老年胃癌患者全胃切除后早期肠内膳食纤维素营养液的作用

目的　探讨老年胃癌患者全胃切除后 ,早期使用膳食纤维素营养液肠内营养 (EN)的可行性。方法　 5 0例 6 0岁以上胃癌全胃切除患者 ,随机分为实验组 2 5例 ,用能全力 (TPF) 9d ;对照Ⅰ组 2 5例 ,用等氮、等热卡、等时间肠外营养 (PN)。另随机抽取同期 6 0岁以下同样患者 2 5例为对照Ⅱ组 ,支持方法和时间与实验组相同。结果　①营养指标。三组患者体重、三角肌皮折厚度、肌酐身高比、白蛋白 ,手术后第 9天都分别恢复到近于手术前 1d水平 (P >0 .0 5 ) ,仅谷氨酰胺对照Ⅰ组降低明显 (P <0 .0 5 )。术后第 4天至第 9天氮累积水平对照Ⅰ组也较低 (P<0 .0 5 )。②安全性。全部患者均无严重不良反应 ,都安全渡过术后恢复期。实验组比对照Ⅰ组肛门排气恢复显著提前 (P <0 .0 1)。结论　老年胃癌患者全胃切除后 ,早期使用膳食纤维素营养液EN ,安全适宜 ,效果良好 ,和较年轻患者近似 ,比同龄患者PN疗效高。     

服务于社区与农村慢性病患者的医学生健康教育实践性课业的研究与实践

目的:研究医学生健康教育社会实践对学生沟通能力的影响,探索可操作性健康教育能力培养模式。方法:选取大二护理专业与康复专业52名学生作为实验组,同年级同专业52名学生作为对照组,实验组学生在专业教师指导与督导下对社区与农村慢性病患者实施健康教育,对照组按传统方式培养。结果:服务对象满意度达98%,所有接受服务者均认为对其健康有利。学生的信息获取(实验组40.12±5.43,对照组27.27±3.43,t=9.13)、重视沟通(实验组39.35±4.98,24.73±4.08,9.78)、信息告知(实验组25.91±3.83,对照组18.37±2.91,t=5.31)、沟通意识(实验组19.34±3.12,对照组12.37±2.01,t=5.09)、尊重意识(实验组20.46±3.27,对照组13.72±2.18,t=4.98)得分均明显高于对照组学生,教师的专业能力得到一定程度提高。结论:社会实践性健康教育对培养医学生的沟通能力与教师的教学能力有重要的促进意义,同时也可作为基层人民群众健康服务的补充力量。     

Effects of pioglitazone on serum leptin and adiponectin in polycystic ovary syndrome patients with insulin resistance

Objective To investigate the effects of pioglitazone on serum leptin and adiponectin in polycystic ovary syndrome (PCOS) patients with insulin resistance (IR). Methods Thirty-five PCOS patients with IR were treated with pioglitazone 15mg/d for 12 weeks. The results of ovulation induction were observed. The changes of fasting plasma glucose (FPG), fasting serum insulin (FINS), serum levels of leptin, adiponectin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and blood fat were examined at the baseline and after the therapy by enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay (RIA). Results After the treatment, the rate of ovulation per cycle was improved in 31 (88.5%) out of the 35 patients. After treatment, the level of serum leptin was decreased (P<0.05) while the level of serum adiponectin was increased (P<0.05). After 12 weeks'treatment, waist-to-hip ratio and F-G score were significantly decreased (P<0.05), BMI declined but without significant difference (P>0.05). The levels of LH, T, FINS, Homa-IR, total cholesterol, triglyceride and low density lipoprotein-cholesterol were significantly decreased (P<0.01, P<0.05), whereas the level of high density lipoprotein-cholesterol was significantly increased (P<0.01). No significant difference was seen in FSH and FPG following treatment (P>0.05). Conclusion Pioglitazone treatment can effectively improve PCOS with IR patients'clinical syndromes, insulin sensitivity, glucose and lipid metabolism at least partly through improving the profiles of leptin and adiponectin.     

Significance of intensive glycemic control on early diabetic nephropathy patients with microalbuminuria

Objective To investigate the therapeutic effect of intensive glycemic control on patients with early diabetic nephropathy. Methods A total of 41 type 2 diabetes patients who developed microalbuminuria were divided into two groups randomly. Patients in Group A received intensive glycemic control and the blood glucose in Group B was regularly controlled. Glycemic monitoring and control were followed for 12 weeks to observe the changes of microalbuminuria in both groups; meanwhile the levels of serum lipids and coagulation indices were also recorded. Results The urine albumin excretion rate (UAER) in Group A decreased significantly from (47.91±13.86)mg/24h to (35.31±14.56)mg/24h after 12 weeks (P<0.05), and this decrease was significantly greater than that in Group B. However, Group B had no significant difference in UAER decrease [(48.93±13.32)mg/24h to (40.48±19.62)mg/24h, P>0.05]. The decrease of triglyceride (TG) and low-density lipoprotein cholesterol (LDL cholesterol), and the increase of high-density lipoprotein cholesterol (HDL cholesterol) showed no significant differences (P>0.05). And the level of plasma fibrinogen (FIB) showed no significant decrease after 12 weeks, either (P>0.05). Conclusion Intensive glycemic control reduces the level of microalbuminuria and may ameliorate the progression of early diabetic nephropathy.     

Increased expression of the 20S proteasome in peripheral blood mononuclear cells of type 2 diabetic patients

Objective To investigate the dynamic expression of the 20S proteasome in peripheral blood mononuclear cells (PBMCs) of type 2 diabetic patients without vascular complications. Methods PBMCs were prepared from 30 type 2 diabetic patients and 30 nondiabetic controls. The general indexes including weight, height and blood pressure were recorded. Fasting plasma glucose, fasting plasma insulin and glycosylated hemoglobin were measured. The protein level of the 20S proteasome was measured by Western blotting. The mRNA expression levels of the 20S proteasome β1, β2 and β5 subunits were detected by real-time PCR. Results Compared with that in the nondiabetic controls, the protein level of the 20S proteasome was significantly increased in the diabetic patients and was positively associated with glycosylated hemoglobin. Conclusion Type 2 diabetic patients without vascular complications have an increased 20S proteasome expression, the significance of which needs to be explored by further study.     

人工智能决策工具对患者安全的影响因素分析

人工智能在医疗行业中给医生和患者带来了很多帮助,与此同时人工智能技术也带来了一定的安全隐患。分析人工智能决策工具对患者安全的影响因素,并从四个层面找出威胁患者安全的原因,进而提出减少和杜绝患者安全影响的改进策略,最大限度的提高人工智能知识决策工具辅助医生服务于患者的安全性。     

糖尿病患者血小板聚集性测定分析

目的：了解糖尿病患者微血管病变的原因及机理。方法：测定正常对照组与糖尿病组血小板聚集指数，全血粘度，红细胞压积。结果：糖尿病组血小板聚集指数明显增高，全血粘度明显偏高，二者呈正相关。结论：65例糖尿病组的血小板聚集指数不同程度地高于正常人组，高切变率下全血粘度的增高，提示糖尿病患者血小板聚集指数明显增高，是导致糖尿病患者微血管病变重要原因之一。     

大骨节病关节软骨细胞形态及工、Ⅱ、Ⅲ、X型胶原表型和MMP-13表达的体外研究

目的体外培养大骨节病（Kashin-Beckdisease,KBD）患者和正常对照的关节软骨细胞并对比观察细胞形态、I、Ⅱ、Ⅲ和X型胶原表型及基质金属蛋白酶13（MMP-13）的表达变化,以明确KBD软骨细胞的生长特性。方法依据我国“大骨节病临床诊断标准”和病理学变化特征,选择KBD患者为KBD组（n=8）,并设立正常对照组（n=8）。在无菌手术条件下采集关节软骨,胶原酶等消化、分离后进行软骨细胞培养,光镜及透射电子显微镜观察形态,免疫组织化学及流式细胞术观察细胞I、Ⅱ、Ⅲ、X型胶原和MMP-13的体外表达变化,对比研究KBD软骨细胞表型表达的特点。结果KBD软骨细胞内空泡及核变形现象较正常增多,并有绒毛及胶原纤维不规则排列等超微结构变化。两组间I、Ⅱ、Ⅲ、X型胶原表型表达差异显著,其中KBD组II型胶原表型表达显著低于对照组（t=-5．54,P〈O．001）,而MMP-13表达显著增高（t=3．70,P〈O．01）。结论KBD软骨细胞I、Ⅱ、Ⅱ、X型胶原表型和MMP-13的表达不同于正常对照组,以软骨细胞的退行性和增生性变化为著。     

一起走过的日日子我们和儿子在路上的故事

六年来,我们这三口之家,几乎游遍了祖国的大江南北。一台车、一个司机、一个心脏病患者、珍上年幼孩子的组合,不知不觉就完成了这着上去不可思议的漫长旅程。在汽车这流动的家里,我们在旅途中共同分享快乐,共同分担痛苦。一起走过的那些日子,我们和我们的孩子一同成长。     

艾里逊全自动变速箱配装奔驰Vario818D型救护车

为了确保越来越多的肥胖患者,以及重症监护患者得到良好的医疗护理及安全运送,德国埃森市消防队引进了两辆具有特殊装备的救护车.这两部装配了艾里逊全自动变速箱的奔驰Vario 818D(177PS)型救护车,比普通救护车宽30厘米,还配备了最大承重量为750公斤的大型担架,电子液压升降尾板,230伏的发电机和2.3 kVA的换流器.