商业医疗保险的引入对病案管理的影响与对策

商业医疗保险的引入,要求医院必须加强对病案的质量管理及业务管理,提高病案管理的质量,与时俱进,开拓创新,以确保病案的法律作用得以充分的发挥。     

外伤性颈动脉海绵窦的ICD-10编码方法

资料表明外伤性颈动脉海绵窦瘘在住院病人疾病构成有上升趋势，为便于资料相互比较，目前各国逐渐采用ICD-10分类方法作为共同比较的基础。为避免编码错误，笔者结合多年的编码经验结合临床诊断探讨ICD-10中颈动脉海绵窦瘘的编码方法。     

护理干预防治早产儿高胆红素血症的效果分析

目的探讨综合护理干预对早产儿高胆红素血症的防治效果。方法将160例早产儿随机分为两组各80例。对照组接受常规治疗和护理，观察组在此基础上给予包括灌肠、抚触、腹部按摩和营养支持在内的综合护理干预。采用钒酸盐法监测两组患儿血清胆红素值，记录黄疸的出现时间、持续时间和消退时间。结果观察组患儿出生后d4和d6的血胆红素值明显低于对照组，差异有统计学意义，均P〈0．01（t=16．142，20．329），而且黄疸出现时间、持续时间和消退时间明显短于对照组，差异有统计学意义，均P〈0．01（t=10．550，17．151，12．981）。观察组高胆红素血症发生率明显低于对照组，差异有统计学意义（X^2=18．829，P〈0．01）。结论综合护理干预可减少早产儿高胆红素血症的发生，从而提高患儿的生存质量。     

肝素化后维持抗凝治疗急性脑梗死的对照研究

目的探讨普通肝素治疗急性脑梗死的确切疗效、剂量和方法。方法大宗资料随机、双盲、对照临床研究，符合入选标准者随机分为4组：A组307例采用普通肝素钠持续静脉泵入，B组308例采用普通肝素钠12500单位，日一次静脉输液，C组307例采用低分子肝素钙常规皮下注射，D组300例采用低分子右旋糖酐加丹参注射液，日一次静脉输液，3周后分别观察神经功能缺损评分、病死率、不良终点事件。结果总有效率各组均有显着差异，分别为A组95．11％、B组89．29％、C组81．76％、D组75．33％。病死率A组1．95％、B组3．57％、C组3．28％、D组5．67％。组间差异有统计学意义。出血不良事件前3组均高于D组，但前3组间无显着性差异。静脉内使用肝素615例仅发生2例脑出血。结论静脉内使用肝素可显着降低病死率、增加治愈、好转率。较之低分子肝素和常规扩管活血类药物有更好的疗效，而普通肝素维持静脉输液较每日一次静脉输液更能尽快达到肝素化，减少肝素总用量，总体疗效最佳。而出血并发症并未超出允许的范围。     

先天性脐尿管未闭畸型的手术编码探讨

脐尿管未闭畸形为泌尿系少见的先天性疾病,多数为男性发病,国内报道发病率约为出生人数的30万分之一,因发病率低,临床少见,编码员对其认识不足,尤其是对手术方式不了解,以致发生手术错码率较高的情况。为避免编码错误,探讨先天性脐尿管畸型的手术编码方法。     

Tumor suppressive role of a 2.4 Mb 9q33-q34 critical region and DEC1 in esophageal squamous cell carcinoma

The key genes involved in the development of esophageal squamous cell carcinoma (ESCC) remain to be elucidated. Previous studies indicate extensive genomic alterations occur on chromosome 9 in ESCC. Using a monochromosome transfer approach, this study provides functional evidence and narrows down the critical region (CR) responsible for chromosome 9 tumor suppressing activity to a 2.4 Mb region mapping to 9q33-q34 between markers D9S1798 and D9S61. Interestingly, a high prevalence of allelic loss in this CR is also observed in primary ESCC tumors by microsatellite typing. Allelic loss is found in 30/34 (88%) tumors and the loss of heterozygosity (LOH) frequency ranges from 67 to 86%. Absent to low expression of a 9q32 candidate tumor suppressor gene (TSG), DEC1 (deleted in esophageal cancer 1), is detected in four Asian ESCC cell lines. Stably expressing DEC1 transfectants provide functional evidence for inhibition of tumor growth in nude mice and DEC1 expression is decreased in tumor segregants arising after long-term selection in vivo. There is 74% LOH in the DEC1 region of ESCC primary tumors. This study provides the first functional evidence for the presence of critical tumor suppressive regions on 9q33-q34. DEC1 is a candidate TSG that may be involved in ESCC development.     

Abilities of 3,4-diarylfuran-2-one analogs of combretastatin A-4 to inhibit both proliferation of tumor cell lines and growth of relevant tumors in nude mice

BACKGROUND: Combretastatin A-4 (CA-4) and its analogs are potent inhibitors of tubulin polymerization and display strong inhibitory activity on both solid tumor and tumor cell growth. Since natural CA-4 is difficult to synthesize and also isomerizes to an inactive form quite readily, a recently reported new 3,4-diarylfuran-2-one-based series of CA-4 analogs was investigated, in the hope of bypassing some of these difficulties. These analogs appear to offer a valuable tool for CA-4 research because of their extremely facile synthesis from readily available starting materials. MATERIALS AND METHODS: The CA-4 analogs were evaluated by MTT assay, cell cycle analysis, tubulin polymerization and tumor-inhibiting experiments. RESULTS: Various benzene ring substitutions on the furan-2-one skeleton (analogs to the two aromatic rings on the CA-4 styrene skeleton) quickly demonstrated that the structure-activity relationships are quite similar to previously synthesized CA-4 analogs. The most interesting analog appears to be an anilino compound (NV-5-9) which was also quite soluble. Analog NV-5-9 was remarkably potent in all tested tumor cell lines and could strongly inhibit tubulin polymerization at doses as low as 1 mM. Further experiments with tumor-bearing mice indicated that NV-5-9 and other potent analogs (NV-4-82 and NV-4-86) were effective in treating human prostate PC-3 and SCLC NCI-H69 tumors at well below an oral MTD dose of around 200 mg/kg body weight. This suggests some bioavailability by this route. CONCLUSION: These data strongly support that NV-5-9 is extremely potent, readily synthesizable and apparently suitable for in vivo studies employing transplanted tumors.     

施今墨验方加减治疗多囊卵巢综合征合并2型糖尿病的临床研究

目的观察施今墨验方加减治疗多囊卵巢综合征(PCOS)合并2型糖尿病的临床疗效。方法将53例多囊卵巢综合征合并2型糖尿病患者随机分为2组。治疗组27例予施今墨验方加减,日1剂,水煎分2次服。对照组26例予二甲双胍500mg,每日3次餐前口服。2组均1个月为1个疗程,连续治疗3~6个疗程。判定2组临床疗效,并观察2组治疗前后空腹血糖、月经情况及血生殖激素变化。结果治疗组总有效率92.59%,对照组总有效率65.38%,2组比较差异有统计学意义(P<0.05)。2组治疗后空腹血糖与本组治疗前比较差异有统计学意义(P<0.05),2组治疗后空腹血糖比较差异有统计学意义(P<0.05)。2组月经不规律阴转率比较差异有统计学意义(P<0.05)。2组治疗后睾酮、黄体生成素比较差异有统计学意义(P<0.05)。结论中药治疗多囊卵巢综合征合并2型糖尿病疗效显著,值得推广。     

Contrast-enhanced ultrasonography for assessment of tumor vascularity in hepatocellular carcinoma.

OBJECTIVE: Studies have shown that angiogenesis is a critical factor for tumor growth and metastasis in a variety of human tumors. Although various methods have been tried to assess vessels in tumors, including microvessel density (MVD), assessment of tumor vessels by radiologic techniques is not well established. The aim of this study was to investigate the efficacy of contrast-enhanced ultrasonography (CEUS) in determining the tumor vascularity of hepatocellular carcinoma (HCC). METHODS: Contrast-enhanced ultrasonography was done in 50 patients with HCC, which was shown histopathologically through subsequent hepatic resection. A contrast pulse sequencing technique and quantitative auto-tracking contrast quantification software were used to analyze the peak intensity (PI) of HCC. Immunohistochemistry was performed to evaluate the level of MVD in HCC. Then the relationship between PI and the level of MVD was analyzed. RESULTS: The mean PIs of HCC and peripheral tissue +/- SD were 135.19 +/- 28.16 and 72.91 +/- 19.22 dB, respectively. The MVDs of HCC and peripheral tissue were 43.44 +/- 12.22 and 17.14 +/- 9.18, respectively. The values of PI and MVD of HCC were significantly higher than those of peripheral tissue. A significant correlation was found between PI and MVD in HCC tissues (P < .05). CONCLUSIONS: The PI in CEUS could reflect the MVD in HCC. Therefore, quantification of CEUS seems to be helpful for assessment of tumor vascularity in HCC.