卡维地洛对慢性心衰合并肾功能不全患者肾功能的影响

目的:评价卡维地洛对慢性心衰(CHF)合并慢性肾功能不全(CRF)患者肾功能的影响。方法:入选27例CHF合并CRF患者,在充分抗心力衰竭治疗的基础上,加用卡维地洛,观察不同阶段左室射血分数(LVEF)和肾功能的变化。结果:卡维地洛治疗后,LVEF在治疗3个月后开始升高,12个月后显著高于基线水平(p<0.01)。治疗后1个月,血肌酐(Scr)升高(p<0.05),3个月时回落到基线水平以下(p<0.05),12个月时仍低于基线水平(p<0.05);治疗后1个月,内生肌酐清除率(Ccr)先轻度下降(p<0.05),3个月时回升高于基线水平(p<0.01),12个月时仍显著高于基线水平(p<0.01)。卡维地洛对尿微量白蛋白和24h尿蛋白定量影响不大(p>0.05)。结论:第三代β-受体阻滞剂卡维地洛,可改善慢性心衰合并慢性肾功能不全患者的心功能,早期引起肾功能的轻度降低,随后肾功能显著改善。     

腹部闭合性创伤163例诊治报告

目的探讨提高腹部创伤的诊治成功率的措施。方法对163例腹部闭合性创伤的临床资料进行回顾性分析总结。结果治愈154例（94．5％）．死亡9例（5．5％），死于失血性休克3例，多器官功能衰竭4例，严重颅脑外伤2例。结论早期迅速而准确的诊断及细致有效的手术探查是提高抢救成功率的关键。     

心肌灌注显像放射性稀疏区成因与组织衰减的实验研究

目的探讨正常心肌灌注显像放射性稀疏区的成因.材料与方法对5例猪心行99mTc-MIBI在体和离体心肌灌注显像,并用ROI技术测量左室各部位心肌的放射性水平(计数/像元),由该值在两种状态下的差值计算衰减程度(%).结果两种状态间壁后部和后壁放射性水平最低;在体心肌前壁中段衰减程度(7.9%)高于其前段和后段,该区衰减程度与胸壁厚度呈正相关;后壁衰减程度最高(11.9%).结论胸壁是造成前壁中段稀疏影的原因,膈肌是形成后壁稀疏影的重要原因之一.心肌图像重建时可根据衰减程度作适当补偿.     

试述餐饮业和集体用餐配送单位卫生规范的制定与施行

我国首部《餐饮业和集体用餐配送单位卫生规范》于2005年6月27日由卫生部发布,并于同年10月1日起施行。该规范规定了餐饮业人员、建筑、设施、设备、工用具等的设置和卫生管理、加工操作等方面应达到的标准或要求,适用于有固定加工场所的餐饮业经营者,也适用于单位和学校的集体食堂和集体供餐企业。本文是作者对该规范的研制说明和实施建议与讨论。     

浙江省精神病医院省级专项经费投入的卫生经济学评估

目的评估浙江省精神卫生专项经费对精神卫生专业机构的卫生经济学效果.方法通过对省内15家接受精神卫生专项经费资助和13家未接受资助的精神卫生专业机构的对比,比较其5年来在服务功能、经济效益和资产结构方面差异以及资助前后的增长率.结果专项经费资助使受资助精神卫生专业机构在服务功能、经济效益、资产结构和职工收入等方面普遍获益,尤其是门诊、住院服务功能,医疗收入和职工收入,固定资产的获益更为明显.结论本次经费有助于使受资助精神卫生专业机构走上更加良性化运作的道路,符合成本效益原则.     

Prolonged focal application of polyethylene glycol induces conduction block in guinea pig spinal cord white matter.

A 2-min focal application of Polyethylene Glycol (PEG) to injured mammalian spinal cords can offer significant yet limited restoration of functional and structural integrity. However, longer application of PEG has not been tested in similar injuries. In this study, isolated spinal cord white matter strips from adult guinea pigs were subjected to a 25 min exposure of PEG (MW: 2000; 50% w/w), with or without prior compression. When applied in a continuous steam, PEG, with a delay of about 6 min, suppressed the compound action potential (CAP) amplitude to 64+/-4% of the pre-PEG level in uninjured cords and to 64+/-7% in compressed cord strips. Both recovered to 70+/-5% (uninjured) and 88+/-11% (compressed) of the pre-PEG level following wash. When PEG was applied in a pulsatile manner, no significant decrease of CAP amplitude was observed. In summary, our results show that focal continuous application of PEG has minimal toxicity if applied for less than 5 min. Pulsatile application could extend this duration to at least 25 min with no toxicity. This study could be useful in determining the optimal protocol for the use of PEG in both animal research and human spinal cord victims.     

固本壮骨胶囊治疗原发性骨质疏松症的临床研究

目的：评价固本壮骨胶囊的疗效和女全性。方法：我们于2002年10月至2003年7月按照国家药品食品监督管理局中药新药审批办法，通过与骨松宝颗粒剂（无糖型）多中心、随机、双盲双模拟对照的临床观察。对223例原发性骨质疏松症（肝肾不足证）患者进行了系统的临床试验研究。结果：治疗后两组都有明确疗效，两组间没有统计学差异，但试验组在改善腰膝酸软和步履艰难这二个症状方面明显优于对照组。比较骨密度的变化，各部位3个月和6个月的骨密度改变，两组无明显差异，而试验组在提高腰椎骨密度方面优于对照组。另外，治疗组在治疗过程中无明显不良反应，治疗后的各项血液生化指标和心电图均无改变。结论：固本壮骨胶囊是一种安全有效的中药新药。     

藜蒿提取物降压作用的动物实验研究

藜蒿为菊科多年生宿根性草本植物,别名芦蒿、蒌蒿、水艾、水蒿.藜蒿清香爽口,是一种蔬菜珍品,主要生长在鄱阳湖一带,在南昌被誉为"鄱阳湖的草,南昌人的宝".远在唐代,孙思邈就记载了藜蒿的药用价值:藜蒿性平,味甘辛,具有健体补虚、清心解毒、利胆退黄作用,主治肝胆湿热、脾虚纳滞等病症.近年来研究表明,藜蒿具有丰富的营养价值和特有的药用价值,可达到降血压、防癌抗癌、健胃等明显的药用效果.欧阳崇学[1]测定了藜蒿中13种微量元素及粗蛋白、维生素C、酸性洗涤纤维等营养成分的含量,并对其营养价值进行了讨论;另有学者研究表明,藜蒿含有丰富的人体必需的微量元素[2]和黄酮类化合物,可作为天然保健饮料和纯天然抗氧化剂[3],因此藜蒿是一种具有较高综合开发利用价值的植物资源[4].     

Dexamethasone induces TrkA and p75NTR immunoreactivity in the cerebral cortex and hippocampus

Nerve growth factor (NGF) plays a crucial role in synaptic plasticity during brain development and adulthood by activating a dual receptor system composed of TrkA and p75 (p75NTR) receptors. Exogenous NGF modulates the expression of both receptors. Little is known about the ability of endogenous NGF to regulate the expression of these receptors in basal forebrain cholinergic terminals. The ability of glucocorticoids to increase NGF expression in the hippocampus prompted us to investigate whether the synthetic glucocorticoid dexamethasone (DEX) increases TrkA and p75NTR expression in NGF-target cholinergic neurons in developing rats. We first examined the effect of DEX on NGF mRNA by in situ hybridization. DEX given systemically (0.5 mg/kg, sc) for 1 week to 7-day-old rats elicited an increase in NGF mRNA levels in the dentate gyrus of the hippocampus and superficial layers II and III of the cerebral cortex. Immunohistochemical analysis of p75NTR and TrkA levels revealed a dramatic increase in p75NTR immunoreactivity (IR) in both basal forebrain and hippocampus and TrkA IR in the hippocampus. Interestingly, in DEX-treated rats more axonal terminals were immunopositive for p75NTR in the hippocampus and cortex, suggesting an increase in p75NTR IR in cell bodies as well as in terminals. Our data indicate that the endogenously produced NGF elicits biological changes similar to those of the exogenously delivered NGF. We suggest that glucocorticoids might regulate and coordinate cholinergic neuronal maturation by increasing the biosynthesis of NGF.     

Fast-track cardiac anesthesia: use of remifentanil combined with intrathecal morphine as an alternative to sufentanil during desflurane anesthesia

The purpose of this cardiac fast-track study was to evaluate the use of remifentanil (R) combined with intrathecal (IT) morphine as an alternative to sufentanil (S) during desflurane anesthesia with respect to postoperative pain control. Prior to entering the operating room, patients in the R group (n = 20) received morphine, 8 microg/kg IT. Anesthesia was induced using a standardized anesthetic technique in all patients. In the R group, anesthesia was maintained with R, 0.1 microg. kg(-1). min(-1) in combination with desflurane 3-10%. In the S group (n = 20), patients received S 0.3 microg. kg(-1). h(-1) and desflurane 3-10%. There were no differences between the two groups with respect to time from arrival in the intensive care unit to tracheal extubation (5.1 +/- 4.3 h vs 5.8 +/- 6.7 h for R and S groups, respectively). After extubation, patients in the R group had significantly lower visual analog pain scores, reduced patient-controlled analgesic requirements, and greater satisfaction with their perioperative pain management, compared with patients in the S group. We conclude that R combined with IT morphine provided superior pain control after cardiac surgery compared with a S-based general anesthetic technique. Implications: As part of a cardiac fast-tracking program involving desflurane anesthesia, the use of intrathecal morphine in combination with a remifentanil infusion provided improved postoperative pain control, compared with IV sufentanil alone.