妊娠高血压综合征孕妇血浆一氧化氮和内皮素的变化及其意义

目的：探讨一氧化氮（ＮＯ）和内皮素（Ｅｎｄｏｔｈｅｌｉｎ，ＥＴ）在妊高征发病中的变化及其病理意义。方法：用分光光度法和放射免疫法分别定量检测正常妊娠３０例（对照组）和妊高征３７例（妊高征组）血浆ＮＯ和ＥＴ的变化。结果：妊高征组血浆ＮＯ水平低于对照组（Ｐ＜０．０１），ＥＴ水平则高于对照组（Ｐ＜０．０１）；妊高征组分娩前后相比，ＮＯ水平分娩后升高（Ｐ＜０．０１），ＥＴ水平则下降（Ｐ＜０．０１），ＮＯ、ＥＴ呈显著负相关（Ｐ＜０．０１），ＮＯ、ＥＴ与平均动脉压均有显著相关性（Ｐ＜０．０１）。结论：ＮＯ与ＥＴ在妊高征的发病机制中有重要作用，ＥＴ／ＮＯ失衡可以反映妊高征的病变程度，其病理变化在某种程度上呈可逆性。     

Otoacoustic emissions as a screening test for hearing impairment in children recovering from acute bacterial meningitis

OBJECTIVES: To study the efficacy of otoacoustic emissions (OAEs) as a screening test for hearing impairment in children with acute bacterial meningitis. Hearing tests were performed before discharge from the hospital in an attempt to improve coverage and avoid delays in the diagnosis of postmeningitic hearing loss. METHODS: Children with bacterial meningitis were recruited from 21 centers. In the 48 hours before discharge from the hospital, all patients underwent a thorough audiologic assessment consisting of transient evoked OAEs, auditory brainstem responses (ABRs), otoscopy, and tympanometry. Hearing loss was defined as ABR threshold >/=30 dB. The results of OAE screening were compared with the gold standard of ABR threshold. RESULTS: Of 124 children recruited, we were able to perform both OAEs and ABRs on 110 children. Seven (6.3%) of the 110 children had ABR threshold >/=30 dB; 2 had sensorineural hearing loss and 5 had conductive hearing loss. At follow-up, hearing loss persisted in both cases of sensorineural hearing loss and no new cases were identified. All 7 children with hearing loss failed the OAE screening test. Ninety-four children with normal hearing thresholds passed the test, and 9 failed. Thus, the screening test had a sensitivity of 1.00 (95% confidence interval, 0.59 to 1.00), a specificity of 0.91 (0.85 to 0.97), a positive predictive value of 0. 44 (0.20 to 0.70), and a negative predictive value of 1.00 (0.96 to 1.00). CONCLUSIONS: OAE screening in children recovering from meningitis was found to be feasible and effective. The test was highly sensitive and reasonably specific. Inpatient OAE screening should allow early diagnosis of postmeningitic hearing loss and prompt auditory rehabilitation.     

利用"分层法"评价中药复杂体系药效时有关权重设立的讨论

本文讨论了以分层法进行中药药效评价时权重设立的问题，主要由以下几部分组成：1．建立递阶层次结构；2．构造两两比较判断矩阵；3．计算单一准则下元素的相对权重；4．计算各层元素的组合权重。由于中药作用具有多途径、多靶点的特性，因此评价过程中权重的设立就占有重要位置。它直接影响对被评价对象药效作用的评判。全面解决中药作用多途径、多靶点药效学评价的数学方法，客观量化的评价中药的综合药效，是中药现代化进程中一个值得研讨的命题。     

Modulation of triceps surae H-reflexes as a function of the reflex activation history during standing and stepping

The facilitatory effectiveness of spindle afferent feedback is controlled by modulation of segmental reflex excitability such that the level of muscle activation is appropriate for the task. Phase-dependent modes of reflex modulation have been well-characterized. We hypothesized that segmental reflex excitability of the triceps surae was also modulated in a manner associated with the activation history of the spindle afferents and the segmental reflex pathway during isometric contractions, standing and stepping. In the first experiment. pairs of soleus (S) H-reflexes were evoked 80 ms apart with equal strength stimuli at rest and while subjects isometrically contracted their S against loads of 10%. 20%. and 50% of their maximum voluntary efforts. The percent depression of the second H-reflex relative to the first was used as a measure of the effect of reflex activation history. At rest, the second H-reflexes were depressed an average of 73% relative to the first. The degree of depression was progressively reduced as the plantarflexion torque increased. In the second experiment, paired H-reflexes were obtained from the S and medial (MG) and lateral gastrocnemii (LG) muscles while subjects were standing and during the stance phase of step initiation. The degree of depression of the second H-reflex during standing ( > 78%) was similar in magnitude to that produced at rest in Experiment I. At the end of the stance phase of stepping. depression of the second H-reflex of all three muscles was reduced to less than 25%. We conclude that the segmental reflex excitability is modulated as a function of the reflex activation history during these tasks.     

穿透性角膜移植术治疗坏死性基质角膜炎23例

目的:探讨穿透性角膜移植术(penetratingkeratoplasty,PKP)治疗坏死性基质角膜炎(necrotizingstromalkeratitis)的手术适应证及其临床效果。方法:按照Holland等的HSK新分类法,选择确诊坏死性基质角膜炎患者,予以局部及全身药物治疗。对病情不能控制,药物治疗无效的患者22例(23眼),其中角膜溶解穿孔3眼,用新鲜角膜组织行穿透性角膜移植术,并随访观察术后疗效。结果:随访3mo～3a,22例(23眼)中,术后视力提高者18眼,其中矫正视力达到0.1～0.5者12眼,0.05～0.1者6眼;无改善者5眼。角膜植片透明17眼,半透明2眼,植片混浊4眼,植片透明率为74%。术后3眼植片发生排斥反应,3眼原发病灶复发。2眼术后因排斥反应及原发病灶反复发作,植片完全混浊,行2次角膜移植术。结论:对坏死性基质角膜炎患者,药物保守治疗无效、角膜坏死穿孔或行将穿孔,及时用新鲜角膜组织行穿透性角膜移植术治疗,不仅能控制炎症,缩短病程,而且能保存眼球,恢复部分视力,因此具有重要临床应用价值。     

做公立医院产权制度改革的促进派

经过数年来政府各有关部委的协商努力，医疗卫生各界人士付出了相当的摩擦成本和交易成本，特别是在抗击非典战役的洗礼后，卫生部新领导的新思路发挥指导作用，公立医院的产权制度改革方向终于明确了。卫生部医政司吴明江司长在全国政协举行的一次研讨会上，就医院产权制度改革发表重要谈话，记者在《健康报》     

长期雾化吸入硝酸甘油对高肺血流大鼠肺动脉压力及肺血管结构重建的影响

目的探讨长期雾化吸入硝酸甘油对高肺血流大鼠肺动脉压力、肺血管结构的作用及其机制。方法24只健康雄性Wistar大鼠随机分为对照组、分流组和吸入组。对分流组和吸入组大鼠开腹行腹主动脉-下腔静脉分流术,12周后两组大鼠分别雾化吸入生理盐水和硝酸甘油3周。以右心导管法测定肺动脉压,颈动脉插管测定体循环压,检测右心室肥厚,观测肺血管显微及超微结构变化,用免疫组织化学法检测大鼠肺动脉人类尾加压素Ⅱ(hUⅡ)的表达。结果分流组大鼠肺动脉平均压(PAMP)和右心室/左心室 室间隔重量比值(RV/LV S)明显高于对照组(P<0.01),且分流组大鼠肺小血管肌化程度明显增强(P<0.01),中、小型肺肌型动脉相对厚度(RMT)增加,肺动脉内皮细胞和平滑肌细胞hUⅡ表达明显增强。吸入组大鼠mSBP未受影响,PAMP明显低于分流组(P<0.01),RV/(LV S)高于对照组(P<0.01),但与分流组比较差异无显著性(P>0.01),吸入组大鼠肺小血管肌化程度明显改善,小型肺肌型动脉RMT及小型肺动脉内皮细胞和平滑肌细胞hUⅡ减少。结论长期雾化吸入硝酸甘油可缓解高肺血流量所致肺动脉高压和肺血管结构的重建,其对肺动脉内皮细胞和平滑肌细胞hUⅡ表达的抑制作用,可能参与高肺血流量所致肺血管结构重建和肺动脉高压的调节。     

The role of laparoscopy in the management of suspected recurrent pediatric hernias

BACKGROUND: This report examines recurrent pediatric groin hernias and the role of diagnostic laparoscopy in the management of these recurrences. METHODS: A chart review of 19 children presenting with recurrent hernias was performed, analyzing the type of primary hernia, nature of recurrence, preexisting medical conditions, surgical complications at primary repair, and time to recurrence. Diagnostic laparoscopy (DL) was used during the remedial repair of the last nine patients. RESULTS: Seventeen indirect hernias were repaired during the primary repair, and 1 femoral hernia was identified. In one child, no inguinal hernia was identified at the initial operation. Overall, 11 recurrences were found to consist of indirect sacs, and 4 were found to have attenuation of the inguinal floor. Four additional recurrences were found to be femoral hernias. In only 1 patient was a wound factor (infection) thought to play a role in the recurrence. Diagnostic laparoscopy in 9 patients found 4 (44%) to have unsuspected intraoperative findings. Four femoral hernias were identified (3 with unsuspected contralateral femoral hernias). Additionally, 1 unsuspected recurrence of an indirect sac was identified. CONCLUSIONS: Laparoscopy accurately identifies the nature of the defect in children with recurrent groin hernias, detecting unsuspected contralateral indirect, direct, or femoral hernias in 44% of those undergoing laparoscopy.