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目的探讨小儿血管迷走性晕厥(VVS)的诊断及防治方法。方法分析1999-10—2004-07上海交通大学附属儿童医院开展斜板试验(TT)(倾斜角度80°,试验时间持续30min)的状况,对不明原因晕厥组74例及正常对照组54例进行前瞻性研究,对TT阳性组加做阳转阴试验,予以饮水试验,并随访。结果基础TT在不明原因晕厥组中阳性41例,阳性率为55.4%,对照组为0(P<0.001)。阳性组表现血管抑制型21例,心脏抑制型7例,混合型13例;28/41(68.3%)例患儿经饮水后阳转阴;随访38例TT阳性患儿,总有效率86.8%。结论TT对诊断小儿血管迷走性晕厥有较高的敏感性(55.4%)和特异性(100%)。阳转阴试验为防治小儿血管迷走性晕厥提供了理论和实验依据,饮水试验是一种简单有效可行的防治措施。     

蛋白酶体抑制剂PS-341对U266细胞凋亡和多种细胞因子表达影响的研究

目的:探讨蛋白酶体抑制剂PS-341(bortezomib)诱导多发性骨髓瘤细胞株U266细胞凋亡时对IL-6、IL-1β和SCF细胞因子表达的影响.方法:用含15?S的RPMI1640培养液体外培养U266细胞,分别用0、50、100、150、200 nmol/L的PS-341干预U266细胞4 h后收集,荧光显微镜观察细胞凋亡,Annexin V-FITC/PI双染法流式细胞术(FCM)检测细胞凋亡率的变化,反转录聚合酶链反应(RT-PCR)分析U266细胞IL-6、IL-1β和SCF三种细胞因子表达的改变.结果:荧光显微镜和FCM发现PS-341以浓度依赖方式诱导U266细胞凋亡;PS-341明显抑制U266细胞IL-6、IL-1β和SCF的表达(P＜0.05);对IL-6和SCF的抑制与PS-341浓度成正相关,对IL-1β的抑制在PS-341浓度为0～150 nmol/L时成正比关系,当浓度大于150 nmol/L时差异无显著性.结论:蛋白酶体抑制剂PS-341诱导U266细胞凋亡时明显抑制其IL-6、IL-1β和SCF的表达,是有效治疗MM的机制之一.     

我院临床药学新进展

医院药学服务是在临床药学工作的基础上发展起来的，与传统的药物治疗有很大的区别。其含义是药师应用药学专业知识向公众（包括医护人员、患者及家属）提供直接的、负责任的、与药物使用有关的服务，以期提高药物治疗的安全性、有效性和经济性，实现改善和提高人类生命质量的理想目标。我院于1995年被青海省卫生厅评审为二级甲等医院，现有医护人员335人，其中药剂人员为37人，占全部医护人员的11．04％。     

新生儿局部脑组织氧检测的多中心研究

Objectives To understand the value of measuring neonatal cerebral regional oxygen ‘saturation(rSO2)using near infrared spectroscopy (NIRS) in assessing cerebral oxygenation,to establish the normal range of neonatal cerebral rSO2,and to collect data of the changes of cerebral rSO2 under certain disease status.Methods Nine large hospitais participated in the multicenter randomized clinical trial from Jan 2007 to Apr 2008.Using the NIRS human tissue oximeter(TSAH-100)independently developed in China.tIle cerebral rSO2 of 223 normal full-term and 95 otherwise healthy preterm neonates without any stmcial disease,Was detected at 1.2 and 3 days after birth,respectively.The cerebral rSO2 of 102 neonates with diseases which may affect the cerebral oxygenation.Was also detected during the severe phases.The pulse oxygen saturation(SpO2)measured at the finger tip,and also the arterial oxygen saturation(SaO2) measured by blood gas analysis,which could indicate the oxygen supply of the whole body,were obtained simultaneously.The correlations among cerebral rSO2,putse SpO2 and arterial SaO2 were analyzed.Results (1)The cerebral rSO2 of the normal full-term neonates wag(62±2)%.Cerebral hypoxia Was deftned as rSO2 lower than 58%. The cerebral rSO2 of the normal full-terms was steady at 1, 2 and 3 days after birth respectively, without any significant differences among them (F = 0. 610, P >0. 05 ). The cerebral rSO2 of the neonates with diseases was ( 55 + 7 ) %, which was significantly lower that that of the normal full-term neonates (t = 15.492,P <0. 05). (2) The cerebral rSO2 was positively correlated with the SpO2(r =0. 74,P < 0. 01 ) and the SaO2 ( r = 0. 71, P < 0. 01 ). ( 3 ) Under some special diseases, the changes of cerebral relatively low hemoglobin concentration, the cerebral rSO2 was significantly low (50%～58% ), but the cerebral rSO2 was lagged as compared with that of pulse SpO2. Especially, during the severe phases of 6 cases with multi-organ failure, the SpO2 and the cerebral rSO2 were both significantly low (55%～80% for SpO2, and 44%～50% for cerebral rSO2 ) ; when the diseases were alleviated, although the SpO2 recovered phases of serious hypoxic-ischemic encephalopathy (HIE), the cerebral rSO2 significantly increased to 70%～72%, which was significantly higher than the normal value (62%). Condusions The range of cerebral rSO2 of the normal full-term neonates was (62 + 2) %. Cerebral oxygenation can be externally indicated by the rSO2 noninvasively and continuously measured by NIP, S, which was positively correlated with traditional pulse SpO2 and arterial SaO2. In some special diseases, the rSO2 measured by NIRS can be helpful for clinical diagnoses and treatments.     

应用Delphi法筛选学习型医院的核心特征

目的筛选出学习型医院的核心特征,为医院创建学习型医院提供参考标准。方法确立25个学习型医院核心特征征询项,采用Delph i法对20名专家进行两轮问卷征询,反复征询专家意见至专家意见趋于一致。结果专家征询两轮的有效回收率分别为95.2%、100%。两轮调查总体指标协调系数分别为0.275、0.353(P<0.001)。结论按照同时满足重要性赋值均数>3.50、满分频率>51%、变异系数<0.25三项指标的标准,有15个征询项被筛选为学习型医院核心特征。     

佛山市350821名新生儿苯丙酮尿症筛查回顾性分析

目的:了解佛山市新生儿苯丙酮尿症的发生率及治疗随访情况。方法:用荧光法检测滤纸干血斑苯丙氨酸浓度。苯丙酮尿症的筛查切值为2 mg/dl,对苯丙氨酸浓度高于切值者,做苯丙氨酸、BH4负荷试验,尿喋呤谱分析,确定苯丙酮尿症类型。并对苯丙酮尿症患儿治疗随访。结果:筛查佛山市350 821名新生儿,阳性9例,筛查阳性率为1/38 980,除1例失访外,余8例患儿体格及智能发育均正常。结论:佛山市苯丙酮尿症的发生率明显低于国内平均水平,早期诊断、医院、社会、家属、患儿共同努力是改善苯丙酮尿症预后的关键。     

护理干预对老年性痴呆患者日常生活能力的影响

目的:改善老年性痴呆患者的认知障碍,提高其日常生活能力.方法:对32例老年性痴呆住院患者进行认知功能训练1年,包括心理护理、认知障碍的护理、日常生活能力的护理、安全护理.干预前后采用日常生活能力量表(activities of daily living,ADL)进行评定.结果:干预后,患者的ADL得分明显降低(P＜0.05).结论:对老年痴呆患者有效地护理干预,可提高患者的日常生活能力,延缓病情的进展.     

运动神经元病的研究进展

运动神经元病（motor neuron disease，MND）是以损害脊髓前角、脑干脑神经运动核和锥体束为主的一组慢性进行性变性疾病。临床以上运动神经元或／和下运动神经元损害引起的瘫痪为主要表现。近年有关自身免疫障碍的证据逐年增多，但免疫治疗效果尚不肯定。本文综述了运动神经元病的发病机制及诊治进展。