改善沟通方法,促进师生沟通

沟通是教育工作的重要内容，本文结合影响教育沟通中的常见因素和师生沟通中的常见问题，从系统分析的角度，对提高师生沟通质量的主要因素包括沟通环境、沟通方法等问题进行了探讨。     

The isolated salivary duct as a model for electrolyte transport studies

Summary An approximately 1 cm length of the main excretory duct of the rabbit submaxillary gland is dissected free from the animal and transferred to a lucite perfusion chamber containing rabbit serum. The ends of the duct are mounted over a pair of capillaries so that the duct could be perfused through one capillary while samples are collected from the other. A special multibarrelled perfusion system allowed intraluminal current application and transepithelial voltage recording. Both sides of the duct epithelium were bathed with continuously flowing solutions, which could be rapidly exchanged.Net Na⁺ transport across the isolated duct is as great as net Na⁺ transport in vivo. Net Na⁺ reabsorption ranges from 380 to 600 neq/min·cm², and net K⁺ secretion is 13 to 26 neq/min·cm². Cation transport is maintained stable during a 3 h period, and thereafter slowly decreases. During perfusion with bicarbonate Ringer's solution, the mean transepithelial electrical potential difference is 17±3 mV (lumen negative). During sodium sulfate perfusion the duct epithelium generates a p.d. of up to 185 mV. Using cable analysis, the specific electrical resistance of the duct epithelium was determined to be 11.2±1.6 cm². Since the duct epithelium shows a linear current-voltage relation, the short-circuit-current can be calculated from the open-circuit-p.d. and the specific wall resistance during perfusion with bicarbonate Ringer's solution. A value of 1.5±0.3 mA/cm² is obtained, which is primarily accounted for by active transport of sodium.     

Antisense oligonucleotide eluforsen improves CFTR function in F508del cystic fibrosis

BackgroundCystic fibrosis (CF) is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene. In this study we assessed the effect of antisense oligonucleotide eluforsen on CFTR biological activity measured by Nasal Potential Difference (NPD) in patients with the most common mutation, F508del-CFTR.MethodsThis multi-centre, exploratory, open-label study recruited adults with CF homozygous or compound heterozygous for the F508del-CFTR mutation. Subjects received intranasal eluforsen three times weekly for 4 weeks. The primary endpoint was the within-subject change from baseline in total chloride transport (Cl-free+iso), as assessed by NPD. Secondary endpoints included within-subject change from baseline in sodium transport.ResultsIn the homozygous cohort (n = 7; per-protocol population), mean change (90% confidence interval) in Cl-free+iso was ?3.0 mV (?6.6; 0.6) at day 15, ?4.1 mV (?7.8; ?0.4, p = .04) at day 26 (end of treatment) and ? 3.7 mV (?8.0; 0.6) at day 47. This was supported by improved sodium transport as assessed by an increase in average basal potential difference at day 26 of +9.4 mV (1.1; 17.7, p = .04). The compound heterozygous cohort (n = 7) did not show improved chloride or sodium transport NPD values. Eluforsen was well tolerated with a favourable safety profile.ConclusionsIn F508del-CFTR homozygous subjects, repeated intranasal administration of eluforsen improved CFTR activity as measured by NPD, an encouraging indicator of biological activity.     

脑梗死正常、病变区ADC差值对出血性转化风险的评估价值

目的研究脑梗死正常、病变区表观弥散系数差值对出血性转化风险的评估价值。方法选取我院2014年7月-2016年6月神经内科收治的50例早期脑梗死患者,入院后给予螺旋CT和MRI常规颅脑平扫,所有患者均行DWI、ADC扫描,在患者MR ADC图上分别测量并计算脑梗死正常区、病变区的ADC差值;发病2周后随访行MR复查,观察HT发生情况,并进一步分析HT和ADC差值的相关性。结果通过随访复查,50例CI患者中共有5例出现HT,未发生HT(NHT)为45例,HT发病率为10.0%,低于未发生HT(NHT)比重90.0%;早期ADC差值测量显示5例明显205.5×10-6mm2/s,且与随访复查出现HT的5例患者完全吻合,ADC差值预测体现较好的准确度和特异性;HT患者ADC差值(221.4±10.2)×10-6mm2/s高于NHT(145.3±11.4)×10-6mm2/s,差异显著(P0.05)。结论早期脑梗死正常、病变区ADC差值测量能较好的反映梗死灶出血状况,本次研究认为当ADC差值205.5×10-6mm2/s即提示HT发生的高风险可能,对临床预测评估HT和指导治疗具有较高的参考价值。     

国家基本药物目录2012版与2009版比较分析

目的比较国家基本药物目录2012版与2009版的异同,为临床用药提供参考。方法采用描述性分析方法,比较国家基本药物目录2012版与2009版在药物分类、剂型、数量及品种方面的差异。结果国家基本药物目录2012版较2009版增加190种药物,其中中成药增补103种,主要是内科用药增补63种与民族药21种;西药增补87种,主要是抗微生物药增补22种,镇痛、解热、抗炎、抗风湿、抗痛风药增补9种,消化系统用药增补12种及专科用药（含中成药）增补37种。国家基本药物目录2012版与2009版剂型增加2种,为滴剂和含片。结论虽然2012版目录比2009版增加了190种药物,与第一批浙江省基层医疗卫生机构增补药物目录（150种）重合41种,但是和现在的用药习惯还有很大的差距。因此,全面实施2012版目录还需要地方政府配套政策的支持。     

时间差攻击疗法治疗下呼吸道多重耐药铜绿假单胞菌感染疗效观察

目的：探讨时间差疗法治疗下呼吸道多重耐药铜绿假单胞菌感染的疗效。方法：将有多重耐药铜绿假单胞菌感染的病例随机分为实验、对照两组,实验组采用磷霉素与头孢哌酮-舒巴坦时间差攻击疗法,对照组采用磷霉素与头孢哌酮-舒巴坦同时联合疗法。结果：治疗14 d 后,实验组的有效率为85.71%,对照组为65.12%。经χ2检验,有显著性差异（P ＜0.05）。结论：时间差攻击疗法疗效好,为多重耐药铜绿假单胞菌感染提供了一种新的治疗方法。     

34组相同成分与给药途径的国产与外资药品说明书“修改日期”项的差异分析

目的:为医疗机构管理药品及药品说明书提供参考。方法:收集我院2012年12月使用中的相同成分与给药途径的国产和外资药品说明书34组,依据2010年版《中国药典·临床用药须知》对药品说明书"修改日期"项的修改次数和修改年份进行统计分析。结果:34组药品说明书中有口服剂型25组(包括心血管系统药物8组)、注射剂型9组,其中国产药品说明书修改次数达33次,外资药品说明书113次;2011-2012年发生修改的国产药品说明书有8种,外资药品说明书有17种。口服剂型中,修改次数≤1的国产药品说明书有18种,外资药品说明书有8种;国产药品说明书修改次数达26次,外资药品说明书76次;2011-2012年发生修改的国产药品说明书有5种,外资药品说明书有12种。心血管系统药物中,修改次数≤1的国产药品说明书有4种,外资药品说明书有1种;国产药品说明书修改次数达11次,外资药品说明书27次;2011-2012年发生修改的国产药品说明书有2种,外资药品说明书有6种。结论:外资药品说明书的修改明显比国产药品说明书频繁。     

国内外社区护理研究进展

介绍了社区护理概念及特征,归纳了国内外社区护理沿革及社区护理模式,对国内外社区护理现状进行了研究,重点分析了我国社区护理现状,探索我国与国外社区护理在组织形式与服务内容、人力资源配置、管理方面的差异。