中国肝移植的的历史记录

中国肝移植的的历史记录中国是肝病大国,是世界上终未期肝病发病率最高的地区之一,每年有数以百万计的终末期肝病患者死亡,肝脏移植作为终末期肝病惟一有效的根本治疗手段,已越来越得到广大医生、患者的认可和社会的接受。     

中国肝移植的的历史记录

中国是肝病大国,是世界上终未期肝病率最高的地区之一,每年有数以百万计的终末期肝病患者死亡,肝脏移植作业终末期肝病惟一有效的根本治疗手段,已越来越得到广大医生、患者的认可和社会的接受.     

我的疾病，我的幸福

2006年的7月,对于我来说是人生里的一个转折,在23年前患急性肾小球肾炎未系统治疗的前提下,尿中出现蛋白持续两年而我未进行任何处理的忽视中,曾经平静的生活终是向我展露了它不为人知的狰狞面目,慢性肾炎——这个让人感到悲     

心肌梗死患者的心理反应的护理

急性心肌梗死是冠状动脉闭塞,血流中断,使部分心肌因严重的持久性缺血而发生局部坏死.目前,它已成为心血管系统的常见病,也是威胁患者生命较严重的疾病之一,多突然发病,表现为心前区压榨性剧痛.患者入院后表现出不同的心理反应,不良的心理变化对疾病极为不利,它使交感神经兴奋性增强,引起心率增快,血管收缩,血压升高,使冠状动脉供血、供氧进一步减少,心肌坏死范围扩大而加重病情.     

患者的安全共同的责任

患者安全是护理质量中基本和重要的部分。然而，国际卫生保健系统是易于出现过失的，并且对患者的安全性护理是有害的，是基本系统缺陷所造成的。大量的利益相关者（社会大众、患者、护士、护理教育者、管理者和研究者、医师、政府和立法机关、职业协会和委任机构）对促进患者安全出院及无伤害发生是负有责任的。本文讨论了护理缺陷中相关者对患者安全的职责与特殊功能及继续接受和促进安全护理。     

军事训练所致的半月板损伤的关节镜术后的康复训练

目的探讨康复训练对军训所致半月板损伤膝关节镜术后疗效的影响。方法将18例膝关节镜术后病人通过正确的心理康复意识建立,同时采用早期骨四头肌的收缩练习,踝泵运动、持续被动运动以及抬腿练习等康复训练。结果经康复训练,18例中有16例恢复满意。结论本文所采用的康复训练方法对军训所致的半月板损伤膝关节镜术后的功能恢复有积极意义。     

HDL的异质性及其功能的检测

HDL具有促使细胞外排胆固醇且将胆固醇逆转运至肝中代谢的功能．因而其抗动脉硬化作用已成为人们的共识。近期的研究对此认识提出疑问。其原因在于HDL具有异质性且HDL在体内经修饰而发生功能的改变。由此．检测HDL的多种亚组分及其多项功能已成为研究HDL与心血管病危险性关系的热点。现就此方面的进展作一综述。     

上消化道大出血患者的的外科诊治

罕见病因引起上消化道出血的及时诊治及是临床外科工作中较棘手的问题。要提高术前诊断率，首先必需提高临床外科医师对这些疾病的认识，以便正确掌握手术指证，我们曾收治20例，报告如下。     

平凡的坚持成就永恒的经典

时尚的风吹过一季又一季,满街的绿荫华盖在春风秋雨的浸润下幻化成金黄的颜色,印染了天与地之间。岁月恰似一首无言的诗歌,凝聚着涌动的情感,积淀着回转的浪漫。流年似水,正是一段心底的音符,也许只需一米温暖的阳光,也许只有一抹清润的雨点,也许只是一篇雕琢的论文,都会无意间触动内心深处的那根琴弦,弹拨出一缕缕曼妙时光。     

永远的学术永远的期刊

又是一个新年开始了.《中华护理杂志》牵手作者、读者、学者一起送走2011,迎来2012.迎新是美好的,辞旧也是一种美好.虽然我们拽不住时间的缰绳,却用辛劳丈量了时间的轮迹,用默默付出印证了我们的责任. 《中华护理杂志》(本刊)自1954年创刊,至2011年已出刊46卷.在护理学科发展的历程中,本刊始终以护理专业的学术研究、专业实践的科学提升作为选题的基线.护理学是一门独立的学科,当下说这个论断很是自信.作为国家教育部确立的一级学科,我国护理学比任何时候都需要科学的理论支持,需要丰富的专业实践充实.学术研究水平是一个学科重要的评价标准,没有学术研究也就没有专业的发展.研究什么、怎么研究是要学界认真思考的问题.在国家力推医疗卫生改革的大环境下,面对日益增长的医疗护理需求,护理的研究者要在融入、参与、适应中找到研究方向、研究课题.在医疗共同体中,要立足护理专业的研究,求证专业的归属,探讨专业的内涵,分析专业的元素,找准专业的视角,确立专业的位置.     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

妊娠合并血小板减少症与心、肝、肾脏器损伤

目的探讨妊娠合并血小板减少症伴随重要脏器的损伤情况。方法前瞻性研究我院及北华大学附属医院2004年10月至2005年5月妊娠合并血小板减少症的临床资料，对41例妊娠合并血小板减少症者尿素氮（BUN）、肌酐（CREA）、谷丙转氨酶（ALT）、乳酸脱氢酶（LDH）的测定及妊娠期高血压疾病与血小板计数（PLT），血小板平均体积（MPV）和血小板体积分布宽度（PDW）参数的测定进行对比分析。结果妊娠合并血小板减少症患者心、肝、肾等重要脏器均有不同程度的改变，且随着血小板计数降低，损害程度加剧，差异具有显著性（P〈0．01）。妊娠期高血压疾病，随着疾病程度的加重，血小板计数较正常孕妇明显减少，MPV、PDW明显升高，有显著性差异（P〈0．01）。结论血小板参数是判断疾病的重要参考指标，肝、肾、心脏器损伤程度与血小板计数具有相关性。     

Literature and poetry: Pleasure and practice

The value of a humanities perspective in the initial and continuing education of practising nurses and midwives is discussed briefly. It is suggested that nursing requires a blend of both science and sensitivity and that empirical knowledge alone is insufficient for one who cares for others. The value of literature in relation to the notions of catharsis, vicarious experience and insight into the lives of patients will be discussed. Some examples of literature that may be used to help nurses gain insight into aspects of death and dying, midwifery, physical disability and mental illness are presented.     

Metformin and neoplasia: implications and indications

Metformin has been shown to exert anti-neoplastic and chemopreventive activities in epidemiological and animal studies. This review article discusses the epidemiological studies and examines the possible mechanisms by which metformin exerts its anti-carcinogenic activities in breast, colon, ovarian, lung, and prostate cancers. We performed a systematic review of the clinical studies examining the anti-neoplastic activities of metformin and the potential mechanisms associated with these activities. Several observational and biological studies revealed a significant association between metformin and reduction in cancer incidence. The mechanisms by which metformin exerts these effects are unknown. This action may be mediated through activation of AMP-activated protein kinase (AMPK), inhibition of the mammalian target of rapamycin (mTOR) pathway, and inhibition of insulin like growth factors (IGFs), and many others. Further laboratory investigation and large, prospective population clinical trials are required to elucidate metformin anti-neoplastic and chemo-preventive actions.