性倒错:丈大夫变娇娇娘

“你太不懂女人了!”每次吵架妻子都会甩给他这句话,这让他产生了破解女人密码的强烈愿望。     

好女人这样催男人回家

曾经在很年轻时结婚、离婚,曾经同时拥有几个女朋友,曾经有几段纠缠不清的恋情的男人,结婚了,也生儿育女了。今天,问他对这段婚姻的感觉,他说:“做人多了一份责任感,工作有目的,每次工作完毕,都很想回家,知道家里有人等我。”最不宜结婚的是浪子,最适宜结婚的也是浪子。一个女人最痛苦的际遇是遇上精力充沛、意犹未尽的浪子,婚姻决不能缚住他。最幸福的际遇是遇上疲倦的浪子。浪子疲倦了,会变成最恋家的丈夫,他会感激那个为他提供一个家的女人。你以为从前没有女人在家里等他吗?一定有这样一个女人,每天晚上孤单地等他回去,终于绝望,离开了。可是,偶尔仍会偷偷回去,为他收拾地方,悄悄洗一个澡,留下女人的气味离去。一定也曾经有一个女人彻夜传呼他,在电话里问他:“你什么时候回来?”他冷漠地说:“你不用等我。”男人一生说尽:“你不用等我。”自命潇洒。突然有一天,他渴望有一个女人跟他说:“我在家里等你回来。”这一句话使生命变得有意义。浪子太太的幸福,是用许多女人的痛苦换回来的。聪明的女人懂得在适当时候跟男人说:“我在家里等你回来。”好女人这样催男人回家@张小娴     

诊

流感说来就来了。好像城市里每个人都在流鼻涕。这让他的诊所里,总是堆满了人。诊所不大,靠墙放着两个并排的长凳,人们挤坐在那里,有秩序地,一个挨一个地,等着他开出药方,或在头顶挂一个吊瓶。这场面让他稍有欣慰。他不喜欢有人插队,正如他不喜欢有人生病,尽管,他是一个大夫。有时他认为自己好像选错了职业。比如现在,他已经忙了一个上午,面前依然晃动着没完没了的病人,这样他就有些烦躁。后来他更烦躁了,因为他看到一个没有排队的女人,身子有些佝偻、头发已经花白的女人。女人紧抱着打成筒的被子,踉跄着慌张的脚步,直接挤到他的面前。他看…     

宽容何需等到临死时

男人和女人相爱存校园。她下嫁给他，这是现代版的七仙女下凡。女人的父亲是那所大学所在地的政府显要，母亲是一家研究所卓有成果的研究员。而他呢，是一位农民的儿子。中国农民的儿子。     

爱到心痛

女人是这家医院的护士,男人是这家医院重症监护室的大夫,他们的相遇是在这生死轮回的监护室。当女人和男人相遇的那一刻,女人蓦然发现,这个男人是自己前世走失的恋人。可是命运却跟他们开了一个苦涩的玩笑,男人已和另一个女人十指紧扣,这个女人视他为生命的全部,他们还有一个残疾的孩子。女人也已和一个没有爱的男人牵手。在时间的荒野,他们错过了那一时三刻相遇与相爱的时机。     

男人不是你的一切

也许你找到了生命中的男人,于是你们开始了婚姻生活。想让婚姻为你带来一生的幸福吗?所谓的婚姻生活带给女人的通常逃不出下面的场景:在男人下班回家之前女人要把饭菜做好,摆在桌子上:等男人回到家,女人要陪他吃饭,听他大吹牛皮或以愤世嫉俗的口气讲讲今天的经历他还可能顺便给饭菜挑点儿毛病。吃饱喝足之后,女人当然要负责洗碗,男人则躺在沙发上吸烟、看报纸或者电视。一切都打理好之后,女人还要随男人上床,满足他们的另一种欲望。女人本来是想从婚姻生活里寻找幸福、寻求照顾的,她们为了这一点点爱可以充当厨娘、保姆和情人三个角色,可最后的结果只能是失望。男     

我没有颜色不想做你的红颜

张爱玲说：女人不停地向前奔跑，所遇到的仍然不过是男人。有些女人运气好，遇到的都是一些不错的男人，但有些女人运气就不好了，比如说我。我在遇到的男人中干挑万选选了一个男人做我的老公，而现在他却成了别人的男人。前夫在离婚前夕竟然泪眼婆娑地对我说：他爱的还是我，夫妻做不了就做朋友吧，希望以后我是他永远的红颜知己。     

催人泪下前妻情——记柳州地区人民医院护士王秀芳厚待身患绝症的前夫

这是发生在龙城--广西柳州市的一个真实的故事.一个与前夫离异了10年的女人,当前夫身患绝症、一贫如洗之时,她用一颗善良的心去温暖他、照料他走完生命的最后数十天,留下一段催人泪下的佳话.……     

用你的肩膀行走

还是热恋时候吧，那时候，女人常常跟男人撒娇。在夜里，寂寥的大街上，女人会突然停下脚步，轻趴上男人的后背。女人说脚好痛，背背我吧……男人看看女人，笑笑，顺从地低了身子，让女人可以抱他更紧更稳。那时候多年轻啊!那时候，男人的下巴刚刚长出淡褐色的绒毛，女人的脸上还挂着红色的可爱的粉刺。一会儿女人说，可以了。男人说再背一会儿吧！女人说真的可以了，就往下跳。怕她摔倒，男人急忙将她放下。     

婚姻不去

在这样的年代,沈鱼不再相信性的纯洁。他和女人的交往有的是因为爱情,有的纯粹是因为生理的欲望。他是一个还算帅气的男人,所以身边总有女人来来往往。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。