雾化吸入川白气雾剂对慢性阻塞性肺病急发期的治疗

144例慢性阻塞性肺病(COPD)患者随机分为三组,观察组用川白气雾剂超声雾化吸入治疗、对照1组为常规治疗加生理盐水超声雾化吸入,对照Ⅱ组为常规治疗。结果表明:观察组的痰、咳、喘症状的缓解时间比对照组明显缩短(P<0.01)。应用气雾吸入的两个组,最大呼气中段流速(MMEF)均比未应用气雾吸入组有明显差异(P<0.01);用力肺活量(FVC)、最大通气量(MVV)亦有显著改善(P<0.05),显然,在COPD急发期,应用超声雾化吸入,值得重视。     

Processing of tetanus and botulinum A neurotoxins in isolated chromaffin cells

Tetanus and botulinum A neurotoxins were introduced into the cytosol of chromaffin cells by means of an electric field in which the plasma membrane is forced to form pores of approximately 1 m at the sites facing the electrodes. As demonstrated by electron microscopy, both [¹²⁵I] and gold-labelled tetanus toxin (TeTx) diffuse through these transient openings. Dichain TeTx, with its light chain linked to the heavy chain by means of a disulfide bond, causes the block of exocytosis to develop more slowly than does the purified light chain. The disulfide bonds, which in both toxins hold the subunits together, were cleaved by the intrinsic thioredoxin-reductase system. Single chain TeTx, in which the heavy and light chains are interconnected by an additional peptide bond, was far less effective than dichain TeTx at blocking exocytosis, which indicates that proteolysis is the rate-limiting step. The toxins were degraded further to low-molecular weight fragments which, together with intact toxins and subunits, were released by the cells. The intracellular half-life of [¹²⁵ I] dichain TeTx was approximately three days. The number of light-chain molecules required to maintain exocytosis block in a single cell, as calculated by two different methods, was less than 10. The long duration of tetanus poisoning may result from the persistence of intracellular toxin due to a scarcity of free cytosolic proteases. This may also hold for the slow recovery from botulism.     

Enabling the sustainable Faecal Sludge Management service delivery chain—A case study of dense settlements in Kigali,Rwanda

The lack of access to basic sanitation is a global concern and alarmingly prevalent in low- and middle- income countries. In the densely populated settlements of these countries, on-site sanitation systems are usually the only feasible option because dwellers there have no sewers in place to connect to. Using on-site sanitation facilities results in an accumulation of faecal sludge which needs to be properly managed to ensure the well-being of the users as well as the surrounding environment. Unfortunately, often the conditions for faecal sludge management (FSM) within dense settlements are adverse and thus hamper sustainable FSM. We use the normative framework of the FSM enabling environment to gather empirical evidence from densely populated settlements of Kigali city in Rwanda to examine current FSM practices and the extent to which these are being influenced and affected by the setting within which they are taking place. The analysis of the study findings confirms that the existing conditions for FSM in these settlements are inadequate. The specific constraints that hinder the achievement of sustainable FSM include limited government focus on the sanitation sector, high turnover of staff in relevant government institutions, pit sludge management is not placed on the sanitation projects agenda, the existing relevant bylaws are not pro-poor oriented, a lack of clear responsibilities, a lack of relevant local professional training opportunities, unaffordability of FSM services and an inhibition to discuss FSM. Drawing on the involved stakeholders’ own perceptions and suggestions, we identify possible approaches to overcome the identified constraints and to allow all actors in the FSM chain to contribute effectively to the management of faecal sludge in densely populated low-income urban settlements. Finally, our study also presents a contribution to the theoretical conceptualisation of the enabling environment for sustainable FSM.     

武汉市东西湖区疟原虫镜检能力建设分析

目的对武汉市东西湖区医疗卫生机构疟原虫镜检能力建设情况进行调查分析,为实现消除疟疾目标及今后疟疾防治工作提供科学依据。方法收集2010-2015年东西湖区15家疟原虫镜检站硬件设施情况以及镜检人员基本信息,并进行统计分析;此外,对该阶段全区阴性血片制作、染色、清洁度合格情况进行评价,对阳性血片进行复核。结果 15家疟疾镜检站有镜检人员28人,合格显微镜9台;一、三级医疗卫生机构镜检人员年龄以40~50岁为主,二级医疗卫生机构以20~30岁为主;一、三级医疗卫生机构镜检人员从事镜检工作年限多在15年以上,二级医疗卫生机构则多在10年以下;一级医疗卫生机构镜检人员学历以大专为主(占50.00%),二、三级医疗卫生机构以本科为主。2010-2015年全区共血检8 561例,复核阴性和阳性血片539张,符合率均为100%,血片制作、染色、清洁度平均合格率分别为82.08%、79.92%、83.33%。2015年血片制作合格率(χ~2=26.45,P0.01)、染色合格率(χ~2=16.85,P0.01)、清洁度合格率(χ~2=13.93,P0.01)均高于2010年。结论东西湖区疟原虫镜检能力建设已明显提高,但应进一步推进区内疟原虫镜检站人才梯队建设和硬件投入,坚持基层镜检质控考核工作,以保障疟疾防治工作持续健康发展。     

腰硬联合麻醉下不同剂量羟乙基淀粉预扩容在剖宫产术中的应用

目的:观察不同剂量羟乙基淀粉130/0.4在腰硬联合麻醉(CSEA)下预扩容行剖宫产术中的效果。方法:ASAⅠ～Ⅱ级、择期剖宫产手术病人90例,随机分为A、B、C三组,每组30例。在麻醉前30min内分别给予5ml/kg(A组)、10ml/kg(B组)、15ml/kg(C组)羟乙基淀粉130/0.4注射液。监测麻醉前、麻醉后1、5、15min和手术结束时的血流动力学,记录麻黄素用量,以及新生儿1、5minApgar评分。结果:A组术中发生低血压14例(46.7%),高于B组7例(23.3%)和C组6例(20.0%),差异有统计学意义,P<0.05;A组应用麻黄素总量分别为100mg,多于B组的63mg和C组的68mg,差异有统计学意义,P<0.05;各组新生儿1、5minApgar评分无统计学差异,p>0.05。结论:10ml/kg羟乙基淀粉130/0.4预扩容更适合应用于CSEA下行择期剖宫产术。     

中华按蚊和嗜人按蚊的遗传关系和传疟能力的比较研究

应用聚丙烯酰胺凝胶电泳分析中华按蚊和嗜人按蚊Ｅｓｔ，ＬＤＨ和ＰＯＤ３种同工酶谱，表明两蚊存在具有分类特征的酯酶带，但又是遗传系十分相近的近缘种。     

面向数据服务的高校图书馆员能力培养策略

通过梳理数据服务的理论依据,概括高校图书馆数据服务的特征。在对数据服务的项目、目的、难度等方面进行分析的基础上,总结出高校图书馆员数据服务的3个层次,并从每个层次构成因素的概念理解、实现方法、实施路径等总结出高校图书馆员需要具备的数据服务能力,探索面向数据服务的高校图书馆员能力培养策略,以全面提升高校图书馆的数据服务水平,为高校图书馆员的数据服务能力提升提供理论依据,并以此助力高校图书馆完成由传统的文献服务型图书馆向知识服务图书馆型的转变。     

临床药师参与1例心衰终末期合并利尿剂抵抗患者容量管理的体会

1例72岁男性患者,因"反复胸痛7年,胸闷气喘3年,加重1个月"入院,入院诊断为慢性心功能不全急性失代偿,陈旧性广泛前壁心肌梗死,冠状动脉支架植入后,急性肾功能不全.临床药师评估后,认为患者存在容量超负荷并且合并利尿剂抵抗,建议将托拉塞米注射液由静脉滴注改为静脉持续输注.同时联合小剂量多巴胺改善肾血流.后患者存在低钠血...     

我院36种滴眼剂的说明书及单包装容量调查分析

目的：对我院36种滴眼剂说明书的项目标注情况、单包装容量合理性等进行汇总分析,为滴眼剂说明书及单包装容量的改进提出建议。方法：收集我院所用的36种滴眼剂的说明书,对其中药品名称、化学成分、性状、药理毒理、药动学、适应证等12个项目进行汇总,并着重对这些药物的容量情况进行分析。结果：我院所用36种滴眼剂的说明书较为规范,除成分、适应证、用法用量外,其他项目均存在标注不明的情况;安全信息提示方面,仅有7种标明产品含有防腐剂,有19种未进行开启使用时限提示;容量方面,我院有9种滴眼液按照说明书规定的每日平均使用剂量无法在4周内用完。结论：建议相关机构进一步规范滴眼剂说明书,完善说明书修订;结合患者实际用药情况,使滴眼剂单包装容量更加合理。     

Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume,Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries

The care for patients with congenital heart disease (CHD) is multi-disciplinary and resource intensive. There is limited information about the infrastructure available among programs that care for CHD patients in low and middle-income countries (LMIC). A survey covering the entire care-pathway for CHD, from initial assessment to inpatient care and outpatient follow-up, was administered to institutions participating in the International Quality Improvement Collaborative for Congenital Heart Disease (IQIC). Surgical case complexity-mix was collected from the IQIC registry and estimated surgical capacity requirement was based on population data. The statistical association of selected infrastructure with case volume, case-complexity and percentage of estimated case-burden actually treated, was analyzed. Thirty-seven healthcare institutions in seventeen countries with median annual surgical volume of 361 (41–3503) operations completed the survey. There was a median of two (1–16) operating room/s (OR), nine (2–80) intensive care unit (ICU) beds, three (1–20) cardiac surgeons, five (3–30) OR nurses, four (2–35) anesthesiologists, four (1–25) perfusionists, 28 (5–194) ICU nurses, six (0–30) cardiologists and three (1–15) interventional cardiologists. Higher surgical volume was associated with higher OR availability (p = 0.007), number of surgeons (p = 0.002), OR nurses (0.008), anesthesiologists (p = 0.04), perfusionists (p = 0.001), ICU nurses (p < 0.001), years of experience of the most senior surgeon (p = 0.03) or cardiologist (p = 0.05), and ICU bed capacity (p = 0.001). Location in an upper-middle income country (P = 0.04), OR availability (p = 0.02), and number of cardiologists (p = 0.004) were associated with performing a higher percentage of complex cases. This study demonstrates an overall deficit in the infrastructure available for the care of CHD patients among the participating institutions. While there is considerable variation across institutions surveyed, deficits in infrastructure that requires long-term investment like operating rooms, intensive care capacity, and availability of trained staff, are associated with reduced surgical capacity and access to CHD care.