师生关系之于医患关系的暗合与影响--兼论医学生医患平等意识与医患沟通能力的培养

师生关系与医患关系在人际交往的价值取向、人际交往的主要形式以及关系双方的不平衡性等方面都存在着暗合之处.因此,今日的师生关系对未来医患关系有着直接的影响和作用.教师应该通过平等的师生关系和良好的师生沟通,来培养医学生未来的医患平等意识与医患沟通能力.     

支架术治疗颈动脉狭窄的临床研究

目的　观察支架术治疗颈动脉狭窄的近期疗效 ,探讨临床应用中的相关问题。方法　将临床经颈部B超、脑血管造影确诊的颈动脉狭窄患者 10 8例 ,实施颈动脉支架术 ,15例行预扩张 ,12例后扩张成形 ,9例使用滤器装置 ,围手术期给予抗血小板聚集等治疗。结果　 2例手术失败 ;术后 2例发生脑出血 ,1例脑栓塞 ,1例支架内血栓形成 ,除 1例脑出血死亡外 ,3例治疗后恢复 ;1～ 6个月的随访中 ,10 5例患者无复发。手术并发症发生率低 ,近期疗效满意。结论　颈动脉狭窄段支架术治疗颈动脉狭窄具有可行性 ,近期疗效肯定 ,是临床上有推广潜力的治疗颈动脉狭窄的方法 ,但远期疗效尚需进一步观察。     

The Chemical Protecting Group Concept Applied in Crosslinking of Natural Tissues with Glutaraldehyde Acetals

This work describes the results of the controlled crosslinking of collagen matrices by glutaraldehyde based on a double protection strategy, glutaraldehyde acetals and lysine protonation due to the acidic conditions of acetal formation. Materials crosslinked by this approach were characterized by thermal stability comparable to those obtained by conventional procedures with mechanical properties expected for bioprosthesis manufacture and with a higher stability toward collagenase hydrolysis. The integrity of the microfibrillar structure was confirmed by optical and scanning electronic microscopy. The results indicate that the glutaraldehyde acetals procedure may be of potential use for the crosslinking of bovine pericardium used in the manufacture of bioprosthetic devices. Advantages may be related to the production of materials with homogeneous crosslinking distributions, associated with better definition in the nature of the chemical link that they introduce, due to a better distribution of glutaraldehyde within the tissue matrix before the crosslinking reaction is allowed to occur. As a result, materials with improved biological and mechanical properties are expected.     

A群多糖脑膜炎菌苗最适免疫剂量的研究

近些年来对Ａ群多糖脑膜炎菌苗最适免疫剂量进行了一系列现场流行病学及血清学效果的对比研究。首先肯定了我国生产的菌苗与法国Ｍｅｒｉｅｕｘ研究所生产的苗苗在人体接种后观察一年内具有同等杀菌抗体反应。以后在严格对比下观察了国内生产的多糖菌苗接种３０μｇ及５０μｇ一年内的血清杀菌抗体反应。结果完全相同；而全身反应则３０μｇ为５０μｇ剂量的五分之一。在我国８０年代流脑流行地区内确证了３０μｇ免后人群保护率为９９％与国外５０μｇ的保护率（９７．２％）相似。国内连续三年在流行地区内对比观察了３０μｇ、与５０μｇ的流行病学预防效果，其人群保护率相似．与国外（Ｒｅｉｎｇｏｌｄ）．的报告亦相似。最后结论是本菌苗的最适免疫剂量为３０μｇ．不但其预防效果与５０μｇ相同，而且菌苗反应轻微，经济效益高，有利于在发展中国家推广使用。     

Outcome of intracerebral hemorrhage: clinical and CT findings in 326 patients

Clinical symptoms and findings in cranial computed tomography (CT) were evaluated in 326 patients with intracerebral hemorrhage (ICH). Localizations of ICH were the lobes (n = 254), the basal ganglia (n = 46), the pons and brain stem (n = 13) and the cerebellum (n = 8). Multiple hematomas were present in nine patients. An initial coma (n = 225) was most frequent in ICH of the pons (n = 7), cerebellum (n = 6), and the frontal (n = 71) and temporal (n = 66) lobes. Epileptic seizures (n = 70) were most common in hematomas of the frontal (n = 24), temporal (n = 19) and parietal (n = 12) lobes and the basal ganglia (n = 6). A history of hypertension was given in 140 patients; 119 of these had an ICH with a size of ≥3 cm. Mortality (n = 162) was high with ICH in the pons and brain stem (10 out of 13), in the frontal (54 out of 98) and parietal (32 out of 58) lobes and the basal ganglia (n = 23). A size of the ICH of 3 cm or more in cranial CT and an associated ventricular hemorrhage were associated with a bad outcome. An initial disturbance of consciousness was the only reliable clinical predictor of outcome (chi-square, p < 0.001). Katamnestic evaluation of 66 of the 164 survivors after 5.2 years revealed seizures in 20 patients and mild neurological deficits in 41. Another 14 patients were partially, and nine totally dependent Nineteen patients had died in between; there was only one death attributable to another ICH.     

脑损伤对记忆的影响

目的:探讨不同程度的脑损伤对意识、无意识记忆的影响。方法:采用Jacoby的加工分离程序(PDP),以具体图形和抽象图形为实验材料,分别对器质性、功能性脑损伤患者和正常健康者的意识、无意识提取贡献率进行测试。结果:在2种图形编码条件下,器质性脑损伤组和功能性脑损伤组的意识性提取贡献率均显著低于正常组。器质性脑损伤组的无意识提取贡献率显著低于正常组;而功能性脑损伤组的无意识提取贡献率与正常组差异无显著性。结论:不同程度脑损伤对意识、无意识记忆的影响不同。意识性记忆在脑损伤中比无意识记忆更容易受到伤害。     

口腔医务人员职业暴露防护的研究

目的探讨口腔医务人员职业暴露防护的危险因素及对策。方法执行标准化、制度化、科学化及普遍预防的管理体系。结果制定了切实可行的口腔医务人员职业暴露防护的管理方案和措施,使口腔医务人员掌握口腔感染管理标准,明确口腔器械消毒程序,在口腔诊治过程中通过实施普遍预防的策略。结论构建口腔医务人员职业暴露防护的措施与方案,可以最大限度地防止口腔医院感染的发生。     

盐酸纳洛酮治疗急性脑卒中致意识障碍40例疗效观察

目的　探讨盐酸纳洛酮治疗急性脑卒中致意识障碍的疗效。方法　应用盐酸纳洛酮治疗急性脑卒中有意识障碍患者40例 ,与同期该类患者 40例常规治疗为对照。结果　治疗组疗效较对照组好 ,治疗组转醒时间明显小于对照组 (P <0 .0 1)。结论　盐酸纳洛酮治疗急性脑卒中致意识障碍 ,可明显缩短患者的转醒时间 ,显著提高疗效。     

医德重建:传统医德危机及其解决途径探析

目前,我国面临的医德危机是非常严重的。如何解决这一危机就成了一个不容回避的重大课题,不少学者提出要用传统医德来规范医务人员,并以此作为解决该危机的良方。然而,这种以人格伦理为特质的传统医德尽管有其一定的合理性,但其在实践中的有效性却受到了人们的质疑。为此,试图从传统医德自身的局限性、医务人员利益意识的觉醒以及因社会失范而导致的越轨三个方面来分析我国医德危机产生的根源,并为此提出了三条对策。     

废弃物处理——一个刻不容缓的问题

介绍了香港环保署通过１０年努力的完整的固体废弃物收运，处理及处置系统，以及他们为实现废弃物减量化和资源化所采取的策略与行动。由此提出上海浦东新区在固体废弃物管理和环卫设施建设上应加强关注；逐步按规划实施；采用多种形式设计，建造，营运环卫设施以及开展全方位宣传教育活动的建议。