生物黏附材料壳聚糖的黏附性能

目的:考察壳聚糖与黏蛋白的相互作用,评价壳聚糖黏附性能的影响因素。方法:于2006-07/12在中国科学院大连化学物理研究所生物医用材料工程实验室完成。将壳聚糖溶液与黏蛋白溶液混合,用紫外分光光度计测定溶液混合前后紫外吸收值的变化,表征壳聚糖的黏附性能。①调节反应溶液的pH值(1.0,3.0,5.0),考察环境pH对壳聚糖黏附性能的影响。②改变反应温度(4,25,37℃),考察环境温度对壳聚糖黏附性能的影响。③选择不同相对分子质量(48000,124000,230000)的壳聚糖,考察壳聚糖相对分子质量对其黏附性能的影响。④选择不同脱乙酰度(56%,67%,97%)的壳聚糖,考察壳聚糖脱乙酰度对其黏附性能的影响。⑤使用不同种类(I-S型及Ⅲ型)黏蛋白,考察黏蛋白中唾液酸含量对壳聚糖黏附性能的影响。结果:①环境介质pH由1.2升至5.0时,壳聚糖黏附性能随之显著升高。②壳聚糖黏附性能随着温度的升高而显著增强。③壳聚糖相对分子质量对于壳聚糖黏附无显著影响。④壳聚糖脱乙酰度增加,其黏附性能显著增强。⑤I-S型黏蛋白与壳聚糖的作用较之Ⅲ型黏蛋白与壳聚糖的相互作用明显增强。结论:壳聚糖的黏附受环境pH、温度、壳聚糖及黏蛋白两种分子电荷密度的显著影响;在酸性环境下增大环境pH值、升高环境温度、增加壳聚糖的脱乙酰度和增加黏蛋白中唾液酸的含量,均有利于壳聚糖的黏附。     

阻断局部肾素-血管紧张素-醛固酮系统不同环节对大鼠肺间质纤维化肿瘤坏死因子α表达的影响

目的:观察阻断肾素-血管紧张素-醛固酮系统不同环节对实验性肺纤维化大鼠肺组织肿瘤坏死因子α的影响。方法:实验于2005-08/2006-08在南华大学附属第一医院临床研究所及南华大学医学院组胚、生理实验室完成。取6周龄SD大鼠50只,随机分为正常对照组、模型组、卡托普利组、螺内酯组和氯沙坦组,每组10只。正常对照组气管内注入生理盐水,其他40只SD大鼠气管内注入博莱霉素5mg/kg复制肺纤维化模型。次日胃管内灌注血管紧张素转换酶抑制剂卡托普利60mg/kg(卡托普利组)、血管紧张素Ⅱ的Ⅰ型受体阻断剂氯沙坦10mg/kg(氯沙坦组)、醛固酮受体拮抗剂螺内酯100mg/kg(螺内酯组)、等量生理盐水(模型组和正常对照组),1次/d。各组动物均于给药后第28天处死,通过苏木精-伊红染色和Mallory染色观察肺组织病理变化,用免疫组织化学法和图像分析系统定量检测肺组织肿瘤坏死因子α的表达。结果:41只大鼠进入结果分析。①肿瘤坏死因子α蛋白表达:模型组高于正常对照组(166.82±4.14,61.44±1.94,P<0.01),卡托普利组、氯沙坦组、螺内酯组低于模型组(107.50±4.60,113.64±8.47,118.00±7.14,P<0.01),各用药组间无差异。②模型组肺泡炎程度、肺纤维化程度显著高于正常对照组(P<0.01,0.05),卡托普利组、氯沙坦组、螺内酯组较模型组好转(P<0.01),各用药组间无差异。结论:肺局部肾素-血管紧张素-醛固酮不同环节可能通过刺激肺部肿瘤坏死因子α表达而发挥致纤维化作用,阻断其不同环节可阻止肿瘤坏死因子α水平升高,抑制肺纤维化形成。     

The European Cancer Patient's Bill of Rights: Action Steps for Success

The European Cancer Concord (ECC) has partnered with patients, caregivers, clinicians, and advocates to construct three articles that form a Patient’s Bill of Rights. We propose four key action steps that will advance the agenda of the ECC. These include (a) robust cancer registries, (b) monitoring of quality of care, (c) broader stakeholder engagement, and (d) dissemination of best practices.Open in a separate windowDr. Christopher R. FrieseOpen in a separate windowDr. John Z. AyanianHealth care delivery systems across the globe share a common goal: to provide efficient and high-quality cancer care equitably to all patients. As they strive to deliver such care, health care systems struggle with increased detection capabilities, diagnostic and treatment innovations, substantial growth in the number of cancer survivors, and shortages of some health care personnel [1]. Inadequate cancer control poses societal and economic harms, such as increased public and private health care spending, decreased worker productivity, and increased job loss [2]. Without an organizing framework to prioritize goals for delivering cancer care that is coupled with concrete action steps, nations will face significant challenges to meet the needs of people with cancer and their families.In this issue of The Oncologist, a new policy statement by the European Cancer Concord (ECC) is a welcome first step to improve outcomes for European patients with cancer and their families [3]. With a population of more than 500 million, the European Union (EU) has a large and growing cancer burden [4]. Cancer is the second leading cause of death in the EU, and EU citizens are aging faster than other populations [5]. The ECC partnered with patients, caregivers, clinicians, and advocates to construct three articles that form a Patient’s Bill of Rights. These include the rights to shared information and decision making; timely access to appropriate specialty care supported by research and innovation; and receipt of high-quality, affordable care to achieve improved outcomes. These three rights and their specific supporting tenets provide a foundation for pursuing legislative, regulatory, and programmatic changes that will be needed in EU countries to decrease the societal burden of cancer.A major strength of the ECC initiative is its broad engagement with patients, clinicians, and other stakeholders across EU countries to articulate a patient-centered vision for improved cancer care. As a key component, the ECC developed its principles within the context of widespread economic austerity measures and rising costs of cancer care that require just and cost-effective pricing of services to ensure effective access. Importantly, the recommendations span the continuum of cancer care, from cancer prevention through survivorship and end-of-life care. These strengths can serve as a catalyst for sustained improvements in cancer care.Amid these strengths, the Patient’s Bill of Rights would be fortified by concrete action steps to assure these rights are achieved. These action steps should be considered within the distinctive structural and cultural context in which EU policy making occurs across national boundaries. Moreover, transparent timelines should be developed, and key stakeholders should be identified to lead these action steps. In addition, we propose four key action steps that will advance the agenda of the ECC. These include (a) robust cancer registries, (b) monitoring the quality of care, (c) broader stakeholder engagement, and (d) dissemination of best practices.     

How health care organizations are using data on patients' race and ethnicity to improve quality of care

Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encountered by health care organizations that attempted to collect and use these data to reduce disparities. Methods: Purposive sampling was used to identify eight health care organizations that collected race and ethnicity data to measure and reduce disparities in the quality and outcomes of health care. Staff, including senior managers and data analysts, were interviewed at each site, using a semi‐structured interview format about the following themes: the challenges of collecting and collating accurate data from patients, how organizations defined a disparity and analyzed data, and the impact and uses of their findings. Findings: To collect accurate self‐reported data on race and ethnicity from patients, most organizations had upgraded or modified their IT systems to capture data and trained staff to collect and input these data from patients. By stratifying nationally validated indicators of quality for hospitals and ambulatory care by race and ethnicity, most organizations had then used these data to identify disparities in the quality of care. In this process, organizations were taking different approaches to defining and measuring disparities. Through these various methods, all organizations had found some disparities, and some had invested in interventions designed to address them, such as extra staff, extended hours, or services in new locations. Conclusion: If policymakers wish to hold health care organizations accountable for disparities in the quality of the care they deliver, common standards will be needed for organizations’ data measurement, analysis, and use to guide systematic analysis and robust investment in potential solutions to reduce and eliminate disparities.     

State Medicaid coverage and access to care for low-income adults

OBJECTIVE: Budgetary pressures have led some states to limit Medicaid eligibility. We evaluated access to care for all low-income adults by the extent of state Medicaid coverage. METHODS: Current Population Survey data compiled by the Kaiser Commission on Medicaid and the Uninsured were used to rank the 48 continental states by the extent of Medicaid coverage for low-income non-elderly adults during 2000-2003. Data from the Behavioral Risk Factor Surveillance System for 2000-2003 were used to assess indicators of access to care, including being unable to see a physician due to cost, not obtaining routine checkups, and four preventive services for appropriate age groups by state. Access gaps were calculated between low-income (under $25,000/year) and high-income ($50,000 or more/year) adults within each state to control for unmeasured economic and health system differences between states. RESULTS: Access gaps between high and low-income people who could not see physicians due to cost were significantly smaller in states with the broadest Medicaid coverage compared with states with the narrowest coverage (19.2% vs. 23.7%, p=.003). Significantly smaller access gaps also occurred in states with broader Medicaid coverage for cholesterol testing (16.0% vs. 18.7%, p=.01), and Pap testing (6.0% vs. 10.8%, p=.002), but not colorectal cancer screening (13.3% vs. 12.5%, p=.28), mammography (14.3% vs. 19.7%, p=.07), and routine checkup within two years (8.0% vs. 9.3%, p=.10). CONCLUSIONS: A state's level of Medicaid coverage was associated with access to physicians' services, cholesterol testing, and cervical cancer screening for low-income adults. Broad Medicaid coverage may be an effective strategy for states to improve access to care and preventive services for low-income adults.     

头孢唑肟在输液中与6种注射剂配伍的稳定性研究

目的：研究头孢唑肟在５％葡萄糖输液与维生素Ｂ６等６种注射剂配伍的稳定性,为临床合理用药提供科学依据。方法：选择在３５℃下６ｈ内观察配伍液的外观,ＰＨ及ＣＺＸ紫外光谱的变化。用紫外分光光度法测定ＣＺＸ的含量。结果：Ａ春稳定性与和ＰＨ有关。结论Ｌ：在３５℃下６ｈ内与维生素Ｂ６、地塞米松、酚磺乙胺、氯化钾注射剂配伍、则稳定可用,与维生素Ｃ、氨茶碱注射剂配伍,则最好在４ｈ内使用。     

Granulocyte-macrophage colony-stimulating factor and interleukin-3 mRNAs are produced by a small fraction of blood mononuclear cells

Northern blot analysis has identified granulocyte macrophage colony stimulating factor (GM-CSF) mRNA in monocytes and both GM-CSF and interleukin-3 (IL-3) mRNA in lymphocytes. However, these results have not addressed whether all cells or a subset of the population is capable of hematopoietic growth factor (HGF) production. To resolve this question, we applied in situ hybridization of radiolabeled antisense RNA probes to centrifuged preparations of total blood mononuclear cells (BMCs) and fractionated lymphocyte subpopulations. Without stimulation, no circulating cells expressed detectable levels of GM-CSF or IL-3 mRNA. On stimulation of BMCs with phorbol myristate acetate (PMA) and phytohemagglutinin or PMA and the calcium ionophore ionomycin, approximately 5% expressed GM-CSF mRNA and approximately 1% IL-3 mRNA. Control sense probes produced no labeled cells. To determine the subsets of lymphocytes capable of GM-CSF and IL-3 expression, BMCs were fractionated by FACS into CD8+ and CD4+ lymphocyte subsets and CD16+ (NK) cells. The unfractionated cells and cell fractions were then stimulated with PMA and ionomycin. Results demonstrated that 3% to 5% of the CD16+, CD8+, and CD4+ lymphocytes produced GM-CSF mRNA. However, the number of IL-3 mRNA-positive cells in the FACS-sorted subsets was greatly reduced (0.02% to 0.05%) as compared with the unseparated cells (1%). Treatment of BMCs with high-dose interleukin-2 (IL-2) for 1 week followed by PMA plus ionomycin resulted in a lymphocyte population in which 50% and 3% of cells expressed GM-CSF and IL-3 mRNA, respectively. Thus, GM-CSF and IL-3 mRNA expression in T cells and NK cells is restricted to a small fraction of cells that can be greatly expanded by IL-2 stimulation. These results suggest a possible physiologic mechanism for increasing HGF production by circulating lymphocytes.