运用市场手段实现医药自然分开的理论探讨

回顾了韩国、我国台湾和大陆实行医药分开改革的过程,认为我国以往的相关改革陷入了“管制”的思维误区。认为通过制度设计,创造医疗机构门诊处方自由流动的环境,依靠市场竞争形成处方流向结构多元化,可以实现医药自然分开状态。提出了“医药自然分开”、“处方流向结构”和“处方分散度”等新概念。     

乳管镜对乳腺导管内疾病的诊断及介入治疗--附100例临床分析

目的:探讨乳管镜在乳腺疾病诊断和治疗中的作用.方法:应用乳腺纤维导管内视镜对100例伴乳头溢液的乳腺导管性疾病进行诊断或介入治疗.结果:13例导管内占位性疾病得到了正确诊断,87例渗出性导管病经治疗后治愈.结论:乳管镜对乳管内病变的正确诊断及手术方式可提供依据,并可对渗出性病变进行介入治疗.     

蝎毒多肽提取物对肺癌荷瘤裸鼠血流变学的影响

目的观察蝎毒多肽提取物（PESV）对肺癌荷瘤裸鼠血流变学的影响。方法移植肺癌荷瘤裸鼠随机分为PESV组（皮下注射PESV）与对照组（皮下注射生理盐水）。采用FASCO-300型全自动表观黏度快测仪对两组的全血黏度进行检测。结果与对照组相比，PESV组血流变学指标均有不同程度的降低，尤其是全血低切表观黏度、全血高切表观黏度、Casson黏度、Casson屈服应力均明显低于对照组（P〈0．01）。结论PESV可降低荷瘤裸鼠血液黏度，对肺癌荷瘤裸鼠肿瘤转移能力有明显的抑制作用。     

Liver regeneration in acute severe liver impairment: a clinicopathological correlation study.

BACKGROUND: Although normally quiescent, the adult mammalian liver possesses a great capacity to regenerate after different types of injury. Major players in the regeneration process are mature residual cells, including hepatocytes, cholangiocytes and stromal cells. However, if the regenerative capacity of mature cells is impaired, hepatic progenitor cells (HPCs) are activated and expand into the liver parenchyma. Upon transit amplification, the progenitor cells generate new hepatocytes and biliary cells to restore liver homeostasis. AIMS/METHODS: To study the relationship between different histopathological parameters as well as their correlations with clinical parameters and outcome, we examined liver specimens from 74 patients with acute or subacute severe liver impairment by immunohistochemistry for CK7/CK19 (evaluation of HPCs activation/differentiation), Mib1(Ki 67)/P21 (evaluation of proliferative activity/proliferation arrest of hepatocytes) and hematoxylin and eosin (evaluation of hepatocyte loss). RESULTS: Of the 74 patients, 32% survived without transplantation, 14% died without transplantation and 54% were transplanted. Our results show that a threshold of 50% loss of hepatocytes, associated with significant decrease in the proliferative activity of remaining mature hepatocytes, is needed for extensive hepatic progenitor cell activation. Such activation is a sign of disease severity and occurs early (within 1 week) in the disease course. However, development of intermediate hepatocytes, suggesting HPCs differentiation towards mature hepatocytes, takes at least 1 week's time. We found a positive correlation between histopathological parameters (percentage hepatocyte loss, number of proliferating hepatocytes and number of HPCs) and clinical parameters of liver impairment such as model for end stage liver diseases (MELD). Surviving patients compared with those who either died or were transplanted had significantly less hepatocyte loss, less HPCs activation and more mature hepatocyte proliferative activity. Hepatocyte proliferative activity and degree of hepatocyte loss were the most important independent histopathological parameters in predicting outcome. CONCLUSION: Liver biopsy can provide important additional information in a patient with severe acute liver impairment.     

Fetal cardiac screening by three- and four-dimensional ultrasound

Objective. The objective of our paper is to show that the spatio-temporal image correlation (STIC) and tomographic ultrasound imaging (TUI) is very convenient and helpful for the fetal screening of complex congenital heart defects (CHD).

Methods. Ultrasound examinations were performed using a Voluson 730 EXPERT or PRO system (GE Medical system, Kretztechnik, Zipf, Austria), and the transabdominal probe (RAB 4-8 MHz or 1-5 MHz) was used to acquire the STIC volumes. Various complex CHD including heterotaxia, ventricular septal defect (VSD), atrio-ventricular septal defect (AVSD), tetralogy of fallot (TOF), transposition of great artery (TGA), hypoplastic left heart syndrome (HLHS) were examined between 20 weeks and 35 weeks. After routine cardiac screening and examination by two-dimensional ultrasound, three- and four-dimensional ultrasound were performed by gray-scaled and color flow mapping. After the examination detailed analysis of CHD were performed by STIC and TUI.

Results. In the case of heterotaxia, STIC and TUI was useful for the detection of stomach and cardiac apex in the different slices. In the case of VSD and AVSD, they were useful for the exact determination of septal defect location. In the cases of TOF, TGA and HLHS, they were helpful for observation of outflow tract and exact diagnosis.

Conclusion. In the screening of complex CHD including heterotaxia, VSD, AVSD, TOF, TGA and HLHS, STIC is very useful and powerful tool.     

EVALUATION OF THE LOOPING FORMATION AND PAIN DURING INSERTION INTO THE CECUM IN COLONOSCOPY

Introduction: One of the causes of pain during insertion of the colonoscope is stretching of the mesenterium by loop formation. The degree of pain differs according to the type of loop formation. Our aims were to study the accuracy of the colonoscopist’s assessment of the presence and type of loop formation and to study the degree of pain in relation to the type of loop by administering the visual analog scale (VAS). Methods: Two hundred and fifty‐seven consecutive patients were enrolled. All procedures were performed by two experienced colonoscopists who were blind to magnetic endoscope imaging view. After the colonoscopy, the colonoscopist was asked to assess the presence and type of loop formation. The degree of pain was assessed using the VAS. Results: The accuracy of estimating N loop, alpha loop, absence of loop formation and U loop was each over 70%. The accuracy of estimating gamma and splenic loop was significantly lower than the accuracy of estimating U loop. Colonoscopy was significantly more painful in women than in men. The degree of pain was significantly higher upon formation of reverse alpha loop and gamma and splenic loop than upon formation of N loop and U loop. Conclusions: Upon formation of reverse alpha loop or gamma and splenic loop, patients experienced more pain and it was difficult for the endoscopists to assess these loops. As women had severe pain compared with men, the use of a pediatric colonoscope or higher dosage of sedation in women should be considered.     

猪喉软骨硫酸软骨素的制备和自由基清除活性

直接用木瓜蛋白酶水解软骨,三氯醋酸除蛋白质,乙醇沉淀干燥得硫酸软骨素粗多糖,经DEAE-Sepharose fast flow离子交换层析分离纯化,高效凝胶渗透色谱和琼脂糖凝胶电泳测定其相对分子质量和纯度,比较硫酸软骨素粗品和纯品的体外自由基清除活性。结果显示硫酸软骨素粗品和纯品提取率分别为31.56±0.46%和19.79±0.78%,后者相对相对分子质量为75 174,粗品的DPPH.和.OH清除活性最强,随着产品纯度的提高,活性降低,而对于O2-.清除活性结果则相反。     

类风湿性关节炎药物治疗的进展

近年来,随着类风湿性关节炎发病机制及某些致炎因子的发现,出现了一系列新药。环氧合酶-Ⅱ特异性抑制剂与传统的非甾体类抗炎药相比具有疗效好、副作用小的优点;早期联合使用改变病情性抗风湿药在近期内有较好的临床疗效。此外重组可溶性肿瘤坏死因子受体融合蛋白 (etanercept)、人体抗肿瘤坏死因子-α单克隆抗体(adalimumab)和阿那白滞素(anakinra)等生物学治疗及中药治疗均显示了新的治疗前景。     

胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.