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。     

Histamine and tryptase modulate asthmatic airway smooth muscle GM-CSF and RANTES release.

Degranulating mast cells are increased in the airway smooth muscle (ASM) of asthmatics, where they may influence ASM function. The aim of the present study was to determine whether histamine and tryptase modulate ASM cell granulocyte-macrophage colony-stimulating factor (GM-CSF) and RANTES (regulated on activation, normal T-cell expressed and secreted) release and also to examine which receptors are involved in this release. Confluent, quiescent ASM cells from asthmatic and nonasthmatic donors were treated with histamine (1 microM-100 microM) with and without histamine receptor antagonist pre-treatment, or the protease-activated receptor (PAR)-2 agonists tryptase (0.5-5 nM) and SLIGKV (100 and 400 microM). The cells were then stimulated with interleukin (IL)-1beta and/or tumour necrosis factor (TNF)-alpha (10 ng.mL(-1)) or left unstimulated for 24 h. Release of GM-CSF and RANTES was determined by ELISA and prostaglandin (PG)E(2) measured by enzyme immunoassay. Neither histamine nor tryptase induced ASM GM-CSF or RANTES secretion. However, histamine increased IL-1beta-induced GM-CSF release and markedly reduced TNF-alpha-induced RANTES release by both asthmatic and nonasthmatic cells to a similar extent, but did not modulate PGE(2) release. All changes involved activation of the histamine H1 receptor as they were partially or fully blocked by chlorpheniramine, but not ranitidine. Tryptase, via its proteolytic activity, also potentiated GM-CSF, but not RANTES, release from asthmatic and nonasthmatic ASM cells induced by both cytokines. PAR-2 involvement in the tryptase potentiation was unlikely because SLIGKV had no effect. In conclusion, mast cells, through histamine and tryptase, may locally modulate airway smooth muscle-induced inflammation in asthma.     

第三脑室脑膜瘤(九例报告及文献回顾)

目的探讨第三脑室脑膜瘤的组织发生学、临床特点和外科治疗。方法报道9例经影像学、手术和病理学证实的第三脑室脑膜瘤，并回顾相关文献。结果第三脑室前部脑膜瘤5例，第三脑室后部脑膜瘤4例，平均发病年龄25．6岁，无明显性别差异；最常见的症状是梗阻性脑积水，缺乏硬脑膜附着为其影像学特征。肿瘤全切除6例。结论第三脑室脑膜瘤是一种罕见的脑室内脑膜瘤，起源于中间帆脉络组织或脉络丛，经半球间裂-胼胝体-穹隆间入路是合理的手术路径选择。     

Cardiokymograph system with a capacitance transducer and its preliminary application in the measurement of heart wall movement

A novel cardiokymograph system is introduced. The new system features a capacitance transducer with increased sensitivity and can be used in multichannel measurements. The novelty of this technique is the injection of a current into the patient coupled with the use of a capacitive displacement transducer and the possibility of multichannel monitoring. It provides for the possibility of removing breath noise when some signal processing technique, such as adaptive filtering, is used. Further investigation is needed to demonstrate clinical significance and pathologies.     

两种不同抗体双弹头标记物导向治疗肝癌的比较

在动物实验的基础上，比较了抗ＡＦＰ单克隆抗体（ｍＡｂ）和抗ＡＦＰ多克隆抗体（ｐＡｂ）两种不同抗体双弹头标记物在肝癌患者体内的生物代谢情况。结果显示，两种抗体标记物的血浆清除半衰期均在２４ｈ左右，ｍＡｂ标记物的清除较ｐＡｂ标记物略慢。尿清除的半衰期，ｍＡｂ标记物约为１２０ｈ，而ｐＡｂ标记物则约为１８ｈ，表明二者的体内生物代谢不同，疗效可能不一。     

胸腰椎稳定性重建方法的改进

为了改进胸腰椎脱位的治疗方法，更好地重建脊柱稳定性，设计了一种新的脊柱固定器械，由滚花钉及连接板构成，并通过椎弓根进行的一种脊柱后路短节段固定方法，脊柱固定范围限制在两个椎体间。１９８９年～１９９５年，临床应用这种新器械矫正胸腰椎脱位１２例，经１～４年随访，畸形矫正满意，固定牢固。结果表明：该器械具有手术方法简单、固定牢固和手术创伤小等优点。认为，该项技术适用于胸腰椎稳定性的重建。     

儿童后腹膜肿块CT表现

目的：报告儿童后腹膜常见与不常见占位病变的CT表现。材料和方法：对34例（32例经病理证实，2例随访复查证实)儿童后腹膜肿块病例完整的临床及CT检查资料进行分析。结果：本组儿童后腹膜占位病变共有11种．以肾上腺瘤和后腹膜神经母细胞瘤最常见，畸胎瘤和肾胚胎瘤、新生儿肾上腺出血其次．肾上腺皮质癌较少见，罕见的有横纹肌肉瘤和血管外皮瘤。临床和CT特点各有其不同。结论：临床特点与CT表现相结合，极大部分儿童后腹膜肿块可作出明确诊断。     

重组人红细胞生成素治疗肾性贫血的临床分析

目的　观察重组人红细胞生成素 (RhEPO)对肾性贫血的治疗作用。方法　根据使用EPO剂量的不同将 39例慢性肾衰竭并血液透析病人分成 4组 ,观察治疗后 2、4、12个月时与治疗前 (0月 )相比红细胞数 (RBC)、红细胞比积 (Hct)及血红蛋白含量 (Hb)的变化。结果　 2 4例使用EPO10 0 - 15 0IU/ (kg·w) (6 0 0 0IU/w - 90 0 0IU/w) ,治疗后RBC、Hct、Hb较治疗前有显著升高 (P≤ 0 .0 0 1) ;5例使用EPO5 0IU/ (kg·w) (30 0 0IU/w) +间断输血患者 ,其RBC、Hct、Hb升高不显著 ;10例不用EPO而单纯输血患者 ,其RBC、Hct、Hb无明显变化 (P >0 .0 5 )。结论　EPO能较好地纠正肾性贫血 ;单纯输血不能治疗肾性贫血     

海水浸泡弹烧复合伤血细菌学与内脏病理学的变化

目的 探讨海水浸泡弹烧复合伤伤后血液细菌学变化与内脏病理学变化之间的关系。方法 建立海水浸泡弹烧复合伤模型后，依模型将15只成年杂种犬随机分为单纯弹烧复合伤组(简称非浸泡组，7只)和海水浸泡弹烧复合伤组(简称浸泡组，8只)，于伤后即刻和4、7、10、20、28h共6个时相点抽取静脉血进行血细菌培养。另于伤后28h和濒死期将动物活杀，取心、肝、肺、肾行病理学观察。结果 浸泡组动物菌血症出现较早且严重。导致菌血症的细菌来源复杂，不仅有肠道菌群，还有海水特有菌群和皮肤常驻菌群。在内脏器官组织病理学上，不仅有不同程度的血液循环障碍及退行性变，还有严重的炎症反应。结论 在海水浸泡弹烧复合伤中，伤后出现的严重菌血症进一步加重了内脏器官损伤。