对分级护理制的商榷

针对分级护理制的局限性，提出其与整体护理不和谐，执行中的医护分工问题以及由此造成的收费问题、医疗纠纷等弊端。建议取消分级护理制，以整理护理为指南进行临床护理及护理质量评价。     

学校食堂卫生量化分级评定结果分析

为进一步加强对学校集体用餐的卫生监督管理，预防和控制食物中毒和其他食源性疾息的发生，保障广大在校师生的身体健康，确保集体用餐的卫生安全，2004年4月对该县各学校食堂进行了量化分级评定，现将评定结果报告如下。     

新生儿缺氧缺血性脑病的CT检查及分级价值的探讨

目的通过对收集病例的回顾性分析探讨CT分级对指导临床治疗和判断预后的价值。方法82例患儿均采用螺旋CT进行头颅扫描。结果CT表现为0级的15例，1级38例．，2级22例，3级7例。结论该病多为各种原因造成的窒息所致，根据cT表现进行分级并结合临床对该病早期作出适时诊断，对该病的治疗及预后有很大的价值。     

应用两种评分系统对409 例肝硬化和重型肝炎病例的评估分析

目的应用两种评分方法对409名肝硬化及重型肝炎患者进行评估比较，对两种评估结果及有关的上消化道出血及死亡等因素进行相关性分析。方法统计409名肝硬化及重型肝炎患者的相关资料，应用Child和MELD评分法分别计算后应用Chiss软件进行统计学分析。结果各种计算比较结果见表格。结论Child-Pugh分级法和MELD评分系统各有特点，将两种评分方式与多因素分析与经验有机结合，才是符合临床实际的判断严重肝病预后的较科学手段。     

Frankel脊髓损伤分级

A级,损伤平面以下感觉及运动功能完全丧失；B级，损伤平面以下无运动功能，仅存某些感觉功能；C级，损伤平面以下仅存一些无用的运动功能；D级，损伤平面以下存在有用的运动功能，但不完全；E级，感觉、运动及括约肌功能正常。该分级比较简单，只需作一般的感觉和运动功能检查即可完成。其缺点是不够严谨，C级和D级包含的损伤范围较大，对变化的观察缺乏敏感性，对感觉和括约肌功能状况的表达也不详细。     

转录因子E2F-4的表达与乳腺癌分级、分期及预后的关系

目的:探讨乳腺癌中转录因子E2F-4的表达与临床分期、病理组织学分级及其预后等参数的关系.方法:采用免疫组化学的方法检测乳腺癌组织中E2F-4的表达,半定量分析E2F-4的表达与肿瘤分期、分级、术后生存时间等临床病理学参数的关系:以正常乳腺组织作为对照.结果:正常乳腺小叶及导管上皮细胞之E2F-4表达呈阴性;65例乳腺癌中33例(50.8%)呈E2F-4高表达;E2F-4高表达与乳腺癌的病理学分级、类型、临床分期以及术后生存时间有关(P<0.05).结论:E2F-4作为肿瘤的相关基因,参与了乳腺癌的发生、发展.E2F-4的高表达可能是评判乳腺癌恶性程度、转移、复发及预后的较好指标.     

实时荧光RT-PCR定量检测前列腺癌组织中AMACR基因表达

目的 建立实时荧光定量逆转录聚合酶链反应(FQ-RT-PCR)检测AMACR mRNA的方法学并检测其在前列腺癌(PCa)组织中的表达.方法 在AMACR基因的2、3外显子之间设计一对引物及MGB探针,将PCR扩增产物与pMD18-T载体连接,构建重组质粒作为定量检测的标准品,建立实时荧光定量RT-PCR方法,然后对32例PCa、60例良性前列腺增生(BPH)及34例其它肿瘤组织进行AMACR mRNA的定量检测.结果 重组质粒经PCR扩增及序列测定,表明克隆成功,该方法灵敏度高,线性范围为5～5×108copies/reaction.AMACR mRNA在PCa组织中表达量显著高于BPH组织(P<0.01)及其他类型肿瘤组(P<0.01).ROC曲线分析结果显示,曲线下面积(AUC-ROC)为0.890,AMACR mRNA诊断前列腺癌的敏感度和特异度分别为81.3%和86.7%.PCa组织中AMACR mRNA表达量及检测阳性率与不同临床分期和病理分级之间的差异尚不具有统计学意义(P值均>0.05).结论 实时荧光定量RT-PCR检测AMACR mRNA的方法具有敏感、特异、准确、重复性好等特点.AMACR mRNA在前列腺组织中的表达对PCa的诊断具有一定的临床应用价值.     

肾功能损伤分级系统在成人心脏术后的应用

Objective The aim of this study was to evaluate of adilty of two acute renal failure-specific scoring systenms (the classification by Bellome et al and the AKIN criteria) for predicting hospital mortality after cardiac surgery in adult patients. Methods Between October 1 st 2006 to Decemjber 31 st 2006, 509 adult patients who ungerwent coronary artery bypass grafting (CABG) and/ or valve operation were enrolled in this study. The medical data collection included gender, age, types of operation, perioperative he- modynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed daily according to the classi- ficatinn by Bellomo and the AKIN criteria, respectively. As references, Acure Physiology and Chronic Health Evaluation(APACHE) Ⅱ and Sepsis-related Organ Failure Assessment (SOFA) score were also calculated. Resuits Three hundred and forty-one patients were male (67.0%), and 168 were female (33.0%), mean age was (56.2±12.0) years old. Tnree hundred and nine patieats un- derwent CABG, 182 underwent valve operation and 18 underwent CABG plus valve operation, Mean duration of ventilation support was (20.4±17.7) houra, and the ICU stay was (1.4±1.0) days. Postoperative hospital stay was (13.8±9.1) days. According to the classification by Bellomo., the highest in-hospital mortality was 52.9% in ARFS group. Mahiplicatinn of in-hospital morality rate was abserved (X2 for trend, P<0.01) in 0.4% (non-ARF), 1.2% (stage 1), 12.0% (stal～ 2) and 32.4% (stage 3) of pa- tients based on the AKIN criteria. By applying the area under the receiver operating characteristic ourve, the classification by Bellomo and the AKIN criteria had good discriminative power. Furthering, multivariate logistic regression analysis verified that the Odds Ratio of the AKIN criteria was 5.478 (P =0.028, 95% Confidence Interval 1.027- 24.856), after adjusting for gender and age. Con- clusion Analytical data confinned good discriminative power of both the AKIN criteria and the classification by Bellomo for predicting hospital mortality of adult postoperative patient with ARF.