河南省二级医院护士医院伦理氛围感知与隐性缺勤的相关性研究

目的 探讨河南省二级医院护士医院伦理氛围感知与隐性缺勤的现状及相关性。方法 采取多阶段分层随机抽样的方法在河南省抽取二级医院护士594名,采用一般资料调查表、医院伦理氛围量表、斯坦福隐性缺勤量表进行调查,采用相关性分析和多元线性回归分析探究护士医院伦理氛围感知与隐形缺勤之间的关系。结果 护士医院伦理氛围总分为(4.36±0.43)分,隐形缺勤为（14.83±4.76）分;不同科室、聘任方式、夜班数、科室工作年限以及饮食是否规律的护士隐形缺勤得分差异具有统计学意义（P＜0.05）;医院伦理氛围总分与隐性缺勤呈负相关(r = - 0.348,P＜0.001),各维度与隐性缺勤呈负相关（P＜0.001）;回归分析结果显示在去除混杂因素（科室工作年限、是否饮食规律、科室）后,医院伦理氛围可负向预测护士隐形缺勤（β = - 0.296,P＜0.001）。结论 医院伦理氛围可能是二级医院护士隐性缺勤的独立危险因素,医院管理者应关注护士对医院伦理氛围感知情况的变化,以降低隐性缺勤。     

人体呼吸道的二级及三级支气管内吸气流动的数值研究

呼吸系统的主要生理机能是在大气和血液之间交换氧气和二氧化碳，其生理过程与呼吸道内的气体流动和输送有密切关系。本文利用数值模拟方法对呼吸道内二级及三级支气管模型内的吸气过程进行数值研究，研究表明：二级支气管的计算结果与现有的实验值吻合很好；在三级支气管内。当人体处于正常吸气流量下，支气管内未发生任何分离现象。但流道几何形状的弯曲和分岔使支气管内出现强烈的二次流现象，主流速度出现倾斜分布及m-型分布特征。从而加大了分岔管内侧壁面及前后侧壁面上的切应力；在三级支气管的末级管内，流量分流不均匀。在计算条件下，中部支气管内的流量与侧部支气管内的流量之比为1．2。     

On the secondary stability of coated cementless hip replacement: parameters that affected interface strength

Unlike primary stability of coated cementless implants, their secondary stability has been poorly studied. This paper considers some theoretical aspects of the secondary stability of a coated cementless hip implant in a human femur. The bone is separated from the implant by a thin layer of microscopic peaks and troughs formed on the surface of the coating. The size of the peaks and troughs is very small compared with the macrosize of the implant stem and bone in contact. The study of the bone–stem contact by direct application of the finite element method is prohibitively costly. A two-scale asymptotic homogenisation procedure that takes into account the microgeometry of the interface layer and mechanical properties of bone and the implant material is applied to obtain effective, homogenised contact parameters. These parameters can be used in finite element analyses involving smooth interfaces, which require hundreds of times fewer finite elements. With the homogenisation technique and finite element analyses for a simplified design, two parameters were found to be most important—the normal contact stiffness and the friction coefficient. They both increase several times as bone grows into the rough surface of the implant and mineralises, thus providing a stronger interface and resulting in reduced micromotions.     

反复自然流产患者血清中封闭抗体的检测

本文根据病史将反复自然流产(RSA)分类为原发性RSA 及继发性RSA,分别以单向混合淋巴细胞反应封闭试验及补体依赖微量细胞毒试验评价封闭抗体与两类流产的关系。结果发现,原发性RSA主要因封闭抗体缺乏所致;而继发性RSA 无封闭抗体缺乏迹象。因此,尽管原发性RSA 与继发性RSA 临床表现类似,但其免疫学病因及发病机理可能不同。     

Die Kombinationstherapie Insulin/Sulfonylharnstoff in der Langzeittherapie des Typ-II-Diabetes nach „Sekundärversagen“

Summary In type 2 diabetes with secondary failure of sulfonylurea therapy good metabolic control can seldom be achieved by insulin therapy even with high insulin doses. Hyperinsulinemia however is a possible risk factor of cardiovascular disease in type 2 diabetes. Maintaining the effects of sulfonylurea action insulin should be added in as small amounts as possible to avoid hyperinsulinemia and to ameliorate hyperglycemia.16 type 2 diabetics with secondary failure were treated either with insulin alone (group A;n=8) or with 3.5 mg b.i.d glibenclamide plus small amounts of intermediate insulin (group B;n=8) in a randomised order. After the inpatient period outpatient control was performed monthly up to six months, later on four times a year up to two years.Both groups were comparable with regard to age, duration of diabetes, body weight and metabolic control. The daily insulin dose was 14±2 IU after one month and 19±2 IU after two years in group B. In contrast 30±3 IU and 43±5 IU respectively were needed in group A (p<0.001). All patients B were treated with one daily injection, all patients A needed two injections. Resulting in nearly identical metabolic control in group A basal insulin levels exceeded those in group B after two years significantly (28.6±3.7 vs. 18.6±1.6 mcU/ml;p<0.01). Endogenous C-peptide response was suppressed in group A compared to group B after inpatient period and after one month (0.12±0.01 vs. 0.49±0.15 and 0.09±0.04 vs. 0.13±0.08 pmol/ml;p<0.05). The combined therapy of insulin and sulfonylureas demonstrates the benefit of a prolonged sulfonylurea administration in the treatment of type 2 diabetes with secondary failure.As compared to common insulin therapy a small amount of exogenous insulin by one daily injection additionally to glibenclamide shows similar improvement in metabolic control. Hyperinsulinemia as a risk factor of macroangiopathy is markedly reduced in patients treated with combined therapy compared to those with insulin alone.

Herrn Professor Dr. N. Zöllner zum 65. Geburtstag gewidmet     

脊髓损伤对大鼠骨细胞凋亡的影响

目的：探讨脊髓损伤（SCI）对骨细胞凋亡的影响及其在SCI后骨质疏松发病中的可能机制,方法：20只3mo龄SD大鼠均分为SCI组与对照组,SCI组于T10 处完全横断脊髓,对照组仅行椎板切除术,3wk后对骨骨进行取材料,应用原位凋亡法计数股骨髁部松质骨骨细胞的凋亡指数,对股骨髁部行透射电镜观察,采用双能线骨密度仪对各组大鼠的股骨髁部骨密度（BMD）进行测定,结果：SCI组BMD较对照组明显降低（P＜0．05）,小梁骨中骨细胞凋亡比率显上升（P＜0．001）,透射电镜观察到SCI组骨细胞异梁色质凝聚,边集等典型的细胞凋亡征象,结论：骨细胞凋亡在SCI后骨质疏松发病中起着重要作用。     

补肾中药佳蓉片对去势小鼠骨丢失的预防作用

目的　研究补肾中药佳蓉片 (JRP)对模型小鼠骨质疏松的影响 .方法　雌性昆明小鼠 6 0只随机分为 6组 ,行去卵巢术或假手术 .处理后分组为 :去卵巢组 (OVX) ,假手术组(Sham) ,去卵巢分为佳蓉片低剂量组 (JRP- L,10 0 mg·d- 1 ) ,佳蓉片中剂量组 (JRP- M,2 0 0 mg· d- 1 ) ,佳蓉片高剂量组 (JRP- H,40 0 mg· d- 1 )和 17β雌二醇组 (E2 ,10 μg·d- 1 ) .手术后灌胃上述药物 2 8d,测定股骨密度、骨生物力学性能、血清碱性磷酸酶 (AL P)、骨钙素 (BGP) .结果　各中药组的股骨骨密度均高于去卵巢对照组 (P<0 .0 5 ) ,与假手术组无差异 ;灌胃中药后骨结构力学参数显著性改善 (P<0 .0 5 ) ,同时 AL P,BGP显著性降低 (P<0 .0 5 ) .结论　补肾中药方剂可预防去卵巢引起的骨丢失 ,改善骨的生物力学性能     

骨折与无骨折史患者的定量超声检查比较

目的：用定量超声方法对有骨折史的骨质疏松症患者进行骨量检查,方法用CUBA Clinical型定量骨密度超声仪对393例被疑为骨质疏松的患者进行检测,并根据病史按有无骨折中进行分组。分析二组患者宽频超声衰减（BUA）、超声速率（VOS）、强度指数（SI）与骨折次数的关系。结果：伴有骨折史的骨质疏松症虱的BUA、VOS、SI值都要比无骨折史的患者明显降低（P＝0．000）。结论定量超声值与骨折的发生次数呈负相关,其测定值越低,骨折的发生次数越多;骨的质量下降是造成骨质疏松骨折的主要原因。     

Management of steroid-induced osteoporosis

Ｐｕｒｐｏｓｅ　Ｔｏｒｅｖｉｅｗｔｈｅｐａｔｈｏｇｅｎｅｓｉｓ ,ｃｌｉｎｉｃａｌｐｒｅｓｅｎｔａｔｉｏｎ ,ｄｉａｇｎｏｓｔｉｃａｓｓｅｓｓｍｅｎｔａｎｄｔｒｅａｔｍｅｎｔｒｅｇｉｍｅｎｓｏｆｓｔｅｒｏｉｄ ｉｎｄｕｃｅｄｂｏｎｅｌｏｓｓ .Ｄａｔａｓｏｕｒｃｅｓ　ＡｎＥｎｇｌｉｓｈ ｌａｎｇｕａｇｅｌｉｔｅｒａｔｕｒｅｓｅａｒｃｈ(ＭＥＤＬＩＮＥ 1966- 1999)ａｎｄｂｉｂｌｉｏｇｒａｐｈｉｃｒｅｖｉｅｗｓｏｆｔｅｘｔｂｏｏｋｓａｎｄｒｅｖｉｅｗａｒｔｉｃｌｅｓ .Ｓｔｕｄｙｓｅｌｅｃｔｉｏｎ　Ｃｒｏｓｓ …