女性控尿机制的研究及其在原位新膀胱术中的应用

近10多年来,随着对女性人体盆腔和尿道局部解剖学的深入研究,临床泌尿外科医师对膀胱颈、尿道、横纹括约肌、尿道支持组织及这些结构的神经支配在女性控尿中的作用有了新的认识,指导和推动了原位新膀胱术在女性患者中的应用,提高了临床效果和患者生活质量。本文就有关女性控尿机制及其在原位新膀胱术中的应用进展作一介绍。     

An investigation of the effectiveness of ready-to-eat breakfast cereals in weight loss: comparison between single and mixed varieties

The present study investigated the effectiveness of ready-to-eat cereals eaten daily for breakfast for six weeks and as a substitute for lunch for two of these six weeks in achieving weight loss. Forty-one overweight and obese subjects (body mass index 25–35 kg/m²) were randomised to either a single cereal (SC) or a variety cereal (VC) group. All subjects consumed their allocated cereal(s) for breakfast and lunch for two weeks followed by ad libitum intake for the rest of the day. For weeks 3–6, subjects continued with their allocated cereal(s) for breakfast only and ate ad libitum for lunch and dinner. Mean weight loss at weeks two and six was −1.1 kg and −1.4 kg, respectively. At the end of week two, 85% of subjects had lost weight, and at the end of the study period (week six), 73% of subjects had achieved weight loss. Greater weight loss was observed in the VC compared with the SC group at weeks two and six. Ready-to-eat cereals eaten daily for breakfast for six weeks and used as a substitute for lunch for the first two weeks resulted in significant weight loss at week two that was sustained at week six. This study has shown that ready-to-eat breakfast cereals eaten daily for breakfast and used as a meal substitute, in particular the provision of a variety of cereals, are an effective method of achieving weight loss.     

连续性肾脏替代治疗在12例大面积严重烧伤患者中的应用

目的探讨连续性肾脏替代治疗（CRRT）在挽救严重烧伤患者生命中的作用。方法收集2003年7月至2007年1月12例采取CRRT治疗的大面积严重烧伤患者，进行病例分析。结果12例患者中2例放弃治疗，10例痊愈，随访时间6个月-2年，1人时有周身浮肿，尿蛋白（＋），其余11例患者均无不适感。结论CRRT可提供稳定的血流动力学，为烧伤常规治疗以及衰竭脏器功能的恢复创造重要保障，有效改善患者的预后。     

Patients' accounts of the differences in nurses' and general practitioners' roles in primary care

AIM: This paper reports a study of patients' accounts of the differences in nurses' and general medical practitioners' roles in primary care. BACKGROUND: Nurses are now diagnosing and treating illnesses including conducting first contact care consultations. However, the findings of international studies reporting patients' views of developments in nursing roles are not consistent. Whilst some studies report higher satisfaction following nurse consultations, others suggest that patients do not want nurses to replace general medical practitioners. Healthcare professionals' views of the boundaries of their roles have been studied, but patients' views have not been reported. METHOD: Semi-structured interviews were conducted with 28 adults attending general practices for urgent 'same day' appointments during 2004. Participants were interviewed prior to their consultation with either the nurse or general medical practitioner and 19 participants were interviewed after the consultation. Data collection and analysis were concurrent, and based on the constant comparative method. FINDINGS: Participants' views reflected traditional hierarchies in primary care. They preferred to consult with general medical practitioners if they perceived their symptoms to be serious and with nurses for minor symptoms and reassurance. They thought that nurses had more time for them and were more compassionate. Interpersonal/relational continuity of care was important and for most participants this was with a general medical practitioner who knew them. Participants trusted known practitioners; they also placed trust in professional groups and familiar structures such as the practice. CONCLUSION: New nursing services should incorporate patients' views on continuity of care provider when developing models of care delivery. Patient information leaflets in general practices should be used to explain the roles of general practitioners and nurse practitioners/practice nurses. As these roles develop further, more research is needed into all aspects of their implementation and patients' views should particularly be evaluated.     

Is there a reason for concern or is it just hype? – A systematic literature review of the clinical consequences of switching from originator biologics to biosimilars

Introduction: While prescribing biosimilars to patients naive to a biologic treatment is a well-accepted practice, switching clinically stable patients from an originator to a biosimilar is an issue for clinicians. Well-designed clinical trials and real-world data which study the consequences of switching from an originator biologic treatment to its biosimilar alternative are limited, especially for monoclonal antibodies.

Areas covered: A systematic literature review was conducted on PubMed to identify evidence of the consequences of switching from original biologics to biosimilars. References of included papers were also scrutinized. After a title-, abstract- and full text screening, out of the 153 original hits and 77 additional ones from screening the references, 58 papers (12 empirical papers, 5 systematic reviews and 41 non-empirical papers) were included.

Expert opinion: Preventing patients on biologic medicines from switching to biosimilars due to anticipated risks seems to be disproportional compared to the expected cost savings and/or improved patient access. Indeed, it is the opinion of the authors that the concern of switching to biosimilars is overhyped.     

高容量血液滤过治疗置换液配方初探

目的探讨高容量血液滤过治疗时置换液的合理配制问题。方法应用高容量血液滤过治疗复旦大学附属中山医院2002年1月～2003年12月,37例MODS患者,前瞻性观察治疗前后患者血流动力学、肝肾功能、血电解质及酸碱平衡的变化。置换液配方生理盐水2500ml、注射用水1000ml、50%葡萄糖水10ml、5%NaHCO3250ml、10%KCl12ml、10%葡萄糖酸钙40ml、25%MgSO43ml。以前稀释方式输入,采用低分子肝素抗凝。结果37例患者共治疗171例次,血液滤过治疗过程中患者心率、平均动脉压、中心静脉压等血流动力学参数稳定,血钾、钠、氯、钙、磷、镁、ALT、AST、白蛋白、球蛋白、血糖等生化指标治疗前后稳定。血pH、PCO2、HCO3-等酸碱指标治疗前后稳定,PO2、BE治疗后较治疗前显著改善。治疗后TB、CB、Cr等指标则均较治疗前显著改善。结论本院自制置换液配制简单、离子浓度准确,可安全应用于高容量血液滤过治疗。