我院提高医院病案质量的四个环节

病案质量的优劣是直接反映医院医疗质量和医疗水平的高低,因为它是记载每一病的疾病发生发展过程,是医师对疾病作出正确诊断,实施治疗措施,以及护理工作等的原始资料和记录,所以提高病案的管理是刻不容缓的.明年医院将实行分级管理,加强病案质量尤其重要,为使病案管理更上一层楼,为使它在医疗中发挥应有的作用,我院的做法有如下几点.     

雷公藤属3种植物不同群体和个体中雷公藤甲素的研究

目的测定雷公藤属3种植物(雷公藤、昆明山海棠和黑蔓)不同群体和个体中雷公藤甲素(tripto lide),为评价雷公藤药材质量和寻找雷公藤的优质种质奠定基础。方法建立雷公藤甲素HPLC测定方法,并测定了全国主要分布区25个群体91个个体的木质部和韧皮部中的雷公藤甲素。结果黑蔓的雷公藤甲素质量分数很低;雷公藤和昆明山海棠种间的雷公藤甲素差异不明显,个体质量分数木质部为1.0×10-6~5.83×10-5;韧皮部为2.3×10-6~1.030×1-0 4。结论雷公藤和昆明山海棠不同个体雷公藤甲素质量分数最高值与最低值相差约50倍,不同居群雷公藤甲素质量分数最高值与最低值相差10多倍,不同来源的药材质量差异极大,严重影响用药的安全性;雷公藤甲素质量分数高的居群位于浙江西南部和中部、湖南新宁、贵州雷山和安徽黄山;湖南新宁、贵州雷山和浙江江山居群中有雷公藤甲素质量分数极高的个体,值得进一步研究,以寻找质量分数高的优良单株。     

当归芍药散精简方CO2超临界萃取部位化学成分研究

目的:分离、鉴定并筛选FBD CO2超临界萃取部位防治血管性痴呆的有效成分.方法:硅胶柱层析法分离、纯化,FD-MS、1H-NMR、13CNMR鉴定化合物结构,并考察各化合物对氯化钾诱导PC12细胞钙超载损伤模型的影响.结果:从CO2超临界萃取部位共分离得到12个化合物,鉴定了其中9个,分别为白术内酯Ⅰ、白术内酯Ⅱ、白术内酯Ⅲ、双白术内酯、levistolid A、茯苓酸、阿魏酸、β-谷甾醇和β-胡萝卜苷;其中,白术内酯Ⅲ能显著地改善氯化钾诱导PC12细胞钙超载损伤.结论:白术内酯Ⅲ可能是CO2超临界萃取部位防治血管性痴呆的有效成分.     

Different astroglial reaction between the vagal dorsal motor nucleus and nucleus ambiguus following vagal-hypoglossal nerve anastomosis in cats

The dorsal motor nucleus of the vagus (DMV) and nucleus ambiguus (NA) were both traced with horseradish peroxidase (HRP) retrograde labelling technique after vagal-hypoglossal nerve anastomosis (VHA). By light microscopy, reinnervation of the new target, viz. tongue skeletal musculature, by DMV and NA was established at 22 days postoperation (dpo) as shown by the neuronal labelling with HRP. Ultrastructurally, signs of retrograde degeneration occurred in some DMV and NA neurons between 3 and 25 days after VHA. The incidence of darkened dendrites, an early sign of dendritic loss, was more common in the DMV compared to the NA. Accompanying the neuronal alteration were drastic astrocytic reactions in the DMV, but not in the NA. Between 3 and 7 dpo, the astrocytes in the DMV showed extensively hypertrophied processes and by 22 dpo, the somata and dendrites of HRP-labelled DMV neurons, but not NA's, appeared to be delineated by the increased lamellar astrocytic processes. Such a feature was sustained throughout the remaining postoperative intervals up to 500 dpo. It is concluded that the DMV motoneurons being autonomic in nature are probably not conducive to the newly acquired target organ. Hence, the insulation of the regenerating DMV motoneurons by the astroglial ensheathment would be vital in the neuronal remodelling and reconstruction of the vagal-hypoglossal pathway.     

上海市闵行区中小学生肥胖患病率调查

[目的 ]　了解上海市闵行区中小学生肥胖和超重患病率情况 ,为预防儿童肥胖制订防制策略及措施提供基础资料。　 [方法 ]　普查区内共 40 3 10名中小学学生的身高体重。采用体重指数 (BMI)和身高别体重法同时评价调查对象的肥胖患病率。　 [结果 ]　研究人群平均年龄 ( 12 .5 9± 3 .0 7)岁 ,总体BMI为 18.63± 3 .3 1,其中男性BMI高于女性。以BMI法为评价标准总体肥胖患病率为 2 .76%,超重患病率为 11.5 7%;以身高别体重法为参考标准则肥胖的患病率为 6.17%,超重的患病率为 6.76%,两种评价方法的总体患病率差异有极显著性。肥胖和超重患病率总体上呈现男高女低 ,并随年龄增加而逐渐减低。　 [结论 ]　闵行区中小学生的肥胖总体患病率呈现随年龄的增高而逐渐降低趋势。中小学生超重比例较高 ,应及早制订防制策略及措施 ,减少肥胖发生     

丝裂霉素C与青光眼滤过泡并发症的相关关系

目的分析小梁切除术中应用丝裂霉素C(mitomycin-C,MMC)与青光眼滤过泡相关并发症的关系。方法对31例36只眼在小梁切除术中应用了MMC而导致的滤过泡相关并发症的患眼进行临床分析,分析其滤过泡形态、眼压、视力的改变和黄斑水肿的发生及与术中MMC的浓度、放置时间、放置部位之间的关系。结果31例36只眼中发生滤过泡渗漏11只眼、滤过泡感染1只眼、巨大薄壁滤过泡7只眼、单纯薄壁滤过泡7只眼、低眼压合并黄斑囊样水肿10眼;并发症的发生时间平均(1724±2000)m;平均视力下降2行以上;并发症的发生与MMC放置的位置显著相关,与时间呈正相关,与浓度无关;眼压下降与MMC浓度呈负相关。结论小梁切除术后滤过泡并发症的发生与MMC的应用密切相关,结膜瓣下与巩膜瓣下同时放置、放置时间长者比较容易发生并发症;高浓度者容易造成低眼压。     

生长因子对晶体上皮细胞生长影响的研究

目的 本研究通过对家兔晶体上皮细胞体外培养，探讨生长因子对其生长的影响。方法 将家兔晶体前囊经消化、离心，以获取分散的晶体上皮细胞，在DMEM培养基(含有10％小牛血清)中培养2周．经消化、传代。对培养的第二代晶体上皮细胞加入不同浓度的碱性成纤维细胞生长因子、表皮细胞生长因子、胰岛素样生长因子。培养1周后，用MTI、法检测其对晶体上皮细胞生长的影响。结果 体外培养晶体上皮细胞前二代晶体上皮细胞能保持较完整的上皮细胞形态及特性，第三代后部分细胞开始发生转化。碱性成纤维细胞生长因子、表皮细胞生长因子、胰岛素样生长因子．均能促进晶体上皮细胞的生长。结论 生长因子是引起后性白内障的一个重要因素。     

坐骨棘筋膜固定术的临床解剖学研究

Objective The study was to explore the safety, firmness and convenience of the fascia around the ischial spine as a new fixation site for the vaginal fornix. Methods Between June 2007 and January 2008, detailed dissections and related measurements of the regions around the ischial spine were performed on 10 Chinese female cadavers (3 unembalmed and 7 embalmed cadavers). At the same time, the sacrospinous ligament,the fascia on the ischial spine, the iliococcygeus fascia as well as the vaginal fornix were exposed and the pull-out strength sequentially tested using a digital push-pull force gauge. Results The fascia on the ischial spine was firm and strong, with a thickness of 3 about mm. No major vessels or nerves were observed on the ischial spine. The greatest pullout strengths of the sacrospinous ligament,the fascia on the ischial spine, the iliococcygeus fascia as well as the vaginal fornix were (102±26),(64±15),(33±8)and(32±6)N, respectively. Conclusion The fascia at 1 cm from anterior lateral ischial spine, free of major vessels and nerves, is safe and strong and could be used as a new site for suspension in vaginal prolapse.     

Late-onset and rare far-advanced pulmonary involvement in patients with sarcoidosis in Taiwan.

BACKGROUND: Sarcoidosis is still considered a rare multisystem disorder in Taiwan, and data on the disease course and outcome are limited. We analyzed the clinical manifestations, disease course and complications in Taiwanese patients with sarcoidosis. METHODS: A retrospective cohort design was used. Fifty-six patients with sarcoidosis diagnosed between 1985 and 2004 were included. Their clinical features, laboratory findings at initial presentation, disease course, and complications were analyzed. RESULTS: Forty-three patients (76.8%) were female. The mean age at symptom onset was 47 years. The most common clinical symptoms were pulmonary (82.1%), cutaneous (23.2%), ophthalmic (19.6%), and articular (17.8%). Only two patients presented with L?fgren's syndrome. There was a seasonal variation in disease onset, with higher incidence in winter and early spring. No advanced pulmonary involvement was noted. Elevated levels of serum angiotensin converting enzyme (sACE) were found in 72.5% (29/40) of patients with active sarcoidosis, and significantly higher levels of sACE were found in patients with lung involvement (27.98+/-1.71 IU/L vs. 18.2+/-2.76 IU/L; p<0.01). In 50% (20/40) of patients, sACE levels declined significantly in parallel with clinical remission (24.75+/-1.53 IU/L vs. 16.33+/-1.21 IU/L; p<0.05). Spontaneous complete remission was found in 20.7% of patients, whereas 39.6% of patients with multiple extrapulmonary involvement responded poorly to intensive corticosteroids plus various immunosuppressants. CONCLUSION: In this series, the mean age of disease onset was in middle age (mean, 47 years old), there was a low incidence of L?fgren's syndrome (3.6%), and no patients had advanced pulmonary syndrome. The results of this study also suggest that sACE might be a marker of pulmonary involvement that is also useful in monitoring disease activity.     

非定型硒平板探测器X线摄影应用价值

X线成像技术经历了100多年的漫长过程,其中作为影像信息的载体从增感屏(感蓝、感绿)到影像增强器加电荷耦合器件(CCD)到CD的IP板获取X线穿过的人体的信息,但其中都存在X线透过人体的有用信息。今天最先进的非定型硒平板探测器数字成像系统,有效地克服了这一缺陷,直接接收带有人体信息的X线,它具有图像分辨率高、放射剂量低、成像速度快等诸多优点,可用于全身数字摄影。本文通过它与屏-片系统性能对比分析,探讨DDR在摄影中的应用价值。