低分子肝素治疗急性脑梗死的临床观察

目的 观察低分子肝素治疗急性脑梗死的临床疗效及对出凝血时间、凝血酶原时间、血小板的影响。方法 ６０例急性脑梗死患者,分为治疗组、对照组各３０例。治疗组采用低分子肝素静滴,对照组用低分子右旋糖酐治疗。结果 治疗组总有效率９３．３％,显效率６３．３％,明显优于对照组（７３．３％,４６．６％）。有显著性差异（Ｐ〈０．０１）;对出凝血时间、凝血酶原时间、血小板无显著性差异（Ｐ〉０．０５）,无１例继发出血。结论 低分子肝素治疗急性脑梗死是安全有效的。     

红细胞平均体积及其分布宽度值鉴别贫血的初步研究

目的　研究用红细胞平均体积 (MCV)及红细胞体积分布宽度 (RDW )鉴别各型贫血 ,以期改进传统的贫血形态学分类方法。方法　选取患者组 2 32例及对照组 12 0例行MCV及RDW测定 ,统计出各病例组及对照组的MCV、RDW值 ,结合临床进行分析。结果　不同贫血时 ,其外周血红细胞的MCV及RDW的改变各具特征。结论　MCV、RDW诊断各类型贫血的敏感性及特异性较高 ,对贫血的鉴别诊断有较为广泛的临床应用价值。     

简易切割法制作健康SD成年大鼠hSCI和tSCI模型

用简易切割法制作ｈＳＣＩ和ｔＳＣＩ模型。４５只ＳＤ大鼠随机分为３组。ＩＳＣ组６只,ｈＳＣＩ组１８只,ｔＳＣＩ组２１只。用显微剪在Ｔ１３－Ｌ间横几完全剪断脊髓或其一则１／２,制成ｔＳＣＩ和ｈＳＣＩ模型,术后动态行为观察和神经功能综合评价,并分别于术后２４ｈ,７ｄ取Ｔ１１－Ｌ３节段脊髓作冻冻切片苏木精染色观察。结果显示,３组间ＣＢＳ两两比较经ｑ检验均有显著性差异。病理改变,ｈＳＣＩ组主要是伤侧伤质缩小     

氩激光治疗视网膜静脉阻塞新生血管的临床研究

为探讨、分析氩激光治疗视网膜阻塞新生血管的疗效。氩激光治疗视网膜静脉塞新生血管５５例,中央静脉塞行全视网膜光凝。分支静脉阻塞区域播散性光凝,光斑２００－５００μｍ,时间０．１－０．２ｓ,能量０．１２－０．４ｗ,Ⅱ级光斑,蓝绿色光波,黄斑格栅光凝光斑１００μｍ,时间０．１ｓ,能量视病情而定,以Ⅰ级反应为度,绿色光波。结果：５５例中４４例有效,新生儿血管消嫁总有效率８０％,无效１１例（其中视盘有新生血     

新生儿缺氧缺血性脑病心肌酶谱测定的临床意义

目的：观察新生儿缺氧缺血性脑病（ＨＩＥ）心肌酶活性化及心脏受损的情况,方法：采用连续监测法等方法检测了１１０例新生儿ＨＩＥ与４５例正常新生儿脐血心肌酶谱测定值比较。结果：血清心肌酶谱ＨＩＥ新生儿组明显高于新生儿正常对照组（Ｐ〈０．０１）,而重度ＨＩＥ组显高于轻、中度ＨＩＥ组（Ｐ〈０．０１）。结论：新生儿ＨＩＥ做心肌产谱测定是诊断其心肌损害、损害程度和估计预后的临床指标之一,有助于临床早期预测新生儿ＨＩＥ心肌损害有给予早期治疗。     

Adrenergic,purinergic, and endothelial mediators and modulators of norepinephrine-induced mesenteric autoregulatory escape

We evaluated the effects of potential factors in autoregulatory escape from norepinephrine-induced vasoconstriction in rat anterior mesenteric artery. We determined mesenteric artery blood flow velocity with a pulsed Doppler, sonic flowmeter, and systemic arterial blood pressure with a transducer. A 4-min norepinephrine infusion (0.125–1.0 × 10^–8 M/min) intravenously evoked a dose-dependent, initial vasoconstriction that was followed by rapid escape of blood flow toward or above the control value during sustained norepinephrine administration. Neonatal capsaicin treatment enhanced vasoconstrictor responses to norepinephrine but failed to affect escape parameters. Propranolol decreased norepinephrine-induced escape dose dependently. Adenosine deaminase attenuated escape, and the combination of this enzyme plus propranolol nearly abolished escape from norepinephrine-induced vasoconstriction. Methylene blue also diminished autoregulatory escape. These findings suggest that norepinephrine-induced autoregulatory escape involves simultaneous -adrenoceptor, purinergic, and endothelial mediation. Norepinephrine-evoked mesenteric vasoconstriction appears to involve predominantly ₂-adrenoceptors and is modulated by peptidergic sensory nerves and adenosine.NIH grant number supporting these studies: USPHS # DK37050.     

Race differences in changing family demographics in the 1980s

Many social forces influence Black and White family demographics, with patterns of family formation varying greatly between the races. The authors explore the degree to which a common set of independent variables can account for differences in the timing of family formation and dissolution for Black and White families. Racial differences are specifically considered in the timing of initiation of sexual activity, first marriage, first birth, and divorce. Independent variables considered are adolescent living arrangements with either one or two parents, mother's educational level, religion, region of the country, area of residency, birth cohort, and year of the survey. Data are drawn from the third and fourth cycles of the National Survey of Family Growth, a national probability sample of women aged 14-45 years including 5778 Blacks and 9004 Whites. Estimates of how Blacks would differ if they had mean values on covariates equal to White observed means suggest that these independent variables inadequately explain differences between Black and White family formation and dissolution. The authors therefore conclude that Blacks and Whites may be responding to different structural and cultural constraints which are not easily captured by basic demographic variables.     

To Stay or Not to Stay: Issues in Rural Primary Care Physician Retention in Eastern Kentucky

An important aspect of primary care physician availability is the retention of physicians once they have located. While retention has been under-researched compared to recruitment, it is especially important in rural areas where physician shortages already exist. This study reports the results of a retention survey completed by 132 primary care physicians in rural eastern Kentucky. The survey sets up an objective, hypothetical retention scenario and asks physicians to respond to structured questions and to an open-ended question about factors not appearing in the survey. In response to the structured portion of the survey, physicians indicate that relief coverage is the most important factor in rural physician retention. A content analysis of 75 open-ended responses reveals that besides the other factors in the survey, "sociocultural integration" is the pre-eminent retention issue for rural practitioners. This article concludes that the role of the local rural community may be more important in retention than in recruitment. Finally, it is suggested that additional in-depth qualitative research be conducted within the local contexts to enhance the understanding of rural physician retention processes.     

MRI of the Stener lesion

Objective. To assess the utility of MR in detecting surgically induced Stener lesions (displaced thumb ulnar collateral ligaments) in cadaveric models. Design. Six cadaver thumbs had ulnar collateral ligament (UCL) tears created surgically. MR examinations (2D STIR and 3D GRASS) were performed identically on all specimens both before displacement (non-Stener) and after displacement (Stener lesion) of the UCL. The MR images were then randomly numbered. Each image was evaluated separately in blinded fashion by four musculoskeletal radiologists for the presence or absence of a Stener lesion. Each radiologist reinterpreted the images after an interval of several days. The interpretation was based on previously published criteria for Stener lesion diagnosis by MR. Results. The sensitivity of GRASS ranged from 0.17 to 0.67 with the most experienced reader scoring the lowest. The specificity of GRASS ranged from 0.33 to 1.0 (most experienced reader 0.67, 0.83). STIR had a sensitivity of 0.00–0.17 and a specificity of 0.53–0.83. The values for inter- and intraobserver agreement were measured. The intraobserver for GRASS was 0.27–0.75 (most experienced reader 0.75). Conclusions. 2D imaging is probably inadequate for the evaluation of Stener lesions. The most likely reason is that the STIR slice thickness of 3 mm limits resolution of small UCLs. The poor sensitivity and specificity of GRASS as well as poor interobserver agreement suggest that MR may not be sufficiently accurate for Stener lesion evaluation.     

Washington State Health Services Act: implementing comprehensive health care reform

In 1993, Washington State enacted the Health Services Act of 1993 (HSA) to guarantee universal access to health care through an employer mandate, with caps on premiums as the primary cost-control mechanism. The HSA represents the Nation's first formal experiment with managed competition. This article reports the results of a case study of the HSA's implementation. The study concludes that the Washington State initiative can be replicated in other States, but that implementation is complex, requires sustained public education, and requires cooperation from the Federal Government through program waivers. A major implementation challenge is to facilitate competition and minimize regulation.