患者知情同意权代为行使的案例分析及启示

以医疗典型纠纷案例为例,通过厘清相关法律对患者知情同意权行使及代为行使的相关规定,探讨知情同意权代为行使行为的界定。启示如下:知情同意权代为行使应设前置条件进行限制和约束;代为行使主体包括近亲属或关系人、委托代理人;患者本人意见具有首要优先性,委托代理人意见应优先于近亲属意见。     

DE-CMR在主动脉关闭不全患者手术预后评估中的应用分析

目的探讨造影剂延迟增强心脏磁共振成像(DE-CMR)在主动脉关闭不全(AI)患者手术预后评估中的应用价值。方法回顾性分析行手术治疗的AI患者48例病例资料,根据术前DE-CMR检查是否出现钆对比延迟增强分为增强组和非增强组,比较两组患者的资料特征,随访至2017年3月记录不良预后发生情况,并分析不良预后的预测因子。结果 48例患者中,钆剂延迟增强患者17例(35.42%),非钆剂延迟增强患者31例(64.48%);两组患者性别、年龄、高血压、糖尿病、术前心功能分级比较,差异无统计学意义(P0.05),增强组术前LVESD、LVEDD、左心房前后径、左心室最大横径均大于非增强组,(P0.05),随访期间室性心律失常、心功能进展为Ⅲ-Ⅳ级、死亡的几率分别为23.52%、35.29%、29.41%高于非增强组的3.23%、9.68%、6.45%(P0.05);Cox比例风险模型分析显示LVEDD、LVESD、左心房前后径是AI术后不良预后的独立预测因子。结论 DE-CMR诊断AI可提供更加全面的影像学资料,其中钆对比剂延迟增强识别的心肌纤维化可预测不良预后。     

Immunomodulatory Activities of HERBSnSENSES™ Cordyceps — in Vitro and in Vivo Studies

The commercially available HERBSnSENSES? Cordyceps (HSCS) belongs to a cultivated strain of Cordyceps sinensis whose immunomodulatory activities has been renowned in traditional Chinese medicine (TCM) for centuries. The present report is the first that describes its immunomodulatory features through a series of in vitro and in vivo experiments. We measured, in peripheral blood mononuclear cells the in vitro effects of HSCS on the gene expression of cytokines and cytokine receptors, cytokine release, and surface expression of cytokine receptors using cDNA expression array, cytometric bead array (CBA), and immunoflorescence staining, respectively, as well as macrophage phagocytosis and monocyte production of H₂O₂ using flow cytometry. Sixty female BALB/c mice were fed with either HSCS (40 mg/kg/day) or water consecutively for 14 days. Proliferation, cytokine liberation, and CD3/4/8 expression of splenic cells were measured using 5-bromo-2′-deoxyuridine proliferation ELISA, CBA, and cytometry immunoflorescence staining, respectively. In vitro results demonstrated that HSCS induced the production of interleukin(IL)-1β, IL-6, IL-10 and tumor necrosis factor alphaα from PBMC, augmented surface expression of CD25 on lymphocytes, and elevated macrophage phagocytosis and monocyte production of H₂O₂. In vivo results showed that HSCS did not induce splenomegaly and cytokine overliberation. Our results possibly provide the biochemical basis for future clinical trials.     

The pathology of lethal exposure to the Riot Control Agents: Towards a forensics-based methodology for determining misuse

The aim of this is to review deaths associated with the use of Riot Control Agents (RCAs) and to assess how the presenting pathologies is such cases may better inform cause of death conclusions upon autopsy. We also sought to present which additional steps should be added to the Minnesota protocol and the European harmonization of medico-legal autopsy rules in suspected cases of deaths associated with the use of RCAs.We included 10 lethal cases in our study. In three cases, RCAs were found to be the sole cause of death, in three cases RCAs were ruled a secondary cause of death due asphyxia or asthma subsequent to exposure to RCAs and in four cases RCAs were contributory factors to death. In three cases the responsible agents were identified as Chloroacetophenone (CN), Chlorobenzylidene malononitrile (CS) and Oleoresin capsicum (OC) and in the remaining 7 cases, the agent was OC alone.As there are no specific findings in suspected cases of death associated with RCA use, establishing cause of death and whether RCAs are the sole cause or only a contributory factor will be based on the elimination of other possible causes of death. For this reason, a specifically structured autopsy is essential. This specifically structured autopsy should contain basic principles of the Minnesota Protocol and the European harmonization of medico-legal autopsy rules with the following additional steps taken: examination of clothing, eyes, and skin; examination of pharyngeal, tracheobronchial, and eusophegeal mucosas; and a thorough recording of the steps taken by the party conducting the arrest, including other possible causes of in-custody death, as well as a detailed medical history of the deceased.     

抗结核药致药物超敏反应综合征1例

1例34岁女性肺结核患者,予口服四联抗结核药治疗（异烟肼片,利福平胶囊,吡嗪酰胺片）,用药35天后出现皮疹,38天后出现发热、腹痛、皮疹加重。实验室检查：丙氨酸氨基转氨酶460 U/L,天冬氨酸氨基转氨酶533 U/L,γ-谷氨酰基转移酶80 U/L,胆碱酯酶3336 U/L。考虑为抗结核药导致的药物超敏反应综合征。停用所有抗结核药物,予支持对症治疗,患者腹痛逐渐缓解,仍反复发热,皮疹逐渐加重。后经保肝、激素冲击和免疫调节治疗后好转出院。     

液相色谱-质谱联用同时测定西洋参制剂中人参皂苷Rg1、Re、Rb1及抗疲劳类非法添加含量

目的 建立同时测定西洋参制剂中人参皂苷Rg1、Re、Rb1及抗疲劳类非法添加含量的液相色谱-质谱联用方法.方法采用Agilent ZORBAX SB-C18色谱柱（3.0mm×150mm,3.5μm）,流动相A为含0.1%乙酸的20mmol·L-1乙酸铵溶液,流动相B为甲醇∶乙腈（3：2）的混合溶液,采用线性梯度洗脱;流速为200μL·min-1,柱温35℃.质谱条件采用电喷雾离子化（ESI）方式,正负离子模式,以多级反应监控（MRM）模式对西地那非、伐地那非、他达拉非、人参皂苷Rg1、Re和Rb1进行含量测定.结果 西地那非、伐地那非、他达拉非、人参皂苷Rg1、Re和Rb1分别在2.99～59.85,0.43～8.60,3.32～66.42,3.16～63.29,2.63～52.68,4.15～82.93μg·mL-1浓度范围内与峰面积呈良好线性关系.西洋参制剂中西地那非、伐地那非、他达拉非、人参皂苷Rg1、Re和Rb1的平均加样回收率均介于92.9%～103.3%之间.结论 本法简单、快速、灵敏、准确,可用于西洋参制剂中西地那非、伐地那非、他达拉非、人参皂苷Rg1、人参皂苷Re和Rb1含量测定,为该药的质量控制提供依据.     

肿瘤耐药性的逆转方法研究进展

肿瘤对化疗药物耐药是肿瘤治疗过程中所遇到的最大障碍,笔者从转运蛋白抑制剂、酶抑制剂,乏氧细胞杀伤剂、中药单体以及脂质体方面对目前肿瘤耐药性的逆转方法进行了综述。