运用系统整体思想探讨架构新型临床医学教学模式

随着知识经济时代的到来,在我国传统医学教学模式下培养的大多数临床医学生,越来越难以适应现代医学发展和新时期群众对医疗服务的需求。本文运用系统整体思想的理念,通过改革临床医学教学培养目标、教学内容、教学方法和教学手段,对架构新型临床医学教学模式进行了初步探讨,以其为提高临床医学教育质量提供有益的借鉴。     

浅谈医患关系的现状与对策

当前我国医患关系呈现紧张状况，这与我国医疗体制改革处于转型阶段，医疗机构自身存在缺陷以及患者医疗观念的变化等方面有关。要改善医患关系必须依靠法律手段来调整、用伦理道德来规范，提高医务人员的素质和加强医院现代化管理。     

Work environment and hand dermatitis among nurses in a Chinese teaching hospital

Objective  The aim of this study was to investigate the effects of the working environment on hand dermatitis (HD) prevalence among nurses in a Chinese teaching hospital. Methods  We utilised a previously validated, self-reporting survey which was translated into Chinese. Results  The prevalence of HD among nurses was 18.3%, although this rate varied between departments, ranging from 9.4% in gynaecology to 26.7% in intensive care (P for Trend=0.3167). Logistic regression indicated that wet work was the most important HD risk factor, with a 9-fold increase (OR 9.0, 95% CI 1.2–74.9, P=0.0342). Allergic disease was also related to HD, with a 4.6-fold increase noted (OR 4.6, 95% CI 1.4–15.0, P=0.0096). Conclusions  Overall, the prevalence of HD among Chinese hospital nurses appears to be less than that of their foreign counterparts. Nevertheless, the burden of this disease does seem to vary with respect to depertment of employment within the hospital.     

The signal transduction pathway in the proliferation of airway smooth muscle cells induced by urotensin Ⅱ

Background Human urotensin Ⅱ (UⅡ) is the most potent mammalian vasoconstrictor identified so far. Our previous study showed that UⅡ is a potent mitogen of airway smooth muscle cells (ASMC) inducing ASMC proliferation in a dose-dependent manner. The signal transduction pathway of UⅡ mitogenic effect remains to be clarified. This study was conducted to investigate the signal transduction pathway in the proliferation of ASMC induced by UⅡ. Methods In primary cultures of rat ASMCs, activities of protein kinase C (PKC), mitogen-activated protein kinase (MAPK) and calcineurin (CaN) induced by UⅡ were measured. The effect of CaN on PKC and MAPK was studied by adding cyclosporin A (CsA), a specific inhibitor of CaN. Using H7 and PD98059, inhibitors of PKC and MAPK, respectively, to study the effect of PKC and MAPK on CaN. The cytosolic free calcium concentration induced by UⅡ was measured using Fura-2/AM. Results UⅡ 10-7 mol/L stimulated ASMC PKC and MAPK activities by 44% and 24% (P<0.01), respectively, after incubating for 20 minutes. It increased CaN activity in a time-dependent manner, being 1.68 times as that of control for 24 hours (P<0.01). It promoted the cytosolic free calcium concentration increase of 18% (P<0.01). CsA 10-6 mol/L and H7 50 μmol/L inhibited UⅡ-stimulated CaN activity by 45% (P<0.01) and 21% (P<0.05), respectively, while PD98059 50 μmol/L had no effect on CaN activity (P>0.05). CsA 10-6 mol/L inhibited UⅡ-stimulated PKC activity by 14% (P<0.05), while having no effect on MAPK activity (P>0.05). Conclusions UⅡ increases cytosolic free calcium concentration and activates PKC, MAPK and CaN. The signal transduction pathway between PKC and CaN has cross-talk.     

创伤性枢椎滑脱的临床诊治分析

目的 探讨创伤性枢椎滑脱(Hangman骨折)的损伤机制、临床表现及治疗方法。方法 回顾1988年6月-2001年3月收治的hangman骨折患者10例,对其影像学表现、损伤机制及治疗方法进行分析。结果 10例患者男9例,女1例,平均年龄40岁,致伤原因为车祸7例,原木砸伤颈部1例,高处坠落1例,另1例患强直性脊柱炎因摔跤致伤,其中Ⅰ型1例,Ⅱ型5例,Ⅱa型2例,Ⅲ型2例;4例保守治疗,6例手术治疗。结论 车祸和坠落为创伤性枢椎滑脱的主要致伤因素,其临床表现多为颈椎局部疼痛、拒动等症状,少有神经系统的损伤;影像学诊断依据颈椎侧位X光片和颈椎CT;创伤性枢椎滑脱Ⅰ型、Ⅱ型及Ⅱa型可保守治疗,Ⅲ型和伴有C2-3间盘突出损伤脊髓的患者应采取手术治疗。     

The role of calcineurin in the lung fibroblasts proliferation and collagen synthesis induced by basic fibroblast growth factor

Objective To investigate the role of calcineurin (CaN) in the lung fibroblast proliferation and collagen synthesis induced by basic fibroblast growth factor (bFGF).Methods We used Western blot and immunohistochemical methods for investigating the content and distribution of calcineurin in the lung tissue. Calcineurin activity in different tissues was measured using 32P-labelled substrate. In the primary culture of lung fibroblasts, 3H-thymidine (3H-TdR) and 3H-proline incorporation methods were used to study the effect of cyclosporin A (CsA), an inhibitor of calcineurin, on the lung fibroblast DMA and collagen synthesis stimulated by bFGF.Results We found that calcineurin was expressed in lung tissue and has phosphatase activity (7.1±2.0 pmol Pi/mg pr/min). CsA (10~(-8)-10~(-6) mol/L) inhibited lung fibroblast 3H-TdR incorporation induced by bFGF in a dose-dependent manner, with the inhibitory rates by 20% , 46% and 66% (P< 0.01). CsA (10~(-7) -10~(-6) mol/L) inhibited 3H-proline incorporation in lung     

幼鼠双侧输尿管梗阻24 h后肾脏水通道蛋白1-4的变化

目的探讨4个月大白鼠双侧输尿管急性梗阻24h后肾脏水通道蛋白1-4的变化。方法14只大白鼠随机分为梗阻组（bilateral ureteral obstruction，BUO，n：7）及对照组（Sham，n=7），梗阻组行双侧输尿管结扎，对照组仅游离输尿管而不结扎，24h后收集动脉血和肾标本，在显微镜下将肾脏分离出内髓（IM）及外髓外带加肾皮质（OSOM＋C）后，分别行免疫杂交实验，检测水通道蛋白。（AQP1-4）的变化。结果BUO24h使血浆渗透压明显增高至（338±3．0）mOsm，原为（300±0．6）mIsm，P〈0．01，血钾显著上升至（5．4±0．2）mmol／L，原为（4．0±0．1）mmol／L，P〈0．01；血浆肌苷（372±5．3）μmol／L，原为（30±2．8）μmol／L，P〈0．01和尿素氮（40．7±1．4）mmol／L，原为（5．8±0．2）mmol／L，P〈0．01明显高于对照组，而血钠低于正常（138．9±0．3）mmol／L，原为（141．0±0．3）mmol／L，P〈0．01。免疫杂交结果发现近端小管上皮细胞AQP，明显降低，下降到对照组的46．6％（P〈0．01）；在肾脏集合管主细胞顶膜上，AQP2的表达明显下降，为对照组的68．1％（P〈0．01）；而基底膜上分布的AQR和AQP4也明显下调，分别为对照组的76．3％和73．2％（P〈0．01）。结论双侧输尿管梗阻24h显著影响肾脏AQP。在近端小管和AQP24。在集合管的表达，使其明显下调。该变化可能对梗阻后水分重吸收障碍并引发低渗性多尿的病理生理过程起重要作用。     

钻取方法对角膜切缘内皮细胞的影响

光镜下观察比较了从上皮侧钻剪和内皮侧冲切兔及人眼角膜切缘内皮细胞损失的情况。从上皮侧钻剪兔眼角膜,植片切缘内皮细胞损失均值为10.59±2.48行,从内皮侧冲切,植片切缘内皮细胞损失均值为6.86±2.80行。后者切缘内皮细胞损失明显少于前者。讨论了从内皮侧冲切角膜植片的优点。     

合并Sweet综合征的骨髓增生异常综合征——一例报告及文献复习

目的　提高对合并Sweet综合征 (SS)的骨髓增生异常综合征 (MDS)的认识 ,探讨SS在MDS中发生的意义。方法　报告 1例合并SS的MDS ,并行文献复习。结果和结论　①MDS并发的SS是一全身性疾病 ,除皮肤外 ,可侵犯肺、肝、脾、心、皮下脂肪及肠系膜等组织和器官。本文首次报告SS侵犯甲状腺的病例 ;②中性粒细胞不高时亦可发生SS ;③MDS合并SS是MDS进展的标志 ,患者易演变为急性髓系白血病     

开书型骨盆骨折与男性尿道损伤关系的实验研究

目的对骨盆骨折模型尿道行CT扫描,探讨耻骨联合分离和后尿道损伤的关系。方法于男性骨盆标本尿道内置入造影剂,制成开书型骨折模型,CT扫描测定尿道和骨盆壁的关系。结果耻骨联合分离6cm时,尿道前列腺、尖部与完整侧耻骨联合后缘的距离从(2.03±0.27)cm分离到(2.95±0.31)cm,伴有尿道向完整侧半骨盆移位。结论骨盆骨折尿道损伤多发生于前列腺尖部,骨折时尿道前列腺尖部、前列腺部及膜部均向尾侧和健侧移位。