努力提高严重多发伤的基础研究和临床救治水平

目的:探讨提高严重多发伤的基础研究和临床救治水平。方法:结合我们的有关研究和参加抢救的临床救治体会,并引用国内外公开发表的相关论文及著作进行分析研究。结果:善于应用现有的先进科技手段,提高严重多发伤的基础研究和临床救治水平。降低伤残率和死亡率。结论:严重多发伤具有脏器损伤率高、出血性休克率高、感染率高、MODS发生率高、死亡率高等“五高”特点,所以其诊治的复杂性、紧迫性远远超过其他许多疾病。因此努力提高我国严重多发伤的基础研究及诊断和救治水平已是当务之急。     

Safety evaluation of surgical materials by cytotoxicity testing

The cytotoxicity of three kinds of commercially available absorbable hemostats [oxidized cellulose (Surgicel, gauze and cotton types), microfibrillar collagen (Avitene), and cotton-type collagen (Integran)] and one adhesion barrier [sodium hyaluronate and carboxymethyl-cellulose membrane (Seprafilm)] were comparatively assessed by a colony assay using V79 cells and a minimum essential medium (MEM) elution assay in combination with a neutral red assay using L929 cells. Strong cytotoxicity was detected for Surgicel by both the MEM elution assay and the colony assay. For Avitene, both methods revealed weak cytotoxicity. For Seprafilm, no cytotoxicity was detected by the MEM elution assay, while a moderate degree of cytotoxicity was observed in the colony assay. For Integran cytotoxicity was not detected by either the MEM elution or the colony assay. The results of the different methods showed some inconsistency in terms of the degree of cytotoxicity of the materials. It is proposed that the combination of two or more sensitive cytotoxicity testing methods for the evaluation of biomaterials is necessary to avoid false-negative results for biomaterials at the preclinical stage. Furthermore, investigation of the correlation between the cytotoxicity and the extraction period of the surgical materials is helpful for predicting the effect of prolonged in vivo use of biomaterials on surrounding cells, tissues, and organs.     

The validity of a simple clinical classification of acute ischaemic stroke

The aim of the study reported here was to test the validity of a simple clinical classification of acute ischaemic stroke (Oxfordshire Community Stroke Project, OCSP) in predicting the site and size of cerebral infarction on computed tomography (CT). Consecutive patients admitted to hospital with acute ischaemic stroke were prospectively identified and classified into one of four clinical syndromes according to the OCSP classification, blind to the result of CT. The CT brain scans were classified blind to the clinical features into those demonstrating: small, medium or large cortical infarcts; small or large subcortical infarcts in the anterior circulation territory; and posterior cerebral circulation territory infarcts. A total of 108 patients were included. A recent infarct was seen. on the CT scan in 91 patients (84%), and the clinical classification correctly predicted the site and size of the cerebral infarct in 80 of these (88%; 95% confidence interval 77–92%). The positive predictive value was best for large cortical infarcts (0.94) and worst for small subcortical infarcts (0.63). The OCSP clinical classification is a reasonably valid way of predicting the site and size of cerebral infarction on CT and can, therefore, be used very early after stroke onset before the infarct appears on the scan.     

The effectiveness of 'nursing beds': a review of the literature

A literature search was conducted to identify 'nursing led in-patient units' where the nurse is the designated leader of the clinical team. The review concentrates on studies which have attempted to measure the impact of nursing-led in-patient units and reviews both the methodology and outcomes. Three major bodies of work were identified. Lydia Hall's evaluation of the Loeb Center for Nursing and Rehabilitation (USA) is reviewed in some detail. This work was the model for 'nursing beds' at the two Oxfordshire Nursing Development Units (UK) in the 1980s. Studies evaluating these centres are reviewed and reports of similar UK units discussed. A third body of work evaluates a nurse-managed critical care environment. Common features include a case mix based on nursing need with nurses having authority to admit and discharge patients. While results are generally favourable, with improved patient independence, fewer readmissions, lower mortality and cost savings reported in some or all of the studies, all studies reviewed demonstrate the difficulties of applying an experimental model to real life clinical services. Methodological limitations render firm conclusions difficult. Techniques adopted from studies in field settings, the so-called 'quasi-experiment', are advocated as a remedy, as is further study of the process of care in investigating this model of care delivery.     

Evaluation of a Swedish version of the Arthritis Self-Efficacy Scale.

There is a great need today for clinically useful instruments in the rehabilitation of chronic pain patients. The Arthritis Self-efficacy Scale measures patients' perceived self-efficacy to cope with the consequences of chronic arthritis. The aim of the present study was to evaluate a Swedish version of the Arthritis Self-efficacy Scale with respect to factor structure and reliability. Twenty-five chronic pain patients and twenty-four rheumatology patients were given a Swedish version of the Arthritis Self-efficacy Scale twice within a three week interval. The three factor structure of the scale was confirmed; Cronbach's alpha for internal consistency ranged between 0.82-0.91 and test-retest correlations ranged between 0.81-0.91, showing that the instrument satisfactorily met psychometric standards.     

神经梅毒的临床特征与诊断分析

目的：分析神经梅毒的分型和临床特征及提供早期诊断依据。方法：回顾性分析经临床和实验室检查确诊的18例神经梅毒病人的有关临床资料。结果：神经梅毒的临床特征包括：(1)急性、亚急性起病为主；(2)临床以间质型，尤其是以脑卒中起病常见，症状元特异性；(3)血清学检查以梅毒螺旋体血凝试验(TPHA)及快速血浆反应素试验(RPR)特异性较高；(4)脑脊液检查表现为压力增高(42．9％)、蛋白增高(81．2％)及细胞数增高(56．3％)；(5)头颅CT、MRI表现与高血压、动脉硬化所致脑梗死不同，为多发、散在病灶。结论：神经梅毒早期误诊率高，临床表现与分型密切相关，实验室及影像学检查是诊断的重要依据。     

顺铂对结直肠癌肿瘤浸润淋巴细胞杀伤活性的影响

为在临床选择有效的免疫化疗方案提供一定的理论依据，作者以结直肠癌肿瘤浸润淋巴细胞（ＴＩＬ）和顺铂（ＣＤＤＰ）为研究对象，对１６名手术治疗的结直肠癌患者，分别观察ＣＤＤＰ体内注射及体外预处理ＴＩＬ和Ｒａｊｉ细胞对ＴＩＬ表面标志和杀伤活性的影响。流式细胞仪检测结果显示，静脉注射ＣＤＤＰ能增加结直肠癌ＴＩＬ中ＣＤ３＋／ＣＤ４＋和ＣＤ３＋／ＣＤ８＋细胞含量，同时增强ＴＩＬ体外杀伤Ｒａｊｉ细胞的活性；而体外以ＣＤＤＰ处理Ｒａｊｉ细胞能增强其对结直肠癌ＴＩＬ杀伤的敏感性。作者认为，对于联合应用ＴＩＬ和ＣＤＤＰ治疗结直肠癌的临床效果有必要进一步研究。     

Worksite health promotion programs in the United States: progress, lessons and challenges

Worksite health promotion programs have become increasinglyprevalent in the United States, and one or more health promotionprograms are found in two-thirds of all private worksites with50 or more employees. Reasons for recent growth in program frequencyinclude increased concern for worker health, rapidly escalatingemployer payments for health care benefits to workers, and growingevidence of a strong linkage between employee health and productivity.Published results of evaluations to date suggest that worksitehealth promotion programs can have positive impacts on healthbehaviors and health status. In addition, economic analysesare suggesting that some programs can affect the slope of healthcare costs and have the potential of high cost-effectivenesscompared to some clinical interventions. A number of researchchallenges remain, particularly understanding the influencesof the worksite environment and how employee health promotionprograms affect individual and organizational productivity.     

Epidemiology and clinical manifestation of HIV infection in Northern Zaire

1275 patients were evaluated for HIV-1+2 seroprevalence and its association with clinical symptoms of HIV infection. Of 667 apparently healthy subjects, 8.2% had anti-HIV-1 antibodies. In 465 patients with clinical signs of AIDS, 39.4% were seropositive. 143 patients with miscellaneous symptoms had positive predictive values for HIV infection between 67% (vaginal ulcerations) and 20% (profound pyogenic abscesses). The WHO definition for AIDS had a specificity of 78.3%, a sensitivity of 72.2% and a predictive value of 61.6%.