摘要:目的:基于肝癌细胞(肝细胞癌细胞和胆管上皮癌细胞)对PGE2的不同反应性,研究Hep3B、HuH7、SG231和HuCCT1肝癌细胞株前列腺素E2受体的表达类型和分布定位.方法:体外培养肝细胞癌细胞株(Hep3B,HuH7)和胆管上皮癌细胞株(SG231,HuCCT1),分别给予不同浓度的外源性PGE2处理,以WST-1细胞增殖实验检测肿瘤细胞增殖率;以RT-PCR实验检测上述细胞4种PGE2受体(EP1、EP2、EP3和EP4)的mRNA表达情况;采用上述肝癌细胞的细胞涂片或细胞爬片进行荧光免疫细胞化学实验,于荧光显微镜和共聚焦显微镜下观察上述4种EP受体蛋白的表达和定位分布.结果:WST-1细胞增殖实验结果显示PGE2可以促进Hep3B和HuH7细胞的生长,但对胆管上皮癌细胞(SG231、HuCCT1细胞)则表现为生长抑制作用;RT-PCR和荧光免疫细胞化学实验结果表明Hep3B、HuH7、SG231和HuCCT1细胞株均有4种EP受体的表达;激光共聚焦结果显示4种EP受体不仅有胞浆、胞膜定位,而且部分在胞核也有表达,其中EP4受体的表达主要定位于细胞核.结论:Hep3B、HuH7、SG231和HuCCT1,4种肝癌细胞株均可以表达EP1、EP2、EP3和EP4受体,且受体的细胞内定位不同.肝癌细胞对前列腺素E2的反应性可能与EP受体的定位以及不同的细胞内信号转导通路激活有关.

摘要:目标:探讨脂联素在人类皮下和网膜脂肪组织中mRNA表达水平,以及糖皮质激素和PPARγ激动剂对脂联素的调控作用.方法:应用real-time RT-PCR方法观察了16名成人腹部皮下和网膜脂肪组织中脂联素mRNA表达水平以及与肥胖的关系.通过体外培养,观察地塞米松(dexamethasone,DEX)和/或PPARγ激动剂(troglitazone,TGZ)对不同部位脂肪组织脂联素的表达和分泌的调控作用.结果:皮下和网膜脂肪组织脂联素mRNA表达丰富但无显著部位差异,网膜脂肪组织脂联素mRNA水平与BMI呈显著负相关(r=0.56,P＜0.05).体外培养24 h后,TGZ处理组脂肪组织脂联素基因的表达明显增加(皮下:70％;网膜:102％),且网膜脂肪组织脂联素的分泌明显高于对照组(P＜0.05);DEX则下调网膜脂肪组织脂联素mRNA的表达水平36％,TGZ可逆转这种抑制作用.结论:网膜脂肪组织中脂联素mRNA的表达随BMI增加而下降,并受到糖皮质激素及PPARγ激动剂调控.脂联素的部位特异性表达和调控可能是内脏型肥胖连接胰岛素抵抗的重要分子机制.

摘要:目的:探讨常规预防方案干预下,造血干细胞移植后出血性膀胱炎(hemorrhagic cystitis,HC)的发病情况、危险因素和有效的防治方法.方法:62例恶性血液病患者(自体移植32例,异基因移植30例),移植过程中均进行常规的HC和移植物抗宿主病(graft versus host disease,GVHD)预防.分析移植后HC发生的特点及与移植类型、其他临床特征的关系和防治效果.结果:共6例发生HC(9.68％),均为异基因移植患者.平均发病时间为46.50天,平均病程为42.50天.4例发生巨细胞病毒(cytomegalovirus,CMV)感染,其中3例合并GVHD,另有1例仅出现GVHD.经治疗后3例完全缓解,2例部分缓解,1例行膀胱切除术.结论:在采取充分的预防措施后,HC多为晚期发生,可能与异基因移植、GVHD和CMV感染有关,病程迁延、部分难治.

摘要:目的:分析血红素氧合酶-2(HO-2)在糖尿病大鼠结肠组织中的表达,探讨一氧化碳(CO)与糖尿病结肠功能紊乱发生发展的关系.方法:应用免疫组化、RT-PCR法检测10例糖尿病大鼠和10例正常大鼠结肠组织中血红素氧合酶-2的表达.结果:免疫组化结果显示血红素氧合酶-2在糖尿病组和正常组大鼠结肠组织中均有表达,糖尿病大鼠结肠组织中表达较正常大鼠减少(P＜0.05);RT-PCR结果显示血红素氧合酶-2 mRNA在糖尿病大鼠近端、远端结肠表达均减少(P＜0.05).结论:血红素氧合酶-2及其mRNA在糖尿病大鼠结肠中的分布及表达异常,提示胃肠道组织中的一氧化碳可能在糖尿病结肠功能紊乱的发病机制中有一定作用.

摘要:目的:探讨2型糖尿病铁储备的临床相关性,为临床合理防治2型糖尿病提供又一新的途径.方法:将75例2型糖尿患者群,按血清铁蛋白(SF)浓度的50百分位点分为:低SF组和高SF组,比较他们的血压、体质量指数(BMI)、腰/臀比(WHR)、血脂、空腹血糖、空腹胰岛素等指标,同时用HOMA公式计算出胰岛素抵抗指数和胰岛β细胞功能进行分析,并以30例正常人群作为对照组.结果:高SF组,WHR、收缩血压、胆固醇、尿Alb/Cr、HOMA IR明显高于低SF组,且均高于正常对照组;而BMI、尿酸、甘油三脂、糖化血红蛋白(HbA1c)、空腹血糖、空腹胰岛素、血红蛋白(Hb)、红细胞(RBC)、转铁饱和度、总铁结合力(TIBC)、血清铁均无统计学差异.结论:铁储备与2型糖尿病密切有关,临床表现在胰岛素抵抗、血压、血脂、体脂、糖尿病肾病等方面,故铁储备是2型糖尿病及其并发症的预测因子,可作为2型糖尿病防治新的着眼点之一.

摘要:目的:探讨昼夜自发性促性腺激素(Gn)水平在性早熟诊断中的价值.方法:采用免疫化学发光法检测40例性早熟女孩白天和夜间自发性黄体生成素(SLH)和自发性滤泡刺激素(SFSH),同时设正常女孩为正常对照组.结果:中枢性性早熟(CPP)(26例)与非中枢性性早熟(NCPP)(14例)女孩的日间SLH无显著性差异(F检验,P＞0.05),但夜间的有显著性统计意义(F检验,P＜0.001).CPP组和NCPP组日间的及其夜间的SLH均值均高于正常对照组(F检验,分别为P＜0.001、P＜O.001、P＜0.001和P＜0.005).当日间SLH≥0.3 IU/L时,78.8％为CPP,在CPP中为80.8％,而在NCPP中为42.9％.当日间SLH≥0.7 IU/L并同时夜间SLH≥1.1 IU/L时,100％为CPP.PLH在(5～8)IU/L之间的CPP女孩均无日间SLH≥0.7 IU/L的同时又有夜间的SLH≥1.1 IU/L的现象.结论:免疫化学发光分析法(ICMA)有可能提升自发性Gn水平在小儿性早熟等内分泌疾病诊疗中的临床价值,但SLH尚不宜作为CPP的筛查手段,当昼夜的SLH同时明显增高时有望作为CPP的重要实验室指标之一.

摘要:目的:研究ESE-3小鼠同源基因Ehf在支气管哮喘(简称哮喘)小鼠肺组织的表达,探索ESE-3在哮喘发病机制中的作用.方法:将20只雌性BALB/c小鼠随机分成2组,即哮喘模型组和对照组,用逆转录PCR、荧光定量PCR检测EhfmRNA的表达,用免疫印迹法检测其蛋白质的表达.结果:EhfmRNA和蛋白质在哮喘模型组和对照组中均有表达,逆转录PCR显示哮喘组Ehf mRNA的表达为0.5800±0.2081,明显高于对照组的表达0.2300±0.2336(P=0.001).荧光定量PCR显示哮喘组Ehf Ct/β-actin Ct值为25.28±1.05/18.71±0.39,与对照组小鼠Ehf Ct/β-actin Ct值(29.68±0.45/18.82±0.47)的差异有显著性(P=0.000).哮喘组Ehf的蛋白质表达为1.0717±0.2088,明显高于对照组的表达0.7300±0.2336(P=0.001).结论:哮喘组Ehf明显较对照组表达高,ESE-3可能是人类哮喘发病过程中一个重要的因子.

摘要:目的:了解下呼吸道感染病原体的流行情况、主要流行病原体的耐药现状以及一些特殊病原体[如耐甲氧西林的葡萄球菌(MRS)、超广谱β-内酰胺酶(ESBLs)菌株等]的流行和耐药现状,为临床合理应用抗菌药物提供依据.方法:用WHONET 5软件统计分析2004年南京医科大学第一附属医院住院患者3 863份痰液标本培养及药敏结果.结果:下呼吸道感染病原体中,革兰阴性菌居首位,占所有阳性标本的50％;其次为真菌占33％.所有致病菌中,白色念珠菌位居第一(14％),铜绿假单胞菌位居其次(11％),不动杆菌属(8％)、肺炎克雷伯菌(8％)、热带念珠菌(7％)亦较为常见,耐药菌株比例较高.产ESBLs菌检出率为12％,对三、四代头孢菌素及氟喹诺酮类耐药比例较高.MRS占所有葡萄球菌的65％,以表皮葡萄球菌为主,对大环内酯类、氟喹诺酮类及头孢菌素类呈现高度耐药.结论:目前下呼吸道感染病原体中条件致病菌比例在逐年上升,多药耐药菌比例增加.针对产ESBLs菌株建议选用碳青霉烯类、哌拉西林/他唑巴坦,对MRS推荐用万古霉素,其他药物耐药率均较高.

摘要:目的:探讨培多普利对原发性高血压大鼠左心室肥厚重构及进程中血管紧张素Ⅱ(Ang-Ⅱ)和肌浆网钙ATP酶的影响.方法:原发性高血压大鼠分成模型组、培多普利治疗组[SHR-t 1 mg/(kg)·d],WKY大鼠为正常对照组(WKY).电镜观察左心室肥厚的超微结构,并分别测定心肌指数(左室重/体质量,LV/WT),血、心肌Ang-Ⅱ水平和肌浆网钙ATP酶的活性变化.结果:SHR-t组的血AngⅡ水平无明显改变,SHR组的血压、LV/WT(3.98±0.32)mg/g、Ang-Ⅱ(16.72±5.24)pg/mg水平显著升高(P＜0.01),电镜下可见心肌相对缺氧及代偿性细胞功能活跃表现.SHR-t组血压、LV/WT(3.38±0.31)mg/g、Ang-Ⅱ(12.94±1.63)pg/mg明显下降(P＜0.05),且未见上述心肌超微结构改变;但SHR-t组的LV/BW与WKY组(2.29±0.49)mg/g相比仍有显著差异(P＜0.01);SHR组肌浆网钙ATP酶活性明显下调[0.52±0.11 μmol/(g·min),P＜0.05],治疗后恢复[0.82±0.11 μmol/(g·min),P＜0.05],但仍未达正常.结论:ACE-I主要通过抑制局部肾素-血管紧张素系统通路,对高血压大鼠左心室肥厚重构起了很好的逆转作用,但不可能完全阻断左心室肥厚的进程.

摘要:目的:探讨超声心动图在经导管膜周部室间隔缺损封堵术中的应用价值.方法:选择行经导管膜周部室间隔缺损封堵术的患者56例,经胸超声心动图用于封堵术前患者的筛选,术中封堵器放置的引导和监测以及术后心脏结构、功能及血流动力学变化的随访.结果:①54例患者成功地进行了室间隔缺损(VSD)封堵.术前超声检查显示VSD最大直径为9.7 mm,最小为2.6 mm,平均4.89±0.92 mm,术中X线左心室造影显示分别为10.8 mm、2.0 mm,平均5.22±0.91 mm,超声测值与造影测值间无明显差异;VSD残端距主动脉瓣距离:超声测值小于X线测值(3.13±1.32 mm vs 5.84±1.71 mm),两者间存在显著性差异(P＜0.05).②封堵术后即刻超声检查可见5例存在残余分流,其中2例1周后残余分流消失,2例1个月后残余分流消失,另1例6个月后虽仍有少量残余分流,但分流速度小于200cm/s,且未见溶血等并发症;术后1周内复查示左室内径明显缩小及左室流出道血流速度增快(P＜0.05).结论:超声检查有利于术前选择合适的VSD封堵术患者,术中引导封堵器的放置,术后检测有无残余分流,对了解心脏结构、功能及血流动力学的改变具有重要作用.

摘要:目的:探讨胃癌组织中凋亡抑制蛋白liyin表达情况及其与各临床病理因素的关系,以及和凋亡抑制蛋白survivin表达的相关性.方法:采用逆转录多聚酶链式反应(RT-PCR)检测胃癌组织中livinα、liyinβ和survivin的mRNA的表达,并用western blot分析livin和survivin蛋白的表达.结果:40例胃癌组织中livin表达阳性率为47.5％、survivin为60％,而在正常和癌旁组未检出阳性结果;livin的表达与组织分化和淋巴结转移有关,组织分化差,淋巴结转移者livin表达率高(P＜0.05);24例survivin阳性样本中有14例livin呈阳性.结论:livin在胃癌组织中表达增高,可作为胃癌的分子标志物,可能成为胃癌治疗的新分子靶点,livin表达和survivin表达在本实验中结果显示没有相关性(P＞0.05).

摘要:目的:观察奥沙利铂(L-OHP)联合卡培他滨(Xeloda)联合化疗方案(Xelox方案)治疗老年胃肠恶性肿瘤的近期疗效并比较其对患者生活质量的影响.方法:第1、8、15天静滴奥沙利铂100mg 2 h;第1～14天口服卡培他滨1 000mg/(m2·d),分2次口服,28天为1个化疗周期.按照WHO的标准进行评价.结果:全组32例老年胃肠恶性肿瘤患者均可进行评价,完全缓解(CR)1例,部分缓解(PR)15例,总有效率(CR+PR)48.8％;中位随访时间13.5(2～26)个月,半年生存率为73％,1年生存率为40％;中位生存期为11个月;Xelox方案毒副反应较轻,主要为神经毒性及口腔黏膜炎,患者均能耐受,化疗前与联合化疗后3个月患者生理和心理领域的生活质量差异有显著意义(P＜0.05).结论:Xelox方案对老年性胃肠恶性肿瘤安全且有明显的疗效,并可显著改善患者的临床症状和提高生活质量.

摘要:目的:研究融合型自杀基因Fcy::Fur联合5-FC对胶质瘤细胞株C6的杀伤效果.方法:扩增Fcy::Fur基因并构建Fcv::Fur基因重组逆转录病毒载体PLXSN-Fcv::Fur;载体转染包装细胞PT67获得高滴度病毒再转染鼠胶质瘤细胞C6,筛选并鉴定阳性转基因克隆;以MTT法和FCM法检测5-FC对Fcy::Fur转基因细胞的杀伤效应.结果:PCR法扩增出全长Fcy::Fur基因,经测序证实序列正确;PLXSN-Fcy::Fur滴度为3×106CFU/ml;RT-PCR检测显示Fcy::Fur转基因阳性克隆的C6细胞有效表达目的基因的mRNA;应用5-FC后FCM法检测到显著的凋亡峰,MTT法检测细胞有明显的杀伤效应.结论:融合型自杀基因Fcy::Fur联合5-FC可对胶质瘤细胞C6产生明显的杀伤作用.

摘要:目的:探讨肿瘤坏死因子(TNF-α)和可溶性肿瘤坏死因子受体(sTNFRⅠ)对体外培养的子宫内膜异位症患者(EMs)在位内膜基质细胞的影响,探索EMs生物治疗的靶标.方法:对10例EMs患者的在位子宫内膜组织进行分离纯化、体外培养、鉴定.将基质细胞接种于96孔板中,用不同浓度的TNF-α和sTNFR Ⅰ处理.用MTT法(溴化钾噻唑基四唑显色法)观察基质细胞的生长情况,并收集细胞上清液,利用ELISA法(双抗体夹心法)检测细胞培养上清液中白介素-8(IL-8)的水平.结果:TNF-α以剂量依赖方式促进EMs基质细胞的增殖,并促进基质细胞表达IL-8(P＜0.05);sTNFR Ⅰ能阻断TNF-α的促增殖作用,但剂量必须很大.结论:TNF-α在EMs的病理生理过程中起了较大的作用,sTNFR Ⅰ可考虑作为EMs生物治疗的新方向.

摘要:目的:探讨大鼠同种异体肾移植外周血淋巴细胞(peripheralblood lymphocyte,PBL)穿孔素、颗粒酶B的表达与急性排斥反应(acute rejection,AR)的关系.方法:实验组:异基因移植组(SD→Wister),对照组:同基因移植组(Wister→Wister).采用逆转录聚合酶链反应(RT-PCR)检测移植肾和PBL穿孔素、颗粒酶B的表达,并以同基因肾移植为对照.结果:病理学检查结果显示实验组大鼠在术后第5、7、9、11天分别发生轻、中、重度排斥,对照组无明显排斥现象.RT-PCR结果显示急性排斥反应发生在肾移植术后3天,即急性排斥早期均表达穿孔素、颗粒酶B基因mRNA,4天后表达明显增强,并贯穿整个排斥反应全过程,而同基因对照组术后11天内均不表达两基因.外周血和肾组织中穿孔素、颗粒酶B mRNA的表达水平平均在急性排斥反应发生前3～5天开始明显上升,其变化趋势早于血清肌酐.结论:穿孔素、颗粒酶B是一种有价值的AR标志物.定量RT-PCR测定外周血淋巴细胞中穿孔素、颗粒酶B mRNA表达可以较敏感预测肾移植急性排斥反应的发生,这一非侵入性检查方法可以为急性排斥反应的监测和诊断提供客观依据.

摘要:目的:观察实验性急性坏死性胰腺炎(acute necrotic pancreatitis,ANP)中炎症细胞因子(TNF-α和IL-1β)和抗炎细胞因子TGF-β之间的动态变化;并且分别进行抗TNF-α和抗IL-1β处理,进而探讨对细胞因子产生水平的影响.方法:制作ANP鼠模型,施加抗TNF-α或抗IL-1β处理,制备血清,ELISA检测TNF-α、IL-1β和TGF-β的表达水平.结果:ANP模型中,TNF-α和IL-1β早期(3 h)即显著升高,TGF-β进展期(6 h)显著升高;TNF-α和IL-1β互相促进分泌;TNF-α单抗处理抑制晚期TGF-β(12 h)的产生;IL-1β单抗处理则促进早期(3 h)和进展期(6 h和9 h)TGF-β的产生.结论:ANP的发生发展与TN,F-α、IL-1β和TGF-β关系密切,且TN F-α、IL-1β和TGF-β3种细胞因子之间存在动态调节.

摘要:目的:探讨全肠外营养(TPN)、传统TPN及添加丙氨酰谷氨酰胺(Ala-Gln)的TPN对肝移植后机体蛋白质代谢及营养状况影响.方法:将35例肝移植患者随机分3组:术后未经TPN(饮食组)、不添加Ala-Gln的TPN组(传统组)、添加Ala-Gln的TPN组(二肽组).TPN于术后第2天予以等热量(每千克体重104.6 lJ)、等氮量(每千克体重0.16 g)共7天.对术后第2天、术后第9天营养预后指数(PNI)、总蛋白(TP)、白蛋白(Alb)、前白蛋白(PAB)、转铁蛋白(TF)监测.结果:术后第9天比较于术后第2天,增高差异有显著性的有:所有组的Alb(P＜0.05).传统组的PAB、TF及二肽组的PNI、PAB、TF(P＜0.01);增高幅度大且差异有显著性的有:二肽组较饮食组及传统组的PNI(P＜0.05),二肽组较饮食组的Alb(P＜0.05),二肽组较饮食组及传统组的PAB(P＜0.01),二肽组及传统组较饮食组的TF(P＜0.01).结论:肝移植术后TPN是必要的,而TPN中添加Ala-Gln能更好地改善蛋白质代谢和营养状况.

摘要:目的:总结分析胆石性肠梗阻的临床诊断与治疗特点.方法:回顾分析1997年2月至2003年12月收治肠梗阻患者中因胆石梗阻所致者的外科治疗与随访情况.结果:胆石性肠梗阻9例(男3例,女6例,中位年龄72岁)均行急症肠切开取石,解除肠梗阻,无手术死亡;其中1例胆石性肠梗阻在术后9月复发而再次手术.2例后期行胆囊切除、胆肠瘘修补.结论:胆石性肠梗阻病例急症手术应以解除肠梗阻为首要目的,是否胆肠瘘修补应根据各别情况考虑,以二期处理较为适宜.

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摘要:人感染高致病性禽流感疫情在世界多个国家的传播,不仅对社会大众健康产生了威胁,而且更加凸显药品专利保护与公众健康需要之间的矛盾,药品专利强制许可无疑是解决这个矛盾的一条途径.文章对药品专利强制许可的背景、理论进行了分析,指出了目前实施这一许可的障碍,并提出了相应的对策.

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摘要:古语云:无信不治、无信不立.诚信是行政执法的基石.药品,作为关乎人民生命健康的特殊商品,对其进行合理有效的监管非常重要,而这就需要大力推进药监部门的自我诚信建设、督促其做到"诚信执法".文章在对目前存在于药品监督管理过程中的诚信问题进行分析的基础上,就如何加强药监诚信建设提出了若干建议.

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摘要:从公共性的角度看,突发性公共卫生事件应对机制中的主体可以划分为政府主体、社会组织主体和个人主体这三大类,依托于现代公共管理活动中的民主性、科学性和权力性价值标准,沿着公共政策的逻辑过程,对三类主体之间的互动关系做出了初步的理论构建.

摘要:"和"是中国传统文化的内在精神和显著特征.当前,在构建当代中国社会主义和谐社会的过程中,中国传统文化担当重要角色.文章在回顾中国传统文化融合发展推动传统和谐社会的历史的基础上,指出我国转型期间传统文化的发展模式:在融合中扬弃,在融合中继承、发扬,这种模式将有利于推动和谐社会的进程.

摘要:依法执政是共产党全面总结半个多世纪以来的执政经验,积极适应建立社会主义市场经济体制和依法治国、建立社会主义法治国家的客观需要,主动应对经济全球化和错综复杂的国际局势对领导方式尤其是执政方式作出的重大变革和创新,既反映了党在新的历史条件下对治国执政思路一以贯之的理论探索,更反映了党对治国执政方式与时俱进的制度创新.党依法执政的关键,则在于实现执政方式和领导方式的变革和创新.

摘要:党内监督是加强党风廉政建设的重要环节,其实质是党从人民利益出发,按照从严治党的要求,进行自我约束和自我完善.邓小平同志深刻阐述了加强党内监督的必要性与紧迫性、基本方法与实现途径等问题,对于加强和改进党的建设,全面推进党的建设新的伟大工程具有重大的现实意义.

摘要:中国的改革开放,一方面促进了生产力的解放和发展,另一方面,也解放了人们的思想.现在,从中央到地方以及一般百姓都认识到人本身发展的重要性,形成了以人为本的科学发展观.为了更好实现这一目标,党中央开始关注并推行带薪休假的休闲生活,以促进人的全面发展.文章简单分析了人的全面发展的现实要求以及带薪休假的休闲生活对人全面发展的重要作用.

摘要:文章采用筹资来源法收集了无锡市1995年至2003年卫生总费用相关数据,分析了无锡市卫生总费用的筹资规模和变化趋势,卫生总费用的筹资结构中政府、个人与社会的总体构成及变化趋势,其中着重分析了政府投入水平和个人医疗保健支出负担水平的变化趋势,并进行了地区比较.最后针对问题提出了相关的政策建议.

摘要:扬州市邗江区1999年对全区21所乡镇卫生院进行了产权制度改革.改制前3年,实行"医防合一"体制,从2002年起实行"医防分设"体制.文章采用定性调查和定量调查相结合的方法,比较改革前后农村卫生体系和农村预防保键资源、组织机构、服务效率、监督执法力度、农民满意度等方面的变化.研究表明,"医防分设"是必由之路,为进一步改革和完善预防保健体系提供了依据.

摘要:医疗基金补偿水平及方式是制约新型农村合作医疗发展的主要因素,各地都在探索有效的补偿模式.本研究在对铜山县2004年度合作医疗资金使用统计分析的基础上,重点分析参保农民住院费用及补偿状况,并对其实施过程中存在的问题进行讨论,以便为经济发展水平相近地区新型合作医疗的可持续发展提供借鉴.

摘要:文章通过对我国卫生人力资源的数量、质量、结构、分布等问题的分析,探讨了产生这些问题的经济、社会、政策等方面的因素,认为医学人才培养结构不合理、缺乏有效人力资源配置机制和政策机制,是导致这些问题的主要因素,据此提出了改善我国卫生人力资源质量、配置的政策建议.

摘要:目的:比较社区卫生服务中心及各级医院常见手术费用;社区卫生服务中心手术是否便捷、低耗,有无保留的必要.方法:调研南京市社区卫生服务中心及各级医院常见手术的单病种费用,社区卫生服务中心与各级医院的费用做统计分析比较.结果:社区卫生服务中心单病种手术平均住院费用明显低于与各级医院.结论:从经济学的角度分析,各级医院手术费用差别很大,在规范和安全的前提下,社区卫生服务中心保留基本的手术功能是符合社区居民需求和社区卫生服务自身发展需要的.

摘要:循证医学反映了现代医学的发展趋势和方向.医院管理必须顺应这一趋势,积极引入循证医学思维,更新医院管理理念和模式,确保医院可持续发展,适应和满足医疗市场的需求.本文就循证医学的概念、医院管理引入循证医学思维的必要性及其对现代医院管理产生的积极影响加以分析.

摘要:病历档案是一种特殊的专门档案,目前我国已经出台了<医疗机构病历管理规定>、<医疗事故处理条例>等与其相关的法律法规.但是患者的权利在这些法律法规中并没有具体体现.随着社会的发展和科学技术的不断进步,必须制定新的法律法规以确保患者的知情权,促进病历档案管理的逐步完善.

摘要:文章阐述了知识管理的概念及涵义,认为医院实行知识管理是适应知识经济时代的需要、适应经济全球化发展的需要、适应医院生存和发展的需要、实现知识共享、发挥个人潜能的需要、实现知识增值的需要,并提出医院实现知识管理的途径,即倡导以人为本的医院管理理念、成立医院知识管理团队、建立医院知识共享支持系统、营造终身学习的氛围、构建适应医院知识管理的医院文化.

摘要:文章从人性、人性需要出发,依据就医人群的生存、舒适、情感的需要,具体探讨医疗服务人性化的内涵.详细分析在医患关系肾张,医疗服务竞争激烈的今天,开展人性化医疗服务是适应了现代医学模式的需要,有利于医院文化的建设,能有效提升医疗服务质量和水平.笔者在充分调研实践的基础上总结出了人性化医疗服务的基础模式(保存生命,保证舒适,保护情感),并对其进行了详细阐述.

摘要:近年来,笔者所在单位试行了多种途径进行高层次人才的培养并付诸实践,全院上下也形成了良好的学习氛围,高层次人才不断涌现,使医院始终在全省保持领生地位.当今充满竞争的形势,需要各大医院不断探索高层次人才培养的途径,以促进整个医疗事业的进步.

摘要:校园"一卡通"信息管理系统的建设,可实现个人消费、远程收费、公用经费远程结算、网上财务查询、水电成本控制等功能,可实现从个人资金消费管理、财务公用经费管理到对财务成本及学校经济资源的控制管理.如何实现有效应用校园"一卡通"加强学校财务管理,是文章主要论述的问题.

摘要:医学院校社科学报要想生存、发展与壮大,必须走出一条特色之路:坚持"医文结合"的办刊理念."医文结合"办刊理念的定位要有理论和实践的依据,还要确定"医文结合"学术研究的范围,只有这样,医学院校社科学报才能从众多期刊中脱颖而出.

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摘要:近年来自主学习一直是外语教学研究的焦点.文章以问卷调查的形式对非英语专业学生的课后听说自主学习情况进行了调查,根据调查分析发现,学生对课堂听说教学较为满意,对课后听说自主学习重要性有充分的认识,课后听说自主学习现状不容乐观.文章在调查分析的基础上对改进大学英语教学提出了几点建议供参考.

摘要:Objective: To examine the effects of deltamethrin(DM) and tBHQ on the activation of Nrf2 and expression of GCS-HS in primary astrocytes. Methods: Rat primary astrocytes were treated with DM (10 μmol/L) and tBHQ (40 μmol/L), for 1 and 6 h respectively. Results: Analysis using immunofluorescent confocal microscopy revealed that tBHQ treatment led to a dramatic increase in the level of Nrf2. The ratio of cytoplasmic Nrf2 protein to nuclear Nrf2 protein was markedly reduced in astrocytes by either tBHQ or DM treatment. The level of Nrf2 was reduced by combined tBHQ with DM treatment for 1 h, but treatment the ratio of cytoplasmic Nrf2 protein to nuclear Nrf2 protein was increased compared with that of the tBHQ only. The expression of GCS-HS in astrocytes was not altered by DM or tBHQ or both in astrocytes. Conclusion: These findings demonstrated for the first time that Nrf2 was activated by pesticides and antioxidants in astrocytes, implicating a role of Nrf2 in response to pesticide neurotoxicity ingla.

摘要:Objective: Heat shock protein (HSP) has the promiscuous abilities to chaperone and present a broad repertoire of tumor antigens to antigen presenting cells including DCs. In this report, we analyzed the modulation of immature DC by HSP 96 (gp96).Method: Murine bone marrow-derived DC was induced by GM-CSF plus IL-4, which aped the immunostimulatory effects of DC.Cocultured DC and gp96-peptide complexes (gp96-PC) or inactivated H22 cells, the expression of MHC class Ⅱ, CD40, CD80 was quantified by flow cytometry. The concentration of IL-12 and TNF- in culture supernatants were determined by ELISA.[51] Cr release assay was used to test specific cytotoxic T cell. Results: Our study demonstrated that the extent of DC maturation induced by gp96-PC, which was reflected in surface density of costimulatory and MHC Ⅱ molecules, was correlated with the secretion of IL-12 and with the T cellactivating potential in vitro. Conclusion: Heat shock protein 96 could be isolated and purified from H22 cells and could induce maturation of dendritic cell. Our findings might be relevance to the use of DC vaccine in therapy of human tumors.

摘要:Objective: To analyze the molecular mechanism of integron mediated multi-resistance in an ESBL-producingK. Pneumoniae NJ 12 isolate. Methods: Susceptibility test was carried out by Kirby-Bauer method. Class Ⅰ, Ⅱ and Ⅲ integrons were detected by integrase gene PCR with primers that annealed to conserved regions of integron-encoded integrase genes intIl, intI2 and intI3.The variable region of integron was amplified by integron PCR with primers that targeted the conserved flanking regions, and the PCR product was sequenced. Six aminoglycoside modifying-enzyme genes, including ant ( 2")- Ⅰ , ant ( 3")- Ⅰ , aac (3)- Ⅰ , aac ( 3 )- Ⅱ , aac (6')- Ⅰ , and aac (6')- Ⅱ, were detected. Results: K. Pneumoniae NJ 12 was resistant to nine antibiotics, including piperacillin,ampicillin, cefuroxime, ceftazidime, cefotaxime, aztreonam, streptomycin, gentamicin and amikacin. This isolate was shown that there was positive with class Ⅰ integron, ant(2")- Ⅰ , ant(3")- Ⅰ , aac(3)-Ⅱ and aac(6')- Ⅰ modifying-enzyme genes. Neither class Ⅱ nor Ⅲ integron was detected; DNA sequencing of the fragment amplified by integron PCR revealed a novel cassette array aadB-cat-blaoxa-10/aadA1. Conclusion: Class Ⅰ integron with a novel cassette array in an ESBL-producing multidrug-resistant K. Pneumoniae NJ 12 isolate was reported from Nanjing area of China, with the GenBank accession number DQ141319.

摘要:Objective: To analyze the effect of cytarabine combined with vincristine on HL-60 cell line in vitro. Methods:The median-effect equation and MTT assay were used on HL-60. Results: The cytotoxic activity of cytarabine(Ara-C) and vincristine (VCR) used alone or in combination enhanced as drug concentration increased. The order of administration did not influence the cytotoxic activity of the combined antitumor drugs. The ratio of drug concentration was a factor to influence the killing effect. The interaction of the agents was synergistic at lower concentration, and antagonistic at higher concentration. Conclusion: The combined drugs interaction(CI ＜ 1)was synergistic at lower concentration and antagonistic at higher concentration. The ratio of drug concentration is a significant factor that can influence the killing effect.

摘要:Objective: To define gene expression profiles during late stage of embryonic pancreatic development of rats and to find out key genes in rat pancreatic functional development. Methods: Pancreata of rats in embryonic day 15.5(E15.5) and 18.5(E18.5)were dissected under microscope respectively. Genechips from Affymetrix company were applied to study gene expression profiles. Some differentially expressed genes were verified by RT-PCR. Results: Comparing El8.5 to El5.5, 8.3％ genes were expressed differently 2-fold above, in which, 50.3％ were up-regulated, including transcriptions related to metabolic development and various kinds of enzymes and hormones (both endocrine and exocrine) and 49.7％ were down-regulated, including transcriptions related to cell differentiation. The percentage of genes having definite function was 63％, and that of expressed sequence tag(EST) was 37％. The result of RT-PCR is accordant to that of genechips. Conclusion: The metabolic function of rat pancreas may be further accomplished during late stage of embryonic day.

摘要:Objective: To investigate the expression of resistin gene in diet-induced obesity (DIO) and diet resistance (DR)rats. Methods: DIO and DR models were prepared with male SD rats after 6 weeks feeding by a diet of relatively high fat, sucrose, and caloric content (HE diet). Body-weight, fat mass, and the concentration of serum insulin were measured, and the expression of resistin and Peroxisome proliferator-activated receptory-γ(PPAR-γ) gene in whit adipose tissue (WAT) was also detected by RT-PCR. Results: ①Body weight, fat mass and the concentration of serum insulin were significantly increased in DIO rats and decreased in DR rats. ② The expression of resistin and PPARγ gene was upregulated in DIO group and supressed in DR group, but the expression of resistin was not detectable in all samples within three groups. Conclusion: Resistin may serve as a link between obesity and insulin resistance, but the individual difference is enormous.

摘要:Objective: To study the clinical features of upper gastrointestinal burns by peroxyacetic acid (PA) in children and improve its treatment and outcome. Methods: The clinical materials of 7 cases with upper gastrointestinal burns by PA including clinical presentation, treatment and outcomes were reviewed. Results: There were six boys and one girl. The concentration of the swallowed PA was from 10％ to 20％ and the amount was 3-10 ml. The mainly burns were located in esophagus in one case, stomach in three cases, both esophagus and stomach in three cases. The gastrostomy and operation of dilating esophagus were performed in the cases with esophageal stricture. The pyloroplasty or gastroduodenostomy was performed in the cases with pyloric obstruction. All the cases were followed up for 12-18 months, dysfunction of esophagus or(and) cardia as well as stiffness and hypodynamia of the stomach was showed in most of the patients. Conclusion: The degree of upper gastrointestinal burns by PA varied according to different concentrations of PA which was swallowed. Correct emergent measures in the acute stage of the bums was very important, gastric tube should be inserted and go through esophagus and pylorus and must be retained for 5-8 weeks to prevent the stricture of esophagus and pylorus, otherwise the tube could act as a passage of nutriment. Prophylaxis of upper gastrointestinal burns by PA is very important because the treatment of the burns is difficulty and the outcomes are not always satisfactory.

摘要:Objective: To study the effects of tetrandrine (Tet) on phenotypic modulation of vascular smooth muscle cells (VSMCs) and expression of p38 mitogen-activated protein kinase (p38MAPK) as well as mitogen-activated protein kinase phosphatase-1(MKP-1) after vascular intimal injury. Methods: HE staining was used to analyze vascular morphology of sham-injured group, injured group and Tet-treated group at day 28. Immunohistochemistry, Western blot and RT-PCR were respectively used to detect the expression change of smooth muscle α-actin (SMα-actin), proliferation cell nuclear antigen (PCNA), p38MAPK and MKP-1 of injured group and Tet neointimal area was significantly increased and the lumen area notably decreased in injured group at day 28. The neointimal proliferation in Tet treated group was less than that in injured group, and the lumen area of Tet group was significantly increased than that of injured group was no difference, and the neointimal proliferation condition was also basically as same as injured group at day 7 after injury. The expression of PCNA and p38MAKP in Tet group was obviously lower than that in injured group, and the expression of MKP-1 in Tet group was obviously higher than that in injured group at days 14 and 28 after injury. The expression of SMa-actin in Tet group was slightly higher than that in injured group at days 14 and 28 after injury. Conclusions: Tet could reduce neointimal proliferation by inhibiting VSMCs phenotypic modulation and p38MAPK signaling transduction pathway as well as its down regulation.

摘要:Objective: To explore the effect of tumor necrosis factor (TNF)-α on matrix metalloproteinase-9 (MMP-9)expression and activity in alveolar macrophages (AM) from patients with chronic obstructive pulmonary disease (COPD) and study its associated signal pathway. Methods: AM were collected from bronchoalveolar lavage fluid in patients with COPD. The AM were incubated for 1.5 h with pyrrolidine dithiocarbamate(PDTC)at concentrations from 0 μmol/L to 50 μmol/L and then stimulated for 24 h by TNF-α at 10 ng/ml. MMP-9 expression and activity were respectively detected by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR), Western blotting and Zymography. NF-κB activity was investigated by electrophoretic mobility shift assay (EMSA).Results: Both the mRNA and protein levels of MMP-9 induced by TNF-α in AM were significantly elevated in a dose dependent manner (P ＜ 0.05). The level of MMP-9 activity was also correspondingly significantly elevated in the induction ( P ＜ 0.05), which was possibly related with the over-expression of MMP-9. NF-κB activity was significantly increased when AM were stimulated by 10 ng/mL TNF-α (P ＜0.05). The expression of MMP-9 induced by TNF-α could be significantly inhibited by PDTC ( P ＜ 0.05). Conclusion: The expression and activity of MMP-9 from AM could be induced by TNF-α, and NF-κB signal pathway played an important role in the induction.

摘要:Objective: To detect the expression of second mitochondria-derived activator of caspase (Smac) in bladder cancer and discuss its clinical significance. Methods: Smac was detected in 15 specimens of normal bladder epithelium and 72 specimens of bladder cancer by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry at the level of gene and protein,respectively. Results: The differences of both Smac protein and mRNA expressions between normal mucous membrane of bladder and grade Ⅰ bladder cancer had no statistical significance ( P ＞ 0.05). The expressions of Smac protein and its mRNA in bladder cancer decreased gradually with the advance of bladder cancer ( P ＜ 0.01 and P ＜ 0.05, respectively ). In invasive bladder cancer, the expressions of Smac protein and its mRNA were higher than those in superficial bladder cancer (P＜0.01). Conclusions: Normal bladder epithelium has high expression of Smac while bladder cancer has low expression of Smac. The expression of Smac is closely related to the grade and stage of bladder cancer. Detection of Smac expression helps to judge the grade and stage of bladder cancer and Smac gene might become a valid target for gene therapy of bladder cancer.

摘要:Objective: To investigate the expression of cyclooxygenase-2 (COX-2) mRNA in drug-sensitive cell and drugresistant clones of ovarian cancer cell lines. Methods: RT-PCR and immunocytochemistry were used to investigate the expression of cyclooxygenase-2 in 3 clones drug-sensitive and 5 clones drug-resistant ovarian cancer cell. Results: Strong COX-2 mRNA expressions were detected in 3 clones of drug-sensitive cell and weak expressions were detected in 5 clones of drug-resistant cell. The protein expression of COX-2 in drug-sensitive cell was strongly positive reaction in immunocytochemistry stain and there was a weak positive reaction in 5clones of drug-resistant cell. Conclusion: The expression of COX-2 mRNA in drug-sensitive cell strains is much higher than that in drugresistant strains of ovarian cancer cell lines, providing a basis of the chemoprevention for ovarian cancer.

摘要:Objective: To study the alternation of distribution of the stress in the necrotic femoral head with different kinds of grafting materials by using three-dimensional element methods and find out the most optimal one with sound biomechanical principles before clinical application. Methods: We prepared a three dimension finite element model of central femoral head necrosis with surface modeling technique (spiral ct)and calculated the peak stress index of necrotic portion in three situations:core drilling in 14 mm diameter and grafting with titanium,fibula,polylactide. Results: The peak stress index of normal femoral head was 0.05,but in osteonecrotic femoral head, the peak stress index was 13 times of the normal (0.67). The value of necrotic portion with big shallow angle (0.67) was larger than the one with small deep angle (0.49). Core drilling in 14 mm diameter and grafting with titanium, fibula and polyactide could diminish the bad stress in the necrotic portion respectirdy. The decrease volume in small necrotic area (90°) is marked(38％), while in big necrotic area (150°) it was indistinctive(10％). In the same necrotic portion, the decrease volume with titanium was(38％) larger than with the fibula (37 ％ ), and also larger than with the polyactide(29％ ). Conclusion: In necrotic portion of femoral head, the badshess could produce 13times of the normal one. Grafting with titanium, fibula and polyactide could reduce the bad stress respectively. The effect of titanium is most marked, second is fibula and polyactide is indistinctive. The effect was in big necrotic portion is bad, the best effect was in small necrotic portion.

摘要:Objective: To determine the expression of c-kit receptor in peripheral blood mononuclear cells (PBMCs) in patients with systemic lupus erythematosus (SLE), and analyze the relationship between the c-kit expression level of PBMCs and clinical parameters. Methods: Peripheral blood mononuclear cells in 47 patients with SLE and 21 healthy volunteers were collected. Expression of c-kit mRNA in PBMCs were determined with reverse transcription-polymerase chain reaction (RT-PCR). The protein of c-kit receptor (CDll7) in PBMCs was measured by flow cytometry. Results: Expression of c-kit receptor protein and mRNA in patients with active or inactive SLE ( n = 47) were significantly higher than those in controls. The c-kit receptor of PBMCs in SLE patients were significantly higher than those in healthy controls ( n = 21), the c-kit receptor of PBMCs in active patients ( n = 27) were significantly higher than those in inactive patients ( n = 20) and there was no significant difference was found between patients with inactive SLE and healthy controls(P＞0.05). The c-kit receptor of PBMCs in SLE have significant association with activity index. Conclusion: Production of c-kit receptor is aberrantly increased in PBMCs in patients with SLE. C-kit receptor might be more closely related to the clinical parameters in SLE patients,which might reflect the clinical status of SLE patients.