运用马克思主义哲学浅析新时代医患关系和解决途径

新时代医患关系具有新的特点和新的矛盾。新特点表现在患者对医疗产品和技术的更高需求,而人民对健康生活的需要与医疗资源不平衡不充分的发展之间的矛盾则是新的矛盾。新时代医患关系日益紧张,急需改善。通过运用马克思主哲学中"科技是最高意义上的革命力量"、"物质与意识的辩证关系"和"人生价值规律",分析导致医患冲突的影响因素,找到切实有效、能够改善和解决医患关系的方法,使医患双方和谐共处。主要以提高医疗服务质量、改善医务工作者的工作环境、推进提升医患间信任为目的,通过切实的方法促进医患间有效的沟通。     

关于新时代医患和谐相处的主要方法

随着科技的发展与时代的进步,新时代医患关系也在发生改变。对于这一备受重视的社会问题,运用马克思主义哲学规律中科技是最高意义上的革命力量规律、物质和意识的辩证关系原理、矛盾普遍性和特殊性的辩证关系原理和人生价值规律来分析探索新时代医患和谐相处的主要方法。通过建立新的思维方式,从源头上认识和解决问题,促进医患和谐健康相处,从而营造一个良好的医疗环境。     

小鼠下丘脑SH2B1, SOCS3, PTP1B及NPY表达的变化及其与肥胖的关系

目的：研究肥胖小鼠及正常小鼠不同周龄下丘脑组织SH2B1(adapter protein with a Src-homology 2 domain),细胞因子信号转导抑制蛋白3(the suppressor of cytokine signaling-3,SOCS3),蛋白质酪氨酸磷酸酶1B(proteintyrosine phosphatase 1B,PTP1B)和神经肽Y(neturopetide Y,NPY)表达的变化规律及其与血清瘦素及胰岛素水平的关系。方法：选用健康C57BL/6乳鼠制作肥胖动物模型,计算Lee’s指数及稳态模型胰岛素抵抗指数。荧光定量RT-PCR法检测下丘脑SH2B1,SOCS3及PTP1B mRNA表达量,Western印迹检测下丘脑SH2B1和NPY蛋白表达量。结果：与同周龄对照组小鼠相比,肥胖组小鼠下丘脑组织SH2B1 mRNA表达减少,SOCS3及PTP1B mRNA表达增加;Western印迹结果显示：肥胖组小鼠SH2B1蛋白表达水平较对照组下降,NPY表达升高。直线相关分析显示：血清瘦素和血清空腹胰岛素水平与SH2B1 mRNA表达呈负相关,与SOCS3及PTP1B mRNA表达正相关。结论：SH2B1,SOCS3,PTP1B及NPY是肥胖发生、发展过程中的关键因子。     

MicroRNAs in hypertrophic cardiomyopathy: pathogenesis,diagnosis, treatment potential and roles as clinical biomarkers

Heart Failure Reviews - Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiomyopathy and is characterized by increased left ventricular wall thickness, but existing diagnostic and...     

p38γ Mitogen-Activated Protein Kinase Contributes to Oncogenic Properties Maintenance and Resistance to Poly (ADP-Ribose)-Polymerase-1 Inhibition in Breast Cancer

p38γ MAPK, one of the four members of p38 mitogen-activated protein kinases (MAPKs), has previously been shown to harbor oncogenic functions. However, the biologic function of p38γ MAPK in breast cancer has not been well defined. In this study, we have shown that p38γ MAPK is overexpressed in highly metastatic human and mouse breast cancer cell lines and p38γ MAPK expression is preferentially associated with basal-like and metastatic phenotypes of breast tumor samples. Ectopic expression of p38γ MAPK did not lead to an increase in oncogenic properties in vitro in most tested mammary epithelial cells. However, knockdown of p38γ MAPK expression resulted in a dramatic decrease in cell proliferation, colony formation, cell migration, invasion in vitro and significant retardation of tumorigenesis, and long-distance metastasis to the lungs in vivo. Moreover, knockdown of p38γ MAPK triggered the activation of AKT signaling. Inhibition of this feedback loop with various PI3K/AKT signaling inhibitors facilitated the effect of targeting p38γ MAPK. We further found that overexpression of p38γ MAPK did not promote cell resistance to chemotherapeutic agents doxorubicin and paclitaxel but significantly increased cell resistance to PJ-34, a DNA damage agent poly (ADP-ribose)-polymerase-1 (PARP) inhibitor in vitro and in vivo. Finally, we identified that p38γ MAPK overexpression led to marked cell cycle arrest in G₂/M phase. Our study for the first time clearly demonstrates that p38γ MAPK is a promising target for the design of targeted therapies for basal-like breast cancer with metastatic characteristics and for overcoming potential resistance against the PARP inhibitor.     

依托咪酯与体外循环直视心脏手术患者炎症因子的关系探讨

目的:研究对实行体外循环直视心脏手术的患者采用依托咪酯后炎症因子的改变。方法:将2010年3月～2011年7月于我院进行体外循环直视心脏手术的患者共26例,随机平均将其分为两组。静脉麻醉研究组采用依托咪酯,对照组采用丙泊酚。测定麻醉诱导前、气管插管后、停机时的IL-10、IL-6、TNF-α水平。结果:两组患者血浆中的炎症因子IL-10、IL-6、TNF-α均升高。研究组的停机时血浆IL-10水平明显高于对照组。结论:丙泊酚和依托咪酯均可减轻体外循环手术导致的机体炎症反应,丙泊酚可更强地抑制全身炎症反应综合症的发生。     

Combined delivery of salinomycin and docetaxel by dual-targeting gelatinase nanoparticles effectively inhibits cervical cancer cells and cancer stem cells

Intra-tumor heterogeneity is widely accepted as one of the key factors, which hinders cancer patients from achieving full recovery. Especially, cancer stem cells (CSCs) may exhibit self-renewal capacity, which makes it harder for complete elimination of tumor. Therefore, simultaneously inhibiting CSCs and non-CSCs in tumors becomes a promising strategy to obtain sustainable anticancer efficacy. Salinomycin (Sal) was reported to be critical to inhibit CSCs. However, the poor bioavailability and catastrophic side effects brought about limitations to clinical practice. To solve this problem, we previously constructed gelatinase-stimuli nanoparticles composed of nontoxic, biocompatible polyethylene glycol-polycaprolactone (PEG-PCL) copolymer with a gelatinase-cleavable peptide Pro-Val-Gly-Leu-Iso-Gly (PVGLIG) inserted between the two blocks of the copolymer. By applying our “smart” gelatinase-responsive nanoparticles for Sal delivery, we have demonstrated specific accumulation in tumor, anti-CSCs ability and reduced toxicity of Sal-NPs in our previous study. In the present study, we synthesized Sal-Docetaxel-loaded gelatinase-stimuli nanoparticles (Sal-Doc NP) and confirmed single emulsion as the optimal method of producing Sal-Doc NPs (Sal-Doc SE-NP) in comparison with nanoprecipitation. Sal-Doc SE-NPs inhibited both CSCs and non-CSCs in mice transplanted with cervical cancer, and might be associated with enhanced restriction of epithelial-mesenchymal transition (EMT) pathway. Besides, the tumorigenic capacity and growing speed were obviously suppressed in Sal-Doc-SE-NPs-treated group in rechallenge experiment. Our results suggest that Sal-Doc-loaded gelatinase-stimuli nanoparticles could be a promising strategy to enhance antitumor efficacy and reduce side effects by simultaneously suppressing CSCs and non-CSCs.     

癌情隐瞒与非小细胞肺癌生存不良的相关性分析

目的：探讨癌情隐瞒与非小细胞肺癌(non-small cell lung carcinoma,NSCLC)患者生存不良的关系。方法： 收集865名NSCLC患者信息,包括年龄、性别、地址、TNM分期和肿瘤知情情况,通过Kaplan-Meier方法和Cox回归分 析计算患者的生存率。通过电话或面对面的方式,对医生、护士、患者及其家属关于患者肿瘤知情或隐瞒的情况及 相关原因进行调查。结果：在平均随访304(0~4 718) d后,肿瘤知情组的394名患者中有62例存活,而471名癌情隐瞒 组中只有26例存活。单因素分析发现癌情隐瞒组肿瘤相关生存率和全死因生存率均明显低于肿瘤知情组(P<0.001)。 Cox多元回归分析表明癌情隐瞒组的肿瘤相关生存率(HR=1.534,95% CI：1.320~1.784,P<0.001)和全死因生存率 (HR=1.558,95% CI：1.346~1.803,P<0.001)显著低于肿瘤知情组。94.57%的患者家属选择癌情隐瞒的主要原因是“避 免心理崩溃”,他们认为肿瘤知情可能加速死亡。结论：癌情隐瞒是NSCLC患者生存不良的危险因素,我国传统文化 中的“讳疾”可能阻止患者获得真正的“生存权”。     

不同生长期罗汉果皂苷对α-葡萄糖苷酶的体外抑制作用研究

目的研究不同生长期罗汉果皂苷对α-葡萄糖苷酶的体外抑制作用。方法选用果实生长期为30d、50d、90d的罗汉果皂苷提取物,在α-葡萄糖苷酶与4-硝基苯-α-D-吡喃葡萄糖苷(PNPG)作为底物的反应体系中筛选出具有良好抑制作用的罗汉果提取物,并观察罗汉果皂苷对Caco-2细胞α-葡萄糖苷酶的抑制作用。结果罗汉果皂苷对α-葡萄糖苷酶活性抑制作用与剂量正相关,50d罗汉果皂苷提取物对α-葡萄糖苷酶的抑制作用强于30d和90d罗汉果皂苷。经酶动力学研究发现,50d罗汉果皂苷对α-葡萄糖苷酶的抑制作用属于混合型抑制。50d罗汉果皂苷在0.05~50μg/ml范围内对Caco-2细胞α-葡萄糖苷酶活性呈现先促进后抑制的趋势。浓度为5.0μg/ml和10.0μg/ml时的罗汉果皂苷能一定程度上抑制Caco-2细胞α-葡萄糖苷酶活性。结论生长期50d的罗汉果皂苷类提取物对α-葡萄糖苷酶的抑制作用强于其他生长期(30d、90d)的罗汉果皂苷提取物,能在体外剂量依赖性地直接抑制α-葡萄糖苷酶的催化活性,并抑制Caco-2细胞α-葡萄糖苷酶活性。     

缺血后处理对大鼠无心跳供体肺移植的保护作用

目的: 在大鼠无心跳供体(non-heart-beating donor,NHBD)肺移植动物模型上观察缺血后处理对NHBD供肺的保护作用。方法: 将40只大鼠随机分成缺血后处理组(IPO组)和对照组(C组),每组10对,用“两套管一支架法”完成无心跳供体左肺原位移植。C组肺移植后直接开放肺动脉恢复灌注,而IPO组肺移植后给予5次1 min再灌 /1 min再阻断的后处理措施,然后全面恢复再灌注。结果: IPO组与C组比较,NHBD肺移植术后肺水含量低、肺损伤程度轻,而肺顺应性、肺结构和功能保存更好。此外,IPO组移植术后供肺细胞凋亡程度和丙二醛(malondialdehyde, MDA)含量较C组低,而SOD含量较C组高。结论: 缺血后处理可以减轻NHBD肺移植术后供肺缺血再灌注损伤,保存供肺结构和功能,还可抑制NHBD肺移植术后脂质过氧化反应和细胞凋亡。