5—FC对经基因修饰而表达胞嘧啶脱氨酶的哺乳类细胞杀伤作用

为获得５┐氟胞嘧啶（５┐ｆｌｕｏｒｏｃｙｔｏｓｉｎｅ，５┐ＦＣ）对含ＣＤ基因哺乳类细胞的“诱导”杀伤表型数据。方法小鼠成纤维细胞ＮＩＨ／３Ｔ３、大鼠神经胶质瘤细胞Ｃ６和包装细胞ＰＡ３１７，经基因修饰而表达非哺乳类酶－胞嘧啶脱氨酶（ｃｙ┐ｔｏｓｉｎｅｄｅａｍｉｎａｓｅ，ＣＤ）。结果体外，ＣＤ基因的表达几乎不影响细胞的生长速率。薄层层析分析（ＴＬＣ）表明，被含有重组逆转录病毒载体ｐＬＣＤＳＮ的假型病毒感染的哺乳类细胞及包装细胞的抽提液可将胞嘧啶代谢成脲嘧啶。５┐ＦＣ对有ＣＤ活性的细胞产生致死性细胞毒性。结论本实验支持了在５┐ＦＣ参与下，于肿瘤细胞内选择性表达ＣＤ的基因治疗方案。     

Knowledge translation of the American College of Emergency Physicians’ clinical policy on syncope using computerized clinical decision support

Aims

To influence physician practice behavior after implementation of a computerized clinical decision support system (CDSS) based upon the recommendations from the 2007 ACEP Clinical Policy on Syncope.

Methods

This was a pre-post intervention with a prospective cohort and retrospective controls. We conducted a medical chart review of consecutive adult patients with syncope. A computerized CDSS prompting physicians to explain their decision-making regarding imaging and admission in syncope patients based upon ACEP Clinical Policy recommendations was embedded into the emergency department information system (EDIS). The medical records of 410 consecutive adult patients presenting with syncope were reviewed prior to implementation, and 301 records were reviewed after implementation. Primary outcomes were physician practice behavior demonstrated by admission rate and rate of head computed tomography (CT) imaging before and after implementation.

Results

There was a significant difference in admission rate pre- and post-intervention (68.1% vs. 60.5% respectively, p?=?0.036). There was no significant difference in the head CT imaging rate pre- and post-intervention (39.8% vs. 43.2%, p?=?0.358). There were seven physicians who saw ten or more patients during the pre- and post-intervention. Subset analysis of these seven physicians’ practice behavior revealed a slight significant difference in the admission rate pre- and post-intervention (74.3% vs. 63.9%, p?=?0.0495) and no significant difference in the head CT scan rate pre- and post-intervention (42.9% vs. 45.4%, p?=?0.660).

Conclusions

The introduction of an evidence-based CDSS based upon ACEP Clinical Policy recommendations on syncope correlated with a change in physician practice behavior in an urban academic emergency department. This change suggests emergency medicine clinical practice guideline recommendations can be incorporated into the physician workflow of an EDIS to enhance the quality of practice.