通过三年资料实证医院检验科常规项目全成本

目的弄清医院常规检验项目的实际成本,为医院及卫生主管部门进行科学管理和政府物价部门制订科学合理的收费价格体系提供科学依据。方法对某二级甲等医院检验科3年中所开展的全部7大类16个项目组169个检验项目的成本按耗材、设备折旧、劳务费、房屋折旧、业务费与后勤管理费共5大类进行实证分析。结果该科的成本构成比是:耗材成本34.1%、设备折旧24.3%、劳务费30.0%、房屋折旧4.0%、业务费与后勤管理费7.6%;检验项目的每项次平均成本为7.17元;成本最低的两类检验项目是生化及定性免疫,其项次成本分别为3.18元和4.25元;最高的则为微生物和血库,项次成本分别为48.63元和35.21元;项次成本过百元的有7项,多为输血项目;5至10倍于平均成本的28项,2至5倍于全科平均成本的22项,其余112项介于全科平均成本上下。结论实证研究是准确掌握检验项目成本的有效方法。     

Neuroprotection with felbamate: a 7- and 28-day study in transient forebrain ischemia in gerbils

The use of glutamate antagonists and GABA agonists may protect neurons from the effects of transient ischemia. Felbamate is a new antiepileptic drug with glutamate antagonist and GABA agonist properties, We tested the efficacy of felbamate in a gerbil model of transient forebrain ischemia. Damage assessment was done with silver staining at 7 and 28 days after 5 min of bilateral carotid occlusion, Cerebral cortex, hippocampus (CA1 and CA4), thalamus and striatum were evaluated on a 4-point scoring system, The animals sacrificed at 28 days were also tested in a water-maze task to assess recovery of function, The initial dose of felbamate (300 mg/kg) was given 30 min before the ischemic insult in one set of animals and 30 min after the insult in another set of animals. There were 8 animals tested per group (total: 48 animals). There was significant neuronal protection with the use of felbamate, both before and after ischemia in all regions of the brain. Protection was seen in animals sacrificed at 7 and 28 days, Protection was moderate when felbamate was used before ischemia. It was highly significant when felbamate was given 30 min after the insult. Behavioral studies however did not show any difference in the felbamate treated animals versus the saline treated controls. The structural protection with felbamate was very significant when used in the post-ischemic period. This window for protection merits further evaluation in relation to the clinical setting of stroke.     

Electrode recovery potential

In some instances the same electrodes are used for stimulation and then for recording a bioelectric event immediately after the stimulus. However, after the current pulse there remains an electrode potential that decays quasiexponentially. We have designated this falling potential the electrode-recovery potential. This study investigated the recovery potentials of single electrodes of rhodium, stainless steel, platinum and platinum-iridium in contact with 0.9% saline at room temperature (25°C) over a current density ranging from 0.1 to 100 mA/cm² using a constant-current pulse. In all cases, with increasing current density, there was a decrease in the time for the electrode potential to fall to one half of the immediate post-stimulus value. Above about 20 mA/cm² the decrease in recovery time was smooth with increasing current density. Below 20 mA/cm², the recovery time was slightly irregular. The shortest recovery times were for platinum and platinum-iridium. The largest decrease in recovery time with increasing current density was for stainless steel, which decreased 10 fold from 0.1 to 100 mA/cm². The recovery time for rhodium decreased about three-and-one half fold over the same current density range. It was found that the waveform of the recovery potential is not a simple exponential because the Warburg and Faradic components of the electrode-electrolyte interface are current-density dependent. In general, for all current densities studied (0.1–100 mA/cm²), there was a sudden initial fall in electrode potential with cessation of current flow, followed by a very gradual nonexponential decrease in potential.     

Aptitude for physical exercise in a population of female hospital workers

Summary The aim of this study was to evaluate the level of physical capacity in a female hospital population of Paris and its suburbs. A total of 1505 women working in the selected departments filled in a questionnaire concerning their working conditions, life habits and health and also attended a medical examination. The effort test performed consisted in flexing the legs 20 times with the chest held straigt, in 40 s. The heart rates were measured for the first, the second and the third minutes of recovery (first 15 s multiplied by 4). The blood pressure was measured just after the heart rate, for the first and the third minute. Recovery indices have been constituted from the results. The respective weights of anthropometric and sociodemographic risk factors for recovery indices were studied in multiple logistic regression models. The classification enables us to consider about 25%–30% of our population as having a satisfactory physical capacity, about 26%–27% as having an acceptable capacit, and about 24%–27% as having a weak capacity. About 21% of the population presented an excessive pressure reaction and 44% a questionable pressure reaction. Our results concerning the level of physical capacity of the female nursing staff should be taken into account especially in the future planning of work loads and architectural choices, which must avoid excessive physical burdens in relation to this level. An improvement in the level of physical capacity could be envisaged as well.     

The in vivo microdialysis recovery of dopamine is altered independently of basal level by 6-hydroxydopamine lesions to the nucleus accumbens

The present study was designed to test the hypothesis that the active neurotransmitter processes of release and uptake affect the in vivo microdialysis recovery of dopamine (DA) in the nucleus accumbens (N ACC) of the rat. The in vivo recovery for DA was established for rats which had received either unilateral infusions of the neurotoxin 6-hydroxydopamine (6-OHDA, 8 μg) or vehicle (0.2 μg ascorbate). In the quantitative dialysis method used (point of no net flux method), DA is added to the perfusate at concentrations above and below the expected extracellular concentration (0, 5, 10 and 20 nM) and DA is measured in the dialysate from the brain to generate a series of points. A linear fit is performed, the slope of which is the in vivo recovery of the dialysis probe. The in vivo recovery of the 6-OHDA group was 30 ± 3% which was significantly lower (P < 0.002) than the in vivo recovery of the control group which was 60 ± 3% (mean ± SEM; n = 6/group). The zero intercept of this regression is the point of no net flux, which is the extracellular concentration of DA independent of the probe sampling characteristics. The extracellular DA concentration for the 6-OHDA group was 7.8 ± 1.1nM, which was not significantly different than the control group which was 6.9 ± 0.7nM. The tissue DOPAC/DA ratios of the 6-OHDA lesioned hemispheres were significantly higher than the contralateral hemispheres of the same animals (0.62 ± 0.1vs.0.27 ± 0.1; P < 0.02) while the DOPAC/DA ratios in the control group were not significantly different (0.24 ± 0.1vs.0.27 ± 0.1). The fractional DA efflux from the terminals in the 6-OHDA group was significantly higher than the fractional DA efflux of the control group (0.52 ± 0.08vs.0.03 ± 0.003; P < 0.0001), indicating that the remaining terminals have increased turnover of DA. Despite the increased turnover, however, the number of remaining release and uptake sites are not sufficient to maintain the high in vivo recovery observed in the control group.     

Spinal cord transplants enhance the recovery of locomotor function after spinal cord injury at birth

Summary Fetal spinal cord transplants placed into the site of a neonatal spinal cord lesion alter the response of immature CNS neurons to injury. The transplants prevent the retrograde cell death of immature axotomized neurons and support the growth of axons into and through the site of injury. In the present experiments we used a battery of locomotor tasks to determine if these transplants are also capable of promoting the recovery of motor function after spinal cord injury at birth. Embryonic (E14) spinal cord transplants were placed into the site of a spinal cord over-hemisection in rat pups. Three groups of animals were used: 1) normal control animals, 2) animals with a spinal cord hemisection only, and 3) animals with a spinal cord transplant at the site of the hemisection. Eight to twelve weeks later, the animals were trained and videotaped while crossing runways requiring accurate foot placement and footprinted while walking on a treadmill. The videotapes and footprints were analyzed to obtain quantitative measures of locomotor function. Footprint analysis revealed that the animals' base of support during locomotion was increased by a neonatal hemisection. The base of support in animals with transplants was similar to control values. Animals with a hemisection rotated their hindlimbs further laterally than did control animals during locomotion. A transplant at the site of injury modified this response. Normal animals were able to cross a grid runway quickly with only a few errors. In contrast, animals with a hemisection took a longer time and made more errors while crossing. The presence of a transplant at the site of injury enabled the animals to cross the grid more quickly and to make fewer errors than the animals with a hemisection only. Animals that received the transplants demonstrated qualitative and quantitative improvements in several parameters of locomotion. Spinal cord transplants at the site of neonatal spinal cord injury result in enhanced sparing or recovery of motor function. We suggest that this transplant induced recovery of function is a consequence of the anatomical plasticity elicited by the transplants.     

Changes in fibre-type composition and myosin heavy-chain IId isoform in rat soleus muscle during recovery period after hindlimb suspension

We examined the changes in myosin heavy-chain (HC) isoforms and fibre-type composition in rat soleus muscle using both myosin adenosine triphosphatase staining and sodium dodecyl sulphate/polyacrylamide gel electrophoresis (SDS-PAGE) analyses during the recovery period after 4 weeks of hindlimb suspension. Although there was no change in type IIc fibres after the suspension, an increase in this type of fibres was observed during the 1- to 4-week recovery period. The increase in type Ilc fibres was considered to be due to a shift from type Ila to IIc fibres. The SDS-PAGE analysis revealed the presence of the HC IId isoform, which was not observed in the control muscle, after a 4-week hindlimb suspension. The HC IId isoform gradually decreased over 3 weeks of recovery and disappeared in the 4th week of recovery after the suspension. These results suggest that the hypogravity conditions induced by hindlimb suspension stimulated the synthesis of the HC IId isoform, whereas an increase in mechanical load to the muscle accelerated the degradation of the HC IId isoform and the synthesis of type Ilc fibres during the recovery period after hindlimb suspension.     

Potassium and sodium shifts during in vitro isometric muscle contraction,and the time course of the ion-gradient recovery

Intracellular potassium ([K⁺]_i), interstitial potassium ([K⁺]_inter), intracellular sodium ([Na⁺]_i), and resting membrane potential (RMP) were measured before and after repetitive stimulation of mouse soleus and EDL (extensor digitorum longus) muscles. At rest, RMP was –69.8 mV for soleus and –74.9 mV for EDL (37°C). [K⁺]_i was 168 mM and 182 mM, respectively. In soleus, free [Na⁺]_i was 12.7 mM. After repetitive stimulation (960 stimuli) RMP had decreased by 11.9 mV for soleus and by 18.2 mV for EDL. [K⁺]_i was reduced by 32 mM and 48 mM, respectively, whereas [K⁺]_inter was doubled. In soleus [Na⁺]_i had increased by 10.6 mM, demonstrating that the [K⁺]_i-decrease is three times higher than the [Na⁺]_i-increase. It is concluded that this difference reflects different activity induced movements of Na and K, and that the difference is not due to the Na/K pumping ratio. The possible involvement of the potassium loss in muscle fatigue is discussed. After stimulation RMP recovered with a time constant of 0.9 min for soleus and 1.5 min for EDL. Within the first minutes after stimulation the intracellular potassium concentration increased by 20.4 mM/min for soleus and 21.7 mM/min for EDL. Free [Na⁺]_i decreased with less than 10 mM/min. The mechanisms underlying the different rate of changes are discussed.Parts of this work have been published in preliminary form (Juel and Sjøgaard 1984)     

The anaerobic recovery of frog muscle

Summary The muscle may undergo a partial recovery of its high energy phosphate stores in the absence of oxygen by the way of glycolysis (anaerobic recovery). This process has been studied in 41 pairs of frog gastrocnemii at different degrees of exhaustion induced by variable trains of supramaximal stimuli. Anaerobic recovery appears to be inadequate to replenish the fraction of muscle high energy phosphate stores (GP=ATP+PC) split as a consequence of the stimulation. The maximal amount of recovery (on the average about 5 Moles of GP per gram of fresh tissue) occurs when the muscle resting stores have been reduced to about 50%. This limitation in the extent of recovery is not a consequence of a reduced availability of glycogen but it is possibly related to the production of some metabolic intermediate, limiting the rate of the glycolytic sequence, likely the accumulation of lactic acid in the fiber. The time course of the anaerobic recovery process is characterized by at1/2 of about 2 min. The efficiency of the process, i.e. the number of the high energy phosphate bonds resynthesized by one Mole of lactic acid, appears to vary between 1.5 and 1.8, being of the same order of magnitude as the GP/L.A. ratio obtained from muscle extracts.     

The rate of lactic acid removal in relation to different baselines of recovery exercise

Summary During strenuous exercise lactic acid (LA) appears in the blood as a result of anaerobic metabolism. The rate at which this LA was removed from the blood after exercise was seen to increase to a maximum with a certain level of post exercise activity. This maximum rate of removal of LA appears to be at approximately 40% of the individual's maximum oxygen uptake when the exercise is performed on a bicycle ergometer.