提高毛发移植的覆盖率

目的探讨显微外科技术自体毛发移植的特点和方法,提高毛发移植成活的覆盖率。方法在较低温度(20°C)环境下,采用边切边缝方法取耳后或枕后毛发,在显微镜下分离成保留周围少量脂肪组织的毛囊族或单株,按需要移植部位不同进行不同的毛囊族或单株并套插的显微外科技术移植共31例。结果31例移植毛发后随访21例,随访时间6~38个月,移植后的毛发能基本覆盖无毛发区的皮肤和瘢痕,移植覆盖率较原来的移植方法提高33%,且外形自然,效果稳定。结论显微外科技术自体毛囊族状(微株小株)或单株移植,具有操作快、损伤小、低温保湿等特点,能较好地保留毛囊周围少量脂肪,在孔与孔的皮肤间隙内再用毛发移植针植入单株毛坯的“套插”移植,更有助于增加毛发覆盖率。     

以新生儿重症监护病房为中心的早产儿视网膜病变筛查模式

目的：介绍一种较为完善的早产儿视网膜病变（ROP）筛查模式。方法：建立基本完善的ROP登记、会诊、筛查、转诊等制度,所有工作均在新生儿重症监护病房（N ICU）完成,形成以NICU为中心的ROP筛查模式,并按此模式开展筛查工作。结果：登记符合ROP筛查标准的患儿239例,其中接受至少一次筛查的患儿222例（占应筛查总数的92.89%）,按要求完成筛查的患儿176例（占应筛查总数的73.64%）。发现ROP患儿39例（占实际筛查数的17.57%）,其中阈值前期1型或阈值期病变11例（占实际筛查数的4.96%）。结论：这种以NICU为中心的ROP筛查模式,制度较为完善,临床中易于操作,能有效节约医疗资源,适合在中小城市中推广。     

Binding units (BU) and the area under binding isotherms (AUI) new indices of effector-target conjugation

New methods for simplified quantitation of effector-target conjugation have been developed. The binding unit (BU) is defined as the number of target cells required to bind a specified percentage of effector cells. The number of binding units is determined from binding isotherms in which effector conjugate frequencies are measured by holding constant the number of effector cells and by varying the number of target cells. Alternately, a binding unit can be defined as the number of effector cells required to bind a specified percentage of target cells. In this case, BU is computed from binding isotherms in which target conjugate frequencies are measured at different values of effector cells by holding constant the number of target cells. Also, the area under the curve (AUI) of these isotherms is another index that can be used as an overall measure of the binding capacity in an effector-target system. The experimental values of BU and AUI determined from effector and target isotherms agree well with theoretical predictions based on our previously developed binding model (J. Immunol. Methods (1992) 155, 133–147). The relationship between BU and AUI, and procedures to determine these parameters are shown. The value of these indices to express effector-target conjugation quantitatively has been confirmed by determining the values of BU and AUI for the NK-K562 effector-target system.     

Motor unit potential contribution to surface electromyography

The background of the bioelectric activity of muscle recorded from the surface of the skin (surface electromyography) in terms of the representation of single motor units of the underlying muscle(s) is not very well documented or understood. An insight into the composition of an electromyogram is essential for the proper interpretation of one of the most widely applied electrophysiological techniques. In the present paper, a study of the contribution of single motor unit potentials to the surface electromyogram is presented. To this end, the decline of different components of the motor unit potential with depth of the motor unit is quantified. Experimentally, the action potentials from motor units at several positions in the muscle were recorded by 30 skin surface electrodes. Simultaneous use of scanning electromyography provided information about the actual position and size of the motor unit. Observed linear log–log relationships between motor unit potential magnitudes and distance indicated the usefulness of a power function to describe the motor unit potential's dependence on recording distance. It is shown that different specific surface motor unit potential characteristics fall off differently with depth. The magnitude–distance relationship is shown to be dependent on the recording configuration (unipolar vs. bipolar recording, including the inter-electrode distance) and the chosen motor unit potential parameter (negative peak amplitude, positive peak amplitude and area).     

The effectiveness of 'nursing beds': a review of the literature

A literature search was conducted to identify 'nursing led in-patient units' where the nurse is the designated leader of the clinical team. The review concentrates on studies which have attempted to measure the impact of nursing-led in-patient units and reviews both the methodology and outcomes. Three major bodies of work were identified. Lydia Hall's evaluation of the Loeb Center for Nursing and Rehabilitation (USA) is reviewed in some detail. This work was the model for 'nursing beds' at the two Oxfordshire Nursing Development Units (UK) in the 1980s. Studies evaluating these centres are reviewed and reports of similar UK units discussed. A third body of work evaluates a nurse-managed critical care environment. Common features include a case mix based on nursing need with nurses having authority to admit and discharge patients. While results are generally favourable, with improved patient independence, fewer readmissions, lower mortality and cost savings reported in some or all of the studies, all studies reviewed demonstrate the difficulties of applying an experimental model to real life clinical services. Methodological limitations render firm conclusions difficult. Techniques adopted from studies in field settings, the so-called 'quasi-experiment', are advocated as a remedy, as is further study of the process of care in investigating this model of care delivery.     

关于放射治疗科室的组建

论述了医院组建放射治疗科室进行可行性分析时应考虑的因素,从技术设施、诊疗室与住院病房等方面介绍了放射治疗科的基本组建要求。     

Trends in the structure,productivity, effectiveness and unit costs of the hospital and community health services workforce in England: 1979–1991

In this paper it is shown that there have been significant structural changes in the composition of the Hospital and Community Health Services (HCHS) workforce over the 1980s. The number of doctors, nurses and other medical professionals has grown at the expense of support staff such as ancillaries and maintenance workers. The number of agency and contract staff has risen rapidly, partly offsetting the loss of directly-employed support staff. Changes in the workforce have been compared with changes in activity, as measured by the cost-weighted activity index. According to this measure labour productivity has grown by a compound rate of 1.9% annually. Adjusting the labour force index for the wage bill of each group reveals productivity growth of 1.5%. The effectiveness of treatment, as proxied by the decline in avoidable perinatal mortality, has grown by 3.4% annually. Unit labour costs have fallen over the period at an average annual rate of 0.3%. The trend conceals wide fluctuations, with labour costs falling slowly during the first half of the decade, and rising strongly during the second half. Medical professionals benefited disproportionately from wage increases in comparison with other HCHS groups during the mid to late 1980s.     

神经外科重症监护病房住院医师规范化培训教育的思考

重症神经外科是神经外科住院医师规范化培训的难点和重点之一。通过对重庆医科大学附属第一医院神经外科重症监护病房的住院医师进行以急救技能培训、理论与实践相辅相成的多模态病例分析、神经影像学及电生理知识的拓展、手术操作及围手术期管理的专科知识培训、定期病例讨论等方式构成的系统性、规范化的培训,他们的临床思维更加地成熟,对神经外科重症监护病人管理方法的掌握时间明显地缩短,参与临床实践的主动性也较前明显地增加,对神经外科患者围手术期管理的方法有了更深刻的认识,有效地提升了神经外科重症监护室的带教成效。     

A Study of Epileptiform Hippocampal Unit Activity Induced by Intracerebroventricular Injection of Kainic Acid in Rats

Hippocampal EEG and unit activities were recorded after seizures were initiated withintracerebroventricular injection of kainic acid (KA) in rats. Three kinds of hippocampal unit re-sponses to KA were found:1. Positive units: These units were characterized by high frequency burst firing temporally coincidentwith each hippocampal EEG spike.2. Negative units: These units showed a cessation of firing during each EEG paroxysm.3. Indifferent units: These units showed no evident chanses coincident with EEG paroxysms.Most positive units were hippocampal complex spike cells which correspond histologically tohippocampal pyramidal cells, and most complex spike cells fired in positive bursts after KA treat-ment. In the early period after KA injection, the positive units were concentrated in CA3 area. It was suggested that the activities of positive units may be considered as the typical epileptiformhippocampal unit activity induced by KA, and the firing features of negative units ma be the resultof the influence of hippocampal inhibitory interneurons or the result of excessive cellulardepolarization, and that hippocampal pyramidal cells were more sensitive to the epileptogenic ef-fect of KA than hippocampal intemeurons, and some pyramidal cells in CA3, in particular,may serve as "epileptic pacemaker neurons " in KA-induced epileptogenesis.     

Receptive field organization of complex cells in cat striate cortex

Summary The receptive field organization of complex cells was studied by analyzing interaction effects between two stationary flashing light stimuli. One was placed in the most responsive part of the receptive field to produce activity against which effects of the other in different visual field positions could be determined.The receptive field was spatially organized into antagonistic center and flanks just like the fields of simple cells. However, both center and flanks were found within the receptive field area where a single slit evoked discharge. Center and flanks were elongated along the optimal stimulus orientation. The flanks were displaced from the center normal to optimal stimulus orientation.In the center, ON- and OFF-responses were usually about equal in strength and the maximum ON- and OFF-responses occurred in about the same position. This shows that complex cells are activated by input from both ON- and OFF-center cells in the lateral geniculate nucleus (LGN) where the receptive field centers of the LGN cells overlap closely. This explains most of the specific features of complex cells, e.g., the spatially overlapping ON- and OFF-zones, the large response field, the repetitive firing when a slit moves over the receptive field, and the marked non-linear spatial summation.Strong flank suppression occurred with both ON and OFF. The effects were usually stronger on one side of the center. Maximal suppression occurred on the same side with both ON and OFF. This is consistent with the interpretation that complex cells are inhibited by input from both LGN ON- and OFF-center cells with overlapping receptive field centers.A model presuming that complex cells have overlapping but acentric excitatory and inhibitory fields was tested by computer simulation and shown to fit the experimental data. This is the same model as presented for simple cells in the preceding paper (Heggelund 1980), except that the excitatory and inhibitory fields of simple cells have input from either ON- or OFF-center LGN cells, whereas in complex cells they have input from both types.The project was financially supported by the Norwegian Research Council for Science and Humanities