加强监管 规范服务 深化医院管理年活动

为推进医院管理的科学化、规范化和标准化建设,着力解决人民群众反映强烈的热点和难点问题,卫生部和国家中医药管理局于去年4月启动了“以病人为中心,以提高医疗服务质量为主题”的医院管理年活动。近一年来,医院管理年活动在全国医疗机构展开。这是我国继开展文明医院评比、医院评审和分级管理、全国创百佳医院活动后,加强医院管理工作的又一举措。2005年8月和10月,卫生部和国家中医药管理局先后两次组织300多位专家,对全国31个省、自治区、直辖市和新疆生产建设兵团及其所属医院的医院管理年活动进行督导。根据督导结果,高强部长在2006年全国卫生工作会议报告中指出:“去年在全国开展的医院管理年活动,已经取得了一定成效,开了一个好头。各地把医院管理年活动作为落实先进性教育成果,维护群众利益,提高服务质量,控制医疗费用,缓解看病难、看病贵的一项重要措施,受到了社会各界的好评。但也存在一些问题,主要是医疗机构加强管理的成果还没有落实到便民、利民措施上,群众感受不深;有些群众反映强烈的突出问题还没有得到有效解决;管理年活动存在一些死角,有的单位损害群众利益的问题仍相当严重”。去年12月23日,卫生部医政司在厦门组织召开了医院管理年阶段工作研讨会,王羽司长出席会议并对医院管理年活动工作进展和督导情况进行了阶段性总结,医疗服务管理处赵明钢处长对全国医院管理年活动督导后整改情况进行了重点说明。护理管理是医院管理的重要组成部分,也是决定医疗服务质量的重要因素。在卫生部派出的督导组中,先后有十几位护理专家参加了督导工作。为使大家了解督查中护理工作存在的问题,以进行持续改进,本刊特邀请参加督导的有关专家撰写了一组稿件,从各角度深入分析我国医疗及护理管理中存在的问题,提出了改进建议。欢迎广大读者通过“读者信箱”把您的感想告诉我们

肝脏肿瘤诊断和治疗双功能超声造影剂的制备及实验研究

目的探索载羟基喜树碱的聚乳酸微泡的制备及超声辐照下对肝脏肿瘤细胞生物效应的影响。方法采用DMSO溶解HCPT,使HCPT大部分以内酯环闭环形式存在,应用改良的乳化-溶剂挥发法,制备载羟基喜树碱的聚乳酸微泡。结果以载羟基喜树碱的聚乳酸微泡载药量和包封率分别达到1.69%和62.2%;超声介导下载药微泡5d累积释药量接近80%。结论通过改变载药方式,可以制备出抗肝脏肿瘤活性更高的药物制剂

Preparation and quality control of Mango Cough Mixture

目的:制备芒果止咳合剂并建立其质量控制方法。方法:采用微波提取法制备芒果止咳合剂;以化学法和薄层色谱(TlC)法鉴别芒果苷;以高效液相色谱(HPlC)法测定芒果苷的含量。结果:化学法和TlC能清晰地鉴别芒果苷;芒果苷进样量在4~14μg范围内线性关系良好(r=1.0000);加样回收率为96.78%(rSd=2.00%)。结论:本制剂制备方法简便,稳定性良好。TlC法专属性强,HPlC法简便、准确,可用于芒果止咳合剂的质量控制。Objective: To prepare Mango Cough Mixture and establish its quality standard.Methods: The methods of microwave extraction was adopted to prepare for the mango cough mixture.Chemistry and TLC were used to identify Mangigerin, and HPLC was used to determine the content of Mangigerin.Results: Mangigerin was clearly identified with chemistry and TCL.A good linearity was seen of Mangigerin in the range of 4-14 μg (r=1.000 0).The recovery rate was 96.78% (RSD =2.00% ).Conclusion: The preparation is simple in preparation technique and good in stability.The TLC method is highly exclusive.The HPLC method is simple, accurate, and can be used for the quality control of Mango Cough Mixture

Preparation of Chitosan Nanoparticles for Targeting and Sustained Drug Delivery System by Ion-induced Combined with Chemical Crosslinking

目的制备粒径相对可控的壳聚糖纳米粒,探索其在药物缓释体系中的应用。方法以多聚磷酸钠为离子诱导剂、戊二醛为化学交联剂,通过离子诱导结合化学交联法,制备壳聚糖纳米粒;在1-乙基-(3-二甲氨基丙基)碳二亚胺盐酸盐(EdC)作用下,分别进行丝裂霉素载药以及聚乙二醇(PEg),叶酸修饰;另外,对载药纳米粒子进行不同PH条件下的体外释药实验;对PEg,叶酸修饰的壳聚糖纳米粒罗丹明b荧光标记后,进行激光共聚焦以及活体成像实验。结果离子诱导交联法可以获得粒径范围在200--500 nM的壳聚糖纳米粒;丝裂霉素载药量可以达到25%,包封率为50%,体外释药呈现突释和缓释双相特征,并且随着PH的升高释药明显加快;未经修饰的、叶酸修饰的以及PEg和叶酸修饰的纳米粒都能有效的进入HElA细胞,而单独PEg修饰的却很少进入细胞内;叶酸修饰的纳米粒有明显的靶向作用,PEg修饰的纳米粒可以明显延长实验裸鼠血液中循环时间。结论采用离子诱导结合化学交联法可以获得粒径可控、稳定、适合于主动靶向给药的壳聚糖纳米粒。OBJECTIVE To prepare chitosan nanoparticle with controllable size and investigate its applications to targeting and sustained drug delivery system.METHODS The combination of an ion-induced and chemical crosslinking method was used to prepare chitosan nanoparticles,and mitomycin C,PEG and folic acid were bound covalently on the surface of chitosan nanoparticles in the presence of 1-ethyl-3-(3-dimethyllaminopropyl) carbodiimide hydrochloride(EDC),respectively.In vitro drug release test was carried out in different pH PBS solution.Confocal laser scanning microscope of Hela cell and in vivo imaging test were carried out using PEG and folic acid-modified chitosan nanoparticles labeled by Rhodamine B.RESULTS The diameter was in the range of 200 and 500 nm,the drug-loading capability and entrapment efficiency were 25% and 50%,respectively.The drug release was somewhat biphasic with an initial burst effect,followed by a subsequent slower release.Furthermore,increasing pH of the medium resulted in a faster release rate.Blank chitosan nanoparticles,folic acid modified and both folic acid and PEG-modified nanoparticles were effectively uptaken by Hela cells,while the single PEG-modified nanoparticles rarely entered the cell.By live imaging techniques,folic acid-modified nanoparticles had a clear targeting character.While,the PEG-modified chitosan nanoparticles enhanced circulation time in the bloodstream of mice.CONCLUSION By the method of ion-induced combined with chemical crosslinking,steady chitosan nanoparticles with controlable size were obtained and suitable for active targeting drug delivery.国家重大基础研究计划项目(973项目)资助(2006CB933300);厦门市科技计划项目(3502Z20093009

Role of Nrf2/ARE in chemoprevention of cancer

化学致癌过程是涉及启动、促进和进展等多阶段的复杂过程。癌症的化学预防是应用天然的或合成的化学物质,以阻断、抑制或其癌变过程,从而达到预防肿瘤的目的。化学致癌物的体内生物转化依靠肝脏的Ⅰ相和Ⅱ相代谢相酶来完成。作为对化学预防剂的应答反应,碱性亮氨酸拉链蛋白家族成员转录因子Nrf2首先从胞质蛋白Keap1上解离,然后发生核内转位,与Ⅱ相代谢酶基因上游的抗氧化反应元件结合诱导Ⅱ相代谢酶基因的表达,这是化学防癌的重要机制;Nrf2/ARE对Ⅱ相代谢酶的调节涉及PI3K、MAPK、PKC等细胞内重要信号传导途径。这些发现加深了化学防癌机制的认识并为评估潜在抗癌物质提供了新的策略。 【英文摘要】 Chemical carcinogenesis is involved in complicated multiple stages of initiation,promotion and progression.Chemoprevention comprises multiple intervention methods using either pharmacological or dietary agents to impede,arrest,or reverse carcinogenesis at various stages.Biotransformation of carcinogens may be associated with hepatic phase Ⅰ and Ⅱ detoxifying enzymes.It is proved that Nrf2,a member of the basic-leucine zipper family of transcription factors,is dissociated from cytoplasmic protein Keap1 first..

Effect of Helix-pin Composite Tissue Flap in the Treatment of Partial Auricle Defect

目的介绍一种修复外伤性小面积耳郭缺损的手术方法。方法根据外伤性部分耳郭缺损患者的耳郭形态,尤其是耳轮脚明显、耳郭缺损位于耳轮部,面积约2CMx0.8CM以下的外伤后患者,采用耳轮脚复合组织瓣游离移植进行缺损修复。结果本组7例患者,术后伤口一期愈合,缺损修复满意,耳郭外形良好。结论耳轮脚复合组织瓣游离移植,治疗外伤性小面积耳郭缺损,尤其是耳轮部缺损,可取得满意效果。Objective To explore the effect of helix-pin composite tissue flap in the repairing of partial auricle defect.Methods Seven cases were treated by using this flap.According to the shape of auricle defect,helix-pin composite tissue flap of auricle was used in those people who have distinct crus of helix and the area of defect was less than 2.0 cm × 0.8 cm.Results All flaps obtained healing by first intension and good contour.Conclusion Repairing defect of partial auricle with helix-pin composite tissue flap is a safe and reliable mothod with satisfactory repairing result

透析法制备载羟基喜树碱-聚乳酸纳米粒及其理化性质研究

采用直接透析法制备载羟基喜树碱-聚乳酸(HCPT-PLA)纳米粒并研究其理化性质、体外释放和细胞毒性.以HCPT-PLA纳米粒的载药率为评价标准,通过正交设计考察PLA浓度、HCPT与PLA的质量比和不同截留分子质量透析袋对其指标的影响.利用Malvern nano-zs粒度测定仪、XRD、DSC和激光共聚焦显微镜(CLSM)对HCPT-PLA纳米粒的理化性质进行表征.薄膜透析法考察体外释药特性;MTT试验检测细胞毒作用.在优化条件下制备的载药纳米粒为实心球形,平均粒径为226.8 nm,多分散系数为0.270,载药率为7.49%.HCPT是以晶体状态均匀分布于PLA纳米粒中.药物体外释药符合Higuchi方程Q=2.000 6X1/2-2.593 4,r=0.989 2.MTT试验显示HCPT-PLA纳米粒呈现明显细胞毒作用.透析法制备HCPT-PLA纳米粒,粒径小且分布均匀,具有较好的缓释特性;细胞毒性试验表明HCPT-PLA纳米粒具有较强的抑瘤作用且抑瘤效果优于HCPT

牡蛎壳纳米羟基磷灰石的制备与表征

以僧帽牡蛎壳粉末为原料,通过水热反应合成纳米羟基磷灰石(n-HA),考察反应时间、反应温度、反应物摩尔比及牡蛎壳粉末的微结构对反应的影响.运用X射线衍射(XRD)、扫描电子显微镜(SEM)、红外光谱(FTIR)、X射线能谱仪(EDS)及MTT实验表征产物的晶相组成、形貌、化学组成及细胞相容性.结果显示,牡蛎壳粉末经水热反应后仍保持其原有形貌,产物为部分CO32-取代的片状n-HA,其Ca/P摩尔比约为1.5,其结构及组成与人骨HA相似,细胞相容性良好.牡蛎壳粉末外表面方解石通过溶解重结晶过程转化为片状n-HA,内部方解石则经由固态局部规整离子交换反应转化为n-HA.最佳水热反应条件为220℃下反应6 h,牡蛎壳中Ca与(NH4)2HPO4中P摩尔比为5∶6

Intratumoral Chemotherapy with an Implantable Collagen Film Impregnated with Epirubicin-loaded Polylactic Acid Microspheres Inhibits Tumor Growth in Hepatocellular Carcinoma Xenografts

[中文文摘]制备用于实体肿瘤局部治疗的植入型表阿霉素缓释药膜。采用复乳-溶剂挥发法制备聚乳酸载表阿霉素缓释微球,用交联复合法制备含载药微球的植入型胶原药膜;用扫描、透射电镜、共聚焦及粒度仪等考察微球和药膜的形貌、结构、粒径及体外释放;用H22肝癌荷瘤动物模型评价其体内抑瘤效果。结果:载药微球粒径分布均匀,外观圆整,平均粒径为5.81μm;微球的载药量4.39%,包裹率为37.2%;10h内载药微球在模拟体液中的累积释放率为35%;腹腔注射载药微球与瘤体局部植入胶原药膜对H22肝癌均有明显的抑瘤效果;微球注射与药膜植入两种不同给药方式对H22肝癌抑瘤效果也存在显著性差异(P<0.05)。植入型载表阿霉素缓释胶原膜具有良好的药物局部缓释特性,在肿瘤的术后局部治疗方面具有良好的临床应用前景。[英文文摘]Drug-releasing implants delivering chemotherapeutic agents can provide promising local therapy to patients with malignant disorders.The purpose of the present study was to develop implantable collagen film impregnated with epirubicin-loaded polylactic acid(PLA) microspheres(EPI-PM) for intratumoral administration in solid tumors.EPI-PM was prepared by double emulsion-solvent evaporation method,and the microspheres were further incorporated in biodegradable chemically cross-linked collagen to formulate implantable collagen film. The microspheres were characterized by scanning electron microscope , transmission electron microscope and laser confocus microscopy. In vitro release of epirubicin was examined by ultraviolet spectrophotometry. Transplantable murine hepatoma 22 (H22) model was used to evaluate the effects of EPI-PMor collagen film impregnated with EPI-PMon murine liver cancer.The results indicated that the epirubicin was well incorporated and dispersed homogeneously in PLA. The EPI-PM was uniformly spherical with average diameter of 5181μm, drug loading of 4139% , and embedding ratio of 3712%. The cumulative drug release rate of EPI2PM was 35 % in analog body fluid at the 10h. The tumor growth rate was significantly inhibited by intraperitonal injection of EPI2PMor intratumoral implantation of collagen film impregnated.国家重大科学研究计划项目(2006CB933300); 福建省自然科学基金(C0610045); 厦门市科技计划项目(3502Z20055007); 厦门市科技创新资金项目(3502Z20041029)