双向转诊绩效评价体系的构建

本文以双向转诊绩效评价为研究目标,分析构建绩效评价体系对于双向转诊工作开展的必要性,同时阐述国外双向转诊绩效评价的现状。找出构建我国双向转诊绩效评价体系的方法,包括指标体系的设计原则;设计方法及指标的取舍;提出相应的建议：分步推进,强化政策配套,将转诊纳入医疗机构的绩效管理体系。     

Comparative Study of Normal and Rheumatoid Arthritis Fibroblast-Like Synoviocytes Proliferation under Cyclic Mechanical Stretch: Role of Prostaglandin E2

Fibroblast-like synoviocytes (FLSs) are one of the main contributors of prostaglandin E₂ (PGE₂) in the hyperplastic synovium of rheumatoid arthritis (RA) patients. cyclooxygenase-2 (COX-2)/PGE₂ pathway is involved in the proliferation of several cell types. We have previously shown that mechanical stretch affects COX-2 and PGE₂ production in human RA FLSs; however, its role in cell proliferation remains to be elucidated. In this study, a comparison is drawn between human RA and normal FLSs to understand the role of mechanical stretch and PGE₂ on the proliferation of FLSs. The results showed that physiological level (6%, 1 Hz) of cyclic mechanical stretch significantly decreased the proliferation of RA FLSs but not normal FLSs, while the induction of apoptosis was not observed by stretch in either RA or normal FLSs. IL-1β (5 ng/ml)-induced COX-2/PGE₂ levels are downregulated by stretch in RA FLSs only. Further investigation showed that high concentration (100 and 500 ng/ml) of PGE₂ significantly induced cell proliferation only in RA FLSs, and this induction failed to be suppressed by stretch. In conclusion, this study demonstrated that elevated levels of PGE₂ in the synovial cavity are involved in the proliferation of RA FLSs, and cyclic mechanical stretch regulates the RA synovial hyperplasia.     

直立式聚丙烯输液袋壁厚度对输液性能影响的数值研究

目的研究直立式聚丙烯输液袋（简称直立式输液袋）壁厚度对袋体输液性能的影响,寻求输液袋各参数随壁厚度改变的变化规律。方法针对标示容量为100、250、500mL3种直立式输液袋,分别设置4种不同壁厚度（n2、n3、0．4、0．5mm）,采用有限元方法模拟排液过程．研究直立式输液袋应力分布、实际加药空间及排空率等参数的变化规律。结果在标示容量一定的条件下．100mL的直立式输液袋应力随壁厚度变化不显著;250mL直立式输液袋随壁厚度的增加应力逐渐减小．最大应力降幅为65％：500mL直立式输液袋壁厚度为0-2～0．3mm时,应力变化不明显,而壁厚度由0．3mm到0．5mm,最大应力下降28％。3种直立式输液袋的实际加药空间、排空率和袋壁接触面积均随壁厚度的上升而降低,100mL直立式输液袋为27％、11％和67％,250mL直立式输液袋为54％、11％和38％,500mL直立式输液袋为49％、11％和43％。结论综合考虑应力分布、实际加药空间、排空率和袋壁接触面积等参数的变化规律,直立式输液袋壁厚度不宜过大。在所考虑的壁厚度参数中．最佳壁厚度为0．2mm,但最终的壁厚度确定还需要综合考虑直立式输液袋的透气、透湿性和抗穿刺能力等因素。     

Repetitive jumping and sprinting until exhaustion alters hamstring reflex responses and tibial translation in males and females

The incidence of anterior cruciate ligament injuries is considerably higher in females than in males and the underlying mechanisms are still under debate. Research indicates that the neuromuscular system of females and males might respond differently to the same fatigue protocol due to differences in muscle activation during movement tasks. This study analyzed sex differences in hamstring reflex responses and posterior‐anterior tibial translation (TT) before and after fatiguing exercise. We measured the isolated movement of the tibia relative to the femur as a consequence of mechanically induced TT in standing subjects as well as muscle activity of the hamstrings before and after repetitive jumping and sprinting until exhaustion. Muscle fatigue delayed reflex onset latencies in females and males. A reduction in reflex responses associated with an increased TT was observed after fatiguing exercise for both sexes. Data indicate that the used fatigue protocol altered the latency and magnitude of reflex responses as well as TT in females and males. Based on the results of previous research and the outcome of this study, it might be that sex‐specific effects of fatigue on reflex activity and mechanical stability of the knee depend on the kind of fatiguing exercise. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1687–1692, 2015.     

Stretch-induced human myometrial cytokines enhance immune cell recruitment via endothelial activation

Spontaneous term labour is associated with amplified inflammatory events in the myometrium including cytokine production and leukocyte infiltration; however, potential mechanisms regulating such events are not fully understood. We hypothesized that mechanical stretch of the uterine wall by the growing fetus facilitates peripheral leukocyte extravasation into the term myometrium through the release of various cytokines by uterine myocytes. Human myometrial cells (hTERT-HM) were subjected to static mechanical stretch; stretch-conditioned media was collected and analysed using 48-plex Luminex assay and ELISA. Effect of stretch-conditioned media on cell adhesion molecule expression of human uterine microvascular endothelial cells (UtMVEC-Myo) was detected by quantitative polymerase chain reaction (qPCR) and flow cytometry; functional assays testing leukocyte–endothelial interactions: adhesion of leukocytes to endothelial cells and transendothelial migration of calcein-labelled primary human neutrophils as well as migration of THP-1 monocytic cells were assessed by fluorometry. The current in vitro study demonstrated that mechanical stretch (i) directly induces secretion of multiple cytokines and chemokines by hTERT-HM cells (IL-6, CXCL8, CXCL1, migration inhibitory factor (MIF), VEGF, G-CSF, IL-12p70, bFGF and platelet-derived growth factor subunit B (PDGF-bb), P<0.05); stretch-induced cytokines (ii) enhance leukocyte adhesion to the endothelium of the surrounding uterine microvasculature by (iii) inducing the expression of endothelial cell adhesion molecules and (iv) directing the transendothelial migration of peripheral leukocytes. (vi) Chemokine-neutralizing antibodies and broad-spectrum chemokine inhibitor block leukocyte migration. Our data provide a proof of mechanical regulation for leukocyte recruitment from the uterine blood vessels to the myometrium, suggesting a putative mechanism for the leukocyte infiltrate into the uterus during labour and postpartum involution.     

Effect of Strengthening Methods on Two-Way Slab under Low-Velocity Impact Loading

In this study, the performance of reinforced concrete slabs strengthened using four methods was investigated under impact loads transferred from the top side to bottom side. The top and bottom sides of test slabs were strengthened by no-slump high-strength, high-ductility concrete (NSHSDC), fiber-reinforced-polymer (FRP) sheet, and sprayed FRP, respectively. The test results indicated that the test specimens strengthened with FRP series showed a 4% increase in reaction force and a decrease in deflection by more than 20% compared to the non-strengthened specimens. However, the specimen enhanced by the NSHSDC jacket at both the top and bottom sides exhibited the highest reaction force and energy dissipation as well as the above measurements because it contains two types of fibers in the NSHSDC. In addition, the weight loss rate was improved by approximately 0.12% for the NSHSDC specimen, which was the lowest among the specimens when measuring the weight before and after the impact load. Therefore, a linear relationship between the top and bottom strengthening of the NSHSDC and the impact resistance was confirmed, concluding that the NSHSDC is effective for impact resistance when the top and bottom sides are strengthened. The results of the analysis of the existing research show that the NSHSDC is considered to have high impact resistance, even though it has lower resistance than the steel fiber reinforced concrete and ultra-high-performance-concrete, it can be expected to further studies on strengthening of NSHSDC.     

脂肪源干细胞与聚丙烯网片的生物相容性研究

目的观察脂肪源干细胞(ADSCs)与聚丙烯网片的生物相容性。方法制备兔ADSCs悬液。取聚丙烯网片浸提液培养ADSCs。用四甲基偶氮唑盐(MTT)法检测细胞活力,评价支架细胞毒性。ADSCs传代扩增后,接种到聚丙烯网片支架上,体外培养1周。用扫描电子显微镜观察细胞在支架上黏附生长及增殖。结果 ADSCs在聚丙烯网片浸提液中可保持较高的增殖率(RGR)(24、48、72 h实验组细胞RGR分别为97%、96%、101%,平均RGR为103.5%),与对照组比较,差异无统计学意义(χ2=17.45,P0.05),聚丙烯网片浸提液无细胞毒性。脂肪干细胞种植于两种支架材料后生长速度快,扫描电子显微镜观察可见脂肪干细胞呈球型,并伸展形成伪足,贴附于支架材料,细胞间相互连接成团。结论聚丙烯网片支架与ADSCs具有良好的生物相容性,无细胞毒性,可作为脂肪组织工程较理想的生物支架材料。     

Indian Hedgehog在牵张力促进成骨细胞增殖中的作用研究

目的观察Hedgehog（Hh）信号在牵张力调控成骨细胞增殖中的作用。方法体外分离和培养新生大鼠颅顶骨成骨细胞,应用Flexcell 4000TM加力系统施加3%和6%的2种牵张应变。用N端Hedgehog重组蛋白（N-Shh）、Hedgehog通道抑制剂环巴胺（cy）和机械通道抑制剂三氯化钆（GdCl3）对成骨细胞进行干预。分别采用细胞计数、甲基噻唑基四唑（MTT）比色法和流式细胞仪检测成骨细胞的增殖。采用SAS 8.0软件包对结果进行统计分析。结果在成骨细胞体外培养过程中,牵张力促进了成骨细胞的增殖,以6%牵张应变更显著;牵张力仍能促进经cy处理后的成骨细胞的增殖,但这种促进作用能被GdCl3抑制。结论牵张力促进成骨细胞增殖的作用有一部分是通过上调Ihh的表达实现的。