医学生沟通与交流技能培养模式探索

从医学生沟通与交流技能的培养模式入手,探索适合我国国情的培养模式,以达到全球医学教育标准。     

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.     

Warm currents affecting the spring and winter distributions of living coccolithophores in the Yellow Sea,China

Spring and winter distributions of living coccolithophores in the Yellow Sea were studied using a polarizing microscope based on two surveys in April 2010 and January 2011. Nine species were recorded, including Emiliania huxleyi and Gephyrocapsa oceanica as the predominant forms. The cell abundance of all coccolithophores in the spring was significantly higher than in the winter (p<0.01), with means of 15 387 and 2470 cells l-1, respectively. Notably, we observed a habitat selection of coccolithophores in the southeastern Yellow Sea (32–35°N, 123–125°E). This habitat was characterized by sharp temperature gradients during both seasons caused by water exchange between the shelf waters and the Yellow Sea Warm Current. Moreover, the cell abundance, standing crop and estimated fluxes of coccolithophores were abnormally high compared to other regions. The habitat preference of coccolithophores in the Yellow Sea was directly related to the hydrodynamic conditions. The unfavorable light conditions caused by the intense convective mixing were responsible for the low biomass of coccolithophores during the winter. However, the increasing temperature influenced by the warm current, in combination with water column stability, triggered the spring bloom of coccolithophores in the southern Yellow Sea.     

冠心病冠脉优势型与血管病变数目及严重程度的相关性分析

目的 探讨冠心病中冠脉优势型与血管病变数目及疾病严重程度的关系,为冠心病危重度预测及分级提供理论依据。方法 选取2010年7月～2014年4月西安交通大学第二附属医院确诊的冠心病患者1654例为研究对象,行单中心回顾性观察性研究。根据病变累及部位分为3组：单支血管病变组（n=465）、双支血管病变组（n=414）和三支血管病变组(n=775）。再根据冠脉优势型将所有患者分为两组：右冠优势型（n=1500）、非右冠优势型（左冠优势型和均衡型,n=154）（考虑后两者所占比例偏低,将其合并）。将年龄、性别、吸烟史、是否患高血压、糖尿病及高脂血症作为协变量,利用Logistic回归模型分析何种冠脉优势型是冠心病血管病变数目增加的可能危险因素;比较Gensini评分,探讨冠脉优势型和冠心病严重程度的关系。结果 右冠优势型患三支血管病变的可能性是非右冠优势型的1.681倍（OR=1.681;95% CI=1.096～2.579; P=0.017）;但右冠优势型患双支血管病变的可能性与非右优势型比较,差异无〖JP2〗统计学意义（OR=1.212; 95%CI=0.781～1.880;P=0.392）。右冠优势型Gensini评分明显高于非右冠优势型（42.3±〖JP〗33.6 vs36.3±29.8,P=0.033）。结论 右冠优势型可能是三支血管病变的独立危险因素,并且右冠优势型会导致较严重的血管病变程度。     

小儿乳糜腹的诊断与治疗

报道5例小儿乳糜腹,总结不同原因乳糜腹的诊断及治疗方法。5例均采用手术及TPN治疗。急性乳糜腹1例,行腹腔及腹膜后负压引流;慢性乳糜腹4例,腹膜乳糜囊肿切除1例,乳糜瘘缝扎1例,单腹腔引流2例。5例均治愈认为小儿乳糜腹在短期正规的非手术治疗效果不明显时早期积极的手术治疗可缩短疗程,减少并发症。     

改良式Cogbill手术治疗重症急性胰腺炎：附22例报告

目的探讨重症胰腺炎（ＳＡＰ）治疗的新方法。方法对我科选择性应用改良式Ｃｏｇｂｉｌ手术２２例ＳＡＰ的临床资料进行回顾性分析。结果全组２２例,后期存有并发症７例,其中胰瘘３例,肠粘连１例,轻型糖尿病３例,均经治疗后痊愈。本组无死亡。结论改良式Ｃｏｇｂｉｌ手术用于治疗ＳＡＰ,具有创伤小,并发症低、成功率高易于掌握等优点。     

脊椎结核的CT表现及其应用价值(附48例报告)

目的:讨论脊椎结核的CT表现和CT诊断的价值。材料与方法:本文报告48例脊椎结核患者,均经临床、X线、CT和手术病理证实。男32例,女16例,以30～39岁多见。结果:CT表现为(1)骨质破坏(48例),(2)骨质密度增高(10例),(3)椎间盘破坏(12例),(4)死骨片形成(20例),(5)椎旁脓肿(32例),(6)骨性椎管狭窄(12例)。结论:脊椎结核的CT表现具有一定的特征性,椎体前缘破坏、椎间隙变窄和椎旁脓肿形成为本病的主要CT征象。此外,CT还可以清晰地划出椎管脓肿和椎管内脓肿的大小及范围,显示椎管狭窄的程度,为手术提供依据。     

分级心理行为干预对中晚期癌症患者疼痛的影响

目的 探讨心理行为干预对中晚期癌症患者疼痛的影响.方法 将便利抽取的70例中晚期癌症疼痛患者按照随机数字法分为对照组和观察组各35例.对照组给予常规疼痛护理和药物镇痛治疗,观察组在对照组的基础上根据疼痛轻、中、重度分级给予不同的心理行为干预.采用视觉模拟疼痛量表、焦虑自评量表和疼痛自我效能量表对患者进行评估.结果 干预后观察组疼痛程度显著低于对照组(P＜0.01),焦虑和疼痛自我效能评分显著优于对照组(均P＜0.01).结论 针对不同疼痛程度的癌症患者给予针对性心理行为干预,可有效改善患者疼痛感,减轻焦虑情绪,提高疼痛自我效能,从而有助干改善生存质量.     

心率与血压变异性的多变量、多维信号分析进展

心率变异性与血压变异性反映心血管系统自主神经的调制活动，近年研究已向多变量、多维、动态分析方向发展。心率与血压变异性的多变量系统辨识、时频分析及非线性动力学分析等技术方法，将在心血管疾病的危险性预报、病情评估、疗效评价及特种环境医学等领域有更多应用。