制定肠外肠内营养指南和规范的"指南":方法学、推荐意见分级与通过程序

中华医学会肠外肠内营养学分会自2004年12月成立，即开始了合理规范应用肠外肠内营养学的有关工作。在中华医学会正副会长的指导下，2005年4月启动了肠外肠内营养“指南”和“规范”的制定工作。参与“指南”和“规范”编写的52位专家来自多个学科，也包括部分基层医院医护人员；共组成8个编写组，分别完成“指南”（草案）相应部分和部分“规范”的内容。 2006年5—8月，有7个编写组先后召开了8次总论和各论的“共识”和“规范”会议，就本版的编撰结构、证据分级和推荐意见分级体系、文献检索策略等方法学问题展开讨论，确定了工作方案，各自召开“共识会议”进行讨论，完成相应的文件。 通过确定检索策略、入选标准和特定关键词，采用系统化的文献检索，收集指南推荐意见相关支持证据。按照证据级别，参照国际标准并结合本领域的国内情况，制定推荐意见分级体系。 分会的“指南”（草案）和“规范”（草案）由各个“共识工作组”相互配合完成。达成“共识”后和最终定稿前，按“议事规则”对“指南”（草案）和“规范”（草案）进行投票表决。“肠外肠内营养临床指南和操作规范”力图反映目前国内外肠外肠内营养支持的最新证据，为临床医师、护理工作者、营养师和患者在特定临床条件下制定和实行肠外肠内营养支持方案提供帮助，并为卫生政策的制定者提供决策依据。由于内容宽广，部分内容欠缺甚多，有待今后补充。     

通因通用法临床运用经验

通因通用法的临床运用已不局限于《素问》所述,文章通过通因通用法在难治性泄泻、崩漏、咳嗽中的运用说明其应用范围及实质内容。     

高等职业学校护理专业中医教学现状调查

目的了解高等职业学校护理专业中医教学的现状.方法对省内外具有代表性的医学职业学校进行问卷调查,了解其护理专业中医课程设置情况及教学情况.同时,对职业大专毕业生进行问卷调查,了解其在临床护理工作中中医知识的运用情况.选择具有代表性的各级医院,对其管理人员及临床医生进行问卷调查,了解其在临床护理工作中中医知识的运用情况及对中医教学的建议.结果在护理实践中多数护士需要运用中医知识护理患者,但临床护士的中医知识贫乏,尤其是对中医护理的操作技能和中药方剂知识了解甚少,影响临床运用.学校的中医教学由于教学时数偏少等多种原因,无法安排充足的实践教学时间,有的操作只能看录像,学生没有动手的机会,更谈不上学以致用,出现了教学与临床严重脱节的局面.结论中医护理教学应进行改革,以适应护理专业学生和临床护理工作的需要.     

终末病案质量常见缺陷及原因分析

目的分析我院2004年与2005年病案书写质量的变化情况。方法对比分析我院2004年和2005年37432份终末病案。结果自成立医疗质量管理委员会和病案质量管理委员会以来,通过三级质控网络的监控,我院病案质量有了进一步的提高。     

血清脂联素、抵抗素与2型糖尿病

目的探讨人血清脂联素、抵抗素水平与2型糖尿病(T2DM)的关系。方法2型糖尿病患者47例和正常对照46例,两组年龄、性别匹配,采用酶联免疫分析法检测其空腹血清脂联素、抵抗素、胰岛素水平,同时测血糖、血压、血脂、身高、体重,计算腰/臀围、体重指数(BMI)、腰臀比值(WHR)和胰岛素敏感指数(ISI)、胰岛素抵抗性(HOMA-IR)、胰岛β细胞功能(HOMA-β)。结果2型糖尿病组的脂联素水平减低,脂联素水平在糖尿病超重组低于糖尿病正常体重组和对照组;相关分析显示脂联素水平与BMI呈负相关,与ISI正相关。而抵抗素水平在糖尿病超重组显著高于糖尿病正常体重和对照组(P<0.05)。相关分析显示抵抗素水平与BMI、腰围、空腹胰岛素、血压呈正相关,在对照组,与ISI、HOMA-IR、HOMA-β相关。结论脂联素、抵抗素可能参与胰岛素抵抗,与2型糖尿病的发生有关。[关键词]脂联素;抵抗素;2型糖尿病     

Recurrent corneal perforation and acute calcareous corneal degeneration in chronic graft-versus-host disease.

Keratoconjunctivitis sicca (KCS) is a common complication of graft-versus-host disease (GVHD), and may lead to corneal epithelial defect and melting. In contrast, recurrent corneal calcareous degeneration and perforation is rare. A 46-year-old woman developed chronic GVHD after bone marrow transplantation for aplastic anemia. Severe KCS with corneal melting and calcium deposits were noted in the left eye. Penetrating keratoplasty was performed because of corneal perforation, but poor re-epithelialization and calcium deposition recurred. Lamellar keratectomy and amniotic membrane transplantation (AMT) were performed, but acute calcareous degeneration developed with subsequent recurrence of corneal perforation. After regraft, AMT and tarsorrhaphy, the corneal graft remained clear for 3 months. However, breakdown of the corneal epithelium occurred 3 weeks after spontaneous separation of tarsorrhaphy. Six months later, corneal perforation recurred again along with exacerbation of GVHD. Regraft was performed, but the patient refused tarsorrhaphy and AMT. Poor re-epithelialization persisted after regraft. Corneal melting with impending corneal perforation ensued. Further corneal surgery was refused and the patient chose to undergo evisceration. This case demonstrates that the ocular complications of GVHD may be severe enough to lead to corneal perforation and calcareous degeneration that is recalcitrant to medical and surgical treatment.     

未足月胎膜早破的封闭疗法

1PPROM概况 未足月胎膜早破（preterm premature rupture of the membranes，PPROM）是指妊娠未满37周胎膜在临产前发生破裂。在所有妊娠中PPROM发生率为2％～3％，早产30％～40％由PPROM引发，PPROM孕妇中只有7．7％～9．7％的胎膜破损能够自然闭合，而60％～80％的孕妇在胎膜破裂7d内分娩，其中位潜伏期为6．6d。     

子癎前期子癎并发止血功能异常的特点与处理

止血功能包括血管壁、血小板、凝血与抗凝血的作用,后者又包括纤维蛋白溶解系统的功能。正常情况下,各部分功能平衡,保证血管内的血液呈流态;血管损伤时血栓形成以止血。正常妊娠中晚期,由于产后止血的需要,大多数凝血因子在肝脏合成增加,同时纤溶活性降低,处于生理性的高凝状态。子疒间前期、子疒间患者由于血管内皮细胞损伤,血小板活化、抗凝血酶Ⅲ消耗,使机体处于明显的血栓倾向,此种更高水平的高凝状态可导致子疒间前期严重并发症的发生,如弥散性血管内凝血(DIC)、胎儿生长受限。1子疒间前期、子疒间并发止血功能异常的特点1.1血小板…     

Molecular Characterization of Duck Hepatitis B Virus Isolated from Hubei Brown Ducks

The objective of this study was to characterize the genome structure of duck hepatitis B virus (DHBV) isolated from Hubei brown ducks. The natural carrier rate of DHBV in adult ducks from Hubei area was investigated and the DHBV DNA-positive serum screened out. The complete genome of a DHBV strain was amplified by polymerase chain reaction (PCR) and cloned into T vector and sequenced. The results showed that the carrier rate of DHBV in Hubei brown ducks was 10 %. This strain (GenBank accession number DQ276978) had a genome of 3024 nucleotides with three overlapping open reading frames encoding the surface, core and polymerase proteins respectively. Comparison of the strain with 17 DHBV strains registered in GenBank revealed a homology from 89.3 % to 93.5 % at the nucleotide level. The sequences of the structural and functional domains of these proteins were highly conserved. The strain was found to share more signature amino acids in the polymerase genes with the "Chinese" DHBV strains than those of the "Western" country strains. This finding was also corroborated by a phylogenetic tree analysis. Therefore, the DQ276978 might belong to a subtype of the Chinese DHBV strains.     

Vascular endothelial growth factor expressing mesenchymal stem cells improves cardiac function in chronic myocardial infarction in pigs

Transplantation of mesenchymal stem cells （MSCs） for myocardial reconstruction has shown promise in both animal models and human phase 1 clinical studies. Vascular endothelial growth factor （VEGF） is a strong therapeutic agent for treating ischaemia by inducing angiogenesis. The feasibility of ex vivo MSCs mediated gene transfer is documented. Matsumoto and colleagues have recently reported genetically engineered MSCs carrying VEGF165 delivery for revascularization in a model of acute myocardial infarction （MI）. The promising data from our laboratory in both angiogenesis and MSCs transplantation in cunicular heart model of acute MI have prompted us to attempt the combined and simultaneous application of the two strategies.