对构建特色医院文化的思考

21世纪的医院是文化的医院,21世纪医院的竞争是文化的竞争,谁能构建出具有特色的医院文化,谁就能赢得竞争主动权。构建特色医院文化,核心是形成共同的理想和精神支柱;关键是打造“学习型”医院组织;根本是树立以人为本、诚信求实的服务理念;目标是树立良好的医院形象;基础是加快医院信息化建设。     

Characteristic modifications of the breathing pattern of mice to evaluate the effects of airborne chemicals on the respiratory tract

A system was developed for exposure of unanesthetized mice to airborne chemicals and for continuous measurement of their breathing pattern prior to, during and following exposure. By measuring inspiratory and expiratory airflows (VI and VE), and integration with time to yield tidal volume (VT), we obtained characteristic modifications to the normal breathing pattern. These permitted recognition that a specific portion of the respiratory tract was affected by the selected airborne chemicals. Following recognition, we also quantitated the degree of effect using one specific measurement in each case. An effect on the upper respiratory tract, induced by the sensory irritant, 2-chlorobenzylchloride, was quantitated by measuring a decrease in respiratory frequency. An effect on the conducting airways, induced by the airway constrictor, carbamylcholine, was quantitated by a decrease in VE at the mid-point of VT. An effect at the alveolar level, induced either by the vagal nerve ending stimulant, propranolol, or by the pulmonary irritant, machining fluid G, was quantitated by an increase in the length of a pause induced at the end of expiration. The system is easy to construct and operate and can be used to rapidly evaluate the effects of airborne chemicals on the respiratory tract.     

Variability of the pattern electroretinogram

Conflicting results have been obtained concerning the parametric properties of the pattern electroretinogram. These discrepancies may be due to the large amount of variability inherent in recording amplitudes. We have found the variability within a single stimulus condition to be so large (ranging from 30% to 67% of the mean value) that it could mask any underlying spatial frequency tuning. Changing the stimulus conditions failed to significantly reduce the observed variability, although changing recording conditions produced some reduction. The use of a narrower rejection band, a greater number of sweeps, and placement of the reference electrode on the ipsilateral ear (as opposed to the ipsilateral temple) combined to decrease variability of the pattern electroretinogram within a single recording session; however, intersession variability remained high. Therefore one must be careful in evaluating data from this technique, and caution is advised in its clinical use.     

两种术式治疗多囊卵巢综合征的远期疗效追踪比较

[目的]评价开腹卵巢楔形切除(OWR)和腹腔镜下双侧卵巢电灼开窗术(LOD)两种术式对多囊卵巢综合征(PCOS)的远期疗效.[方法]1981至2001年在我院诊断为PCOS并接受手术治疗的妇女共151例,其中行OWR 61例、LOD 90例,追踪分析两组妇女术后妊娠率、术后妊娠时间的分布及术前后月经模式变化.[结果]两组的临床特征具有可比性,OWR组累积妊娠率84%,LOD组累积妊娠率72%,两组间没有明显差异,绝大部分妊娠发生在术后18个月内;OWR组术后3个月、半年、1年、3年、5年及10年月经规律的妇女所占的比例分别是81.3%、81.3%、77.3%、77.6%、78.9%、85.2%,明显高于术前的31.1%(P值＜0.05);LOD组术后3个月、半年、1年、3年、5年及10年月经规律的妇女所占的比例分别是80.6%、63.5%、56.7%、58.0%、57.6%、42.9%,明显高于术前的35.6%(P值＜0.05);术后OWR组月经规律妇女占的比例明显高于LOD组(P均＜0.05).[结论]两种术式的术后妊娠率相似.OWR比LOD更好、更长远地改善PCOS妇女的月经异常.     

Influence of the mother-child relationship on the development of the Type A Behavior Pattern

Investigation of the Type A Behavior Pattern (TABP) of pre-school children was conducted to determine the influence of the mother-child relationship on the development of TABP. The incidence of TABP was 44.2% (51.7% in boys and 38.7% in girls). The TABP tendency of the boys decreased as the manifest dissension or conflict in the family grew, in marked contrast with the tendency seen in girls, suggesting that conflict in the family can either weaken or reinforce TABP.     

Obsessive-compulsive disorder: admission patterns and diagnostic stability

All first-time admissions from 1970 to 1986 with obsessive-compulsive neurosis (OCD) (ICD-8 diagnosis number 300.39) or obsessive-compulsive personality disorder (OCPD) (ICD-8 diagnosis number 301.49) were analyzed based on an extract from the nationwide Psychiatric Case Register in Denmark. All patients with secondary diagnoses other than neurotic disorders or personality disorders (including “neuroses characterogenes”) were excluded from the study. A total of 284 patients were first-time admitted with a main diagnosis of OCD during the period. The sex ratio was 0.67 (males/females). A total of 126 were first-time admitted with a diagnosis of OCPD, with a sex ratio of 1.18 (males/females). Seventy-seven percent of the readmitted patients with a first-time diagnosis of OCD kept a diagnosis within the “emotional spectrum” at the last admission. About half kept OCD as a main diagnosis, whereas only 15% shifted to a severe psychiatric diagnosis such as schizophrenia or manic-depressive psychosis. Of the readmitted patients with OCPD. 13% later developed a diagnosis of manic-depressive psychosis.     

The synchronization of respiration and swallow sounds with videofluoroscopy during swallowing

Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obtained by videofluoroscopy together with feeding respiratory patterns and swallow sounds from the Exeter Dysphagia Assessment Technique (EDAT). These allowed visual representations of respiration and swallow sounds to be superimposed on a videofluoroscopy recording using a split-screen technique. Sequentially numbered, 1/50 sec, half-frame photographic prints were examined and schematic drawings of the relevant radiographs were made. These were superimposed on to the actual EDAT printed chart of the same swallow event, theri exact time relationship with respiration and cervical swallow sounds being preserved. The results allow events in the barium videofluoroscopy to be related to events in the feeding respiratory pattern and swallow sounds recorded by EDAT.     

CS-3000 plus血细胞分离机在治疗性血液成分单采中的临床应用

【目的】观察应用CS-3000plus血细胞分离机进行治疗性血液成分单采的临床疗效，分析影响血液成分单采效果的相关因素。【方法】对87例患者应用CS-3000plus血细胞分离机进行161次治疗性血液成分单采，分析临床效果和实验室指标的改善情况。【结果】应用CS-3000plus血细胞分离机进行血浆置换后，71．43％患者临床症状、体征或者实验室指标取得明显改善。相关分析提示，进行治疗性血细胞成分单采患者的白细胞、血小板、红细胞、血红蛋白、红细胞比容下降值与采前相应初始值均呈正相关（P〈0．05）。白细胞单采术的患者白细胞计数下降值与处理全血量呈正相关（P〈0．05），在处理血量达到5000～7000ml时，血小板单采术患者血小板计数下降值与处理全血量无明显相关性（P〉0．05）。当处理全血量达到500～800ml时，红细胞单采术患者红细胞、血红蛋白、红细胞比容下降值与处理全血量无明显相关性（P〉0．05）。【结论】应用CS-3000plus血细胞分离机进行治疗性血液成分单采对迅速缓解临床症状，减少并发症的发生和提高临床药物治疗效果均有较大意义。合理设定全血处理量，调整采集相关参数，有助于采集的顺利进行和采集效果的进一步提高。     

Fracture separation of the articular pillar of C5 following brass knuckles trauma

We report the case of a fracture separation of the articular pillar at the lower cervical spine. The trauma, following a brass knuckles, repeats almost in an experimental way the rotation and extension mechanism given in literature for the genesis of such injuries. From the admission in the orthopaedic service to the surgery, the development went in a characteristic way towards a rotatory displacement. Received: 12 July 2002, Accepted: 18 August 2002 Correspondence to: R. Massicot