-dose (25 mg, plus 12.5 mg supplemental dose) or full-dose MDMA (125 mg, plus 62.5 mg supplemental dose). MDMA was administered during three experimental sessions, interspersed with weekly non-drug-based psychotherapy sessions. Outcome measures used were the Clinician-Administered PTSD Scale (CAPS) and the Posttraumatic Diagnostic Scale (PDS). Patients were assessed at baseline, three weeks after the second and third MDMA session (end of treatment), and at the 2-month and 1-year follow-ups. We found that MDMA-assisted psychotherapy can be safely administered in a clinical setting. No drug-related serious adverse events occurred. We did not see statistically significant reductions in CAPS scores (p = 0.066), although there was clinically and statistically significant self-reported (PDS) improvement (p = 0.014). CAPS scores improved further at the 1-year follow-up. In addition, three MDMA sessions were more effective than two (p = 0.016).

背景与目标： : 美国 (20世纪70年代1985年) 和瑞士 (1988-1993) 的精神科医生和心理治疗师合法使用MDMA作为处方药，以提高心理治疗的有效性。早期报告表明，它在治疗创伤相关疾病中很有用。最近，第一个完成的MDMA辅助心理治疗PTSD的初步研究取得了令人鼓舞的结果。旨在测试MDMA辅助心理治疗在治疗耐药的PTSD患者中的安全性和有效性; 我们的随机，双盲，活性安慰剂对照试验招募了12名患者接受低剂量 (25 mg，加12.5 mg补充剂量) 或全剂量MDMA (125 mg，加62.5 mg补充剂量)。MDMA在三个实验课程中进行，并散布在每周的非基于药物的心理治疗课程中。使用的结果指标是临床医生管理的PTSD量表 (CAPS) 和创伤后诊断量表 (PDS)。在基线，第二次和第三次MDMA疗程 (治疗结束) 后三周以及2个月和1年随访时对患者进行评估。我们发现MDMA辅助心理治疗可以在临床环境中安全施用。未发生与药物相关的严重不良事件。尽管有临床和统计学上显着的自我报告 (PDS) 改善 (p = 0.066)，但我们没有看到CAPS评分的统计学显着降低 (p = 0.014)。在1年的随访中，CAPS评分进一步提高。此外，三个MDMA会话比两个更有效 (p = 0.016)。

BACKGROUND & AIMS: :Many studies have shown how a 'paternal effect' can cause repeated assisted reproduction failures. In particular, with increasing experience of intracytoplasmic sperm injection (ICSI), it became evident that spermatozoa from some patients repeatedly fail to form viable embryos, although they can fertilize the oocyte and trigger early preimplantation development. Many authors have shown how this paternal effect can be traced back to anomalies in sperm chromatin organization: the spermatozoa of subfertile men are characterized by numerical abnormalities in spermatozoal chromosome content, Y chromosome microdeletions, alterations in the epigenetic regulation of paternal genome and non-specific DNA strand breaks. In particular, pathologically increased sperm DNA fragmentation is one of the main paternal-derived causes of repeated assisted reproduction failures in the ICSI era. The intention of this review is to describe nuclear sperm DNA damage, with emphasis on its clinical significance and its relationship with male infertility. Assessment of sperm DNA damage appears to be a potential tool for evaluating semen samples prior to their use in assisted reproduction, helping to select spermatozoa with intact DNA or with the least amount of DNA damage for use in assisted conception.

背景与目标： : 许多研究表明，“父系效应” 如何导致反复的辅助生殖失败。特别是，随着卵胞浆内单精子注射 (ICSI) 经验的增加，很明显，尽管某些患者的精子可以使卵母细胞受精并触发早期植入前发育，但它们反复未能形成存活的胚胎。许多作者已经证明了这种父系效应如何可以追溯到精子染色质组织的异常: 不育男性的精子的特征是精子染色体含量，Y染色体微缺失，父系基因组表观遗传调控的改变和非特异性DNA链断裂。特别是，病理上增加的精子DNA片段化是ICSI时代反复辅助生殖失败的主要父亲来源原因之一。这篇综述的目的是描述核精子DNA损伤，重点介绍其临床意义及其与男性不育的关系。精子DNA损伤的评估似乎是在精液样本用于辅助生殖之前评估精液样本的潜在工具，有助于选择DNA完整或DNA损伤最少的精子用于辅助受孕。

BACKGROUND & AIMS: :Radical cystoprostatectomy remains the gold standard treatment for muscle invasive bladder cancer. Use of minimally invasive approaches have gained prominence aided by surgical adjuncts such as harmonic scalpel and laparoscopic bowel staplers, however laparoscopic radical cystoprostatectomy remains extremely technically challenging even for experienced laparoscopic surgeons. Following the successful application of the da Vinci robotic surgical system for radical prostatectomy, attention has now turned to the use of robot assistance for laparoscopic cystoprostatectomy. Several centers have explored the feasibility of robotic cystoprostatectomy although long-term data is lacking. Controversy exists on the oncologic efficacy and safety, need for intracorporeal diversion and standardization of technique. This article details the history, technique, results and current status of robotic cystoprostatectomy and urinary diversion.

背景与目标： : 根治性膀胱前列腺切除术仍然是肌肉浸润性膀胱癌的金标准治疗。在谐波手术刀和腹腔镜肠吻合器等外科辅助手段的帮助下，微创方法的使用已得到重视，但是即使对于经验丰富的腹腔镜外科医生来说，腹腔镜根治性膀胱前列腺切除术在技术上仍然极具挑战性。随着达芬奇机器人手术系统在根治性前列腺切除术中的成功应用，现在的注意力转向使用机器人辅助腹腔镜膀胱前列腺切除术。尽管缺乏长期数据，但一些中心已经探索了机器人膀胱前列腺切除术的可行性。在肿瘤学的疗效和安全性，对体内转移的需求以及技术的标准化方面存在争议。本文详细介绍了机器人膀胱前列腺切除术和尿流改道的历史，技术，结果和现状。

BACKGROUND & AIMS: :Thirty-five patients with definite multiple sclerosis (MS) were studied. They underwent neuropsychological testing and magnetic resonance imaging (MRI). The MRI findings at different brain areas levels were compared with the neuropsychological findings. A quantitative system was used to measure MRI-MS lesions. In this series, a positive correlation was established between memory and learning disturbances measured by Battery 144, and the lesions measured by MRI (total, hemispheric and, particularly, periventricular lesions). MRI can detect MS lesions, and this study shows that a correlation between MRI and neuropsychological findings is possible if quantitative methods are used to distinguish different MS involvement areas in relation to neuropsychological tasks. These findings suggest that hemispheric lesions in MS produce cognitive disturbances and MRI could be a useful tool in predicting memory and learning impairment.

背景与目标： : 研究了35例确诊的多发性硬化症 (MS) 患者。他们接受了神经心理学测试和磁共振成像 (MRI)。将不同脑区水平的MRI表现与神经心理学表现进行比较。定量系统用于测量MRI-MS病变。在该系列中，通过电池144测量的记忆和学习障碍与通过MRI测量的病变 (总，半球，特别是脑室周围病变) 之间建立了正相关。MRI可以检测MS病变，这项研究表明，如果使用定量方法区分与神经心理学任务有关的不同MS受累区域，则MRI与神经心理学发现之间的相关性是可能的。这些发现表明，MS的半球病变会产生认知障碍，MRI可能是预测记忆和学习障碍的有用工具。

BACKGROUND & AIMS: BACKGROUND:Fine needle aspiration (FNA) cytology has been widely used for pathologic assessment of breast lesions. However, the examination suffers a risk of false-negative results owing to insufficient sample volumes, inaccurate sampling positions, nondefinitive cytologic features, or suboptimal cell preservation. One approach to improve its accuracy is using modern mass spectrometry to detect disease biomarkers, of which the tissue samples are collected through FNA. METHODS:The biological compounds in the FNA tissue samples were extracted and characterized by matrix-assisted laser desorption ionization time-of-flight/mass spectrometry (MALDI-TOF/MS). The results were further analyzed by principal component analysis. Distribution of lipid biomarkers on tissues was explored by imaging mass spectrometry. RESULTS:Lipid profiles of the tissue samples collected by FNA were rapidly obtained through MALDI-TOF/MS analysis. Phosphatidylcholines and triacylglycerols were detected as the predominant compounds in cancerous and normal regions, respectively. The samples were clearly classified by principal component analysis, based on the differences in their lipid profiles. Different lipid patterns were clearly viewed through the molecular imaging of normal and tumorous regions of breast tissue samples. CONCLUSION:The FNA-MALDI-TOF/MS approach can provide complementary information for pathological examinations and improve the accuracy of breast cancer diagnoses. Owing to the ease of operation and automation, it is possible to efficiently screen the lipid biomarkers in a large number of tissue samples by means of MALDI-TOF/MS.

背景与目标：

BACKGROUND & AIMS: :Patient safety is one of the greatest challenges facing health care today and nurses are well placed to find opportunities for enhancing care and making it safer. Nurse education has an important role to play in ensuring future professions have capabilities and confidence to meet this challenge however this requires new pedagogies in nurse education. This paper reports on an initiative to develop the safety improvement and leadership capabilities of final year nursing students using Action Learning to support students to undertake a safety improvement project in the clinical setting. A qualitative, interpretive research approach was used to explore students' experiences of participation in Action Learning. 52 nursing students from a UK University participated in the study. Student accounts of their experiences were generated through focus group and individual interviews and data were subject to thematic analysis. Findings are discussed in relation to three categories including "creating an enabling environment", "learning through action and reflection" and "the emergence of safety improvement and leadership practices." The study findings provide valuable insights into how AL processes can engender personal leadership capabilities and support students to make a valuable contribution to safer care practices, both as students and as future health care professionals.

背景与目标： : 患者安全是当今医疗保健面临的最大挑战之一，护士处于有利地位，可以找到加强护理并使其更安全的机会。护士教育在确保未来的职业有能力和信心应对这一挑战方面发挥着重要作用，但是这需要护士教育中的新教学法。本文报告了一项倡议，即利用行动学习来支持学生在临床环境中进行安全改进项目，以发展最后一年护生的安全改进和领导能力。采用定性，解释性的研究方法来探索学生参与行动学习的经验。来自英国一所大学的52名护理专业学生参加了这项研究。通过焦点小组和个人访谈生成学生对其经历的描述，并对数据进行主题分析。讨论了有关三个类别的调查结果，包括 “创造有利的环境”，“通过行动和反思进行学习” 和 “安全改进和领导实践的出现”。研究结果为AL流程如何提高个人领导能力提供了宝贵的见解，并支持学生作为学生和未来的医疗保健专业人员为更安全的护理实践做出了宝贵的贡献。

BACKGROUND & AIMS: AIM:To explore nursing students' experiences of patient safety and peer reporting using hypothetical medication administration scenarios. BACKGROUND:Pre-registration nurse training is tasked with the preparation of students able to provide safe, high quality nursing care. How students' contextualise teaching related to patient safety, risk recognition and management in the clinical setting is less clear. METHOD:A total of 321 third year students enrolled in the final semester of an adult branch pre-registration nursing programme in 2011 in a UK university were surveyed. Using free texts, the questionnaire contained hypothetical medication administration scenarios where patient safety could potentially be at risk. Students' qualitative responses were analysed using thematic analysis. FINDINGS:The response rate was 58% (n = 186). Four themes were identified from the scenarios: (1) Protecting patient safety (2) Willingness to compromise; (3) Avoiding responsibility; (4) Consequences from my actions. CONCLUSION:The findings underscore the importance of contextual teaching about risk management, practical techniques for error management and leadership for optimal patient safety in nursing curricula. IMPLICATIONS FOR NURSING MANAGEMENT:Nurse managers are role models for nursing students in the clinical setting. Nursing management must lead, by example, the patient safety agenda in the clinical setting.

背景与目标：

BACKGROUND & AIMS: :Mutation of the DNA-binding region of the FOXP2 protein causes an inherited language disorder. A recent study provides the first data on mice with this mutation, which exhibit deficits in motor-skill learning and abnormal properties of neural circuits that contribute to these skills.

背景与目标： : FOXP2蛋白的DNA结合区的突变导致遗传性语言障碍。最近的一项研究提供了有关具有这种突变的小鼠的第一个数据，这些小鼠表现出运动技能学习的缺陷以及导致这些技能的神经回路的异常特性。

BACKGROUND & AIMS: :We have previously shown in normal subjects that motor adaptation to imposed visual rotation is significantly enhanced when tested few days later. This occurs through a process of sleep-dependent memory consolidation. Here we ascertained whether patients with Parkinson's disease (PD) learn, improve, and retain new motor skills in the same way as normal subjects. We tested 16 patients in early stages of PD and 21 control subjects over two days. All subjects performed reaching movements on a digitizing tablet. Vision of the limb was precluded with an opaque screen; hand paths were shown on the screen with the targets' position. Unbeknownst to the subjects, the hand path on the screen was rotated by 30 degrees . In experiment 1, patients taking dopaminergic treatment and controls adapted to rotation with targets appearing in an unpredictable order. In experiment 2, drug-naïve patients and controls adapted to rotation in a less challenging task where target's appearance was predictable. Patients and controls made similar movements and adapted to rotation in the same way. However, when tested again over the following days, controls' performance significantly improved compared to training, while patients' performance did not. This lack of consolidation, which is present in the early stages of the disease and is independent from therapy, may be due to abnormal homeostatic processes that occur during sleep.

背景与目标： : 我们先前已经在正常受试者中表明，几天后进行测试时，对施加的视觉旋转的运动适应性显着增强。这是通过依赖睡眠的记忆巩固过程发生的。在这里，我们确定帕金森氏病 (PD) 患者是否以与正常人相同的方式学习，改善和保留新的运动技能。我们在两天内测试了16名PD早期患者和21名对照受试者。所有受试者都在数字化平板电脑上进行了伸手动作。不透明的屏幕阻止了肢体的视力; 屏幕上显示了目标位置的手路径。受试者不知道，屏幕上的手路径旋转了30度。在实验1中，接受多巴胺能治疗的患者和对照适应旋转，目标以不可预测的顺序出现。在实验2中，未接受药物治疗的患者和对照组适应于在目标外观可预测的挑战性较小的任务中进行旋转。患者和对照组进行了类似的运动，并以相同的方式适应了旋转。但是，在接下来的几天中再次进行测试时，与训练相比，对照组的表现显着改善，而患者的表现却没有。这种缺乏巩固，存在于疾病的早期阶段，独立于治疗，可能是由于睡眠期间发生的异常稳态过程。

BACKGROUND & AIMS: :K. Cheng (1986) suggested that learning the geometry of enclosing surfaces takes place in a geometric module blind to other spatial information. Failures to find blocking or overshadowing of geometry learning by features near a goal seem consistent with this view. The authors present an operant model in which learning spatial features competes with geometry learning, as in the Rescorla-Wagner model. Relative total associative strength of cues at a location determines choice of that location and thus the frequencies of reward paired with each cue. The model shows how competitive learning of local features and geometry can appear to result in potentiation, blocking, or independence, depending on enclosure shape and kind of features. The model reproduces numerous findings from dry arenas and water mazes.

背景与目标： : K。Cheng (1986) 建议学习封闭表面的几何形状发生在对其他空间信息视而不见的几何模块中。无法通过目标附近的特征发现几何学习的阻塞或遮盖似乎与此视图一致。作者提出了一种操作模型，在该模型中，学习空间特征与几何学习竞争，例如rescarla-Wagner模型。某个位置处提示的相对总关联强度决定了该位置的选择，从而决定了与每个提示配对的奖励频率。该模型显示了根据外壳形状和特征种类，对局部特征和几何形状的竞争性学习如何导致增强，阻塞或独立性。该模型再现了来自干燥竞技场和水迷宫的大量发现。