医保制度对医患关系影响的关键维度分析 ——基于中国、加拿大比较研究

目的 探讨医保制度对我国医患关系产生影响的关键维度,通过对比中国与加拿大不同医保制度设计与要素安排及其对医患关系的影响,提出以医保制度重构为契机的医患关系改进政策建议。方法 采用定量与定性相结合的分析方法对中国和加拿大的相关医保制度安排进行对比并提出合理政策建议。结果 中国与加拿大在筹资机制、支付机制、报销机制、基金运行管理机制、立法监督机制以及异地就医等医保要素上所作出的不同制度安排,是造成两国医患关系不同结果的关键制度根源。结论 构建和谐的医患关系绝不仅仅是医生与患者个人的责任,医保制度在其中起着不可忽视的作用。国际经验表明,合理的制度设计和要素安排能够为医患关系提供良好的制度环境。     

医生视角下的城市三级医院医患信任建立机制研究

目的 从医生的视角，了解首都城市三级医院医患信任的现状、医患信任建立的途径，剖析医患信任建立机制，为提高医患信任程度提出对策和建议。方法 选取3家三级甲等医院，每家医院分别选取12名医生作为研究对象，共计36人；每家医院进行5天的实地观察和个人深入访谈，累计15天。结果 不同人际信任程度从高到低排序前三位分别是家人、亲戚、朋友，而最低的是医患信目的抽样的方法，在北京市选取三家三级甲等医院（X、Z、B）作为实地观察的研究现场；医患信任建立类型的选择人次从高到低依次是声誉型、关系运作型、社会背景相似型、法制型；医患信任建立渠道的选择人次前三位分别是是经人介绍认识、和医生交谈建立关系、彼此熟悉（亲戚）。结论 首都城市三级医院医患信任呈现普遍主义信任的特点，且医患间信任程度不高；城市三级医院医患信任建立方式以声誉型、关系运作型为主；需要加强相关制度建设，建立良好的制度型信任建立机制。     

医患行为均衡的微观经济分析

首先,界定了医疗服务制度均衡的涵义,在此状态下,医疗卫生领域的制度供给适应制度需求;其次,重点分析了政府制度约束对医生行为的微观经济分析和医生行为与患者之间的微观经济分析;最后,提出了制度均衡下医患管理的政策建议。通过分析政府、医生和患者之间的关系,从微观的角度分析了制度非均衡本身就意味着制度创新机制或制约机制的失灵,从而使社会经济效率遭受损失。因此,一方面要进一步健全和完善制度,另一方面要加强制度的监管。     

基于因子分析法的医患信任危机成因研究

目的 探讨导致医患信任危机的多维影响因素与解决策略。方法 运用文献研究、专家咨询、现场调查及因子分析的方法,寻找对医患关系信任构成重要影响的潜在公因子,分析医患信任危机的成因。结果 医疗服务因子、医疗纠纷调解与行业监管因子、社会制度因素及文化价值因子、医患沟通因子是驱动医患信任危机形成的主因。结论 医患信任危机的形成受到医疗服务过程、外部社会制度及文化观念、行业监管及医患沟通和互动等多重因素的影响,需要政府、医疗机构和全社会共同努力,消解医患信任危机的坚冰,促进医患关系修复与和谐。     

耳鼻咽喉科医患沟通的影响因素分析及对策

目的:分析耳鼻咽喉科医患沟通的影响因素,提出针对性的对策,为改善医患沟通现状提供科学依据。方法:通过调查患者和医生对医患沟通满意度的评价及对可能影响医患沟通效果的因素进行定量分析,以黑龙江省几所三级甲等医院就诊患者及就职的医生为对象,通过问卷调查收集数据。结果:医患沟通满意度方面,有19.3%的被调查者认为医患沟通很好,41.7%的被调查者认为较好,两项合并占被被调查者总数的61%。被调查者认为医患沟通时间少、看病难、看病贵,医患信息不对称等因素在不同程度上影响着医患沟通效果。结论:建议针对影响医患沟通效果的因素在耳鼻喉科教学及工作中建立以人为本的沟通体系,改善医疗服务质量,促进医患关系顺畅与和谐的发展。     

医患关系紧张与医患风险管理

当前医疗纠纷呈快速上升趋势,医患之间的信任急剧滑坡,医患关系成了社会焦点问题。医患关系作为医疗活动开展始终的核心,在医疗活动中担当着举足轻重的地位。对医患关系的把握不能仅仅从概念上获得,还必须分析医患关系的性质与特点,及其紧张的内外部原因,预估其发展形势,完善与之相适应的医患风险管理制度,缓解紧张的医患关系,最终建立起新型和谐的医患关系。     

医务人员视角下的医患关系影响因素研究

目的 从医务人员视角出发,分析医患关系的现状、存在的问题及其原因。方法 选取广东省10所医院,以“科室”为层,抽取1 125名医务人员对医患关系认知状况进行问卷调查。结果 86.21%的人认为当前医患关系更加紧张,影响医患关系的主要因素依次为医疗技术方面、候诊服务、医患沟通、非医疗技术方面、医院管理。患者抱怨最多的是药价贵和排队时间长,分别占29.7%,26.9%。结论 医务人员对医患关系信心不足,医生技术水平、医患沟通、医院管理是当前改善医患关系的重点。     

电子退费制度对患者满意度的影响分析

目的 探讨电子退费制度对患者治疗体验的影响。方法 收集北京肿瘤医院1 436例退费患者的个人简要信息，设计调查问卷，调查患者对医院退费机制的满意度情况。建立定序逻辑斯特回归模型对问卷结果进行分析，分析影响患者满意度的主要原因。最后分析电子退费制度改善患者满意度的可行性。结果 对患者的满意度情况进行分析，最终结果表明多种因素都涉及现有的收费和退费制度。结论 新型电子退费制度不仅能够降低医院运行成本，有益于医院的长期发展，更能有效地提高患者满意度，改善医患关系。     

网络医疗中医患关系的建立与认定

医患关系的建立与认定在网络医疗中关乎医患双方合法权益的维护,对网络医疗的规范与发展有重要意义。通过文献分析、专家咨询等方法,分析网络医疗医患关系建立与认定上存在的障碍,借鉴美国实践经验,提出基于我国国情的建议。网络医疗带来了医患关系主体、建立条件、认定方式的变化,对通过挂号建立与认定医患关系的传统模式带来了挑战。应在承认线上医患关系及医疗行为的基础上,制定符合我国法律法规、严于线下诊疗标准的网络医疗医患关系建立标准。同时,应从法律手段与技术手段两方面加强网络医疗医患关系的认定,保障网络医疗中医患双方的合法权益。     

医务人员遭受医院暴力及对媒体作用的认知研究

目的 对医务人员遭受暴力事件的周期、类型、场所进行分析;对媒体医患报道行为方式进行评价,为规范媒体行为,减少医院暴力提供政策依据。方法 通过问卷星软件收集某省医务人员医院暴力发生情况及对媒体作用的认知情况等相关数据。结果 暴力发生频率相对较低,多发生在内科,以语言暴力为主;医务人员有60%以上对媒体的医患报道采取不可信和负面态度,且职称越高这一趋势越明显。结论 应在医患间建立良好的沟通机制,做好医患暴力应急,规范媒体行为,缓和紧张的医患关系。     

The association of human coagulation factors VIII,IXa and X with phospholipid vesicles involves both electrostatic and hydrophobic interactions

Blood coagulation factor X (FX) is converted to its active form (FXa) by a membrane bound multi-protein enzyme complex, comprised of factor VIII (FVIII), factor IXa (FIXa) and FX. Characterization of the molecular forces involved in the association of these proteins with phospholipids is crucial to understanding how these proteins bind to the lipid milieux of physiological membranes. In this report, the molecular forces involved in the association of FVIII, FIXa or FX with phospholipid vesicles (PLV) were characterized by ligand affinity chromatographic analyses. Treating FVIII-affinity columns with agents that disrupt electrostatic interactions caused elution of 15.2% of the total bound PLV, while agents that disrupt hydrophobic interactions caused elution of 84.8% of the total bound PLV. These results demonstrate that the association of PLV with FVIII is primarily hydrophobic. In contrast, the association of PLV with FIXa or FX is largely the result of electrostatic forces. This was established by observing that 71.3% and 78.9% of the total bound PLV was eluted from FIXa- and FX-affinity columns, respectively, by agents that disrupt electrostatic interactions. Of the total bound PLV, 28.7% and 21.2% were eluted from FIXa- and FX-affinity columns, respectively, by agents that disrupt hydrophobic interactions. These data demonstrate that hydrophobic forces play a heretofore unrecognized role in the association of PLV with FIXa or FX.     

The translation factors of Drosophila melanogaster

Synthesis of polypeptides from mRNA (translation) is a fundamental cellular process that is coordinated and catalyzed by a set of canonical ‘translation factors’. Surprisingly, the translation factors of Drosophila melanogaster have not yet been systematically identified, leading to inconsistencies in their nomenclature and shortcomings in functional (Gene Ontology, GO) annotations. Here, we describe the complete set of translation factors in D. melanogaster, applying nomenclature already in widespread use in other species, and revising their functional annotation. The collection comprises 43 initiation factors, 12 elongation factors, 3 release factors and 6 recycling factors, totaling 64 of which 55 are cytoplasmic and 9 are mitochondrial. We also provide an overview of notable findings and particular insights derived from Drosophila about these factors. This catalog, together with the incorporation of the improved nomenclature and GO annotation into FlyBase, will greatly facilitate access to information about the functional roles of these important proteins.     

Model analysis of difference between EGF pathway and FGF pathway

The difference in time course of Ras and mitogen activated protein kinase (MAPK) cascade by different growth factors is considered to be the cause of different cellular responses. We have developed the computer simulation of Ras-MAPK signal transduction pathway containing newly identified negative feedback system, Sprouty, and adaptor molecules. Unexpectedly, negative feedback system did not profoundly affect time course of MAPK activation. We propose the key role of fibroblast growth factor receptor substrate 2 (FRS2) in NGF/FGF pathway for sustained MAPK activation. More Grb2-SOS complexes were recruited to the plasma membrane by binding to membrane-bound FRS2 in FGF pathway than in EGF pathway and caused sustained activation of ERK. The EGF pathway with high concentration of EGF receptor also induced sustained MAPK activation, which is consistent with the results in the PC12 cell overexpressing the EGF receptors. The simulated time courses of FRS2 knock-out cells were consistent with those of the reported experimental results.     

凝血因子药物市场分析

凝血因子是一类特殊的药物,是血友病等血液疾病的治疗药物,目前已经成为血液制品的重要组成部分。国外已经有二十多种重组凝血因子药物上市,2015年全球重组凝血因子药物的市场规模已经达到78.54亿美元,未来还将持续增长,Baxalta公司的重组凝血因子产品销售额位居全球首位,达到28.40亿美元。国外有多种重组凝血因子处于研发阶段,其中长效重组凝血因子将成为新的市场增长点。国内各类凝血因子药物的批签发状况良好,且随着国家发展和改革委员会取消血液制品最高零售价,各类产品价格均有不同幅度增长,其中人纤原蛋白原增长幅度最高,达到189%。国产凝血因子市场空间巨大,但存在产品供给和研发力度不足等问题,发展受到限制,必须改革行业管理制度、提高血浆分离技术、加强重组产品研发。     

Defined medium for normal adult human prostatic stromal cells

Summary Stromal-epithelial interactions are pivotal in many aspects of prostatic biology. A defined culture system is critical for the investigation of factors that regulate the growth and differentiation of human prostatic stromal cells. We have identified conditions which promote stromal cell attachment and proliferation in serum-free medium. MCDB 201, originally developed for the clonal growth of chick embryo fibroblasts, proved to be a superior basal medium of those that we tested. Supplementation of MCDB 201 with basic fibroblast growth factor (FGF), insulin-like growth factor (IGF), and platelet-derived growth factor (PDGF) permitted attachment and exponential growth of cells throughout a 7-d period with an initial inoculum as low as 10³ cells per well of a 96-well microtiter dish. Using these assay conditions, we subsequently verified that basic FGF and IGF, but not PDGF, were required for optimal growth. No activity was found for heparin, transferrin, or the androgen R1881. Epidermal growth factor (EGF) didn’t stimulate growth when added to medium containing basic FGF and IGF, but was moderately stimulatory when added to basal medium alone. Cholera toxin inhibited growth. This simple and efficient culture medium provides a suitable assay system for more extensive studies of growth regulation and differentiation of human prostatic stromal cells, and will provide the basis for future development of a defined medium that supports clonal growth. Characterization of stromal-epithelial interactions will be facilitated by the use of this defined culture system for stromal cells in conjunction with the serum-free culture systems previously developed for human prostatic epithelial cells.     

Contribution of allosteric disulfide in the structural regulation of membrane-bound tissue factor–factor VIIa binary complex

Abstract

Two distinct populations, active and cryptic forms of tissue factor (TF), reside on the cell surface. Apart from phospholipid contribution, various models have been introduced to explain decryption/encryption of TF. The proposed model, the switching of Cys186–Cys209 bond of TF, has become the matter of controversy. However, it is well accepted that this disulfide has an immense influence upon ligand factor VIIa (FVIIa) for its binding. However, molecular level understanding for this remains unveiled due to lack of detailed structural information. In this regard, we have performed the molecular dynamic study of membrane-bound TF/TF–FVIIa in both the forms (±Cys186–Cys209 allosteric disulfide bond), individually. Dynamic study depicts that disulfide bond provides structural rigidity of TF in both free and ligand-bound forms. This disulfide bond also governs the conformation of FVIIa structure as well as the binding affinity of FVIIa toward TF. Significant differences in lipid–protein interaction profiles of both the forms of TF in the complex were observed. Two forms of TF, oxidized and reduced, have different structural conformation and behave differentially toward its ligand FVIIa. This disulfide bond not only alters the conformation of GLA domain of FVIIa in the vicinity but allosterically regulates the conformation of the distantly located FVIIa protease domain. We suggest that the redox status of the disulfide bond also governs the lipid-mediated interactions with both TF and FVIIa.

Communicated by Ramaswamy H. Sarma     

生长因子及其受体在淋巴瘤中异常表达的研究进展

生长因子是一类与受体结合后可以促进细胞增殖和调节细胞多项功能的多肽分子。生长因子及其受体信号通路包括Ras/MAPK、PI3K/AKT和STAT等不仅调控正常细胞的生物学行为,对恶性肿瘤细胞增殖、分化、转化和迁移也具有重要意义。研究发现多种生长因子如VEGF、PDGF和IGF及其受体在多种实体肿瘤如肺癌、乳腺癌、结肠癌中发现有异常表达,在淋巴瘤如DLBCL、PTCL、ML和NL中也存在异常的共同表达,提示在淋巴瘤中可能构成生长因子及其受体的自分泌/旁分泌环路。生长因子及其受体的表达对淋巴瘤患者的预后有一定指导意义,临床研究发现表达生长因子或其受体阳性患者比表达阴性患者有较差的临床预后。这可能与生长因子及其受体对淋巴瘤细胞的增殖、转移和耐药调控有关。目前生长因子及其受体已成为潜在的药物靶点,多种生长因子及其受体抑制剂在开发和临床试验中。本文就近年来生长因子及其受体在淋巴瘤中异常表达研究进展作简要综述。     

Fluorine and metals in Polygonum arenastrum Bor. from areas influenced by various types of industry

A herbaceous plant Polygonum arenastrum Bor. (=P. aequele Lindm., Polygonum aviculare ssp. aequale (Lindman) Ascherson & Graebner) (equal-leaved knotgrass), is a widespread, good coloniser, able to survive in wastelands where other species became extinct. Therefore, the bioindication abilities of this species for F, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, and Zn were investigated. P.arenastrum was collected from 90 sites affected by six polluting factories: copper smelter, chlor-alkali plant, former ferrous-chromium smelter and active combustion smelter, power plant, cement plant and coke plant. Plant samples were collected at 0.75, 1.5, 3 and 4.5 km from each of these polluters in N, S, W and E directions. For comparison, a control site with 16 sampling points was selected in an area relatively free from pollution. Concentrations of Cr, Cu, Fe, Pb and Zn in shoots and roots positively correlated with those in soil (both total and plant-available). Cu, Pb and Zn in P.arenastrum were within the values reported in literature as toxic for other plants with the highest bioaccumulation factor (BF) from soil to shoots for Cr and the highest translocation factor (TF) from roots to shoots for Co and Pb for more and less polluted and control sites. Polygonum arenastrum has a potential to accumulate Cr even in sites with low chromium concentration in soil. Polygonum arenastrum does not show any form of shoot injury at increased levels of F and metals in its tissues. Based on these characteristics we conclude that the ubiquitous P.arenastrum may be utilised as a relevant indicator of contamination in industrial zones and may function as an early warning system of increased toxicity in the environment.     

Acute Regulation of the Epidermal Growth Factor Receptor in Response to Nerve Growth Factor

PC12 cells possess specific receptors for both nerve growth factor and epidermal growth factor, and by an unknown mechanism, nerve growth factor is able to attenuate the propagation of a mitogenic response to epidermal growth factor. The differentiation response of PC12 cells to nerve growth factor, therefore, predominates over the proliferative response to epidermal growth factor. We have observed that the addition of nerve growth factor to PC12 cells rapidly produces a decrease in surface 125I-epidermal growth factor binding capacity. Unlike previously described nerve growth factor effects on 125I-epidermal growth factor binding capacity, which required several days of nerve growth factor exposure, the decreases we report occur within minutes of nerve growth factor addition: A 50% decrease in 125I-epidermal growth factor binding capacity is evident at 10 min. This rapid nerve growth factor response is concentration dependent; inhibition of 125I-epidermal growth factor binding is detectable at nerve growth factor levels as low as 0.2 ng/ml and is maximal at approximately 50 ng/ml, consistent with known ranges of biological activity. No demonstrable differences in the rate of epidermal growth factor receptor synthesis or degradation were observed in cells acutely exposed to nerve growth factor. Scatchard analysis revealed that acute nerve growth factor treatment decreased the number of both high- and low-affinity 125I-epidermal growth factor binding sites, while the receptor affinity remained unchanged. We have also investigated the involvement of various potential intracellular mediators of nerve growth factor action and of known intracellular modulatory systems of the epidermal growth factor receptor for their capacity to participate in this nerve growth factor activity.