资料收集中的护患沟通交流技巧

正确的护理评估依赖于资料收集的充足与准确。因此资料收集是否全面、系统、真实、及时，直接影响着护理诊断和护理措施的正确制订。如何应用护患沟通技巧，准确、及时、全面地收集资料保证护理质量是当今护理工作应关注的重要内容。     

Junctional epidermolysis bullosa keratinocytes in culture display adhesive, structural, and functional abnormalities.

An unusual, elongated, refractile cell morphology was observed in keratinocytes cultured from three patients with non-lethalis forms of junctional epidermolysis bullosa (JEB). To determine whether these changes might be related to altered cell adhesion, keratinocyte strains established from one patient were examined for adhesive, structural, and functional characteristics. JEB keratinocytes expressed keratin tonofilaments, as determined by staining with AE1 monoclonal antibodies and direct observation of tonofilaments by electron microscopy. JEB keratinocytes showed diminished cell-substratum adhesions, judged by interference reflection microscopy. Areas of diminished cell-substratum adhesion corresponded to F-actin-rich cell adhesions (focal adhesions) and not to cellular areas that abundantly express hemidesmosomal antigens. Analysis of cell-substratum adhesion by electron microscopy revealed extensive areas of cell-substratum separation in JEB keratinocytes that were not present in normal keratinocytes maintained in serum-free medium. Normal keratinocytes displayed numerous regions of focal contact between the ventral plasma membrane and the culture substratum, but these structures were not seen in JEB keratinocytes. Bundled actin filaments (stress fibers) were greatly diminished in expected regions of cell-substratum adhesion in JEB keratinocytes and, instead, displayed disorganized individual filaments. The growth rate of JEB keratinocytes was quite slow in culture, with a population doubling time of 2.7 d versus 1.5 d for normal keratinocytes under identical conditions. JEB keratinocytes also displayed a reduced ability to aggregate into colonies upon exposure to medium with increased extracellular calcium. JEB keratinocytes thus display adhesive, structural, and functional abnormalities that suggest this cell type may be central to the pathogenesis of junctional epidermolysis bullosa. Study of affected keratinocytes could be important to characterize associated molecular pathologies.     

本刊现已实行“中华医学会信息管理平台"在线投稿

本刊的审稿专家可使用同一个用户名作为审稿人进行稿件审理和作者投稿。(3)作者投稿请直接登录中华医学会业务巾心下信息管理平台的稿件远程管理系统，点击“作者在线投稿”。投稿成功后，系统自动发送回执邮件。作者可随时点击“在线查稿”，获知该稿件的审稿情况、处理进展、审稿意见、终审结论等；有关稿件处理的相关结果编辑部不再另行纸质通知。     

Keratinocyte conditioned medium abrogates the modulatory effects of IGF-1 and TGF-β1 on collagenase expression in dermal fibroblasts

Overexpression of wound healing-promoting factors such as transforming growth factor-1 (TGF-beta1) and insulin-like growth factor-1 (IGF-1) during the healing process has been implicated in the development of dermal fibrosis in patients following thermal injury, surgical incision, and deep trauma. However, the mechanism through which the expression of these two fibrogenic factors is slowed down and/or abrogated in the late stages of the healing process is not known. Here, we hypothesize that keratinocyte-releasable factors counteract the fibrogenic role of both IGF-1 and TGF-beta1 in fibroblasts. To test this hypothesis, the levels of collagenase (MMP-1), as an index for extracellular matrix degradation, in dermal fibroblasts in response to either keratinocyte-conditioned medium (KCM) or our recently identified keratinocyte-releasable stratifin in the presence and absence of either IGF-1, TGF-beta1, or both were evaluated. The results of Northern analysis showed a significant increase in collagenase mRNA expression in cells treated with KCM in the presence of both IGF-1 and TGF-beta1. The effect was, at least in part, due to keratinocyte-derived stratifin that was present in KCM. This was ascertained as the levels of MMP-1 mRNA were markedly reduced when cells were treated with stratifin-immuno-depleted KCM. The results of Western blot analysis showed an increase in the level of MMP-1 protein in stratifin-treated fibroblasts and this was consistent with the level of MMP-1 mRNA expression detected by Northern analysis. However, in contrast to KCM, whose efficacy on MMP-1 expression was modestly reduced by either IGF-1 and TGF-beta1, or a combination of both, these factors abrogated the MMP-1 stimulatory effect of stratifin in fibroblasts. In summary, the results of this study revealed that both stratifin and KCM stimulate the expression of MMP-1-in fibroblasts and this effect can be abrogated by either IGF-1, TGF-beta1, or a combination of both.     

治疗时机对创伤性漂浮膝预后的影响

目的:探讨不同的手术时机对于创伤性漂浮膝术后功能恢复的影响。方法:回顾性分析42例接受手术治疗并获得随访的漂浮膝患者术后膝关节功能恢复情况,将患者按接受手术的时间分为72h内（23例）和72h后（19例）手术组,根据Karlstrom标准对两组患者术后膝关节功能恢复情况进行评定,将评定结果使用SPSS10·0软件进行统计学分析。结果:随访11个月⁶年,平均26个月,72h内接受手术者膝关节功能恢复情况优10例,良7例,中5例,差1例;72h后接受手术者优2例,良5例,中4例,差8例,两组结果差异有显著性统计学意义（P<0·01）。结论:早期手术坚强内固定、早期进行功能锻炼对于漂浮膝损伤远期功能的恢复具有重要的意义。     

阴茎勃起神经再生模型和机制的研究

探明神经性勃起功能障碍(NED)的分子生物学机制以期对该类疾病进行神经调控干预,是男科学研究的当务之急。本文回顾了急性神经损伤、前列腺癌、糖尿病和帕金森病所致的NED的研究进展。通过利用大鼠阴茎勃起神经的盆腔大神经节(MPG),在体外构建一个三维培养体系来研究各种生长因子和细胞信号通路对神经再生的影响。体外结果表明脑源性神经生长因子(BDNF)通过JAK/STAT信号通路可显著促进NED的恢复,并在体内证实了该效应。因此,通过调控JAK/STAT信号通路来达到神经调控干预措施预防治疗神经性勃起功能障碍成为可能。     

Development of a risk-adjusted capitation model based on principal inpatient diagnoses in Taiwan.

BACKGROUND AND PURPOSE: Taiwan's National Health Insurance (NHI) program has considered the use of capitation payments to health care providers as a method for control of the rising costs of the system. The establishment of capitation payments usually requires the performance of risk adjustment. The purposes of this study were to develop a diagnosis-based risk adjustment model for the NHI and to evaluate its predictability. METHODS: Using a 2% random sample of 371,620 NHI enrollees, the authors developed a Taiwan version of the Principal Inpatient Diagnosis Cost Groups (TPIPDCGs) from 1996 claim records to predict an individual's expenditure in 1997. Weighted least squares regression models were built in an estimation sample (two-thirds of the study sample), and were cross-validated in a validation sample (the remaining one-third of the study sample). Predictive R2 and predictive ratios were used to evaluate the model's predictability. RESULTS: Only 7.88% of the study sample could be classified into 1 of the 16 TPIPDCGs. Combined with demographic variables, which alone could explain 3.7% of the variation in an individual's future expenditure, the risk adjustment model based on TPIPDCGs could explain 12.2% of expenditure variation. In addition, the finding that the predictive ratios of the TPIPDCG model approximated unity better than those of the demographic model in all subgroups indicates that the capitation payment as predicted by the TPIPDCG model for each subgroup would better correlate to the actual spending. CONCLUSION: Taiwan's risk-adjusted capitation model based on principal inpatient diagnoses has higher predictability on individual's future expenditure than its counterpart in the USA. This finding provides insight into not only the development of Taiwan's diagnosis-based risk adjustment models but also the necessity of modification when applying foreign-developed risk adjustment models to the NHI.     

谷胱甘肽、自由基在砷剂诱导卵巢癌细胞凋亡中的作用

目的　观察谷胱甘肽、自由基在砷剂诱导卵巢癌细胞凋亡中的作用。方法　砷剂孵育卵巢癌细胞 4 8h后 ,琼脂糖凝胶电泳及流式细胞仪检测细胞凋亡 ,分光光度法检测细胞内谷胱甘肽、活性氧及丙二醛含量。结果　砷剂具有诱导卵巢癌细胞凋亡作用 ,砷剂诱导后细胞内谷胱甘肽含量减少 (P <0 .0 1)、活性氧及丙二醛含量增加(P <0 .0 5 )。结论　氧化还原系统的改变是砷剂诱导卵巢癌细胞凋亡的重要途径之一。     

如何强化医院医德医风建设

深圳市第二人民医院在不断完善、加大力度、加强医德医风建设方面制订出一系列纠风长效机制，采取有力措施：认真解决“红包”、回扣问题；进一步推动和规范药品集中招标采购工作；加强对中标药品价格和管理；切实加强医德医风建设，规范医疗服务行为；进一步规范药品生产流通秩序，加大源头治理力度；加强监管，严肃查处医药购销和医疗服务中的违纪违法行为。使医德医风常抓不懈，为医院在医疗服务行业、深化改革竞争中赢得了一席之地，也使医院在社会效益和经济效益能在全社会中取得了较高威信奠定了坚实的基础。