MK-801对围生期缺氧缺血性损伤后脑细胞线粒体膜电势的影响

目的了解围生期缺氧缺血性脑损伤(HIBD)后脑细胞线粒体膜电势(△ψm)的变化及NMDA型谷氨酸受体拮抗剂MK-801对这一变化的影响.方法应用7日龄新生SD大鼠HIBD动物模型,将实验动物分为正常对照组(n=6),HIBD组(n=10)和HIBD+MK-801组(n=10)(MK-801于低氧处理前按0.3mg/kg剂量腹腔注射).于缺氧缺血后立即断头处死动物,制成脑细胞悬液后,以罗丹明123(Rho123)标记、以流式细胞仪测定△ψm的变化.结果围产期HIBD时双侧脑细胞△ψm值均显著降低,差异具有显著性(P＜0.05),以损伤侧(右侧)为甚,右侧脑细胞△ψm由正常状态下的(18.93±0.74)MFL降至损伤后的(7.59±0.32)MFL,右左△ψm比值由正常状态下的1.06±0.05降至损伤后的0.80±0.06(降低了24.5%),差异具有显著性(P＜0.05).结论HIBD后脑细胞△ψm明显降低,提示线粒体功能明显受损;MK-801可减轻这一变化,提示NMDA型谷氨酸受体拮抗剂可通过减轻线粒体功能受损程度治疗围产期缺氧缺血性脑损伤.     

护理人力资源危机管理

随着人力资源的社会化和资源配置市场化的形成，人才流动成为现实和可能，人才已成为一种商品、一种资源、一种无形资本，如人才一旦另择良木而牺，将会大大削弱医院竞争的优势。为此，我们对部分三级医院中的护理人力资源管理中存在的两大危机即人员流失危机和人员梯队危机（临时聘用护士占护理人员总数的50％左右）进行分析，从重视育才、用才、留才及内部员工的安定就业、维护品质着手，采取了行之有效的措施，取得了显著的效果。     

硬膜外穿刺针外套管在腹腔镜小儿斜疝高位结扎术中的应用

目的探讨硬膜外穿刺针外套管在腹腔镜小儿斜疝疝囊高位结扎中的应用价值。方法2003年4月-2006年5月,我院对230例小儿斜疝手术应用硬膜外穿刺针外套管代替雪橇钩针实施腹腔镜疝内环口荷包高位结扎术。结果230例手术均获得成功,手术时间：单侧161例8-10 min,嵌顿疝39例15-20 min,双侧30例16-20 min;术后未见有阴囊水肿及睾血疼痛及缺血坏死。术后随访2-6个月111例,6-12个月52例,12-24个月37例,24-36个月30例,无复发。结论硬膜外刺针外套管可替代小儿疝囊结扎专用的雪橇钩针,简便,经济,适合在所有基层医院推广。     

Performance and comparison of the Cockcroft-Gault and simplified Modification of Diet in Renal Disease formulae in estimating glomerular filtration rate in a Chinese Type 2 diabetic population.

AIMS: Our aim was to assess performances of the Cockcroft-Gault and simplified Modification of Diet in Renal Disease (MDRD) formulae in estimating glomerular filtration rate (GFR) in Chinese diabetic populations and their association with vascular risks. METHODS: A total of 1009 patients with Type 2 diabetes were categorized into low estimated GFR groups (GFR < 60 ml/min/1.73 m(2)) and control groups by the two equations. The performances of these formulae were assessed at different stages of kidney function. Carotid artery intima-media thickness (IMT) and the prevalence of diabetic retinopathy or albuminuria were compared among the groups. The ability of these formulae to identify established vascular risk markers using sensitivity, specificity, positive and negative predictive values were also compared. RESULTS: The prevalence of low estimated GFR was 32.7% with the Cockcroft-Gault formula and 5.2% with the MDRD formula, respectively. In low estimated GFR subjects by the MDRD formula, IMT was significantly thicker than those by the Cockcroft-Gault formula (1.2 mm vs. 1.0 mm; P < 0.05), with a higher prevalence of albuminuria (78.4 vs. 52.8%, P < 0.05) and diabetic retinopathy (46.5 vs. 30.5%; P < 0.05). The Cockcroft-Gault formula gave a specificity of 71.7% and a sensitivity of 37.0%, and the MDRD formula gave a specificity of 96.6% and a sensitivity of 7.9% in estimating low GFR relevant for established vascular risks. CONCLUSIONS: These formulae performed differently in Chinese diabetic populations. The simplified MDRD formula is minimally superior to the Cockcroft-Gault formula for its high specificity and positive predictive values in estimating low GFR relevant for vascular risks.     

血管内栓塞结合显微手术治疗颅内动脉瘤临床研究

目的应用显微手术夹闭、血管内栓塞和栓塞后手术夹闭3种治疗方法，探讨治疗颅内破裂动脉瘤的安全有效方案。方法显微手术瘤颈夹闭30个动脉瘤，栓塞34个动脉瘤，栓塞后夹闭15个动脉瘤。结果夹闭组30个完全夹闭，无复发，死亡率6％（2／30）。栓塞组完全闭塞率70．6％（24／34），复发率17．6％（6／34），死亡率11．8％（4／34）。栓塞后手术组15个完全夹闭，无复发，死亡率6．7％（1／15）。治疗结束用GOS评价，1个月后3组良好率分别为80．0％、79．4％和80．0％；半年后良好率分别为90．0％、88．2％和86．7％。结论显微手术瘤颈夹闭术仍然是治疗破裂动脉瘤的有效方法，具有1次治疗彻底和复发率低的优势，并可作为栓塞失败的补救手段。     

引入PDCA循环规范医疗废物管理

目的采用PDCA循环法,规范医院医疗废物管理。方法通过计划、实施、检查、处理4个阶段具体实施。结果医疗废物要达到规范化管理,建立有效的组织管理体系,制定切实可行的规章制度是重要保证;加强培训与宣传教育,提高全员管理意识是重要环节;完善医疗废物处置过程中的配套设施是重要基础;制定管理质量标准认真督促检查考核是重要手段。结论PDCA循环法是加强完善医疗废物管理的一种科学的管理方式。     

面部烧伤病人感染危险因素的分析及护理

面部是人体的暴露部位,在烧伤病中占有较大比例。烧伤后很容易引起组织毁损及吸入性损伤,反复感染影响创面愈合,伤愈后常留有色素沉着、瘢痕增生、睑外翻、唇外翻等后遗症,影响面部美观及五官功能,给病人带来长期精神痛苦。我院1998年—2001年面部烧伤病人感染率为6.09%。因此,2002年—2005年,我科护理人员加强面部烧伤感染的防护措施,使其感染率下降到2.49%。正确的护理干预可以有效预防病人感染,减轻各种并发症的发生。现对面部烧伤病人的护理干预报告如下。1临床资料我科2002年—2005年共收治烧伤病人558例,其中面部烧伤281例,男195例,女…     

Analysis on origin and evolution of mumps]

There was a preliminary recognition on mumps during the Qin-Han to Sui-Tang dynasty, laying a foundation for the scholastic development on this topic in later generations. The title of this disease was identified in Song-Jin-Yuan dynasty with gradual deepening on its principle-method-formula-medication system, a great progress of recognition as compared with the previous ages. In the Ming-Qing dynasty, the recognition became even more systematic, with certain breakthrough in the system of principle-method-formula-medication. In modern age, the experiences were inherited and developed to integrate to modern biomedicine, so that the theory and clinical practice become even more perfect.     

慢性丙型肝炎患者α干扰素和α干扰素受体1的检测

目的建立检测外周血单个核细胞α干扰素受体1(IFNAR1)及检测诱导表达α干扰素(IFN-α)的方法,评价慢性丙型肝炎患者外周血单个核细胞(PBMC)细胞免疫功能与α干扰素治疗的关系。方法Poly IC体外刺激正常对照组和慢性丙型肝炎病毒(HCV)感染组患者PBMC,利用病毒保护试验研究干扰素治疗前后患者PBMC表达的干扰素抗病毒生物学活性差异;IFN-α治疗前后,RT-PCR检测慢性丙型肝炎患者不同干扰素应答组患者PBMC IFNAR1表达的变化。结果对照组PBMC分泌的干扰素活性显著高于慢性丙型肝炎患者应答组患者(P<0.001);干扰素应答组患者PBMC分泌的干扰素活性随治疗时间延长而增加,治疗1个月后显著高于无应答组患者PBMC分泌的干扰素活性(P<0.01),后者始终处于低下水平;IFN-α治疗期间干扰素应答组患者PBMC IFNAR1水平从治疗前的高表达而逐渐减少,正常对照和干扰素无应答组患者PBMC IFNAR1的表达始终较低。结论慢性HCV感染患者的细胞免疫功能受损,不能正常表达IFN-α,但应答组患者经干扰素治疗后IFN-α表达能力逐渐恢复;干扰素无应答组患者PBMC IFNAR1表达受到严重抑制;慢性丙型肝炎患者PBMCIFN-α活性检测及IFNAR1检测结果也许可以作为干扰素治疗预后的判断指标。     

Early uptake of 99mTc-C2A in the acute phase of myocardial infarction as a prognostic indicator for follow-up cardiac dysfunction

OBJECTIVE: The C2A domain of Synaptotagmin I is a molecular probe for the specific imaging of cell death. Here we test the hypothesis that the uptake of 99mTc-C2A in the acute phase of an infarction is associated with cardiac dysfunction in follow-ups. METHODS: The left coronary artery was occluded in Sprague-Dawley rats for 0, 10, 20, and 30 min. 99mTc-C2A was injected intravenously at 2 h of reperfusion. Anterior planar images were acquired with one million counts on a gamma camera 3 h after injection. 99mTc-C2A uptake was calculated as the total counts in the left ventricle region minus blood pool signal. The in-vivo signal detected was correlated with wall motion score index at 1 and 3 weeks follow-ups measured by echocardiography. RESULTS: 99mTc-C2A uptake was higher with increased ischemic time (2244+/-852, 4054+/-1223, and 6178+/-1451 for 10, 20, and 30 min ischemia, analysis of variance P<0.001). A significant correlation was found between 99mTc-C2A uptake and wall motion score index at 1 week (R=0.800, P=0.0006) and 3 weeks (R=0.810, P=0.0008). CONCLUSION: In this ischemia/reperfusion model, 99mTc-C2A uptake in the acute phase was associated with functional abnormality at 1 and 3 weeks. This demonstrates the potential diagnostic and prognostic value of 99mTc-C2A as a novel imaging agent.