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.     

过敏性紫癜中医证治

过敏性紫癜小儿多见,也有部分成人发病。病因有外感和内伤,病机有虚实,实则热毒迫血妄行,虚则阴虚内热伤络,气虚失于统摄;病情迁延则气虚致瘀,瘀血阻络又易导致血液溢于脉外而复发。小儿外感因素居多,成人与饮食、情志和劳伤等因素更密切。发病无明显季节性,外感风、寒、暑、湿、燥、火均可致病。有阳络伤和阴络伤以及伤经络和伤脏腑不同＂,阳络伤则血外溢,阴络伤则血内溢＂＂,斑出阳明,疹出太阴＂。临床证型有热毒伤络、阴虚火旺、气不摄血和瘀血阻络等,热毒伤络型带有明显外感特征,其余三个证型则表现为内伤特征。前者多以疏风清热或清热解毒联合凉血止血方法,其余三个证型则滋阴清热或降火、健脾益气摄血或活血化瘀止血等。治疗体现止血、消瘀、宁血、养血总纲。     

中国林芝地区某院眼科门诊疾病谱分析

目的 对林芝市巴宜区人民医院眼科门诊患者疾病构成进行分析,为该地区眼科疾病的诊疗及眼科医疗资源合理配置提供参考.方法 选取2020年4月1日-2020年10月31日就诊于林芝市巴宜区人民医院眼科门诊的患者,对其疾病构成、顺位、性别、年龄、主要诊断等进行统计分析.结果 纳入统计共749例,男312例,女437例,比例为1...     

从督脉探讨扶阳理论在针灸临床中的应用

扶阳理论以阴阳为总纲,重视阳气,主张阳主阴从。通过针对督脉的诊治,可以最大限度地激发人身之阳气,促成扶阳之效。在针灸临床上,督脉为阳脉之海,总督诸阳,联系脏腑,故根据督脉的生理基础和病候表现,提出通督扶阳和补督扶阳的方法,治疗脑卒中后手足浮肿、痉挛性瘫痪、腰椎间盘突出症、肌萎缩侧索硬化症、五更泻、类风湿性关节炎等疗效显著。应准确辨证,通补结合,方能达到最佳扶阳的效果,祛除病邪。     

慢性充血性心力衰竭患者血浆BNP含量与心脏结构和功能参数之间关系探讨

目的 探讨慢性充血性心力衰竭患者血浆BNP含量与超声心功能参数及心脏主要结构测量值之间的关系.方法 选择慢性充血性心力衰竭的住院患者178例,用免疫荧光定量法检测血浆BNP值,并检查心脏彩超,记录反映心功能的参数左心室射血分数(LVEF)、短轴缩短率(FS)、每搏量(SV)、左室重量(LVMI)和心脏结构的参数升主动脉根部内径(AAO)、左房内径(LAS)、左室舒张期内径(LVDD)、左室收缩期内径(LVSD)、室间隔厚度(IVST)、左室后壁厚度(LVPW)、主肺动脉内径(MPA)、升主动脉宽度、肺动脉压(PA)、右室流出道内径、右室舒张末期内径、右房内径、右肺动脉内径.分析BNP与心脏各超声参数之间的相关性.结果 患者BNP平均水平为236.12±376.51 pg/ml.BNP与LVEF,FS,SV呈负相关(相关系数r依次为-0.559,-0.567,-0.206,P值均<0.01).与LVDD,LVSD,LAS,LVPW,IVSD,MPA和PAP呈正相关(相关系数r依次为0.338,0.494,0.371,0.194,0.215,0.381,0.400;P值≤0.01).结论 慢性充血性心力衰竭患者血浆BNP含量与某些心功能参数呈负相关,与心脏某些结构参数呈正相关.