大剂量甲基强的松龙冲击疗法治疗急性视神经炎临床疗效观察

目的：评估大剂量甲基强的松龙冲击疗法治疗急性视神经炎的疗效． 方法：应用大剂量甲基强的松龙冲击疗法治疗急性视神经炎30例．并与常量地塞米松疗法进行了病例对照观察。 结果：治疗组与对照组比较篷异有显著性(P<0.01)，治疗组见效快、副作用少、安全可靠。 结论：大剂量甲基强的松龙冲击疗法是治疗急性视神经炎的更为有效方法． （中华眼底病杂志，1996，12：186-187）     

慢性活动性肝炎中单核性细胞超微形态研究

经电镜观察,慢活肝中主要为淋巴细胞及单核巨噬细胞浸润。淋巴细胞分3型,通过4种方式与肝细胞接触,可能代表杀伤肝细胞的动态过程。与肝细胞接触的主要为起细胞毒作用的T_8~+Ⅱ型淋巴细胞及单核巨噬细胞。多数T_4~+淋巴细胞为Ⅰ型淋巴细胞,可能为T辅助细胞。在肝细胞损伤中,淋巴细胞及单核巨噬细胞均起重要作用。     

我院开展住院医师制度化培养的方法与体会

我院开展住院医师制度化培养的方法与体会沈昭在卢玉敏附属甘泉医院科教处（上海，２０００６５）关键词住院医师；制度化培养；方法中图号Ｒ１住院医师培养是一项有关卫生事业发展与队伍建设的大事，是培养临床医学人才，提高我国医疗水平的重要环节和措施［１—２］。我...     

联合国驻利比里亚维和部队二级卫勤保障中航空医疗后送的组织实施

目的 通过伤病人员空运后送的组织实施,了解联合国维和部队快速空中转运系统与卫勤保障. 方法 2004年12月至2005年7月,中国维和医疗分队在非洲执行了联合国利比里亚维和行动中的二级卫勤保障任务.利用联合国在任务区建立的陆空一体化机动后勤保障力量,我们对63例伤病员组织实施了航空医疗后送.通过与维和战区小型军事移动通信单位联络,经卫星远程通讯设施,用电话、传真、电子邮件等与任务区军事指挥、卫生、运输等部门联通.采取多国维和部队联军协调,联合行动,外军护卫,专人陪送,保障伤病员安全与生命.所有伤病员在后送前经严格对症治疗处理,病情稳定.空运机种为俄罗斯米-8通用型直升机和加拿大Duch-7固定翼飞机,采用固定的野战直升机场. 结果 全部伤病员无一例因空运后送死亡或病情加重. 结论 在维和行动中,多国维和部队合作实施安全高效的航空医疗后送伤病人员是新时期我军开展的一项新课题.在联合国维和行动卫勤保障体系框架下,注重联络、协调、理顺与任务区各相关部门关系,配合多国维和军兵种单元联军合作,可以实施高效快速的卫勤行动,提高保障的整体效能.利用维和卫勤保障锻炼部队,是培训和提高我军医务人员综合实战能力的极好时机.     

陈旧性髋臼骨折治疗进展

髋臼骨折是一种暴力机制复杂 ,移位方式多样 ,常伴有股骨头脱位 ,治疗困难的严重关节内骨折 ,常因处理不当而并发创伤性关节炎。目前国内外对于陈旧性髋臼骨折的治疗方法还存在一些不同看法 ,在此将已达成的共识与仍存在的分歧综述如下。1　治疗方法选择陈旧性髋臼骨折治疗的目的与其他关节内骨折一样 ,不仅是使股骨头回纳到髋臼负重区 ,并要恢复关节面的完整 ,尤其是髋臼负重面[1,2 ] 。过去曾采用牵引等非手术疗法 ,仅重视股骨头的复位 ,却很难使髋臼骨折达到理想复位 ,多数情况根本不可能。目前大多数学者认为除了以下几种情况外 ,陈旧性…     

中医药路在何方?

正方观点：力挺中医 “不能消灭、不能否定中医。” --钟南山（中田工程院院士） 钟南山指出，中医最大的特点是整体变化，而西医则更重视局部系统和器官。中医药能一直流行至今并受到广大老百姓的喜爱，肯定是有其疗效的。面对现今的“中医信任危机”，钟南山提出建议：一是抵制江湖医生。江湖医生中很多人都以祖传秘方等面目出现，其实是在歪曲中医药形象；二是抵制假冒伪劣中药，特别是重金属等不良物质含量超标问题；三是强烈呼吁中医药加快现代步伐，用现代医学方法来研究。中医药要发展，就需要利用现代医学方法，过去我们在这方面强调不够。但是，我们不能否定延续几千年的中医药，废除中药的言论是不负责任的。     

Propofol and Sevoflurane in Subanesthetic Concentrations Act Preferentially on the Spinal Cord: Evidence from Multimodal Electrophysiological Assessment

Background: Animal experiments in recent years have shown that attenuation of motor responses by general anesthetics is mediated at least partly by spinal mechanisms. Less is known about the relative potency of anesthetic drugs in suppressing cortical and spinal electrophysiological responses in vivo in humans, particularly those, but not only those, connected with motor responses. Therefore, we studied the effects of sevoflurane and propofol in humans using multimodal electrophysiological assessment.

Methods: We studied nine healthy volunteers in two sessions during steady state sedation with 0.5, 1.0, and 1.5 [mu]g/l (targeted plasma concentration) propofol or 0.2 and 0.4 vol% (end-tidal) sevoflurane. Following a 15-min equilibration period, motor responses to transcranial magnetic stimulation and peripheral (H-reflex, F-wave) stimulation were recorded, while electroencephalography and auditory evoked responses were recorded in parallel.

Results: At concentrations corresponding to two thirds of C50 awake, motor responses to transcranial magnetic stimulation were reduced by approximately 50%, H-reflex amplitude was reduced by 22%, F-wave amplitude was reduced by 40%, and F-wave persistence was reduced by 25%. No significant differences between sevoflurane and propofol were found. At this concentration, the Bispectral Index was reduced by 7%, and the middle-latency auditory evoked responses were attenuated only mildly (Nb latency increased by 11%, amplitude PaNb did not change). In contrast, the postauricular reflex was suppressed by 77%.     

Risk of Respiratory Complications and Wound Infection in Patients Undergoing Ambulatory Surgery: Smokers versus Nonsmokers

Background: Smoking is considered to be a risk factor for patients undergoing surgery and anesthesia, but it is unclear whether this is applicable to patients undergoing ambulatory surgery. The aim of this study was to determine the risk of respiratory complications and wound infection among smokers.

Methods: The authors studied a random selection of 489 adult patients undergoing ambulatory surgery. Smoking status was determined by self-report and confirmed with end-expired carbon monoxide analysis. The risk of respiratory complications (i.e., desaturation, cough, laryngospasm, bronchospasm, breath-holding, or apnea) and wound infection (i.e., wound redness or discharge +/- positive microbial culture, requiring antibiotic therapy) in smokers versus nonsmokers was ascertained. Odds ratios were estimated from multivariable logistic regression and adjusted for age, gender, body mass index, partner's smoking status, domiciliary smoking exposure, and extent and duration of surgery.

Results: Most smokers continued to smoke up until the day of surgery. Smokers had a higher rate of respiratory complications (32.8%vs. 25.9%; adjusted odds ratio, 1.71; 95% confidence interval, 1.03-2.84;P = 0.038) and wound infection (3.6%vs. 0.6%; odds ratio, 16.3; 95% confidence interval, 1.58-175;P = 0.019). Odds ratios comparing current plus ex-smokers with nonsmokers were of similar magnitude for most of these complications.     

缺锌和补锌对运动大鼠锌营养状况的影响

通过建立大鼠缺锌模型，观察缺锌及补锌对游泳大鼠血清、肝脏锌含量和五种含锌金属酶活性的影响。结果表明：（１）血浆锌浓度和碱性磷酸酶（ＡＫＰ）活性是评价机体锌缺乏的灵敏指标；（２）血浆ＡＫＰ活性同时也是评价运动大鼠锌缺乏的较好指标，而血管紧张素Ｉ转换酶、酸性α－Ｄ－甘露糖苷酶５－核苷酸酶等不太理想；（３）运动时，缺锌大鼠血浆锌金属酶活性多数变化剧烈，表明机体内环境遭受较大破坏。而补锌后上述指标均接近正常水平，说明适量补锌有助于改善机体缺锌状况，维持机体内环境的稳定