社区卫生服务功能落实障碍的供方调查分析

目的从供方探讨社区卫生服务功能落实障碍,提出改进建议。方法文献研究,现场调查。结果供方认为国家投入不足、政策落实和支持不到位、人员业务素质水平低下、政府领导重视不够、卫生系统内部协调不够等是社区卫生服务功能落实的主要障碍。结论对社区卫生服务投入不足、各主管部门社区卫生服务政策未能落实是妨碍社区卫生服务功能实现最基本的原因,应建立科学可行的、可持续的社区卫生服务筹资和补偿机制,切实落实现有的社区卫生服务政策。     

冠状动脉造影评价ST↑Ⅲ＞Ⅱ与STV4R↑诊断右心室心肌梗死的价值

目的 以冠状动脉造影（coronary angiography，CAG）显示右冠状动脉（fight coronary artery。RCA）右室支近端闭塞作为右心室心肌梗死（fight ventricular myocardial infarction，RVMI）的诊断依据，评价心电图Ⅲ导联ST段抬高幅度大于Ⅱ导联（ST↑Ⅲ〉Ⅱ）与V4R导联ST段抬高（STV4R↑）的诊断价值。方法 选择发病12小时内入院的急性下壁MI患者158例，分别计数存在ST↑Ⅲ〉Ⅱ或STV4R↑的病例数。根据CAG结果判断RCA或LCX的闭塞部位，以RCA右室支近端闭塞作为RVMI的诊断依据，计算并比较ST↑Ⅲ〉Ⅱ与STV4R↑诊断RVMI的敏感性和特异性。结果 158例急性下壁MI患者中，CAG证实为RCA右室支近端闭塞即合并RVMI者159例，其余89例为RCA右室支远端或LCX闭塞。ST↑Ⅲ〉Ⅱ诊断RVMI的敏感性明显高于STV4R↑（98．6％vs66．7％，P〈0.01），而特异性前者明显低于后者（58．4％vs80．9％，P〈0．01）。当两种心电图指标并存（ST↑Ⅲ〉Ⅱ＋STV4R↑）时。其敏感性不低于STV4R↑（P〉0．05），而特异性高于两者单独存在（P〈0．05）。结论 以CAG结果为依据评价急性下壁MI时Ⅲ导联ST段抬高幅度大于Ⅱ导联与V4R导联ST段抬高诊断RVMI的价值具有较大临床意义，前者敏感性较高，后者特异性较高，两者并存时进一步提高诊断的准确性。     

提高心腔粘液瘤手术疗效的临床探讨

自１９８１年１１月至１９９２年６月共手术治疗心腔粘液瘤２７例；其中左房瘤２５例，右房、右室瘤各１例。手术死亡１例。随访８个月至１０年，无晚期死亡或并发症。我们认为：（１）本病潜在危险大，决定手术时不应过分拘泥于常规禁忌；（２）应用保守的小部分房间隔切除术，远期效果一样良好；（３）术中重视对受累瓣膜的检查和处理，有利于提高疗效。     

Meningitis and midline facial deformity

A baby with unilateral cleft lip, midline cleft palate and hypertelorism developed meningitis in the first 48 h of life. Examination of the nasopharynx showed a soft tissue mass, which was confirmed as a basal encephalocele by computed tomography. There was also congenital hydrocephalus and the corpus callosum was absent. Surgical treatment included repair of the anterior basal skull defect, repair of the lip and palate, and ventriculo-peritoneal shunt. There is currently evidence of developmental delay and right-sided visual impairment due to Morning Glory syndrome. This case demonstrates that basal encephalocele should be considered in any baby with midline facial deformity who develops meningitis.     

Experimental study of the therapeutic effect of You-Gui-Wan on hypogonadism in rats

Rats raised on a diet containing 0.5% adenine showed atrophy of the testes and retrogressive degeneration of the convoluted seminiferous tubules. The development of spermatids was suppressed, and the cell count decreased. In these rats, the activity of 3β-hydroxysteroid dehydrogenase was markedly decreased, and the blood levels of testosterone and oestradiol were also very low. However, in rats that were also given You-Gui-Wan, retrogressive degeneration of the testes was milder, and the blood levels of testosterone and oestradiol were higher, indicating the beneficial effects of You-Gui-Wan on the histomorphology of the testes.     

济南假单胞菌代谢产物体外抑瘤及对肿瘤细胞HLA抗原表达影响的初步研究

济南假单胞菌菌苗(PJV)及其胞壁成分(PJ—CW)的抗肿瘤及免疫调节作用．我们已做了系列研究报道，济南假单胞菌代谢产物PS161呈针形结晶体．有黑金属光泽，其结构与某些抗肿瘤抗生素类似．但尚未做进一步的鉴定。初步观察表明其具一定的抗肿瘤作用。本研究采用MTT法观察了PS161对四种人类肿瘤细胞株增殖的抑制作用。     

高温中暑患者血浆中热应激蛋白70与细胞因子的关系

Objective　To study the change of levels of plasma heat stress protein 70 (HSP70) and cytokine and their interrelationship in pathogenicity of heat apoplexy. Methods　Plasma HSP70 was determined with Western blot, and plasma interleukin-2 (IL-2), soluble interleukin-2 receptor (sIL-2R) and interleukin-6 (IL-6) were determined with enzyme-linked immunosorbent assay (ELISA). Results　Plasma level of HSP70 was 4 211.2±1 286.2 (integral optical density) in average in the patients of heat apoplexy group, 4 137.8±1 207.5 in those of severe heat apoplexy group,and 6 043.5±1 354.8 in control group, with very significant difference (P<0.01). Plasma IL-2 level was (64.3±32.3) pg/ml and (200.0±50.0) pg/ml and sIL-2R (54.9±33.3) U/ml and (167.5±89.0) U/ml in the patients with heat apoplexy and in controls, respectively, with very significant difference. But, there was no significant difference in IL-6 between varied groups. Conclusions　The above-mentioned results suggest that establishment of heat acclimatization correlates to the interaction of network of neuroendocrine-cytokine-HSP, in which decrease in plasma IL-2 was one of the important factors causing reduction of HSP70 expression. Balance of network regulation was broken by pathological factors, finally resulting in heat apoplexy.     

三种降眼压药物对眼部血流的影响

目的 观察３种常用的降眼压药物连续滴用１周后对眼部血流的影响。方法 选择原发性开角型青光眼或高眼压症患者３２例,分为３组,分别滴用０．５％左旋丁萘酮心安、０．５％噻吗心安及０．１％地匹福林１周,均为每日２次。将患者滴药前、后１周在激光扫描眼底镜下拍摄的荧光素、吲哚青绿视网膜和脉络膜务管造影录像带作为分析资料,利用计算机视频图像处理技术和相应测量软件,以单盲测量３组患者的眼部血流动力学目标。在正式测