上好综合实践活动课的点滴体会

综合实践活动课近年来在国家颁布《基础教育改革纲要》中明确规定为小学到高中的必修课程，是我国新一轮课程改革的一项重要举措，因为综合实践活动课是一门基于学生直接经验，密切联系学生自身生活和社会生活，体现对知识综合运用，强调学生通过实践增强探究和创新意识的能力和方法为宗旨所在的课程，而我有幸成为了这一学科的专职教师，同时也为我的教学生涯提出了新挑战。起初在教学中，很多学生认为综合实践活动课没有直接的学习成果，因此开展起来很困难。那么，如何焕发小学综合实践活动课的生机呢？我在几年的教学实践中有以下几点体会。     

病毒性肝炎糖代谢、C肽及生长抑素变化的临床意义

[目的]阐明病毒性肝炎及肝硬化患者胰岛β细胞功能及糖代谢状况.[方法]在基础状态下同时测定了血糖(GS)、胰岛素(INS)、C肽(CP)、皮质醇(F)、生长激素(GH)、生长抑素(SS)和胰岛素血糖素(GN),并分别作了静脉法糖耐量试验(ivGTT)和胰岛素、C肽释放试验(IRT、CPRT).血糖用葡萄糖氧化酶法检测,其他内分泌激素皆用放免法检测.[结果]75例中17例糖耐量减退,其中慢性肝炎(CH)组2例,代偿性肝炎肝硬变(HLC-I)组5例,失代偿性肝炎肝硬变(HLI-H)组10例,急性肝炎(AH)组无.凡糖耐量正常(NGT)者基础血糖、胰岛素、C肽均在正常范围,但其中大多数度患者胰岛素、C肽释放曲线低平,峰值低于对照组;糖耐量减退(IGT)者空腹血糖、胰岛素大多升高,C肽大多正常,但胰岛素、C肽释放曲线以及胰岛素释放指数比NGT组还要低.各族血浆皮质醇基本正常,仅少数病情较重的CH和失代偿性HLC患者稍高于正常水平.约1/4的患者血浆生长激素(GH)升高,3/4的患者血浆胰岛素(GN)升高.5例肝硬变患者服心得安以后血栓/胰岛素比值显著下降.[结论]糖耐量减退在慢性肝炎特别是肝硬变患者中相当常见.其发病机制与肝功能减退、胰岛β细胞受损、胰高血糖等生糖激素增加、周胰岛素抵抗等因素有关.心得安治疗可提高胰岛素的敏感性.     

浅谈颈椎病患者的体疗保健法

1 颈椎病的致病原因 长时间的伏案工作、操作电脑等,会造成供应脊髓、椎骨和相关肌肉氧气和养料的血管受到压迫,导致头部的血液、组织液代谢受阻,长时间保持紧张状态,也会损伤肌肉、肌腱及腱膜受损.     

台湾发现首例屈公热境外移入病例

2006年11月23日,疾病管制局证实首例屈公热境外移入病例。该个案为13岁学生,2005年起在新加坡求学,2006年11月19日出现发热症状,11月20日在桃园机场入境时,过红外线测体温仪侦测有体温过高现象,经采血检验确定为屈公热。屈公热(chikungunya fever)是感染屈公病毒(chikungunyavi     

食品安全与食品安全恐怖

买肉类怕有"疯牛病"和病死猪,买鸡鸭鱼类怕有"禽流感"和含激素,买果蔬担心"转基因"和农药残留,买米面怕用了抛光矿物油和掺有增白剂……媒体曝光的新闻几乎涉及人们需要吃的各种食物……     

不让O157往事重现

1996年夏秋季节,此起彼伏的食物中毒吓坏了东洋人。在短短两个多月的时间内,就有1万多人中毒,12人死亡。元凶是一种肠道病原菌,全名叫O157:H7肠出血性大肠杆菌,简称“O157”。病菌通过食物和饮水     

应对孕期三大棘手问题

70%以上的准妈妈,孕期会遭遇痔疮的烦恼;几乎是所有的准妈妈在孕期前3个月或轻或重都会产生恶心呕吐的状况,严重的甚至会持续更长时间;一旦怀孕后,准妈妈常常有昏昏欲睡的感觉,很容易疲惫。痔疮、疲劳、孕吐,是准妈妈孕期非常棘手的三大问题,让孕妈妈想说轻松不容易。     

产褥感染

产褥期是产妇体质恢复和新生儿开始独立生活的阶段。产妇分娩时经历了较大的精力和体力消耗,抵抗力有所减弱,加上妊娠期疾病和分娩损伤的影响,体质更差。这期间,产妇不仅要适应全身各系统所发生的明显变化,还要担负起哺育婴儿的重任,若不注意,容易发生产后并发症,影响正常康复,甚至危及生命。有资料显示,孕产妇死亡多数发生于产褥期。很多人重视妊娠期保健,却忽视产褥期保健。其实,虽然分娩已经结束了妊娠期,但是随之而来的产褥期仍是妇女保健的重要一环。本刊特组织产褥期常见问题的专题笔谈,以飨读者。     

夏季清补四宜

宜以清为补:夏季气温高,人体喜凉,应以清补为宜,进食寒凉食物为主,如大麦、小麦、绿豆、百合、黄瓜、菠菜、白菜、豆芽菜、芹菜、水萝卜、竹笋、茄子、荸荠、兔肉、鸭肉、羊肝、牛乳、鸡蛋及新鲜水果;多吃凉拌菜、成鸭蛋、成鸡蛋、松花蛋、豆制品、芝麻酱等.     

Effects of enzymatic and non-enzymatic antioxidants in diluents on cryopreserved bull epididymal sperm

Objective:To evaluate the supplementation effects of vitamin E,vitamin C,superoxide dismutase(SOD),and catalase to diluents on bull cryopreserved epididymal sperm.Methods:Sperm were retrieved from 20 bull testes and were then supplemented with 0.1 mM vitamin E,5.0 mM vitamin C,100.0 IU/mL SOD,and 100.0μg/mL catalase alone,or in a combination.The control treatment contained no addition.After supplementation,samples were frozen and stored in liquid nitrogen.The sperm parameters including motility,progressive motility,viability,acrosome integrity,plasma membrane integrity,kinematics and DNA damage were evaluated following the thawing process.Results:Vitamin E alone significantly increased the parameters of acrosome and membrane integrity compared to the control treatment(P<0.05).While compared to the control treatment,vitamin C had no improvement effect on sperm characteristics except for membrane integrity.Treatment of vitamin E+vitamin C had a significant improvement in total motility,progressive motility,viability,membrane and acrosome integrity compared to the control and other treatments(P<0.05).Compared to the control treatment,addition of SOD or catalase alone significantly improved the percentages of total motility,progressive motility,viability,membrane and acrosome integrity(P<0.05).Furthermore,SOD+catalase significantly increased total motility,progressive motility,viability,acrosome and membrane integrity characteristics compared to the catalase treatment(P<0.05).Vitamin E alone,vitamin E+vitamin C,and SOD in diluents decreased DNA damages and thereby improved the rate of intact sperm heads.Conclusions:Addition of 100.0 IU/mL SOD alone and 0.1 mM vitamin E+5.0 mM vitamin C,and also 5.0 mM vitamin C+100μg/mL catalase in a combination improves the quality of cryopreserved bull epididymal sperm and could be used for cryopreservation.     

Occupational Health Services in Manufacturing Industries in Nigeria

The provision of adequate health care facilities to cater forthe health of workers is an important consideration in the managementof manufacturing industries, since productivity is dependenton the health status of the workers. There are very few studiesevaluating the health care provision in Nigerian industries.This study elucidates such health care services in Edo and DeltaStates of Nigeria. One hundred and thirty-five (56%) of the241 registered manufacturing industries in Edo and Delta Statesof Nigeria were randomly selected and investigated. The responserate was 91.1% and the result showed that the medical staffcomprised 2.5% of the total workforce, with the large scaleindustries contributing the highest proportion of these. Fourpoint five per cent of the medical staff had formal trainingin occupational health and 15.6% of them visited the factoryshop floor. The doctor:staff ratio in the medium and large scaleindustries were 1:819 and 1:618 respectively. It was found thatall the industries used the health care facilities providedby the government, there were no clinics in all the small scaleindustries and group practice was not used by any of the industriesstudied. Pre-employment medical examinations were carried outin each of the groups of industries (100%, 39.4% and 5%) respectively,as were periodic medical examinations during employment, althoughto a lesser extent (100%, 13.2%, 0%) for the large, medium andsmall scale industries respectively. These finding suggest theavailability of a reasonable standard of health care provisionfor large scale industries and somewhat less availability formedium and small scale industries. Health education of boththe employers of labour, and the employees and the enforcementof existing laws are needed to improve the existing standardof occupational health services.     

Les cellules endothéliales du tissu adipeux

The adipose tissue plays a major role in energy homeostasis through the storage and release of fatty acids as well as adipokine production. The endothelial cells of the adipose tissue vascular network constitute a barrier between the blood and the adipocyte compartments. They are key players in the metabolic status of the fat mass controlling the exchanges of nutrients, hormones, oxygen and immune-inflammatory cells. Recent data highlight the process of lipid handling at the endothelial cell surface and of the transendothelial transit of fatty acids. The extension of the vascular network and its functionality are necessary for the adipose tissue integrity. Insufficient oxygen supply generates hypoxic area within the tissue that favors metabolic abnormalities and the recruitment of immuno-inflammatory cells. The present review relates to the role of adipose tissue endothelial cells in the adipose tissue physiology. Their involvement and more particularly the role of accelerated ageing, in the link between obesity and associated metabolic and cardiovascular pathologies are described.     

镉对大鼠胰脏的毒作用

目的探讨镉对内分泌和外分泌功能的影响。方法将96只SD大鼠分为4组,分别为对照组和50、100、200mg/LCdCl2染毒组,饮水染毒30、60、90d。测定不同染毒时间大鼠血糖、尿糖、血胰岛素、淀粉酶的改变及血液中金属含量的改变;测定尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG);并测定了胰脏组织中金属的含量以及胰脏金属硫蛋白基因、胰岛素基因和淀粉酶基因的表达情况。结果染毒组大鼠血糖水平在染毒90d的中、高剂量组有明显增加,差异有统计学意义(P<0.05),中剂量组血糖平均值为5.83mmol/L,高剂量组为6.46mmol/L;发现尿糖水平的增高先于尿NAG的增高。各剂量组大鼠血液和胰脏中镉的含量明显增加。在染毒90d中、高剂量组血锌含量降低。在染毒30d的中、高剂量组血液中胰岛素水平明显降低,而血淀粉酶改变不明显。在染毒90d的中、高剂量组胰脏组织中锌的含量明显增加。胰脏中金属硫蛋白基因表达均有不同程度的增加;胰岛素基因的表达除染毒60d中剂量组明显降低外,其他各组差异均无统计学意义(P>0.05)。而胰淀粉酶的基因表达在染毒60d和90d的中、高剂量组均明显增高。结论镉可以在胰脏组织蓄积,引起组织中必需元素锌水平的改变,导致基因和蛋白表达的改变,进一步引起胰脏内、外分泌功能的改变。     

脑卒中亲属防治知识知晓现状调查

目的 脑卒中是危害人类健康的主要疾病，其治疗目前还没有十分可靠的方法，但人群的防治知识水平直接影响着其发病率和治疗效果，为此，对脑卒中亲属的防治知识知晓现状进行了调查，并提出了改进措施。方法 选取4所不同级别的医院，对陪同前来就诊住院患者的亲属进行“脑卒中知晓”调查，调查采用答卷或提问的方式，当场独立完成，调查资料使用显著性检验进行统计学处理。结果 调查发现脑卒中患者的亲属对脑卒中的危险因素，早期症状和需紧急治疗认识不足，其知晓率同年龄、职业、文化程度、医院级别、被调查者同患者的关系等均密切相关，经统计学处理有显著意义。结论 脑卒中患者亲属的“脑卒中知晓”程度和健康教育密切相关。因此加强健康教育，是搞好脑卒中防治的重要措施。     

运动对男性生殖影响的研究进展

运动对男性生殖的作用具有双重性，即合理运动有益于生殖内分泌，超负荷运动却常会损害男性的生育力。合理运动量的体能锻炼，卵泡刺激素（FSH）水平相比锻炼前上升，黄体生成激素（LH）和睾酮（T）水平显著上升；改善睾丸局部微环境，还改变生殖细胞的表观遗传修饰，有利于后代健康。超负荷运动则使睾丸微环境的温度显著上升，热应激可损伤精子的结构和功能并最终导致男性生育力下降；超负荷运动还抑制促性腺激素释放激素（GnRH）神经元和垂体功能，干扰生殖激素分泌。此外，运动还使精子DNA CpG岛相关基因发生明显的去甲基化，影响微小RNA（miRNA）表达水平，影响表观遗传。综述运动对男性生殖的影响及其机制。     

Optimizing energy for a ‘green’ vaccine supply chain

This paper describes an approach piloted in the Kasserine region of Tunisia to increase the energy efficiency of the distribution of vaccines and temperature sensitive drugs. The objectives of an approach, known as the ‘net zero energy’ (NZE) supply chain were demonstrated within the first year of operation. The existing distribution system was modified to store vaccines and medicines in the same buildings and to transport them according to pre-scheduled and optimized delivery circuits. Electric utility vehicles, dedicated to the integrated delivery of vaccines and medicines, improved the regularity and reliability of the supply chains. Solar energy, linked to the electricity grid at regional and district stores, supplied over 100% of consumption meeting all energy needs for storage, cooling and transportation. Significant benefits to the quality and costs of distribution were demonstrated. Supply trips were scheduled, integrated and reliable, energy consumption was reduced, the recurrent cost of electricity was eliminated and the release of carbon to the atmosphere was reduced. Although the initial capital cost of scaling up implementation of NZE remain high today, commercial forecasts predict cost reduction for solar energy and electric vehicles that may permit a step-wise implementation over the next 7–10 years.Efficiency in the use of energy and in the deployment of transport is already a critical component of distribution logistics in both private and public sectors of industrialized countries. The NZE approach has an intensified rationale in countries where energy costs threaten the maintenance of public health services in areas of low population density. In these countries where the mobility of health personnel and timely arrival of supplies is at risk, NZE has the potential to reduce energy costs and release recurrent budget to other needs of service delivery while also improving the supply chain.     

白藜芦醇抗骨质疏松的研究机制进展

骨质疏松是一种随着年龄增长或病态而骨质不断流失、骨微结构不断恶化且易致骨折的全身代谢性疾病。随着人口的老龄化,全世界的发病率都在持续上升,这严重的影响了老年人群的健康和生活质量。白藜芦醇具有雌激素样作用且在骨骼中具有多向靶点,能促进骨髓间充质干细胞成骨分化、增加成骨细胞增殖生长及抑制破骨细胞,白藜芦醇治疗骨质疏松的研究日益增多并有一定的进展。本文将对近年来白藜芦醇防治骨质疏松症的研究进展作一综述。     

Political violence and mental health: A multi-disciplinary review of the literature on Nepal

Implementation of current international consensus guidelines regarding mental health and psychosocial support in emergencies requires the consideration of findings from both the medical and social sciences. This paper presents a multi-disciplinary review of reported findings regarding the relations between political violence, mental health and psychosocial wellbeing in Nepal. A systematic search of six databases resulted in the identification of 572 studies, of which 44 were included in the review. These studies investigated the influence of political violence on contextual variables that shape mental health and psychosocial wellbeing, and examined psychological distress and mental disorders in the context of political violence. The majority of studies addressed the mental health of Bhutanese refugees in Nepal and the impact of the Maoist People's War. Based upon these results from Nepal, we discuss a number of issues of concern to international researchers and practitioners and present policy and research recommendations. Specifically, we consider (a) the need for longitudinal multi-disciplinary research into protective and risk factors, including agency, of psychological distress and mental disorders in situations of political violence, (b) the continuing controversy regarding the PTSD construct, and (c) the lack of robust findings regarding the effectiveness of mental health and psychosocial support.     

医疗事故处理中的法学思考

国务院《医疗事故处理条例》的正式颁布是我国医学法制建设的一件大事，具有重要的意义。《条例》对医疗事故的概念及级别进行了更具体、公正、合理的定义，使之更符合法学的意义和范围。作者参比《民法》、《民事诉讼法》、《消费者权益保护法》、《刑法》等法律法规，用法学的观点分析《条例》对医疗事故的法学界定及法学度量标准。在此基础上对《条例》中一些重要的观点进行法学思考，进而提出完善医疗法律法规，建立处理医疗纠纷制约机制，拓宽医疗纠纷救济途径的建议和办法。     

Validity of the HSE stress tool: an investigation within four organizations by the Corporate Health and Performance Group

AIM: To examine the validity and accuracy of the HSE Management Standards Stress Tool. METHODS: A cross-sectional questionnaire was administered to employees of the occupational health and human resource departments of four of the Corporate Health and Performance Group organizations. The relationship between the six first-pass stress filter questions and self-rated health were examined using the General Health Questionnaire (GHQ12) and the Short Form. The relationship between the filter questions and objective work characteristics such as sickness absence, self-rated performance and job satisfaction was also examined. RESULTS: Two hundred and thirty-five employees participated, giving an overall response rate of 68%. The study sample met the proposed HSE of 85 and 65% pass rates and would not normally progress to further analysis. Almost 40% of the group were above threshold on the GHQ12; 19% rated their work as very or extremely stressful. While the filters were highly specific, they were insensitive and at best detected for less than 40% of those with psychological or work stress. All but one of the filters had less than 50% positive predictive value for work stress and the majority of those identified by the filters did not consider themselves stressed, either overall or by work. Five of the filter questions were significantly associated with self-rated performance, three with absence and two with other objective work indicators. CONCLUSIONS: Further developmental work on these filter questions is indicated. Use of work absence as a measure of the impact or 'cost' of stress may lead to a significant underestimation of the 'true cost' of psychosocial hazards in the workplace.