补肾法延缓免疫衰老的临床与实验研究

目的：观察补肾法延缓免疫衰老的临床疗效及相应的实验研究。方法：老年人22对（44名），采用随机分组，双盲给药（补方即补肾益寿胶囊和安慰剂）；实验研究则比较两个补肾方（右归饮和补肾益寿胶囊）和活血方（桃红四物汤）对老年大鼠T细胞凋亡及Fas、FasL基因表达的调控作用。结果：临床结果显示补肾组T细胞凋亡率比安慰剂组明显降低（P＜0．01），FasL基因表达亦明显降低（P＜0．05）。动物实验显示两个补肾方组老年大鼠T细胞凋亡均明显降低（P＜0．05），FasL基因表达亦明显降低（P＜0．01），而活血方组均无变化。结论：补肾法对老年人与老年大鼠T细胞FasL基因的转录具有负调控作用。这是补肾法下调老年人与老年大鼠T细胞过度凋亡的分子机理之一。     

长白蝮蛇毒纤溶组分的纯化及理化性质的研究

采用DFAE-Sepharose-CL-6B离子交换层析和Sephacryl S-200凝胶过滤层析,从长白蝮蛇毒中分离到五种具有纤溶活性的组分,并对其理化性质进行了较为深入的研究。结果表明,长白蝮蛇毒各纤溶组分具有纤溶酶和纤溶酶原激活因子的双重作用,能被金属酶抑制剂EDTA-Na_2完全抑制。已纯化的三种纤溶组分,无出血活性。     

Optimal designs for clinical trials with dichotomous responses

We consider two-stage designs for clinical trials that involve two treatments with dichotomous responses. The first is the information-gathering stage; the treatment chosen as the better from first stage and prior data is used exclusively in the second stage. Determination of treatment allocation in the first stage results from weighing the anticipated gain in information with effective treatment; the objective is to maximize the expected number of successes in the entire trial. This is in contrast to randomized controlled trials with the restricted objective of obtaining information concerning treatment differences. We allow the length of the first stage to be arbitrary and fixed in advance, or optimized as a function of prior information and the ‘patient horizon’. We can regard this patient horizon as either the number of patients in the trial or the number who have the condition under treatment. We consider two forms of prior information: (i) both success probabilities known but the better of the two treatments is unknown, and (ii) one success probability known whereas the other has an arbitrary distribution. In many instances of the latter case the optimal first stage size is of the order of the square root of the patient horizon.     

Epidemic of health care reforms

An epidemic of health care reforms is spreading through the world. The basic reason behind the epidemic is the concept of these reforms. Namely, at the time in which Modernity (the main context of mechanicism) has worn out its potentials, they are based on the principles of mechanistic paradigm. Epidemic could fade away if health care reformers would abandon their role of engeneers and turn to catalist role. In that role they could work on reforms which would rely on priciples of evolution. The first result of this reform orientation would be creation of the germ of pluralistic health care systems.     

体外5-氟脲嘧啶及华蟾素对人胃癌细胞株的相互作用

目的:体外观察5-氟脲嘧啶(5-Fu)及华蟾素合用对人胃癌细胞株(BGC823)的相互作用.方法:采用噻唑兰(MTT)法,利用中效原理判定两药合用的效果.结果:两种药单独应用及合用时随着药物剂量和时间增加,其效应也增加.结论:两药合用时是协同作用.     

论新型医德观的构建

在社会和医学科学发展的新形势下,医学界应与时俱进、逐步转变医德观念,构建新型的医德观,以不断促进医德进步和医疗卫生事业的全面、协调、可持续发展.本文就新型医德观构建应遵循的原则、应处理好的几个关系以及构建的意义进行了论述,以期望对新型医德观念的形成起到直接的指导作用.     

乙型病毒性肝炎中医研究近况

中医中药在抗HBV、调整机体免疫力、保护肝细胞、转阴病毒指标方面都发挥出较好的疗效。但在乙肝的病因、病机及其实质的研究方面尚缺乏深度和广度，仍停留在一般酶学及病毒的监测和症状的好转上，未进入分子、细胞水平的微观研究。运用中医气血、阴阳、脏腑、伏气温病、疫病等理论，结合现代科技手段，建立相似的动物模型，从细胞、分子水平深入研究乙肝的病因病机及其实质，筛选出抗乙肝的新型高效中草药及复方，对乙肝的中医辨证分型进行合理、严谨的科学设计。注重中西医结合的治疗思路，找出中西医结合治疗乙肝的最佳组合方案，是中医研治乙肝期待解决的重点难题。     

Accommodating intraocular lenses: a critical review of present and future concepts

Background Significant efforts have been made to develop lens implants or refilling procedures that restore accommodation. Even with monofocal implants, apparent or pseudoaccommodation may provide the patient with substantial though varying spectacle independence. True pseudophakic accommodation with a change of overall refractive power of the eye may be induced either by an anterior shift or a change in curvature of the lens optic. Materials and methods Passive-shift lenses were designed to move forward under ciliary muscle contraction. This is the only accommodative lens type currently marketed (43E/S by Morcher; 1CU by HumanOptics; AT-45 by Eyeonics). The working principle relies on various hypothetical assumptions regarding the mechanism of natural accommodation. Dual-optic lenses were designed to increase the dioptric impact of optic shift. They consist of a mobile front optic and a stationary rear optic which are interconnected with spring-type haptics. With active-shift lens systems the driving force is provided by repulsing mini-magnets. Lens refilling procedures replace the lens content by an elastic material and provide accommodation by an increase of surface curvature. Results Findings with passive-shift lenses have been contradictory. While uncorrected reading vision results were initially reported to be favorable with the 1CU, and excellent with the AT-45 lens, distant-corrected near vision did not exceed that with standard monofocal lenses in later studies. Mean axial shift from laser interferometric measurements under stimulation with pilocarpine showed a moderate anterior shift with the 1CU, while the AT-45 paradoxically exhibited a small posterior shift. With the 1CU, the shift-induced accommodative effect was calculated to be less than +0.5 D in most cases, while +1 D was achieved in a single case only. Ranges and standard deviations were very large in relation to the mean values. Under physiological near-point stimulation, however, no shift was seen at all. Prevention of capsule fibrosis by extensive capsule polishing did not enhance the functional performance. Dual optic lenses are under clinical investigation and are reported to provide a significant amount of accommodation. However, possible long-term formation of interlenticular opacifications remains to be excluded. Regarding magnet-driven active-shift lens systems, initial clinical experience has been promising. Prevention of fibrotic capsular contraction is crucial, and it has been effectively counteracted with a special capsular tension ring, or lens fixation technique, together with capsule polishing. Lens refilling has been extensively studied in the laboratory and in primates. Though it offers great potential for fully restoring accommodation, a variety of problems must be solved, such as achieving emmetropia in the relaxed state, adequate response to ciliary muscle contraction, satisfying image quality over the entire range of accommodation and sustained functioning. The key problem, however, is again after-cataract prevention. Conclusions As opposed to psychophysical evaluation techniques, laser interferometry measures what shift lenses are designed to provide: axial shift on accommodative effort. While under pilocarpine some movement was recorded, no movement at all was found under near-point stimulation with any of the lenses currently marketed. In contrast, magnetic-driven active-shift lens systems carry the potential of sufficiently topping up apparent accommodation to provide for clinically useful accommodation while using conventional lens designs with proven after-cataract performance. Dual optic implants significantly increase the impact of axial optic shift. The main potential problem, however, is delayed formation of interlenticular regenerates. Lens refilling procedures offer the potential of fully restoring accommodation due to the great impact of increase in surface curvature on refractive lens power. However, various problems remain to be solved before clinical use can be envisaged, above all, again, after-cataract prevention. The concept of passive single-optic shift lenses has failed. Concomitant poor capsular bag performance makes these lenses an unacceptable trade-off. Magnet-assisted systems potentially combine clinically useful accommodation with satisfactory after-cataract performance. Dual optic lenses theoretically offer substantial accommodative potential but may allow for interlenticular after-cataract formation. Lens refilling procedures have the greatest potential for fully restoring natural accommodation, but will again require years of extensive laboratory and animal investigations before they may function in the human eye. The author has no proprietary interest in any of the materials or equipment mentioned in this study.     

射频手术治疗的原理及临床应用

射频机在临床应用越来越广泛。介绍射频机的原理及其在临床的应用,阐明其优越性和广泛的应用前景。     

高值医用耗材管理信息化流程再造

高值医用耗材使用贯穿医疗的各个环节,是现代化医疗水平的标志之一。本文阐述了阜外医院在SMART原则下建立的多套高值耗材管理体系的优点及成功因素。