参加社会活动和锻炼对冠心病并发抑郁的影响1

目的：研究参加社会活动和锻炼对新兴工业化农村社区冠心病患者并发抑郁的影响。方法：对114例在我院就医、属三角镇户籍常住人口的冠心病（CHD）患者进行Zung量表（SDS量表）检测，同时调查其经济状况、健康习惯、参加社会活动和锻炼情况等。用SPSS13．0版统计软件进行统计分析。结果：抑郁发生率37．7％，女性44．3％（27／61）高于男性30．2％（16／53）。70岁以上者47．6％（30／63）高于70岁以下者25．5％（13／51）。缺少社会活动（几乎不参加社会活动）、缺少锻炼（几乎不锻炼身体）都抑郁发生率高，可能是冠心病并发抑郁的独立预测因素。结论：适度参加社会活动和锻炼对CHD患者并发抑郁可能有预防作用。     

应激相关因素对护士生活质量作用模型的理论构建和结构方程分析

目的应用结构方程分析研究应激相关因素对护士生活质量的影响机制。方法通过随机抽样,采用生活质量综合评定问卷、压力反应问卷、生活事件量表、特质应对方式问卷、领悟社会支持量表、艾森克人格问卷对405名护士进行调查,并应用结构方程分析方法对其作用机制进行探索。结果在5个理论可行的竞争模型中获取了最佳模型(CMINDF2.344;GFI0.928;AGFI0.891;CFI0.945;RMSEA0.060),即应激相关5因素(压力反应、生活事件、社会支持、应对方式和个性特征)中除应对方式外均能直接影响生活质量,而应对方式则以其他应激相关因素为中介对生活质量产生间接影响,这5个因素均可互为中介对护士生活质量产生间接作用。结论结构方程分析方法证实应激对护士生活质量的影响是一个交叉作用系统,在干预应激对护士生活质量的影响时应综合运用直接和间接方法。     

全院PACS／HIS中影像科室工作流程的优化

在PACS实施中，合理构建影像科室工作流程是关键环节。取消预约、等片，在专业级显示器上进行读片和书写检查诊断报告，集中登记和打印检查诊断报告等工作流程在文中得到阐述。     

护理诊断的进展

本文从护理诊断的概念与发展；护理诊断的目标与发展；护理诊断的分类与发展；护理诊断在我国的应用与发展以及如何作出护理诊断五个方面综述了护理诊断的发展过程及重要性。     

腹膜透析患者腹透液中细胞因子水平的研究

目的　研究不卧床持续性腹膜透析 (CAPD)患者腹透液中转移生长因子 β1 (TGF β1 )水平及影响因素对腹膜小分子物质清除功能的影响。方法　测定CAPD患者血浆中和腹透液中TGF β1 、IL 6、TNF、CRP(C反应蛋白 )水平 ;同时统计CAPD患者腹透液葡萄糖含量、交换量、次数、留腹时间及腹膜炎次数 ;计算CAPD患者KpT V、Cpcr。结果　CAPD患者血浆中IL 6、TNF、CRP水平均明显高于正常健康人 ,P <0 .0 5～ 0 .0 1;透析第 12月 (KpT V +Cpcr) 2较第 3月下降超过 10 %的CAPD患者其腹透液中TGF β1、IL 6、TNF、CRP、葡萄糖浓度、腹膜炎次数均较对照组明显升高 ,P <0 .0 5～ 0 .0 1;腹透液中TGF β1 与IL 6、TNF、CRP、腹透液中葡萄糖浓度呈正相关 ,P <0 ..0 5～ 0 .0 1,与腹膜炎次数无关 ;腹透液中CRP与葡萄糖浓度、腹膜炎次数呈正相关 ,P <0 .0 5～ 0 .0 1,与腹膜交换量、次数、留腹时间无关。结论　CAPD患者体内确实存在慢性炎症状态 ,其炎症标志性因子CRP与腹透液葡萄糖浓度、腹膜炎次数有关 ,CAPD患者腹膜物质转运功能丧失与TGF β1 、IL 6、TNF、CRP升高有关。     

动脉硬化性脑白质病的CT表现与临床分析

目的 :探讨动脉硬化性脑白质病的临床与CT表现特点。方法 :收集 10 0例动脉硬化性脑白质病的临床与CT资料进行综合分析。结果 :10 0例的CT表现为 :弥漫性脑白质低密度改变 ,主要分布在双侧脑室旁及半卵圆中心白质区 ,病灶多呈条带状及月晕状。合并脑萎缩 90例 ;脑梗塞 76例 ,其中 2 5例有大的梗塞灶 ,其余为腔隙性梗塞 ;脑出血 9例 ,其中位于壳核 5例 ,丘脑 3例 ,小脑 1例 ;有 15例伴发基底节区软化灶。增强扫描 8例 ,显示病灶无明显增强。结论 :动脉硬化性脑白质病是发生于老年人的缺血性脑血管病 ,高血压动脉硬化是其主要发病因素。     

Validation of the Taiwan Birth Registry using obstetric records.

BACKGROUND AND PURPOSE: Birth certificates are a major source of population-based data often used in maternal and child health research, but their value depends upon the level of accuracy of the data. The purpose of this study was to assess the validity of the birth registry data in Taiwan. METHODS: Obstetric records of a total of 2779 infants born at a municipal hospital in Taipei between 1995 and 1997 were abstracted and linked to the Taiwan Birth Registry (TBR). Concordance was presented by agreement percentages for various birth characteristics including gender, birth order, birth weight, and gestational age. Concordance was further assessed using Cohen's k and sensitivity/specificity for both birth weight and gestational age, with both variables categorized according to their customary definitions. RESULTS: Missing data for specific items in the TBR ranged from 0% (gender) to 1.6% (birth order). The birth registry accurately reported all 4 selected items, with the highest and lowest concordance percentage noted for gender (99.0%) and gestational age (88.3%), respectively. The level of agreement indicated by the Cohen's k statistic ranged from 0.92 to 0.96 for birth weight and gestational age when both variables were treated as categorical variables. CONCLUSIONS: The TBR showed a low rate of missing information and high levels of validity for the elements frequently used in maternal and child health research in Taiwan.     

一个医学生眼里的医学伦理学教育

主要通过医学生的视角，从教学内容、教学方法等方面谈了对医学伦理学教育的感受和一些建议，并通过医学生的声音反映医学伦理学教育的成果以及存在的一些问题。     

Triflavin, an Arg-Gly-Asp containing snake venom peptide, inhibits aggregation of human platelets induced by human hepatoma cell line

Triflavin, an Arg-Gly-Asp (RGD)-containing peptide, purified from snake venom of Trimeresurus flavoviridis, inhibits human platelet aggregation through the blockade of fibrinogen binding to fibrinogen receptors associated with glycoprotein IIb/IIIa complex. In this report, we examined the effect of triflavin on tumor cells (human hepatoma J-5)-induced platelet aggregation (TCIPA) of heparinized platelet-rich plasma (PRP). ADP-scavenger agents, apyrase (10 U/ml) and creatine phosphate (5 mM)/creatine phosphokinase (5 U/ml) did not inhibit TCIPA while hirudin (5u/ml) completely inhibited it. J-5 cells initially induced platelet aggregation, then blood coagulation occurred. J-5 cells concentration-dependently shortened the recalcification time of normal as well as Factor VIII, IX-deficient human plasmas, while it was inactive at shortening the recalcification time of Factor VII-deficient plasma, suggesting J-5 cells induced platelet aggregation through activation of extrinsic pathway, leading to thrombin formation as evidenced by the amidolytic activity on S-2238 by expressing tissue factor-like activity. Triflavin inhibited TCIPA in a dose-dependent manner (IC₅₀, 0.02 μM). When compared on molar ratio, triflavin was approximately 30,000 times more potent than GRGDS (IC₅₀,0.58 mM). On the other hand, GRGES showed no significant effect on TCIPA, even its concentration was raised to 4 mM. Additionally, the monoclonal antibodies, raised against glycoprotein IIb/IIIa complex (i.e., 7E₃ and 10 E₅) inhibited J-5 TCIPA. In conclusion, we suggest the inhibitory effect of triflavin on J-5 TCIPA may be chiefly mediated by the binding of triflavin to the fibrinogen receptor associated with glycoprotein IIb/IIIa complex on platelet surface membrane.     

Roles of PMN leucocytes, platelets and some mediators in rat hind-paw oedema induced by two phospholipase A2 enzymes from Trimeresurus mucrosquamatus venom.

Two phospholipase A2 (PLA2) enzymes, TMVPLA2 I and TMVPLA2 II, isolated from Trimeresurus mucrosquamatus venom induced rat hind-paw oedema. Recovered myeloperoxidase activity increased within 1 h and was greatly elevated in the rat paw 3-6 h after subplantar injection of these venom PLA2 enzymes. Methotrexate pretreatment significantly reduced not only the peripheral leucocyte count but also venom PLA2-induced paw oedema. In rat isolated PMN leucocyte suspension, venom PLA2 induced superoxide radical formation. Paw swelling caused by TMVPLA2 I or TMVPLA2 II was only slightly or not, respectively, reduced in the rats pretreated with anti-platelet plasma, which reduced peripheral blood platelet count by greater than 96%, suggesting platelets are not involved. In isolated platelet preparation, TMVPLA2 I induced platelet activation in a concentration-dependent manner, while TMVPLA2 II had no effect. Pretreatment with diphenhydramine/methysergide greatly suppressed the oedematous responses caused by the two venom PLA2 enzymes; the residual responses were significantly further depressed by aspirin. The oedematous responses caused by the enzymes were also suppressed by FPL 55712, BW 755C, dexamethasone, superoxide dismutase/catalase, isoprenaline and terbutaline. However, BN 52021 and L 652731, both platelet aggregating factor antagonists, were not effective on these responses. Thus, in addition to histamine and 5-hydroxytryptamine release by the mast cells in PLA2-induced paw oedema (Wang & Teng 1990), the results of this study indicate minor, but significant, roles for neutrophils and inflammatory mediators including prostaglandins, leukotrienes and superoxide radicals.