第六届亚太地区循证医学研讨会组委会： 欣闻第六届亚太地区循证医学研讨会首次在中国深化医疗体制改革的中部重镇——安徽省芜湖市皖南医学院隆重召开，邀请了世界上最富盛名的高质量医学证据生产的两大非盈利学术组织Cochrane协作网和Campbell协作网前主席、WHO国家临床试验注册平台技术负责人和Cochrane协作网英国中心、南非中心、南亚中心和韩国分中心主任及培训部主任赴会，与国内800余名会议代表齐聚一堂，就当前为实现“2020 Health for All”的世纪目标的探索与实践中，共同面临的医疗卫生改革、医学教育改革、决策模式、服务体系、运行机制、政策环境、人才培训、公众教育等难题，以及为解决当前这些难题开发的种种决策模式、研究方法、评价标准等前沿，通过大会专题报告，分会场口头报告，工作会当堂切磋等多种形式充分交流，共享信息，可喜可贺！ 1997年7月27日，卫生部科教司发文批准建立卫生部中国循证医学中心。13年来，在卫生部两届指导委员会的宏观指导和大力帮助下，中国循证医学中心圆满完成了创建卫生部中国循证医学中心、Chinese Cochrane Center的任务。并按照1997年卫生部批建时确定的目标，学习美国/加拿大建立13个循证医学实践中心，为美国卫生保健政策和研究委员会（Agency for Healthcare Research and Quality，AHRQ）生产高质量决策证据的经验，同时学习英国国家临床评价研究所（National Institute for Health and Clinical Excellence，NICE）、苏格兰地区学院指南网络（Scottish Intercollegiate Guideline Network，SIGN）作为非盈利学术机构生产循证临床指南和合成高质量证据的经验，与中心领导创办的循证医学教育部网上合作研究中心及其分中心合作，共同为推动中国的循证医学事业，服务于中国的医疗改革、医学教育改革，做出了宝贵的贡献。 中国的医疗改革正处于关键之年，中国的卫生事业发展正面临前所未有的挑战和机遇，“2020健康中国”的政府承诺，建立国家基本药物制度、临床指南生产和审查制度、国家战略性新兴产业、卫生技术和产品的临床转化……，急需大量训练有素的EBM人才团队，应卫生部要求，有组织、有计划地生产高质量决策依据，并及时将政府的各种科学决策迅速转化到实践中，用于提高当地的医疗服务质量。 正是从这个意义上讲，您们的存在和发展，对保障此项工作的国际接轨和可持续发展，意义重大！ 我谨代表卫生部预祝大会圆满成功！卫生部副部长 黄洁夫2010.9.24
Objective To probe into the roles of inositol 1, 4, 5-trisphosphate (IP3) and bcl-2 gene expression in inhabiting hepatocellular carcinoma of nude mice by quercetin. Methods Animals with hepatocellular carcinoma in quercetin group were treated with injection peritoneum of quercetin 50 mg/（kg·d ） for 3 weeks, while which in control group were treated with 0.4% DMSO of RPMI 1640 0.05 ml/（g·d）. Then the volume and the weight of tumors were measured, IP3, bcl-2 mRNA and bcl-2 protein were assayed by IP3-［3H］ Birtrak Assay, RT-PCR and Western blot respectively. Results The volume and weight of tumors in quercetin group were lower than those in control group 〔（15.8±10.1） mm3 vs. （52.3±26.5） mm3 in volume, （44.8±10.4） mg vs.（91.3±31.4） mg in weight， P＜0.01〕. Content of IP3 in quercetin group was lower than that in control group 〔（13.4±1.4） pmol/mg prot vs. （35.3±6.6） pmol/mg prot， P＜0.01〕. There was no significant difference in bcl-2 mRNA expression between quercetin group and control group 〔RI （the gray degree multiply area of bcl-2 /the gray degree multiply area of β-actin）： 0.55±0.05 vs. 0.79±0.19， P＞0.05〕， but the expression of bcl-2 protein in quercetin group was lower than that in control group (RI: 1.07±0.12 vs. 6.69±1.80, P＜0.01). Conclusion Quercetin can inhabit the growth of hepatocellular carcinoma tansplanted into liver of nude mice by reducing IP3 production and down-regulating bcl-2 gene expression.
【Abstract】Objective To study the antitumor activity of HSVtk/CD combinative gene toward human cholangiocarcinoma in vivo. Methods Nude mouse models with transplanted subcutaneous cholangiocarcinoma were constructed and divided into 4 groups randomly, each group had 8 mice. Adenovirus solution free from suicide gene was injected in subcutaneous tumors of each mouse of control group. Adenovirus solution containing cytosine deaminase (CD), thymidine kinase (tk) and HSVtk/CD fusional gene were injected into single suicide gene either HSVtk or CD was transinfected into the tumor cells by injecting viras into subcutaneous tumor of mice of CD gene,tk gene and fused CD and tk gene group respectively. 24 hours after the injection, 5fluorocytosine (5FC) and ganciclovir (GCV) were injected introabdominally in each mouse. Growth of the tumors were monitored.Results Tumor growth of the genetransfection groups was suppressed in different degrees. Compared with the control group, the suppressing rates of the genetransfection groups were 41.2%, 55.7% and 70.0% respectively (P＜0.05). Histological examination showed good tumor growth in the control group, and tumor necrosis in the other 3 groups, particularly obvious in the group transfected with pAd(HSVtk/CD).Conclusion Combinative gene system has a b antitumor effect on cholangiocarcinoma in vivo. But it’s not powerful enough to eliminate tumor thoroughly because of insufficient “Bystander effect”.
Objective To investigate the effect of S-adenosylmethionine (SAM) on mitochondrial injury that was induced by ischemia-reperfusion in rat liver. Methods Fifty-four rats were randomly divided equally into 3 groups: control group, ischemia-reperfusion group (I/R group), and SAM-treated group (SAM group). Hepatic ischemia had been only lasted for 30 min by obstructing the blood stream of hepatic portal vena (the portal vena was only separated but not obstructed in control group). The rats of SAM group received SAM intraperitoneally 2 h prior to ischemia. Blood samples of each group were collected from the inferior cava vena at 0, 1 and 6 h after reperfusion and the serum levels of AST and ALT were detected. Mitochondrial super oxidedismutase (SOD), malondialdehyde (MDA), adenosine triphosphate (ATP) and energy charge (EC) in samples of liver tissue were detected, and the mitochondrial ultrastructure was observed with electronmicroscope. Results The serum levels of AST, ALT and mitochondrial MDA at 0, 1 and 6 h after reperfusion in the I/R group were significantly higher than those in the control group, whereas the levels of mitochondrial SOD, ATP and EC were significantly lower than those in the control group (P＜0.01). Except the value of 0 h, when it comes to SAM group, the levels of AST, ALT and mitochondrial MDA were significantly lower (P＜0.05) and the levels of mitochondrial SOD, ATP and EC were significantly higher (P＜0.05, P＜0.01) than those in the I/R group, respectively. The mitochondrial ultrastructure was injured obviously in I/R group when compared with that in control group. The number of mitochondria decreased and the mitochondria swelled, making the crista became obscure and the density of matrix became lower. The above changes in SAM group were less obvious when compared with those in I/R group. Conclusion SAM may protect mitochondrion against hepatic ischemia injury, since it may prevent mitochondrial lipid peroxidation, increase ATP, and eventually improve energy metabolism after ischemia-reperfusion.
Objective To analyze the surgical techniques for the procurement and back-table surgery of the graft in living-related small bowel transplantation. Methods Eligible donor was chosen according to the donor selection criteria of living-related small bowel transplantation, and preoperative plan was designed. A segment of ileum of 120 cm was procured 20 cm proximal to the ileocecal valve which was preserved in the donor. The techniques for the procurement and back-table surgery of the graft were summarized, which included measurement of entire small bowel length from Treitz to ileocecal valve, palpation and transillumination to identify the distal branch of the superior mesenteric artery， and transient blockage of isolated blood vessels with vascular clamps in order to observe the influence on the blood circulation of graft and residual ileum. The detailed manipulation techniques in processing the graft blood vessels were discussed. Results The operations were successful both on the donor and the recipient. The functions of implanted segment of bowel were well. The donor had no other complications, such as mesenteric thrombi and anastomosis leakage of intestine, except for transient moderate diarrhea. She was discharged 14 days after operation. In the next 8 months of following-up, the donor has not experienced significant alteration in bowel habits or weight loss. Now she is in good appetite, without any changes in the habit and amount on diet. No changes have been found in lifestyle, work habits, or psychosocial conditions after the small bowel donation. Conclusion The procurement of a segment of ileum as graft and preservation of 20 cm proximal to the donor ileocecal valve may be ideal protocol. Using a standardized technique with attention presents little recent or long-term risks for the donor and brings satisfied effect for the recipient.