新冠肺炎疫情正在全球大流行,目前我国面临着外防输入、内防扩散的巨大压力.发热门诊作为发现可疑患者的第一道关口,其信息化建设是有序、规范开展诊疗工作的基础.该院在现有门诊系统上加以改造和功能拓展,在短时间内建立了发热门诊留观子系统,极大方便了临床一线工作,为其他医疗机构提供参考.

目的 探讨新型冠状病毒肺炎(以下简称新冠肺炎)医疗救治定点医院设置独立预检分诊管理策略对控制疫情传播的有效性.方法 自2020年1月24日重庆市启动突发公共卫生事件一级响应,该院设置相对独立的预检分诊处,严格执行各项防疫措施和工作流程,以集中分流和快速处置疑似病例和感染病例.结果 经过1年的运行和实践,效果显著,就诊患者新冠肺炎筛查效率高、新冠肺炎疑似或确诊病例零漏诊,医务人员零感染,无院内交叉感染发生.结论 在传染病疫情暴发时,设置独立的预检分诊处这一举措值得在医疗机构推广.

目的·探讨长链非编码 RNA(long non-coding RNA,lncRNA)GK-IT1 通过调控醛缩酶 A(aldolase A,ALDOA)对非小细胞肺癌(non-small-cell lung cancer,NSCLC)细胞A549及H358恶性进展的影响.方法·应用实时荧光定量PCR(quantitative real-time PCR,qRT-PCR)检测42对NSCLC组织和癌旁组织以及NSCLC细胞系中GK-IT1的表达.荧光原位杂交(fluorescence in situ hybridization,FISH)实验检测GK-IT1在A549及H358中的亚细胞定位.RNA免疫共沉淀(RNA immunoprecipitation,RIP)检测 GK-IT1 与 ALDOA 的相互作用关系.以 2条 GK-IT1 的小干扰 RNA序列(Si-GK-IT1#1 和Si-GK-IT1#2)及空白对照(Si-NC)转染A549及H358细胞,再以Si-GK-IT1#2和ALDOA过表达质粒共转染上述细胞系.设置Si-NC组、Si-GK-IT1#1及Si-GK-IT1#2组,采用CCK-8及EdU实验检测细胞增殖能力,Transwell侵袭实验与细胞划痕实验检测细胞侵袭能力及迁移能力.Western blotting检测各实验组内波形蛋白(vimentin)、E钙黏蛋白(E-cadherin)、N钙黏蛋白(N-cadherin)及ALDOA的表达水平.结果·与正常组织相比,NSCLC组织中GK-IT1的表达量明显升高;与正常支气管上皮细胞BEAS-2B相比,H358、A549细胞中GK-IT1的表达量明显升高(均P＜0.05).FISH实验表明GK-IT1主要位于细胞质;RIP实验及生物信息学分析表明GK-IT1可能与ALDOA蛋白结合;CCK-8实验结果显示,Si-GK-IT1#1及Si-GK-IT1#2组较Si-NC组细胞增殖能力明显受到抑制(均P＜0.05);EdU实验结果显示,Si-GK-IT1#1及Si-GK-IT1#2组较Si-NC组细胞EdU阳性率显著降低(均P＜0.05);Transwell侵袭实验结果显示,与对照组相比,Si-GK-IT1#1及Si-GK-IT1#2组细胞侵袭能力明显受到抑制(均P=0.000);细胞划痕实验结果显示,Si-GK-IT1#1及Si-GK-IT1#2组较Si-NC组细胞迁移率明显降低(均P=0.000).敲减GK-IT1后,ALDOA、vimentin表达水平降低,E-cadherin表达水平升高.过表达ALDOA可逆转敲低GK-IT1对NSCLC细胞增殖、侵袭、迁移及蛋白表达水平的影响(均P＜0.05).结论·GK-IT1可通过调控ALDOA蛋白促进NSCLC细胞的增殖、侵袭与迁移能力.

Objective:To explore the application of English for medical purpose (EMP) in integrated medical education for medical undergraduates.Methods:A total of 120 undergraduates who participated in the integrated medical education in Chongqing Medical University were divided into EMP group and traditional medical English teaching group. There was no difference in the syllabus knowledge between the two groups. The teaching method of EMP group combined with integrated medical education and gave medical English teaching according to the organ system. The traditional group conducted the teaching according to the traditional medical English teaching method based on word formation and sentence understanding. SPSS 24.0 was used for t-test. Results:The scores of medical vocabulary test in the EMP teaching group were higher than those in the traditional teaching group [(85.00±3.52) vs. (65.67±3.33)]. The number of Review papers published in EMP group was 14, while 6 in traditional teaching group. The teachers used a randomized double-blind method to score the students' review papers (total score was 100 points). The results showed that the score of properly using medical vocabulary of students in the EMP teaching group were higher than those in the traditional teaching group [(84.52±2.34) vs. (70.98±1.45)]. The scientific evaluation score on review content in EMP group was higher than that in traditional teaching group [(88.87± 4.68) vs. (71.87±2.41)]. The grammar score of EMP group was higher than that of traditional teaching group [(90.01±7.24) vs. (76.00±3.76)].Conclusion:Medical English EMP course can better cooperate with the integrated education for medical undergraduates, improve students' ability of using medical English to retrieve literature and understand medical English according to organ system.

目的:探讨加速康复外科理念在胸腔镜肺切除术患者应用的安全性和有效性.方法:回顾性收集2016年1月至2017年1 1月在重庆医科大学附属第一医院胸心外科接受胸腔镜肺切除的139例患者,其中77例按传统康复模式管理患者为对照组,62例按加速康复外科理念指导的患者为ERAS组.比较2组患者的基本信息、手术相关资料、术后恢复相关指标.结果:①2组患者在基本信息、手术时间、术中出血、术中尿量、手术方式、术后病检等方面比较无统计学差异(P＞0.05);②ERAS组与对照组相比,ERAS组在术后并发症如肺部感染(8.06％ vs.10.39％,x2=0.219,P=0.640)、漏气(6.45％ vs.12.99％,x2=1.620,P=0.203)、切口感染(1.61％ vs.1.30％,P=1.000)、胸腔积液(1.61％ vs.1.30％,P=1.000)、喉返神经损伤(1.61％ vs.1.30％,P=1.000)的发生率较对照组低,但无统计学差异;③ERAS组与对照组相比,ERAS组在拔气管导管时间[(2.47±1.31)h vs.(3.29±1.24)h,t=3.765,P=0.000]、ICU住院时间[(17.20±12.98)h vs.(34.10±20.47)h,t=5.940,P=0.000]、拔尿管时间[(20.55±12.64)h vs.(36.65±20.55)h,t=5.847,P=0.000]、拔胸腔引流管时间[(82.02±54.24)h vs.(111.58±60.57)h,t=2.894,P=0.004]、术后住院时间[(4.87±2.80)d vs.(6.29±3.48)d,t=2.597,P=0.001]、总住院时间[(9.47±4.64)d vs.(11.43±±5.42)d,t=2.259,P=0.025]和住院费用[(54 861.59±17 627.46)元vs.(70 281.00±57 732.68)元,t=2.027,P=0.045]均少于对照组,有统计学差异.ERAS组就医满意度评分(9.24±0.64 vs.8.94±0.92,t=-2.303,P=0.023)高于对照组,有统计学差异.结论:对于胸腔镜肺切除术患者,应用加速康复管理模式能够缩短患者住院时间,减少住院费用,提升就医满意度,并且不会增加术后并发症发生率.

Objective To investigate the therapeutic effect and value of surgery on foreign body in esophagus. Methods The clinical data of 21 patients with foreign body in esophagus who underwent surgical treatment from December 2012 to January 2018 were retrospectively analyzed. Combined with preoperative clinical symptoms, signs, imaging and endoscopic findings, accurately locate foreign bodies, choose transesophageal or transthoracic foreign body in esophagus removal, postoperative parenteral and early enteral nutrition support, anti -infection, acid suppression treatment. Results 15 patients were cured and discharged. The other 6 patients were transferred to local hospitals for further nutritional support and acid suppression treatment. No deaths occurred. There were 8 cases (38.09％) with postoperative complications. The postoperative complications of cervical foreign body and thoracic foreign body were 2 cases (9.52％) and 6 cases (28.57％). Among them, 2 cases (9.52％) of esophageal fistula, 1 case were cured after conservative treatment such as mouth drainage, nutritional support, anti-infection, 1 case was cured after second thoracotomy, and 3 cases (14.29％) were postoperative hoarseness. All patients were followed up for 1 to 2 months after discharge and returned to normal. During the follow-up of 7 months to 5 years, except for one case of death due to esophageal cancer, the rest did not have any symptoms such as dysphagia, eating sensation, and the quality of life was not affected. Conclusion Surgical surgery is one of the main treatment methods for foreign body in esophagus. Foreign bodies should be removed in a timely and safe manner. In combination with preoperative positioning, intraoperative suture of the esophagus or only patency drainage is feasible, but attention should be paid to postoperative complications and postoperative nutritional support.

高校众创空间建设发展迅速,但是医科院校以公众营养健康服务为主题的众创空间尚未见报道.为了帮助培养公众营养健康服务方面创新创业的医学生团队和个人,以更好地对接"健康为中心"的健康服务产业,本团队两年多来进行创建"健行生活"公众营养健康服务众创空间的教学改革研究与实践.本文对该众创空间的创建背景、创建过程以及初步成果等方面进行了介绍.

目的:探讨适量运动对老年人自身营养状况与机体免疫平衡的变化.方法:60周岁及以上的老年人,根据长期适量运动与长期不运动分为运动组与非运动组,每组20人,采用微型营养评估法(MNA)评价两组老年人营养状况;采用24h膳食回顾法调查两组老年人膳食特征并分析;收集两组老年人全血并用流式细胞技术检测Th1/Th2的细胞比值.结果:两组老年人在饮食结构上无明显差异.运动组老年人营养状况优于不运动组,且适量运动老年人机体免疫维持平衡,不运动老年人免疫平衡偏移.结论:适量运动能够改善老年人的机体的营养状况和免疫能力.

肺癌是严重威胁人类健康的疾病,其发病率和死亡率高居恶性肿瘤之首[1].外科手术是早期肺癌患者有效的治疗手段,其标准术式为解剖肺叶切除及系统性淋巴结清扫.肺癌手术包括常规开胸手术和胸腔镜微创手术,前者创伤和风险较大而后者具有术后疼痛轻,创伤小,胸管留置时间及住院时间较短等诸多优点[2].尽管如此,胸腔镜微创手术的远期疗效与常规开胸手术相似,胸腔镜单镜头二维成像缺乏立体感,其准确性和协调性在复杂的手术操作中也不尽人意[3-4].随着医学技术的发展,外科手术中医生的手臂被机器人取代,医生在电脑终端区操作即可将体内手臂的活动转化成计算机辅助-微型仪器准确、精细的操作,达芬奇手术系统(daVinci surgical system)应运而生[5].自2001年美国食品和药品管理局(FDA)批准达芬奇手术系统可用于胸腔镜手术以来,全球装机量已超过3000台[6].鉴于达芬奇手术系统的诸多优势,本文就系统的构成、在肺癌根治术中的应用现状进行综述.

目的:调查重庆地区男男性行为者(men who have sex with men,MSM)人巨细胞病毒(human Cytomegalovirus,HCMV)感染现状.方法:采用非概率抽样法,对907例MSM(来源为2012年至2014年重庆地区进行临床药物实验预防艾滋病感染的MSM人群)和170例健康成人血清(同期健康体检的成年男性),采用ELISA方法检测HCMV的IgG、IgM抗体,使用x2检验对结果进行分析,以P ＜0.05为差异具有统计学意义.结果:907例MSM中HIV(+)130例,HIV(-)777例;130例HIV(+)MSM中HCMV既往感染率为98.46％,感染后再活化率为6.25％;777例HIV(-)MSM中HCMV既往感染率为96.78％,感染后再活化率为5.05％.170例健康对照组既往感染率92.94％,感染后再活化率1.27％.HIV(+)MSM的HCMV既往感染率及感染后再活化率虽然高于HIV(-)对照组,但两者比较差别无统计学意义(x2=0.583,P＞0.05;x2=0.369,P＞0.05);MSM的HCMV既往感染率及感染后再活化率明显高于健康成人,且两者比较差别有统计学意义(x2=6.835,P＜0.05;x2=4.227,P＜0.05).结论:重庆地区MSM人群的HCMV既往感染率及感染后再活化率明显高于健康成人,提示MSM人群面临HCMV感染威胁较严重.

Objective To study the virulence and environmental adaptability of extensively drug-resistant Acinetobacter baumannii (XDRAB) ST238 clone, and explore the potential mechanisms of the persistent prevalence of this clone. Methods MTT method was employed to examine the in vitro growth of these strains. The competition index (CI) were determined by in vitro competition experiment to compare with A. baumannii ATCC 19606. The gelatinase activity, D-mannose related O/AB hemagglutination activity, twitching motility, and biofilm formation were studied to analyze its virulence. The median lethal dose (LD50) was determined for mice in sepsis peritoneal infection model. Results The in vitro growth (P>0.05) or competition experiment (CI=0.29, P>0.05) did not show significant difference between ST238 clone and the reference strain ATCC 19606. The gelatinase (P>0.05) and hemagglutination activity (P>0.05) did not show significant difference between ST238 clone and the susceptible strain. However, the susceptible reference strain ATCC 19606 did show stronger motility and biofilm formation ability than ST238 clone (P<0.05). The LD50 of ST238 clone and reference strain ATCC 19606 was 6.9 and 6.7 log CFU/mL, respectively. There was no significant difference in the mean time to death of mice after challenging with 9.3 log CFU/mL (P>0.05). Conclusions A. baumannii ST238 clone acquired extensively drug-resistant ability but without loss of environmental adaptability and virulence. This biological nature may contribute to its persistent prevalence in our hospital.

考试是检验学生学习情况、教师教学质量的最直接手段,其本质意义在于督促学生学习、提示教师改进教学方法,从而提高人才培养质量.考务工作是教学管理工作的重要组成部分,管理规范、秩序井然的考务工作可激发学生的学习积极性,是维持高校正常教学秩序、促进校风学风建设、提高教学质量的重要保障.

通过分析现行主流医院评审评价标准中患者安全的内容,得出患者安全已成为评价医院全面质量建设的重要环节,是医院持续健康发展的基石.通过比较部分国家和地区主流医院评审评价标准与现行三级综合医院评审标准中有关患者安全条款的异同,明确患者安全在医院评审评价中的重要性.

Objective To retrospectively analyze the application effect of clinical pathway for total hip replacement patients in perioperative period. Methods The study objects were 163 total hip replacement patients discharged from department of orthopedics in the First Affiliated Hospital of Chongqing Medical University from December 2014 to December 2015. According to whether they were implemented in clinical pathway or not,those subjects were divided into control group (102 patients,Group A) and group of clinical pathway (61 patients,Group B). Average total hospitalization expenses,average operation expenses,average material expenses,average medicine expenses,average auxiliary examinations expenses,average hospital stay and average preoperative hospital stay were compared. Results There were no significant differences in average total hospitalization expenses, average operation expenses and average material expenses between two groups,whereas average medicine expenses and average auxiliary examinations expenses were obviously lower in group of clinical pathway (Group B). Average hospital stay and average preoperative hospital stay of Group B were significantly shorter than those of control group (Group A). Conclusions It indicated that the clinical pathway could reduce the average length of stay,the average of preoperative stay,the average auxiliary examination expenses,and the drug expenses in the application of total hip arthroplasty. Clinical pathway could guarantee medical quality and safety,and decrease medical threshold which was worth spreading.

Objective To summarize the medical rescue of Chinese Government Medical Team (Chongqing) in Nepal earthquake region in order to explore the work pattern of transnational medical rescue,and improve the rescue efficiency.Methods From the experience about the post-earthquake medical rescue of Chinese Government Medical Team (Chongqing) in Nepal in 2015,several aspects were worthy to summarize such as the establishment of medical team,the layout of camp site,the work algorithm and process,with the analysis of injury feature and outcome of treatment.Results Under the setting of efficient organization and rational assignment of professional work,special working rules,the mutual transfer treatment and multi-disciplinary treatment were employed for 737 emergency patients.Of them,128 patients were hospitalized (including 63 patients completely recovered,56 patients were of clinical improvement,and 9 patients were critically ill transferred to other hospital for advanced treatment),and post-traumatic complication occurred in 48 cases without death.In addition,148 operations were carried out successfully.Conclusions The earthquake disaster has specific feature such as suddenness,a host of casualties and poor rescue conditions,and overseas rescue is with the presence of the language barrier,the difference in living habit,and the lack of coordination with local rescue system,therefore,rationally assigning personnel and resources and establishing work pattern with flexibility,orderly and good communication are the key to promote the efficiency of transnational medical rescue for the injured patients in earthquake region.

目的检测Hsp70与肿瘤转移相关蛋白MMP-9、VEGF、E-cadherin和CD44v6在非小细胞肺癌组织中的表达,探讨其表达与肺癌生物学行为的关系,以研究这些蛋白对非小细胞肺癌转移的作用,进而探讨其诊断价值。方法应用免疫组化方法检测60例肺癌组织标本以及9例癌旁正常组织中Hsp70、MMP-9、VEGF、E-cadherin和CD44v6的表达,采用统计学方法分析Hsp70与肿瘤相关转移蛋白的表达与患者的临床病理特征的关系。结果 Hsp70、MMP-9、VEGF、E-cadherin和CD44v6在肺癌组织中的阳性表达水平均明显高于在癌旁组织的表达,并且Hsp70、MMP-9及E-cadherin与肿瘤组织学分级、淋巴结转移、TNM分期有关（P＜0.05）,与肿瘤的分型无关（P＞0.05）;CD44v6与肿瘤组织学分级、分型、TNM分期均无关（P＞0.05）,与肿瘤的淋巴结转移有关（P＜0.05）;VEGF与肿瘤的分型、组织学分级、淋巴结转移、TNM分期均无关（P＞0.05）。结论 Hsp70、MMP-9、VEGF、E-cadherin和CD44v6阳性表达预示非小细胞肺癌具有较强的侵袭和转移能力,可作为预测非小细胞肺癌转移潜能生物学指标。

<正>肺癌是最常见的恶性肿瘤,发病率及死亡率居癌症首位,而75%～80%为非小细胞肺癌(non-small cell lung cancer,NSCLC)。多数患者确诊时已进入晚期,标准化疗方案疗效已达稳定水平,且效果较差,不良反应明显。近年来,针对特定靶点的个体化治疗成为研究的热点。棘皮动物微管相关蛋白4-间变型淋巴瘤激酶(echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase,EML4-ALK)融合基因是最新发现的一个肿瘤相关基因[1],3%～13%的NSCLC患者含有此基因[1-4],为NSCLC个体化治疗提供了一个新的靶点,已有多种针对该靶点的ALK抑制剂进入临床研究。本文将从EML4-ALK融合基因阳性NSCLC患者的分子生物学特征、临床特征、检测、临床研究及耐药机制进行综述。

结缔组织生长因子(CTGF/CCN2)属于即刻早期基因编码的CCN家族中的一员,参与正常细胞增殖、黏附、迁移、凋亡及新生血管形成,在创伤修复、纤维化疾病和肿瘤形成中也具有重要的作用.新近研究发现,CTGF在肺癌组织中表达较正常肺组织降低,与肺癌的发生、发展密切相关,被视为肺癌转移和预后的评价指标.本文简要介绍了CTGF的结构、功能及在其肺癌中的研究进展,以期为肺癌的临床治疗提供新的思路.

Objective To determine the expression of transcription factor FoxO1,and its correlations to the clinicopathological features of esophageal squamous cell carcinoma(ESCC).Methods SYBR green real-time fluorescent quantitative reverse transcriptase PCR was used to detect the expression levels of FoxO1 mRNA in 42 matched pairs of ESCC tissues and normal samples.The protein expression and location of FoxO1 were measured by immunohistochemistry(SP method).The expression was analyzed with gender,age,site,TNM stage,lymphatic metastasis,and tumor cell differentiation.Results The expression of FoxO1 at mRNA or protein levels was upregulated significantly in ESCC tissues compared with normal esophageal epithelium tissues(P<0.01).The expression of FoxO1 was higher in well differentiated ESCC than in poorly differentiated ESCC and normal esophageal epithelium tissues(P<0.01).However,the expression of FoxO1 was not correlated to clinicopathological characters,such as gender,age,tumor site,TNM stage,lymphatic metastases and tumor cell differentiation(P>0.05).The protein expression of FoxO1 was consistent with that of its mRNA expression.Conclusion The expression of FoxO1 varies significantly in ESCC and normal esophageal epithelium tissues.Over-expression of FoxO1 is closely related to the differentiation of ESCC.

As a general practitioner's standardized pilot training base of the health ministry,the outhors strain clinical teachers and improve their teaching level through many ways,such as short-term training for general practice and community health service,popularizing general medical knowledge and its teaching method through our hospital newspaper,discussion activities in teaching and research section of general practice,general diagnosis and treatment in community health service center,etc.We have improved the quality of standardized training to general medical residents,through mending of clinical training plan and strengthening of humanistic quality education,such as increasing the number of common case required in learning,add specifications on oncology and geriatrics training,taking part in activities sponsored by the party,the communist youth league or the labor union,visiting human attractions and listening to sociological lecture given by well-known medical experts,etc.Our experience may be a reference to standardized training of general practitioners developed widely in our country.