以病人为中心的口腔科门诊数字化建设初探

目的：总结以病人为中心的口腔科门诊数字化建设的经验。方法：从诊疗手段、就医流程、医疗文书以及科室管理4个方面总结广州军区武汉总医院口腔科门诊数字化建设的概况。结果：2009年以来开始进行El腔科门诊的数字化建设,经过3年多的运行,科室工作流程优化明显,提高了工作效率和医疗服务质量。结论：科室的数字化建设有助于提高科室的工作效率和医疗服务质量,充分体现了”以病人为中心”这一理念。     

Adhesion of sickle neutrophils and erythrocytes to fibronectin

The pathophysiology of vaso-occlusive crisis in sickle cell disease involves interactions among blood cells, plasma proteins, and vessel wall components. The initial goal of this work was to quantify the adhesion of sickle red blood cells (RBCs) to fibronectin immobilized on glass under both static and dynamic shear stress conditions. High-power microscopic inspection of static assay plates showed striking numbers of adherent neutrophils as well as RBCs. Sickle neutrophils and RBCs were significantly more adherent to fibronectin than the corresponding normal cells in static adhesion assays. Adhesion of both sickle neutrophils and sickle RBCs in dynamic adhesion assays was promoted by a period of static incubation preceding initiation of shear stress conditions. Adherent neutrophils remained attached at shear stresses up to 51 dyne/cm2; most adherent RBCs were attached at shear stresses up to 13 dyne/cm2, but detached at a shear stress of 20 dyne/cm2. Sickle neutrophil adhesion was enhanced significantly by autologous plasma. Elevated levels of plasma interleukin-6 (IL-6; but not IL-1 or IL-8) were found in 6 of 9 sickle cell disease samples examined, and elevated levels of tumor necrosis factor were found in 2 of 9 samples. Plasma IL- 6 levels correlated positively with both the number of sickle neutrophils adherent to fibronectin and the ability of sickle plasma to enhance adhesion of normal neutrophils to fibronectin. These data suggest possible roles for neutrophil activation and for fibronectin in mediating sickle neutrophil and RBC adhesion.     

Macrolides: A Canadian Infectious Disease Society position paper

Since the introduction of erythromycin in 1965, no new compounds from the macrolide antimicrobial class were licensed in Canada until the 1990s. Clarithromycin and azithromycin, since their introduction, have become important agents for treating a number of common and uncommon infectious diseases. They have become prime agents in the treatment of respiratory tract infections, and have revolutionized the management of both genital chlamydial infections, by the use of single-dose therapy with azithromycin, and nontuberculous mycobacterial infections, by the use of clarithromycin. The improvement of clarithromycin and azithromycin over the gastrointestinal intolerability of erythromycin has led to supplanting the use of the latter for many primary care physicians. Unfortunately, the use of these agents has also increased the likelihood for misuse and has raised concerns about a resultant increase in the rates of macrolide resistance in many important pathogens, such as Streptococcus pneumoniae. This paper reviews the pharmacology and evidence for the current indications for use of these newer agents, and provides recommendations for appropriate use.Key Words: Azithromycin, Clarithromycin, Erythromycin, Macrolides, Review, Therapeutic useErythromycin A is a naturally occurring, microbiologically active compound of the macrolide class of antibiotics. Chemical modification of erythromycin A''s 14-membered lactone ring has led to the formation of semisynthetic derivatives with not only improved bioavailability and tolerability, but also expanded spectrums of microbiological activity and improved pharmacokinetic profiles. Such modifications produced clarithromycin, classified as a macrolide because it retains the central 14-membered lactone ring (1,2), and azithromycin, classified as an azalide due to its 15-membered aglycone ring (1). The latter two compounds are the newest agents in the macrolide class licensed for use in Canada. Roxithromycin and dirithromycin are available in other countries.These compounds are clinically active against Gram-positive and Gram-negative cocci, and Gram-negative bacilli (primarily Haemophilus influenzae, Legionella species, Moraxella catarrhalis, Campylobacter jejuni, Bordatella pertussis and Helicobacter pylori). Azalides such as azithromycin have exhibited superior activity against Gram-negative pathogens and are generally less active against Gram-positive pathogens. Intracellular pathogens such as Chlamydia species, Mycoplasma species, Ureaplasma species, Borrelia species and nontuberculous mycobacteria species show varying susceptibilities. On the basis of their microbial activity, both the macrolides and azalides have been shown to be clinically useful in the treatment of uncomplicated skin and soft tissue infections, upper and lower respiratory tract infections, sexually transmitted Chlamydia trachomatis infection and peptic ulcer disease. Additionally, the improved pharmacokinetic profiles and acid stability exhibited by the newer agents may lead to enhanced patient adherence through less frequent dosing and improved bioavailability in the presence of food.     

纤溶酶相关蛋白在冠心病患者中的表达

目的:了解冠心病患者是否存在组织型纤溶酶原激活物(t-PA)及纤溶酶原激活抑制物Ⅰ(PAI-Ⅰ)功能紊乱,以及这两个指标与血脂、胰岛素抵抗的相关关系。方法:选择2004年1月至2006年1月于我院住院就诊的冠心病患者作为观察对象。按临床类型分为SAP组、UAP组、AMI组、OMI组,并设健康对照组。检测t-PA、PAI-Ⅰ、胰岛素敏感性指数(IAI)、胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)等指标。结果:(1)健康对照组t-PA高于各型冠心病组(P<0.05),AMI组t-PA低于其余各型冠心病组(P<0.05);健康对照组PAI-Ⅰ低于各型冠心病组(P<0.05),AMI组PAI-Ⅰ高于其余各型冠心病(P<0.05)。(2)t-PA与IAI呈正相关,与TC、TG、LDL呈负相关;PAI-Ⅰ则与IAI呈负相关,与TC、TG、LDL呈正相关。(3)各病例组t-PA于治疗后有所升高,PAI-Ⅰ于治疗后有所下降(P<0.05)。结论:冠心病患者存在明显的纤溶功能紊乱,且以急性期为重,并且纤溶功能紊乱与胰岛素抵抗、血脂异常等因素有关。     

不同抗生素用药方案在预防腹膜透析置管术后腹膜炎中的比较

目的比较不同预防性用药方案在新置腹膜透析导管患者的使用情况,探讨抗生素用药在预防新置腹膜透析导管患者术后发生腹膜炎的重要性。方法回顾性分析2008年10月至2012年10月在北京大学深圳医院肾内科腹膜透析中心接受腹膜透析置管术开始行腹膜透析治疗的患者173例。按照预防性使用抗生素方法分为3组,A组:患者在腹膜透析置管术后3天内使用含有头孢唑啉0.25g/L的腹透液,共计101例次;B组:患者在腹膜透析置管术前3h静脉滴注头孢唑林0.5g,共计48例次;C组:患者术前及术后3天均未使用抗生素,共计24例次。比较3组患者术后14天内腹膜炎的发生率。结果 A组101例患者中1例出现腹膜炎,发生在术后第11天,占0.99%;B组48例患者中2例出现腹膜炎,均发生在术后第1天,占4.17%;C组24例患者中4例出现腹膜炎,3例发生在术后第1天,1例发生在术后第2天,占16.67%。对3组患者腹膜炎发生率进行两两比较,A组与C组比较,P=0.005,P<0.01,差异有统计学意义;B组与C组比较,P>0.05,差异无统计学意义;A组与B组比较,P>0.05,差异无统计学意义。结论腹膜透析置管术围手术期预防性抗生素用药十分有必要,术后腹腔内给药或术前一次静脉用药能有效预防术后腹膜炎发生。