用知信行理论指导糖尿病人的健康教育

调动患者自身的积极性,对提高治疗糖尿病效果非常必要。通过对60名糖尿病人治疗护理的观察分析,认为用知信行理论指导糖尿病人的健康教育,对控制好血糖,提高治疗效果,减少并发症是十分有效的。     

2001年硚口区医疗卫生机构消毒效果监测报告

为预防医源性感染 ,提高医疗卫生机构消毒工作质量 ,对口区医院、工厂卫生所及牙科诊所等 10 5个单位进行了6种样品消毒效果检测。现将结果报告如下。1　对象与方法1.1　样品来源　监测对象为区内各级医疗单位及个体诊所。主要样品是正在使用中的消毒液、诊疗室内的空气、医护人员手、压力蒸气灭菌器、物体表面、医疗用品。其中物体表面包括操作台、水龙头、门把、消毒盆等 ,医疗用品包括牙钻头、牙托盘、探针、口腔镜、镊子等。1.2　样品采集　医院样品随机采样 ,采样方法依据 GB15 982 - 1995 ;牙科医疗用品 :用棉拭子均匀涂布于随机抽…     

CT引导下125I放射性粒子植入治疗头颈部浅表恶性肿瘤近期疗效观察

目的探讨CT引导下~(125)I放射性粒子治疗头颈部浅表恶性肿瘤的近期疗效。方法回顾性分析28例头颈部浅表恶性肿瘤患者的资料,所有患者均接受CT引导下~(125)I放射粒子植入治疗,并具有完整的术后随访复查资料。观察患者术后并发症发生情况,并评价术后放射性皮肤损伤程度。基于术后6个月影像学检查图像,评价治疗效果,计算客观缓解率(ORR)及疾病控制率(DCR)。通过绘制生存曲线,获得患者术后总生存期及无进展生存期,并计算术后1年生存率及无进展生存率。结果术后6个月ORR为92.86%(26/28),DCR为100%(28/28)。术后平均随访(25.6±8.9)个月。28例患者中位总生存期为26.98个月[95%CI(22.55,31.39)],中位无进展生存期为16.93个月[95%CI(14.47,19.39)];术后1年总生存率为96.43%(27/28),无进展生存率为82.14%(23/28)。96.43%(27/28)患者术后放射性皮肤损伤为0～Ⅱ度,仅3.57%(1/28)患者为Ⅲ度。术后均未出现血管栓塞、破裂等并发症。结论 CT引导下~(125)I放射性粒子治疗头颈浅表恶性肿瘤近期疗效确切,且安全性较高。     

以持续高热首发症状的肺鳞癌1例报告

1　临床资料患者 ,男 ,32岁因高热 1个月 ,咳嗽 7天于 2 0 0 2年 11月 13日院。曾于我院门诊抗炎治疗效果不佳。入院时查体 ;体温 39.3℃ ,脉搏 96min- 1,呼吸2 0min- 1,BP130 / 80mmHg ,急性热病容 ,咽部充血 ,双肺呼吸音粗 ,未闻及干湿性罗音。血常规 :白细胞13.4× 10 9L ,中性粒 0 .84 2。肝功能 :ALT83U/L ,GGT179U/L ,CHE395 3U/L。HBsAg (+) ,抗 -HBc(+)。胸部X线示心、肺、隔未见异常。胸部CT示双肺CT未见明显异常 ,少量心包腔积液。B超示少量胸腔积液 ,少量心包腔积液。腹部B超及肝脏CT均提示 :肝硬化 ,脾功能亢进。…     

西安市家庭医生对签约服务认知及满意度分析*

目的从社区家庭医生的视角,探究其对家庭医生签约服务的认知、对所在社区工作的满意度。方法采用随机整群抽样方法,对西安市17家社区卫生服务中心全部103名家庭医生进行调研,运用卡方检验和相关分析对满意度的10个维度及相互关系进行分析。结果有16.4%的家庭医生表示不明确其工作职责,28.21%的家庭医生认为家庭医生工作的价值与意义一般,30.1%的家庭医生对职业发展缺乏信心,不太看好家庭医生的未来发展前景;被调查家庭医生认为居民不愿接受家庭医生签约服务的主要原因是对家庭医生服务能力缺乏信任。推进家庭医生签约服务,应该加强政策宣传,提高家庭医生业务能力,以及提高家庭医生待遇。政策建议加大政府投入,完善经费管理;加强宣传力度,提高认知水平;加强家庭医生人才培养、引进;完善激励机制,调动家庭医生工作积极性;各方联动,完善配套措施。     

高密度脂蛋白防治动脉粥样硬化的新进展

<正> 研究证实,HDL与冠心病风险呈负相关,同时,HDL潜在的抗动脉粥样硬化(AS)功能,使其成为AS性心血管疾病预防和治疗的主要靶向。但是2007年ILLUMINATE研究结果显示,胆固醇酯转运蛋白(CETP)抑制剂torcetrapib虽然能大幅增高HDL-C水平,但是torcetrapib组的死亡人数反而较对照组增多,差异有统计学意义,使研究被迫提前终     

抗HLA和抗MICA抗体的表达对移植肾功能和急性排斥反应的预示作用

Objective To investigate the prediction of anti-human leukocyte antigen antibodies (HLA) and anti-major histocompatibility complex class I-related chain A antibodies (MICA) to the development of acute rejection (AR) and kidney allograft function. Methods Forty-one kidney transplant patients were prospectively tested for anti-HLA and anti-MICA. Thirty-seven patients were screened using Luminex/single-antigen beads to determine the HLA and MICA-specific antibody levels at 0,30,90, 180,360,720 and 1080 days post-transplantation. The patients and donors of HLA and MICA allele typing were determined by PCR-SSOP, and donor specific antibody (DSA) and non-donor specific antibody (NDSA) were identified.Simultaneously,their serum creatinine (SCr) levels and clinical data were analyzed. Results Nine patients (21.95 % ,9/41 ) had pre-existing anti-HLA and(or) anti-MICA, including 6 cases of anti-MICA,2 cases of anti-HLA, and one case of anti-MICA and anti-HLA. Nine patients had pre-existing DSA and NDSA. In the 37 patients, 6 patients (16.2% ) developed de novo anti-HLA, and 3 (8.1%) developed de novo antiMICA. In patients positive for de novo anti-HLA, the titer of antibody was gradually increased during the follow-up of three years. Four patients out of 9 patients with pre-existing antibodies were suffered from AR (44.4%); In 6 patients positive for de novo anti-HLA,three cases (50.0%) were suffered from AR; In three patients positive for de novo anti-MICA,no AR occurred (P＜0.05). In two patients positive for DSA of HLAⅡ antibody detected at the third and seventh day after transplantation, the renal grafts were renovecd due to rejection. The Scr levels in patients positive for pre-existing MICA with AR were higher than in those positive for pre-existing MICA without AR at each scheduled time point during the follow-up period (P＜0.05). The Scr levels in patients negative for antibodies pre-transplantation and having AR were higher than in those having no AR at each scheduled time point during the follow-up period (P＜0. 01 ). The Scr levels in patients positive for de novo HLA and MICA and having AR one month following transplantation were higher than in those negative for antibodies and having no AR (P＜0.01 ). Conclusion Pre-existing and de novo anti-HLA were the irnportant factors for the development of AR, but the mismatch of HLA and MICA alleles in donors and patients was primary causes for generation of de novo antibodies.     

肾移植患者血清中可溶性B7-H3水平的变化及其临床意义

Objective To detect the serum soluble B7-H3 (sB7-H3) in patients before and after renal transplantation, and to investigate the clinical significance. Methods The serum level of sB7-H3 in 34 patients were determined before and 3, 6, 12 months after renal transplantation. Besides, 11 health adults were elected as controls. These 34 patients were divided into two groups according to HLA and/or MICA antibodies using Luminex before operation. After transplantation, all the patients were divided into two groups according to their conditions; group Ⅰ with rejection; group S with stable renal function and no rejection. Results The serum level of sB7-H3 in all 34 patients before operation was significantly higher than health controls [(27. 10 ± 13. 61) μg/L,n = 34 vs (11.61 ±3.77) μg/L,n = 11 ,P ＜0. 01], and significantly higher in patients with antibodies than in those without before operation [(34. 96 ± 17. 37) (μ/L, n = 11 vs (23. 34 ± 9. 75) (μg/L, n = 23, P ＜ 0. 05]. There was no significant difference in the serum level of sB7-H3 between control group and S group after operation (P ＞0. 05). In group Ⅰ, the serum level of sB7-H3 was increased obviously when rejection occurred [(20. 63 ±4. 28) μg/L,n = 12; (18. 95 ±2.98) μg/L,n=6; (28.36 ±19. 83) μg/L,n = 10] , as compared with group S and control group (P＜0. 01), while at the time without rejection, there was no difference among them (P ＞0. 05). Conclusion Monitoring serum sB7-H3 after renal transplantation would be clinically useful in indicating therapeutic effect and outcome of the patients.     

失功能高密度脂蛋白的诊断方法新进展

既往流行病学认为,高密度脂蛋白胆固醇(HDL-C)水平与冠心病风险呈负相关,血清HDL-C是预测心血管事件发生率的重要指标.NCEPATPⅢ把HDL-C＜40 mg/dl当作冠心病的独立危险因素;认为每升高1 mg/dl就能降低2%～3%冠心病发病率.但升高HDL水平就能很好的降低冠心病的风险吗?CETP抑制剂torcetrapib虽然能升高HDL-C水平,但研究结果却发现其增加了患者心脏事件发生率和全因死亡率[1].