某院三级查房考核质量分析

目的了解三级查房中各级医师存在问题,提出改进策略。方法由7名具有高级职称的临床专家,按照统一评分标准进行观摩并打分,利用词云图分析存在问题。结果一级医师存在辅助检查解读不全面、疑难点报告不清晰、病历陈述缺项、查体手法不规范及查体前后未执行手卫生等问题;二级医师存在解答疑难问题不全面、临床思维讲解不透彻及查体纠正不到位等问题;三级医师存在对国内外最新知识进展讲解不全面及对查房内容点评不到位等问题。结论各级医师查房中都存在一定问题。医院管理者应针对不同级别医师提供个性化培训,促其努力提升医疗服务能力。同时,树立优秀科室榜样,充分发挥榜样带动作用。此外,还应充分利用人工智能技术辅助。     

联苯双脂滴丸制备工艺的研究

目的　对滴丸剂型的制备工艺进行研究。方法与结果　通过对联苯双脂滴丸制备过程的试验 ,确定了联苯双脂滴丸的重量、处方组成与制备工艺 ,讨论了影响滴丸成形、丸的圆整度和丸重差异的因素。结论　该制备工艺适用于滴丸剂型的工业化生产。     

圆窗区颞骨切片和CT对照观察

目的明确圆窗区及其相关结构在耳的横断薄层和在CT上的定位及毗邻关系,为该区域病变的影像诊断和手术治疗提供解剖学参考.方法外观无异常的经10%甲醛固定的成人头颅标本15例(30侧),以眦耳线为基线,用高分辨率CT扫描,获得间隔为1.00 mm,厚度为1.00 mm的CT图像,扫描后的颅脑标本按原定位截取以耳颞区为中心的组织块,常规脱钙、脱水、火棉胶浸胶,包埋并按标记切制成厚为1.00 mm的连续横断薄层切片,肉眼和手术显微镜下观察切片的下表面并扫描照相.标本切片与CT图像对照,逐一辨识颞骨内听小骨、骨性半规管、前庭、圆窗、圆窗龛、耳蜗、锥隆起、内耳道、耳蜗水管等结构.结果颞骨横断CT扫描,有18～22个层面,圆窗和圆窗龛出现层面多为第10层(右侧)和第11层(左侧),圆窗龛前壁厚度平均为右侧0.92 mm和左侧0.90 mm,龛深平均为右侧1.89 mm和左侧2.04 mm,龛与颈静脉窝间骨壁的平均距离为右侧2.10 mm和左侧2.39 mm.龛前壁厚度、龛深、龛与颈静脉窝骨壁的距离左、右侧差异无显著性 (P>0.05).结论耳颞区火棉胶薄层断面标本能良好显示圆窗区及其周围结构的解剖位置和毗邻关系,可直接与高分辨率CT扫描图像进行对照研究,其结果对耳科疾病的影像诊断及手术治疗有参考价值.     

Breast cancers with round lumps: Correlations between imaging and anatomopathology

A round lump with a well-defined outline is, in most cases, benign. However, in 10 to 20% of all cases, a round and well-defined lump may correspond to a cancer. Most often, it consists of grade III infiltrating ductal carcinoma (IDC). Other histological sub-types may provide round masses with smooth contours: colloid carcinoma (still called mucinous carcinoma), medullary carcinoma, intramammary metastases, intra-cystic papillary carcinoma, lymphoma and high-grade phyllode tumours.     

Detection and Characterization of Hyperlipoproteinaemia in Middle-aged Men

Serum lipoprotein (LP) concentrations were determined and LP patterns were classified in 261 middle-aged men, recruited from a health examination survey, with serum lipid values above the 80th percentile of the same population. Individuals with hyperlipoproteinaemia (HLP) and normolipidaemic controls were characterized also regarding family history of cardiovascular disease, socio-economic factors and clinical and laboratory variables. Subjects with HLP type IV–V and IIB were overweight and showed hyperuricaemia and hyperinsulinaemia compared with normolipidaemic controls and subjects with HLP type IIA. The latter showed elevated erythrocyte sedimentation rate. In spite of being overweight, subjects with HLP type III showed normal fasting values of insulin and uric acid in serum and normal early insulin response to intravenous glucose. The glucose tolerance did not differ significantly between the groups. Men with HLP types IV–V had predominantly sedentary occupations, in contrast to those with type IIA. There were significantly more smokers in the groups with HLP type IIB and IV–V than in the control group. Thus, individuals with different types of HLP tend to show different metabolic profiles but also different socioeconomic and clinical patterns, suggesting that exogenous factors are of importance in the expression of the LP abnormalities.     

Nitric oxide production of rat Leydig and Sertoli cells is stimulated by round spermatid factor(s)

In this study, we provide evidence of cell-to-cell interaction between rat germ cells and Leydig or Sertoli cells in relation to nitric oxide (NO) production and inducible nitric oxide synthase (iNOS) messenger RNA (mRNA) expression. As a result of being cultured in a round spermatid-conditioned medium (RSd-CM), NO production in both Leydig and Sertoli cells increased in proportion to the length of the culture period. iNOS mRNA expression in both types of cells also increased in a dose-dependent manner as a result of being cultured with RSd-CM. This increase was detected as early as 3 h and was maintained up to 24 h. In contrast, neither NO production nor iNOS mRNA increased in either type of cell following culture in a pachytene spermatocyte-conditioned medium (PS-CM). Our findings suggest that RSd may control NO production of Leydig and Sertoli cells. This cell-to-cell interaction may be an important mechanism of regulation of testicular function.     

内耳局部给药临床与实验研究进展

药物治疗一直是内耳病的首选方法,由于内耳与全身血液循环之间存在血 迷路屏障,药物进入内耳的剂量极为有限。内耳局部给药可以减小用药剂量与药物的不良反应,药物在内耳的作用效力也会提高。关于内耳局部给药的临床应用有鼓膜穿刺/经咽鼓管给药、经圆窗膜缓释/控释给药、内耳开窗给药,实验研究包括缓释药物制剂和控释给药装置的研究。作者对内耳局部给药的临床与实验研究进行综述,为更加微创、有效治疗疾病提供依据。