白蛋白和免疫球蛋白检测在神经系统疾病诊断中的临床应用

目的探讨免疫球蛋白(Ig)和白蛋白(Alb)检测在神经系统疾病诊断中的应用价值。方法以16例非神经系统疾病为对照组,用散射光比浊法测定137例神经系统疾病患者脑脊液与血清中免疫球蛋白(IgG、IgA、IgM)和白蛋白的含量,通过Protis分析软件计算免疫球蛋白商值(QIg)、白蛋白商值(QAlb)和IgG指数,用以判断血脑屏障(BBB)功能状态及免疫球蛋白鞘内合成情况。结果1.正常组QAlb、QIgG、IgA和IgM分别为(4.3±1.4)、(2.1±0.8)、(1.2±0.6)、(0.3±0.2),与单纯BBB损害组和BBB损害伴有鞘内Ig合成组比较,三者差别具有统计学意义(P<0.05);2.单纯鞘内Ig合成组QAlb为(4.08±1.48),与正常组比较差异无统计学意义(P>0.05);3.单纯鞘内Ig合成组QIgA、QIgM值与正常组差别具有统计学意义(P<0.05),QIgG与正常组比较无统计学意义(P>0.05)。4.在正常组IgG指数为(4.7±1.2),与BBB损害伴有鞘内Ig合成组及单纯鞘内Ig合成组比较差别具有统计学意义(P<0.05),与单纯BBB损害组比较无统计学意义(P>0.05)。结论不同神经系统疾病BBB功能障碍发生频率、BBB损害程度、鞘内Ig合成类型及蛋白商值不同,因此,免疫球蛋白和白蛋白检测能够为某些神经系统疾病提供诊断及鉴别诊断依据。     

麻醉诱导期罗库溴胺与阿曲库胺不同注射速度对血流动力学的影响

目的观察腹腔镜胆囊切除手术麻醉诱导期不同注射速度的罗库溴胺与阿曲库胺对血流动力学的影响。方法57例择期进行腹腔镜胆囊切除手术的患者随机分为R1、R2、A1、A2四组。监测并记录诱导前,肌松药注射后1、3min及手术结束时的平均动脉压（MBP）、心率（HR）,同时评估插管条件。结果A,组中,肌松药注射后1、3min的MBP比诱导前有明显下降,HR明显增快。其他各组MBP、HR未观察到明显变化。各组手术结束时的MBP、HR与诱导前比较,差异无统计学意义。结论麻醉诱导时快速注射罗库溴胺与阿曲库胺,阿曲库胺明显影响血流动力学。     

pIRES-GFP-前脑啡肽原载体在体内外的表达及生物学效应

目的检测pIRES-GFP-前脑啡肽原载体在体内外的表达,以探索脑啡肽基因镇痛的生物学效应与临床应用的可行性。方法将大鼠前脑啡肽原基因与绿色荧光蛋白真核质粒连接构建重组质粒,体外转染机体细胞,通过阳性细胞绿色荧光表达的强弱与细胞上清液脑啡肽水平的放射免疫测定,观察重组质粒在细胞内的合成与表达;大鼠蛛网膜下腔注射重组质粒,观察大鼠热痛阈值的变化,确定重组质粒在机体细胞内合成外源性脑啡肽的生物学活性。结果体外试验表明重组质粒转染24 h后COS-7细胞内开始有绿色荧光表达,48 h达高峰,持续27 d开始减弱,动物实验大鼠热痛阈值的变化与体外试验基本相符。结论重组质粒在机体细胞内合成的外源性脑啡肽具有与内源性脑啡肽相同的生物学活性,可以作为一种长效的基因镇痛方法应用于临床。     

海事立法与相关涉海立法的边界及协调研究

海事管理涉及面广,与一些涉海管理部门存在管理交叉。海事立法是一个系统工程,进一步明晰海事立法和其他涉海立法的边界,深入分析海事立法与其他涉海立法之间的交叉领域,着力加强海事立法与其他涉海立法的协调,对于加强海事立法和海事管理具有重要意义,有必要对我国海事立法与相关涉海立法的边界和协调加以深入研究。     

试论医学院校“以学生为本”的管理实践

本文从行政管理的角度,探讨了北京大学医学部“以学生为本”的管理实践,具体涉及了四个方面的内容:为学生配备学业精深、素质优良的师资队伍;为学生营造有利于个人潜能发展的学习实践平台;为学生提供高水平的服务型管理;为学生提供人性化的公共硬件设施.     

Implementing an interprofessional first-year teamwork project: some key reflections

Abstract

Implementing an interprofessional teamwork project for first-year students presents pedagogical and practical challenges. While transferable skills and attributes are important, engagement of students with limited professional experience in teamwork depends on relevance to current learning needs. This report outlines principles learned from planning and implementing a teamwork project for an interprofessional health administration and service development course. Practising interprofessional teamwork as leaders and teachers, aligning with previous, current and future teamwork content and processes and responding to student feedback and achievement have been the key factors in shaping the project over three semesters. Face-to-face and online interprofessional teamwork learning has necessitated developing resources that support self-direction, using familiar technology and providing enabling physical environments. Implications for first-year interprofessional teamwork are that structured well-resourced processes, responsiveness and alignment of learning all improve student outcomes.     

Encounters with Children

No abstract available for this article.     

Toward the elimination of lymphatic filariasis by 2020: treatment update and impact assessment for the endgame

Lymphatic filariasis (LF) is an important public health problem endemic in 73 countries, where it is a major cause of acute and chronic morbidity and a significant impediment to socioeconomic development. It is targeted for elimination by 2020, through preventive chemotherapy using albendazole in combination with either ivermectin or diethylcarbamazine citrate. Preventive chemotherapy enables the regular and coordinated administration of safe, single-dose medications delivered through mass drug administration (MDA). Many countries are now scaling down MDA activities after achieving 100% geographic coverage and instituting monitoring and evaluation procedures to establish the impact of several consecutive rounds of MDA and determine if transmission has been interrupted. At the same time, countries yet to initiate MDA for elimination of LF will adopt improved mapping and coverage assessment protocols to accelerate the efforts for achieving global elimination by 2020. This review provides an update on treatment for LF and describes the current global status of the elimination efforts, transmission control processes and strategies for measuring impact and continuing surveillance after MDA has ceased.     

Depression of NMDA-receptor-mediated segmental transmission by ketamine and ketoprofen, but not L-NAME, on the in vitro neonatal rat spinal cord preparation

Activation of spinal N-methyl-D-aspartate (NMDA) receptors and then the nitric oxide and the arachidonic acid pathways is important in pain transmission. This study assessed the effects of the NMDA receptor channel blocker ketamine, the nitric oxide synthase inhibitor L-NAME, and the cyclooxygenase inhibitor ketoprofen in nociceptive transmission using an in vitro neonatal rat spinal cord preparation. Supramaximal electrical stimulation of the dorsal root evoked the A-fibre- and C-fibre-mediated high intensity excitatory postsynaptic potential (EPSP) in the ipsilateral ventral root. Low intensity stimulation evoked the A-fibre-mediated monosynaptic compound action potential (MSR) superimposed on the low intensity EPSP. Both the low intensity EPSP and the high intensity EPSP contain NMDA-receptor-mediated components. Only ketamine and ketoprofen depressed the synaptic responses. Ketamine depressed all three spinal reflexes with IC(50) values (with 95% CI) of 10.80 microM (5.97 to 19.54 microM) for the MSR, 8.29 microM (4.53 to 14.17 microM) for the low intensity EPSP, and 5.35 microM (3.05 to 9.40 microM) for the high intensity EPSP. Ketoprofen depressed the low intensity EPSP and the high intensity EPSP only; IC(50) values (with 95% CI) were 354.5 microM (217.5 to 576.8 microM) and 302.7 microM (174.0 to 526.7 microM), respectively. Reflexes recovered after drug washout. These data demonstrated that ketamine and ketoprofen, but not L-NAME, depressed NMDA-mediated nociceptive transmission in spinal cord preparations from neonatal rats.     

三级甲等医院实施分级管理效果探讨

目的 建立适合大型三级甲等医院的护理管理组织体系,提高护理质量.方法 设立16个科护士长岗位,建立护理部主任-总护士长-科护士长-护士长分级管理组织体系,分层管理.实施6个月后选取呼吸专科和骨科评价效果.结果 分级护理管理组织体系建立与实施后,呼吸专科7项基础护理质量和6项专项质量评分从89.5~99.5分上升至95.5~100.0分;骨科上述质量评分从96.8~100.0分上升至97.0~100.0分.结论 分级护理管理组织体系的实施可提高护理质量及工作效率,适合大型三级甲等医院的发展.