江西省2017年度临床核医学应用频度调查与分析

目的 掌握江西省临床核医学应用频度和受检者的分布特点，估算2017年全省临床核医学应用频度。方法 对全省范围内开展临床核医学工作的各级医疗机构进行普查，以发放调查问卷的形式对样本医院进行应用频度调查与分析。结果 除正电子发射断层扫描（PET）检查男性多于女性外，其余临床核医学诊疗项目均为女性多于男性；全省临床核医学诊疗应用频度为0.67人次/千人口，其中诊断频度为0.58人次/千人口，治疗频度为0.09次/千人口。结论 与"九五"期间相比，江西省临床核医学应用频度迅猛发展，有必要进一步规范核医学诊疗工作，增强核医学工作人员的放射防护意识，促进核医学健康有序地发展。     

Temporal Trends of Women Enrollment in Major Cardiovascular Randomized Clinical Trials

Background

Although it is known that women do not participate in trials as frequently as men, there are limited recent data examining how women recruitment has changed over time.

呫吨酮并吡啶衍生物XP-15联合紫杉醇对耐药肝癌细胞QGY-7701 的体外抑制作用

目的:探索呫吨酮并吡啶衍生物XP-15联合紫杉醇对人肝癌QGY-7701耐药细胞株的体外抗肿瘤作用。方法:运用CCK8法、Transwell实验和流式细胞仪检测凋亡技术观察细胞功能学变化，运用Western Blot蛋白免疫印迹技术探索其可能的作用机制。结果:XP-15可明显增强紫杉醇对耐药QGY-7701细胞的抑制作用，XP-15联合紫杉醇作用于耐药QGY-7701细胞24 h后，QGY-7701细胞活力明显减弱，且其侵袭迁移能力明显降低，同时流式细胞仪凋亡检测提示细胞凋亡百分比明显增加。Western Blot蛋白免疫印迹亦证实细胞抗凋亡蛋白bcl-2表达明显降低，肝癌增殖分化相关PI3K及AKT蛋白分子表达减少。结论:XP-15具有增敏紫杉醇诱导耐药QGY-7701细胞凋亡同时抑制其增殖活力的作用，其作用机制可能与下调PI3K-AKT通路活性，同时减少bcl-2抑制凋亡蛋白表达相关。     

髋臼螺钉对非骨水泥全髋置换术中假体稳定性的影响

目的探讨髋臼螺钉在非骨水泥全髋置换术中对髋臼假体稳定性的影响。 方法回顾性分析2009年8月至2015年8月在深圳市龙岗区人民医院骨科行非骨水泥全髋置换术114例(117髋)病例资料，患者根据术中是否植入髋臼螺钉分成两组，其中A组无螺钉组59髋，B组螺钉固定组58髋。分别在术后3个月、12个月、24个月和末次随访时对病人进行随访，评估并比较影像学的改变及Harris评分。A组57髋B组56髋获得完整随访资料，平均随访(5.7±1.6)年。以Kaplan-Meier法分析两组假体生存率。 结果A组平均手术时间(t＝2.213, P<0.05)、术中出血量均小于B组(t＝2.342, P<0.05)；随访末期，A、B组术后平均Harris评分为(95.0±2.1)分及(93.0±5.5)分(P>0.05)；A、B组术后3个月、12个月、24个月分别有4髋(7.0%)、3髋(5.3%)、1髋(1.8%)和1髋(1.8%)、2髋(3.6%)及2髋(3.6%)出现髋臼周围透亮线；A组1髋术后4年出现骨溶解，B组2髋出现骨溶解。以影像学证明假体松动作为失败标准，计算两组假体平均随访(5.7±1.6)年生存率分别为97%和95%，两者差异无统计学意义(P >0.05)。 结论髋臼骨质条件良好时是否使用髋臼螺钉固定对臼杯的稳定性无明显影响，全髋关节置换术中植入髋臼螺钉不是必需的。     

肝移植术后移植物抗宿主病的诊治进展

肝移植术后移植物抗宿主病(GVHD)发生率低，但病死率极高，典型症状包括不明原因发热、皮疹、腹泻和骨髓抑制。其发病机制目前尚未完全阐明，诊断缺乏统一标准，治疗缺乏特异性手段。近年来，针对GVHD免疫反应进程中的病理生理学研究，为开辟新的诊断方法和治疗手段提供可能。目前，大剂量糖皮质激素联合静脉注射免疫球蛋白冲击、免疫抑制剂减少或停用可能是较为有效的治疗方案。而对于糖皮质激素难治性GVHD，应用多种不同的分子靶向药物可能对改善受者预后起到积极作用。     

Grappling with complexity: Medical students’ reflective writings about challenging patient encounters as a window into professional identity formation

Aim: Clerkship-specific interactive reflective writing (IRW)-enhanced reflection may enhance professional identity formation (PIF), a fundamental goal of medical education. PIF process as revealed in students? reflective writing (RW) has been understudied.

Methods: The authors developed an IRW curriculum within a Family Medicine Clerkship (FMC) and analyzed students? reflections about challenging/difficult patient encounters using immersion-crystallization qualitative analysis.

Results: The qualitative analysis identified 26 unique emergent themes and five distinct thematic categories (1. Role of emotions, 2. Role of cognition, 3. Behaviorally responding to situational context, 4. Patient factors, and 5. External factors) as well as an emergent PIF model from a directed content analysis. The model describes students? backgrounds, emotions and previous experiences in medicine merging with external factors and processed during student?patient interactions. The RWs also revealed that processing often involves polarities (e.g. empathy/lack of empathy or encouragement/disillusionment) as well as dissonance between idealized visions and lived reality.

Conclusions: IRW facilitates and ideally supports grappling with the lived reality of medicine; uncovering a “positive hidden curriculum” within medical education. The authors propose engaging learners in guided critical reflection about complex experiences for meaning-making within a safe learning climate as a valuable way to cultivate reflective, resilient professionals with “prepared” minds and hearts for inevitable challenges of healthcare practice.     

Factors associated with provision of depot medroxyprogesterone acetate to adolescents by US health care providers

ObjectiveIdentify factors associated with healthcare providers' frequency of depot medroxyprogesterone acetate (DMPA) provision to adolescents.Study designWe analyzed data from surveys mailed to a nationally representative sample of public-sector providers and office-based physicians (n=1984). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of factors associated with frequent DMPA provision to adolescents in the past year.ResultsAlthough most providers (>95%) considered DMPA safe for adolescents, fewer reported frequent provision (89% of public-sector providers; 64% of office-based physicians). Among public-sector providers, factors associated with lower odds of frequent provision included working in settings without Title X funding (aOR 0.44, 95% CI 0.30–0.64), reporting primary care as their primary clinical focus versus reproductive or adolescent health (aOR 0.42, 95% CI 0.28–0.61), and providing fewer patients with family planning services. Among office-based physicians, factors associated with lower odds of frequent provision included specializing in obstetrics/gynecology (aOR 0.50, 95% CI 0.27–0.91) and family medicine (aOR 0.21, 95% CI 0.09–0.47) versus adolescent medicine, completing training ≥15 versus <5 years ago (aOR 0.27, 95% CI 0.09–0.83), and reporting that 0–24% of patients pay with Medicaid or other government healthcare assistance versus ≥50% (aOR 0.23, 95% CI 0.09–0.61). The reason most commonly reported by providers for infrequent DMPA provision was patient preference for another method.ConclusionsWhile most providers reported frequently providing DMPA to adolescents, training on evidence-based recommendations for contraception, focused on subgroups of providers with lower odds of frequent DMPA provision, may increase adolescents' access to contraception.ImplicationsAlthough >95% of providers considered depot medroxyprogesterone (DMPA) a safe contraceptive for adolescents, only 89% of public-sector providers and 64% of office-based physicians reported frequently providing DMPA to adolescents. Provider training on evidence-based recommendations for contraception counseling and provision may increase adolescents' access to DMPA and all methods of contraception.     

PDCA循环在缩短肺功能患者等候时间中的作用

目的：探讨PDCA在缩短肺功能患者等候时间中的作用。方法：通过调取2018年3月19~4月19日肺功能工作量与2017年同期对比，查找患者等候时间长的原因。结果：通过完善绩效考核体系、设定基础工作量、加强科室内部协调等措施，有效缩短了患者等候时间，提高了工作效率。结论：通过PDCA循环，不仅缩短了患者等候时间和呼吸科平均住院日，还提高了患者满意度，使科室内部合作更加协调与紧密。