乡村医疗卫生集团化运作和管理的调查与思考

通过对安徽省太湖县城西乡实施的“乡村医疗卫生集团化运作和管理”项目的现场调查，了解该项目实施的背景、进展和主要问题，提出“乡村医疗卫生集团化运作和管理”是“乡村医生股份合作制联合体”的一种形式，将是农村基层卫生机构管理体制的有效实现形式之一。     

略谈公立医院产权制度改革

介绍公立医院改制的几种基本模式，认为在我国对部分公立医院实行产权制度改革是历史发展的必然，并且迟改不如早改、股份制改不如全部退出、被动突围不如主动突围。与此同时，国家应建立较完善的医疗保障制度；加强对改制后医院的监管，而不是一卖了之。     

口腔颌面部肿瘤细胞Fas和Apo2.7表达及临床意义

目的探讨口腔颌面部恶性肿瘤细胞凋亡因子Fas和Apo2.7的表达及临床意义。方法对56例不同临床期别及组织学类型的口腔颌面部恶性肿瘤细胞Fas和Apo2.7表达进行了流式细胞学定量研究并进行其分布分析。结果56例口腔颌面部恶性肿瘤Fas及Apo2.7表达含量变化范围分别为12.17%±5.49%和15.12%±7.31%,其中Fas表达含量高于阳性界值者36例,占64.29%;Apo2.7表达含量高于阳性界值者38例,占67.86%。其中Fas和Apo2.7表达同时阳性者34例,占60.71%,同时阴性者14例,占25.00%。不同组织学类型卵巢癌细胞Fas及Apo2.7表达无显著性差异(P>0.05);Fas及Apo2.7表达与组织学分型无显著相关。Fas及Apo2.7表达与临床分期和预后也有一定的关系,Ⅱ及Ⅲ期口腔颌面部恶性肿瘤组织细胞Fas及Apo2.7含量均明显低于Ⅰ期;恶性组肿瘤Fas及Apo2.7表达同时阴性者3年和5年生存率比Fas及Apo2.7表达同时阳性者显著下降。结论对口腔颌面部恶性肿瘤组织细胞Fas及Apo2.7的检测,有助于预测病情进展程度和淋巴结转移的趋势以及评估预后。     

Success of de novo reimplantation of the artificial genitourinary sphincter

PURPOSE: We evaluate our experience with de novo reimplantation of the artificial genitourinary sphincter with a particular emphasis on mechanical and nonmechanical failure rates. De novo reimplantation is defined as implantation of an artificial sphincter following removal of a previously placed sphincter for erosion and/or infection and a waiting period of several months. MATERIALS AND METHODS: A retrospective analysis of more than 400 patients with an artificial sphincter revealed 23 who underwent de novo reimplantation between January 1983 and October 1998. All patients were men with a mean age of 66.5 years (range 16 to 88) and all had a urethral cuff. Reasons for cuff removal were erosion in 12 cases (52.2%), infection in 10 (43.5%) and intraoperative urethral injury in 1 (4.3%). Mean waiting period was 6.8 months (range 1.5 to 32) between explantation and de novo reimplantation. Mean followup was 32.6 months (range 1 to 108). RESULTS: Of the 23 patients 20 (87%) had no mechanical or nonmechanical failures and 3 (13%) had nonmechanical failures, including 2 patients (8.7%) whose cuff eroded into the urethra and 1 (4.3%) who had recurrent urinary incontinence which was successfully treated with implantation of a tandem cuff. There were no mechanical failures or infections in this group of patients. CONCLUSIONS: Our study suggests that de novo artificial sphincter reimplantation is an excellent treatment option. It is safe and associated with complication rates that are comparable to those of primary implantation.     

浙江省农村低保户农民卫生保健状况调查

目的 :了解浙江省农村低保户卫生保健状况及医疗卫生费用。方法 :采用分层整群抽样 ,抽取浙江省开展新型农村合作医疗的试点县和非试点县 343户低保户进行了入户调查。结果 :低保户家庭因病致贫现象严重 ,农民疾病经济负担比较重 ,卫生保健状况令人担忧。结论 :新型农村合作医疗对解决低保户的医疗费用 ,维护其卫生保健有重要意义     

口腔颊粘膜给药系统及其质量评价

介绍了口腔颊粘膜给药系统,并对其制剂的粘附力、粘附时间、膨胀率、均匀度和有效性等质量评价方面进行了综述。作为新型给药系统,颊粘膜给药系统的成熟与发展还需要在质量评价等方面进行深入研究。     

CD4^＋CD25^high Regulatory Cells in Peripheral Blood of NSCLC Patients

The proportion and changes of CD4 CD25high regulatory T cells (Trs) in peripheral blood of non-small cell lung cancer (NSCLC) patients were analyzed and their clinical significance explored. The peripheral blood was collected from 61 patients with NSCLC and 15 healthy controls. By using monoclonal antibodies, the blood samples were evaluated with the flow cytometry for lymphocyte subsets (CD3 , CD4 and CD8 ) and CD4 CD25high Tr cells. The results showed that the proportion of CD4 CD25high Tr cells in NSCLC group was significantly higher than in control group [(4.36±2.07) % vs (2.04±1.03) %, P<0.01]. The proportion of CD4 CD25 high Tr cells in late stage was higher than that in early stage [stages I II (2.26 0.6) %; stage III (3.28 1.38) %; stage IV (6.06±4.08) %] (P<0.05). Kaplan-Meier survival analysis revealed that the prognosis of the patients who had higher proportion of CD4 CD25high Tr cells in peripheral blood was worse (P=0.0026). In conclusion, the relative increase in CD4 CD25high Tr cells in peripheral blood may be related to im-munosuppression and tumor progression in patients with NSCLC. This finding suggests that CD4 CD25 high Tr cells in peripheral blood of NSCLC may be positive for prognosis analysis. The use of depletion of the CD4 CD25high Tr cell therapy to treat NSCLC patients may be an effective strategy.     

数字化医院的信息共享与标准化

阐述了数字化医院的概念，详细介绍总结了数字化医院的业务及信息构成，分析了目前数字化医院所面临的问题和困难，针对这些信息共享中存在的问题，提出了在电子病历、医疗设备信息传输以及信息系统信息交换三个方面进行标准化建设的观点，最后展望了深入完善和发展数字化医院、远程医疗及社区医疗的前景。     

彩色多普勒超声对颈部淋巴结诊断价值的分析

目的探讨彩色多普勒超声(CDFI)对颈部淋巴结的诊断价值,提高彩超对不同疾病所致淋巴结肿大的鉴别诊断水平。方法应用彩超观察共62例124个颈部肿大淋巴结(分良、恶性两组)的长径与短径之比(L/S),内部回声及CDFI血流特征。结果良性肿大淋巴结形态呈椭圆形,L/S比值>2,内部回声多为髓质增强、增宽,皮质相对变窄,门部回声规则存在。恶性肿大淋巴结形态呈类圆形,L/S比值<2,内部回声以皮质低回声为主,或强弱不等或非均匀性增厚,髓质及门部强回声变形偏移、不规则或消失。CDFI示良性肿大淋巴结内多呈门部规则血流,呈低速低阻型,部分未见血流。恶性肿大淋巴结内多呈不规则血流及周边包绕血流,血流速度Vmax及阻力指数RI显著高于良性组(P<0.01)。结论根据彩色多普勒血流及二维声像图特点、结合病史等,超声检查对颈部肿大淋巴结良、恶性鉴别有一定诊断价值,可作为首选方法。     

彩色多普勒超声在诊断结节性甲状腺肿的应用价值

目的:探讨高频超声声像图和彩色多普勒血流图对结节性甲状腺肿的诊断价值.方法:对31例甲状腺肿的结节进行仔细观察,评价二维图象和彩色多普勒血流图的表现.结果:超声诊断与病理诊断的符合率为68%,实质性及囊实性结节性甲状腺肿的结节表现无包膜或包膜不完整,周边无明显的晕环.结节内部及周边血供不丰富,边缘无环形血流,呈星点状或结节间穿行血流,彩色多普勒能量图,在结节血流显示上优于彩色多普勒血流图.结论:应用彩色多普勒超声对结节性甲状腺肿能够提供重要的血流信息,有助于结节性甲状腺肿的诊断及鉴别诊断,对提高超声诊断正确率有重要意义.