RAS相关通路介导的结直肠癌药物联合治疗的应用

RAS相关信号通路在结直肠癌的发生、发展中起着重要作用，与该类肿瘤细胞的增殖、转移、凋亡密切相关。目前，包括靶向药物、化疗药物的单药治疗对结直肠癌的临床获益并不理想。近年来，在临床试验和临床前研究中RAS相关信号通路的抑制剂与其他药物的联合应用取得了良好效果，其中EGFR抑制剂、VEGF抑制剂、RAS直接抑制剂、MEK抑制剂和RAF抑制剂的表现尤为突出。本文就RAS相关信号通路与结直肠癌的作用关系、临床试验和临床前研究中的联合用药策略以及组合用药的耐药机制研究进行系统性综述，以期为未来临床多药治疗策略奠定基础。     

护理管理技巧的探讨

目的：探讨护士长管理过程中应具备的管理艺术，帮助新时期的护士长更好地提高管理素质，获得更好的管理技巧以适应高质量的护理工作的需要。方法：本文引进国内外先进的护理管理理念，比较各专家学者的观点，结合自己在临床工作中实践经验，从不同角度阐明了护士长应掌握的管理技巧和方法。结果：该研究的观点、技巧和方法，在临床工作中经实际应用，取得了良好的效果。结论：在临床护理管理工作中，护士长是科室和病房护理管理的主体，提高管理能力，改善护理质量，增加护理管理技巧，总结一套行之有效的途径和方法，并运用到临床实践中是非常必要的。     

RNA药物递送载体的研究进展

核糖核酸(ribonucleic acid, RNA)疗法通过将外源RNA引入特定细胞来精准调控基因的表达，从而实现对疾病的干预。近年来，临床结果表明RNA疗法在基因调控和疾病预防上是一种十分有潜力的基因疗法。然而，RNA药物在递送过程中仍然面临如稳定性差、组织靶向性弱、免疫原性强等诸多问题，限制了RNA药物的进一步临床转化应用。本文总结了不同RNA药物的递送方式在临床前和临床实验中取得的最新研究进展，并讨论不同递送载体的应用前景和局限性，旨在为RNA药物递送方式的优化提供新的设计思路，促进RNA疗法的临床应用。     

琦韧膏在中医外科临床的应用观察

琦韧膏又名奇应膏、高效多能奇应膏。为作者近30年临床使用并不断改进、创新的一种新型外用制剂。有消肿，拔毒生肌功效。在临床应用中，必要时结合辨证中药内服治疗疮疡、痛风、跌打损伤、蛇虫咬伤等症，疗效满意。现报告如下。     

探究式课程设计在医学生临床决策能力培养中的探索

临床决策能力是一个医生的必备能力之一，是医学教育中必要且重要的培养目标之一。目前对医学生临床决策能力的培养没有形成完备的体系，一般安排在高年级阶段进行，为时较晚。如何把临床决策能力的培养融入低年级基础课中，以尽早开展能力训练值得探索研究。本研究以医学遗传学课程为例，结合探究式教学方式的特点，模拟临床决策思维过程的各细分模块，优化了课程设计，探索在低年级课程中融入临床决策能力的培养。结果提示：探究式课程设计能充分调动学生主动性，增加学生分析、思考的投入；在教师引导下，促使学生依循临床决策思维的过程得到有效地训练。最后，整理分析了探究式课程设计及实践的思路，总结了设计原则和要点，反思了教学中的经验得失。     

基于EMR数据挖掘的临床路径构建中EMR数据采集

在基于电子病历数据挖掘构建临床路径中，并非所有的电子病历都符合要求，也并非所有的电子病历所记录的内容都是必须的，因此，在采用基于电子病历数据挖掘技术构建临床路径过程中，需要对电子病历及电子病历中的具体内容进行筛选。文章即从该两个方面进行了探讨。     

CDK 抑制剂在抗肿瘤领域的研发进展

细胞周期蛋白依赖性激酶（cyclin dependent kinase，CDK）为细胞周期调节的关键激酶，参与细胞增殖、转录、存活等生理过程。 CDK 在多种肿瘤中异常活化，是抗肿瘤药物研发的重要靶点之一。目前已有 1 个 CDK 抑制剂（palbociclib, CDK4/CDK6 抑制剂）被美国 食品药品监督管理局批准于 2015 年上市，数十个 CDK 抑制剂处于针对实体瘤和血液系统肿瘤的临床或临床前研究阶段。综述目前抗肿瘤 领域 CDK 抑制剂的研发现状、遇到的问题和可能的解决方案，并讨论其临床应用的可能。     

基于知识库和商业智能的临床用药指引及监测系统

目的 有效规范临床用药，进行合理用药指标的监控，降低临床用药风险。方法 依据临床用药知识库，将用药规范和制度与医嘱系统流程融合；采用商业智能技术，抽取医院管理、医嘱、检验等临床业务数据库，建立主题模型，监测临床用药的各项指标。结果 软件化定制了临床用药规范和制度，在医嘱系统中实现提醒和审批流程。实时、精细化展示合理用药指标报表，并能进行潜入分析。结论 减少不合理用药医嘱，同时极大提高了合理用药数据统计、分析的效果和效率。     

基于临床的专利信息分析工作模式的构建

在大多数医疗机构中，知识产权管理往往容易被忽视，尤其是专利信息很难得到有效的利用。从基于临床的专利信息利用角度出发，结合医疗机构临床的发展方向，构建一套专利信息分析工作模式，为其发展提供决策性意见，以提高专利产出效率。     

临床药师职业风险防范的伦理观照与法律思考

随着我国临床药学工作的普及和不断深入，有关临床药师职责的立法任务也越来越受重视。临床药师存在药学和法学的含义界定、产生背景不清，而临床药师职业中存在着法定权利空泛责任不清、专业地位及流向不明确、对临床药师的认知程度不高等风险，其职业风险防范具有行善、无害、自主、公平原则的伦理观照和立法、守法、司法的法律思考。     

山西重要黍稷种质资源品质性状的初步鉴定与评价

营养品质和口感品质是组成黍稷种质子粒品质的重要组成部分。粗蛋白和粗脂肪含量是组成营养品质的主要成分,赖氨酸和可溶性糖含量是组成口感品质的主要成分。通过对山西省有代表性的90份黍稷种质的粗蛋白、粗脂肪、赖氨酸和可溶性糖的测定,评价了参试黍稷种质资源的营养品质和口感品质。结果表明,黍稷种质资源的粗蛋白平均含量为11.88%,粗脂肪平均含量为3.69%,赖氨酸平均含量为0.19%,可溶性糖平均含量为2.04%。鉴定筛选出7份粗蛋白含量13.00%、粗脂肪含量4.00%以上的高营养品质种质;15份赖氨酸含量0.20%以上、可溶性糖含量2.00%以上的口感品质优的种质;3份粗蛋白含量13.00%以上、粗脂肪含量4.00%以上、赖氨酸含量0.20%以上和可溶性糖含量2.00%以上的营养品质和口感品质均优的种质。营养品质和口感品质与不同类型种质的相关性分析表明,稷的营养品质好于黍,黍的口感品质好于稷,红粒种质营养品质和口感品质最好,白、褐、复色的种质居中,黄粒的最差;粒形和营养品质及口感品质相关不显著。研究结果为今后优质种质利用提供了参考依据。     

Establishment of laboratory quality control indicators for NAT on blood donors' samples

In order to establish and screen nucleic acid test (NAT) quality control indicators for blood donor samples, C_T value of each test item were detected by NAT, internal and external quality controls, the number of unsuccessful mixed samples, the split positive rate, the rate of detection efficiency, and the equipment failure rate were collected. The "instant method" is used to establish the Levey-Jennings quality control chart, the mixed test positive rate, the rate of unqualified sample. Possion distribution is used to establish the quality control chart, and it is easily to operate and monitor NAT effectively. The results displayed that quality control charts were established, including unqualified sample Possion distribution quality control chart, the rate of equipment failure quality control chart, the failure rate of reagent batch and inefficient quality control chart, test result positive of Possion distribution quality control chart, quality control charts of NAT positive Possion distribution probability, the rate of split positive quality control charts, quality control charts of unsuccessful mixed samples, quality control chart of reagents effective rate, internal quality control chart, correctness, and NAT qualitative quality control chart. The study established quality control indicators throughout the whole NAT process, which were able to effectively improve NAT quality control and the efficacy of laboratory management.     

基于可变模糊识别模型的海水环境质量评价

海水环境质量评价可以视为是一个具有确定性的评价指标和评价标准与具有不确定性的评价因子及其含量变化相结合的分析过程,各评价指标含量具有中介过渡性,构建了基于可变模糊集合理论的海水环境质量评价方法(简称“VFEM”),并以莱州湾海水水质为研究对象,应用提出的可变模糊评价模型对该区域海水水质状况进行评价,实例应用表明,该模型通过可变模型参数变化(a,p),以线性模型与非线性模型相结合,将最后稳定结果作为海洋水质环境的最后评价结果,从而确定水质评价等级,评价结果更为可信,同时该模型通过级别特征值精确区分各水质采样点的水质优劣,对各水质采样点的水质级别有更准确的定位,为海水环境质量综合评价提供了一种合理而适用的方法.     

A Transparent and Transferable Framework for Tracking Quality Information in Large Datasets

The ability to evaluate the validity of data is essential to any investigation, and manual “eyes on” assessments of data quality have dominated in the past. Yet, as the size of collected data continues to increase, so does the effort required to assess their quality. This challenge is of particular concern for networks that automate their data collection, and has resulted in the automation of many quality assurance and quality control analyses. Unfortunately, the interpretation of the resulting data quality flags can become quite challenging with large data sets. We have developed a framework to summarize data quality information and facilitate interpretation by the user. Our framework consists of first compiling data quality information and then presenting it through 2 separate mechanisms; a quality report and a quality summary. The quality report presents the results of specific quality analyses as they relate to individual observations, while the quality summary takes a spatial or temporal aggregate of each quality analysis and provides a summary of the results. Included in the quality summary is a final quality flag, which further condenses data quality information to assess whether a data product is valid or not. This framework has the added flexibility to allow “eyes on” information on data quality to be incorporated for many data types. Furthermore, this framework can aid problem tracking and resolution, should sensor or system malfunctions arise.     

我院临床科室全面质量管理实践与探索

全面质量管理（total quality managenment,TQM）模式是一种科学的质量管理方法,在西方发达国家及我国台湾地区已广泛推广,近几年也逐渐被我国医院管理者所接受。在深化医改进程中,为切实提高医疗质量,在内、外科及医技科室等部分临床科室开展全面质量管理实践,通过建立科室质量与安全管理小组,明确其相关职责,完善其管理记录,组织定期质量会议,落实整改措施,追踪整改效果,切实推进了医院的质量管理工作。     

Life-history analysis of the Trivers and Willard sex-ratio problem

Phenotypic quality, such as condition or size, often variesbetween individuals. For species with extensive maternal care,the quality of offspring may partially be determined by thequality of their mother. Trivers and Willard (1973) predictedthat high quality females should prefer offspring of the sexwhose reproductive success is most strongly influenced by maternalcare, which in many cases will be sons. Correspondingly, lowquality females should prefer daughters. However, this predictionis not based on a proper analysis of variation in reproductivevalue. Using state-dependent life-history theory, I show herethat high quality females should prefer offspring of the sexwhose reproductive value is most strongly influenced by maternalcare. I also show that when offspring quality is strongly determinedby their mother's quality, but not influenced by their father'squality, high quality females can have higher reproductive valuethan high quality males, even though their reproductive successmay be much lower. In such cases, high quality females shouldprefer daughters and, correspondingly, low quality females shouldprefer sons.[Behav Ecol 7: 316–325 (1996)]     

Rearing conditions determine offspring survival independent of egg quality: a cross-foster experiment with Oystercatchers Haematopus ostralegus

Variation in rearing conditions, due either to parental or to environmental quality, can result in offspring of different quality (e.g. body condition, immune function). However, evidence is accumulating that egg size and composition can also affect offspring quality. In Oystercatchers Haematopus ostralegus , high-quality rearing conditions result in a higher quantity as well as quality of offspring. This is thought to be caused by increased parental food provisioning to the chicks in high-quality environments. However, variation in egg quality between rearing conditions could also affect the quantity and quality of offspring. Determining the mechanism and ontogeny of quality differences is important in unravelling the causes of variation in reproductive success. To disentangle the effects of egg quality, and quality of the rearing conditions, on the future survival of offspring, we cross-fostered complete clutches between nests. When reared under conditions of similar environmental quality, chicks originating from eggs laid in low-quality environments survived as well as chicks originating from eggs laid in a high-quality environment. However, chicks reared in high-quality environments survived twice as long as chicks reared in low-quality environments, independent of the environmental quality in which the eggs were laid. This suggests that variation in the future survival of offspring is primarily caused by differences in environmental and/or parental quality, with no clear effect of egg quality (size).     

What is the quality of quality of medical care measures? Rashomon-like relativism and real-world applications

Much attention has been directed toward the measurement of health outcomes and the quality of medical care. Some policymakers tout outcomes measurement as a promising tool for improving health care, while others question whether current quality of care assessment is valid and of practical importance. Although significant advances have been made in the ability to measure quality of care with validity, several major methodological challenges remain. We analyze the quality of quality of medical care measures, using a conceptual framework that outlines the purpose of the measures; paradigms of the quality of care, including Donabedian's structure-process-outcome model and continuous quality improvement; and other key elements, such as scope, time, unit of analysis, and perspectives. Patient preferences and organizational contexts have been underemphasized, and should be incorporated into the framework for conceptualizing quality of care. Quality of care has relativistic and dynamic aspects. Different perspectives lead to different views of what high quality care is, and quality of care is a changing concept since medical science and treatment are constantly evolving. The most appropriate quality measures depend upon whose perspective one takes and the purpose of the measures; if the measures are chosen wisely, the current state of quality of medical care measurement is adequate for both accountability and quality improvement.     

我国医疗质量研究30年的历史回顾与基本特征

医药卫生体制改革已走过30年光辉历程。利用CNKI检索系统,采取文献回顾方法,首次全面系统回顾医疗质量研究状况。医疗质量研究可以划分为阶段明显的3个时期,每个历史阶段的基本特征明显。研究发现,卫生质量研究的主题是医疗质量。医疗质量议题由少到多,由冷到热,由边缘到主流,成为卫生政策与医院管理的核心议题。基本结论是,卫生质量与医疗质量的研究目的、动力源泉、研究范围、研究议题、研究方法和理论视角亟待结构调整,以回应国人不断提高的健康需要,深化医药卫生体制改革,加强医学人文关怀,建立卫生保健财政制度,构建和谐医患关系。     

Definition of a New Information-Based Per-Residue Quality Parameter

For biomolecular NMR structures typically only a poor correspondence is observed between statistics derived from the experimental input data and structural quality indicators obtained from the structure ensembles. Here, we investigate the relationship between the amount of available NMR data and structure quality. By generating datasets with a predetermined information content and evaluating the quality of the resulting structure ensembles we show that there is, in contrast to previous findings, a linear relation between the information contained in experimental data and structural quality. From this relation, a new quality parameter is derived that provides direct insight, on a per-residue basis, into the extent to which structural quality is governed by the experimental input data.