搭建基础平台实现高职医学订单教学

搭建基础平台是改传统三年制医学教学“1＋1＋1”模式为“1＋1”模式，为以“市场为导向，就业为中心”的高职教学进行多向培养提供条件，既拓宽教学渠道，适应市场需求，解决学生就业问题，同时又有利于学校发展，符合教学新模式量展要求。     

Proposal of a modified Child-Turcotte-Pugh scoring system and comparison with the model for end-stage liver disease for outcome prediction in patients with cirrhosis.

The model for end-stage liver disease (MELD) has a better predictive accuracy for survival than the Child-Turcotte-Pugh (CTP) system and has been the primary reference for organ allocation in liver transplantation. The CTP system, with a score range of 5-15, has a ceiling effect that may compromise its predictive power. In this study, we proposed a refined CTP scoring method and investigated its predictive ability. An additional point was given to patients with serum albumin < 2.3 g/dL, bilirubin > 8 mg/dL or prothrombin time prolongation > 11 seconds. The modified CTP system, containing class D, was compared to the MELD and original CTP system in 436 patients. There was a significant correlation between the MELD and modified CTP score (rho = 0.59, P< 0.001). Using mortality as the endpoint, the area under receiver operating characteristic curve for modified CTP system was 0.895 compared with 0.872 for MELD (P = 0.450) and 0.809 for original CTP system (P < 0.001) at 3 months; the area was 0.890, 0.837 and 0.756, respectively (P = 0.051 and < 0.001, respectively) at 6 months. The risk ratio per unit increase for the modified CTP score was 2.7 and 3.08 at 3 and 6 months respectively (P < 0.001). In conclusion, the modified CTP system can be proposed as an alternative prognostic model for cirrhotic patients. By extending the score range according to the influence of the laboratory-derived variables, the modified CTP system has a better performance than the original system and is as efficient as the MELD for outcome prediction.     

兔视网膜方向选择性神经节细胞树突的独特分枝模式及其生理意义

本实验研究了兔视网膜中的方向选择性神经节细胞 (direction selective retinal ganglion cells,DS cells)树突野的分枝模式。测量了视网膜中方向选择性神经节细胞和作为经典分枝模式神经元代表的α神经节细胞的树突直径。发现 ,方向选择性神经节细胞的树突在分枝后直径达到 0 .5 μm,进一步分枝树突直径仍保持在 0 .5 μm左右 ,这样 ,在方向选择性神经节细胞树突野中大多数树突直径在 0 .5μm左右。而作为经典分枝模式神经元代表的α神经元的树突每次分枝后都逐级变细 ,最终直径达到 0 .5μm左右 ,这样 ,α神经节细胞的树突直径大部分都大于 0 .5μm。我们应用程序“NEU RON”对在两种神经元模型中 ,抑制点落于兴奋点与胞体之间 (proximal)和抑制点不落于兴奋点与胞体之间 (distal)这两种情况进行模拟。我们发现 ,当抑制点不落于兴奋点与胞体之间时 ,在方向选择性神经节细胞的树突分枝模型中 ,抑制效果更强。那么 ,将使得方向选择性神经节细胞对抑制点落于兴奋点和胞体之间的要求变得不是那么迫切。所以 ,方向选择性神经节细胞的这种独特分枝模式 ,也许可以避免或至少减轻其在发育中可能会产生的连线的复杂性。并且 ,我们对得出的结论进行了电路分析 ,对方向选择性神经节细胞这种独特的分枝模式具有的?     

Best-practice algorithms for the use of a bilayered living cell therapy (Apligraf®) in the treatment of lower-extremity ulcers

Tissue-engineered skin substitutes such as Apligraf have emerged over the past 20 years as among the most carefully studied and efficacious of the advanced wound modalities. These products have been proven as effective enhancements to general wound care, promoting wound closure particularly in instances where conventional wound care fails. Marketed for hard-to-heal wounds since 1998, Apligraf has become part of standard wound care in many wound centers across the United States. Despite this situation, few general wound care guidelines incorporate advanced and active wound-healing technologies, such as tissue-engineered skin products. Because of this deficiency, appropriate patient selection and proper use of these product remain largely unaddressed within the general wound care community. Here, we describe the development of guidelines surrounding optimal use of the bilayered living cell therapy, Apligraf, in the treatment of the two types of lower extremity ulcers for which the product is FDA approved: venous leg ulcer and diabetic foot ulcer. The guidelines detailed in this article focus on the identification and selection of patients who are at risk for failure of standard wound care therapy and thus appropriate for Apligraf treatment. The intended audience for these guidelines is the general wound care practitioner, for whom the developed treatment algorithms and accompanying figure legends should provide practical, user-friendly direction simplifying both patient selection and appropriate use of Apligraf within the context of good wound-healing practice.     

Structural white matter abnormalities in patients with idiopathic dystonia

We investigated whether structural white matter abnormalities, in the form of disruption of axonal coherence and integrity as measured with diffusion tensor imaging (DTI), constitute an underlying pathological mechanism of idiopathic dystonia (ID), independent of genotype status. We studied seven subjects with ID: all had cervical dystonia as their main symptom (one patient also had spasmodic dysphonia and two patients had concurrent generalized dystonia, both DYT1‐negative). We compared DTI MR images of patients with 10 controls, evaluating differences in mean diffusivity (MD) and fractional anisotropy (FA). ID was associated with increased FA values in the thalamus and adjacent white matter, and in the white matter underlying the middle frontal gyrus. ID was also associated with increase in MD in adjacent white matter to the pallidum and putamen bilaterally, left caudate, and in subcortical hemispheric regions, including the postcentral gyrus. Abnormal FA and MD in patients with ID indicate that abnormal axonal coherence and integrity contribute to the pathophysiology of dystonia. These findings suggest that ID is not only a functional disorder, but also associated with structural brain changes. Impaired connectivity and disrupted flow of information may contribute to the impairment of motor planning and regulation in dystonia. © 2006 Movement Disorder Society     

全雄激素阻断治疗晚期前列腺癌

为了评价全雄激素阻断治疗晚期前列腺癌的疗效，采用双侧睾丸切除、Ｆｌｕｔａｍｉｄｅ和Ｆｉｎａｓｔｅｒｉｄ联合治疗Ｄ２期前列腺癌病人５例。随访１５～２０个月，结果ＰＳＡ均正常，前列腺体积缩小６１．２％～６９．３％，有显著性差异（Ｐ＜０．０１），骨转移灶缩小、部分消失，积水肾脏完全恢复正常，所有病人治疗后全部有效。表明全雄激素阻断对晚期前列腺癌有良好的治疗效果。提出在三个层次上阻断雄激素治疗晚期前列腺癌的策略。     

Protein kinase C agonist and antagonist effects in normal human epidermal keratinocytes

Abstract Several lines of evidence implicate protein kinase C (PKC) in the development of basal cell and squamous cell carcinomas, tumors which originate from epidermal keratinocytes. To examine PKC in a model relevant to human skin, we exposed normal human epidermal keratinocytes (NHEK) in serum-free media to a variety of PKC agonists and antagonists. NHEK PKC activity increased up to 10-fold within the 1st hour of exposure to tetradecanoyl phorbol acetate (TPA), and gradually returned to control values within 72 h. TPA-induced PKC activity was enhanced by pretreatment of cultures with protein and RNA synthesis inhibitors. TPA-induced growth arrest and differentiation was antagonized by staurosporine. Down-regulation by bryostatin pretreatment blocked TPA-stimulated differentiation. Our overall conclusion is that activation of PKC in cultured human keratinocytes is required for differentiation. These results are crucial to the analysis of compounds suspected of promoting or inhibiting epidermal tumors.     

Rupture of the supradiaphragmatic inferior vena cava by blunt decelerating trauma: case report

Lacerations of the inferior vena cava resulting from blunt external trauma are relatively rare, but extremely serious. The high lethality is due to the difficulty in diagnosis and technical problems with repair, particularly if the injury is located above the renal veins. During a 12-month period seven patients with inferior vena cava laceration were seen, of whom two presented with laceration of the inferior vena cava above the diaphragm. Both had a deceleration injury while wearing seatbelts. The clinical presentation was similar. The etiology is discussed. Caval continuity should be repaired because acute sudden occlusion at the suprahepatic level is incompatible with survival. Median sternotomy is advised, moreover it provides good exposure for eventual cannulation.