住院医师规范化培训与专业型硕士研究生培养模式衔接的思考

以甘肃中医药大学第一附属医院为例,对住院医师规范化培训与专业型硕士研究生培养模式开展的科学性、实施情况作了剖析和说明,对确保改革模式的顺利实施及高层次临床应用型人才的培养等方面具有一定的参考价值。     

胶体磨法包合紫苏叶和荆芥混合挥发油的工艺研究

目的:优选胶体磨法制备紫苏叶和荆芥混合挥发油?β?CD包合物的最佳工艺。方法:以包合物得率和挥发油包合率为综合评价指标,采用单因素试验结合Box?Behnken响应面法,考察β?CD与水的比例、挥发油与β?CD的投料比和包合时间对包合工艺的影响;通过薄层色谱法初步验证紫苏叶和荆芥混合挥发油包合物是否形成。结果:确定紫苏叶和荆芥挥发油包合的最佳工艺条件:紫苏叶和荆芥混合挥发油与β?CD的比例为1:9,β?CD与水的比例为1:3,包合时间23min。结论:胶体磨法制备包合紫苏叶和荆芥混合挥发油的工艺合理可行。     

Chemerin partly mediates tumor-inhibitory effect of all-trans retinoic acid via CMKLR1-dependent natural killer cell recruitment

Down-regulated chemerin expression has been reported to correlate with poor prognosis of several types of cancer including melanoma. All-trans retinoic acid (atRA) is a potent inducer of chemerin, and we previously reported that atRA inhibited murine melanoma growth through enhancement of anti-tumor T-cell immunity. Here, we aimed to investigate whether loss of endogenous chemerin accelerated melanoma growth and whether chemerin was involved in the melanoma-inhibitory effect of atRA. We demonstrated that chemerin was constitutively expressed in the skin, which was down-regulated during murine melanoma growth. Rarres2^−/− mice, which are deficient in chemerin, exhibited aggravated tumor growth and impaired tumor-infiltrating natural killer (NK) cells that express CMKLR1, the functional receptor of chemerin. Topical treatment with atRA up-regulated skin chemerin expression, which was primarily derived from dermal cells. Moreover, atRA treatment significantly enhanced tumor-infiltrating NK cells, which was completely abrogated in Rarres2^−/− mice and Cmklr1^−/− mice, suggesting a dependency of NK cell recruitment on the chemerin–CMKLR1 axis in melanoma. Despite comparable melanoma growth detected in wild-type mice and Cmklr1^−/− mice, lack of CMKLR1 partially abrogated the melanoma-inhibitory effect of atRA. This may be due to the inability to enhance tumor-infiltrating NK cells in Cmklr1^−/− mice following atRA treatment. Collectively, our study suggests that down-regulation of chemerin could be a strategy used by cancers such as melanoma to impair anti-tumor NK cell immunity and identifies a new anti-tumor mechanism of atRA by up-regulating chemerin to enhance CMKLR1-dependent NK cell recruitment.     

婴儿心脏移植术后的护理

目的 总结4例婴儿心脏移植术后的护理经验。方法 对4例心脏疾病婴儿在全麻低温体外循环下行原位心脏移植。做好大供心综合征预防护理,俯卧位机械通气的监测与护理,延迟关胸的观察和护理,腹膜透析护理,一氧化氮吸入治疗肺动脉高压的观察与护理,营养支持护理,免疫排斥反应的观察与护理。结果 4例婴儿住院55~131 d。出院时复查心脏超声显示左心室射血分数55%~68%。出院后门诊定期复查,随访3~62个月,4例婴儿一般情况可,左心室射血分数53%~70%。结论 婴儿心脏移植手术复杂,术后并发症多,病死率高,护理人员需掌握婴儿心脏外科术后各项危重症护理技术,多维度实施护理干预措施,提高婴儿心脏移植术后生存率。     

超细腹腔镜诊断结核性腹膜炎25例分析

目的:评价超细腹腔镜诊断结核性腹膜炎的价值和安全性.方法:对2006年1月-2008年6月接受超细腹腔镜检查病例中的25例结核性腹膜炎患者的临床资料作回顾分析.结果:25例患者中,1例因腹腔严重粘连造致气腹失败终止检查,余24例经超细腹腔镜检查均可见腹腔内弥漫粟粒样结节,结合临床镜下诊断为结核性腹膜炎(96.0%);其中21例行活检后获得明确的病理诊断(84.0%).25例中,渗出型14例(56.0%),粘连型8例(32.0%),干酪型3例(12.0%).术后发生穿刺部位出血1例(4.0%),皮下气肿1例(4.0%),总并发症发生率8.0%,未出现危及生命的严重并发症.在诊断结核性腹膜炎的敏感性方面,腹腔镜检查优于其它临床常用诊断方法(如PPD试验、腹水LDH、血和腹水CA125、腹水ADA),统计学检验示有显著差异(P<0.05).结论:超细腹腔镜因其操作简便、安全以及高诊断准确率,在结核性腹膜炎的诊断中具有重要价值.     

３ ６ ６例发作性睡病患者的人群分布 及临床特征分析

目的:研究分析就诊于广安门医院睡眠医学科的发作性睡病患者的人群分布及临床特征分析.方法:选取科室于2013年1月至2016年1月收治的366例确诊为发作性睡病患者的临床资料,进行回顾性分析.结果:广安门医院就诊的发作性睡病患者性别比例与国外研究基本一致,发病年龄偏小,四联征发生几率基本相同.结论:发作性睡病是慢性神经系统疾病,症状复杂,病因不明,应提早诊断,多样化治疗,并加强对患者的管理教育,以提高生活质量.     

A piezoelectric immunosensor for the detection of alpha-fetoprotein using an interface of gold/hydroxyapatite hybrid nanomaterial

The ideal immobilization methods that are suitable for binding immuno-active materials with high efficiency onto the sensing surface are the key target to pursue in the current biosensor design. In this paper, a new hybrid material formed by assembling gold nanoparticles (GNP) onto nano-sized hydroxyapatite (HA) has been employed for the interface design of piezoelectric immunosensor, on which the antibodies were bound. The detection performances of the resulting immunosensor were investigated by use of the antibody-antigen model system of alpha-Fetoprotein (AFP), an important indicator in the diagnosis of clinical cancers. The hybrid material was characterized by the UV-vis spectroscopy, the SEM and TEM measurements. The frequency and electrochemical impedance responses characteristics for the processes of immobilization and immunoreaction of anchored anti-AFP antibodies were studied in detail. The immunoresponse of the proposed immunosensor was compared with those antibodies immobilized by using HA or GNP alone. It was found that the developed sensing interface has some advantages such as the activation-free immobilization and the high antigen-binding activities of antibodies. The as-prepared immunosensor can allow for the determination of AFP in the concentration range of 15.3-600.0ngml(-1). Such an interface design with the nano-sized hybrid materials should be tailored as a new alternative used for biosensor design.     

多目标遗传算法优化金荞麦的提取工艺

目的 优选金荞麦的提取工艺。方法 选择乙醇浓度、溶媒倍数、提取时间、提取次数为考察因素,以总黄酮和浸膏得率为考察指标进行正交试验,运用SPSS 19.0软件建立总黄酮和浸膏得率的二次回归模型,采用多目标遗传算法对其进一步优化,确定金荞麦的最优提取工艺。结果 金荞麦的最佳提取条件：加金荞麦药材24倍量的61%乙醇于80℃提取3次,每次1.90 h;总黄酮和浸膏得率分别为11.58%和22.83%,与遗传算法模型预测结果相符。结论 多目标遗传算法优化的效果理想,所得工艺稳定可行,有效成分得率高,可用于金荞麦有效部位的提取。