Admission,recruitment, and retention

As the country strives to produce larger numbers of generalist physicians, considerable controversy has arisen over whether or not generalist applicants can be identified, recruited, and influenced to keep a generalist-oriented commitment throughout medical training. The authors present new and existing data to show that: 1) preadmission (BA/MD or post-baccalaureate) programs can help to identify generalist-oriented students; 2) characteristics determinedat admission to medical school are predictive of future generalist career choice; 3) current inpatient-oriented training programs strongly push students away from a primary care career; 4) women are more likely than men to choose generalist careers, primarily because of those careers’ interpersonal orientation; and 5) residency training programs are able to select applicants likely to become generalists. Therefore, to produce more generalists, attempts should be made to encourage generalist-oriented students to enter medical schools and to revise curricula to focus on outpatient settings in which students can establish effective and satisfying relationships with patients. These strategies are most likely to be successful if enacted within the context of governmental and medical school-based changes that allow for more reimbursement and respect for the generalist disciplines.     

Treatment of systemic and renal-limited vasculitic disorders with pooled human intravenous immune globulin

Idiopathic crescentic glomerulonephritis is characterized by an absence of immunohistological evidence of immune deposits, often with evidence of segmental glomerular necrosis. Such pauciimmune crescentic glomerulonephritis is the most common renal manifestation seen in patients with Wegener's granulomatosis, polyarteritis nodosa, and glomerulonephritis associated with other systemic vasculitic disorders (i.e., Churg-Strauss syndrome). Recently, the idiopathic crescentic glomerulonephritides, either in renal-limited form or in association with other systemic vasculitic disorders, were found to have in common a serologic marker, antineutrophil cytoplasmic autoantibodies. These cytoplasmic and perinuclear antineutrophil cytoplasmic autoantibodies are specific for constituents of neutrophil primary granules and monocyte lysosomes. As serologic markers for vasculitic disorders, they are also felt to be directly involved in the pathogenesis of necrotizing vascular injury.In vitro, both perinuclear and cytoplasmic antineutrophil cytoplasmic autoantibodies are capable of causing cytokineprimed neutrophils to undergo degranulation and respiratory burst, releasing toxic oxygen species and lytic enzymes. Antiidiotype antibodies which inhibit antineutrophil cytoplasmic autoantibodiesin vitro, in a V region-dependent manner, are found in pooled humanγ-globulin preparations. Intravenous immune globulin infusionsin vivo have produced dramatic improvements in the necrotizing vascular injury produced by antineutrophil cytoplasmic autoantibodies, and a rapid reduction in these autoantibody levels is seen post-intravenous immune globulin infusion in most patients. The proposed mechanisms of action of intravenous immune globulin in vasculitic disorders include Fc-dependent mechanisms, and F(ab′)₂-dependent mechanisms are likely important. Intravenous immune globulin infusions appear to have an important place in the management of the necrotizing vascular injury. Blinded, randomized, placebo-controlled trials will be necessary to establish definitively intravenous immune globulin as a therapeutic option in vasculitic disorders.     

大鼠三叉神经本体觉中枢传导通路的电生理学证明

近年来形态学上发现了三叉神经领域本体感觉中枢通路,在此基础上,本文用电生理学方法,通过电刺激咬肌神经和压下颌,观察了由四级神经元组成的此通路的二级（三叉神经脊束核吻侧亚核背内侧部及邻接的网状结构）、三级（沿三叉神经感觉主核内缘存在的“带状区”）中继核团以及作为最后驿站的丘脑腹后内侧核等处的单位放电反应;另外又分别刺激或损毁二、三级中继核团,观察了丘脑腹后内侧核的单位放电变化,结果证明电刺激咬肌神经和压下颌,在上述核团都出现对本体觉冲动反应的单位放电,包括兴奋性反应单位、抑制性反应单位和无关单位三种类型,以兴奋性单位为主,占神经元单位放电总数的５２．９％～６７．７％．分别刺激二和三级神经元的所在核团,在丘脑腹后内侧核处发生相应的单位放电效应;损毁二和三级核团,本体觉传入冲动被阻断。本研究结果从电生理学上确证了形态学上发现的三叉神经本体感觉中枢通路的客观存在,从定性研究方面支持了定位研究的结果,并填补了以往生理学上只证明初级传入核团与丘脑腹后内侧核之间存在着一条多突触联系的本体觉传递通路但未能判断其具体行径和中继部位的空白,本研究并对方法论以及一些有关问题进行了讨论．     

我国消除丙型肝炎的普通人群HCV检测策略的成本效果分析

目的 分析我国消除丙型肝炎（丙肝）的普通人群HCV检测策略的成本效果,明确最佳成本效果的HCV检测年龄。方法 运用TreeAge pro 2019软件构建决策树马尔科夫模型,以1年为周期,模拟10万名20~59岁各年龄组人群HCV检测和治疗结果,以全社会角度分析策略间比较的成本效果和效益。效果指标为增量成本效果比（ICER）,效益指标为净货币效益（NMB）,以我国2022年人均国内生产总值（85 698元）为意愿支付阈值。通过单因素敏感性分析和概率敏感性分析评估结果可靠性。结果 在20~59岁人群HCV检测有成本效果,在40~49岁年龄组进行HCV检测成本效果最佳。20~59岁年龄组人群HCV检测策略与未HCV检测策略比较,增量成本为161.24元/人,增量效用为0.003 6质量调整寿命年（QALYs）/人,ICER为45 197.26元/QALY,ICER小于意愿支付阈值,具有成本效果。各年龄组人群HCV检测策略与未HCV检测策略比较,ICER为42 055.06~53 249.43元/QALY,NMB为96.52~169.86元/人,其中40~49岁年龄组的ICER最低,NMB最高。单因素敏感性分析结果显示,贴现率、丙肝抗体（抗-HCV）检测成本、人群抗-HCV阳性率和直接抗病毒药物治疗成本对经济学评价影响较大,但改变参数取值,结论不变。概率敏感性分析结果表明模型分析结果稳定。结论 医疗机构探索动员20~59岁普通人群进行HCV检测具有较好的成本效果,以40~49岁年龄组人群的HCV检测成本效果最佳。在我国普通人群中实施HCV检测的“愿检尽检”策略,能降低人群丙肝疾病负担。     

工频电磁场对人体免疫功能的作用

目的　探讨工频电磁场对人体免疫功能的影响。方法　检测２５ 例长期工作在３ ×１０５ Ｖ超高压环境中的工作人员与５ 例正常对照者的外周血Ｔ 淋巴细胞分泌白细胞介素２（ＩＬ２） 活性,白细胞介素２ 受体（ＩＬ２Ｒ） 表达;单核／ 巨噬细胞抗体依赖的细胞介导的细胞毒（ＡＤＣＣ） 效应,白细胞介素１５（ＩＬ１５） 活性;血清中ＩｇＧ、ＩｇＡ、ＩｇＭ 的水平。结果　（１） 观察组ＩＬ２ 活性为（３６２ ±７８） Ｕ／ｍｌ,明显高于对照组［（２５４ ±６７）Ｕ／ｍｌ］ ,差异有显著性（ Ｐ ＜ ０ ．０５） 。（２） 观察组ＩＬ２Ｒ 表达比率为２８ ．４ ％ ±３ ．２ ％ ,对照组为２２ ．８ ％ ±１０ ．７ ％ ,差异无显著性（ Ｐ ＞ ０ ．０５） 。（３） 观察组单核／ 巨噬细胞ＡＤＣＣ 效应及ＩＬ１５ 分泌水平均有增强或增高的趋势,但差异无显著性（ Ｐ ＞ ０ ．０５） 。（４） 观察组血清中ＩｇＧ 水平为（１０ ．３７ ±１ ．２８）ｇ／Ｌ,明显高于对照组［（８ ．８９ ±１ ．８８）ｇ／Ｌ］ ,差异有显著性（ Ｐ ＜ ０ ．０５） ,而血清中ＩｇＡ、Ｉｇ Ｍ 水平与对照组比较,差异无显著性（ Ｐ ＞ ０ ．０５） 。结论　长期工作在工频电磁场环境中人员的Ｔ     

整体奋进攻坚破难全力做好灾区防疫灭病宣教工作

１９９８年特大洪水已经退去。然而,灾害给人们心灵和精神带来的创伤永远不会抹去。在人与洪灾抗争中,我们对灾区不应仅仅停留在物质上、经济上的援助,更重要的是给予精神上的关怀和知识上的帮助。为达到促进生产、重建家园、抵御疾病、保护生产力的目的,做好灾区防疫...     

自动变温热交换水箱的研制

通过对变温热交换水箱的智能化设计（硬件和软件）,实现了循环水温的自动化控制,从而达到对热交换水箱中逆向运动的血液温度按临床需要自动进行温度调节。     

干扰素防治狂犬病毒感染的小鼠实验

用小鼠试验干扰素防治狂犬病毒 (CVS)感染的作用 ,结果表明 ,小鼠在感染CVS前 2周开始使用干扰素 ,可获得 5 0 %左右的保护率 ,而在感染CVS后使用干扰素却无保护作用。干扰素与狂犬病疫苗联合使用可获得比两者单独使用更佳的保护效果 ,疫苗效力可提高 5倍以上。 5× 10 3IU剂量组与 5× 10 2 IU剂量组干扰素作用无显著差异。     

子宫肌瘤声象图诊断分析(附85例报告)

本文总结了我院Ｂ超检出并经手术病理证实的子宫肌瘤８５例。叙述了子宫肌瘤的声象图表现,病理结果与超声结果对照,超声诊断符合率为９２９６％。本组病例所见最大肌瘤为２５×２０×２１ｃｍ,最小肌瘤为１２×１５×１５ｃｍ,对子宫肌瘤的病因、病理、临床表现、声象图诊断价值及误诊原因进行了分析讨论。认为超声显象诊断子宫肌瘤迅速、可靠、诊断符合率高,是有价值的检查方法;对易误诊病例的声象图特点,尚需进一步探讨     

The Burden of Obesity and Its Sequelae

Obesity [body mass index (BMI) ≥30 kg/m²] is common in many parts of the world, especially in the established market economies, formerly socialist economies of Europe and Latin America and the Caribbean, as well as the Middle Eastern Crescent. Worldwide, as many as 250 million people may be obese (7% of the adult population) and 2 to 3 times as many may be considered overweight (BMI 25 to 30 kg/m²). The prevalence of obesity seems to be increasing in most parts of the world, even in areas where obesity used to be rare.A waist circumference greater than 102cm in men and 88cm in women may be a more sensible classification than BMI to identify individuals who are at increased health risk because of obesity, but information on this point is still scarce.Increased fatness measured by a high BMI, large waist circumference or high waist/hip circumference ratio is associated with many chronic diseases as well as poor physical functioning. These all contribute to the costs associated with excess bodyweight. The economic costs of obesity can be broken down into 3 levels Direct costs: costs to the community related to the diversion of resources to the diagnosis and treatment of diseases directly related to obesity as well as the treatment of obesity itself. These costs have been estimated to account for 2 to 8% of total healthcare costs of various countries. Indirect (or societal) costs: these costs are related to the loss of productivity caused by absenteeism and premature death and disability pensions. There is a lack of good economic analysis in this area, although research from Sweden, Finland and The Netherlands has clearly shown that obesity is associated with increased sick leave and the need for disability pensions. Personal costs: obese individuals may earn less than their lean counterparts because of job discrimination (related to the stigma associated with obesity or because of diseases and disabilities caused by obesity). Many insurance companies (particularly life insurance) charge higher premiums with increasing degrees of overweight.In conclusion, there is much indirect information that obesity and overweight are important and growing public health concerns that contribute substantially to healthcare-related costs. Effective strategies for the prevention and management of obesity are needed.