综合型医院绩效考评系统的研究及应用

准确的绩效考评可以提高医院管理水平。介绍了兰州军区兰州总医院针对大型综合型医院人员多、科室多、事务多的特点研制的绩效考评系统。系统基于B／S结构,采用J2EE技术。详细闸述了系统的需求、设计、实现和应用。系统经过半年的运行,收到了良好效果。     

Multifunctional Amphiphilic Nanoparticles Featuring (Bio)Degradable Core and Dual‐Responsive Shell as Biomedical Platforms for Controlled Release

Multifunctional polymeric platforms combining (bio)degradable and biocompatible, temperature and pH‐sensitive entities hold great promise as nanocarriers for targeted drug and gene delivery, and tissue engineering. In this work, preparation and characterization of surfactant‐free polyester nanoparticles (NPs) from biobased polyesters poly(butylene sebacate) (PBSE) and poly(butylene sebacate‐co‐butylene dilinoleate)s (PBSE/PBDL) using nanoprecipitation is reported. This strategy leads to spherical nanosized particles with sizes narrowly distributed in a range of 30–200 nm which is appropriate for internalization by a variety of cells. The effect of molecular parameters and type of solvent used in the nanoprecipitation protocol on the size and shape of produced polyester nanocolloids and their in vitro degradation in PBS solution at 37 °C is elucidated by quasi‐elastic light scattering (QELS), atomic force microscopy (AFM), transmission electron microscopy (TEM), and size‐exclusion chromatography (SEC) techniques. A dense cationic brush layer (≈ 20 nm) of stimuli‐responsive and biocompatible poly(2‐dimethylaminoethyl methacrylate‐co‐acrylonitrile) is grafted on the surface of PBSE/PBDL NPs through “grafting onto” (arm first) coupling chemistry.

     

电针头穴治疗脑卒中后肩手综合征Ⅰ期的即刻效应研究和多功能磁共振成像研究

目的观察电针顶颞前斜线中2/5和顶颞后斜线中2/5治疗脑卒中后肩手综合征Ⅰ期的临床疗效即刻效应,并应用多功能磁共振成像(functional magnetic resonance imagine, fMRI)技术观察其中枢效应并探讨其作用机理。方法选取80例符合纳入标准的脑卒中后肩手综合征Ⅰ期患者按随机数字表法分为观察组和对照组各40例。对照组给予常规针刺加电针治疗,观察组给予电针头穴治疗。评价两组即刻治疗效果,观察两组治疗前、针刺后10 min、电针后10 min上肢运动功能评分(FMA)、VAS疼痛指数评分、改良Barthel指数(MBI)的变化情况。并在观察组中按编号随机选取5例患者行fMRI检查。结果 (1)观察组总有效率为95.00%(38/40),对照组总有效率为82.50%(33/40),差异有统计学意义(P<0.05)。(2)头针对上肢功能的改善优于对疼痛症状的改善,而电针对疼痛症状的改善优于对上肢功能的改善;(3)fMRI扫描分析显示观察组激活的脑功能区以中央前回中部、中央后回中部、颞叶、小脑为主;电针后激活强度进一步增强。结论头针缓解脑卒中后肩手综合征Ⅰ期患者上肢疼痛症状即刻疗效更加显著,并能即刻改善肩部功能,电针疗效更加明显,提示机理可能与中央前回、中央后回、小脑等区域在疼痛接受、处理、加工、反馈等环节发挥重要作用相关。     

多功能床边康复治疗车干预对中风早期患者肢体功能及负性情绪的影响

目的:探究多功能床边康复治疗车干预对中风早期患者肢体功能及负性情绪的影响。方法:160例中风早期患者随机分为观察组和对照组各80例,对照组给予常规康复治疗,观察组在此基础上进行多功能床边康复治疗车治疗,治疗前及治疗1个月后对2组患者进行Fugl-Meyer运动功能评定(FMA)、美国国立卫生院卒中量表(NIHSS)、焦虑自评量表(SAS)及抑郁自评量表(SDS)评定,并统计治疗期间并发症的情况。结果:治疗1个月后,2组FMA评分均明显高于治疗前(均P<0.05),且观察组高于对照组(P<0.05);2组NIHSS评分均明显低于治疗前(均P<0.05),且观察组低于对照组(P<0.05)。2组SAS和SDS评分均较治疗前明显下降(均P<0.05),且观察组均低于对照组(均P<0.05)。治疗后,观察组并发症发生率明显低于对照组(P<0.05)。结论:将多功能床边康复治疗车应用于中风早期患者时,可显著改善患者肢体功能及负性情绪,此方法值得应用与推广。     

Optimizing a multifunctional microsphere scaffold to improve neural precursor cell transplantation for traumatic brain injury repair

Tissue engineering using stem cells is widely used to repair damaged tissues in diverse biological systems; however, this approach has met with less success in regenerating the central nervous system (CNS). In this study we optimized and characterized the surface chemistry of chitosan‐based scaffolds for CNS repair. To maintain radial glial cell (RGC) character of primitive neural precursors, fibronectin was adsorbed to chitosan. The chitosan was further modified by covalently linking heparin using genipin, which then served as a linker to immobilize fibroblast growth factor‐2 (FGF‐2), creating a multifunctional film. Fetal rat neural precursors plated onto this multifunctional film proliferated and remained multipotent for at least 3 days without providing soluble FGF‐2. Moreover, they remained less mature and more highly proliferative than cells maintained on fibronectin‐coated substrates in culture medium supplemented with soluble FGF‐2. To create a vehicle for cell transplantation, a 3% chitosan solution was electrosprayed into a coagulation bath to generate microspheres (range 30–100 µm, mean 64 µm) that were subsequently modified. Radial glial cells seeded onto these multifunctional microspheres proliferated for at least 7 days in culture and the microspheres containing cells were small enough to be injected, using 23 Gauge Hamilton syringes, into the brains of adult rats that had previously sustained cortical contusion injuries. When analysed 3 days later, the transplanted RGCs were positive for the stem cell/progenitor marker Nestin. These results demonstrate that this multifunctional scaffold can be used as a cellular and growth factor delivery vehicle for the use in developing cell transplantation therapies for traumatic brain injuries. Copyright © 2013 John Wiley & Sons, Ltd.     

偶联双基因靶点的多功能金纳米颗粒对三阴性乳腺癌细胞的毒性分析

目的:设计并构建偶联双基因靶点的多功能金纳米棒颗粒（TKI-258-pGNRs@mSiO2-RGD）,并探讨该多功能金纳米棒颗粒对人三阴性乳腺癌MDA-MB-231细胞的细胞毒性,初步明确该新型多功能金纳米棒颗粒在体外实验中所需的剂量范围。方法:运用种子介导生长法制备金纳米棒,以改良的奥伯法对其表面进行介孔二氧化硅包裹,通过表面修饰偶联整合素αvβ3和表皮生长因子受体（VEGFR）的特异性抑制剂RGD和TKI-258,采用紫外分光光度计和透射电镜对其特征进行检测。以不同浓度（0、12.5、25、50、100、200μg/ml）多功能金纳米棒颗粒孵育人三阴性乳腺癌MDA-MB-231细胞株,采用CCK-8法检测细胞增殖率,并进行细胞毒性评级。结果:多功能金纳米棒颗粒物理状态稳定,吸收峰位于515、860 nm处。偶联的双基因靶点抑制剂TKI-258、RGD分别在360、204 nm处有特征性吸收峰,药物包封率分别为58.18%±7.13%,57.95%±5.22%,载药率分别为4.26%±0.42%,4.35%±0.79%。不同浓度多功能金纳米棒处理后,细胞增殖率在50%-100%之间,细胞毒性评级为I-II级,0-100μg/ml浓度范围内无细胞毒性。结论:偶联双基因靶点的多功能金纳米棒颗粒（TKI-258-pGNRs@mSiO2-RGD）具有热疗/放疗增敏的特殊光学性质,偶联双基因靶点抑制剂TKI-258、RGD的载药量稳定,生物相容性良好,可作为三阴性乳腺癌细胞特异性靶向的热疗/放疗载药增敏材料。     

Laparoendoscopic single-site distal pancreatectomy in pigs

AIM:To explore the technique for laparoendoscopic single-site distal pancreatectomy.METHODS:Laparoendoscopic single-site spleenpreserving distal pancreatectomy was performed in pigs using a novel flexible multichannel port,a curved laparoscopic multifunctional operative device and a fish hook retractor,which provided a favorable operative field.RESULTS:Six pigs were involved in this study,and five survived the procedure.The first animal died following injury to the superior mesenteric vein and uncontrolledintraoperative bleeding.Except for this failure,the mean operative time was 155 min(range:102-236 min).A steep learning curve was observed in the study,with a mean operative time of 177 min in the first two operations vs 134 min in the last three operations.The mean blood loss was 50 mL,and the postoperative course was uneventful.The animals were sacrificed three weeks after the procedures,and no pancreatic leakage or abdominal infection was found macroscopically.CONCLUSION:Laparoendoscopic single-site distal pancreatectomy is a safe and feasible procedure and can be implemented in humans in selected cases at qualified surgical centers.     

重组血管基膜衍生多功能肽抗血管新生活性的研究

目的:观察重组血管基膜衍生多功能肽(rVBMDMP)抗血管新生的活性。方法:采用MTT法检测rVB-MDMP对血管内皮细胞增殖活性的影响,台盼蓝染色细胞计数法测定其对血管内皮细胞生长的影响,内皮管结构形成实验测定其对血管内皮细胞内皮管结构形成能力的影响,PI染色流式细胞分析术检测其对血管内皮细胞凋亡率的影响,吖啶橙染色荧光显微镜观察rVBMDMP作用后细胞凋亡形态学的改变,划痕法测定其对血管内皮细胞迁移能力的影响。结果:MTT法、台盼蓝染色细胞计数法显示rVBMDMP能显著抑制血管内皮细胞增殖和生长,其作用呈剂量和时间依赖性,1.0μmol/L rVBMDMP作用96 h时,血管内皮细胞的活细胞数仅为溶酶对照组的50%。内皮管结构形成实验结果表明,rVBMDMP能显著降低血管内皮细胞的内皮管状结构数目(17.67±3.055与50.33±3.055)。流式细胞术结果显示,rVBMDMP处理后细胞凋亡率呈浓度依赖性增加,其中1.0μmol/L浓度组凋亡率高达14.41%。吖啶橙染色荧光显微镜下观察细胞出现典型凋亡的形态学改变。划痕法显示rVBMDMP对细胞迁移能力无明显影响。结论:rVBMDMP具有显著的抗血管新生活性。     

Role of calcium dysregulation in Alzheimer's disease and its therapeutic implications

The increasing incidence of Alzheimer's disease (AD) coupled with the lack of therapeutics to address the underlying pathology of the disease has necessitated the need for exploring newer targets. Calcium dysregulation represents a relatively newer target associated with AD. Ca⁺² serves as an important cellular messenger in neurons. The concentration of the Ca⁺² ion needs to be regulated at optimal concentrations intracellularly for normal functioning of the neurons. This is achieved with the help of mitochondria, endoplasmic reticulum, and neuronal plasma membrane channel proteins. Disruption in normal calcium homeostasis can induce formation of amyloid beta plaques, accumulation of neurofibrillary tangles, and dysfunction of synaptic plasticity, which in turn can affect calcium homeostasis further, thus forming a vicious cycle. Hence, understanding calcium dysregulation can prove to be a key to develop newer therapeutics. This review provides detailed account of physiology of calcium homeostasis and its dysregulation associated with AD. Further, with an understanding of various receptors and organelles involved in these pathways, the review also discusses various calcium channel blockers explored in AD hand in hand with some multitarget molecules addressing calcium as one of the targets.