抗真菌药物研究的新进展

真菌感染是一种常见病、多发病。由于近年来临床上广谱抗生素、化疗药物和免疫抑制剂大量应用,艾滋病的流行以及放射治疗和器官移植的广泛进行,真菌病发病率大幅上升。本文着重介绍当前临床上常用的抗真菌药物的应用情况以及当前有希望的新一代抗真菌药物的研究进展,以期对临床应用有所帮助。     

转化医学指导下研究型医院建设的讨论

转化医学是国际医学研究的一个新模式,也是一种研究思维,强调基础和临床之间的双向互动,是基础研究和临床应用研究之间的桥梁,目的是将基础研究成果尽快转向临床应用。由于研究型医院的基本理念和转化医学相一致,主要从转化医学和研究型医院的内涵联系、以转化医学思维指导建设研究型医院的策略出发提出设想,以供讨论。     

药物基因组学在新药临床试验及个体化用药中的应用

药物安全性和有效性评价是药物临床试验和个体化用药的核心,也是药物基因组学研究的主要内容。药物基因组学研究贯穿于药物 研发、上市评价和临床应用整个过程, 根据药物代谢酶、转运体、受体相关基因多态性对用药者进行分层分析,评价与药物体内的处置过程、 安全性、有效性个体差异的相关性。综述药物基因组学在新药临床试验、个体化用药中的应用研究新进展。     

飞秒激光在白内障手术中的应用新进展

飞秒激光辅助的白内障手术是目前最热门的白内障手术之一。即在计算机系统引导下利用飞秒激光进行透明角膜切口的制作,晶状体核裂解和晶状体前囊膜的切开,明显降低了传统超声乳化手术中的并发症,具有十分广阔的临床应用前景。然而飞秒激光辅助的白内障手术目前仍然处于临床应用初级阶段,其昂贵的价格是影响其研究和应用的主要原因,手术安全性及远期屈光效果仍然需要长期的随访观察。本文根据文献资料,就飞秒激光在白内障手术中的优势及临床应用的局限性进行综述。     

鸦胆子油乳抗肿瘤机制及其临床应用研究进展

鸦胆子油乳是临床上广泛应用的抗肿瘤中药,毒副作用小,疗效确切,临床应用安全。我们针对鸦胆子油乳的抗肿瘤机制,在分子基础、改变细胞周期分布、诱导细胞凋亡、破坏细胞结构、逆转多药耐药和临床应用等几方面进行了简要综述,为鸦胆子油乳的进一步应用研究提供参考。     

脑电双频指数监测技术及其临床应用

适宜的麻醉深度是保证患者的生命安全和创造良好手术条件的关键。脑电双频指数(bispectralindex,BIS)是用于监测镇静程度的一种新方法,自从临床应用以来它已得到多方面关注和研究,本文就其概念、原理及临床应用等方面进行综述。     

碱性成纤维细胞生长因子的研究进展

碱性成纤维细胞生长因子是一种多肽细胞生长因子,具有广泛的生理功能。碱性成纤维细胞生长因子的研究近年来取得了迅速发展,尤其是基因的表达及临床应用等方面。本文就该生长因子基因的克隆和表达、生物功能及临床应用研究进展作一概述。     

多部门联动推行抗菌药物合理应用的精细化管控

探讨抗菌药物临床合理应用中存在的问题,列举了多部门联动实行抗菌药物精细化管控的具体做法和取得的成效,进而提出多部门联动精细化管控是实现抗菌药物临床合理应用的有效策略。     

临床医师临床路径应用和实施效果评价影响因素分析

目的 探索我国公立医院临床医师临床路径应用和实施效果评价的影响因素。方法 对我国东、中、西3省（直辖市）1 638名临床医师进行问卷调查;对54所公立医院进行机构问卷调查。结果 甘肃省医院和二级医院临床医师临床路径执行率较高, 但临床路径实施病种数较少医院的临床医师临床路径执行率较低。临床路径相关培训可提高临床医师临床路径应用和实施效果的正向评价。结论 医院所处地区和级别对临床医师临床路径执行率影响大,医院临床路径实施推广和培训能推动临床医师临床路径应用和正向效果评价。     

重组猪肝脏临床应用于人得到FDA的认可

美国Nextran公司和美国Duke大学Medical Center的Jeffrey Platt小组1995年7月27日宣布,将基因重组猪肝脏临床应用于人获得美国食品与药物管理局(FDA)认可。将基因重组猪脏器临床应用于人是世界首例。 第一阶段临床试验是在exvivo辅助肝脏运动的系统中应用基因重组猪,作为临时性措施(为人找到了     

我国心血管专科临床科研数据中心的建设与思考

中国是心血管疾病的数据大国,但是从数据质量和临床科研上讲,并非强国。为了提高心血管数据在临床质量评估和科研中的应用,我院心内科开始了心血管专科临床科研数据中心的尝试和建设。通过借鉴美国相关经验,以及对我国心血管临床质量评估以及科研需求的深入调研,我们建设了以心血管专科临床数据仓库以及心血管注册数据中心为核心的心血管专科临床科研数据中心。在此基础上,进一步探索并建设了自定义科研表单,多维度组合筛选,基于随访策略的心血管随访管理,基于个性化诊疗计划的心血管病人院后管理,相关性分析及不良心血管事件模式发现等应用和工具,有助于提升心血管专科的临床流程效率,临床质量评估和科研水平,同时为建立全国性的心血管疾病注册数据库打下了基础。     

Do we want more cancer patients on clinical trials If so, what are the barriers to greater accrual

It is often stated that only a small proportion of adult cancer patients participate in clinical trials. This is said to be a bad thing, with calls for more trials to include more patients. Here I argue that whether or not greater accrual to clinical trials would be a good thing depends on the trials we conduct. The vast majority of clinical trials in cancer are currently early phase trials, and most do not lead to further studies even if they have encouraging results. The key metric is thus not the number of patients on clinical trials, but the number on the sort of large, randomized, Phase III trials that can be used as a basis for clinical decisions. I also address two important barriers to greater clinical trial participation. The first barrier is financial: clinical research has long been the poor cousin of basic research, with perhaps no more than a nickel in the cancer research dollar going to clinical research. The second barrier is regulatory: clinical research has become so overburdened by regulation that it takes years to initiate a trial, and dedicated staff just to deal with the paperwork once the trial starts. This not only adds significantly to the costs of clinical research, but scares many young investigators away. It has been estimated that nearly half of all US-sponsored trials are being conducted abroad, and it is plausible that excessive regulation is at least partly responsible. That statistic should serve as a wake-up call to the US clinical research community to implement the recommendations of the now decade-old report of National Cancer Institute Clinical Trials Program Review Group, which largely center around simplifying trials and streamlining trial procedures.     

圣乔治教堂诺卡菌引起的肺部感染1例

诺卡菌肺部感染可引起肺诺卡菌病,因其无特异性的临床表现,容易误诊、漏诊。因此,临床实验室的培养鉴定能力非常重要,若不能及时诊治,则会导致病死率较高。诺卡菌病临床较为少见,为引起临床实验室对诺卡菌的鉴定和药敏试验的重视,本文报道了上海市嘉定区中心医院2019年2月收治的1例由圣乔治教堂诺卡菌(Nocardia cyriacigeorgica)感染引起的肺诺卡菌病病例,针对其临床特征、实验室检测及治疗等进行分析,期望对临床诊治诺卡菌病有所帮助。     

Syndromale Formen geistiger Behinderung

Mental retardation of varying degree is a major component of genetic syndromes. Affected individuals with the same disorder may show different degrees of mental retardation. Making a diagnosis is a great challenge for clinical geneticists, especially because of the wide clinical variability. Besides carefully evaluating the family history and conducting a clinical examination, consideration of guiding clinical signs – including obesity, macrosomy, microcephaly, prenatal or/and postnatal growth restriction, and multiple congenital anomalies – is very helpful in establishing the correct clinical diagnosis. Modern cytogenetic and molecular cytogenetic techniques help clarify the etiology and define new disease nosologies.     

神经内科硕士研究生临床和科研能力的培养

临床医学硕士研究生阶段是培养临床和科研思维能力的重要阶段,从某种意义上说是人生和医疗生涯的关键时期。神经内科硕士研究生不仅应该具有一定的临床工作能力,还应具有一定的科研能力。临床工作能力培养包括临床基本功的培训,基本理论的加强和基本技能的培养,临床思维能力的培养及医患沟通能力的培养等多个方面。科研能力包括文献阅读能力、科研思维能力和论文写作能力等。这样,硕士研究生毕业后不仅能够诊治神经内科常见病和多发病,会思考临床工作中的问题,更重要的是能想办法探索和解决这些问题。这也是硕士研究生和本科生的本质区别。因此,研究生阶段是医学生涯一个重要的里程碑,临床和科研能力的培养对个人未来的发展具有十分重要的意义。     

Clinical penetrance of C282Y homozygous HFE haemochromatosis

The prevalence of the C282Y homozygous HFE genotype is high, approximately 1 in 200 in populations of Anglo-Celtic descent, and most authorities assumed this mutation would have a high clinical penetrance. Recent studies report the clinical penetrance of C282Y homozygous hereditary haemochromatosis is much lower than its prevalence, with possibly less than 5% developing clinical disease, although there is lack of consensus on a precise estimate. This review discusses reasons for this paradigm shift, including controversy on various definitions of clinical penetrance.It is inescapable that there are pronounced variations in clinical penetrance, and that certain C282Y homozygous individuals will not develop the clinical phenotype. This has prompted a search for modifier gene mutations amongst iron-metabolism genes, especially the known non- HFE haemochromatosis genes, and for possible environmental factors which might explain the observed variation in clinical penetrance.     

抗肿瘤药物临床药师培训及其参与合理用药的应用进展

临床药学是药学的重要分支,临床药师为病人提供药学监护,优化了使用药物治疗,促进康复,加强了保健和疾病的预防。开展临床药师教育,有利于临床用药审查,并将为培养临床药师的工作提供参考。回顾近年来国内外的临床药师及抗肿瘤药物专业临床药师的培训经验和合理用药的进展情况,分别对临床药师培养模式、理论课程设置、药学查房带教、临床记录书写和业务学习等方面作了总结。本文通过系统性的回顾了和对比了国内外的临床药师的培养方案,从理论和实践两方面的应用进展分析了临床药师在临床中的重要作用。     

“分子与细胞”翻转课堂教学模式在临床专业教学中的探究

提高医学创新人才培养手段是医学教育改革的重点内容之一。"分子与细胞"是临床医学教育改革的重点专业基础课,也是一门全新的整合课程,具有学时多、难度大且要求和临床专业紧密结合的特点。如何转变临床专业课程的传统教学模式,是临床专业课程改革创新的焦点。该研究通过基于嵌入式文献阅读和临床案例式的翻转课堂教学模式,将传统的面对面授课转化为以学生为中心的授课方式,将课堂主阵地由线下转移至线上,为线下课堂提供了更多创新融合的方式,同时增强了医学生对于生命学基本原理的理解,为培养具有精准医学专业背景的医学生提供了理论基础。通过三年的翻转课堂实施,临床专业卓越医生试点班学生对教学满意度以及学生成绩显著提升,说明在临床专业整合课程开展翻转课堂教学具有积极意义。     

In Search of the Good: Narrative Reasoning in Clinical Practice

Based on ethnographic work among North American occupational therapists, I compare two forms of everyday clinical talk. One, 'chart talk," conforms to normative conceptions of clinical rationality. The second, storytelling, permeates clinical discussions but has no formal status as a vehicle for clinical reasoning. I argue that both modes of discourse provide avenues for reasoning about clinical problems. However, these discourses construct very different clinical objects and different phenomena to reason about. Further, the clinical problems created through storytelling point toward a more radically distinct conception of rationality than the one underlying biomedicine as it is formally conceived. Clinical storytelling is more usefully understood as a mode of Aristotle's "practical rationality" than the technical rationality of modern (enlightenment) conceptions of reasoning, [narrative, practical reasoning, clinical reasoning, ethics]     

Clinical applications of physical anthropology

In recent decades physical anthropology has moved from its more traditional confines into many areas of clinical interest including growth and development, nutrition, clinical medicine, dysmorphology, and physical fitness. The “clinical applications” of physical anthropology is a broad topic, given the space limitations of a review. Hence, selected clinical applications, emphasizing anthropometry at the expense of physiology and genetics, are considered. Since the author is a pediatrician, the review concentrates largely on areas dealing with children.