法律视角下我国医院伦理委员会建设中存在的问题和对策

通过系统梳理涉及伦理委员会建设的现行立法,从法律角度探讨伦理委员会的法律地位、人员组成、资质考核、操作规程、法律监督等方面存在的问题。通过剖析存在的问题,建议提高立法等级,确定性别比例和专业占比标准,参考美国伦理委员会专业认证制度加强委员资质考核;建立专门操作指南,强调跟踪审查;适当调整各方监管权限,下设专门监管机构。     

肺癌患者血浆cofilin蛋白含量检测在肺癌诊断中的应用分析

目的探讨血浆cofilin蛋白检测对诊断肺癌的价值。方法随机抽取60例肺癌患者作为实验组,80例健康体检者为对照组,检测两组血浆cofilin蛋白含量并比较。结果实验组血浆cofilin蛋白水平(0.538±0.145)ng/ml,对照组(0.187±0.132)ng/ml,实验组高于对照组(t=14.924,P=0.000);方差分析,实验组的三个临床分期的血浆cofilin蛋白水平差异有统计学意义(F=12.382,P0.05),Ⅲ期、Ⅳ期的血浆cofilin蛋白水平高于Ⅱ期(t=3.529,P=0.001;t=5.674,P=0.000),Ⅳ期高于Ⅲ期(t=2.085,P=0.045)。结论血浆cofilin蛋白的检测对诊断肺癌有重要参考价值,肺癌患者的血浆cofilin蛋白含量高于健康者,且临床分期越晚含量越高。     

7例孤立性骨浆细胞瘤的临床分析

目的 探讨孤立性骨浆细胞瘤的诊断和治疗,总结其临床特点,以提高临床诊治水平.方法 收集中山大学孙逸仙纪念医院白2007年4月至2011年6月收治7例孤立性骨浆细胞瘤患者的临床资料并对其临床特点、诊断标准及治疗和预后作一回顾性分析.结果 所有病例均经病理证实为骨浆细胞瘤并符合孤立性骨浆细胞瘤的诊断标准,其中1例伴POEMS综合征(多神经病、器官巨大症、内分泌病、M蛋白和皮肤病变综合征),1例术后6个月出现多处骨转移.所有患者治疗后随访1~13个月,平均随访时间为4个月.其中5例患者预后良好,随访期间未出现病情进展.结论 孤立性骨浆细胞瘤好发于中老年,是少见的低度恶性肿瘤.主要依靠病理确诊,手术结合适当剂量的放疗是其治疗的最佳手段.     

Wiskott-Aldrich syndrome protein (WASP) and N-WASP are critical for peripheral B-cell development and function

The Wiskott-Aldrich syndrome protein (WASP) is a key cytoskeletal regulator of hematopoietic cells. Although WASP-knockout (WKO) mice have aberrant B-cell cytoskeletal responses, B-cell development is relatively normal. We hypothesized that N-WASP, a ubiquitously expressed homolog of WASP, may serve some redundant functions with WASP in B cells. In the present study, we generated mice lacking WASP and N-WASP in B cells (conditional double knockout [cDKO] B cells) and show that cDKO mice had decreased numbers of follicular and marginal zone B cells in the spleen. Receptor-induced activation of cDKO B cells led to normal proliferation but a marked reduction of spreading compared with wild-type and WKO B cells. Whereas WKO B cells showed decreased migration in vitro and homing in vivo compared with wild-type cells, cDKO B cells showed an even more pronounced decrease in the migratory response in vivo. After injection of 2,4,6-trinitrophenol (TNP)-Ficoll, cDKO B cells had reduced antigen uptake in the splenic marginal zone. Despite high basal serum IgM, cDKO mice mounted a reduced immune response to the T cell-independent antigen TNP-Ficoll and to the T cell-dependent antigen TNP-keyhole limpet hemocyanin. Our results reveal that the combined activity of WASP and N-WASP is required for peripheral B-cell development and function.     

Oct-2、Bob.1在肺结核组织B细胞中的表达及其意义

目的探讨肺结核组织B细胞中Oct-2、Bob.1的表达与机体免疫的关系。方法采用免疫组织化学检测20例肺结核组织B细胞中Oct-2、Bob.1的表达情况。结果 (1)在肺结核组织生发中心的B细胞中Oct-2和Bob.1主要表达在细胞核;在无形成生发中心聚集的B细胞中,细胞核和细胞浆均呈阳性;(2)肺结核组织B细胞中Oct-2阳性的细胞数明显少于Bob.1阳性的细胞数,Oct-2和Bob.1阳性率分别为:10.8%、65.6%;(3)形成生发中心的肺结核组织B细胞中Oct-2和Bob.1阳性的细胞数明显高于无生发中心形成的肺结核组织,差异有统计学意义(P<0.05)。结论肺结核组织B细胞Oct-2表达低下和/或Oct-2、Bob.1表达不一致可能导致B细胞在发育过程中未能形成生发中心。     

异位中肾管囊肿合并异位睾丸恶变1例报告并文献复习

目的:报告1例罕见异位中肾管囊肿合并异位睾丸恶变病例,提高对本病的诊治水平。方法:回顾分析异位中肾管囊肿合并异位睾丸恶变的病例的临床资料,结合国内外相关文献,探讨异位中肾管囊肿合并异位睾丸恶变的发病机制、诊断及治疗。结果:经腹切除巨大囊肿及右侧异位恶变睾丸,左侧隐睾行下降固定,病理示"右异位中肾管囊肿,右侧异位睾丸精原细胞瘤",随访1年无转移。结论:异位中肾管囊肿合并异位睾丸恶变极为罕见,影像学检查可协助诊断,但最终需病理确诊,应早期行手术切除。后续治疗取决于隐睾恶变的病理类型及分期。     

Treatment efficacy of social communication skills training after traumatic brain injury: a randomized treatment and deferred treatment controlled trial

Dahlberg CA, Cusick CP, Hawley LA, Newman JK, Morey CE. Harrison-Felix CL, Whiteneck GG. Treatment efficacy of social communication skills training after traumatic brain injury: a randomized treatment and deferred treatment controlled trial.

Objective

To evaluate the efficacy of a replicable group treatment program to improve social communication skills after traumatic brain injury (TBI).

Design

Randomized treatment and deferred treatment controlled trial, with follow-up at 3, 6, and 9 months post-treatment.

Setting

Community.

Participants

Volunteer sample of 52 people with TBI who were at least 1 year postinjury, who received rehabilitation, and who had identified social communication deficits.

Intervention

Twelve weekly group sessions (1.5h each) to improve social communication.

Main Outcome Measures

The Profile of Functional Impairment in Communication (PFIC), Social Communication Skills Questionnaire–Adapted (SCSQ-A), Goal Attainment Scale (GAS), Craig Handicap Assessment and Reporting Technique–Short Form social integration and occupation subscales, Community Integration Questionnaire social integration and productivity subscales, and Satisfaction With Life Scale (SWLS).

Results

Independent samples t test analysis showed significant treatment effect compared with no treatment on 7 of 10 of the PFIC subscales (P range, .024 to <.001) and the SCSQ-A (P=.005) after the first 12 weeks of the study. After 12 weeks of treatment for all participants, repeated-measures analysis showed significant improvements from baseline on 9 of 10 PFIC subscales (P range, .01−.001), SCSQ-A (P≤.001), GAS (P≤.001), and SWLS (P=.011). At 6-month follow-up, scores were significantly better than baseline on 6 of 10 PFIC scales (P range, .01−.001), the SCSQ-A (P≤.001), GAS (P≤.001), and SWLS (P≤.001).

Conclusions

TBI subjects who received social communication skills training had improved communication skills that were maintained on follow-up. Overall life satisfaction for participants was improved.     

甘草查尔酮A对人乳腺癌MDA-MB-231细胞凋亡的影响

目的 观察甘草查尔酮A对人乳腺癌MDA-MB-231细胞凋亡的影响,并探讨其可能作用机制。方法 细胞增殖与活性检测（CCK-8）法检测不同浓度甘草查尔酮A对MDA-MB-231细胞存活率的影响;甘草查尔酮A（10,20,40 μmol·L^-1）作用MDA-MB-231细胞24 h,分别用细胞凋亡试剂盒（Annexin V-FITC/PI）检测细胞凋亡情况;荧光探针法（DCFA-DA）检测细胞内活性氧（ROS）水平,荧光探针（JC-1）法检测细胞线粒体膜电位（MMP）;蛋白免疫印迹法（Western blot）检测细胞凋亡相关蛋白B细胞淋巴瘤-2（Bcl-2）,B细胞淋巴瘤-2相关X蛋白（Bax）的表达及内质网应激相关蛋白（CHOP）,转录激活因子4（ATF4）,蛋白激酶R样内质网激酶（PERK）,磷酸化蛋白激酶R样内质网激酶（p-PERK）,真核翻译起始因子2α（eIF2α）,磷酸化真核翻译起始因子2α（p-eIF2α）表达。结果 与空白组比较,随着甘草查尔酮A浓度增大,从甘草查尔酮A 5 μmol·L^-1开始,细胞存活率明显降低（P<0.05）,其半数抑制浓度（IC₅₀）为19.05 μmol·L^-1;甘草查尔酮A（10,20,40 μmol·L^-1）组细胞凋亡明显升高（P<0.05）,甘草查尔酮A 40 μmol·L^-1时细胞凋亡率达30.2%（P<0.05）;甘草查尔酮A（10,20,40 μmol·L^-1）使抗凋亡蛋白Bcl-2的表达明显降低（P<0.05）,促凋亡蛋白Bax表达明显升高（P<0.05）,且呈浓度依赖性;甘草查尔酮A（10,20,40 μmol·L^-1）明显升高细胞内ROS水平（P<0.05）,降低线粒体MMP水平（P<0.05）,导致线粒体功能障碍,呈浓度依赖性;甘草查尔酮A（10,20,40 μmol·L^-1）诱导内质网应激,使内质网应激相关蛋白CHOP,ATF4表达明显增多,磷酸化（p）-PERK,p-eIF2α表达明显升高（P<0.05）,呈浓度依赖性。结论 甘草查尔酮A可能通过增加细胞内ROS水平,降低MMP引起线粒体功能障碍和内质网应激诱导MDA-MB-231细胞凋亡。     

十全大补汤加减对高龄骨质疏松性股骨粗隆间骨折气血两虚型患者炎症及骨代谢指标的影响

目的 探讨十全大补汤在气血两虚型高龄骨质疏松性股骨粗隆间骨折患者治疗中的应用价值,观察其对炎性指标及骨代谢指标的影响。方法 所有病例均来自2018年4月至2020年4月于南昌市洪都中医院就诊的气血两虚型高龄骨质疏松性股骨粗隆间骨折患者,共98例,随机分为观察组（49例）和对照组（49例）。所有患者均行股骨近端防旋髓内钉（PFNA）内固定术治疗,对照组联合归脾丸口服治疗,观察组联合十全大补汤口服治疗,治疗4周后比较两组患者临床疗效、炎症及骨代谢指标、并发症发生情况等。结果 治疗后观察组血清成纤维细胞生长因子-2（FGF-2）,骨保护素（OPG）,转化生长因子-β₁（TGF-β₁）,β-内啡肽（β-EP）,骨特异性碱性磷酸酶（BALP）,骨钙素（BGP）等指标水平均明显高于对照组,差异具有统计学意义（P<0.05）;治疗后观察组血清肿瘤坏死因子-α（TNF-α）,D-二聚体（D-D）明显低于对照组（P<0.05）;治疗后观察组中医症状积分低明显于对照组,髋关节功能评分（Harris评分）明显高于对照组（P<0.05）;观察组总有效率93.88%（46/49）,高于对照组的75.51%（37/49）,差异具统计学意义（χ²=6.376,P<0.05）;并发症方面,对照组切口感染、下肢深静脉血栓、肺部感染总发生率24.49%（12/49）,高于观察组的6.12%（3/49）,差异有统计学意义（χ²=6.607,P<0.05）。结论 对于气血两虚型高龄骨质疏松性股骨粗隆间骨折患者而言联合十全大补汤口服有助于减轻炎症反应,调节骨代谢,促进骨质修复,降低并发症发生率。