医疗服务操作分类与编码的设计与应用简

医疗服务操作分类与编码是医学信息标准化的重要组成部分,是临床数据提取、分析和应用的基础。世界卫生组织及世界多国一直致力于开发、更新和维护此分类与编码。我国此前一直沿袭美国准备在2014年停止使用的ICD-9-CM-3（卷3）,中国需要结合国际主流设计思路,根据国情开发出适宜的多轴、一体化的医疗服务操作分类与编码体系。     

环境中双酚A的污染及降解去除的研究进展

近10年来随着科学与社会的发展,环境雌激素污染日益引起人们的关注。双酚A是环境雌激素的一种,用途广泛,但具有多方面的毒性。对其毒理、污染及降解去除的研究已经成为国际上的研究热点。该文拟对上述几方面的研究进展情况作一简要介绍。     

黄体功能不健的调控机理

主要就引起卵巢黄体功能不健的因素 ,分别从激素调节、细胞因子 (VEGF、TNF α、BFGF、IFN γ、IGF)、C myc、Fas、SGP 2基因调控以及细胞连接、细胞粘附分子、NO等对卵巢功能的调节及对黄体细胞的凋亡影响进行阐述 ,认为卵泡发育不良、颗粒细胞、黄体细胞的凋亡与黄体功能不足有密切的关系。且多种细胞因子、基因表达产物参与此过程的调控。深入的研究这一调控机制 ,对于进一步了解卵巢卵泡生长发育、卵泡闭锁及黄体细胞凋亡的内在机制有重要意义     

HIS与PACS软件融合方案的设计与实现

目的：实现PACS与HIS的系统集成。方法：使用Powerbuilder设计电子申请系统，利用Oracle存储过程实现不同系统间的数据同步。结果：完成了第四军医大学西京医院的PACS／HIS软件融合，经临床应用，反应良好。结论：系统集成应根据医院需求，由信息科牵头，多方论证，遵循高可用性、低耦合度的原则，在保证软件实用、流程合理的前提下，应最大限度地压缩新旧流程的共存时间。     

Intake of dietary phytoestrogen and indices of antioxidant and bone metabolism of pre- and post-menopausal Korean women

A group of 101 women, aged 40-65 years consisted of 48 premenopausal subjects and 53 postmenopausal ones living in Daegu and Gyeongbuk area in Korea were evaluated with their general characteristics, lifestyle factors, nutrient and phytoestrogen intakes, blood and urinary indices concerning antioxidant status and bone metabolism. Body mass index (BMI), waist hip ratio (WHR) and systolic blood pressure (SBP) of the postmenopausal women were significantly higher (23.8, 0.86, and 126.9 mmHg, respectively) than those of the premenopausal women (22.6, 0.82, and 115.9 mmHg; respectively). Nutrient intakes of the postmenopausal and premenopausal groups were not different except lower fat intake and higher dietary fiber and iron intakes in the postmenopausal group. Daily total phytoestrogen intake was significantly higher in the postmenopausal group (48.54 mg) than the premenopausal (31.41 mg) and was resulted mostly from higher intakes of daidzein and genistein from soy and soy products (45.42 mg vs 28.91 mg). Serum genistein level and excretion of enterolactone, major lignan metabolite, were not very different between the two groups. Serum retinal and α- tocopherol levels were higher in the postmenopausal group but TBARS levels were not different between the two groups. Serum osteocalcin (7.18 ng/mL) and urinary deoxypyridinoline (7.15 nmol/mmol creatinine), in the postmenopausal group were significantly higher than those in the premenopausal group (4.80 ng/mL, 5.95 nmol/mmol creatinine). Urinary excretion of enterolactone was positively correlated with serum osetocalcin in premenopausal women and serum genistein negatively correlated with the urinary DPD in postmenopausal women. Dietary phytoestrogen intake was negatively correlated with serum level of TBARS in all subjects. It is concluded that the effect of total phytoestrogen intake is beneficial on body antioxidant status in all middle-aged women regardless of menopause but the effect on bone metabolism appears different by the type of the phytoestrogen and the menopausal state.     

Reliability and validity of indices of hand-grip strength and endurance

Background/aim: Grip strength is useful in clinical practice for the assessment of disease and/or rehabilitation progression. Brief maximal gripping is seldom required in everyday occupations, with repeated or sustained gripping at sub‐maximal power more commonly involved. It has been proposed that assessment of both maximal hand‐grip force and endurance is utilised. While the suitability of maximal contraction measures has been clearly established, the reliability and validity of other hand‐grip indices have not been investigated. This study examined the reliability of various hand‐grip indices and their validity in relation to distance walked during the six‐minute walk test, a standardised exercise capacity test. Methods: Subjects undertook static sub‐maximal (50%) and maximal force contraction hand‐grip testing from which various indices were derived, and six‐minute walk testing from which distance walked was determined. Testing was repeated on three separate occasions for determination of test–retest reliability. Results: Pre‐ and post‐fatigue maximal contraction measurements demonstrated excellent test–retest reliability and validity. Conversely, other hand‐grip indices were shown to be unreliable and exhibited no relationship with distance walked and hence concurrent validity could not be established. Conclusions: Based on the results of this study, it is recommended that pre‐ and post‐fatigue maximal contraction may be utilised for the assessment of client ability and progression due to their established validity and test–retest reliability. However, previously proposed measures of fatigue such as endurance (duration of sustained contraction), Strength Decrement Index and work performed (function of endurance and force of contraction) are unreliable and invalid and may have limited use in clinical practice.     

疾病预防控制机构实验室设备资产配置及缺口研究

目的明确2002～2005年疾病预防控制机构设备资产配置变化情况。方法全国系统抽样调查省市县各级疾病预防控制机构的各类设备配置种类和数量,计算设备资产,和标准比较得到缺口。结果疾病预防控制机构实验室设备资产配置明显增加,但缺口仍然很大,就A类设备缺口达到50·2亿。     

依布哂啉纯度、杂质检测及安全性实验

目的 检测合成的依布哂啉(Ebselen Ebs)的纯度、杂质并进行急性毒性实验。方法 Ebs测定采用自建立的高效液相色谱法(HPLC)，杂质(苯胺)采用比色法，急性毒性试验采用成年大鼠1次性灌胃，观察24h内死亡率。结果 Ebs纯度为99.95％～99．99％，苯胺含量为0．00017％～0．00019％，大鼠1次经口的LD50为2355．05mg／kg。结论 Ebs质量可靠，安全性高，可供开发研究。     

Evaluation of impact of temperature and pH alterations on the size and antigenicity of meningococcal serogroup A and X polysaccharides and conjugates

The changes in the recommended storage conditions of the glycoconjugate vaccines against Neisseria meningitidis (Men) serogroup A and serogroup X can affect its activity or potency. Elevated temperature and the change in pH may result in the physical instability leading to the size degradation of the polysaccharide (PS) and subsequent loss of PS epitopes. Moreover, high temperature may also result in protein aggregation and altered tertiary structure of the protein in the conjugate. Consequently, the construction of a potent glycoconjugate is dependent on optimal temperature and pH. The changes in both these conditions can also affect the production of a capsular polysaccharide (PS) and its conjugation to a protein carrier and may also affect the integrity of the vaccine molecule including the maintenance of the protective epitopes. In our study we have used inhibition ELISA as a tool to assess the impact of temperature and pH alterations on the antigenicity of N. meningitidis serogroup A and X, PS and conjugates and their correlation with the size distribution analysis using high pressure size exclusion chromatography. The studies on pH alterations from 5 to 9 led to minimal impact on size and antigenicity of all antigens, however, an elevated temperature adversely impacted the antigen size as well as antigenicity to varying extent. Results indicate the higher stability of MenX PS and conjugate as compared to that for MenA counterparts at elevated temperatures. Furthermore, both the MenA and MenX conjugates appears to be more stable as compared to the corresponding PSs.     

伤害及其定义的内涵和外延

2003年我国卫生部把伤害纳入疾病预防控制的内容,明确该项工作包括传染性疾病、慢性非传染性疾病和伤害三部分.那么,伤害的定义是什么?伤害到底包括哪些内容?其预防控制工作的对象又是什么?只有搞清楚这个问题,才能够知晓伤害预防与控制的目标和预防医学在伤害控制工作中的定位.     

Adenocarcinoma of the stomach and esophagus and drinking water and dietary sources of nitrate and nitrite

We conducted a population-based case-control study of adenocarcinoma of the stomach and esophagus in Nebraska, U.S.A. Nitrate concentrations in public drinking water supplies were linked to residential water source histories. Among those using private wells at the time of the interview, we measured nitrate levels in water samples from wells. Dietary nitrate and nitrite were estimated from a food-frequency questionnaire. Among those who primarily used public water supplies (79 distal stomach, 84 esophagus, 321 controls), average nitrate levels were not associated with risk (highest versus lowest quartile: stomach OR=1.2, 95% CI [0.5-2.7]; esophagus OR=1.3, 95% CI [0.6-3.1]). We observed the highest ORs for distal stomach cancer among those with higher water nitrate ingestion and higher intake of processed meat compared with low intakes of both; however, the test for positive interaction was not significant (p=0.213). We did not observe this pattern for esophagus cancer. Increasing intake of nitrate and nitrite from animal sources was associated with elevated ORs for stomach cancer and with a significant positive trend in risk of esophagus cancer (P-trend=0.325 and 0.015, respectively). Larger studies with higher exposures to drinking water sources of nitrate are warranted to further evaluate N-nitroso compound precursors as risk factors for these cancers.     

依布哂啉的稳定性及杂质和急性毒性试验

目的了解合成的依布哂啉(Ebs)的稳定性和杂质及急性毒性。方法采用高效液相色谱法测定2～8℃及室温下和0-4年中的Ebs的含量；亚硝酸盐氮和苯胺分别用比色法测定，成年小鼠3次／24h灌胃的死亡率。结果Ebs在2-8℃中可保存3年，亚硝酸盐氮和苯胺的含量为4．83μg／kg和1．78mg／kg，小鼠3次经口的LD50为2355．05mg／kg。结论Ebs质量可靠，性能稳定，安全性高，可供开发研究。     

柯尔克孜族儿童青少年2010年与2014年生长发育水平的比较

目的 了解新疆柯尔克孜族中小学生2010年和2014年的身体形态状况、变化及原因,为提高柯尔克孜族学生体质健康水平提供依据。方法 利用参加2010年和2014年全国学生体质与健康调研的新疆柯尔克孜族中小学生形态指标数据,对7～18岁柯尔克孜族学生的身高、体重、胸围等指标进行比较及统计分析。结果 与2010年比较,2014年柯尔克孜族男女生各年龄组3项指标均不同程度的增长。柯尔克孜族男生身高、体重、胸围等三项指标的平均增长值分别为1.7 cm,2.5 kg和0.3 cm;女生分别为 1.4 cm,1.9 kg和1.9 cm。男生身高和体重增长的幅度总体高于女生,女生胸围增长幅度明显快于男生。不同年度7～18岁同年龄组比较,多数年龄组差异均有统计学意义(P<0.05或<0.01 )。结论 2014年新疆7～18岁柯尔克孜族学生的身体形态均保持增长,但与全国平均水平比较依然存在较大的差距,应加强重视,采取有效措施,提高柯尔克孜族学生生长发育水平。     

高校和地方艾滋病联动防控策略的研究与实践

目的阐述高校和地方艾滋病联动防控策略研究的重要性与必要性;创新性地构建高校和地方艾滋病联动防控策略“三层次”技术新方案,即从理论层面来研究防艾工作机制的管理层结构和实践层结构,理顺“三层次”之间的依赖关系;其研究成果经过2年的实践与推广应用,取得良好的效果,为今后艾滋病防治问题的进一步研究提供了有益的参考。     

Indico 100系列高频高压发生器原理及其应用

通过介绍Indico 100系列高频高压发生器的结构和原理,正确掌握X线成像设备的使用方法。分别介绍高频高压发生器的原理、构成、系统电路和电源分配,并总结分析设备在应用过程中故障的维修过程。掌握设备原理及结构后在排除设备出现的故障时更加科学、自如。对设备原理应精确的掌握,要知其然更知其所以然,提高维修工作的效率和准确率。     

锌铅对大鼠子代生长发育和学习记忆的影响

目的:探讨宫内外铅锌暴露对大鼠子代生长发育和学习记忆的影响。方法:16只Wistar健康孕大鼠分为4组,正常对照组、高铅组、高锌组、高锌高铅组。从受孕第14 d起分别给予相应饲料及饮水,子代断乳后饲以与其母亲相同的饲料和饮水。于出生时、1 w、4 w、8 w时测体重,分离8 w龄子鼠大脑、海马称重,观察海马病理改变,测定全血和海马铅、锌含量,主动回避反应(AAR)测试习得率和保持率。结果:高铅组全血和海马铅浓度显著升高(P<0.01),锌浓度显著降低(P<0.01);高锌组全血和海马锌显著升高(P<0.01);高锌高铅组全血和海马铅、锌浓度无显著改变。高锌组4 w时体重增长缓慢(P<0.01),8 w时更加明显,8 w龄大脑及海马重量显著降低(P<0.01);高铅组和高锌高铅组的体重、大脑和海马重量无显著改变。高锌组电镜超微结构见部分神经元胞体较小、细胞器减少、粗面内质网扩张、核糖体脱落。其它各组光镜和电镜检查均未见明显病理改变。高铅组和高锌组AAR习得率与保持率都显著低于对照组和高锌高铅组(P<0.01)。结论:亚临床铅中毒对大鼠生长和脑发育无显著影响,但显著损害学习记忆功能,适量补锌能改善学习记忆功能。长期摄取高锌影响大鼠生长和脑发育,损害学习记忆功能。     

医疗装备、耗材招标的优势和存在问题探讨

叙述了招标采购的优势,在分析现有问题的基础上,提出了相应的对策,指出医疗装备及耗材这一特殊商品的招标采购必须本着“三公”原则,注重严谨性和科学性,以服务患者、服务医院为宗旨,努力维护供求双方的利益,才能杜绝违规、违法现象的发生,使招标采购工作圆满完成。     

长春市企事业单位更年期妇女营养知识及行为习惯现状调查分析

目的:了解长春市更年期妇女营养行为现状,为开展健康教育提供理论依据。方法:采取随机整群抽样的方法,对长春市部分企事业单位498名更年期妇女的营养行为现状进行面对面的调查。结果:更年期妇女在营养知识、饮食习惯、饮食行为等方面存在较多问题。每天坚持喝牛奶者仅占34·7%,坚持食用豆制品者占17·7%,坚持每天选择适量鱼肉蛋肝者也只占45%。61·8%的人很少或从不讲究粗细搭配,80%以上的人不吃或很少吃粗粮,68·9%的人很少或从不根据食物的营养价值选择食物。尚存在暴饮暴食、节食及不吃早餐的行为。结论:更年期妇女营养知识、行为习惯亟待提高和改善,各种媒体应加强对营养知识的宣传管理,医疗保健机构及社区应大力开展对更年期妇女合理营养及平衡膳食的咨询指导和健康教育。