运用市场手段实现医药自然分开的理论探讨

回顾了韩国、我国台湾和大陆实行医药分开改革的过程,认为我国以往的相关改革陷入了“管制”的思维误区。认为通过制度设计,创造医疗机构门诊处方自由流动的环境,依靠市场竞争形成处方流向结构多元化,可以实现医药自然分开状态。提出了“医药自然分开”、“处方流向结构”和“处方分散度”等新概念。     

Linear atrophoderma of Moulin together with leuconychia: a case report

Linear atrophoderma of Moulin has a distinctive disease pattern characterized by hyperpigmented atrophoderma and was described originally in 1992. It follows the line of Blaschko, and occurs without preceding inflammation, subsequent induration or scleroderma. The lesions usually develop during childhood or adolescence, and the prognosis is good. The diagnosis is made clinically and histopathologically. In our 18-year-old male patient, there were atrophic plaques unilaterally located on the trunk and arm, and white discoloration on all finger nails. Histopathological examination revealed epidermal atrophy together with disruption of collagen fibres.     

Reviewing the definition of "elderly"

Conventionally, "elderly" has been defined as a chronological age of 65 years old or older, while those from 65 through 74 years old are referred to as "early elderly" and those over 75 years old as "late elderly." However, the evidence on which this definition is based is unknown. We have attempted to review the definition of elderly by analyzing data from long-term longitudinal epidemiological studies, and clinical and pathological studies that have been accumulated at the Tokyo Metropolitan Geriatric Hospital and the Tokyo Metropolitan Institute of Gerontology. Our recommendation might be a starting point in developing a strategy for a successful society by reviewing the definition of elderly based on comprehensive evidence in all aspects of social, cultural and medical sciences.     

胃癌术后残胃无力(附17例分析)

目的:探讨胃癌术后残胃无力的诊治及预防。方法:对1998年~2004年间284例胃癌术后出现的17(6%)例残胃无力患者进行回顾性研究。结果:残胃无力发生于术后6~15天,症状持续10~21天。经消化道造影确诊,用非手术方法治疗后症状全部消失。结论:消化道造影是可靠的诊断方法,非手术方法治疗效果肯定。     

Effect of short daily home haemodialysis on quality of life, cognitive functioning and the electroencephalogram.

BACKGROUND: End-stage renal disease patients have a poor quality of life (QoL), suffer from impaired cognitive functioning, and their electroencephalogram (EEG) shows abnormalities. Conventional haemodialysis (CHD) only partially restores these disorders. Short daily haemodialysis (SDHD) has been reported to improve QoL, but effects on cognitive functioning and EEG have yet to be described. METHODS: Of the 13 patients (11 male, 2 female, age 45.5 +/- 8.1 years), 11 completed the Kidney Disease Quality of Life and Affect Balance Scale questionnaires, 10 underwent neuropsychological testing, and all 13 underwent EEG examination. For the neuropsychological assessments, nine patients (six male, three female, age 45.4 +/- 12.6) who remained on the CHD schedule, served as controls. The dialysis schedule of thrice-a-week for 4 h was changed in the experimental group to six times a week for 2 h (SDHD) over a period of 6 months and back to thrice a week for 4 h. RESULTS: When on SDHD, patients rated several dimensions of health-related QoL as being improved. After resuming CHD, one of these dimensions again decreased and several others worsened even lower than baseline. Cognitive functioning did not change when compared with control data. On the EEG, alpha peak frequency increased slightly when on SDHD but decreased significantly after resuming CHD. CONCLUSIONS: SDHD improves health-related QoL, but has no clear effects on cognitive functioning and EEG. Resumption of CHD after SDHD decreases aspects of QoL and EEG alpha peak frequency but has no effect on cognitive functioning.     

急性低氧运动对血液流变性和红细胞形态的影响及电解质饮料的干预效果

目的:探讨急性低氧运动对血液流变性和红细胞形态的影响以及补充电解质饮料的干预效果。方法:受试者为8名健康成年男性,均进行两次实验。第1次为急性低氧运动加补充电解质饮料(运动前和运动中)实验,第2次为急性低氧运动不补充任何液体实验,两次实验间隔1周。受试者以70%最大摄氧量(VO2max)强度在低氧环境(O2浓度为15.5%,环境温度为20℃,湿度为55%)下进行1小时的功率自行车运动。分别测定受试者运动前、后的血液流变学指标并观察其红细胞形态的变化。结果:不补液情况下,受试者运动后的血液粘度、红细胞压积及红细胞刚性指数显著增加(P<0.01)。红细胞形态由双凹圆盘形变为一面凸、一面凹的草帽形。运动前和运动中补充电解质饮料,受试者运动后的各项血液流变学指标与运动前相比变化均不显著(P>0.05),且运动后红细胞形态未见明显变化。结论:运动前和运动中补充电解质饮料可缓解急性低氧运动对机体血液流变性产生的不良影响。     

关节镜下应用“微骨折”方法修复关节软骨缺损

目的:探讨关节镜下应用“微骨折”技术对膝关节全层关节软骨缺损修复的效果。方法:对68例全层关节软骨缺损患者进行随机分组:实验组(35例),男17例,女18例,平均年龄35.1岁,采用关节清理后应用“微骨折”技术进行处理,即利用骨刀设计的特性和适度的锤击力量造成软骨下的骨组织微小骨折,刺激软骨生长。对照组(33例),男17例,女16例,平均年龄31.6岁,仅作关节清理术。结果:术后随访6~18个月,平均8.6个月,按Lysholm评分标准,实验组明显优于对照组(P<0.01)。结论:关节镜下应用“微骨折”技术能够显著减轻关节疼痛,增加关节活动度,改善关节功能,是一种简单有效的修复全层关节软骨缺损方法。     

经尿道前列腺电切术和汽化电切术并发症48例分析

目的 分析经尿道前列腺电切术（TURP）与经尿道前列腺汽化电切术（TVP）术中、术后常见并发症的原因、预防及治疗，提高手术安全性和有效性。方法 回顾性分析1999年5月-2006年6月我院TURP和TVP术48例并发症患者的临床资料。结果 平均手术时间75min，平均切除组织41g。术中、术后出血20例，电切综合征（TURS）5例，暂时性尿失禁11例，膀胱颈部挛缩5例，尿道狭窄8例，尿路感染7例，膀胱穿孔1例。结论 TURP和TVP是良性前列腺增生症安全有效的外科治疗方法，术前详细采集病史，术中正确操作。术后对病人正确指导及处理可有效减少手术并发症。     

Association Between Outpatient Follow-Up and Pediatric Emergency Department Asthma Visits

Background. The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend that patients receive a follow-up outpatient asthma visit after being discharged from an emergency department (ED) for asthma. Objective. To measure the frequency of follow-up outpatient asthma visits and its association with repeat ED asthma visit. Design. We conducted a retrospective cohort study of children with asthma using claims data from a university-based managed care organization from 01 1998 to 10 2000. We performed a multivariate survival analysis using Cox proportional hazards model to determine the effect of follow-up outpatient asthma visits on the likelihood of a repeat ED asthma visit, after controlling for severity of illness, patient age, gender, insurance, and the specialty of the primary care provider. Results: A total of 561 children had 780 ED asthma visits. Of these, 103 (17%) had a repeat ED asthma visit within 1 year. Almost two-thirds of children (66%) did not receive outpatient follow-up for asthma within 30 days of an ED asthma visit. Outpatient asthma visits within 30 days of an ED asthma visit are associated with an increased likelihood (relative risk = 1.80; 95% confidence interval 1.19, 2.72) for repeat ED asthma visits within 1 year. Conclusions. Most patients do not have outpatient follow-up after an ED asthma visit. However, those patients that present for outpatient follow-up have an increased likelihood for repeat ED asthma visits. For the primary care provider, these outpatient follow-up visits signal an increased risk that a patient will return to the ED for asthma and are a key opportunity to prevent future ED asthma visits.