关键词： 内科学   视黄醇类X受体   氧化型低密度脂蛋白   巨噬细胞   动脉粥样硬化  

摘要： 目的探讨激活视黄醇类X受体对氧化型低密度脂蛋白诱导巨噬细胞凋亡的影响及其机制。方法小鼠巨噬细胞系RAW264.7经氧化型低密度脂蛋白处理24h诱导凋亡,同时观察给予视黄醇类X受体特异性配体9-cisRA或SR11237对氧化型低密度脂蛋白诱导凋亡的干预作用,MTT法检测细胞活力,流式细胞仪PI单染法和DAPI染色检测细胞凋亡,CM-H2DCFDA荧光探针测定细胞内活性氧浓度。结果RAW264.7细胞经氧化型低密度脂蛋白(100mg/L)处理24h后细胞活力较对照组下降约60,细胞凋亡百分率较对照组升高约75,10-8mol/L和10-7mol/L9-cisRA及10-7mol/LSR11237能够显著抑制氧化型低密度脂蛋白诱导引起的细胞活力下降和凋亡(P<0.05)。给予氧化型低密度脂蛋白(100mg/L)4h后细胞内活性氧水平显著升高约17倍以上,如联合给予9-cisRA(10-7mol/L)或SR11237(10-6mol/L),平均荧光强度分别下降约52和28,较氧化型低密度脂蛋白单独处理组有显著性差异(P<0.05)。结论激活视黄醇类X受体能够抑制氧化型低密度脂蛋白诱导巨噬细胞凋亡,其机制可能与减轻细胞氧化应激损伤有关。

摘要： 《国际内科学杂志》(原《国外医学内科学分册》)是由中华人民共和国教育部主管、中山大学附属第三医院承办的一本国家级医学期刊,自2007年全面改版以来,在广大审稿专家、作者及读者的关心支持下,不断进步和发展,现已被美国化学文摘、万方数据库、中国核心期刊(遴选)数据库、中文科技期刊全文数据库(维普资讯)、中国期刊全文数据库等收录。主要栏目设有综述、论著(包括临床论著和基础研究论著)、述评、病例报告、会议报道、药物与临床、最新医学信息等栏目。《国际内科学杂志》以从事临床、科研和教学的医务工作者为主要读者对象,主要报道国内外有关内科学

关键词： 内科学   血小板   心肌梗死   心室重塑   组织修复  

摘要： 目的检测移植活化富血小板血浆上清液对心肌梗死后组织修复过程的影响。方法105只雄性Wistar大鼠随机分为富血小板组、贫血小板组和假手术组。经腹主动脉取血后采用二次离心法和凝血酶激活制作活化富血小板血浆上清液和活化贫血小板血浆上清液。采用酶联免疫吸附试验测定活化富血小板血浆上清液和活化贫血小板血浆上清液中血管内皮生长因子的浓度。建立急性心肌梗死模型即刻,于梗死周边注射活化富血小板血浆上清液(富血小板组)和活化贫血小板血浆上清液(贫血小板组)。心肌梗死后7d和28d处死动物,取出心脏行离体心脏压力-容积曲线测定、天狼猩红染色和荧光检测。结果富血小板组心肌梗死后28d离体心脏压力-容积曲线较贫血小板组左移;梗死周边区注射活化富血小板血浆上清液可在一定程度上减小梗死面积、增加梗死游离壁厚度并缓解非梗死区肥厚,同时促使心肌梗死区小动脉和毛细血管的新生。结论移植活化富血小板血浆上清液可加速心肌梗死后愈合并改善心室重塑。

关键词： 肿瘤预防   内科学   多中心临床研究   专家   临床试验   教育工作   规范化应用   抗肿瘤新药  

关键词： collaboration   emotion work   emotional labour   internal medicine   interprofessional practice   nursing   teamwork  

摘要： Aim. This paper is a report of a study to examine nursing emotion work and interprofessional collaboration in order to understand and improve collaborative nursing practice. Background. Nursing standards identify collaborative practice as necessary for quality patient care yet many nurses are often reluctant to participate in interprofessional teams. Strategies intended to improve participation often fail which suggests that the factors underpinning nurses' disinclination towards interprofessional collaboration have yet to be understood. The concept of emotion work has not been applied to nursing interprofessionalism, and holds the potential to improve collaborative practice. Nursing emotion work is defined as the management of the emotions of self and others in order to improve patient care. Methods. Qualitative data were collected in 2006 using non-participant observation, shadowing and semi-structured interviews with nursing, medical and allied professionals in the general internal medicine wards of three hospitals in urban Canada. Findings. Nurses' collaborations with other professionals are influenced by emotion work considerations. The establishment and maintenance of a nursing esprit de corps, corridor conflicts with physicians, and the failure of the interdisciplinary team to acknowledge the importance of nursing's core caring values are important factors underpinning nurses' interprofessional disengagement. Conclusion. Longstanding emotion work issues must be addressed before nurses will engage collaboratively. We suggest improving nursing collaboration through the refining of holistic nursing information, and reflections on practice by all interprofessional team members.

关键词： Heart failure   Disease management   Case management   Patient care management  

摘要： Background and objective: To evaluate if consultation between specialists in Internal Medicine and family doctors (CIMFD) improves the clinical management and prognosis of patients with heart failure (HF). Methods: Design: prospective case-control study (5 years of follow-up). Setting: community-based sample within the area of a university teaching hospital. Subjects: 1857 patients (>= 14 years) diagnosed for the first time with HF (1stDxHF), in the CIMFD. Control group: 1981 patients (from health centres not covered by the CIMFD), 1stDxHF, in the external consultations of the hospital. Main outcome measures: mortality rate (MR). Admissions (HA). Emergency services visits (ESV). Delays in receiving specialist attention (DRSA), and the resolution of the process (DR-P). Number (NTP) and delays in reporting (DTP) tests performed. Proportion (PRC) and delay (DRC) in resolving cases. Results: We observed a reduction of. MR (by 10.8%, CI 95%, 8.6-13.0, p < 0.005);HA, per patient per year (ppy) (by 1.8, 1.3-2.3, p < 0.0 1);ESV, ppy (by 1.9, 1.2-2.6, p < 0.01);DRSA (by 26.5 days, 21.8-31.2, p < 0.00 1);DRP (by 2 1.0 days, 18.3-23.7, p < 0.001), and DRC (by 25.8 days, 20.3-31.4, p < 0.01). The PRC (17.2%, Cl 95%, 15.5-18.9, p < 0.01) was higher for the CIMFD. Conclusion: The CIMFD approach improves prognosis and efficacy in the clinical management of patients with HF because it reduces mortality and morbidity (HA and ESV), shortens the delays in receiving care and in resolving the diagnostic and therapeutic process (DRSA, DRP, DRC), and increases the proportion of diagnosed and treated patients. (C) 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

ISBN: (纸本)9787509121528

摘要： A well-designed curriculum with appropriate goals and clearly articulated, behaviorally based objectives is vital to the success of any learning experience. Curricula serve many important functions: focusing teaching and learning efforts; delineating required educational resources (faculty, patients, facilities, materials); influencing the selection of educational methods; setting standards of competence; and driving assessment. Here, De Fer and Fazio describe the revision process of Clerkship Directors in Internal Medicine's (CDIM) and the Society of General Internal Medicine's (SGIM) Core Medicine Clerkship Curriculum Guide, which is aimed to emphasize the learning of general clinical core competencies in the third year of medical school and to create a consensus for curricular content. Also, they detail the outcomes and the subsequent assessment of this curriculum. Moreover, they note that the CDIM and SGIM has developed a national clerkship curriculum to consolidate the efforts of internal medicine clerkships and ensure a means of consistency across all undergraduate medical institutions. Furthermore, they stress that this curriculum features training problems highlighting different clinical activities that clerkship directors agreed students should know by the end of their clerkship year.

关键词： Diastolic heart failure   Prognosis   Internal medicine  

摘要： Background: At least 70% of patients with heart failure (HF) are referred to departments of internal medicine. Some 40-50% have preserved systolic ventricular function (PSVF;LVEF > 0.45). The aim of this study was to evaluate survival and prognostic value of several functional parameters in PSVF-HF patients admitted to a department of internal medicine. Methods: Eighty-two consecutive patients hospitalized between January I and December 31, 2001 (44 men and 38 women, mean age 63.7 years) were followed Lip for a mean period of 37 months. The severity of symptoms at admission was assessed by NYHA classification. Twenty-five patients were in NYHA class 1, 43 in II, and 14 in III-IV. All patients underwent chest X-ray, echocardiogram, and a 6-minute walking test. Results: Seventeen patients (20.7%) died, 16 of cardiovascular causes and I of cancer. Survival was not affected by etiology, sex, age, left ventricular ejection fraction (LVEF), LV filling pattern, or Pulmonary artery pressure. With univariate analysis, NYHA class at admission was the strongest predictor of death. Distance covered after the 6-minute walking test was also related to survival. The Cox stepwise regression model showed that only NYHA class at admission (p < 0.05) was significantly related to survival. Conclusions: During a 3-year follow-up, mortality in PSVF-HF patients referred to a department of internal medicine is close to 7% per year. A high NYHA class at admission and decreased functional capacity (i.e., distance walked at 6 min < 350 m) are related to a worse prognosis. (C) 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

关键词： 医药、卫生   内科学   传染病