医院实施ISO9001质量管理体系内部审核的探讨

医疗机构实施ISO9001,其目的是为了提高医疗服务质量,满足病人一切明确和隐含的需求。那么,内审是否发挥作用,直接关系管理体系的有效性。文章对此进行了初步的探讨,即:①明确内审的目的是检查体系满足标准要求的程度;②建立正规的内审机构,要选拔责任心强、综合素质高的人担任内审员;③编制合理且有特色的内审计划,是内审有效性的关键;④适当增加专题审核;⑤医院最高管理者应重视内审结果。     

神经营养素受体在人外周血T细胞中表达的研究

目的 研究人外周血CD4^ /CD8^ T细胞4种神经营养素受体基因的转录。方法 应用尼龙手法分离出T细胞，磁式细胞分离法（MACS）分离CD4^ /CD8^ T细胞亚群，再以RT－PCR法研究4种神经营养素受体在两种T细胞亚群上的表达。结果 未经刺激的CD4^ /CD8^ T细胞亚群不表达任何神经营养素受体。经PHA或PPD刺激后，CD4^ /CD8^ T细胞亚群表达trkA,CD8^ T细胞亚群表达trkC；而在各种状态下的T细胞上均未见表达trkB及p75^NGFR。结论神经营养素受体在两种T细胞亚群中有不同的表达格局，提示不同T细胞亚群受神经营养素调节的模式可能各不相同。     

Defective Treg response in acute kidney injury was caused by a reduction in TIM-3+ Treg cells

Background: Despite years of research, the treatment of acute kidney injury (AKI) remains a significant challenge. Animal studies presented causal links between elevated regulatory T cell (Treg) response and better prognosis in AKI. Previous studies in mice and humans showed that TIM-3+ Treg cells were more potent than TIM-3- Treg cells. In this study, we investigated the role of TIM-3 in Treg in AKI patients.

Methods: Peripheral blood from AKI patients and healthy controls were gathered, and TIM-3+ Treg subset was examined.

Results: Compared to healthy controls, the AKI patients presented a significant upregulation in the frequency of circulating CD4+CD25+ T cells; however, the majority of this increase was from the CD4+CD25+TIM-3- subset, and the frequency of CD4+CD25+TIM-3+ T cells was downregulated in AKI patients. In both healthy controls and AKI patients, the CD4+CD25+TIM-3+ T cells expressed higher levels of Foxp3, and were more potent at expressing LFA-1, LAG-3, CTLA-4, IL-10 and TGF-β. In addition, the CD4+CD25+TIM-3+ T cells from both healthy controls and AKI patients presented higher capacity to suppress CD4+CD25- T cell proliferation than the CD4+CD25+TIM-3- T cells. Interestingly, the total CD4+CD25+ T cells from AKI patients presented significantly lower inhibitory capacity than those from healthy controls, indicating that the low frequency of CD4+CD25+TIM-3+ T cells was restricting the efficacy of the Treg responses in AKI patients.

Conclusions: We demonstrated that TIM-3 downregulation impaired the function of Treg cells in AKI. The therapeutic potential of CD4+CD25+TIM-3+ T cells in AKI should be investigated in future studies.     

严重急性呼吸综合征患者尸解肺标本的病理改变和致病机制研究

目的研究严重急性呼吸综合征（SARS）患者尸解肺标本的病理改变和致病机制。方法观察了2003年4-7月期间死于SARS的6例患者的肺标本,并采用光镜、电镜、Masson三色染色和免疫组织化学染色方法（EnVision法）进行研究。结果肺标本的病理形态改变：（1）6例的双肺均可见到弥漫性实变病灶,肺重量明显增加;（2）6例均可见到弥漫性肺泡损伤,包括透明膜形成、肺泡腔内水肿／出血、纤维素沉积和肺泡上皮细胞脱屑,AE1／AE3免疫组织化学染色显示肺泡上皮细胞的完整性明显破坏;（3）Ⅱ型肺泡上皮细胞轻度增生,有一定异型性,细胞体积增大,胞质呈双染性和颗粒状,胞质内可见小脂肪空泡聚集（5／6）;（4）6例中有5例可见巨细胞在肺泡内浸润,巨细胞大多AEl／AE3阳性（5／6）,少数CD68阳性（2／6）;（5）组织学形态和免疫组织化学染色证实肺泡腔内和肺泡间隔内有多量巨噬细胞浸润（6／6）;（6）6例中有5例可见巨噬细胞噬红细胞象;（7）6例中有5例可见肺纤维化,包括肺泡间隔和肺间质增宽（5／6）、肺泡腔内渗出物机化（6／6）和胸膜增厚（4／6）。Masson三色染色证实胶原纤维明显增生,免疫组织化学染色显示大多数为Ⅲ型胶原。光镜和免疫组织化学染色显示5例有明显的成纤维细胞／肌纤维母细胞增生灶;（8）5例可见支气管黏膜鳞状上皮化生;（9）6例患者均可见血栓;（10）2例同时合并其他感染,1例合并细菌感染,另1例合并真菌感染。此外,电镜发现在肺泡上皮细胞和肺血管内皮细胞的胞质内有冠状病毒样颗粒。结论SARS冠状病毒直接损伤肺泡上皮细胞、巨噬细胞明显浸润和成纤维细胞／肌纤维母细胞显著增生在SARS的致病机制中起重要作用。     

DAF与CD3协同刺激人外周血T细胞活化的实验研究

目的：探讨人促衰变加速因子（decay-accelerating factor,DAF)作为共刺激分子参与T细胞活化的作用机制。方法：观察3株针对DAF不同SCR的单抗单独使用或者与抗人CD3单抗联合使用时，对人外周血T细胞增殖、IL－2分泌以及胞浆Ca^2 水平的影响。结果：所用3株抗人DAF单抗不能活化T细胞，而抗人DAF单抗与抗人CD3单抗可以协同刺激T细胞增殖，促进IL－2分泌以及提高胞浆Ca^2 水平。结论：抗人DAF单抗与抗人CD3单抗可协同刺激人外周血T细胞活化。     

人工组织神经移植物修复狗缺损坐骨神经后腓肠肌的形态观察

目的 了解复合型医用可降解材料制成的人工组织神经移植物辅加神经再生素修复狗坐骨神经缺损后，腓肠肌的形态变化。方法 将人工组织神经移植物连接在狗的坐骨神经缺损30mm处。以自体神经桥接和神经缺损的狗为对照组Ⅰ和Ⅱ。术后6个月时取腓肠肌进行称重、特殊染色和组织化学染色，显微镜下了解腓肠肌的形态变化并进行图像定量分析，同时了解肌纤维的超微结构变化。结果 术后6个月，实验组腓肠肌的萎缩形态指标变化均轻于对照组Ⅱ，而与对照组Ⅰ相似。结论 经人工组织神经移植物修复缺损的坐骨神经后，使腓肠肌又重新获得神经支配，肌肉萎缩明显减轻。     

汉族男子体格及生殖器发育特点

2411例汉族男性大学生体格和生殖器的测量结果如下:阴茎周径8.17±0.64cm,阴茎长度7.43±1.04cm,阴茎牵长13.33±1.19cm,右睾丸容积17.91±4.09ml,左睾丸容积17.83±4.05ml,身高171.07±5.66cm,体重58.43±7.75kg.北方学生体格和生殖器发育均优于南方.城、县、乡学生的生殖器发育无明显差异,但城市学生体格发育优于农村.16岁后阴茎、睾丸大小变化不大,但生殖器的发育可持续到30岁.     

音猬因子的功能受体斑片在培养神经干细胞中的表达

目的　观察在培养的神经干细胞内是否有发育调控分子———音猬因子 (sonichedgehog)功能受体———斑片 (patched)表达。　方法　神经干细胞克隆在体外培养传代后 ,用patched的特异性引物对培养的神经干细胞进行RT PCR分析 ,PCR产物经克隆测序后 ,用地高辛标记克隆的探针 ,对神经干细胞进行原位杂交分析。　结果　神经干细胞克隆内大量的细胞均可表达sonichedgehog的功能受体patched ,patched阳性细胞间未见明显差别 ,克隆边缘与中央的patched分布也未见明显差别。　结论　sonichedgehog信号传导路可能在神经干细胞的增殖与分化过程中起重要作用。     

Acute myeloid leukemia with t(6;9)(p23;q34) is associated with dysplasia and a high frequency of flt3 gene mutations

We report 12 cases of t(6;9)(p23;q34)-positive acute myeloid leukemia (AML), all classified using the criteria of the World Health Organization classification. There were 10 women and 2 men with a median age of 51 years (range, 20-76 years). Dysplasia was present in all cases (9 previously untreated), and basophilia was present in 6 (50%). Immunophenotypic studies showed that the blasts were positive for CD9, CD13, CD33, CD38, CD117, and HLA-DR in all cases assessed. CD34 was positive in 11 (92%) of 12, and terminal deoxynucleotidyl transferase was positive in 7 (64%) of 11 cases. The t(6;9) was the only cytogenetic abnormality detected in 7 cases (58%), and 5 cases had additional chromosomal abnormalities. Of 8 cases assessed, 7 (88%) had flt3 gene mutations. We conclude that t(6;9)-positive AML cases have distinctive morphologic features, an immunophenotype suggesting origin from an early hematopoietic progenitor cell, and a high frequency of flt3 gene mutations.