基层医院重症监护病房的医院感染特点及其对策

目的分析基层医院重症监护病房(ICU)的医院感染特点,提出相应的防范措施,以有效降低医院感染发生率. 方法以主动监测与系统回顾相结合的方法,对2003年全年入住ICU 383例患者的相关临床资料进行分析评判,并与全院住院患者进行对比. 结果 ICU的医院感染率是28.8%,显著高出同期的医院平均感染率23.6个百分点;因医院感染而导致死亡的占ICU总死亡的36%;ICU医院感染的病原菌以G-菌为主,占50%,而双重感染达78.7%;下呼吸道感染为医院感染的主要部位占61.7%,但多部位多器官感染占29.6%. 结论 ICU医院感染的特点是高发病率、高死亡率、高耐药性;其相关因素有病情重、年龄大、基础疾病多、侵入性诊疗操作多与交叉感染等.     

各具特色的国外妇幼保健工作

本文通过对国际上几个主要国家的妇幼保健工作的介绍,使人们对不同特色的妇幼保健事业有所了解,他山之石,可以攻玉,希望能够对我国妇幼保健工作的发展提供借鉴。     

Comparison of the APACHE III, APACHE II and Glasgow Coma Scale in acute head injury for prediction of mortality and functional outcome

Objectives: This study examines the efficacy of the predicting power for hospital mortality and functional outcome of three different scoring systems for head injury in a neurosurgical intensive care unit (NICU). Design: On the day of admission, data were collected from each patient to compute the Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II and III, and Glasgow Coma Scale (GCS) scores. Hospital mortality was defined as the deaths of patients before discharge from hospital. Early mortality was defined as death before the 14th day after admission. Late mortality was defined as death after the 15th day from admission. Functional outcome was evaluated by Index of Independence in Activities of Daily Living (Index of ADL). Setting: An 8-bed NICU in a 1270-bed medical center in Taichung Veterans General Hospital. Patients and participants: Two hundred non-selected patients with acute head injury were included in our study in a consecutive period of 2 years. Patients less than 14 years old were not included. Interventions: None. Measurements and results: Sensitivity, specificity and correct prediction outcome were measured by the chi-square method in three scoring systems. The Youden index was also obtained. The best cut-off point in each scoring system was determined by the Youden index. The difference in Youden index was calculated by Z score. A difference was also considered if the probability value was less than 0.05. The area under Receiver Operating Characteristic (ROC) curve was computed. Then the area under ROC of each scoring system was compared by Z score. There was statistical significance if p was less than 0.05. For prediction of hospital mortality, the best cut-off points are 55 for APACHE III, 17 for APACHE II and 5 for GCS. The correct prediction outcome is 82.4% in APACHE III, 78.4% in APACHE II and 81.9% in the GCS. The Youden index has best cut-off points at 0.68 for APACHE III, 0.59 for APACHE II, and 0.56 for GCS. The area under Receiver Operating Characteristic (ROC) curve is 0.90 in the APACHE III, 0.84 in the APACHE II and 0.86 in the GCS. There are no statistical differences among APACHE III and II, and GCS in terms of correct prediction outcome, Youden Index and the area under the ROC curve. Other physiological variables excluding GCS in APACHE III and II (AP III-GCS, AP II-GCS) have less statistical value in the determination of mortality for acute head injury. For the prediction of late mortality, APACHE III and II yield significantly better results in the area under the ROC curve, correct prediction and Youden index than those of GCS. Other physiological variables (AP III-GCS and AP II-GCS) play an important role in the prediction of late mortality in APACHE scores. For prediction of the functional outcome of surviving patients with acute head injury, the APACHE III yields the best results of correct prediction outcome, Youden index and the area under the ROC curve. Conclusion: The APACHE III and II may not replace the role of GCS in cases of acute head injury for hospital or early mortality assessment. But for prediction of the late mortality, the APACHE III and II have better accuracy than GCS. Other physiological variables excluding GCS in the APACHE system play a crucial contribution for late mortality. GCS is simple, less time-consuming and economical for patients with acute head injury for the prediction of hospital and early mortality. The APACHE III provides better prediction for severe morbidity than GCS and APACHE II. Therefore, the APACHE III provides a good assessment not only for hospital and late mortality, but also for functional outcome. Received: 22 May 1995 Accepted: 2 September 1996     

Fibrous metaphyseal defects — determination of their origin and natural history using a radiomorphological study

The radiomorphological appearance of fibrous metaphyseal defects (FMDs) is demonstrated by long-term follow-up studies. A characteristic radiomorphological course rather than a typical single appearance can be established. These findings correlate well with the duration of these tumor-like lesions; therefore, the radiological findings allow conclusions to be made about the age of a fibrous metaphyseal defect. In addition, the characteristic locations of FMDs will be explained in respect of their origins at insertions of tendons and ligaments.     

评价酶联免疫检测血清CYFRA21—1对非小细胞肺癌的诊断价值

目的评价检测ＣＹＦＲＡ２１┐１对非小细胞肺癌的诊断价值。方法用ＥＬＩＳＡ法测定７０例肺癌（ＬＣ）其中４７例非小细胞肺癌（ＮＳＣＬＣ），３例小细胞肺癌（ＳＣＬＣ）和２０例未分型肺癌、６４例肺部良性疾病患者及４０例健康人血清ＣＹＦＲＡ２１┐１浓度。试验的诊断性能用相对操作特征（ＲＯＣ）分析法估测之。结果测得全阈诊断准确率（ＯｖｅｒａｌＤｉａｇ┐ｎｏｓｔｉｃＡｃｃｕｒａｃｉｅｓ）ＬＣ为０．７５、ＮＳＣＬＣ为０．７６，ＳＱＣ为０．８３，ＡＤＥ为０．６７和ＳＣＬＣ为０．３８。在相应于特异性为０．９５的界定值３．４７μｇ／Ｌ处，各型的灵敏度分别为ＳＱＣ０．６２，ＬＣ０．５３，ＮＳＣＬＣ０．５１，ＡＤＥ０．４８和ＳＣＬＣ０．００。结论结果显示ＣＹＦＲＡ２１┐１是ＮＳＣＬＣ较灵敏和特异的一个标志物。未观察到ＴＮＭ各期间该标志物的平均水平有明显的差异；然而异常升高水平的患者的比例随病期的进展而显著增加，提示一系列检测ＣＹＦＲＡ２１┐１水平可能有助于监查ＮＳＣＬＣ患者的疗效。     

利用脉搏波特征参数连续测量血压的方法研究

通过研究血压与脉搏波特征参数的关系，提出了一个选择多个与血压相关的脉搏波特征参数,通过回归分析建立适合不同人的特征方程，进行血压的连续测量的新方法，为了验证测量结果的准确性；研制了张力计。实验结果表明：该方法具有较高的测量精度，可以应用于临床危重病人的血压监护和一般医学研究中，经过进一步地改进和完善后可应用于载人航天和日常动态环境。     

Viewer-centred and object-centred coding of heads in the macaque temporal cortex

Summary An investigation was made into the sensitivity of cells in the macaque superior temporal sulcus (STS) to the sight of different perspective views of the head. This allowed assessment of (a) whether coding was viewer-centred (view specific) or object-centred (view invariant) and (b) whether viewer-centred cells were preferentially tuned to characteristic views of the head. The majority of cells (110) were found to be viewer-centred and exhibited unimodal tuning to one view. 5 cells displayed object-centred coding responding equally to all views of the head. A further 5 cells showed mixed properties, responding to all views of the head but also discriminating between views. 6 out of 56 viewer and object-centred cells exhibited selectivity for face identity or species. Tuning to view varied in sharpness. For most (54/73) cells the angle of perspective rotation reducing response to half maximal was 45–70° but for 19/73 it was >90°. More cells were optimally tuned to characteristic views of the head (the full face or profile) than to other views. Some cells were, however, found tuned to intermediate views throughout the full 360 degree range. This coding of many distinct head views may have a role in the analysis of social signals based on the interpretation of the direction of other individuals' attention.     

Clinical applications of characteristic frequency measurements: preliminaryin vivo study

In vivo electrical impedance tomography images have been available for some years, and most of them show variation in impedance amplitude between two different states, for example between inspiration and expiration of the lungs. A refinement of the tomography technique has made it possible to show images of the complex impedance of the body. If several frequencies are used, more information on the investigated tissues can be collected, and new areas made available for investigation. It has been shown that tissues exhibit a characteristic frequency that can be derived from the maximum magnitude of the (negative) reactance. The characteristic frequency-related images can be calculated from several imaginary part curves obtained using the back-projection technique. The paper shows in vivo impedance spectra from different parts of the body, determines the characteristic frequency of the different in vivo measurements and suggests different applications of characteristic frequency imaging. Several data sets are collected to show the reproducibility of the measurements.     

医学科技期刊新媒体爆款文章的特征及生成策略——以《协和医学杂志》实践为例

【目的】 探析医学科技期刊新媒体爆款文章的特征及生成策略。 【方法】 以《协和医学杂志》为例,筛选出其在今日头条平台2018年10月至2020年12月阅读量为“10万+”的爆款文章,分析文章特征,并从资源挖掘、内容生产及推广传播环节提出有效策略。 【结果】 医学科技期刊新媒体爆款文章具有话题热、标题靓、排版精、互动深的特点;借力平台优势、融合科普定位、发挥“意见领袖”作用、巧搭新闻热点事件、精心设计版式以及多网媒滚筒式传播均为医学科技期刊新媒体爆款文章生成的有力之举。 【结论】 医学科技期刊新媒体深挖优势资源,把好内容及传播环节,策略性运营,可为爆款文章生成提供保障,进而提升期刊品牌影响力和新媒体综合实力。     

142例女性肺癌的临床特点

目的：对肺癌病人中女性患进行分析，探讨女性肺癌的临床特点，根据这些临床特点指导手术前诊断及肺癌的分型。方法：调集本院10年来142例女性肺癌资料，对其年龄、吸咽情况、辅助诊断和病理资料等进行分析。结果：经本组资料分析发现女性肺癌在年龄分布、X线摄片及纤维支气管镜分型、病理类型等方面有明显特征。结论：女性肺癌随年龄增长发病比重增大，以5O岁～59岁年龄组比重最大；周围型肺癌占59．3％，肺腺癌占57．0%。