被倒卖的"上帝"

“生命诚可贵,患者价更高,若为创收故,两者皆可抛”,近年来,医疗卫生行业不乏新闻,遗憾的是其中丑闻居多,比如最近这一出。“大部分医院都有倒卖病人的现象,有的倒出去,有的倒进来,医生从中收取少则50元,多则数千上万元的‘转院费’。当然,接受病人的医院,会采取种种方式尽量获得更多的医疗费：接受病人的医生,也将获得相应的奖金和提成……”近日,南京某三级医院一位外科医生曝出黑幕,“倒卖病人”由此进入公众视野,为不甘寂寞的医疗卫生领域又添新丑闻。这位医生同时反戈一击,向患者支招：看病千万别透露出有钱,不能爽快地告诉医生尽管用好药、用好设备。千万不能     

牛磺酸对视网膜感光细胞光损伤及NFκB/caspase-1表达的影响

目的观察牛磺酸对光化学损伤后感光细胞凋亡的影响,并探讨其防护机制.方法 70只SD大鼠随机分为对照组(control),牛磺酸组(taurine, Tau),分别喂饲标准饲料或添加4%Tau饲料15d后接受3 000±200 lx持续0、1、3 、6 、9 、12 、24 h光照,用TUNEL法检测感光细胞凋亡并计算凋亡指数(apoptotic index, AI),免疫印迹法测定caspase-1和核内p65蛋白表达水平,RT-PCR法检测IκBa mRNA.结果 光照9 h后Tau组出现凋亡细胞,且多个时相点该组AI值显著低于对照(P＜0.05);短期光照(3h/6h)诱导p65核转位,Tau组核内p65量显著高于对照组(P ＜0.05),长时程光照后(12 h/24 h)对照组核内p65显著降低,Tau组仍有较高表达;光照1 h后对照组IκBa mRNA迅速升高,而Tau组在光照3、6 h后升高较显著.视网膜caspase-1蛋白随光照时间延长表达增高,Tau组显著低于对照组对应时相点(P ＜0.05).结论 牛磺酸抑制视网膜光化学损伤中感光细胞凋亡,可能与其维持NFκB激活状态进而下调caspase-1表达有关.     

Transnasal Endoscopic and Transoral Approaches in the Biopsies of Ventral Atlas and Axis Vertebrae: A Comprehensive Retrospective Study for Preprocedural Scheme,Biopsy Procedure,Core Technique Analysis,Diagnostic Yield and Clinical Outcome

ObjectiveThis study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically challenging regions for diagnostic biopsy.MethodsA series of transnasal endoscopic approach (TNA) and transoral approach (TOA) biopsies for the pathologies of the first and second cervical vertebrae were conducted and retrospectively analyzed from July 2014 to May 2021. The depth of the biopsy trajectory was measured on computed tomography images for all nine patients (eight males and one female with an average age of 58.11 ± 11.60 years), as were the coronal, sagittal, and vertical biopsy safe ranges. The characteristics of each lesion, including radiographic features, blood supply, and destruction of anterior or posterior vertebral body edges, were evaluated to guide the biopsy. Four biopsy core techniques (BCTs), including “lesion perforating”, “aspiration”, “cutting‐and‐scraping” and “biopsy forceps utilization” were elaborated in this study. The biopsy procedures and periprocedural precautions were demonstrated. Patient demographics, clinical data, lesion characteristics, diagnostic yield, and complications were recorded for each case.ResultsEight TOA biopsies for the axis vertebral body and one TNA biopsy for the atlas anterior arch were successfully performed and yielded adequate pathologies. All biopsies were organized based on the preprocedural radiographic measurements, which showed that the average length of biopsy trajectory and coronal, sagittal, and vertical safe biopsy ranges were 85.00 ± 5.88, 20.63 ± 4.75, 16.25 ± 1.49, and 24.63 ± 2.26 mm, respectively, and these corresponding data were 95, 36, 9, and 26 mm in the TNA patient. Six osteolytic lesions (66.7%), one osteoblastic lesion (11.1%), and two mixed lesions (22.2%) were observed, among which seven lesions had a rich blood supply. Biopsy forceps and core needles were utilized to obtain samples in six and three patients, respectively. All the TNA and TOA biopsies were performed with cooperative application of multiple BCTs under compound anatomic and stereotactic navigations. Intraprocedural or postprocedural complications occurred in no patients who underwent the biopsy in the follow‐up period (1–39 months). No significant differences were found between the preprocedural and postprocedural blood indexes and visual analogue scale scores.ConclusionWith a sophisticated preprocedural arrangement, cooperative application of BCTs, and careful periprocedural precautions, transnasal endoscopic and transoral biopsies are two feasible, efficient, and well‐tolerated procedures that achieve satisfactory diagnostic yield, complication rate, and clinical outcome.     

Sexual Functioning in Female Patients Undergoing Surgical Treatment for Colorectal Cancer—A Single-Center,Prospective Triple Timepoint Yearly Follow-Up

The study was aimed at assessing the quality of sexual functioning in female patients having undergone surgical treatment for cancer depending on the type of surgery. The prospective cohort consisted of 48 female patients (23 patients with stoma [A2] and 25 patients with maintained continuity of the GI tract [A1]). Study methods included a diagnostic survey and the analysis of medical records of patients. Research tools consisted of a standardized FSFI questionnaire and a proprietary form for evaluation of sociodemographic data. Measurements were performed at threetimepoints: On the day before the surgery (Measurement I) as well as six and 12 months after the surgery (Measurements II and III, respectively). Statistically significant differences in results were observed in Measurements II and III in the subscales of arousal (II:p = 0.0068, III:p = 0.0018), lubrication (II:p = 0.0221, III:p = 0.0134), orgasm (II:p = 0.0044, III:p = 0.0021), satisfaction (II:p = 0.0021, III:p = 0.0433), and pain/discomfort (II:p = 0.0343, III:p = 0.0473). In all cases, lower scores corresponding to lower quality of sexual functioning were observed in patients in whom stoma had been performed. Statistically significant differences in sexual functioning were observed at Measurements II and III in each group, with the results being significantly (p > 0.05) worse in patients having undergone Hartmann’s procedure or abdominoperineal resection). Variables significantly affecting self-assessed sexual satisfaction included marital status, age, and modality of neoadjuvant treatment. Restoration of the continuity of the gastrointestinal tract is a chance for better self-assessment of the patient’s quality of life as regards sexual functioning.     

中药调控一氧化氮合酶-一氧化氮系统的研究

一氧化氮(NO)是生物体细胞内及细胞间的重要信号分子,由不同类型一氧化氮合酶(NOS)催化生成,即内皮型一氧化氮合酶(eNOS)、神经元型一氧化氮合成酶(nNOS)和诱导型一氧化氮合酶(iNOS)。生理情况下,组织中eNOS和nNOS持续低水平表达维持正常生理功能。病理情况下,eNOS活性下降,NO生成减少,中药可以通过蛋白质磷酸化调节eNOS活性增加NO浓度以及通过抗氧化作用提高NO的生物利用度。而iNOS在生理情况下不表达,炎症状态下,iNOS被激活产生大量NO,导致组织损伤,加剧炎症进程。中药通过NF-κB和p38MAPK下调iNOS减少NO生成治疗炎症。不少活血化瘀药可以下调iNOS起到抗炎作用,为活血化瘀药治疗炎症提供了试验依据。     

含咖啡因某维生素功能饮料对机体运动行为能力影响分析

目的探讨含咖啡因某维生素功能饮料对人体运动行为能力的影响。方法 2015年3月选取某高校35名学生为受试者,随机将其分为对照组(去咖啡因的某维生素饮料)16例和咖啡因干预组(含咖啡因的某维生素功能饮料)19例。所有受试者干预前后开展PWC170机能试验、血清β-内啡肽水平测定、疲劳程度指数测定、背肌力和握力测试、15 s反弹跳测试及模拟篮球比赛测定。结果干预前,所有受试者PWC170、β-内啡肽水平、疲劳程度指数、背肌力、右手和左手握力、弹跳次数、弹跳最高高度及弹跳总高度、模拟篮球比赛中移动距离、平均速度、平均移动速度和最快速度比较,差异均无统计学意义(P>0.05);干预后,咖啡因干预组受试者PWC170、15 s反弹跳测试中弹跳最高高度、模拟篮球比赛中平均移动速度均较对照组显著增加,差异均有统计学意义(P<0.05)。结论饮用含咖啡因的维生素功能饮料可以适当提高人体运动行为能力。     

The overall benefits of empagliflozin treatment in adult siblings with glycogen storage disease type Ib: one year experience

IntroductionRecently published case reports suggest the benefit of empagliflozin use in subjects with glycogen storage disease Ib (GSD Ib).MethodsWe present the clinical and laboratory data of 2 adult brothers with GSD Ib treated with empagliflozin for 12 months.ResultsThere was no severe infection during administration of empagliflozin. The improvement of clinical symptoms of inflammatory bowel disease and arthritis along with reduction in serum CRP levels and urinary albumin excretion was noted. Neutrophil count increased, allowing for reduction or temporary withdrawal of G-CSF treatment.ConclusionsEmpagliflozin may be a new safe treatment in GSD Ib patients with an advanced stage of the disease.     

Feasibility and clinical utility of real-time tele-echocardiography using personal mobile device-based pocket echocardiograph

IntroductionRecently introduced microUSB ultrasound probe, which can be connected to personal mobile device constitutes a new class of diagnostic pocket size imaging devices (PSID).The aim of this study was to assess the feasibility and clinical utility of real-time tele-echocardiography with the use such device.Material and methodsThe study group comprised 30 patients (18 men and 12 women; mean age: 54 ±14 years; mean body mass index: 27 ±6 kg/m²), admitted to various hospital departments (infectious diseases, internal medicine and cardiology). All patients underwent focused echocardiographic examination performed by an inexperienced operator using PSID and collaborating remotely in real-time with cardiologist by means of tele-consultation. Before commencing the examination, the operators underwent 1 h training in use of the PSID.ResultsIn most of patients PSID imaging provided sufficient diagnostic image quality. The dimensions of left ventricle, left atrium and the aorta obtained during the this examination showed good correlation with standard echocardiography (r = 0.89, r = 0.82, r = 0.92 respectively), but the correlation for TAPSE measurements was less pronounced (r = 0.52). The agreement in detection of pathologies (wall motion abnormalities, morphological and functional valvular abnormalities) between the tele-echocardiography and standard echocardiographic examination was good to very good (κ ranged from 0.648 to 0.823).ConclusionsPocket size imaging devices allows an inexperienced operator to perform a focused echocardiographic examination under a remote supervision of an experienced cardiologist. The introduction of new technology in the form of PSID with tele-echocardiography feature can revolutionize access to this imaging technique.     

滋阴清热药在维护健康血管内环境中的作用

现代医学研究表明,滋阴和清热类中药在维护血管内环境健康中起着重要的作用,可以改善和调节血管内环境紊乱时的氧化应激、炎症损伤、血液高凝状态等;从中医理论分析,滋阴和清热类中药药性寒凉,性属阴,可以抑制体内阳热(氧化应激、炎症、凝血、血管收缩物质,归为阳)的过盛,维护机体阴阳协调平衡。     

The presence of monoiodinated derivates of daidzein and genistein in human urine and its effect on thyroid gland function

Dietary supplements used by women during menopause are usually based on plant extracts containing isoflavonoids, daidzein and genistein. Genistein is a known inhibitor of many enzymes, including thyroid peroxidase (TPO). In the thyroid follicle, genistein acts as its alternate substrate for the formation of genistein iodinated derivatives. The aim of this study was to search for daidzein- and genistein-iodinated derivatives in urine of isoflavonoid-supplemented women. Additionally, selected phytoestrogens, steroid and thyroid hormones before and after three months of phytoestrogen supplementation were estimated. Urinary levels of free phytoestrogen increased significantly after therapy. They ranged between 0.3–1600, 0.6–670 and 0–206 nmol/L for daidzein, genistein and S-equol, respectively. Monoiodinated derivatives of genistein were observed (0–504 pmol/L) in 60% of the investigated samples. Steroid and thyroid hormone levels were within the normal range and were not significantly altered. The presence of monoiodinated derivates in human urine confirmed that genistein and daidzein may enter human thyroid follicles and influence TPO. Since the levels of the free thyroid hormones were not affected, we propose that the use of phytoestrogen dietary supplements is not associated with the development of thyroid-gland disorders in subjects with adequate iodine intake.