仙戟汤对甲状腺功能低下的动物实验及临床观察

目的探讨仙戟汤对甲状腺功能低下的疗效及机理.方法用双盲法随机分组,设仙戟汤治疗组(31例)与对照组(甲状腺素片33例),观察仙戟汤对甲状腺功能低下的治疗情况;并进行了动物实验,观察治疗前后的TSH、T3、rT4、T4的含量变化,自身比较,并与正常对照组相比.结果临床结果仙戟汤组总有效率87.10%,甲状腺素组总有效率96.96%,两者相比无明显差异(P＞0.05);动物实验研究结果显示,仙戟汤对肾阳虚症家兔具有保护作用.结论仙戟汤治疗甲状腺功能低下有较好的疗效,是一种治疗甲状腺功能低下的良好复方中药制剂.     

Effects of Xinjining(心悸宁) Extract on Inward Rectifier Potassium Current in Ventricular Myocytes of Guinea Pig

<正>Objective:To study the effect of Xinjining extract(心悸宁,XJN) on inward rectifier potassium current(I_(K1)) in ventricular myocyte(VMC) of guinea pigs and its anti-arrhythmic mechanism on ion channel level. Methods:Single VMC was enzymatically isolated by zymolisis,and whole-cell patch clamp recording technique was used to record the I_(K1) in VMC irrigated with XJN of different concentrations(1.25,2.50,5.00 g/L;six samples for each).The stable current and conductance of the inward component of I_(K1) as well as the outward component of peak I_(K1) and conductance of it accordingly was recorded when the test voltage was set on -110 mV.Results:The suppressive rate of XJN on the inward component of I_(K1) was 9.54%±5.81%,34.82%±15.03%,and 59.52%±25.58%with a concentration of 1.25,2.50,and 5.00 g/L,respectively,and that for the outward component of peak I_(K1) was 23.94%±7.45%,52.98%±19.62%,and 71.42%±23.01%,respectively(all P0.05).Moreover, different concentrations of XJN also showed effects for reducing I_(K1) conductance.Conclusion:XJN has inhibitory effect on I_(K1) in guinea pig's VMC,and that of the same concentration shows stronger inhibition on outward component than on inward component,which may be one of the mechanisms of its anti-arrhythmic effect.     

Increased frequency of cystic fibrosis deltaF508 mutation in bronchiectasis associated with rheumatoid arthritis.

This study investigated the clinical characteristics and the possible involvement of the cystic fibrosis transmembrane conductance regulator (CFTR) gene in patients with symptomatic diffuse bronchiectasis (DB) associated with rheumatoid arthritis (RA). Twenty-six patients with both RA and DB (group RA+DB) and control groups of 29 consecutive patients with RA but no bronchiectasis (group RA) and 29 patients with symptomatic DB of unknown origin (group DB) were prospectively studied. Among the patients of the RA+DB group, four (15.4%) were heterozygous for the CFTR gene deltaF508 mutation, whereas no deltaF508 mutation was found in patients of the RA and the DB groups (both, p<0.05). This frequency of deltaF508 mutation was also higher than the expected frequency (2.8%) in the general European population (p<0.04). Sweat chloride values and nasal potential differences were normal in three out of four patients carrying the deltaF508 mutation. In the RA+DB group, those with deltaF508 mutation had more frequent chronic sinusitis (p<0.05), a trend toward a more severe pulmonary involvement, and a lower value of nasal potential differences (p<0.01) whereas their rheumatic features had no particularity. In the RA+DB group, patients with adult-onset bronchiectasis (including two with deltaF508 mutation) had a greater reduction in total lung capacity (p<0.05) and lower nasal potential differences (p<0.005) than those with childhood-onset bronchiectasis. This study suggests a possible deleterious effect of the cystic fibrosis transmembrane conductance regulator mutated protein in the airways which may predispose to the development and severity of bronchiectasis in patients suffering from rheumatoid arthritis.     

触摸屏和PLC在钴机控制中的应用研究

介绍了触摸屏和可编程序控制器PLC在钴-60治疗机中的应用,简述了硬件组成和软件设计内容,此系统控制先进,运行稳定,具有一定的推广价值。     

德国医院管理体制对我国医院管理的启示

目的 比较中德两国在医院管理方面的差异.方法 通过亲身经历,对比分析两国在医院管理方面的不同.结果 德国医院管理体制和我国存在明显不同.结论 通过分析德国医院管理体制的特点,借鉴德国医院管理的先进经验,结合我国的国情和医疗现状,对于我国医院管理有着重要的现实意义.     

Lymphangiomyomatosis: CT, chest radiographic, and functional correlations

Eight patients with the diagnosis of lymphangiomyomatosis were evaluated with computed tomography (CT), chest radiography, and pulmonary function tests to determine the relationship between the extent of disease seen on imaging studies and functional status. Chest radiographic assessment included the subjective determination of disease extent and measurements of lung length and the arc of the right hemidiaphragm. Disease extent on CT scans was scored as a percentage of lung that was abnormal on the basis of visual assessment of the degree of cystic replacement of the lung parenchyma. Significant correlations were observed between CT scores and percentages of predicted forced expiratory volume in 1 second/forced vital capacity (r = -.92, P less than .002) and diffusing capacity of the lungs for carbon monoxide (r = -.80, P less than .017). No significant correlations were observed between subjective chest radiographic scores and pulmonary function tests, although measurements of lung length and percentage of predicted total lung capacity were correlated (r = .76, P less than .045). CT was more accurate than chest radiography in defining the presence and extent of parenchymal cysts and provided for greater morphologic-physiologic correlation. CT, particularly high-resolution CT, may be useful in the diagnosis and longitudinal evaluation of patients with this disease and may be more sensitive than pulmonary function tests in the early stages of lung damage.     

User involvement in clinical governance

Objectives  To investigate the involvement of users in clinical governance activities within Primary Care Groups (PCGs) and Trusts (PCTs). Drawing on policy and guidance published since 1997, the paper sets out a framework for how users are involved in this agenda, evaluates practice against this standard and suggests why current practice for user involvement in clinical governance is flawed and why this reflects a flaw in the policy design as much as its implementation.
Design  Qualitative data comprising semi-structured interviews, reviews of documentary evidence and relevant literature.
Setting  Twelve PCGs/PCTs in England purposively selected to provide variation in size, rurality and group or trust status.
Participants  Key stakeholders including Lay Board members ( n =12), Chief Executives (CEs) ( n = 12), Clinical Governance Leads (CG leads) ( n = 14), Mental Health Leads (MH leads) ( n = 9), Board Chairs ( n =2) and one Executive Committee Lead.
Results  Despite an acknowledgement of an organizational commitment to lay involvement, in practice very little has occurred. The role of lay Board members in setting priorities and implementing and monitoring clinical governance remains low. Beyond Board level, involvement of users, patients of GP practices and the general public is patchy and superficial. The PCGs/PCTs continue to rely heavily on Community Health Councils (CHCs) as a conduit or substitute for user involvement; although their abolition is planned, their role to be fulfilled by new organizations called Voices, which will have an expanded remit in addition to replacing CHCs.
Conclusions  Clarity is required about the role of lay members in the committees and subcommittees of PCGs and PCTs. Involvement of the wider public should spring naturally from the questions under consideration, rather than be regarded as an end in itself.     

乳腺增生病p53基因第6外显子突变检测

目的：探讨p53基因在乳腺癌发生早期的作用及早期诊断乳腺癌的分子病理指标。方法：用PCR－SSCP检测36例乳腺单纯性增生、31例不典型增生、30例乳腺癌中p53基因第6外显子突变，用DNA直接测序技术确定突变的碱基及其所在的密码子。结果：乳腺单纯性增生、不典型增生、乳腺癌中p53基因第6外显子的突变率分别为0、6．5％（2／31）、13．3％（4／30）。6个点突变均为碱基替换，其中4个发生于第192密码子（CAG→TAG），2个发生于第213密码子（CGA→TGA），两者均导致多肽链合成提前终止。结论：乳腺癌不典型增生中存在p53基因第6外显子突变，该突变可能在乳腺不典型增生发展到乳腺癌过程中起重要作用，可作为早期诊断乳腺癌的辅助指标。     

Association of the steroid synthesis gene CYP11a with polycystic ovary syndrome and hyperandrogenism

Biochemical data implicate an underlying disorder of androgen biosynthesis and/or metabolism in the aetiology of polycystic ovary syndrome (PCOS). We have examined the segregation of the genes coding for two key enzymes in the synthesis and metabolism of androgens, cholesterol side chain cleavage (CYP11a) and aromatase (CYP19), with PCOS in 20 multiply-affected families. All analyses excluded CYP19 cosegregation with PCOS, demonstrating that this locus is not a major determinant of risk for the syndrome. However, our results provide evidence for linkage to the CYP11a locus (NPL score = 3.03, p = 0.003). Parametric analysis using a dominant model suggests genetic heterogeneity, generating a maximum HLOD score of 2.7 (alpha = 0.63). An association study of 97 consecutively identified Europids with PCOS and matched controls demonstrates significant allelic association of a CYP11a 5' UTR pentanucleotide repeat polymorphism with hirsute PCOS subjects (p = 0.03). A strong association was also found between alleles of this polymorphism and total serum testosterone levels in both affected and unaffected individuals (p = 0.002). Our data demonstrate that variation in CYP11a may play an important role in the aetiology of hyperandrogenaemia which is a common characteristic of polycystic ovary syndrome.