临床单纯胰腺移植的社会学和伦理学思考

单纯胰腺移植是治疗尚未出现严重并发症的Ⅰ型糖尿病的有效方法,尚未在临床上普及,造成这种情况除了技术方面的原因之外,还包括众多的社会学和伦理学原因,本文就这些问题进行探讨.     

单眼发病的原发性开角型青光眼黄斑脉络膜厚度及影响因素初探

目的:初步探讨原发性开角型青光眼（POAG）单眼发病患者黄斑中心凹下脉络膜厚度（SFCT）与其对侧眼和健康人的差异及其影响因素。方法:横断面研究。收集2018年9月至2019年9月就诊于首都医科大学附属北京同仁医院青光眼门诊确诊为POAG的单眼发病、对侧眼正常的患者（POAG组）以及健康志愿者（健康对照组）。对所有参与...     

胃苏颗粒联合莫沙必利治疗大学生功能性消化不良33例

目的：观察胃苏颗粒联合莫沙必利治疗大学生功能性消化不良的临床疗效。方法将68例大学生功能性消化不良患者随机分为治疗组和对照组,对照组予以口服枸橼酸莫沙必利片,治疗组在此基础上加服胃苏颗粒治疗,疗程均为4周,观察临床疗效。结果治疗组总有效率为93.93%,对照组的总有效率为72.29%,治疗组疗效明显优于对照组。结论胃苏颗粒联合莫沙必利治疗大学生功能性消化不良具有良好的临床疗效。     

内镜黏膜下剥离术在早期胃癌患者中的长期疗效研究

目的 探索内镜黏膜下剥离术（ESD）和外科手术对早期胃癌患者长期疗效的影响。方法回顾性分析2016年11月-2018年3月该院早期胃癌患者的临床资料,根据治疗方式不同分为两组,观察组（n=46）行ESD,对照组（n=46）行外科手术治疗。结果 观察组手术时间和住院时间较对照组短,术中出血量和住院费用较对照组少,两组患者比较,差异有统计学意义（P <0.05）。两组患者1、2和3年生存率比较,差异无统计学意义（P> 0.05）。两组患者1、2和3年复发率比较,差异无统计学意义（P> 0.05）。观察组并发症总发生率为4.35%,明显低于对照组的19.57%,两组患者比较,差异有统计学意义（P <0.05）。结论 与外科手术相比,对早期胃癌患者实施ESD,手术时间和住院时间短,患者出血量少,创伤小,术后并发症发生风险低,有助于提高患者预后,具有较好的治疗效果。     

Smad7基因沉默对细胞增殖的影响

TGF—β是一种多功能的细胞因子,可调节细胞的分化、增殖和凋亡。它对多种上皮细胞尤其是支气管上皮细胞的生长、增殖有很强的抑制作用。Smad7作为TGF—β信号转导通路的抑制分子,可以抑制TGF—β信号在胞浆内的传导。我们以永生化人支气管上皮细胞BEP2D,及恶性转化的BERP35T2细胞为基础所做的研究表明：Smad7基因的表达随细胞恶性度增高而增高,     

早产儿视网膜病变的筛查与高危因素

目的探讨早产儿视网膜病变(ROP)的发生及其危险因素。方法对2003年5月1日~2004年11月30日北京协和医院172例胎龄小于37周,或胎龄大于37周、但出生体重低于2500g的早产儿定期检查眼底。根据ROP国际分期标准进行诊断、分期。同期住院的20例正常足月新生儿作为对照组。结果172例早产儿中,放弃治疗或死亡12例,检查并随访完全160例。早产儿ROP的患病率为19·4%,对照组新生儿未发生ROP。出生体重≤2000g组的ROP患病率(28·4%)显著高于出生体重>2000g组(8·3%)(χ2=10·217,P=0·001)。孕周≤32周组的ROP患病率(42·5%)显著高于孕周>32周组(11·7%)(χ2=18·258,P=0·000)。胎龄(OR=0·959,P=0·036)和出生体重(OR=0·999,P=0·026)与ROP的发生相关性最高;输血(OR=0·076,P=0·029)和Apgar评分(OR=23·62,P=0·012)与ROP的发生具有负相关性。未发现吸氧方式、表面活性物质、多巴胺和出生前地塞米松的使用、输血和母亲病情与ROP的发生具有相关性。结论早产儿ROP的患病率高于正常足月新生儿。孕周越短、出生体重越低,ROP患病率越高。应定期检查早产儿眼底,早期发现ROP。     

不育症患者指长波动不对称性特点的分析

目的 分析宁夏汉族男性不育症患者指长波动不对称性（FA）的特点。方法 遵循体质测量法,计算384例宁夏汉族男性（不育组192例,对照组192例）各指指长FA（2FA、3FA、4FA、5FA）及复合FA（CFA）的均值,比较各均值的差异性。结果 （1）不育组和对照组各指长FA均值分布趋势均为5FA < 3FA < 4FA < 2FA。（2）不育组各指长FA均值均高于对照组,2FA及4FA差异显著（P<0.05）,且不育组2FA与体重指数（BMI）正相关（P<0.05）;不育组2FA分布在|L-R|≥0.04中的人数显著高于对照组（P<0.05）。结论 2FA可能为男性不育的早期筛查提供重要的参考信息。     

Construction and evaluation of detachable bone-targeting MOF carriers for the delivery of proteasome inhibitors

Tumor bone metastasis is an important cause of tumor recurrence and death. Although bone-targeting nanoparticles decorated with targeting ligands have shown good affinity for bone tissues with the properties of adhesion to the bone matrix, it is not easy to detach from the surface of the bone matrix in the tumor-bone microenvironment, attributed to the robust coordination force between the targeting ligands, such as bisphosphates with bone-deposited calcium. This may hinder the transport of nanoparticles from bone tissue to bone metastatic tumors. In this research, we designed a bone-targeting nanocarrier with detachable bone-targeting character for the therapy of bone metastases. The nanoparticles were constructed by using ZIF-8 and bone-targeting and MMP enzyme sensitive polypeptide-modified hyaluronic acid as a carrier and proteasome inhibitor Bortezomib (BTZ) as cargo. The results show that the constructed D8-M3-HA-ZIF8@BTZ nanoparticles possessed several favorable properties such as good colloidal stability, acid-sensitive drug release, D8 peptide mediated bone targeting and MMP enzyme-responsive desorption. Besides, nanoparticle endocytosis and cytotoxicity were enhanced through HA-mediated targeting to CD44 over-expressing tumor cells. Altogether, this study provides a potential cascade targeting strategy for improving the delivery effects of bone targeted nanoparticles for the delivery of proteasome inhibitors.

Tumor bone metastasis is an important cause of tumor recurrence and death.     

The eighth American college of chest physicians guidelines on venous thromboembolism prevention: implications for hospital prophylaxis strategies

Venous thromboembolism (VTE) is the most common potentially preventable form of hospital-related mortality. It presents as a major healthcare burden, affecting both medical and surgical patients. The prevention of VTE has been identified as one of the most important in-hospital safety practices in the US. VTE guideline recommendations provide a framework for clinical practice and guide VTE prophylaxis policies. Guidelines produced by the American College of Chest Physicians (ACCP) are considered to be the ‘gold standard’ in VTE prevention, diagnosis and management, and have been updated. A number of differences exist between the new 2008 ACCP guidelines on VTE prevention and the previous version published in 2004. There are variations regarding VTE prevention, including new and stronger evidence-based recommendations for several indications and agents. The updated guidelines give a strong recommendation that every hospital develop a VTE prevention policy, which is particularly important given the current international drive to reduce the incidence of VTE. A formal hospital policy should help improve compliance with appropriate VTE prophylaxis strategies. The ACCP guidelines form a basis for improving patient safety at a time of public reporting of quality of care, hospital accreditation, national standards of care, and pay for performance initiatives. In this review, changes in recommendations for VTE prevention in the 2008 ACCP guidelines compared with the previous edition in 2004 are outlined. In addition, outstanding areas of debate are discussed and the role of the 2008 ACCP guidelines in the context of the new VTE performance measures analyzed.     

空肠炎性肌纤维母细胞瘤伴出血一例

1例患者间断腹部不适8年，加重伴黑便3 d入院，经胃镜、肠镜、腹部CT等检查未见出血病灶，后经胶囊内镜、双气囊小肠镜检查发现病灶，遂行“小肠肿物切除+小肠吻合术”治疗，术后组织病理确诊为（小肠）炎性肌纤维母细胞瘤，术后恢复良好。