护士分层级多途径联合培训实践

目的在护士岗位管理的基础上,探讨护士分层级多途径联合培训的效果。方法将全院1 012名护士根据护理工作性质设护理管理岗、医技护理岗、教学岗及临床护理岗,再将后两者分为N1~N4级;根据岗位及各层级护士实际情况进行分层级多途径联合培训、分层考核,实施1年后评价效果。结果联合培训后全院护士考核合格率达92.3%,考核成绩(67.30±10.41)~(83.83±7.13)分,显著高于联合培训前(P0.01);护理质量及患者满意度显著提高(P0.05,P0.01),护士科研能力相应提高。结论以岗位胜任力为核心的护士分层级多途径联合培训可满足不同层级护士需求,有利于提高培训效果和护理质量。     

F-ERG信号滤波及参数差异分析研究

目的：通过滤波技术,排除震荡电位干扰,准确测量闪光视网膜电图a波、b波的隐含期及振幅。
　　方法：对15例30眼门诊健康体检者行闪光视网膜电图检查,通频带为0.6~300 Hz和0.6~70 Hz时,分别测量a波、b波的隐含期及振幅,并进行对比分析,采用配对 t检验。
　　结果：将通频带设置为0.6~70Hz时,a波、b波表现为单峰,对比通频带为0.6~300 Hz时, a波、b波的隐含期延长,振幅下降(P<0.01)。
　　结论：将通频带设置为0.6~70 Hz时能获得光滑的a波、b波波形,能准确测量a波、b波的隐含期及振幅。     

立体定向手术与内科治疗中小量基底核区脑出血的对比研究

目的探讨立体定向手术治疗中小量基底核区脑出血病人的疗效。方法回顾性分析82例中小量基底核区脑出血病人的临床资料,以立体定向手术抽吸结合尿激酶引流治疗为立体定向治疗组(n=41),采用内科保守治疗为内科治疗组(n=41),比较2组病人发病后30 d瘫痪侧肢体运动功能和90 d格拉斯哥预后评分(glasgow outcome scale,GOS)情况。结果立体定向治疗组病人血肿消散时间为(3.3±1.5)d,内科治疗组为(24.0±7.3)d,两组血肿消散时间存在显著差异(P<0.01)。立体定向治疗组中发病后30 d运动功能预后好者和发病后90 d GOS 5分者均明显多于内科治疗组(均P<0.05)。结论对于血肿量≤30 ml的基底核区脑出血、瘫痪侧肢体肌力为1~3级的病人,应首选立体定向手术治疗。     

Changes in circulating inflammatory cells and the relationship to secondary brain injury in patients with craniocerebral injury★

BACKGROUND: Recent studies have indicated that reactive encephalitis plays an important role in secondary tissue damage after craniocerebral injury. OBJECTIVE: To observe changes in white blood cells (WBC) and polymorphonuclear neutrophils (PMN) in peripheral blood, and to determine their role in secondary brain insult in patients with craniocerebral injury. DESIGN, TIME AND SETTING: A case-control study at the Department of Neurosurgery of the Affiliated Hospital North Sichuan University of Medical Sciences between August 2007 and May 2008. PARTICIPANTS: Sixty-three patients, admitted within 24 hours after craniocerebral injury and who received no surgery, were included in the study. The cohort consisted of 41 males and 22 females, aged 9–72 years, with an average age of 42 years. Ten healthy volunteers, selected from the Department of Neurosurgery, were designated as the control group. METHODS: WBC and PMN from the peripheral blood were measured 0, 24, 48, 72, and 168 hours after admission to hospital. The Glasgow coma scale, area of cerebral hemorrhage, and degree of brain edema were simultaneously determined. The Glasgow outcome scale was evaluated six months after injury. The relationship between changes in WBC and PMN were analyzed. Sixty-three patients were divided into 0, 24, 48, 72, and 168 hours groups, with admission time to hospital as the determining factor. As controls, WBC and PMN of peripheral blood were also detected in 10 healthy volunteers. MAIN OUTCOME MEASURES: The main outcome measures were WBC and PMN counts in the peripheral blood at 0, 24, 48, 72, and 168 hours after admission to hospital, the mutual relationship between GCS, WBC and PMN, and changes in brain hemorrhage volume and edema size. RESULTS: WBC peaked at 24 hours after injury, and PMN peaked at 48 hours after injury (P < 0.01). These measures negatively correlated to the Glasgow coma scale (r = -0.657, -0.541, respectively, P < 0.05). In patients with Glasgow coma sale < 8, WBC and PMN were significantly higher than in the patients with GCS ≥ 8 (P < 0.05). Cerebral hemorrhage reached a peak at 24 hours after injury, and the degree of brain edema was maximal at 168 hours after injury. WBC and PMN counts were positively correlated to cerebral hemorrhage volume and brain edema size (P < 0.05). CONCLUSION: WBC and PMN counts significantly increased after craniocerebral injury and exhibited a correlation with the GCS score, volume of hemorrhage and edema, and Glasgow outcome scale. Key Words: craniocerebral injury; inflammatory cells; secondary brain injury     

Resting frontal gamma power at 16, 24 and 36 months predicts individual differences in language and cognition at 4 and 5 years

Gamma activity has been linked to a variety of different cognitive processes and exists in both transient and persistent forms. Across studies, different brain regions have been suggested to contribute to gamma activity. Multiple studies have shown that the function of gamma oscillations may be related to temporal binding of early sensory information to relevant top-down processes. Given this hypothesis, we expected gamma oscillations to subserve general brain mechanisms that contribute to the development of cognitive and linguistic systems. The present study aims to examine the predictive relations between resting-state cortical gamma power density at a critical point in language and cognitive acquisition (i.e. 16, 24 and 36 months), and cognitive and language output at ages 4 and 5 years. Our findings show that both 24- and 36-month gamma power are significantly correlated with later language scores, notably Non-Word Repetition. Further, 16-, 24- and 36-month gamma were all significantly correlated with 4-year PLS-3 and CELF-P sentence structure scores. Although associations reported here do not reflect a direct cause and effect of early resting gamma power on later language outcomes, capacity to generate higher power in the gamma range at crucial developmental periods may index better modulation of attention and allow easier access to working memory, thus providing an advantage for overall development, particularly in the linguistic domain. Moreover, measuring abilities at times when these abilities are still emergent may allow better prediction of later outcomes.     

LRRK2 R1628P variant is a risk factor of Parkinson's disease among Han‐Chinese from mainland China

Mutations in LRRK2, the gene that encodes leucine‐rich repeat kinase 2 (LRRK2), are associated with autosomal dominant and sporadic forms of Parkinson's disease (PD) and are the most common genetic causes of PD. Recently, a R1628P variant has been reported as a risk factor for PD in Taiwan and Singapore. To determine the association of this variant and PD in the Han‐Chinese population from mainland China, we analyzed its frequency in a cohort of 600 patients and 459 unrelated healthy controls. Forty (6.7%) patients were heterozygous and 3 (0.5%) homozygous for the R1628P variant, which was significantly more frequent than in the controls [2.4% heterozygous and 0.0% homozygous, Odds ratio = 3.14, 95%CI: 1.60–6.17, P < 0.01]. Considering the age at onset, this difference was found only in late‐onset PD (older than 50) [Odds ratio = 3.76, 95% CI: 1.90–7.45, P < 0.01]. Our data confirms that the LRRK2 R1628P variant is associated with an increased risk to develop late onset PD in the ethnic Han‐Chinese population. © 2009 Movement Disorder Society     

Effect of myasthenic IgG on degradation of junctional acetylcholine receptor

We investigated the effect of the lgG from patients with myasthenia gravis (MG) on the degradation of normal rat junctional acetylcholine receptor (AChR) labeled with ¹²⁵l-α-bungarotoxin (BuTx) and calculated the degradation rate (DR). The DR for the lgG from these patients was significantly higher than that from healthy volunteers and patients with other autoimmune diseases. For MG, DR was significantly correlated with the severity of the disease but not with anti-AChR antibody titer. DR was accelerated by lgG from patients with generalized MG whose antibody titers were in the normal range and by lgG from patients with ocular MG. These results indicate that measurement of the DR of junctional AChR in normal rats is more closely correlated with the severity of the disease than is measurement of anti-AChR antibody and that the former is a sensitive and confirmatory method for evaluating MG. © 1993 John Wiley & Sons, Inc.     

四时感冒的中医辨证治疗

将临床常见的感冒按春、夏、秋、冬四时分型，以气虚、阴虚、气郁、经期感冒分证，从病因、症状、辨证、方药等方面进行综合阐述，并辅以临证医案予以验证，对临床工作有较好的参考价值。     

Activity of angiotensin peptides in clitoral cavernosum of alloxan induced diabetic rabbit

OBJECTIVES: To assess the role of peptides of the angiotensin (ANG) on the regulation of clitoral cavernosum tone and changes in ANG binding affinity in the rabbit with diabetes mellitus. MATERIAL AND METHODS: The isometric tension measurement and in vitro autoradiography were used in sham and diabetic clitoral cavernosum. RESULTS: In tension study, contractility in response to ANG I, ANG II, ANG III and ANG IV was enhanced in diabetic clitoral cavernosum strips (EC50 was 67.6 +/- 27.2, 4.3 +/- 0.4, 189.3 +/- 37.3, 443.2 +/- 0.4 nM for diabetic versus 155.2 +/- 76.1, 38.3 +/- 0.1, 528.0 +/- 75.2, 616.9 +/- 69.5 nM for sham, respectively). Contractile responses to ANG II was significantly inhibited by type 1 ANG II receptor (AT1) antagonist but not by type 2 ANG II receptor (AT2) antagonist in both groups. Percentages in contractions by ANG II (1 nM) in the presence of Dup 753 decreased significantly 36.2 +/- 4.6 to 6.3 +/- 2.4% in sham and 56.1 +/- 7.7 to 6.0 +/- 4.8% in diabetic group. The binding affinities were enhanced in diabetic clitoral cavernosum for ANG II (dissociation constant, 4.9 +/- 1.0 for sham versus 0.9 +/- 0.2 nM for diabetic) and for ANG I, ANG III, and ANG IV (inhibitory constant, 28.6 +/- 1.5, 398.7 +/- 157.2, and 3966.5 +/- 1524.1 nM for sham versus 20.6 +/- 5.7, 78.5 +/- 23.7, and 1098.7 +/- 195.5 nM, for diabetic, respectively, all p < 0.05). Sensitivities of AT1 and AT2 receptors to ANG II enhanced in diabetic than sham clitoral cavernosum tissue. CONCLUSIONS: This results suggest that the contractile responses to all four ANG peptides are enhanced in the diabetic clitoral cavernosum. Enhancement of contractility in diabetic clitoral cavernosum may be related to the increased affinity to ANG II receptors for ANG peptides.