二硫化碳对大鼠视网膜组织诱导型一氧化氮合酶及细胞凋亡的影响

目的探讨二硫化碳（CS2）对大鼠视网膜组织诱导型一氧化氮合酶（iNOS）及细胞凋亡的影响。方法将24只SD雄性大鼠随机分为对照组、低剂量CS2染毒组和高剂量CS2染毒组，染毒结束后取视网膜组织制成切片，测量内视网膜厚度比率，还原型烟酰胺腺嘌呤二核苷酸黄递酶染色（NADPH-NDP）法检测iNOS活力，原位缺口末端标记法（TUNEL）检测细胞凋亡。结果（1）染毒组的内视网膜（包括内核层、内丛状层、节细胞层、神经纤维层和内界膜）厚度减小，与对照组相比，差异有统计学意义（P〈0．05）；高剂量染毒组与低剂量染毒组之间差异亦有统计学意义（P〈0．05）。（2）染毒组视网膜iNOS表达增加，与对照组相比，差异有统计学意义（P〈0．05或P〈0．01）；高剂量染毒组与低剂量染毒组之间差异亦有统计学意义（P〈0．05）。（3）染毒组视网膜出现细胞凋亡，凋亡指数与对照组相比，差异有统计学意义（P〈0．05或P〈0．01）；高剂量染毒组与低剂量染毒组之间差异亦有统计学意义（P〈0．05）。结论CS2能激活视网膜组织iNOS表达，由此产生的过量的NO可损伤视网膜细胞。同时，视网膜细胞凋亡也是CS2所致视网膜损害的机制之一。     

尘肺病患者心率变异性分析及其临床意义

目的探讨尘肺病患者心率变异性（HRV）改变的临床意义。方法对比分析30例尘肺病患者与20例键康对照组HRV之间的差异以及尘肺病组HRV昼夜之间的变化。结果尘肺病组HRV所有时域指标均明显低于对照组，差异有统计学意义（P〈0．01或P〈0．05）。尘肺病组昼夜HRV指标中SDNN差异无统计学意义（P〉0．05）。RMSSD、PNN50差异有统计学意义（P〈0．05或P〈0．01）。结论尘肺病患者进行HRV检测，对患者的疾病诊断、治疗及预后有重要临床价值。     

血管内皮生长因子和基质金属蛋白酶9在急性白血病骨髓细胞中的表达

目的 探讨血管内皮细胞生长因子（VEGF）和基质金属蛋白酶9（MMP-9）在骨髓细胞中的表达与急性白血病的发生、发展和髓外浸润转移过程的关系。方法 将研究对象分为初诊组、复发组、完全缓解组、正常对照组、急性淋巴细胞白血病（ALL）组、急性非淋巴细胞白血病（ANLL）组、有髓外浸润组、无髓外浸润组，采用免疫组化染色方法分别测定各组急性白血病患者骨髓细胞的VEGF和MMP-9阳性率。结果 （1）VEGF和MMP-9阳性率初诊组与正常对照组比较差异有统计学意义（P〈0．05）；完全缓解组与初诊组比较差异有统计学意义（P〈0．05），与正常对照组比较差异无统计学意义（P〉0．05）；复发组与正常对照组比较差异有统计学意义（P〈0．05）；ALL组与ANLL组比较差异无统计学意义（P〉0．05）；有髓外浸润组与无髓外浸润组比较差异有统计学意义（P〈0．05）。（2）VEGF与MMP-9之间无相关性（P〉0．05）。结论 VEGF和MMP-9在骨髓细胞中的表达与急性白血病的发生、发展和髓外浸润转移过程密切相关。     

七氟醚复合瑞芬太尼在门诊短小手术中的应用

目的比较七氟醚与丙泊酚临床疗效的异同，探讨其在门诊短小手术麻醉中应用的临床效果。方法将40例ASAI或Ⅱ级门诊短小手术（手术时间〈45min）患者随机分成两组，Ⅰ组单纯静脉麻醉组，Ⅱ组静吸复合麻醉组。记录两组患者注药前、切皮前、术中、术毕时间四个点的MAP、HR、Sp02变化以及不良反应发生情况。结果两组患者术前一般情况比较差异无统计学意义（P〉0．05）；Ⅱ组诱导时间慢于I组，Ⅱ组术毕清醒时间快于Ⅰ组，差异有统计学意义（P〈0．05）；Ⅰ组呼吸抑制及术中体动反应发生率均明显高于Ⅱ组，差异有统计学意义（P〈0．05）；清醒后疼痛程度轻，VAS0～3分，两组差异无统计学意义（P〉0．05）；两组术后均无术中知晓、恶心呕吐等不良反应。结论咪唑安定与瑞芬太尼复合吸入七氟醚用于门诊短小手术的麻醉效果很好，与丙泊酚有着同等重要的临床价值。     

胰激肽原酶与依那普利治疗糖尿病肾病的对照研究

目的探讨治疗糖尿病肾病（DN）的有效方法。方法将72例糖尿病肾病患者分为三组。分别为胰激肽原酶组、依那普利组和对照组，治疗前后观察血糖、血压、尿白蛋白排出率（UAER）、血尿素氮（BUN）、血肌酐（Cr）的变化情况，并进行统计学分析。结果治疗后胰激肽原酶组和依那普利组患者UAER均较对照组明显降低，差异有统计学意义（P〈0．01）；胰激肽原酶组患者治疗后Cr水平较依那普利组和对照组均明显降低，差异有统计学意义（P均〈0．05）；依那普利组患者治疗后收缩压（SBP）和舒张压（DBP）较治疗前差异有统计学意义（P〈0．05），较对照组治疗后差异有统计学意义（P〈0．05）；胰激肽原酶组SBP较治疗前差异有统计学意义（P〈0．05）。结论胰激肽原酶和依那酱利均有较好治疗糖尿病肾病的效果，胰激肽原酶还可以改善患者的肾功能。     

西安市细柳社区老年糖尿病患者颈动脉粥样硬化高危因素分析

目的西安市细柳社区老年糖尿病患者颈动脉粥样硬化高危因素。方法选择在细柳中心卫生院进行健康检查的老年人3482例中血糖升高患者567例，根据OGTT结果进行分组，对各组血脂水平、同型半胱氨酸（Hcy）、颈动脉内膜一中层厚度（IMT）等进行测定。结果三组之间BMI及收缩压、舒张压、年龄及性别构成无统计学差异（P〉0．05）。IGT组患者TG较NGT组有显著增高（P〈0．05），但TC、HDL、LDL并无显著统计学意义（P〉0．05）。DM组患者TG、HDL、LDL较NGT组均有显著性差异（P〈0．05），但TC较NGT虽有升高但无统计学意义（P〉0．05）。IGT组Hcy及IMT较NGT组有显著升高（P〈0．05），HbAlc未见显著变化（P〉0．05）。DM组患者Hcy、HbAlc及IMT较NGT、IGT组均有显著增高（P〈0．05）。IMT与TG、HDL、HbA1c显著相关（P〈0．05），与TC及LDL无显著相关性（P〉0．05）。IMT与Hey呈极显著正相关（P〈0．01）。结论Hey升高是导致颈动脉粥样硬化的重要原因，其监测对判断糖尿病发生不同阶段颈动脉等大血管病变具有重要意义。     

兰州市服务行业人员结核病防治知识知晓水平及影响因素现状调查

目的了解兰州市服务行业人员对结核病知识的知晓情况的影响水平。方法 利用整群抽样的方法对2005年12月8日至30日所有在兰州市疾病预防控制中心参加体检但尚未接受培训的外来服务行业人员进行问卷调查，搜集合格研究对象。结果 （1）合格对象为513人。以女性、年龄30岁以下、高中取以上文代程度、月收入500—800元之间、饮食服务行业及流动人口居多。（2）不同研究对象对结核病的知晓情况：年龄组、婚姻状况、文化程度、工作场所等因素对多数结核病知识单一信息掌握情况有显著影响（P〈0．05），不同研究对象对“肺结核是一种严重危害人民健康的疾病”的知晓程度差异有统计学意义（P〈0．05）；而性别差异对结核病知识单一信息掌握无明显影响（P〉0．05）；（3）综合分析表明，不同研究对象对结核病综合知识得分情况：年龄组、月收入、文化程度、工作场所、户口等因素对结核病知识掌握情况差异有统计学意义（P〈0．05）。结论 在服务行业人员中开展结核病知识宣教时．应当针对不同人群的不同需求来采取不同的策略和措施。     

脑出血患者血浆MMP-2、MMP-9变化的临床研究

目的 探讨脑出血（ICH）患者血浆MMP-2、MMP-9含量及临床意义。方法 分别测定50例ICH患者和50例健康人血浆中MMP-2、MMP-9的含量。结果 脑出血组患者血浆MMP-2、MMP-9上升，与正常对照组比较差异有高度统计学意义（P〈0．01）；MMP-2、MMP-9在轻、中、重型组之间比较差异均有高度统计学意义（P〈0．01）；在不同发病时间组中的MMP-9含量比较差异具有高度统计学意义（P〈0．01）；MMP-2在6h组与12h组比较差异无统计学意义（P〉0．05），在其他时间组比较差异有高度统计学意义（P〈0．01）；不同血肿体积组中MMP-2、MMP-9含量比较差异均有高度统计学意义（P〈0．01）。结论 ICH患者MMP-2、MMP-9水平与血肿体积、发病时间和神经功能缺失程度都具有密切关系，可作为判定病情和评估预后的参考指标。     

进展期胃癌血浆胆固醇水平相关研究

目的 了解进展期胃癌及对照组胃溃疡病人手术前后血浆胆固醇水平，探讨其与胃癌临床分型的相关性。方法 术前及术后10d测定临床确诊的胃癌及胃溃疡病人血浆胆固醇含量，记录相应病例胃癌临床分型，进行统计学分析。结果 进展期胃癌患者术前血浆胆固醇较对照组术前显著降低，差异有高度统计学意义（P〈0．01）；胃癌术后血浆胆固醇水平升高，与术前比较。差异有统计学意义（P〈0．05），与对照组术后比较差异无统计学意义。A组Bormann（Ⅲ、Ⅳ型）手术前血浆胆固醇较B组Bormann（Ⅰ、Ⅱ型）降低，差异有统计学意义（P〈0．05）；A、B组术后血浆胆固醇均升高（P〉0．05）；各自与术前相比，A组差异无统计学意义，B组差异有高度统计学意义（P〈0．01）。结论 进展期胃癌患者，手术前血浆胆固醇水平降低，术后升高；降低、升高的程序与临床分型相关；临床分型越差，术前、术后血浆胆固醇水平越低，升高的程度越明显。     

2012年滨州市某纺织企业职工职业病防治知识知晓情况调查

目的了解滨州市某纺织企业职工对职业病防治知识的掌握情况,为制定有效的防护措施提供科学依据。方法对该企业2012年来我单位进行职业健康体检的494名职工进行调查,发放《职业卫生知识调查问卷》,分析年龄、学历及工龄与职业卫生知识掌握情况的关系。结果①不同年龄组职工对职业病危害因素、职业病基本常识及个人防护用品的使用知晓情况有统计学差异（P〈0．05）;各年龄组对《职业病防治法》和职业健康监护基本知识方面知晓情况无统计学差异（P〉0．05）;②职工的文化程度与职业病防治知识知晓率差异有统计学意义（P〈0．05）;③不同工龄组职工对《职业病防治法》、职业病基本常识、职业健康监护基本知识知晓情况及个人防护用品的使用方面有统计学差异（P〈0．05）;各工龄组职业病危害因素知晓程度差异无统计学意义（P〉0．05）。结论企业应加强职业卫生知识的宣传工作,并对不同职业人群制定有针对性的防护措施。     

Estimating the nursing staff required in a new hospital

Opening a new hospital poses a complex and consequential set of challenges. One of these challenges is to estimate the nursing staff. The aim of this article is to report the entire process adopted to estimate the required nursing staff for a new Hospital in Brazil. The nursing staff was projected according to the Brazilian Federal Nursing Council (Cofen). We applied an equation to estimate nursing staff and compared the results with two other existing hospitals. A significant difference (p<0.05) was observed when comparing the Nurse-License Practice Nurse ratio recommended by Cofen between the new Hospital and other hospitals. This statistical difference is mostly due to reduced nurse staff in intensive care units. Almost one year after the hospital opened its doors, it is necessary to review nursing staff hours with the real information to reinforce the expenditure on these personnel and to evaluate the decisions made so far.     

The Role of the Federal Government in Promoting Health Through the Schools: Opening Statement of Senator William S. Cohen

Opening Statement of Senator William S. Cohen, Subcommittee on Oversight of Government Management, Committee on Governmental Affairs, U.S. Senate, at Hearing on Healthy Schools, Healthy Children, Healthy Futures: The Role of the Federal Government in Promoting Child Health Through the Schools, November 14, 1991.     

The Role of the Federal Government in Promoting Health Through the Schools: Opening Statement of Senator Carl Levin

Opening Statement of Senator Carl Levin, Chairman, Subcommittee on Oversight of Government Management, Committee on Governmental Affairs, U.S. Senate, at Hearing on Healthy Schools, Healthy Children, Healthy Futures: The Role of the Federal Government in Promoting Child Health Through the Schools, November 14, 1991.     

灰色预测在新建医院开放床位数预测中的应用

目的探讨灰色预测在新建医院开放床位数预测中的应用。方法以东莞市2004—2010年人口数据为依据建立人口灰色预测模型,对2013—2015年当地常驻人口进行预测。根据当地医疗卫生基本数据测算当地开放床位需求及缺口,对新建医院开放床位进行预测。结果模型预测当地人口2015年达到103.65万人。2015年塘厦新医院的首期开放病床需要达到800张。各类开放病床需呈合理分布。结论数学建模用于新医院开放床位的预测简便、实用,有助于卫生资源规划和配置,值得进一步研究。     

Veteran's affairs hospital discharge databases coded serious bacterial infections accurately

OBJECTIVES: We sought to test the ability of large health care utilization databases to accurately identify serious bacterial infections and opportunistic infections leading to hospital admission. STUDY DESIGN AND SETTING: We conducted a cross-sectional validation study using patients admitted to hospitals in the administrative database of the Department of Veterans Affairs, VISN 1, between 2001 and 2004. Detailed hospital chart abstraction protocols were developed to define a gold-standard diagnosis of serious bacterial infections and opportunistic infections. Hospital acquired infections were not considered. RESULTS: A total of 158 patients who were hospitalized for selected bacterial infections and 69 patients for opportunistic infections were identified using ICD-9 discharge diagnoses. The positive predictive values (PPV) of identifying specific bacterial infections that lead to hospital admissions varied between 100% and 66%. All conditions combined yielded a PPV of 80%. Once the gold-standard definition of bacterial conditions was broadened to hospital admissions due to any acute infectious condition, the PPV increased to 90%. Excluding systemic candidiasis, the average PPV for the selected opportunistic infections was 76%. CONCLUSION: Our findings suggest that ICD-9 codes of selected serious infections from hospital discharge files can be used as substitutes for chart-based diagnoses.     

The prevalence of colonization with vancomycin-resistant Enterococcus at a Veterans' Affairs institution.

OBJECTIVE: To study vancomycin-resistant Enterococcus (VRE) prevalence, risk factors, and clustering among hospital inpatients. DESIGN: Rectal-swab prevalence culture survey conducted from February 5 to March 22, 1996. SETTING: The Veterans' Affairs Medical Center, Atlanta, Georgia. PATIENTS: Hospital (medical and surgical) inpatients. RESULTS: The overall VRE prevalence was 29% (42/147 patients). The VRE prevalence was 52% (38/73 patients) among patients who had received at least one of six specific antimicrobials during the preceding 120 days, compared with only 5% (4/74) among those who had not received the antimicrobials (relative risk, 9.6; P<.001). The longer the period (up to 120 days) during which antimicrobial use was studied, the more closely VRE status was predicted. Among 67 hospital patients in 28 multibed rooms, clustering of VRE among current roommates was not found. CONCLUSIONS: At this hospital with relatively high VRE prevalence, VRE colonization was related to antibiotic use but not to roommate VRE status. In hospitals with a similar VRE epidemiology, obtaining cultures from roommates of VRE-positive patients may not be as efficient a strategy for identifying VRE-colonized patients as obtaining screening cultures from patients who have received antimicrobials.     

VA hospital settles HIV transfusion suit for $595,000

The widow of a White River Junction, Vermont Veteran's Affairs hospital patient will be paid $595,000 to settle claims she brought against the institution. Jane Doe's negligence and malpractice suit claimed that her husband contracted HIV from a contaminated blood transfusion that he received in the Veteran's Hospital. According to the suit, the American Red Cross notified the hospital that Mr. Doe's transfusion was tainted with HIV. Mr. and Mrs. Doe underwent an HIV test and were told that they would be notified if either tested positive. When they were not notified by the hospital of the test results, they assumed that they were free of HIV infection. The suit also claimed that hospital staff lied to the Mr. Doe regarding his HIV status and subsequently engaged in unprotected sexual relations with his wife and fathered two children. Mr. Doe died seven years following his initial transfusion.     

医院与医疗保险机构之间接口系统的优化

统一医院与医保中心之间的信息标准，建立带宽更高，更稳定的网际传输通道。编写了医院信息系统与社保中心的医疗保险信息系统之间更高效的接口软件。提高了接口系统的可靠性，适用性和工作效能，使医保结算快捷而准确，并降低了对网际通讯的依赖性。     

Peterborough Hospital at Home: an evaluation

An evaluation of the Peterborough Hospital at Home scheme was undertaken to examine the complementary roles of Hospital at Home, hospital ward and the District Nursing Service. The evaluation involved two surveys; the first was a retrospective study of records of patients admitted to one of the three care settings during 1983. The second survey was a prospective study of Hospital at Home patients in 1985 with the index diagnoses of malignant neoplasms, cerebrovascular accidents and post-operative patients discharged early from hospital. In 1985, 284 patients were admitted to Hospital at Home, and of these the largest group (73 patients) were terminally ill cancer patients. Hospital at Home provided care for more severely ill patients than those normally looked after by the District Nursing Service, and comparable in severity and outcome to those in hospital. There was an emphasis on terminal care by Hospital at Home which would make it appear to be an enhancement to the usual domiciliary nursing services available, as, for the majority of the cancer patients cared for by Hospital at Home, admission to hospital would probably not be sought.