论医疗过程标准化管理在医疗纠纷防范中的重要作用

医疗纠纷是指对产生不良后果的事件医患双方认识达不成一致意见时所产生的争端。由于患方对医疗技术的局限性缺乏正确认识，患者或患者家属就医的过高心理期望值和医疗技术现实水平间的客观差异所产生的矛盾，以及由于医院医疗过程中存在着不同程度缺陷所引起的纠纷，在引起医疗纠纷┄┄┄┄     

促红细胞生成素在子宫内膜异位症组织的表达

目的探讨促红细胞生成素(Epo)在子宫内膜异位症(EMs)发生中的病理生理作用及其临床意义。方法应用免疫组织化学SABC法、mRNA原位杂交法检测39例子宫内膜异位症的异位内膜及35例正常子宫内膜Epo的组织定位和表达强度,并对比其差异。结果Epo、EpomRNA的表达主要定位于腺体细胞胞质、胞核,间质细胞表达不明显。异位内膜组织Epo、EpomRNA表达分别为9.68±2.90,3.08±0.48,明显高于正常对照的4.54±2.86,0.55±0.46,差异有高度显著性(P<0.01);Epo、EpoRNA在EMs组、正常对照组的增殖期和分泌期表达相比,差异均无显著性(P>0.05);EMs组EpomRNA与AFS分期呈正相关(r=0.979,P=0.013)。结论Epo通过旁分泌或自分泌方式过度转录表达引起的局部新生血管生成增强可能是子宫内膜异位症发生的机制之一。     

Up-regulation of Niacinamide in Intervertebral Disc Aggrecan in vitro

The regulatory effects of niacinamide （Nia） on intervertebral disc （IVD） aggrecan in vitro was investigated. Chiba＇s 10 ng/mL interleukin-1 （IL-1）-induced rabbit IVD degeneration model in vitro was established. 0.5, 0. 25 and 0.05 mg/mL Nia was added to normal and degenerated IVDs for intervention. On the first and second week after intervention, safranin O-fast green staining intensity and glycosaminoglycan （GS） content were measured. The expression of aggrecan core protein was detected by RT-PCR. The results showed： （1） After treatment with 0. 5 mg/mL Nia for one week, the GS content in nucleus pulposus （NP） was increased by 44.80% as compared with control group （P〈0. 01） ; The GS content in IL-1 induction groups was increased with the increase of Nia concentrations： After treatment with 0. 5 mg/mL for one week, the GS content in NP was increased by 68.30% as compared with control group （P〈0. 01）. After two weeks, GS content in NP and fibrous rings was still higher than in control group at the same period （P〈0. 01） and untreated group （P〈0.01）. （2） Safranin O-fast green staining revealed that with the increase of Nia concentrations, staining density in NP and fibrous rings was increased and histological structure damage to IVDs by IL-1β was alleviated. （3） RT-PCR showed that the expression of core protein gene in IL-1β-induced degenerated IVDS was increased with the increase of Nia concentrations. It was concluded that under conditions in vitro, Nia could up-regulate the expression of aggrecan in IVDs and protect IVDs from IL-1β-induced degeneration at least partially, which offers a potential choice for IVD degeneration clinical therapy.     

骨质疏松性骨折骨痂软骨细胞CD44、FN表达的实验研究

目的：探讨骨质疏松性骨折愈合过程中胞内信号因子CD44及其配体FN在骨痂软骨细胞的表达情况。方法：建立28只SD大鼠骨质疏松性股骨骨折愈合模型作为实验组以及28只二期股骨骨折愈合模型作为对照组，分别于骨折后的d10、d20、d30、d40取材，对骨痂进行HE染色及CD44、FN免疫组化染色。结果：在骨痂组织中CD44和FN的表达及分布在时空上有一致性。在实验组中，随着骨折愈合进程的发展，软骨细胞CD44与FN的表达逐渐减少，而对照组中，CD44与FN共同表达于骨折愈合各阶段的各区软骨细胞中。结论：大鼠骨质疏松性骨折愈合过程中骨痂软骨细胞CD44、FN的表达明显弱于正常二期骨折愈合过程中的表达，提示：CD44、FN在软骨细胞中表达的明显减少可能是造成骨质疏松性骨折骨痂软骨组织向骨组织演变缓慢的原因之一。     

中药饮片质量的风险评估

风险管理是一种现代管理模式，在美国、澳洲、欧盟、日本、韩国以及台湾地区常作为商品质量检验的一种模式。中药饮片质量管理工作好坏直接影响到医疗单位的医疗质量和病人安危，为确保医疗质量的需要和病人的身体健康就必须有一套与之相适应的科学管理方法。我们把风险管理这种模式试着应用于中药饮片的质量管理，通过一年多的探索，取得了一定成效。     

重庆市区主要交通干道苯并(a)芘污染状况及其危害分析

目的 了解重庆市区交通干道苯并(a)芘质量污染状况,分析其对人群健康的危害.方法 测定重庆市区主要交通干道空气中苯并(a)芘质量浓度、总悬浮颗粒、PM10、PM2.5和PM1浓度,分析各污染物之间的关系.结果 除隧道外,重庆市主要交通干道苯并(a)芘浓度最高为0.570 7μg/m3,TSP为1.516 7mg/m3,PM10为0.857 5 mg/m3,均超过国家环境卫生标准.结论 表明重庆市区大气中苯并芘[B(a)P]污染已极为严重,有必要对其引起的人群健康效应进行深入研究.     

如何利用Blackboard教学管理系统构建生理学网络课程

B lackboard教学管理系统可为教师创建、发布和管理网络课程提供方便、快捷的工具模块。文章介绍了如何利用B lackboard教学管理系统提供的课程内容模块、测验模块和课程工具模块来构建生理学网络课程的过程。指出生理学网络课程的建设,对突破传统面授教学的局限性和帮助学生网上学习具有重要意义。     

海藻糖在气管低温保存中的保护机制

目的探讨海藻糖在气管低温保存中的保护作用和机制。方法新鲜配制4组保存液，其中：Ⅰ组LPD；Ⅱ组LPD 10％DMSO；Ⅲ组LPD 0．15M海藻糖；Ⅳ组LPD 10％DMSO 0．15M海藻糖。切取SD大鼠气管后立即分别放入含上述4种溶液的冻存管，在程序降温仪降至-80℃后投入液氮中保存。20d后对气管标本进行HE染色和Bcl-2、Pax蛋白检测(免疫组化)，并将其异位移植到Wistar大鼠腹腔，15d后取出移植气管，观察组织学变化。结果4种保存液低温保存气管20d后，Ⅲ组和Ⅳ组气管结构完整，软骨细胞Pax蛋白表达较低，尤其Ⅳ组保存效果最好，同种异体异位移植后生长良好。各组Bcl-2蛋白表达无明显区别。结论在气管低温保存中海藻糖的保护作用主要是通过对软骨细胞的保护实现的，抑制软骨细胞Pax基因的表达是其中的保护机制之一。海藻糖和DMSO合用保护作用更好。     

益气健脾祛痰化瘀方药对D-gal拟衰小鼠自由基代谢及免疫功能的影响

自由基对细胞成分的有害攻击及机体免疫功能下降是老化的重要机制[1,2],测定自由基产物和相关酶以及免疫功能的变化可反映机体的衰老程度已成为共识.中医延缓衰老研究向以补肾占居优势,然脾胃为后天之本,脾虚气亏亦为衰老的重要原因之一.同时,脾虚易聚湿生痰,痰凝气滞或脾虚气亏,可生瘀血,痰浊瘀血是导致衰老的重要因素.据此立益气健脾祛痰化瘀法作为延缓衰老治则,并选用四君子汤加祛痰化瘀药物观察其对自由基体系及免疫功能有关指标的影响.     

Pivotal study of iodine-131-labeled chimeric tumor necrosis treatment radioimmunotherapy in patients with advanced lung cancer.

PURPOSE: Tumor necrosis treatment (TNT) uses degenerating tumor cells and necrotic regions of tumors as targets for radioimmunotherapy. Previous studies in animal tumor models and clinical trials have demonstrated that when linked to the therapeutic radionuclide iodine-131, recombinant chimeric TNT antibody ((131)I-chTNT) can deliver therapeutic doses to tumors regardless of the location or type of malignancy. Therapeutic efficacy and toxicity of (131)I-chTNT in advanced lung cancer patients were studied in this pivotal registration trial. PATIENTS AND METHODS: Patients with advanced lung cancer were treated with systemic or intratumoral injection of (131)I-chTNT in eight oncology centers in China. The objective response rate (ORR) was assessed as the primary end point. RESULTS: All 107 patients who were entered onto the study and completed therapy had experienced treatment failure after prior radiotherapy or chemotherapy a mean of three times. The results showed an ORR of 34.6% (complete response, 3.7%; partial response, 30.8%; no change, 55.1%; and progressive disease, 10.3%) in all patients and 33% in 97 non-small-cell lung cancer patients. A biodistribution study demonstrated excellent localization of the radioactivity in tumors in both systemically and intratumorally injected patients. The most obvious adverse side effect was mild and reversible bone marrow suppression. CONCLUSION: Radioimmunotherapy with (131)I-chTNT was well tolerated and can be used systemically or locally to treat refractory tumors of the lung.