Ethical issues in neonatal intensive care and physicians' practices: A European perspective

An international project (EURONIC) was carried out to explore the end-of-life decision-making process in a large, representative sample of neonatal intensive care units (NICUs) in eight western European countries: France, Germany, Great Britain, Italy, Luxembourg, the Netherlands, Spain and Sweden. Structured questionnaires were used to record data on NICU organization and policies, and to survey staff views and practices regarding ethical decision-making. One hundred and twenty-two NICUs were recruited by census or random sampling (response rate 86%); 1235 physicians and 3115 nurses completed the staff questionnaire (response rates 89 and 85%, respectively). This paper focuses on the physicians' answers. In all countries but Italy, most physicians reported having been involved at least once in setting limits to intensive care because of a baby's incurable condition and/or poor neurological prognosis. Adopted strategies varied between countries. Practices such as the continuation of current treatment without intensifying it and the withholding of emergency manoeuvres appeared widespread. In contrast, the frequency of doctors reporting withdrawal of mechanical ventilation was highest in the Netherlands (93%), Sweden (91%) and the Great Britain (88%), intermediate in France and Germany, and lowest in Spain and Italy (34 and 21%, respectively).
Conclusion: Ethically problematic clinical cases are approached differently in the various countries. The findings of this study may provide an opportunity for physicians to review their practices critically, in light of how other colleagues proceed, and foster an open discussion about these difficult issues.     

持续性护理质量改进在新入院病人接诊方面的应用

推行全面质量管理，建立健全质量保证体系，已成为当今各个行业、各个部门改善服务理念，提高服务质量的追求目标，对于护理工作中运用全面质量管理理论已呈现趋势。而全面质量管理的目标是建立组织对持续改进的承诺，持续性质量改进，是全面质量管理的重要组成部分，其本质是持续的、渐进的变革。我科自2003年6月至2004年8月，应用持续性质量改进理论，在接诊新入院病人方面取得了很好的效果，现总结如下。     

对苄氧基氯苄的HPLC测定

对苄氧基氯苄(p-benzyloxy benzyl chloride,1)是合成抗肿瘤新药的中间体,其纯度直接影响成品的质量.本研究建立了RP-HPLC法测定1纯度[1,2].方法简便、快速,可用于1的质量评定.     

HPLC法测定通天口服液中咖啡因的含量

目的:建立高效液相色谱法测定通天口服液中咖啡因的含量.方法:采用ODS柱;乙腈-水(15:85)为流动相;流速1.0ml·min-1;检测波长272 nm;进样量10μl.结果:咖啡因在0.5μg～10μg范围内呈良好线性关系(r=0.999 9);平均回收率为100.4%,RSD=0.55%.结论:本法准确,可靠,简便迅速,适用于测定通天口服液中咖啡因的含量.     

格列吡嗪血药浓度测定及中国健康人体药物动力学研究

目的建立反相高效液相色谱法测定人血浆中格列吡嗪浓度的方法,以及研究格列吡嗪片在中国健康人体的药物动力学。方法以KiomasalC18(4.6mm×125mm,5μm)为分析柱,乙腈0.05mol·L-1磷酸二氢钾缓冲液(38∶62,v/v)为流动相,流速为1.0mL·min-1,二极管阵列检测器(DAD)检测波长为225nm,艾司唑仑为内标,测定血浆中格列吡嗪的浓度。结果在浓度20.4～2040ng·mL-1,格列吡嗪和内标峰面积比值与浓度呈良好的线性关系(r=0.9993)。格列吡嗪高、中、低3个浓度的平均回收率分别为(105.2±4.4)%、(92.9±5.0)%、(109.4±8.4)%;日内、日间RSD均小于10%。药物动力学研究表明,格列吡嗪体内过程符合一室模型,体内药物tmax、cmax、t1/2(Ke)、AUC0～24分别为(1.6±0.3)h、(728.5±229.7)ng·mL-1、(3.3±0.9)h、(4130.5±1383.0)ng·h·mL-1。结论方法简便、快速准确、重现性好,可用于格列吡嗪的药物动力学研究。     

阿昔莫司胶囊致支气管哮喘

患者女,65岁。因高脂血症,于2005年3月21日自服阿昔莫司胶囊250mg。30min后,感胸闷,憋气、呼吸急促,伴大汗,立即来我院就诊。查体:T36℃,P110次/min,BP112/68mmHg(1mmHg=0.133kPa),R32次/min。气喘,面色苍白,呼吸困难,强迫坐位,大汗淋漓,双肺闻及广泛哮鸣音,呼气相延长。临床诊断:支气管哮喘。立即给予低流量吸氧,2L/min,地塞米松10mg 0.9%氯化钠注射液250mL静脉滴注,氨茶碱0.25g 5%葡萄糖注射液250mL缓慢静滴,雾化吸入博列康尼(硫酸特布他林雾化液)5mg。30min后,上述症状逐渐缓解。经询问患者既往无药物过敏、哮喘发作、哮喘病家族史…     

肠道菌群失调对小鼠脾脏的影响

目的:观察小鼠肠道菌群失调对脾重、脾细胞数和脾抗体形成细胞数的影响,为研究肠道菌群失调对机体免疫功能的影响提供组织学依据.方法:采用口服卡那霉素造成小鼠肠道菌群失调的动物模型.测定小鼠肠道双歧杆菌、乳杆菌、肠杆菌和肠球菌的数量;测定小鼠脾脏重量和脾细胞数;通过溶血空斑试验测定小鼠脾抗体形成细胞数(PFC).结果:实验组小鼠肠道内双歧杆菌、乳杆菌、肠杆菌和肠球菌的数量明显低于对照组(P＜0.01);脾重量、脾细胞数和脾抗体形成细胞数均较对照组明显减少(P＜0.01或P＜0.05).结论:肠道菌群失调对小鼠脾脏的量与质均有明显的影响.     

舒胃胶囊质量标准研究

目的:研究制定舒胃胶囊(阿魏、延胡索、木香等)质量控制指标.方法:采用薄层色谱法对舒胃胶囊中的木香、香附进行了定性鉴别;采用高效液相色谱法对制剂中的阿魏酸进行了含量测定.结果:木香、香附薄层色谱清晰,无干扰,重现性良好;阿魏酸在0.007～0.056μg范围内呈良好的线性关系,回收率达到98.51%,RSD=2.64%.结论:方法简便,专属性强,可作为该制剂的质量控制指标.     

The effect of divalent cations on neuronal nitric oxide synthase activity.

Neuronal nitric oxide synthase (NOS I) is a Ca(2+)/calmodulin-binding enzyme that generates nitric oxide (NO*) and L-citrulline from the oxidation of L-arginine, and superoxide (O(2)*(-)) from the one-electron reduction of oxygen (O(2)). Nitric oxide in particular has been implicated in many physiological processes, including vasodilator tone, hypertension, and the development and properties of neuronal function. Unlike Ca(2+), which is tightly regulated in the cell, many other divalent cations are unfettered and can compete for the four Ca(2+) binding sites on calmodulin. The results presented in this article survey the effects of various divalent metal ions on NOS I-mediated catalysis. As in the case of Ca(2+), we demonstrate that Ni(2+), Ba(2+), and Mn(2+) can activate NOS I to metabolize L-arginine to L-citrulline and NO*, and afford O(2)*(-) in the absence of L-arginine. In contrast, Cd(2+) did not activate NOS I to produce either NO* or O(2)*(-), and the combination of Ca(2+) and either Cd(2+), Ni(2+), or Mn(2+) inhibited enzyme activity. These interactions may initiate cellular toxicity by negatively affecting NOS I activity through production of NO*, O(2)*(-) and products derived from these free radicals.