构建医生服务行为内在约束机制的思考

构建医生服务行为的内在约束机制已经成为治理当前医疗服务行业诸多问题的关键，结合相关政策、主要机理及医疗服务的特点，阐释和分析了构建医生服务行为内在约束机制的依据、关联影响因素及其主要制度架构。     

甘乐胶囊大鼠长期毒性研究

目的 观察甘乐胶囊对大鼠所产生的毒性反应,为临床用药提供安全剂量.方法 甘乐胶囊20.4、40.8、81.6 g/ks(相当于临床剂量的15、30、60倍),连续给药6个月,观察对大鼠体重、心电图、血液细胞学、肝肾功能、系统尸解和脏器系数、组织形态学的影响.结果 灌胃给药6个月小、中、大剂量组与对照组体重增长率分别为433.6%、407.8%、398.7%和414.4%,各剂量组体重与对照组比较差异均无统计学意义(P均＞0.05);仅见大剂量组(临床剂量60倍)肝功能指标ALT、AST明显降低(P＜0.05、P＜0.05)、TP明显升高(P＜0.05);大剂量组动物肝、肾脏器系数增大(P＜0.05、P＜0.05).给药6个月其他检查:心电图、血液细胞学、肾功能、系统尸解和主要脏器病理组织学检查各剂量组与对照组比较差异均无统计学意义(P均＞0.05).结论 甘乐胶囊40.8 g/kg(相当于临床剂量30倍)以下剂量180 d灌胃大鼠无明显毒性反应,提示临床应用比较安全.但需注意在给药剂量较大时(临床剂量60倍)重点观察肝、肾方面的指标.     

Correlation between Medium-term Multi-organ Carcinogenesis Bioassay Data and Long-term Observation Results in Rats

The effects of four test chemicals [2-acetylaminofluorene (2-AAF), D, L-ethionine (ethionine), butylated hydroxyanisole (BHA), and catechol] were compared in medium- and long-term in vivo systems. In the medium-term assay, animals were sequentially treated with N-diethylnitrosamine (100 mg/kg body weight, i.p., single injection), N-methylnitrosourea (20 mg/kg body weight, i.p., 4 times during weeks 1 and 2), N-butyl-N-(4-hydroxybutyl)nitrosamine (0.05% in the drinking water during weeks 1 and 2), 1,2-dimethylhydrazine (40 mg/kg body weight, s.c., 4 times during weeks 3 and 4) and dihydroxy-di-N-propylnitrosamine (0.1% in the drinking water during weeks 3 and 4) for multi-organ initiation, and then treated with one of the four test chemicals for 24 weeks, and killed at week 28 (group 1). In the long-term assay, animals were treated in the same manner and then given hasal diet and tap water (group 3) or test chemical continuously (group 4) for the remainder of the lifespan. Animals receiving multi-organ initiation and then maintained on hasal diet for 24 weeks (group 2) or their lifespan (group 5) served as controls. Detailed histopathological examinations were performed on all rats. Hepatocellular carcinoma incidences in the long-term assay were found to reflect closely the respective medium-term results. Induction of proliferative forestomach or glandular stomach lesions by BHA and/or catechol, and bladder lesions by 2-AAF and BHA in the mediumterm assay also correlated with tumor development in the long-term. Furthermore, inhibition of thyroid proliferative lesions by all test chemicals corresponded with low thyroid tumor incidences in the long-term assay. The observed strong correlation between medium- and long-term results confirms the applicability of our medium-term multi-organ carcinogenesis bioassay system for detection of modifying effects of test chemicals in different organs.     

Comparison between research data and routinely collected register data for studying childhood health

Cohort studies are usually based on detailed information gathered on a limited number of individuals. Increasing collection of administrative registers offers an alternative method to gather health data. In the first study health information from birth until the age of seven years on 8708 children born in the two most northern provinces of Finland in 1985–86 was gathered through questionnaires, medical record reviews, medical examinations and some register data. In the second study, similar information on 8222 children born in the same provinces in 1987 was gathered using administrative registers. Both data collection methods gave equal results for mortality, long-term medication, and cumulative incidence of diabetes and intellectual disabilities. The register data identified more children with delayed development, but less children with long-term illness (77% of the level identified by the research data), with asthma (74%), and with epilepsy (40%). The register data was unsuitable for investigating hearing and vision disorders. The administrative data gave a gender ratio similar to that of the research data for two of the variables with poor coverage (asthma and epilepsy), but identified more boys with long-term illness in general than the research data. Administrative registers are useful for studying many long-term health problems, e.g. those resulting in hospital care or social benefits or those registered in vital statistics. Specific cohort studies with separate data collection is still needed to study for example outpatient care, self-assessed health, growth and development.     

糖尿病心肌病发病机制及病理生理改变的研究现状

糖尿病心肌病 (DCM)是与糖尿病 (DM )特有代谢紊乱有关的一种特异的心肌疾病 ,对其发病机制和病理生理改变的探讨是目前心血管临床研究的热点之一。作者从组织、细胞、分子水平就DCM发病机制及病理生理改变的研究现状作综述     

中草药裸花紫珠的细胞学作用机理

以体外培养的人胚纤维母细胞为对象，利用细胞生化技术，同位素掺入技术等，观察了中草药裸花紫珠对细胞ＤＮＡ合成，细胞生长曲线，蛋白质合成与释放及ＬＤＨ同功酶活性的影响。实验结果表明：①裸花紫珠的生药浓度在０．４ｍｇ／ｍｌ￣１．６ｍｇ／ｍｌ范围内，抑制人胚纤维母细胞的ＤＮＡ合成。抑制作用随药物浓度的增加而增加；②裸花紫珠的生药浓度在０．４ｍｇ／ｍｌ￣１．２ｍｇ／ｍｌ范围内，细胞生长曲线右移，群落倍增时间     

Optical Recordings of Ventricular Excitability of Frog Heart by an Extracellular Stimulating Point Electrode

To enhance understanding of the excitability of cardiac wusde during rest, an optical technique using the fluorescent voltage sensitive dye di-4-ANEPPS was used. Unlike conventional electrical recordings, optical recordings are free from electrical artifacts and. therefore, allow the observation of the transmembrane potential not only following the stimulation pulse, but also during the pulse itself Transmembrane potentials (V?_m) were recorded optically from frog ventricular epicardium in calcium containing Ringer's solution directly under an extracellular stimulating point electrode. Anodal and cathodal S stimuli were applied at rest. As observed by previous investigators, the post-pulse excitatory responses for cathodal pulses, compared with anodal pulses were greater. Changes in transmembrane potential (ΔV?_m) during the pulse were as expected for a passive cable only for low intensity pulses (< 4 × the cathodal threshold of excitation in diastole. CTE). However, at the higher intensities necessary to produce an excitatory response (> 6–8 × CTE), an “irregular” response in V?_m was observed—a reversal of the hyperpolarization during an anodal stimulus pulse and a reversal of the depolarization during a cathodal stimulus pulse. To elucidate further the biophysical basis for this behavior, ΔV?_m was mapped around the stimulating electrode. During stimulation, regions could be observed having a response with opposite polarity to that under the electrode (i.e. depolarization for an anodal pulse and hyperpolarization for a cathodal pulse). Removal of the bath solution or the addition of channel Mockers did not eliminate the occurrence of these regions. These regions appear to be the basis for the irregular behavior of ΔV?_m directly under the electrode as well as for anodal excitation.     

Long-term follow-up after surgical treatment of cerebellar astrocytomas in 100 children

A retrospective study was performed in 100 children, who were operated on between 1954 and 1984 for cerebellar astrocytoma. Twenty-nine patients died during the 1st month after the operation. Of the patients who survived, 24 lived up to 5 years, 17 up to 10 years, and 30 lived 20 or more years. In 22 cases, tumor recurrence was the reason for reoperation. Radiation therapy was used in 25 cases with histological malignancy and/or after partial removal of the tumor. The analysis in 6 cases with brainstem involvement allowed us to conclude that in such cases the prognosis is poor with regard to survival. Although total removal of cerebral astrocytomas appears to be the most effective form of treatment, we are of the opinion that even subtotal excision may be compatible with long-term survival. This suggests that many of these tumors may show benign biological behavior.Presented at the XIth Meeting of the European Society for Pediatric Neurosurgery, Naples, 1988     

TiO_2、Al_2O_3基燃烧催化剂的固态化学研究

研究了TiO_2烧结及相变过程的动力学、机理及载体TiO_2经Al2O_3改性后的热稳定性。考察了以纯TiO_2和改性TiO_2为载体所制催化剂的耐热性。结果表明,Tio_2的烧结为体积扩散过程,锐钛型TiO_2变为金红石型的核化-生长过程中,成核和生长的活化能分别为71kJ/mol和227kJ/mol,其中生长过程为晶界扩散。用共沉淀法在TiO_2中掺杂Al_2O_3能明显提高Tio_2的热稳定性。Cu-Mn-Ce-O/TiO_2催化剂在700℃高温处理时,催化活性反而升高,这可能与TiO_2的相变过程有关。     

Application of DNA filter hybridization and PCR to distinguish between human and non-human tissues of poor quality

Summary The present report describes a novel approach for the identification of human or non-human specimens after long-term storage in a badly preserved state. The application of the PCR-technique (polymerase chain reaction) using human-specific primers as well as Southern blot (filter) hybridization of the sample DNA to a primate-specific DNA probe enabled us to extend the positive identification beyond the limits of conventional methods such as serological or morphological examinations.