阻塞性睡眠呼吸暂停低通气综合征与高血压的研究进展

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hyponea syndrome,OSAHS）是指在睡眠过程中上呼吸道塌陷阻塞引起的呼吸暂停和通气不足,伴有打鼾、睡眠结构紊乱、频繁发生血氧饱和度下降及白天嗜睡等病理综合征。OSAHS与高血压病关系密切,OSAHS是高血压独立危险因素之一,可通过导致血管内皮功能障碍,激活交感神经系统和肾素一血管紧张素一醛固酮系统,促进脂质代谢障碍及增加氧化应激等途径介导高血压病的发生、发展。现就目前OSAHS与高血压研究新进展做一综述。     

双侧结节性甲状腺肿合并桥本甲状腺炎不同术式的疗效比较

目的：比较不同术式对双侧结节性甲状腺肿（NG）合并桥本甲状腺炎（HT）的疗效。 方法：收集2006年1月—2013年7月经手术治疗并病理证实的双侧NG合并HT患者的临床资料,将患者按照手术切除范围分为甲状腺大部/部分切除组、甲状腺次全切除组、甲状腺全切除组,每组均选取30例,比较各组术前、术中及术后相关指标。 结果：3组患者术前临床资料具有可比性（均P>0.05）;大部/部分切除组手术时间明显短于另两组（均P<0.05）,而术中出血量、住院总天数、术后住院天数、留置引流天数、引流量方面,3组间差异均无统计学意义（P>0.05）;3组均未发生术后大量出血及永久性声音嘶哑和低钙血症,暂时性声音嘶哑发生率差异无统计学意义（P>0.05）,全切除组暂时性低钙血症发生率高于另两组（均P<0.05）,而大部/部分切除组复发率高于另两组（均P<0.05）。 结论：双侧NG合并HT行甲状腺大部/部分切除术手术时间短,但复发率较高;全切除术发生暂时性低钙血症较多。     

我国暴力伤医事件成因的政策分析及应对

暴力伤医事件是我国医患信任解体的具体表现,并有逐年上升的趋势,已严重威胁到医疗正常秩序,阐释其复杂的成因并提出政策应对建议,对减少暴力伤医以及构建和谐医患关系具有重要意义。文章旨在剖析伤医事件的成因的政策根源,并提出相应的政策应对策略及意见,进而为构建和谐的医患关系提供理论参考。     

亚专业组在手术室专科化管理中的应用实践

专科化管理模式是综合医院手术室管理的必然趋势。自2012年起哈尔滨医科大学附属第一医院中心手术室心外专科组实施了亚专业组管理模式,各组成员业务水平及工作热情显著提高,医护合作更加默契,患者及外科医生对手术室护理工作的满意度大大提高。2年多的实践证明,亚专业组在手术室专科化管理中的应用保证了手术室护理质量,提高了工作效率,调动了护士的工作积极性。     

公立医院临床医生薪酬体系结构研究

临床医生是医疗服务的提供者,其行为直接影响医院医疗服务的质量和水平。文章在分析公立医院临床医生薪酬体系现状及问题的基础上,构建了基于闭环控制的动态薪酬体系,使薪酬体系更加科学地服务于临床医生,可以有效激励临床医生的医疗服务行为,更好地提高公立医院的医疗服务质量。     

大型公立医院实行院务公开制度的实践探索

为了进一步提高公立医院的透明度,通过在社会、患者、内部职工等各个层面开展院务公开工作,提升了医院外部形象,使患者对公立医院的内部结构、就医流程、个人账目等一目了然,改善了医患之间的关系,提高了医生和患者的满意度,同时有助于杜绝腐败现象的发生。     

三氧化二砷对人舌鳞癌细胞CAL-27侵袭能力的影响

目的 检测三氧化二砷对人舌鳞癌细胞CAL-27体内、外侵袭能力的影响并探讨其相关作用机制。方法 体外采用黏附实验、划痕实验、Transwell侵袭实验、免疫荧光染色和蛋白质印迹法检测三氧化二砷对CAL-27细胞黏附、迁移及侵袭能力的影响;体内采用免疫组织化学和蛋白质印迹法检测三氧化二砷对裸鼠移植瘤中CD44和基质金属蛋白酶（MMP）-2和MMP-9表达的影响。结果 三氧化二砷作用后,实验组CAL-27细胞的黏附、迁移及侵袭能力明显低于对照组（P〈0.05）,细胞骨架微丝解聚,微管结构模糊、紊乱,MMP-2和MMP-9的表达下降;三氧化二砷降低了裸鼠移植瘤中CD44、MMP-2和MMP-9的表达。结论 低浓度的三氧化二砷可降低人舌鳞癌细胞CAL-27细胞黏附能力,改变细胞骨架排列,下调CD44、MMP-2和MMP-9的表达,进而抑制癌细胞的侵袭能力。     

被动吸烟对鼠牙槽骨钙、磷含量及碱性磷酸酶活性的影响

目的 分析被动吸烟鼠牙槽骨钙、磷含量和碱性磷酸酶（AKP）的活性。方法 40只6周龄健康雄性Wistar鼠被随机等量分为实验组和对照组,每组再被随机等量分为15、30、45和60 d 4个亚组,烟熏法建立被动吸烟的大鼠模型,浓酸消化法提取牙槽骨内钙和磷,光谱分析法和改良Reddi法分别测定钙、磷含量和AKP的活性,行析因设计的方差分析。结果 与各对照组牙槽骨相比,被动吸烟鼠的钙、磷含量在15 d组略有升高,30 d组略有下降,差异无统计学意义（P〉0.05）,45、60 d组显著下降（P〈0.01）;AKP活性在15、30 d组略升高,45、60 d组略下降,差异无统计学意义（P〉0.05）。结论 本实验周期内,鼠牙槽骨钙、磷含量和AKP活性在被动吸烟初期略有升高,随被动吸烟时间的延长,钙、磷含量呈时间依赖性减少,AKP活性也呈时间依赖性减少的趋势。     

针药并用治疗书写痉挛症5例

Combined acupuncture and Chinese herb decoction were applied for 5 cases with graphospasm. Acupuncture included scalp acupuncture and body acupuncture. Using transcranial repeated needling, Băihuì (百会GV20), Chorea-trembling controlled area, Emotional area, as well as Dàzhuī (大椎GV14), Fēngchí (风池 GB20), and Yíngxiāng (迎香EX-HN8) etc. were stimulated by proposed by Sun Shentian. Meanwhile, the patients took orally Chinese herb decoction, on the basis of the Sìwù decoction (四物汤four substances decoction) addition and subtraction, relieve symptoms under syndrome differentiation. The treatment was carried out for 4 courses in total. One course consisted of 5 days, with an interval of 2 days between two courses. After treatment of 5 patients, 2 patients were cured, 2 patients achieved markedly effective response, and 1 patient achieved effective response.     

电针联合骨质疏松治疗仪对脊髓损伤患者骨代谢指标的影响

ObjectiveTo observe the effect of electroacupuncture combined with low-frequency pulsed electromagnetic field on bone metabolism in patients with spinal cord injury (SCI).MethodsThe 60 SCI patients who met the inclusion criteria were randomly divided into 2 groups by means of a random number table. In the control group, 30 patients were treated with osteoporosis treatment apparatus. In the observation group, 30 patients were treated with osteoporosis treatment apparatus and electroacupuncture at the foot-shaoyangacupoints [Yánglíngquán (阳陵泉GB 34) and Xuánzhōng (悬钟GB 39) of both sides].The treatment was applied once a day, 5 days a week, for 8 weeks.Before and after treatment, the changes of indexes in the two groups, including the bone mineral density (BMD), bone gla-containing protein (BGP), serum alkaline phosphatase (ALP), procollagen type I C-peptide (PICP), and 25‑hydroxy-vitamin D [25(OH)D], were observed for comparison.ResultsAfter treatment, in the two groups, the BMD and 25(OH)D indexes of the femoral neck, greater trochanter, and Ward's triangle region were not significantly changed in comparing with those before treatment (P>0.05), while the BGP, ALP, and PICP indexes were significantly higher than those before treatment (P<0.05). After treatment, in the observation group, the BGP and ALP indexes were significantly increased in comparing with those of the control group, and the difference was statistically significant (P<0.05), whilst the BMD, PICP, and 25(OH)D indexes of the femoral neck, greater trochanter, and wards triangle region, were not significantly different in comparing with the control group (P>0.05).ConclusionThe osteoporosis treatment apparatus can improve bone metabolism in SCI patients, and the curative effect can be enhanced when combined with electroacupuncture at foot-shaoyangacupoints.