A2M、A1PI、MMPs水平与肺部感染合并肺不张患者的相关性及临床意义

目的探讨α2-巨球蛋白(A2M)、α1-蛋白酶抑制物(A1PI)、血清基质金属蛋白酶(MMPs)水平与肺部感染合并肺不张患者的相关性及临床意义。方法选取2018年1-12月于该院就诊的100例患者作为研究组;选取同期就诊的肺部感染患者45例和体检健康者100例分别作为对照组和健康对照组。检测各组血清A2M、A1PI、MMP-1、MMP-2和MMP-9水平,比较组间水平差异。对研究组行常规治疗,对比治疗前、后各指标水平差异。结果研究组A2M、A1PI和MMPs水平均明显高于对照组和健康对照组(P<0.05),对照组各指标水平均明显高于健康对照组(P<0.05)。研究组和对照组患者随着肺部疾病程度增加,A1PI和MMPs水平逐步升高(P<0.05),对照组各感染程度患者间A2M水平差异无统计学意义(P>0.05),而研究组差异有统计学意义(P<0.05)。常规治疗后研究组各指标水平均明显下降(P<0.05)。结论肺部感染合并肺不张患者血清A2M、A1PI和MMPs水平异常升高,A2M、A1PI和MMPs可为临床肺部感染合并肺不张提供诊断参考。     

医学人文教育对住培生心理状态的影响

住院医师培养基地医生(住培生)是我国为探索医科大学毕业生接受临床继续教育而产生一类特殊群体。医学是一门培养应用型人才的科学,随着我国社会经济快速发展及社会开放与文明程度的提高,医学生的独立意识和自我价值的实现,要求医院对毕业后的医学生除了医学专业的教育外,必须增加更为广博的人文教育。为了让医学生将来更好为患者服务,成为称职的住院医师,2005年我国卫生部逐步在全国建立住院医师培养基地,进一步规范住院医师培养基地医生(住培生)制度,而有关住培生的人文教育尚处于探索之中,尤其是对住培生人文教育与住培生相关心理因素的分析。     

NM-3对裸鼠移植胃癌组织VEGF—C、VEGF—D和VEGF—R-3表达的影响

目的：探讨NM-3对裸鼠移植人胃癌组织微淋巴管生成的影响及可能机制。方法：28只未分化人胃腺癌SGC-7901移植BALB／C裸鼠随机分为4组，每组7只，分别腹腔内注射生理盐水、NM-3、卡铂及NM-3加卡铂，每周2次，剂量为NM-310mg／kg，卡铂5mg／kg。于第8周末处死裸鼠，取下肿瘤组织，定量免疫组化染色检测移植瘤组织VEGF—C、VEGF—D和VEGF—R-3表达。结果：各组VEGF—C免疫组化染色阳性面积（μm^2）为：卡铂组（1647．83±501．70）、NM-3组（2106．01±437．11）及联合给药组（1825．61±277．24），均较生理盐水对照组（2962．84±519．77）显著下降（P〈0．05），各治疗组之间无显著差别。VEGF—D值：NM-3组（1032．25±460．44）及联合给药组（1009．08±370．13），较生理盐水组（1882．15±359．38）及卡铂组（1854．00±322．07）均显著下降（P〈0．05），卡铂组较生理盐水组下降，但是差别无显著意义。VEGF—R-3值：NM-3组（1222．05±470．80）及联合给药组（1103．34±265．94）较生理盐水组（2123．05±117．99）下降，并有显著意义（P〈0．05），而卡铂组（1668．30±256．34）与生理盐水组比较差异无显著性；各治疗组之间无显著差别。结论：NM-3能够抑制胃癌微淋巴管生成，并能增强卡铂的抗肿瘤作用。     

Autologous melanocyte–keratinocyte suspension in the treatment of vitiligo

Background In stable vitiligo, several techniques of autologous transplantation of melanocytes are used. Autologous melanocyte transplantation of non‐cultured melanocytes is one of those techniques with variable reported outcomes. Objective The objective of this study was to evaluate the response to autologous melanocyte–keratinocytes suspension transplantation in cases of stable vitiligo. Methods A total of 25 cases of vitiligo were treated by autologous melanocyte–keratinocytes suspension transplantation. After 6–17 months, patients’ response was evaluated according to the extent of pigmentation (excellent 90–100%, good 50–89%, fair 20–49% and poor response <20%). Results Of the 25 patients treated, 22 continued the follow‐up period. Five (23%) patients showed excellent response, 7 (32%) good, 6 (27%) fair and 4(18%) showed poor response. Conclusion Unlike transplantation of cultured melanocytes, which requires experience in culture technique, autologous melanocyte–keratinocytes suspension transplantation is an easy economic technique, which may be used in resistant areas of stable vitiligo.     

Innovative technology for web-based data management during an outbreak

Lack of automated and integrated data collection and management, and poor linkage of clinical, epidemiological and laboratory data during an outbreak can inhibit effective and timely outbreak investigation and response. This paper describes an innovative web-based technology, referred to as Web Data, developed for the rapid set-up and provision of interactive and adaptive data management during outbreak situations. We also describe the benefits and limitations of the Web Data technology identified through a questionnaire that was developed to evaluate the use of Web Data implementation and application during the 2009 H1N1 pandemic by Winnipeg Regional Health Authority and Provincial Laboratory for Public Health of Alberta. Some of the main benefits include: improved and secure data access, increased efficiency and reduced error, enhanced electronic collection and transfer of data, rapid creation and modification of the database, conversion of specimen-level to case-level data, and user-defined data extraction and query capabilities. Areas requiring improvement include: better understanding of privacy policies, increased capability for data sharing and linkages between jurisdictions to alleviate data entry duplication.     

Internal-external percutaneous transhepatic biliary drainage for malignant biliary obstruction: a retrospective analysis

When percutaneous transhepatic biliary drainage (PTBD) is required for the management of malignant biliary obstruction, the local policy favours the use of internal–external drains. Regular planned drain exchanges are scheduled, and patients have open access back into the system to minimise complications. The aim of this study was to evaluate the success and complication rate of this method for the palliation of malignant biliary obstruction. The hospital records of 43 consecutive patients who underwent PTBD for malignant biliary obstruction at a single institution between 1 February 2004 and 31 January 2006 were reviewed. Outcomes were examined until January 2008. Biliary decompression was achieved in all 43 patients. The level of obstruction was defined as distal in 24 patients and perihilar in 19 patients. There was one procedure-related death. There were 91 routine outpatient drain exchanges performed at a median interval of 45 (range 21–64) days. Overall, 24/43 patients encountered 80 discrete complications related to biliary drainage. Fifty-two non-scheduled drain exchanges (accounting for 65% of all complications) were performed on an outpatient basis. Fourteen patients were readmitted on a median of one (range 1–3) occasion for a median duration of 3 (range 1–12) days. Median survival was 71 (range 7–850) days. PTBD can be performed with low mortality, but long-term morbidity remains high despite an aggressive approach to maintaining biliary patency. Providing patients with an open-access service means the majority of complications can be dealt with on an outpatient basis.