一枝失落的玫瑰——《病人》赏析

小说《病人》带给读者的震撼是强烈的,作者用一支直接透视心灵的笔,通过生活的层层帷幕,巧妙运用象征、对比、细节描写等手法,在尖锐的矛盾冲突之中完成了对人物的刻画和主题的升华。

标准化病人在医学教育中的应用现状及前景展望

标准化病人又叫病人模仿者,目前在国内外医学界的应用越来越广泛。本文着重论述了标准化病人在国内外医学工作中的应用现状、优缺点及发展前景,以期为标准化病人在我国医学工作中的应用提供参考和借鉴。

生前预嘱和尊严死亡——《病人自主权利法》宣传片的多模态隐喻分析

本文以Fauconnier和Turner(1996)的概念整合理论为框架,对我国台湾地区的《病人自主权利法》宣传片中隐喻性最强的动画场景进行多模态隐喻分析,集中探讨其中的多模态隐喻映射关系和意义建构在提高宣传效力和实现社会意义方面的重要作用。研究发现,该宣传片的动画场景主要围绕“面对死亡”“选择预嘱”和“尊严死亡”三个目标域展开,不同感官的多种模态符号资源构成源域的表征意象。目标域和源域之间的映射关系出现了部分非对应性,从概念整合视角分析可知,这种非对应性关系突显为层创结构,表达包含特殊社会文化价值的新型隐喻意义,从而充分彰显宣传片“生前预嘱”和“尊严死亡”的主题。

我爱《病人必读》

没有农活的时候，我除了看电视、打扑克以外很少再有其他爱好。而自从读了一本《病人必读》后，我变了，变得爱读书、爱学知识了。 此书内容实在，语言朴实，很适合我们农民。它外观漂亮，价格却不高，350页才卖12元，对农户来说买得起，也值得买。

Recovery after ischemic stroke:Effects of FuekFone home-based program on upper limb and cognitive function

Objectives:This study aimed to explore the effects of the“FuekFone(F.F.)home-based program”on the upper limb and cognitive function of ischemic stroke patients after discharge.Methods:A single group pre-and post-test design was conducted.A total of 40 patients with recovery after ischemic stroke were recruited from two university hospitals in Thailand.The study was conducted between June 2022 and January 2023.Participants underwent a six-week“F.F.home-based program,”which combined an upper limb and cognitive function rehabilitation device with Android games,including stationary barrel,adventure walk,adventure stroll,sliding barrel,sauce squeeze,and cut objects.Each game has different difficulty levels.Patients can perform corresponding exercises through the games according to their conditions under the guidance of medical staff.The patients played for 24 min per time,4 min each game,three days a week.The second week,let the patients play games for 30 min per time,5 min each game,3 days a week.Then,in the 3e6 weeks,let the patients play games for 1 h per time,10 min each game,5 days a week.At the pre-and post-intervention,the Thai version of the National Institutes of Health Stroke Scale(NIHSS),the Motor Assessment Scale,and the Montreal Cognitive Assessment(MoCA score)were administered to patients at discharge and at 2,4,and 6 weeksafter discharge,and the results were compared.Results:All participants completed this program.Participants had statistically improved upper limb function(upper arm function score,hand movements score,advanced hand activities score,total Motor Assessment Scale score)and MoCA score at 2,4,and 6 weeks after discharge(P<0.001).In the comparison of upper limb function and cognitive function at each of the study times,we found statistically improved upper limb function(upper arm function score,hand movements score,advanced hand activities score,total Motor Assessment Scale score)and MoCA score at 4,and 6 weeks after discharge when compared to after discharge and 2 weeks after discharge,respectively(P<0.05).Conclusions:Continuing care of patients post-stroke after discharge from hospital,such as F.F.homebased program should be applied at home to enhance upper limb and cognitive function.

成人Still病淋巴结病理特征分析

目的总结成人Still病(adult-onset Still disease,AOSD)病理形态特征、诊断及鉴别诊断,避免误诊误治。方法回顾分析3例AOSD淋巴结病理形态学特征、免疫表型、分子检测结果。结果病例1淋巴结活检组织见显著的淋巴滤泡增生,伴滤泡间区增生;生发中心可见星空现象,未见明显组织细胞增生灶及浆细胞、中性粒细胞等;副皮质区CD3、CD5 T淋巴细胞阳性,CD20、CD79α染色提示B淋巴细胞主要位于滤泡区,CD21滤泡树突细胞阳性,CD68组织细胞阳性。病例2淋巴结穿刺组织中可见副皮质区增生,滤泡数目减少、体积缩小,未见明显组织细胞增生灶及浆细胞、中性粒细胞等;副皮质区CD3、CD5 T淋巴细胞阳性,滤泡区CD20、CD79αB淋巴细胞阳性。病例3淋巴结穿刺组织中见淋巴结正常结构部分保存,副皮质区淋巴组织弥漫性增生,组织细胞增生呈片状伴部分坏死,坏死区可见明显核碎屑、散在浆细胞及嗜酸性粒细胞,未见明显中性粒细胞浸润;CD21、CD23滤泡树突细胞阳性,部分淋巴细胞Bcl-2、Bcl-6、CD3、CD5、CD20、CD79α、多发性骨髓瘤致癌蛋白1(multiple myeloma protein 1,MUM1)阳性,Ki-67增殖指数较高(约70%阳性),少量浆细胞CD138阳性,个别细胞CD1α阳性,CD10、CyclinD1阴性,组织细胞骨髓过氧化物酶(myeloperoxidase,MPO)阳性,原位杂交EBER阴性。3例病例TCR基因重排、IG基因重排结果均为阴性。结论AOSD免疫表型多样,须综合临床、病理形态特点及免疫表型,除外感染性疾病、恶性肿瘤、淋巴瘤等疾病后诊断。

电视胸腔镜手术16例报告

共完成电视胸腔镜手术１６例，包括电刀切除肺内肿块２例，纵隔囊肿摘除２例，胸腔内取异物２例，肺大泡切除和胸膜粘连术２例，纵隔淋巴结活检２例，胸膜活检和胸膜粘连术１例，凝固性血胸血块清除１例，肺楔形切除１例，左下和右下肺叶切除各１例，恶性胸膜间皮瘤切除１例。本组无严重并发症，仅１例恶性胸膜间皮瘤术中剥离肿瘤时出血，立即改为开胸手术。１６例ＶＡＴＳ均痊愈出院。对ＶＡＴＳ的适应证、禁忌证、手术切口、术野暴露和外科手术技术进行了讨论。

Alterations of red blood cell immunoadherence function in hepatitis B patients

AIMS To investigate the alterations of RBC immunoadherence function in patients with various hepatitis B. METHODS RBCC3bRR,RBCICRR and serum CIC levels were measured in 42 patients with acute and chronic hepatitis B at ac- tive and convalescence stages. RESULTS RBCC3bRRs at the active/acute stage of various hepatitis were decreased.They were 13,54%±5,23% in AH, 7.61%±4.12% in AFH,and 16.18%±6.10% in CH, respectively,all of which were lower than those in normal persons (18.12%±3.91% ).At the quiescent/recovery stage of various hepatitis,the RBCC3bRRs were increased significantly.The changes of RBCICRR and serum CIC level were contrary to those of RBCC3bRR. CONCLUSIONS RBC immunoadherence function is decreased in acute and chronic hepatitis.The decrease is in direct proportion to the severity of the diseases.

Research Progress on the Control of Ginseng Gray Mold

This review article describes the research progresses on the control of ginseng gray mold, summarizes domestic and international related experimental re-sults and literature data using chemical fungicide, plant extracts, microbial prepara-tion and antagonistic bacteria to control ginseng gray mold, and final y puts forward the existing problem and future research direction of the treatment and control of ginseng gray mold.

Antibiotic Activity of Seven Fungicides against Alternaria panax Whetz

[Objective] This study was conducted to screen suitable fungicides to con-trol ginseng leaf blight caused by Alternaria panax_Whetz. [Method] The antifungal activity of seven fungicides against A. panax_ was determined based on mycelial growth rate in vitro. [Result] The results of in vitro antibiotic activity assay showed that there were significant differences in inhibition rate among different concentration treatments of each of the seven fungicides. Toxicity test results showed that among the seven fungicides, difenoconazole had the smal est EC50 （0.61 mg/L）, fol owed by streptomycin and captan, with EC50 value lower than 100 mg/L. [Conclusion] A fungicide which had strong antifungal activity on A. panax was screened out, and the results wil provide a theoretical basis for further field trial.

Histopathological Study on Chickens Artificially Infected with Infectious Laryngotracheitis

[Objective] This study aimed to investigate the histopathological changes in chickens artificially infected with infectious laryngotracheitis（ILT）. [Method] Through ar- tificial injection of allantoic liquid containing ILTV into chickens to induce infectious laryngotracheitis, the clinical symptoms in infected chickens were observed; tissues of trachea, lungs, heart, liver, kidney and spleen were collected from dead chickens, and prepared into paraffin sections, followed by histopathological observation under a microscope. [Results] This disease occured in the inoculated chickens 3d later, with a morbidity rate of 95%. The main symptoms were dyspnea, asthma and coughing up of bloody exudate; yellowish-white pseudomembrane was observed on dissected larynx trachea; swelling, haemorrhage, and further erosion were observed on the in- fected tracheal mucosa, resulting in death of chickens, with the mortality rate of 25%; histopathological observation showed that parenchymal organs exhibited exuda- tive inflammation; swelling, degeneration, necrosis and shedding of epithelial cells were observed; disturbance of blood circulation occured.[Conclusion] This study pro- vides reference bases for the treatment of ILT.

Peripherally inserted central catheters in critically ill patients-complications and its prevention:A review

Peripherally inserted central catheter(PICC)is extensively used in critical care settings,because it plays a vital role in providing safe central venous entry.However,PICC is associated with several complications,which should be detected to shorten the duration of patients'improvement,reduce health care cost,and lessen the incidence of various PICC-related complications.Therefore,this study aimed to outline current literature on PICC procedures,potential complications,and measures for prevention.Understanding evidence-based guidelines regarding insertion technique,early detection of complications,and care bundle of PICC is significant in complication prevention.Implementation of education,training,and appropriate multidisciplinary approaches on PICC care among nurses and caregivers is the key to preventing complications.Thus,the strict care of indwelling PICC lines,the targeted and reasonable PICCassociated complication prevention,and nursing care have a major clinical significance in reducing the occurrence of potential PICC complications.

The expression of core fucosylated E-cadherin in cancer cells and lung cancer patients: prognostic implications

It is well documented that the glycosylation of E-cadherin is correlated with cancer metastasis, but whether E- cadherin could be core fucosylated remains largely unknown. We found that E-cadherin was core fucosylated in highly metastatic lung cancer cells while absent in lowly metastatic lung cancer cells. Since α-1,6 Fucosyltransferase (α-1,6 FucT) is known to catalyze the reaction of core fucosylation, we investigated the biological function of core fucosylation on E-cadherin by α-1,6 FucT targeted RNAi and transfecting α-1,6 FucT expression vector. As a result, calcium dependent cell-cell adhesion mediated by E-cadherin was strengthened with the reduction of core fucosylation on E- cadherin after RNAi and was weakened with the elevated core fucosylation on E-cadherin after α-1,6 FucT over expression. Our data indicated that α-1,6 FucT could regulate E-cadherin mediated cell adhesion and thus play an important role in cancer development and progression. Computer modeling showed that core fucosylation on E-cadherin could significantly impair three-dimensional conformation of N-glycan on E-cadherin and produce conformational asym- metry so as to suppress the function of E-cadherin. Furthermore, the relationship between the expression of core fucosylated E-cadherin and clinicopathological background of lung cancer patients was explored in lung cancer tissue of patients. It turns out to demonstrate that core fucosylated E-cadherin could serve as a promising prognostic indicator for lung cancer patients.

Increasing dietary fiber intake in terms of kiwifruit improves constipation in Chinese patients

AIM： To investigate if increased dietary fiber, in terms of kiwifruit, is effective in Chinese constipated patients. METHODS： 33 constipated patients and 20 healthy volunteers were recruited for a 4-wk treatment of kiwi fruit twice daily. Response during wk 1-4 was defined as an increase in complete spontaneous bowl, motion （CSBM）≥ 1/wk. Secondary efficacy included response during wk 1-4, individual symptoms and scores of bowel habits and constipation. Responses were compared with the baseline run-in period. Colonic transit time and anorectal manometry were performed before and after treatment. RESULTS： Responder rate was 54.5% in the constipated group. The mean CSBM increased after treatment （2.2±2.6 vs 4.4± 4.6, P = 0.013）. There was also improvement in the scores for bothersomeness of constipation （P = 0.02）, and satisfaction of bowel habit （P = 0.001）, and decreased in days of laxative used （P = 0.003）. There was also improvement in transit time （P = 0.003） and rectal sensation （P 〈 0.05）. However, there was no change in the bowel symptoms or anorectal physiology in the healthy subjects. CONCLUSION： Increasing dietary fiber intake is effective in relieving chronic constipation in Chinese population.

LncRNA PVT1 promotes ovarian cancer progression by silencing miR-214

Objective: Emerging evidence indicates that long non-coding RNAs(lnc RNAs) are critical in carcinogenesis and progression of ovarian cancer. This study aimed to explore the functions and molecular mechanisms of plasmacytoma variant translocation I(PVT1) in ovarian cancer Methods: PVT1 and miR-214 were detected by qRT-PCR assays in ovarian cancer tissues and cells. The cell proliferation,migration, and invasion abilities were detected by cell functional experiments, respectively. Western blot assay was performed to detect epithelial-mesenchymal transition(EMT) markers. MiR-214 expression regulated by PVT1 was studied by RNA immunoprecipitation(RIP) and chromatin immunoprecipitation(Ch IP) assays.Results: The expression of PVT1 was up-regulated in ovarian cancer tissues and cell lines. Elevated PVT1 expression was associated with advanced stage and indicated poor prognosis for ovarian cancer patients. The knockdown of PVT1 impaired SKOV3 cell proliferation, migration, and invasion in vitro. The promotion of ovarian cancer progression by PVT1 involved in regulation of the epithelial-mesenchymal transition process and PVT1 interaction with EZH2 represses miR-214 expression in ovarian cancer cells.Conclusions: PVT1 plays an important role in ovarian cancer tumorigenesis, which might be as a novel diagnostic marker and therapeutic target for ovarian cancer.

Impact of disease severity on gastric residual volume in critical patients

AIM: To investigate whether illness severity has an impact on gastric residual volume (GRV) in medical critically ill patients. METHODS: Medical intensive care unit (ICU) patients requiring nasogastric feeding were enrolled. Sequential Organ Failure Assessment (SOFA) score was assessed immediately preceding the start of the study. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores were recorded on the first, fourth, seventh, and fourteenth day of the study period. GRV was measured every 4 h during enteral feeding. The relationship be-tween mean daily GRV and SOFA scores and the correlation between mean daily GRV and mean APACHE Ⅱ score of all patients were evaluated and compared. RESULTS: Of the 61 patients, 43 patients were survivors and 18 patients were non-survivors. The mean daily GRV increased as SOFA scores increased (P < 0.001, analysis of variance). Mean APACHE Ⅱ scores of all patients correlated with mean daily GRV (P = 0.011, Pearson correlation) during the study period. Patients with decreasing GRV in the first 2 d had better survival than patients without decreasing GRV (P = 0.017, log rank test). CONCLUSION: GRV is higher in more severely ill medical ICU patients. Patients with decreasing GRV had lower ICU mortality than patients without decreasing GRV.

Fatty liver disease in severe obese patients:Diagnostic value of abdominal ultrasound

AIM:To evaluate the sensitivity and specificity of abdominal ultrasound (US) for the diagnosis of hepatic steatosis in severe obese subjects and its relation to histological grade of steatosis. METHODS: A consecutive series of obese patients, who underwent bariatric surgery from October 2004 to May 2005, was selected. Ultrasonography was performed in all patients as part of routine preoperative time and an intraoperative wedge biopsy was obtained at the beginning of the bariatric surgery. The US and histological findings of steatosis were compared, considering histology as the gold standard. RESULTS: The study included 105 patients. The mean age was 37.2 ± 10.6 years and 75.2% were female. The histological prevalence of steatosis was 89.5%. The sensitivity and specificity of US in the diagnosis of hepatic steatosis were, respectively, 64.9% (95% CI: 54.9-74.3) and 90.9% (95% CI: 57.1-99.5). The positive predictive value and negative predictive value were, respectively, 98.4% (95% CI: 90.2-99.9) and 23.3% (95% CI: 12.3-39.0). The presence of steatosis onUS was associated to advanced grades of steatosis on histology (P = 0.016). CONCLUSION: Preoperative abdominal US in our series has not shown to be an accurate method for the diagnosis of hepatic steatosis in severe obese patients. Until another non-invasive method demonstrates better sensitivity and specificity values, histological evaluation may be recommended to these patients undergoing bariatric surgery.

Inflammatory bowel disease: An evaluation of health information on the internet

To evaluate the quality and accuracy of websites written to the public on inflammatory bowel disease (IBD) (Crohn’s disease and ulcerative colitis) and assess their readability level.METHODSGoogle™, Bing™, and Yahoo™ search engines were searched independently by three researchers in December 2014. Only English-language websites were selected on the basis of predetermined inclusion and exclusion criteria. Researchers independently evaluated the quality of each website by using the DISCERN and the HONcode instruments. The readability levels were calculated using two formulas; the Flesch-Kincaid Grade Level Index, and the Coleman-Liau Readability Index. The agreement between the evaluators was calculated using Cohen kappa coefficient.RESULTSEighty-four websites were finally identified. Scores varied from a minimum DISCERN score of 18 to a maximum of 68 [mean ± SD, 42.2 ± 10.7; median = 41.5, interquartile range, interquartile range (IQR) = 15.8] and a minimum score of HONcode of 0.14 and a maximum of 0.95 (mean ± SD, 0.16 ± 0.19; median = 0.45, IQR = 0.29). Most of these websites were reviewed in 2014 and 2015 (n = 51). The creators of these websites were: universities and research centers (n = 25, 30%), foundations and associations (n = 15, 18%), commercial and pharmaceutical companies (n = 25, 30%), charities and volunteer work (n = 9, 10%), and non-university educational bodies (n = 10, 12%). The Flesch-Kincaid Grade Level readability score (mean ± SD) was 11.9 ± 2.4 and the Coleman-Liau Readability Index score was 12.6 ± 1.5. Significant correlation was found between the two readability scores (R2 = 0.509, P = 0.001). The overall agreement between evaluators measured by Cohen kappa coefficient was in the range of 0.804-0.876; rated as 'Good'.CONCLUSIONThe DISCERN and the HONcode scores of websites varied and the readability levels of most websites were above the public readability level. The study highlights the areas that need further improvement and development in patient education online materials about IBD.

Studies on gallstone in China

INTRODCTlONGallstone is one of the common primary diseases of bile system. Chinese researchers have done comprehensive and thorough studies on it, but there are still some problems we have not solved. It is necessary to review the achievements we have made in this field recently, to summarize the experiences and find the tendency so as to provide a sound foundation for the researches in the new century. Due to the popularization of molecular biological research methods, a rapid development of modern imaging techniques and medical equipment, the basic and clinical studies of cholelithiasis have set foot on the fast lane. Studies on the cause of cholelithiasis formation and its prevention have covered areas from epidemiological investigation at macroscopical level to molecular biological researches at microcosmic level. Clinical studies include prevention and treatment of cholelithiasis with traditional Chinese medicine, popularization of micro-injury surgery,treatment of complicated calculus of bile duct, and other aspects.

Intussusception of the bowel in adults:A review

Intussusception of the bowel is defined as the telescop-ing of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment.This condi-tion is frequent in children and presents with the classic triad of cramping abdominal pain,bloody diarrhea and a palpable tender mass.However,bowel intussusception in adults is considered a rare condition,accounting for 5% of all cases of intussusceptions and almost 1%-5%of bowel obstruction.Eight to twenty percent of cases are idiopathic,without a lead point lesion.Secondary intus-susception is caused by organic lesions,such as inflam-matory bowel disease,postoperative adhesions,Meckel's diverticulum,benign and malignant lesions,metastatic neoplasms or even iatrogenically,due to the presence of intestinal tubes,jejunostomy feeding tubes or after gas-tric surgery.Computed tomography is the most sensitive diagnostic modality and can distinguish between intus-susceptions with and without a lead point.Surgery is the definitive treatment of adult intussusceptions.Formal bowel resection with oncological principles is followed for every case where a malignancy is suspected.Reduction of the intussuscepted bowel is considered safe for benign lesions in order to limit the extent of resection or to avoid the short bowel syndrome in certain circumstances.