耳穴贴压治疗单纯性肥胖症临床研究

目的探讨耳穴贴压治疗单纯性肥胖症的临床效应。方法应用耳穴贴压治疗单纯性肥胖症，观察治疗前后患者肥胖指标、血脂指标等的变化，评测耳穴贴压减肥的效果。结果各项指标在治疗前后差异均有显著性。结论耳穴贴压治疗单纯性肥胖，疗效确切，对患者各项生理指标有良性调节作用。     

Certification and quality assurance in Dutch occupational health services

Since 1994, each Dutch enterprise has to be affiliated to an independent occupational health service (OHS), recognized by the government. In addition, each enterprise has to be supported by this occupational health service in its activities for the improvement of working conditions, and in the guidance of employees absent from work. From 1994 to 1998, the government was carrying out the certification and recognition of occupational health services. Since 1998 the certification has been carried out by private certifying institutions, in general consultancy bureaus that also provide ISO certification. In the Netherlands, the supervision of the quality of occupational safety and health care is twofold. Firstly, the Labor Inspectorate is checking if the enterprises keep to the rules. For example, each enterprise should have a risk assessment report at its disposal. The latter should be approved by the OHS. If an enterprise does not meet these rules, a penalty may be imposed. In practice, this happens rather seldom. Secondly, each OHS unit should be recognized by the Ministry of Social Affairs and Employment. The recognition takes place if the private certifying institution has assessed that the OHS meet a large number of requirements laid down in the "Guideline for the Certification of Occupational Health Services". This Guideline consists of 50 conditions and about 200 verification points. The requirements deal with the internal organzation and the output. By order of the Dutch government the IVA, a Dutch institute for social research, has recently investigated if this certification leads to a sufficient guarantee for appropriate occupational safety and health care. By means of a large number of discussions and workshops, the IVA has investigated how OHS, employees, employers, insurance companies and others judge the quality management. In this study, the current method of certification turned out to produce insufficient incentives for quality improvement. None of the involved parties turned out to be satisfied with the current system. The fundamental problem of this certification system can be summarized as follows. The requirements prescribe a quality management system in conformity with ISO, but they also contain a lot of organization rules, much more than ISO. It is this degree of specification that, if practiced slavishly, leads to an output that is not able to satisfy the needs and demands of employers, employees and government. There are no rules with regard to this output, but only to the process, e.g. the way an advice has been brought about. In this paper, we show how the current certification system is working, how this system has been evaluated, and what criticisms have been uttered. We also indicate how we might achieve a real improvement of quality management in prescribing much less details about the OHS internal organization, and in demanding employers and employees to make clear agreements about the desired OHS output and to monitor carefully if the agreed output quality has been achieved.     

肝郁痰凝型乳腺癌的钼靶X线表现及病理分析

目的：研究肝郁痰凝型乳腺癌的钼靶X线影像特点，探讨其病理基础。方法：观察41例中医证型为肝郁痰凝型、术后病理检查结果为乳腺癌患者的钼靶X线影像表现，对其病理学基础进行分析。结果：41例肝郁痰凝型乳腺癌中，乳腺类型以致密型及混合型居多（占78％）。异常血管征及透环征出现频率较高（占80％以上）。腋淋巴结转移出现频率偏低（占12％）。结论：（1）肝郁痰凝型乳腺癌患者，乳腺密度多偏高，可能与较多发生在绝经期前有关。（2）肿瘤周围透亮环征象及异常血管征象出现频率较高，表明此型患者肿块周围脂肪代谢异常较为普遍及血管生长刺激因子分泌较多。（3）腋窝淋巴结转移者所占比例较小，可能是由于此类患者多属于癌变早、中期，相对气血不足或脾肾虚弱等正虚表现不明显。     

中心静脉导管胸腔留置治疗胸腔积液

目的评价中心静脉导管留置治疗胸腔积液的疗效。方法257例胸腔积液患者分为两组，治疗组207例，应用胸腔留置中心静脉导管治疗；对照组50例，常规胸穿抽液治疗，观察并比较不同治疗方法的疗效、并发症等指标。结果两组对比多项指标差异有显著性（P〈0．05）。结论采用中心静脉导管治疗胸腔积液可减少胸穿次数、降低反应，提高治愈率。     

Antibodies to diphtheria, tetanus and pertussis in infants before and after immunization with DTP (Triple Antigen) vaccine

Objective : To determine antibody levels to the Australian manufactured combined diphtheria, tetanus and pertussis (DTP) vaccine (Triple Antigen, CSL Ltd) in infante before and after their primary immunization course.
Methodology : Serosurvey (antibody prevalence study) in two groups: infants aged 5-9 weeks who had not received any immunizations ( n = 25), and infants aged 7-10 months who had received two ( n = 25) or three immunizations ( n = 57) with DTP, sampled from infants attending the Royal Children's Hospital, Melbourne, either as inpatients or outpatients between February and April 1993. The immunization history for each infant was determined from hospital records, the parent-held child health record, or the local council or family doctor who immunized the infant.
Results : Enzyme immunoassay (EIA) of antibodies to diphtheria and tetanus showed all infants to have adequate protective levels after two or three vaccinations (£0.01 IU/mL). All subjects who had received all three DTP vaccinations had detectable antibody to at least one pertussis antigen. Antibodies to the pertussis antigens filamentous haemagglutinin and pertussigen (pertussis toxin) were comparable to levels determined for whole cell pertussis vaccines used elsewhere in the world. EIA-determined antibodies to pertussis agglutinogen type 2 and agglutinogen type 3 showed substantially higher geometric mean titres when results for pre-immunization and post-immunization subjects were compared.
Conclusions : These data show that the Australian manufactured DTP vaccine has immunogenic properties similar to those of vaccines used elsewhere, and that antibody concentrations following immunization are at levels consistent with efficacy.     

Excision of a recurrent mediastinal cyst through mid sternotomy with high thoracic epidural anesthesia as the sole anesthetic—A case report

Conclusion Our case report highlights the possibility of tackling mediastinal, pericardial and pleural problems with regional anesthesia alone even if the surgery requires opening of the pleura.     

公共产品价格机制及价格约束分析

公共产品涉及千家万户的切身利益，近10多年来，部分公共产品价格变化又多以超过国民经济发展速度提高，怎样正确认识和判断其价格的合理性，具有十分重要的现实意义。本文分析了我国公共产品的价格类型，定价机制，阐明了我国公共产品的价格约束制度构建的主要内容，希望为政府及相关部门工作提供有益的帮助。     

PBL在病原生物与免疫学教学中的实践

目的探讨病原生物与免疫学教学中开展PBL教学的效果。方法对照组采用传统的教学方法，实验组采用PBL教学方法，通过问卷调查、考试成绩综合分析教学改革效果。结果实验班绝大多数学生接受并欢迎PBL教学模式，并在自学能力、理解能力、分析解决问题能力等方面得到明显的提高。结论PBL教学方法优于传统的教学方法，能有效提高病原生物与免疫学教学质量。