The trend and features of the doctor workforce supply in China after the national medical licensing system reform from 2005–15: a longitudinal analysis

Background

The annual number of newly licensed doctors is an important indicator of medical workforce supply, which can accurately reflect an inflow into the health-care market during a time period. Since the implementation of the Law on Practicing Doctors in 1999, the Chinese Government has established its medical licensure system to both regulate medical professions and improve the quality of health-care services. We aimed to analyse the trend and structure of newly licensed doctors since the establishment of its medical licensure system.

大黄附子汤对重症急性胰腺炎大鼠肠黏膜上皮细胞及线粒体结构和功能的影响

目的探讨大黄附子汤对重症急性胰腺炎(SAP)大鼠肠黏膜上皮细胞(IEC)结构的保护作用及IEC线粒体功能的影响。 方法本研究为随机对照试验,将60只健康雄性SD大鼠(体重250～300 g),采用随机数字表法将大鼠分为对照组、重症急性胰腺炎组(SAP组)和大黄附子汤治疗组(大黄附子汤组),每组20只。每组再按建模后时间(6、12、24、48 h)分为4个亚组,每个亚组5只。SAP组和大黄附子汤组采用5%牛磺胆酸钠(0.1 mL/100g)胰胆管注射法诱导SAP模型,对照组开腹翻动胰腺数次后关腹。大黄附子汤组大鼠分别于术后0、15、30、45 h以大黄附子汤灌肠(10 mL/kg),对照组和SAP组在同时间点给予同体积0.9%氯化钠溶液灌肠。各组按各时间点处死动物,左侧股静脉取血测定血清淀粉酶和内毒素变化。采用分光光度计、荧光定量法检测IEC线粒体ATP合成酶、细胞色素C氧化酶(CcO)含量变化,光镜观察小肠上皮组织的形态学变化。 结果与SAP组相比,大黄附子汤可降低SAP后24 h、48 h的血清淀粉酶水平[24 h：(769.14±456.99) vs (1 399.85±623.40)U/L,P<0.01;48 h：(889.59±209.82) vs(1 562.00±316.19)U/L,P<0.001)。与SAP组相比,大黄附子汤组大鼠血清内毒素在建模后24 h、48 h均有不同程度下降[24 h：(108.78±22.16) vs(168.77±29.25)pg/mL,P<0.01;48 h：(242.90±45.12) vs(124.01±321.45)pg/mL,P<0.001]。与对照组相比,SAP后IEC线粒体ATP合成酶和CcO活性均降低且随病程推移呈递减趋势;经大黄附子汤治疗后IEC线粒体ATP合成酶活性高于同时相点的SAP组[12 h：(19.60±1.67)vs(13.60±2.88)nmol·min^－1·mg^－1 pro,P<0.05;24 h：(17.40±2.79) vs(11.2±2.78) nmol·min^－1·mg^－1 pro,P<0.05;48 h：(18.60±2.07) vs (11.2±1.92)nmol·min^－1·mg^－1 pro,P<0.01],且24 h、48 h线粒体CcO活性高于同时相点SAP组[24 h：(1.56±0.11)vs(1.06 ±0.18)μmol·min^－1·mg^－1;48 h：(1.04±0.31) vs(0.50±0.16)μmol·min^－1·mg^－1,P均<0.01]。SAP后12 h小肠上皮损伤指数开始升高(2.2±0.84 vs 0.60±0.55,P<0.01),且24、48 h持续性升高;大黄附子汤组可显著降低SAP后48 h小肠上皮损伤指数(1.2±0.45 vs 4.0±1.0,P<0.001)。 结论大黄附子汤能通过增强大鼠IEC线粒体ATP合成酶和CcO活性,改善IEC线粒体能量代谢和呼吸功能,保护SAP后肠屏障的完整性和功能,降低血清淀粉酶和内毒素含量,缓解SAP病情。     

自拟益气化痰汤联合姑息性化疗对晚期非小细胞肺癌患者近期生存率及生活质量的影响

目的:探讨自拟益气化痰汤联合姑息性化疗对晚期非小细胞肺癌(NSCLC)患者近期生存率及生活质量的影响。方法:选择2011年1月-2014年1月我院收治的晚期NSCLC患者94例。随机分为观察组（n=47）和对照组（n=47）。对照组仅采用姑息性化疗方案治疗,观察组在对照组基础上联合自拟益气化痰汤。对比分析两组疗效、生活质量、不良反应发生情况及随访6个月患者生存率。结果:两组化疗后躯体功能、情绪功能、社会功能、角色功能、认知功能以及整体生活质量评分均显著高于化疗前（P＜0.05）;观察组化疗后上述指标评分高于对照组（P＜0.05）;观察组近期总有效率显著高于对照组（P＜0.05）;观察组白细胞减少、恶心呕吐、贫血发生率显著低于对照组（P＜0.05）,而血小板减少、外周神经毒性比较无统计学差异（P＞0.05）。结论:自拟益气化痰汤联合姑息性化疗对晚期非小细胞肺癌疗效显著,可明显提高患者近期生存率,改善患者生活质量。     

三七不同部位提取物体外抗氧化功效研究

目的:研究三七不同部位提取物的抗氧化功效,为三七化妆品原料的开发提供实验依据.方法:采用超氧阴离子自由基清除活性实验及羟自由基清除活性实验检测三七根、茎、叶、花提取物对超氧阴离子自由基及羟自由基的清除活性,依据自由基清除率计算半抑制浓度(inhibitory concentration 50,IC50).采用H2O2诱...     

Partial Component–Retained 2-Stage Reconstruction in the Treatment of Infected Hip Arthroplasty

BackgroundIt is considered the gold standard treatment for infected hip arthroplasty to remove and reimplant the corresponding whole set of implant components before and after infection control, but it usually causes substantial bone loss to remove the well-fixed cup or stem, which may increase the difficulty in reconstruction. We would like to determine whether infected hip arthroplasty can be treated without removal of a well-fixed cup or stem.MethodsPatients with infected hip arthroplasty and a radiographically well-fixed, cementless cup or stem were selected. During the first surgical stage, we retained the stem or cup if these cannot be removed using a stem or cup extractor. We performed the reimplantation surgery after control of infection.ResultsFrom January 2008 to December 2016, 26 patients underwent partial component–retained 2-stage reconstruction. All the patients were free of infection with a mean follow-up time of 43.85 months.ConclusionPartial component–retained 2-stage reconstruction may be a treatment option for infected total hip arthroplasty with a well-fixed component in patients.     

Effects of Lizhong Tang on cultured mouse small intestine interstitial cells of Cajal

AIM:To investigate the effects of Lizhong Tang,an herbal product used in traditional Chinese medicine,on mouse small intestine interstitial cells of Cajal(ICCs).METHODS:Enzymatic digestions were used to dissociate ICCs from mouse small intestine tissues.The ICCs were morphologically distinct from other cell types in culture and were identified using phase contrast microscopy after verification with anti c-kit antibody.A whole-cell patch-clamp configuration was used to record potentials(current clamp) from cultured ICCs.All of the experiments were performed at 30-32 ℃.RESULTS:ICCs generated pacemaker potentials,and Lizhong Tang produced membrane depolarization in current-clamp mode.The application of flufenamic acid(a nonselective cation channel blocker) abolished the generation of pacemaker potentials by Lizhong Tang.Pretreatment with thapsigargin(a Ca 2+-ATPase inhibi-tor in the endoplasmic reticulum) also abolished the generation of pacemaker potentials by Lizhong Tang.However,pacemaker potentials were completely abolished in the presence of an external Ca 2+-free solution,and under this condition,Lizhong Tang induced membrane depolarizations.Furthermore,When GDPβ-S(1 mmol/L) was in the pipette solution,Lizhong Tang still induced membrane depolarizations.In addition,membrane depolarizations were not inhibited by chelerythrine or calphostin C,which are protein kinase C inhibitors,but were inhibited by U-73122,an active phospholipase C inhibitors.CONCLUSION:These results suggest that Lizhong Tang might affect gastrointestinal motility by modulating pacemaker activity in interstitial cells of Cajal.     

基于网络药理学探讨四君子汤治疗结直肠癌靶点及通路研究

目的:通过网络药理学方法预测四君子汤治疗结直肠癌潜在的作用靶点及信号通路。方法:利用TCMSP获得四君子汤的化学成分及作用靶点,结合Swiss Target Prediction网站进行靶标垂钓;通过TTD、OMIM、Drugbank和GeneCards数据库收集结直肠癌相关靶点。运用Venn图取药物和疾病交集靶点,并...     

M-Tang法肌腱缝合技术的生物力学研究及其在Ⅱ区屈肌腱修复中的应用

目的报道一种新的肌腱缝合方法 M-Tang法的生物力学特性及临床应用结果。方法本研究采用36根猪后足屈肌腱作为实验材料,在相当于Ⅱ区水平造成切割伤后,18根用Tang法、18根用M-Tang法进行修复。将修复后的肌腱分别进行直线和90°成角状态下的拉伸,用Instron力学测定仪测定2 mm间隙形成负荷及断裂负荷。M-Tang法用于临床修复Ⅱ区屈肌腱65例共96指,术后均采用保护性主、被动活动相结合的锻炼计划。采用Strickland标准进行功能评价。结果在直线拉伸模式下,M-Tang法的2 mm间隙形成负荷为(46.2±5.2)N,断裂负荷为(61.9±6.0)N,与Tang法相近;在90°成角拉伸模式下,M-Tang法的2 mm间隙形成负荷为(35.9±3.6)N,与Tang法相近,断裂负荷为(57.0±4.5)N,高于Tang法。65例患者术后平均随访26个月,临床运用M-Tang法修复的Ⅱ区屈肌腱无1例发生断裂,根据Strickland TAM标准,其中优78指,良10指,可8指,优良率91.6%。结论 M-Tang法具备Tang法的生物力学强度,操作简便,使用缝线和外露线结少,能满足肌腱早期保护性主动活动的需要,是Ⅱ区屈肌腱修复的优选方法之一。     

加味四物汤促进血管新生改善急性心肌梗死大鼠心功能

目的:观察加味四物汤(modified Siwu Tang concentrated solution,mSWT)对急性心肌梗死(acute myocardial infarc-tion,AMI)大鼠血管新生、心室重构及心功能的影响.方法:结扎雄性SD大鼠冠状动脉左前降支制备AMI模型,假手术组(Sham组)、模型组灌...     

自拟易激宁汤治疗肠易激综合征42例

[目的]观察易激宁汤中西医结合治疗肠易激综合征的临床疗效和毒副作用。[方法]将82例肠易激综合征患者随机分为实验组和对照组进行研究。两组均进行对症、心理、行为和饮食治疗，实验组加用易激宁汤加减治疗，观察并记录疗效。[结果]两组均有效，但实验组在症状程度、持续时间、复发等方面疗效均优于对照组（P〈0．05）。[结论]自拟易激宁汤中西医结合治疗肠易激综合征疗效显著，无明显副作用，能提高生活、学习、工作质量。