"十要":门急诊工作必须坚持的主要伦理原则

门急诊是医院对外开放的窗口,是医院最直接的社会形象,因此,要做好门急诊工作,建立健康和谐的医患关系,就一定要坚持“十要”的伦理原则：态度要端正,沟通要真诚,速度要快捷,诊断要准确,处置要灵活,用药要合理,应激要沉着,护理要周到,能力要综合,管理要规范。     

急性绞窄性小肠梗阻的CT诊断

目的 确定CT对急性绞窄性小肠梗阻的影像学诊断价值。方法 收集经手术证实的急性绞窄性小肠梗阻（n=17）和单纯性梗阻（n=19）患者术前腹盆部CT检查资料,对肠梗阻的CT征象进行逐一分析,以判断梗阻性质。结果 CT对单纯性小肠梗阻组诊断正确率达95％,而绞窄组诊断正确率为82％。梗阻肠段肠壁增厚对于诊断急性绞窄性小肠梗阻的敏感度及特异度分别为88％、74％;靶征为12％、100％;肠壁强化异常为12％、100％;肠壁积气为29％、100％;肠系膜积液为94％、58％;肠系膜血管水肿47％、100％;漩涡征为12％、1000k;鸟嘴征为18％、100％;腹水为59％、84％。结论 CT是一种诊断急性绞窄性肠梗阻有效、快速的方法。梗阻肠段肠壁强化缺如、肠壁积气、缆绳征、靶征、漩涡征和鸟嘴征,为诊断绞窄性肠梗阻的较为特异性的征象;而梗阻肠壁增厚、肠系膜积液、腹水等征象,对于急性绞窄性小肠梗阻的诊断具有一定价值。     

After the first death there is no other

Discussion at case conferences often returns to the difficulties of effective communication and deficiencies in training of students in the necessary skills. On this occasion we record a discussion about the problems encountered at three levels in a doctor's training: that of a medical student in his first weeks of ward work; of a student about to become a doctor and take clinical responsibility, and of a trainee general practitioner nearing the end of his year's attachment to a group practice. The problems are discussed among a general practice team involved in teaching. Those present are: a final year medical student, a trainee medical practitioner, a health visitor, an attached social worker and three general practitioners, one a lecturer at the nearby teaching hospital, one a trainer in the practice, and a third partner.     

2022miR-216a、miR-301a调控BMPR2促进缺氧环境下肺动脉平滑肌细胞的增殖

目的: 探讨miR-216a、miR-301a对缺氧环境下人肺动脉平滑肌细胞（human pulmonary arterial smooth muscle cells,HPASMC）增殖的影响并研究其发生机制。方法: 采用CCK8法检测常氧和不同缺氧时间培养下HPASMC的增殖活力,qRT-PCR检测各组miR-216a、miR-301a和骨形成蛋白2型受体（bone morphogenetic protein receptor type 2,BMPR2）mRNA表达。CCK8和蛋白免疫印迹法分别检测转染了miR-216a或miR-301a抑制物后HPASMC的增殖能力及增殖细胞核抗原（proliferating cell nuclear antigen,PCNA）表达水平。双荧光素酶报告分别检测BMPR2与miR-216a、BMPR2与miR-301a之间的关系。CCK8和蛋白免疫印迹法分别检测同时转染miR-216a或miR-301a联合BMPR2过表达质粒后HPASMC的增殖能力及BMPR2、PCNA的表达水平。结果: 随着缺氧时间的延长,HPASMC的增殖活力和miR-216a表达增加,BMPR2 mRNA表达逐渐下降,miR-301a在缺氧24 h表达水平最高。下调miR-216a和miR-301a均显著抑制HPASMC的增殖活力及PCNA表达。双荧光素酶报告测定证实BMPR2分别是miR-216a和miR-301a的靶点。同时转染miR-216a或miR-301a联合BMPR2过表达质粒,BMPR2表达下降,细胞增殖活力及PCNA表达增加。结论: 缺氧环境下,miR-216a、miR-301a通过抑制BMPR2促进HPASMC增殖,引发肺动脉高压的形成。     

阴道毛滴虫Rab1a重组蛋白的表达和细胞内定位

目的制备阴道毛滴虫(Trichomonasvaginalis,Tv)Rab1a重组蛋白及其多克隆抗体,并对TvRab1a蛋白进行阴道毛滴虫的细胞内定位。方法将我们已构建的pQE80L/TvRab1a重组表达质粒转入大肠埃希菌E.coliM15,在IPTG诱导下表达重组蛋白,经Ni-NTA亲和柱层析后获得纯度较高的TvRab1a的重组蛋白;用经复性处理的重组蛋白免疫动物,获得TvRab1a重组蛋白抗血清,免疫印迹WesternBlot鉴定抗血清。采用荧光免疫细胞化学对TvRab1a蛋白进行细胞内定位。结果WesternBlot分析显示,TvRab1a重组蛋白可与豚鼠的抗TvRab1a血清反应,同时该抗血清在滴虫提取蛋白中检测到与预测TvRab1a分子量一致的条带;免疫荧光化学检测发现TvRab1a分布于细胞核周围的高尔基复合体与内质网。结论获得的抗TvRab1a蛋白的多抗血清可用于TvRab1a基因功能的研究;TvRab1a功能场所位于高尔基复合体与内质网。     

提升上清液Wnt3a蛋白含量的L-Wnt3a细胞培养体系及其促进多能干细胞诱导黑素细胞分化的效应研究

目的: 明确L-Wnt3a条件培养基的收集方案并标定Wnt3a蛋白浓度,验证其作为多能干细胞向黑素细胞分化体系中Wnt3a来源的作用。方法: 通过观察L-Wnt3a细胞的生长特性及其分泌Wnt3a蛋白量特点,设定收集条件培养基的参数,使用ELISA法对收集到的条件培养基进行Wnt3a蛋白浓度的标定,配制出明确Wnt3a浓度的黑素细胞分化培养基,对胚胎干细胞株WA09及诱导多能干细胞株WTC-11细胞进行黑素细胞的悬浮诱导分化,对获得的诱导黑素细胞进行黑素相关基因表达检测及Masson-Fontana染色等相关验证。结果: 优化后的L-Wnt3a 条件培养基收集体系能够稳定高效获取Wnt3a蛋白,明确Wnt3a浓度的分化体系能够使WA09和WTC-11成功诱导黑素细胞,使用相应浓度的Wnt3a重组蛋白也能够达到相似的效果。结论: 通过优化收集方案能够高效获得明确浓度的L-Wnt3a 条件培养基,将其应用于明确Wnt3a浓度的培养体系能够成功诱导多能干细胞分化为功能性黑素细胞。     

聚乙二醇化海葵神经毒素的稳定性考察

目的 考察聚乙二醇(PEG)修饰海葵神经毒素(rhk2a)所得产物mPEG-rhk2a的稳定性.方法 制备和纯化PEG化的修饰产物mPEG-rhk2a,并采用RP-HPLC法分别考察rhk2a和mPEG-rhk2a在4、25、37℃条件下的稳定性.结果 在4℃下,mPEG-rhk2a和rhk2a在放置24 d后,含量分...     

A Study of the Medical Record Interface to Natural Language Processing

The information about a patient tends to be handled more on a computer system. However, it is not sufficiently rational enough because of the fundamental difference between man and a computer. Up to now, man has treated information using a natural language. Therefore, if it can be applied to handle medical information electrically, that will become more rational. For this reason, we developed a new classification method that interfaces a computer with the human being, using a natural language. This method was named as a situation-oriented medical record, and this depicts changes in a situation by the case frame from a viewpoint of man's cognition. Moreover, the medical communication by a natural language, which is currently used when a patient changes a hospital, was analyzed in order to confirm the validity of this method. In addition, we developed a prototype system that allows computers to implement this kind of communication.     

miR-18a对结直肠癌SW116细胞辐射敏感性的影响

目的:探讨miR-18a与结直肠癌SW116细胞辐射敏感性之间的关系,阐明miR-18a影响细胞凋亡和自噬的可能机制。方法:人结直肠癌SW116细胞分为miR-18a NC组、miR-18a mimic组、miR-18a NC+4Gy组和miR-18a mimic+4Gy组。qRT-PCR法检测照射前后SW116细胞中miR-18a的表达;集落形成实验观察miR-18a对SW116细胞辐射敏感性的影响;GFPLC3形态学方法检测SW116细胞自噬率;流式细胞术检测SW116细胞凋亡率;采用生物信息学方法预测miR-18a的靶基因,以荧光素酶报告基因验证miR-18a与靶基因3'UTR结合;Western blotting法检测SW116细胞中共济失调-毛细血管扩张突变基因(ATM)蛋白表达。结果:与照射前比较,照射后SW116细胞中miR-18a表达水平明显降低(P<0.05)。集落形成实验,与miR-18a NC组比较,miR-18a mimic组SW116细胞辐射敏感性增强(P<0.05),细胞凋亡率和自噬率明显增加(P<0.05)。与miR-18a NC+4Gy组比较,miR-18a mimic+4Gy组SW116细胞中ATM蛋白表达减少。结论:miR-18a的靶基因为ATM;miR-18a mimic可促进辐射诱导的细胞凋亡和自噬,且能增加结直肠癌SW116细胞辐射敏感性。     

Antepartum prediction of respiratory distress syndrome: a comparison of the shake test, the tap test and the turbidity test

The shake test, the tap test and the turbidity test were evaluated to determine their accuracy in predicting lung function maturity, ie their ability to predict respiratory distress syndrome (RDS). The turbidity test was the most efficient with a sensitivity of 60%, a specificity of 97%, a positive predictive value of 82% and a negative predictive value of 92%. The shake test had a sensitivity of 40%, a specificity of 95%, a positive predictive value of 63% and a negative predictive value of 88%. The tap test at 2 minutes had a sensitivity of 57%, a specificity of 78%, a positive predictive value of 35% and a negative predictive value of 89%. It was fortuitous that the simplest and cheapest test was found to be the most efficient test of the three. We recommend that the turbidity test or at least one of these tests should be used to determine the maturity of lung function when non-urgent elective deliveries are contemplated, to help reduce the incidence of RDS in this group of patients.