举案学法

1学法《医疗事故处理条例》第八条,医疗机构应当按照国务院卫生行政部门规定的要求,书写并妥善保管病历资料。因抢救急危患者,未能及时书写病历的,有关医务人员应当在抢救结束后6h内据实补记,并加说明。《医疗事故处理条例》第九条,严禁涂改、伪造、隐匿、销毁或者抢夺病历资料。《医疗事故处理条例》第十条,患者有权复印或者复制其门诊病历、住院志、体温单、医嘱单、化验单(检验报告)、医学影像检查资料、特殊检查同意书、手术同意书、手术及麻醉记录单、病理资料、护理记录以及国务院卫生行政部门规定的其他病历资料。患者依照前款规定要…     

举案学法

<正> 1 学法 《医疗事故处理条例》 第二条:本条例所称医疗事故,是指医疗机构及其医务人员在医疗活动中,违反医疗卫生管理法律、行政法规、部门规章和诊疗护理规范、常规,过失造成患者人身损害的事故。注:医疗事故概念的4个要件:第一,主体是医疗机构及其医务人员,第二,行为的违法性;第三,过失造成人身损害,第四过失行为和后果之间存在因果关系。     

机械能守恒定律该如何表述

全国中等卫生职业教育《物理》教材对机械能的转化和守恒定律是这样表述的:“任何物体在没有媒质阻力和摩擦力作用的条件下,物体的势能和动能可以相互转化。但总的机械能保持不变。这个结论就是机械能转化和守恒定律。”笔者认为教材中关于机械能守恒定律的表述是不严谨的。对此,笔者想谈一下自己的看法。讨论机械能守恒,首先应当从对势能的讨论入手。对于势能,是这样定义的:若作用在物体上的力仅为坐标x、y、z的单值的、有限的和可微的函数,则在空间区域任一点上,都将有一定的力作用着。此力只和该点的坐标有关,这样的空间区域叫力场。若满…     

论《内经》“天人合一”的科学性

《内经》认为天地是大宇宙,人是小宇宙,天地与人关系密切,人的生理、病理变化都受天地的影响。它不是脱离、割裂人与天地的联系来解释人的生理和病理现象,而是从人与天地的相互联系中来解释生理和病理现象,提出对疾病的治疗原则。“天人合一”是《内经》研究、分析问题的出发点,也是它的一个基本原则。     

《伤寒论》与“《伤寒论》学”——郝印卿教授访谈录

郝印卿,男,58岁,湖北中医学院伤寒专业硕士研究生,师从著名《伤寒论》专家洪子云教授和李培生教授。1981年毕业,现任山西中医学院教授、主任医师。郝教授舌耕之余,阐编撰出版《中医多选题题库·伤寒分册》、《中医学问答题库·伤寒分册》等论著七部,发表《论伤寒内经是脏腑、经络、气化的有机结合》、《伤寒论·递变源流叙议》等学术论文30余篇。问:郝教授,近年来中医界研究《伤寒论》的学术空气已不如八十年代那么浓厚了,相关的学术论文和著作也在减少。您一直从事《伤寒论》教学和研究,对此您感想如何?郝印卿:研究不敢当,只能说是一直在孜…     

《伤寒论句解》作者及成书年代考

《伤寒论句解》作者李文锦,字襄浥,号治庵、淑景堂主人,金陵(今南京)人,家住金陵天印山南的许村.大约生于康熙四十七年(1708),具体卒年不详,约在乾隆朝末期.李氏性豪迈,喜交游,医卜星相,诗词书画皆有涉猎,后专于医,著有《伤寒论句解》和《医家二十四则》.《伤寒论句解》包括《医圣张仲景伤寒杂病论淑景堂亲解》14卷和《思问集》7卷.前书为李氏注释发挥《伤寒论》之作,于1768年成书;后书又包含了《淑景堂改订注释寒热温平药性赋》4卷、《淑景堂眘医杂著》1卷、《医药箴言》1卷、《淑景堂医药集案》1卷,于1765年成书.     

宋立人教授

宋立人教授宋立人教授，男１９２７年３月生，江苏吴江人。六代世医，家学渊源，早年受业于其父——中医界耆宿宋爱人教授，深得其传，遂悬壶乡里，颇得病家信仰。１９５５年攻读于江苏省中医进修学校，毕业后留校任教，主要从事《伤寒论》教学，中医药文献研究和内科临床...     

论喻昌"三纲鼎立"学说的意义及启示

喻昌(公元1585~1664年),字嘉言,别号西昌老人,江西新建人。是中国医学史上清初三大名医之一。喻氏生平著述甚多,流传后世且影响深远的有《尚论篇》、《寓意草》、《医门法律》。本文拟对喻氏“三纲鼎立”学说及其意义和启示作一探讨。1“三纲鼎立”学说的内容喻昌在研究《伤寒论》方面是一位具有改革和创新精神的医家,他研究《伤寒论》的学术思想主要反映在《尚论篇》一书中,喻氏源于对《内经》、《伤寒论》等经典著作的钻研和大量的临床实践活动,在方有执《伤寒论条辨》的基础上,对《伤寒论》的篇章结构作了新的调整,他认为《伤寒论》经晋…     

《伤寒杂病论》在祖国医学中的地位和成就

《伤寒杂病论》是伟大医学家张仲景(150~219年)“勤求古训,博采众方”,参考《内》、《难》、和《药录》,集汉以前医学之大成,结合自己和民间经验撰就的传世之著和宏篇巨制。经林亿等校正后,始分作治外感为主的《伤寒论》和治杂病为主的《金匮要略》。自金聊摄人成无己穷五十年精力,博采《内经》诸说,阐释论中辨证施治道理,著《注解伤寒论》十卷,卓然成为注解《伤寒论》大家。至斯始,《伤寒论》道乃大行,注家蜂起,迄今不下五百家。古今中外,对本论的研究,大量临床实践使医界为之倾倒。可以说,本论名传遐迩,为祖国赢得了崇高声誉。     

恽铁樵及其《温病明理》

诨铁樵(1878—1935)名树珏,早年毕业于南洋公学,善译西洋小说,有名文坛。后锐志攻医,文名反为医名所掩。曾问业于伤寒名家汪莲石,深通内经、伤寒之学,“为近代中医界精通旧学,独具只眼,又受过较系统的近代科学训练的第一人。”著有《群经见智录》、《伤寒论辑义按》、《脉学发徼》、《温病明理》等书共二十二种。这些著作     

Determination of Conversion Coefficient to Evaluate Couple-year of Protection （CYP） for Tubectomy and Vasectomy in Urban and Rural Regions of Iran： IMES Study

Objective To calculate couple-year of protection （CYP） by conversion coefficient （F） of tubectomy and vasectomy in urban and rural regions of Iran. Methods A total of 103 450 married women aged 10-49 years in 2005 across urban and rural regions of lran were sampled by multi stage cluster sampling. The data were collected by household survey and direct interview and analyzed by STATA8.0 software and survey analysis commands. Results Mean age of the women at the time of tubectomy estimated 31.9 years and conversion coefficient of tubectomy was 17.1 ±0.1. Mean age of women at the time of her husband vasectomy estimated 31.48 years and its conversion coefficient was 17. 5 ± 0. 1. Cluster analysis defined different regions of Iran on the basis of evaluated conversion coefficients of tubectomy and vasectomy which both of them presented seven clusters. Literacy of women and total coverage of family planning in a region had a direct relationship with this conversion coefficient （P〈0.05）. Conclusion The variations observed in the conversion coefficients and their dissimilarity among different regions of Iran may be due to a variety of fundamental factors of which literacy and culture are of important factors.     

Correlational Research of Platelet-derived Growth Factor（PDGF）-BB and Chronic Hepatitis B

Objective To explore the relevance of CHB patients＇ serum levels of PDGF-BB with their ages, sexes, medical histories, serum HBVDNA levels, liver function and Liver Fibrosis markers （HA, CⅣ, PCⅢ, LN）, and relevance between serum levels of PDGF-BB and CHB patients＇ liver fibrosis degrees. Methods （1） 74 CHB patients with serum levels of PDGF-BB and their ages, sexes, medical histories, serum HBVDNA levels, liver functions and serum hepatic fibrosis markers （HA, CⅣ, PCⅢ, LN） to conduct an analysis of their relations; （2） 74 CHB patients were divided into three groups： mild, moderate and severe, and analyzed the relevance of PDGF-BB levels and serum HBVDNA levels, hepatic fibrosis and liver functions. Results （1） serum levels of PDGF-BB have no significant correlation with CHB patients＇ ages, sexes, medical histories and HBVDNA （P〉0.05）; but liver function parameters and serum HA, PCIH, CIV, LN were significantly correlated （P〈0.01）; （2） PDGF-BB levels in serum and liver fibrosis markers： HA, PCⅢ, CⅣ, LN level and liver function were positively correlated （P〈0.01）; （3） PDGF-BB levels in serum and hepatic fibrosis markers： HA, PCⅢ, CⅣ, LN level were positively correlated （P 〈0.01）. Conclusions （1） The extent of the development of liver fibrosis in CHB patients is not determined by their ages, sexes, the length of a histories or the levels of HBVDNA. Liver inflammation activity is the beginning promote in the development of liver fibrosis, which decide the extent of fibrosis; the levels of serum PDGF-BB not only can reflect the CHB patients with liver damage but also can reflect the degree of liver fibrosis; （2） It can be used in CHB patients＇ liver function and fibrosis assessment.     

《内经》修辞格及英译实例分析

《黄帝内经》（以下简称《内经》）是我国中医学四大经典之一,包括《素问》和《灵枢》两部分。虽然为一部医学著作,但受先秦两汉文风的影响,全书采用半韵半散的文学语体,大量使用修辞格,形象精练地阐述中医学深奥的理论,向世人呈现出中国文化医文互通、医文互用的独特风格,奠定了中医学黑箱理论传承的语言基础。     

Overexpression of SIRT1 is a poor prognostic factor for advanced colorectal cancer

Background Sirtuin 1 （SIRT1） has been reported to have diverse roles in various biological processes through deacetylation of histone and nonhistone proteins.However,the correlations among SIRT1 protein expression,clinicopathological parameters,and survival of colorectal cancer patients remain unclear.Methods SIRT1 protein expression was measured by immunohistochemistry in a paraffin-embedded tissue microarray,including 120 paired colorectal cancer and normal mucosa tissues.The correlations among SIRT1 protein expression,clinicopathological features,and prognosis were analyzed.Results All samples （100%） were positive for SIRT1,with variable staining in the cytoplasm rather than in the nucleus.There was significant difference in SIRT1 overexpression between adenocarcinomas and normal mucosal tissue （P〈0.01,x2 test）.SIRT1 overexpression was more frequently observed in advanced-stage tumors （P=0.046,0.002,x2test）.SIRT1 overexpression was significantly correlated with poor overall survival （P=0.013,log-rank test） and diseasefree survival （P=0.012,log-rank test）.Conclusions SIRT1 overexpression correlated with advanced stage and poor prognosis.SIRT1 may play an important role in the progression of colorectal cancer.     

A （H1N1） Influenza Pneumonia with Acute Disseminated Encephalomyelitis： A Case Report

INTRODUCTION
A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A （H1N1） influenza can infect CNS, and we should pay more attention to patients of A （H1N1） influenza pneumonia with neurological complications.     

《内经》常见句式变化修辞格英译

《黄帝内经》（以下简称《内经》）被看作是中医界的“圣经”。其语言深奥难懂,辞格古老丰富,需从多层次多角度进行研究,方可对其正确理解,其中从修辞角度进行研究,是不可或缺的重要环节。     

学术自述

1978年,我调往中国社会科学院哲学研究所。到了哲学所,我面临着科研方向的重要抉择。我决定选择科学哲学和生命伦理学作为我今后科研的主要方向。由于闭关多年,我们对世界科学哲学的长足发展一无所知,对波普尔、库恩等科学哲学家一无所知。实际上,自然辩证法是中国马克思主义派的科学哲学,但不参加科学哲学的国际对话,是无法进一步发展自己的。对新出现的生命伦理学这一新领域也一无所知。     

Preliminary radioimmunoimaging and biodistribution of 131iodine-labeled single-chain antibody fragment against progastrin-releasing peptide(31–98) in small cell lung cancer xenografts

Background Monoclonal antibodies （mAbs） such as DD3,raised against progastrin-releasing peptide（31-98） （ProGRP（31-98）） antigen,have been used to target small cell lung cancer （SCLC）.However,as an intact mAb,DD3 is cleared slowly from the body,with an optimal radioimmunoimaging time of 72 hours.More recently,a singlechain antibody fragment has demonstrated reduced excretion time in blood and normal tissues and is increasingly used in diagnostic cancer research.Thereby,it potentially increases the radioimmunoimaging efficacy.However,there have been few studies with this antibody fragment.The aim of this study was to characterize the preliminary radioimmunoimaging and biodistribution of 1311I-anti-ProGRP（31-98）scFv in nude mice bearing SCLC xenografts.Methods Anti-ProGRP（31-98） scFv was used to detect ProGRP expression by flow cytometry analysis and immunohistochemistry.131I-anti-ProGRP（31-98） scFv was injected intravenously into healthy Kunming mice and the percentage injected dose per gram （%ID/g） in various organs was calculated.Similarly,the %ID/g and tumor/non-tumor ratio in xenograft-bearing mice was calculated.After injection of 131I-anti-ProGRP（31-98） scFv,treated mice were imaged at 1,24,and 30 hours.Then the tumor/base ratios were calculated.Results ProGRP was highly expressed in NCI-H446 cells and xenograft tissue.The metabolism of 131I-anti-ProGRP（31-98） scFv in healthy mice was consistent with a first-order and two-compartment model; T1/2α and T1/2β were 10.2 minutes and 5 hours 18 minutes,respectively.The %ID/g of 131I-anti-ProGRP（31-98） scFv in xenografts was much higher than in healthy tissues at 12 hours after injection,reaching a maximum of （5.38±0.92） %ID/g at 24 hours.Successful imaging of xenograft tissue was achieved as early as 1 hour post-injection and persisted until 30 hours,with 24 hours proving optimal.Conclusion 131I-anti-ProGRP（31-98）scFv shows highly selective tumor uptake with low accumulation in normal tissues and rapid blood clearance,indicating thatit could be a promising agent for SCLC radioimmunoimaging.     

Changes in immunological function after treatment with transarterial chemoembolization plus radiofrequency ablation in hepatocellular carcinoma patients

Background Different strategies for hepatocellular carcinoma （HCC） may have distinct effects on the immune system.The aim of this research was to investigate changes in the immunological function after transcatheter arterial chemoembolization （TACE） plus radiofrequency ablation （RFA） in HCC patients.Methods A total of 51 consecutive HCC treatment-naive patients was enrolled in this study and 20 healthy subjects served as controls.The therapeutic strategy was selected according to the tumor stage and general conditions.TACE was performed in 25 cases,TACE plus RFA in 17 and RFA in nine.All the patients underwent routine examinations and peripheral blood was harvested for the detection of lymphocyte subset by flow cytometry 1 day before,and 2 and 4 weeks after the treatment.The serum levels of alpha-fetoprotein （AFP）,ALT and AST were also measured before and 4 weeks after treatment for the evaluation of therapeutic efficacy and liver function impairment.Results When compared with healthy controls,the CD4/CD8 ratio and the number of B cells and natural killer （NK） cells were significantly decreased in HCC patients before treatment （P 〈0.05）.When compared with before treatment,the CD4＋ cells and CD4/CD8 ratio decreased but CD8＋ cells increased in the TACE group （P 〈0.05）; the CD4/CD8 ratio and NK cells decreased but CD8＋ cells increased in the TACE-RFA group （P 〈0.05）; the CD3＋ cells,CD4＋ cells,CD4/CD8 ratio and NK cells increased in the RFA group （P 〈0.05）.Significant differences in the CD3＋ cells,CD8＋ cells,CD4/CD8 ratio and NK cells were observed among groups （P 〈0.05）.Moreover,the AFP level decreased and transaminase level increased in all groups （P 〈0.05）.Differences of pre and post treatment between groups were statistically significant （P =0.016,0.025,0.018 respectively）.Conclusions Immunity was compromised in HCC patients; TACE and TACE plus RFA lowered immunologic function to a certain extent.RFA improved it accompanied by a protective effect on liver function.     

肺鳞状细胞癌和肺腺癌患者ERCC1、RRM1、TS表达差异的对照研究

1 文献来源 Maus MKH,Mack PC,Astrow SH,et al.Histology-related associations of ERCC1,RRM1,and TS biomarkers in patients with non-small-cell lung cancer:Implications for therapy [J].J Thorac Oncol,2013,8(5):582-586. 2证据水平 4. 3背景 肺鳞状细胞癌(squamous cell carcinoma,SCCA)和肺腺癌(adenocarcinoma,AC)患者的化疗疗效存在差异,而这种差异可能和核苷酸切除修复交叉互补基因1 (excision repair cross-complementation group 1,ERCC1)、核糖核苷酸还原酶M1 (ribonucleotide reductase M1,RRM1)、胸苷酸合成酶(thymidylate synthase,TS)表达差异相关.