剖宫产妇女放置两种IUD临床效果观察

目的 :观察剖宫产妇女放置新型GyneFixIN宫内节育器 (IUD)的临床效果。方法 :采用随机对照临床研究方法 ,对 195例有剖宫产史的健康妇女于月经后或人工流产术毕即时放置GyneFixINIUD 99例 (吉妮组 )及TCu2 2 0CIUD 96例 (TCu2 2 0C组 ) ,于放器后 1、3、6、12和 2 4个月随访 ,以生命表法统计两种IUD的终止情况。结果 :吉妮组使用 2年脱落率和因症取出率分别为每百妇女 1.0 1和 2 .0 2 ,明显低于TCu2 2 0C组的每百妇女 10 .4 2和 8.33(P <0 0 1)。结论 :GyneFixINIUD无支架 ,铜表面积大并固定于子宫底 ,更适合有剖宫产史妇女放置     

Adenovirus-mediated genetic manipulation of the myocardial beta-adrenergic signaling system in transplanted hearts

OBJECTIVES: Ex vivo perfusion of the cardiac allograft during organ procurement is an ideal environment for adenoviral vectors with transgenes that target improving graft contractility. One such target is the beta-adrenergic receptor-signaling system, in which alterations in transgenic mice have elucidated novel means to improve the function of the heart in vivo. The purpose of the current study was to determine the functional consequences of beta-adrenergic receptor manipulation in a rabbit model of cardiac allograft transplantation. METHODS: New Zealand White rabbits weighing 3 kg served as recipients to 1-kg outbred donors. Donor hearts were arrested and harvested, and 1 of 3 adenoviral constructs was administered into the aortic root perfusing the graft. Transgenes delivered encoded either the human beta(2)-adrenergic receptor, a peptide inhibitor of beta-adrenergic receptor densensitization, or the marker transgene beta-galactosidase. RESULTS: Five days after cervical heterotopic transplantation, left ventricular performance was measured on a Langendorff apparatus. A moderate pattern of rejection was seen in all grafts. Biventricular myocyte expression of beta-galactosidase was observed, and beta(2)-adrenergic receptor density was elevated 10-fold in grafts that received adeno-beta(2)-adrenergic receptor. Left ventricular systolic and diastolic performance was significantly increased in grafts transfected with either adeno-beta(2)-adrenergic receptor or adeno-beta-adrenergic receptor densensitization compared with control grafts that received adeno-beta-galactosidase. CONCLUSIONS: Ex vivo adenovirus-mediated gene transfer is feasible in a rabbit allograft model and, more important, genetic manipulation of beta-adrenergic receptor signaling either by increasing beta(2)-adrenergic receptor density or blocking endogenous receptor desensitization improves graft function acutely in this allograft model.     

职业接尘及吸烟致呼吸系统疾病死亡危险度比较的队列研究

目的 比较接尘、吸烟对呼吸系统疾病死亡的影响.方法 在1989年至1992年广州建立职业健康监护档案的基础上对30岁以上、职业接触粉尘和无粉尘接触的80 987名工人进行前瞻性队列研究.结果 （1）队列平均年龄43.5岁,职业性粉尘接触率16.3%,吸烟率43.7%,饮酒率33.5%.（2）队列平均随访8年,35人失访,失访率0.04%,总死亡1 593人中,219人死于肺癌,90人死于非恶性肿瘤性呼吸系统疾病.（3）调整相关因素后,相对于不吸烟者,吸烟者肺癌死亡相对危险度（RR）为3.32,是粉尘接触者相对于无粉尘接触者肺癌死亡RR（1.53）的2.2倍.粉尘接触者非恶性肿瘤性呼吸系统疾病死亡RR为2.41,是吸烟者（1.89）的1.28倍.尤其是矽尘接触者,其非恶性肿瘤性呼吸系统疾病死亡RR为5.72,是吸烟者的3.03倍.既接触粉尘又吸烟,呼吸系统疾病死亡RR增加更明显.（4）男性吸烟者呼吸系统疾病死亡危险分别随日吸烟量、烟龄的增加而增加.结论 职业接触粉尘和吸烟均可引致超额的呼吸系统疾病死亡,两者存在协同作用.吸烟致肺癌死亡RR高于接尘,而致非恶性肿瘤性呼吸系统疾病死亡RR则低于接尘.吸烟与呼吸系统疾病死亡危险存在明显的剂量-效应关系.     

3种国产牛奶中脂肪酸营养价值分析

目的测定不同种类牛奶中脂肪酸的含量。探讨牛奶脂肪酸的营养价值。方法以3种市售国产牛奶为研究对象，采用毛细管气相色谱-质谱法进行牛奶脂肪酸的分离测定。结果3种国产牛奶含有13～16种脂肪酸，酸牛奶总脂肪酸的含量最低。不同类型脂肪酸的比例不均衡。其中饱和脂肪酸的含量最高，约占70％；多不饱和脂肪酸的含量最低，仅为3％～7％。除低脂牛奶外。全脂牛奶和酸牛奶的ω-6／ω-3脂肪酸比率基本接近推荐值。结论与全脂牛奶和低脂牛奶相比。酸牛奶更适宜高血脂患者或心脑血管病高危人群的饮用。3种国产牛奶中的饱和脂肪酸（SFA）：单不饱和脂肪酸（MUFA）：多不饱和脂肪酸（PUFA）均不符合世界卫生组织推荐的1：1：1。有必要优化牛奶脂肪酸的组分以满足人体的营养需求。     

Validation of a computer-based bronchoscopy simulator developed in Taiwan.

BACKGROUND/PURPOSE: Conventional training in bronchoscopy may increase patient's discomfort and procedure-related morbidity. Computer-based bronchoscopy simulator (CBBS) permits the acquisition and evaluation of the necessary skills through a realistic bronchoscopic experience. This study was conducted to validate the use of a CBBS system developed in Taiwan as a learning and assessment tool. METHODS: Twenty novice bronchoscopists and 10 expert bronchoscopists were enrolled as subjects in this prospective study. The 20 novice bronchoscopists were randomized into two groups, which received conventional bronchoscopic training or CBBS training and then completed a satisfaction survey. Subsequently, the novices who received CBBS training underwent an observational performance trial and the results were compared with those of expert bronchoscopists. All 10 expert bronchoscopists completed a realism survey and observational trial after CBBS performance. RESULTS: The satisfaction survey showed that the CBBS training program significantly increased participants' satisfaction (p = 0.002) and interest in learning (p < 0.001). The realism survey by the 10 expert bronchoscopists indicated that CBBS provides a favorable degree of realism with regard to the mechanical and visual parameters examined. Analysis of the performance results showed that the following parameters were capable of differentiating the participants by level of expertise: total procedure time (p = 0.002), percentage of bronchial segments entered (p = 0.012), percentage of bronchial segments identified (p < 0.001), percentage of repeated bronchial segments entered (p = 0.004), percentage of pathologies identified (p < 0.001), number of times that the bronchoscope tip collided with airway walls (p = 0.013), and number of times oral instruction was needed (p = 0.01). CONCLUSION: CBBS is a valid training method that increases interest in learning and provides a favorable degree of virtual realism. It can also distinguish various levels of competence at actual bronchoscopy and may have a useful role in the bronchoscopic training curriculum.     

医院成本核算的探讨与实践

在目前社会主义市场经济还不成熟,医疗补偿机制还不完全到位,医疗保障制度尚不完善的情况下,医院如何使用有限的资源获得最大的效益,是医院经济管理的核心内容,同时,也是解决当前人民群众反映最强烈的“看病难、看病贵”问题的关键所在.要实现社会效益和经济效益的最大化,就要使医院成本最小化.文章从医疗服务成本的概念和特点,医院成本核算的目的以及成本核算的实践和效果等三个方面,阐述了医院成本核算是提高医疗工作效率的新型管理手段,也是医院实现“优质、低耗、可持续发展”的有效途径.     

中医疾病证候学研究方法初探

此次调查在西医辨病的基础上,以中医辨证理论方法为核心,按照事先设计的方案,收集特定时间内膝关节骨关节炎患者的病状,先进行计量诊断确立辨证要素,再进行聚类分析及logistic回归分析等筛选出特异性较高的症状,为疾病辨证分型、辨证标准的阐明提供依据.是一种值得介绍的中医证候研究方法.     

Clinical application of neck acupoints in acupuncture

论述了颈部的局部解剖结构及常用穴位,以人迎穴为例,对针刺颈部穴位的刺法和注意事项进行阐述.     

高效液相色谱法测定复方麻仁丸中大黄素的含量

采用高效液相色谱法测定复方麻仁丸中大黄素的含量.色谱柱:Techsphese ODS C18;流动相:甲醇-水-冰醋酸(80:20:1);流速:1ml·min-1;柱温:25℃;检测波长:254nm.大黄素进样量在0.5～5.0μg内呈现良好的线性关系,r=0.9999,平均回收率为99.73%,RSD为1.57%(n=6).本方法简便,准确,重现性好.     

RP-HPLC测定贯叶连翘中金丝桃素、芦丁和槲皮素的含量

目的:采用高效液相法测定贯叶连翘中的金丝桃素、芦丁和槲皮素的含量方法.方法:色谱柱为Symmtry C18(4.6mm×250 mm,5μm),检测波长分别为588 nm,359 nm,流动相分别为甲醇-乙腈-1.0%磷酸二氢钠溶液(340:12:7)和甲醇-水(40:60).结果:线性范围分别在0.02704～0.1352μg和0.264～1.32μg,0.052～0.260μg内良好,回收率分别为98.39%(n=3)、98.56%(n=3)和98.85%(n=3).RSD分别为0.78%和1.01%和1.02%.结论:该法简便,精密度高,结果准确可靠.