品管圈活动在降低血液透析相关性低血压发生率中的作用

目的探讨应用品管圈（quality control circle,QCC）方法降低血液透析相关性低血压发生率的效果。方法选择2011年10月在航空总医院血液透析中心发生透析相关性低血压患者21例为研究对象,成立品管圈活动小组、确立活动课题,进行现状调查、分析发生血液透析相关性低血压的原因、设定目标值、制订对策并实施,比较实施品管圈活动前后低血压的发生率。结果开展品管圈活动后血液透析相关性低血压发生率从15．00％下降到5．38％,活动前后比较,差异具有统计学意义（P〈0．05）。结论品管圈活动可降低血液透析相关性低血压发生率。     

The Cellular Toxicity of PM2.5 Emitted from Coal Combustion in Human Umbilical Vein Endothelial Cells

ObjectiveTo explore the relationship between different components offineparticulate matter (PM2.5) emitted from coal combustion and their cytotoxic effect in the vascular endothelial cells. MethodsCoal-fired PM2.5was sampled using a fixed-source dilution channel and flow sampler. The sample components were analyzed by ion chromatography and inductively coupled plasma atomic emission spectroscopy(ICP-AES). The PM2.5suspension was extracted using an ultrasonic water-bath method and thenhuman umbilical vein endothelial cells (EA.hy926) were treated withvarious concentrations of the PM2.5 suspension. Cell proliferation,oxidativeDNA damage, and global DNA methylation levelswere used to measurethe cellulartoxicity of PM2.5emitted fromcoalcombustion. ResultsComparedtoothertypesof coal-fired PM2.5preparations,thePM2.5 suspension from Yinchuan coal had the highest cytotoxicity.PM2.5 suspension from Datong coal hadthe highest toxic effectwhile that fromYinchuan coal had the lowest.Exposure to coal-fired PM2.5 from Jingxi coalresulted inlower 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels. At the same dose, PM2.5 emitted from coal combustion could produce more severeDNAimpairmentcompared to that produced by carbon black.Cell survival rate was negatively correlated with chloride and potassiumionscontent.The5-methylcytosine(5-mC) level waspositively correlated withMnandnegatively correlated withZn levels.The 8-OHdG% level was positively correlated withboth MnandFe. ConclusionPM2.5 emitted from coal combustion can decrease cell viability, increase global DNA methylation, and causeoxidativeDNA damage inEA.hy926 cells. Metalcomponentsmay be important factors that influence cellular toxicity.     

阿司匹林肠溶片治疗老年冠心病患者引起上消化道出血的影响因素分析

目的:探讨阿司匹林肠溶片治疗老年冠心病患者引起上消化道出血的影响因素。方法:对2010年10月-2013年10月我院接诊的214例口服阿司匹林肠溶片的老年冠心病患者进行回顾性分析,对51例发生上消化道出血的患者的原因进行分析,内容包括:性别、年龄、服药时间和剂量、既往消化道病史、吸烟史及联用胃黏膜保护剂等情况。结果:随着患者年龄增长,上消化道出血率显著升高(=11.526,P<0.01);服药超过3个月的患者出血发生率显著高于服药低于3个月的患者(=8.530,P<0.01),差异有统计学显著意义;大剂量组出血发生率显著高于小剂量组(=5.127,P<0.01),差异有统计学意义;性别与上消化道出血的发生无相关性(P>0.05),有吸烟史或消化道病史的患者服用阿司匹林肠溶片后更易导致上消化道出血(P均<0.05),而服用阿司匹林肠溶片同时服用胃黏膜保护剂的患者上消化道出血的发生率显著低于未服用胃黏膜保护剂的患者(P<0.05)。结论:有消化道病史、高龄、大剂量、服药时间、有吸烟史、不用胃黏膜保护剂是上消化道出血的独立的危险因素,使用阿司匹林肠溶片治疗的同时,应注意及时给予胃黏膜保护药,以期减少上消化道出血的危害性。     

Major chemical compositions,possible sources,and mass closure analysis of PM2.5 in Jinan,China

The fine particulate matter samples for 24 h were carried out at the Environment Monitoring Station (EMS) and Shandong Jianzhu University (SJU) sites during 2010 in Jinan City, China. Eight water-soluble ion species were analyzed by ion chromatography, while organic carbon (OC) and elemental carbon (EC) were determined with the IMPROVE thermal optical reflectance method, and 20 inorganic elements were measured by inductively coupled plasma-atomic emission spectrometer and inductively coupled plasma-mass spectroscopy. The annual average mass concentration of PM_2.5 was 168.85 μg m^?3 at EMS and 148.67 μg m^?3 at SJU. The coefficient of divergence was 0.14, 0.19, 0.23, and 0.23 in spring, summer, fall, and winter, respectively, indicating that there was no obvious spatial difference at the two sampling sites. The highest PM_2.5, OC, and OC/EC ratio were in winter because of the enhanced emissions from coal combustion for heating and poor atmospheric dispersion. By the method of enrichment factors, the 20 inorganic elements were divided into three types owing to their sources. Al, Si, and Ti were mainly contributed by crustal sources. Na, Mg, P, K, Ca, V, Cr, Mn, Fe, Co, Ni, Ba, and Sr were from both natural emissions and anthropogenic sources. Cu, Zn, Pb, and Sn mainly originated from anthropogenic sources such as vehicular exhaust and industrial emission. Chemical mass closure calculation estimated that SO₄ ^2? was the largest contributor and explained 29.66 % of PM_2.5 mass at EMS, while 31.64 % was at SJU. The organic matter, crustal matter, and NO₃ ^–, respectively, accounted for 15.12, 12.87, and 13.77 % to PM_2.5 at EMS, while it accounted for 13.46, 13.96, and 14.93 % at SJU, respectively. By the positive matrix factorization analysis, the coal combustion and biomass burning, secondary sulfate, soil dust, secondary nitrate, and vehicle emissions were identified as the major emission sources.     

奥美沙坦酯片联合苯磺酸氨氯地平治疗老年高血压的临床效果观察

目的 观察奥美沙坦酯片联合苯磺酸氨氯地平治疗高血压的临床疗效.方法 将2011年7月-2013年7月收治的老年高血压患者116例随机分为研究组及对照组各58例.研究组给予奥美沙坦酯片联合苯磺酸氨氯地平治疗,对照组给予单纯苯磺酸氨氯地平治疗.治疗后比较2组临床疗效,血压值及不良反应发生情况.结果 研究组总有效率为94.8%高于对照组的82.8%,差异有统计学意义（P＜0.05）.治疗后研究组收缩压、舒张压均低于对照组,差异均有统计学意义（P＜0.05）.116例患者服药后出现不良反应3例,发生率为2.58%,主要表现为轻微头痛,患者可耐受,不影响治疗.结论 奥美沙坦酯片联合苯磺酸氨氯地平治疗高血压的临床疗效优于单纯苯磺酸氨氯地平治疗,且不良反应少,值得临床推广应用.     

The add-on effect of dengzhan shengmai capsules on secondary prevention of ischemic stroke: A multicentre,randomised, placebo-controlled clinical trial

ObjectiveThe Dengzhan Shengmai (DZSM) capsule is a commercially available type of Chinese herbal medicine frequently administered to improve neurological impairment after stroke. Its ability to prevent recurrent stroke, however, has not been determined. This study therefore evaluated the ability of DZSM as an add-on to conventional secondary preventive agents to prevent recurrent ischemic stroke.MethodsIn this randomised, double-blind, placebo-controlled trial, conducted at 83 hospitals in Mainland China, 3143 patients in 14–180 days after the initial onset of ischemic stroke, were randomly allocated to the DZSM (0.36 g, twice daily for 12 months) or the placebo group. All patients in both groups received standard secondary preventive medications. The primary outcome was the 1-year incidence of stroke. Between group differences were assessed using the Cox proportional hazards model.ResultsIntent-to-treat analysis showed that 58 (3.8%) participants in the DZSM group and 82 (5.4%) in the placebo group experienced new stroke events (hazard ratio = 0.70, 95% confidence interval = 0.50–0.98, P = 0.036). The type and incidence of adverse events were similar in the DZSM and placebo groups.ConclusionsThe addition of DZSM capsules to standard secondary preventive agents provides additional benefits after the initial onset of ischemic stroke, reducing recurrent stroke without increasing severe adverse events. However, further study is needed to elucidate the role of DZSM on the updated practice of conventional secondary prevention for ischemic stroke.     

特发性间质性肺炎患者18F-FDG PET/CT与肺功能及炎性指标的相关性

目的 观察特发性间质性肺炎（ⅡP）患者¹⁸F-FDG PET/CT显像与肺功能及实验室炎性指标的关系。方法 回顾性分析20例ⅡP患者（ⅡP组）和20例肺部正常患者（对照组）的PET/CT图像,测量全肺最大标准摄取值（SUV_max）和平均标准摄取值（SUV_mean）,并校正获得最大靶背景比（TBR_max）和平均靶背景比（TBR_mean）,比较ⅡP组与对照组间SUV和TBR的差异,评价ⅡP组TBR与肺功能及炎性指标的相关性。结果 ⅡP组SUV_max、SUV_mean、TBR_max和TBR_mean均显著高于对照组（P均<0.001）。ⅡP组TBR_mean与用力肺活量（FVC,r=-0.811,P=0.004）、肺一氧化碳弥散量（DLCO,r=-0.715,P=0.020）、第1秒用力呼气量（FEV1,r=-0.698,P=0.025）、残气量（RV,r=-0.844,P=0.002）、肺总量（TLC,r=-0.693,P=0.026）及RV/TLC（r=-0.711,P=0.021）呈负相关,与FEV1/FVC（r=0.888,P=0.001）呈正相关。TBR_max与FVC（r=-0.667,P=0.035）和RV（r=-0.643,P=0.045）呈负相关,与DLCO、FEV1、FEV1/FVC、TLC、RV/TLC无明显相关性（P均>0.05）。ⅡP组TBR_max和TBR_mean分别与红细胞沉降率、C反应蛋白均无明显相关性（P均>0.05）。结论 ⅡP患者¹⁸F-FDG放射性摄取增高,其程度与肺功能具有一定相关性。     

借鉴管理体系认证经验保证医院评审规范公平

回顾了国内外医院评审的现状、分析了我国医院评审管理中存在的问题.介绍了国内外管理体系认证的方法,提出我国医院评审应在评审研究、审核员注册、持续改进措施、评审咨询及评审机构管理等方面吸收借鉴.