对“红包”现象的深层思考

本文试将“红包”现象由表及里的进行剖晰.(1)红包现象林林总总,从3点着笔.①红包之“风乍起,吹皱一池春水”;②红包类别、特性;③医患复杂心态(各7种).(2)红包现象的危害;(3)红包的综合治理“八抓”(抓教育,正向导廉;抓道德,自律清廉;抓制度,规范保廉;抓案例,褒贬倡廉;抓经常,时时冷廉;抓监督,约束促廉;抓评价,准绳测廉;抓支部,牢牢固廉).     

异体硬脊膜桥接周围神经缺损的实验研究

探讨异体硬脊膜修复周围神经缺损的可行性。方法：采用狗的异体硬脊膜桥接缺损２ｃｍ的狗腓总神经，对照组仅切取２ｃｍ神经而不作处理。在术后不同时间段作大体观察、神经电生理检测、光镜利电镜检查。结果：再生神经纤维在管腔内呈纵行整齐排列Ｔ偕窬宋峤岣弧＝崧郏菏5验结果证实异体硬脊膜能成功地引导周围神经再生。     

红色素基因RFLP及其与情感性精神病关系的研究

以红色素基因全长ｃＤＮＡ作探针，２０例正常人，２６例双相型情感性精神病患者进行ＲＦＬＰ分析。ＳａｃＩ酶切显示：部分正常人和部分患者基因组ＤＮＡ产生的７．５ｋｂ，４．８ｋｂ，４．５ｋｂ呈多态性改变的片段。正常人具多态改变的占４５％，患者为４６．２％，按Ｘ染色体数计，正常人出现７．５ｋｂ限制性片段的频率为１４．３％，患者为３２．４％，但两者差异不显著。     

高血压鼠局部脑梗塞后脑超微结构改变动态观察

本文选用肾血管性高血压鼠(RHR)复制大脑中动脉闭塞(MCAO)模型,其后2h至7d分8次取不同区域脑组织进行透射电镜动态观察超微结构的改变。显示局部脑梗塞后发生全脑性改变,其损害程度和出现时间梗塞区最早,以坏死为主,呈完全不可逆性损害;边缘区稍后,主要是微血管塌陷和微血栓形成及部分脑细胞坏死,呈部分可逆性损害,远隔区和镜区最迟,以内皮和星形细胞水肿为主,呈可逆性损害,认为用RHR复制MCAO,更接近于高血压性脑血管损害基础上发生脑梗塞的临床病理改变,全脑超微结构的动态性改变中微血管损害起着重要作用。     

Computerized follow-up of discrepancies in image interpretation between emergency and radiology departments

Radiographs are ordered and interpreted for immediate clinical decisions 24 hours a day by emergency physicians (EP’s). The Joint Commission for Accreditation of Health Care Organizations requires that all these images be reviewed by radiologists and that there be some mechanism for quality improvement (QI) for discrepant readings. There must be a log of discrepancies and documentation of follow up activities, but this alone does not guarantee effective Q.I. Radiologists reviewing images from the previous day and night often must guess at the preliminary interpretation of the EP and whether follow up action is necessary. EP’s may remain ignorant of the final reading and falsely assume the initial diagnosis and treatment were correct. Some hospitals use a paper system in which the EP writes a preliminary interpretation on the requisition slip, which will be available when the radiologist dictates the final reading. Some hospitals use a classification of discrepancies based on clinical import and urgency, and communicated to the EP on duty at the time of the official reading, but may not communicate discrepancies to the EP’s who initial read the images. Our computerized radiology department and picture archiving and communications system have increased technologist and radiologist productivity, and decreased retakes and lost films. There are fewer face-to-face consultations of radiologists and clinicians, but more communication by telephone and electronic annotation of PACS images. We have integrated the QI process for emergency department (ED) images into the PACS, and gained advantages over the traditional discrepancy log. Requisitions including clinical indications are entered into the Hospital information System and then appear on the PACS along with images and readings. The initial impression, time of review, and the initials of the EP are available to the radiologist dictating the official report. The radiologist decides if there is a discrepancy, and whether it is category I (potentially serious, needs immediate follow-up), category II (moderate risk, follow-up in one day), or category III (low risk, follow-up in several days). During the working day, the radiologist calls immediately for category I discrepancies. Those noted from the evening, night, or weekend before are called to the EP the next morning. All discrepancies with the preliminary interpretation are communicated to the EP and are kept in a computerized log for review by a radiologist at a weekly ED teaching conference. This system has reduced the need for the radiologist to ask or guess what the impression was in the ED the night before. It has reduced the variability in recording of impressions by EP’s, in communication back from radiologists, in the clinical follow-up made, and in the documentation of the whole QI process. This system ensures that EP’s receive notification of their discrepant readings, and provides continuing education to all the EP’s on interpreting images on their patients.     

Effects of Polyethyleneglycol Chain Length and Phospholipid Acyl Chain Composition on the Interaction of Polyethyleneglycol-phospholipid Conjugates with Phospholipid: Implications in Liposomal Drug Delivery

Purpose. The purpose of this study was to investigate polyethyleneglycol(PEG)-phosphatidylethanolamine(PE) conjugate interaction with phospholipid bilayers, in an attempt to explain the dependence of liposome circulation time on formulation. Methods. Differential scanning calorimetry, electron microscopy, dynamic light scattering and NMR were the major methods used in the study. Results. Mixtures of PEG-phospholipid conjugates and phosphatidylcholine existed in three different physical states: a lamellar phase with components exhibiting some miscibility, a lamellar phase with components phase separated, and mixed micelles. Beyond 7 mol% of PEG(l,000–3,000)-dipalmitoyl phosphatidylethanolamine (DPPE), and 11 mol% PEG(5,000)-DPPE in dipalmitoyl phosphatidylcholine (DPPC), a strong tendency towards mixed micelle formation was observed. All concentrations of PEG(12,000)-DPPE and PEG(5,000)-DPPE beyond 8 mol% formed phase separated lamellae with phosphatidylcholine. Decreasing the acyl chain length from C_16:0 to C_14:0 caused a decrease in tendency towards micelle formation and phase separation. These tendencies increased upon increasing acyl chain length to C_18:0. Phase separation was at least partly due to PEG chain-chain interaction. This was supported by an increased fraction of PEG chains exhibiting a fast NMR transverse relaxation in DPPC/PEG(5,000)-DPPE mixtures as compared to that in distearoyl phosphatidylcholine (DSPC)/PEG(5,000)-dioleoyl-PE (DOPE). Conclusions. These phenomena are discussed in relation to both bilayer and steric stabilization of liposomes, and the lack of prolonged circulation with certain formulations is discussed.     

高血压病患者左心室舒张功能新指标测定

目的观察左心室舒张功能新指标测定的意义。方法应用脉冲多普勒技术测定高血压病Ⅰ期（20例）、高血压病伴左心室肥厚（22例）、高血压病伴有房颤（14例）及25例正常人二尖瓣口及瓣下1cm、2cm、3cm左心室内不同部位的舒张早期充盈速度（E0、E1、E2、E3），计算E1／E0、E2／E0、E3／E0比值。结果高血压病人E3显著降低，E3／E0与自身E2／E0相比有显著差异（P＜0．01），且E3／E0与常规测定舒张功能指标E／A法有良好的相关性。高血压病Ⅱ组与高血压病Ⅰ组相比，舒张功能障碍更为明显。结论高血压病早期即有左心室舒张功能减退，并出现于心室功能障碍之前，且左心室舒张功能减退随心肌受损加重而明显。E3／E0法是反映左心室舒张功能障碍的良好指标，可弥补E／A法的不足。