干部门诊就诊质量的影响因素与对策

对900例干部门诊中的就诊患者进行问卷调查分析,探讨干部门诊就诊质量的各种影响因素,提出干预措施,在提高患者就诊质量的前提下节省卫生资源.     

银杏叶提取物对宫内缺氧新生大鼠神经细胞凋亡的保护效应

目的 探讨银杏叶提取物(EGb)对宫内缺氧新生大鼠急性脑缺血损伤的保护作用。方法 夹闭妊娠大鼠子宫血管，制成急性脑缺血损伤新生鼠模型，治疗组给予腹腔注射EGb，在生后不同时间比较两组仔鼠脑组织含水量、NO的变化,神经型一氧化氮合酶(nNOS)的表达及神经细胞凋亡情况变化。结果 急性脑缺血后，脑组织含水量明显增加，NO的含量迅速上升，同时凋亡细胞数增加，两者成直线正相关。EGb治疗后NO含量显著低于未治疗组，同时观察到治疗组的nNOS表达明显降低，凋亡细胞数量减少。结论EGb对急性缺血引起的脑损伤有保护作用。     

低浓度5-Fu24-小时持续化疗对BEL-7402肝癌细胞株的细胞周期的影响

目的研究低浓度5-Fu 24-小时持续化疗和高浓度5-Fu短时间化疗对BEL-7402肝癌细胞株的细胞周期的影响：方法用低浓度(1000．0μg/L)的5．Fu对BEL-7402肝癌细胞株进行持续24小时的培养(A组)，用高浓度(50000．0μg/L)的5-Fu对BEL-1 7402肝癌细胞株进行2小时培养(B组)，在培养后的不同时间点用流式细胞技术检测细胞周期的变化。结果A组结果显示：0h、4h、8h、12h、16h、20h和24h的S期细胞的百分数分别为25.23％、32．35％、39．28％、41．05％、46．02％、47．00％及47．14％。B组结果显示：0h、4h、8h、12h、16h、20h和24h的S期细胞的百分数分别为24．68％、68．43％、46．67％、43．67％、35．42％、33．22％及32．96％。结论5-Fu引起的S期细胞周期阻滞不但和浓度相关，也和作用时间相关。低浓度(1000．0μg/L)的5-Fu持续化疗较高浓度(50000．0μg/L)的5-Fu短时间(2小时)化疗更容易引起BEL-7402肝癌细胞株S期阻滞。     

出血性脑室铸型的疗效分析

目的 探讨出血性脑室铸型的治疗方法与疗效。方法 分析脑室外引流、尿激酶脑室内注入、气管切开、控制血压以及脑积水的处理等多种治疗手段在治疗脑室铸型过程中的作用及其效果。结果 经过综合治疗完全恢复日常生活者10例(28．6％)，部分恢复日常工作或独立进行家庭生活者13例(37．1％)，生活需要照顾或护理者7例(20％)，死亡5例(14．2％)。结论 对于出血性脑室铸型这类重症病人早期及时的脑室外引流是快速而有效的抢救措施，尿激酶脑室内注入对溶解血凝块，疏通脑室系统行之有效。气管切开对降低死亡率至关重要，控制血压是防止再出血的关键。脑积水的处理是康复过程中需要高度重视的环节。     

转基因食品的快速PCR鉴定

用十六烷基-二甲基-乙基-溴化铵(CTAB)法快速高效地从样品中提取了可供分析的基因组DNA,经PCR扩增,鉴定了含有35S启动子和NOS终止子的转基因样品.该方法的灵敏度可达0.1%,并且具有很好的稳定性.     

MMP-2、TIMP-2在内毒素诱导性葡萄膜炎中的表达

目的　探讨基质金属蛋白酶 2 (MMP 2 )及其组织型抑制剂 (TIMP 2 )在内毒素诱导性葡萄膜炎 (EIU)模型中的表达及意义。方法　 2 0 0 μg伤寒杆菌内毒素注射于SD大鼠双后足垫 ,建立EIU模型。用免疫组织化学方法检测MMP 2、TIMP 2在内毒素注射后不同时间点 (0、 6、 12、 18、 2 4、 4 8、 72、 96h和 7d)的表达。结果　内毒素注射后 6h开始出现炎症 ,于 2 4h炎症达到高峰 ,以后逐渐减轻 ,7d时基本消退。虹膜、睫状体的上皮细胞和渗出的炎性细胞表达MMP 2和TIMP 2。MMP 2在 6h表达开始增高 ,18～ 2 4h达高峰 ,以后逐渐下降。TIMP 2于 12h出现表达 ,4 8h达高峰 ,以后逐渐下降。TIMP 2和MMP 2平均吸光度值的比值与炎症程度呈负相关。结论　MMP 2是与炎症反应相关的调节因子 ,其过量表达参与葡萄膜炎的发病。减低MMP 2的活性或降低MMP 2 /TIMP 2的比值可能为治疗葡萄膜炎的新思路。     

撑开式椎板成形术治疗伴有马尾神经损害的腰椎间盘突出症

目的总结分析伴有马尾神经损害的腰椎间盘突出症的临床特点,并对手术方法进行探讨.方法对采用撑开式椎板成形术治疗的26例伴有马尾神经损害的腰椎间盘突出症患者的临床资料进行回顾性分析.结果获得随访资料26例平均随访6年5个月,根据Macnab疗效标准,优17例,良7例,可1例,差1例.优良率92.3%.结论伴有马尾神经损害的腰椎间盘突出症的临床症状重,手术治疗需要彻底减压方能取得优良效果.采用撑开式椎板成形术显露,除具有全椎板切除的优点,还不破坏腰椎后柱的稳定性,最大限度地保留了脊柱的完整性,减小了手术创伤,是行之有效的手术方法.     

从ECCE到Phaco的转变--核处理技术的实验研究

目的通过化学方法制成动物核性白内障模型,探讨相对能量复合指数(RECP)与角膜内皮细胞活性的关系。方法将5种化学物质注入晶状体,以透过黑白条纹的清晰程度判断晶状体混浊程度并分级。然后将实验眼球分为6组(Ⅰ组为对照组;Ⅱ-Ⅵ为实验组),行标准超声乳化白内障摘除手术。手术后立即取下角膜,作锥蓝-茜素红联合染色标本和扫描电镜标本。结果晶状体内注入甲醛、冰醋酸、无水乙醇、丙酮和苯扎溴铵均能形成晶状体混浊,其中:冰醋酸致晶状体混浊能力最弱,无水乙醇、丙酮次之,甲醛、苯扎溴铵最强。当RECP≤90时,锥蓝-茜素红双重染色和扫描电镜均表明角膜内皮细胞活性好,其形态和细胞联接均无改变。当RECP=120时,角膜内皮细胞形态尚正常,但是细胞联结和胞膜部分破坏。当RECP=150时,角膜内皮细胞严重损伤。结论用化学方法制作核性白内障模型供过渡训练使用是可行的。当RECP超过某一数值(>90)时,即与角膜内皮细胞的活性成负相关。     

What methods do stakeholders prefer for feeding back performance data: a qualitative study in palliative care.

OBJECTIVE: To investigate the opinions of stakeholders (service commissioners and providers) on how performance data should be presented, in order to develop effective feedback methods to facilitate the use of these data in decision making. DESIGN: A qualitative analysis of semi-structured face-to-face and telephone interviews. League tables and fictional box plots were presented as an illustrative guide. The themes covered in the interviews were the effectiveness of these two feedback formats, their positive and negative characteristics, and ideas for new and improved feedback mechanisms. PARTICIPANTS: Thirty-six stakeholders representing a range of clinical and non-clinical roles within palliative care and the wider health care system across a variety of statutory and non-statutory organizations from London and the West Midlands. RESULTS: Box plots were received more positively than league tables, and qualitative information was considered more appropriate than pictorial feedback. Conventional methods such as league tables and box plots were judged to lack essential information on which important decisions could be based, such as additional contextual information and the methodological assumptions of the instrument. Both feedback methods were considered useful as an impetus to further discussion. There was a consensus that feedback should be constructive and able to be adapted to the organizational realities in which UK health services function. CONCLUSION: Qualitative research was viewed as the right evidence for gaining an understanding of the quality of end of life care. Stakeholders highlighted the importance of the lay perspective, which requires approaches that illuminate the subjective meanings of patient experience.     

Usefulness of osteoprotegerin in assessing responses to neridronate treatment in Paget's disease of bone

Osteoprotegerin (OPG) is a protein that inhibits of osteoclastogenesis. The aim this study was to evaluate the response of serum OPG levels to neridronate treatment in patients with Paget's disease of bone resistant to previous therapy. Nine patients (4 men) affected by active Paget’s disease of bone (6 polyostotic, 3 monostotic) not responsive to clodronate were studied. Serum OPG, osteocalcin, total and bone isoenzyme of alkaline phosphatase (AP and BAP, respectively), and urinary deoxypyridinoline (DPD) were measured before and 5 months after neridronate treatment (100 mg/day, i.v. for two days). A scintigraphic activity index (SAI) was also calculated before treatment. Mean baseline OPG levels were within normal values and were not significantly different 5 months after neridronate treatment. In contrast, there were significant reductions in AP (41.9%, p<0.02) and BAP (38.8%, p<0.04). Serum OPG levels correlated with DPD (r=0.925) and SAI (r=0.689). Although OPG is an important regulator of bone metabolism, in our series of already treated patients it was not a sensitive marker for diagnosing Paget's disease and for monitoring the response to pharmacological treatment, whereas AP and BAP confirmed their clinical usefulness. This preliminary study requires confirmation by a study with a larger population.