心脏辅助装置对缺血性心脏功能恢复作用的研究

心肌能量平衡是研究缺血状态下心脏功能的一个重要因素。本文从建立可动态描述左心室各区域能量活动规律的左心室模型和冠脉模型入手，采用计算机仿真的办法研究了以下条件下缺血性心脏功能的恢复①不采用辅助装置；②采用主动脉内气囊反搏（ＬＡＢＰ）；③采用左心房－左心室辅助装置（ＬＶＡＤ）．仿真结果表明，不仅心肌缺血的范围，而且心肌缺血的程度都会影响到心脏功能的恢复。在心肌缺血不太严重时，心脏可通过自身代偿功能恢复正常心功能，但当左心室有超过３０％的心肌严重缺血时，则必须采用气囊反搏甚至心室辅助装置才能抑制心力衰竭的发达。最后用动物实验证实了部分仿真结果。     

左心室辅助装置的技术进展及对未来的展望

左心室辅助装置（LVAD）是辅助而不是替代心脏工作的一种机械泵。当病人出现心力衰竭，左心室功能微弱，无法提供全身需要的足够血液时，LVAD基本上可接替左心室的采功能，LVAD由泵、控制系统和能源组成。不同类型的LVAD采用不同能源，例如：电池或压缩空气（气动）。在通常情况下，LVAD中的泵放在病人体内，但也有把泵置于病人体外的例外情况。     

FDA2003年新批准的三种心脏病诊疗仪器

1 可长期置入人体的心室辅助装置 由Thratec公司生产的HeartMate Snap-Valves已为FDA批准用于心室辅助.据FDA介绍,该装置是第一种获准用于长期置入人体内的左心室辅助装置(LVAD).这类装置可帮助心脏主要的泵送室即左心室将血液泵送到身体的其它部位.     

循环式氦氧混合气辅助呼吸装置的氧浓度解耦控制

在给出保持本系统稳定的相对增益矩阵后，介绍了循环式氯氧混合气辅助呼吸装置设计中的氧浓度解耦控制方法。目的是通过循环式氦氧混合气辅助呼吸装置设计中的氧浓度解耦控制技术的研究，探索循环混合气技术在呼吸支持设备中应用的可行性及其重要意义。研究结果表明：氧浓度解耦控制技术是循环式氯氧混合气辅助呼吸装置设计中的一项关键技术。     

左心室辅助循环驱动系统的研制

简要介绍了左心室辅助循环驱动系统的工作原理,着重介绍了该系统的总体设计,包括系统硬件的组成、软件模块设计,以及元器件选择和试验结果。     

机械循环辅助装置的临床应用

机械循环辅助装置对于挽救严重心功能衰竭患者是有效的。其核心部分是血泵，分类方法很多。在临床应用中，根据其应用特点，分为康复过渡辅助，心脏移植前辅助及永久性辅助三种类型。出血、血栓栓塞及感染等是临床常见并发症。     

心力衰竭患者左心室辅助装置传动系统感染的研究进展

左心室辅助现已成为终末期心力衰竭患者的主要外科治疗策略,在提高心力衰竭患者存活率的同时,常导致一些严重的并发症。心室辅助装置特异性感染,特别是传动系统感染,是心室辅助患者术后常见并发症。生物膜的形成和迁移促进感染向泵腔和血流等更深层次组织的扩散,为后续治疗增加难度,甚至会危及患者生命安全。本文从心室辅助装置传动系统感染的流行病学特征、致病机制、诊断,以及预防和治疗方面的现状进行综述。     

System 98 XT主动脉球囊反搏泵维修2例

0引言主动脉内球囊反搏泵(intra-aortic balloon pump,IABP)是一种以左心室辅助循环功能为主的机械性装置,是将气囊导管经股动脉插入降主动脉,气囊导管的尾端与体外的气囊反搏泵相接,以心电信号或压力信号等触发反搏,控制气囊的充气和放气[1]。IABP 1968年首次应用于临床,早期主要用于心脏围术期血流动力学不稳定、心源性休克或心功能衰竭患者的循环支持,通常需要外科手术切开血管     

19例风湿性心瓣膜病巨大左心室的外科治疗

本文回顾性分析19例风湿性心瓣膜病巨大左心室病人手术治疗的临床资料、治疗效果，结果表明，术前对于心衰，胃肠道瘀血者应静脉给药，术中加强心肌保护，尽可能保留二尖瓣装置，巨大左房者行左房折叠术，同时处理三尖瓣病变。术后延长呼吸机辅助呼吸及使用PEEP，出院后服药治疗半年以上等措施对提高巨大左心室瓣膜替换术疗效均十分重要。     

SH—3型左心室辅助装置的研制和评价

本文介绍一种气动隔膜式左心室辅助泵。这种装置的材料血液相容性优良,血室形态、结构设计合理,制作工艺和质量控制严格。经动物实验证明:该装置性能优良,具有较好的抗血栓性能。     

Waste not--want not

The waste budget rarely gets the attention it requires. After all, c'mon it's garbage. We produce it and it costs money to get rid of it. There's nothing we can do about it. Sound familiar? We feel as if we have a handle on it when we negotiate to receive the lowest bid, but our efforts can not stop there. Do we really know what we-re getting for our money? Do we really need everything that is being suggested by the hauler? Are we investigating every avenue that involves waste or are we wasting valuable dollars? With the ever increasing need to find savings, let's look for in in our waste. The following overview of current waste issues is Part One of a guide for the review of practices and potential opportunities. The second part will appear next month.     

略论行风建设中医德机制的失调与重构

行业作风既是行业理念的体现,又是行业内部矛盾运动的反映.目前医疗行业出现的各种行风问题,症侯固然很多,根子却在医德机制的失调.从"硬"的方面看,它表现为体制上的错位;从"软"的方面看,它表现为医德理论与实践的脱节.所以,要建立稳固的纠风工作长效机制,就必须两手抓:一手抓医德理论的创新与教育,一手抓医疗体制改革和医药市场的监管与规范.     

The treatment of malaria in a hyperendemic zone

I have tried to take a realistic view of the problem of malaria in a hyperendemic zone and to show how it differs from endemic malaria. In hyperendemic conditions anti-larval measures could never solve this problem for the native and are probably undesirable. We should not interfere with infection for it is on this the evolution of immunity depends. In this respect the interests of the native might appear to clash with those of the immigrant but in reality it is not so for various reasons which we need not consider here. Future advances in the handling of hyperendemic malaria will probably be along the lines of improved technique in individual treatment. For the native, immunological considerations must determine the technique. In the case of the European, we must rely on continual treatment of a disease, which we cannot hope to prevent by sanitation or control by immunity.     

The stairway to recovery. An emerging worldview uncovers God's wisdom in nature

What is lacking for the renewal of the earth is not so much ethical consensus as political will. The myth of "man" as the self-sufficient and autonomous master of "inanimate" nature has been ingrained for centuries, and it will take a powerful force to dislodge it. However, we are in a unique period of convergence--a time when we might be transformed by the truth if we only seek it. This new spiritual awakening represents a conscious commitment to a common cause that lies beyond individual self-interest. The commitment has been kindled by a perception that we are creatures intimately connected with the rest of creation and to the power that has called us into being. And it is a commitment carried out in action through a disciplined way of life. If we want to heal the earth, we have to get better ourselves, because it is the way we think and live and act that is harming the earth. We have much to learn from participants in Alcoholics Anonymous, who have learned the secret of proclaiming the good news by doing it, one step at a time, by living it, day by day. The first step is acknowledgment that, as a society--indeed, as the human race-we are at the bottom and cannot get back up. Once we admit we have hit the bottom, there is hope for the environment because we have taken the first step to recovery.     

Healthcare reform's moral, spiritual issues. The problems are not just political

Although President Clinton's proposals were defeated in 1994, healthcare reform is an issue that will not go away. But it is an especially complex issue because it is moral and spiritual as well as political. Catholic social teaching could help free us Americans from our confusion on the topic. For example, the Catholic ideas of justice, subsidiarity, and the common good could help us address the crux of the healthcare reform debate, which questions the fairness of forcing more fortunate people to provide healthcare for those who are sick and poor. Catholic social teaching tells us that our healthcare decisions must be made not only on the basis of what is good for me but what is good for us as a community. By the same token, we might find that several specifically spiritual ideas are helpful. Christianity says, for example, that sickness can be a gift because it is a window on immortality for us; that we should not prize life above all other values; and that friendship--including the civic friendship involved in healthcare--is a way we can enter full friendship with God. These moral and spiritual ideas lead us to certain political conclusions: Healthcare reform should be politically realistic, relatively simple. and inclusive. Because healthcare is a good like no other, it can be a powerful occasion for realizing God's own compassion, healing, and justice.     

Evidence-based health policy: context and utilisation

Evidence-based decision-making is centred on the justification of decisions. In the shift from an individual-clinical to a population-policy level, the decision-making context becomes more uncertain, variable and complex. To address this we have developed a conceptual framework for evidence-based decision-making, focusing on how context impacts on what constitutes evidence and how that evidence is utilised. We present two distinct orientations towards what constitutes evidence, representing different relationships between evidence and context. We also categorise the decision-making context based on the ways in which context impacts on evidence-based decision-making. Furthermore, we invoke the concept of axes of evidence-based decision-making to describe the relationship between evidence and context as we move from evidence-based medicine to evidence-based health policy. From this, we suggest that it may be more important how evidence is utilised than how it is defined. Based on the research and knowledge utilisation literature, we present a process model of evidence utilisation, which forms the basis for the conceptual framework for context-based evidence-based decision-making. The conceptual framework attempts to capture the role that context plays in the introduction, interpretation and application of evidence. We illustrate this framework with examples from policy development for colorectal cancer screening.     

Mercy: an insufficient motive for euthanasia. Catholic ethical tradition requires that we temper our motives with reason and care before acting

Some experts argue that acts of assisted suicide and euthanasia are ethically appropriate because they are merciful. Compelling though it is, this argument is not sufficient for determining the morality of these acts. The ethical tradition that calls for mercy has never suggested that mercy is, by itself, a sufficient criterion for determining an act's moral appropriateness. Human motives are rarely, if ever, pure and objective. For that reason, our ethical tradition has insisted on tempering motives with reason and care. The criteria for determining when it is merciful to assist in another's suicide or engage in an act of euthanasia are, for all practical purposes, impossible to define. Commonly writers refer to a person's hopeless condition to justify the merciful response of assisted suicide or euthanasia. But unless we can agree on whether hopelessness is an objective or subjective reality, and until the criteria to define this reality are evident, it is difficult to see how assisted suicide or euthanasia can be a careful and reasoned expression of mercy. Only by examining one's intention can one judge whether an act that may appear to be merciful in a hopeless situation is appropriate. "Intention" refers to the reasoned decision or judgment one makes about a goal and the means used to achieve that goal. Even if we cannot control our emotional response (our motives) in a particular situation, we can control our judgment (our intentions). Within our moral tradition, we can be sure we are being merciful in a careful and reasoned way when we intend to protect and promote the good of life.(ABSTRACT TRUNCATED AT 250 WORDS)     

The social life of self-injury: exploring the communicative dimension of a very personal practice

This article makes the case for a sociological focus on the communicative, relational and interactional dimensions of nonsuicidal self-injury. While current research tends to be dominated by highly individual and intrapsychic models, it is increasingly observed that such models leave a social dimension to the practice unexplained. A burgeoning sociological literature has begun to address this paradox of the social in self-injury; however, we argue that the role of the social must be considered beyond the issues of aetiology, social learning and social construal/construction that are typically covered in this literature. Specifically, we argue that, since the lived meanings of self-injury directly implicate the interactional along with the intrapsychic, a more systematic focus on the role of social relations and social communication is vital. To illustrate this conceptual argument and embed it in the lived experiences of self-injury, we draw on two case studies taken from pilot research conducted by the authors. The more thoroughly sociological approach to self-injury that we present here offers an important compliment to the existing evidence base by reframing the absent presence of social communication contained within it, and suggesting important future directions for research.     

医院医学工程科科室建设探究

目的：医院医学工程科是为医院开展医疗、科研、教学工作提供物质保障的重要科室之一,研究医学工程科科室建设对医院的科学发展有重要的意义。方法：分析医学工程科的现状,并研究出现阻碍医学工程科发展问题的原因所在。结果：结合医院的实际情况以及工作经验,得出改善医学工程科现状的对策,并对其进行进一步的分析和探讨。结论：提高医学工程科的工作质量是促进医疗卫生事业发展的一项重要工作,同时也是医院全面建设、科学发展的可靠保证。     

The impact of phospholipid transfer protein (PLTP) on lipoprotein metabolism

ABSTRACT: It has been reported that phospholipid transfer protein (PLTP) is an independent risk factor for human coronary artery disease. In mouse models, it has been demonstrated that PLTP overexpression induces atherosclerosis, while its deficiency reduces it. PLTP is considered a promising target for pharmacological intervention to treat atherosclerosis. However, we must still answer a number of questions before its pharmaceutical potential can be fully explored. In this review, we summarized the recent progresses made in the PLTP research field and focused on its effect on apoB-containing- triglyceride-rich particle and HDL metabolism.