野战医疗所技术装备建设思考

通过分析维和二级医院与野战医疗所的建制及运行模式，结合外军战伤急救进展，提出野战医疗所的人员必须一专多能，应加强急救技术及跨专业技术训练；将先进的创伤理论应用于危重伤员急救；加强网络技术及远程会诊建设；应用简便、高效、安全的设备及技术。     

完善急救医疗服务体系的思考

院前急救、院内急诊急救和重症监护治疗是生命支持治疗连续体中的三个重要环节，彼此密切相关，缺一不可。由此三者构成的急救医疗服务体系是生命救治的绿色通道，其服务质量已成为一所医院医疗能力与管理水平的综合体现。充实和完善急救医疗服务体系，是我国急诊急救医学发展的重要方向，也是和平时期我军卫勤保障准备的有效途径。     

院前急救医护纠纷的防范

目的探讨院前急救医疗护理纠纷防范措施。方法建立健全院前急救有关规章制度,提高出诊医护人员的综合素质,配备齐全院前急救所需的各种急救物品和急救药品,处理好与城管、交警、公安等部门的关系。结果院前急救成功率提高,病人满意度提高,医疗护理纠纷下降。结论强化医护人员法律行为,加强岗位培训,提高院前急救管理人员的管理意识和重视程度是减少医疗护理纠纷的有效防范措施。     

The Induction of Cytotoxic T Lymphocytes against HLA-A Locus-matched Lung Adenocarcinoma in Patients with Non-small Cell Lung Cancer

To induce cytotoxic T lymphocytes (CTL) against non-small cell lung cancer (NSCLC) efficiently, the induction of CTL was attempted using HLA-A locus-shared allogeneic NSCLC cells. T cells derived from either tumor tissue specimens or the regional lymph nodes of patients with NSCLC were stimulated twice or three times with an HLA-A2/A24-positive NSCLC cell line (PC-9), and thereafter the cytotoxic activity was examined by ⁵¹Cr-release assay. In patients with HLA-A24/ adenocarcinoma, anti-PC-9 cytotoxicity was induced in all 6 patients tested. Anti-PC-9 cytotoxicity was induced in 2 out of 5 patients with HLA-A2 (A24⁻)/adenocarcinoma, in 2 out of 4 patients with HLA-A24/squamous cell carcinoma, and 1 of 2 patients with HLA-A2/squamous cell carcinoma. The cytotoxic activity was observed to kill PC-9 selectively, not other NSCLC lines, and the activity was substantially blocked by anti-MHC class I antibody, but not by anti-MHC class II antibody. The PC-9-specific CTL produced γ-interferon in response to autologous tumor cells. These results indicated that the anti-PC-9 cytotoxicity was mediated by cytotoxic T lymphocytes that may recognize the T cell epitope(s) shared and presented by HLA-A2 and/or HLA-A24-positive NSCLC.     

肝细胞癌患者外周血性激素受体和糖皮质激素受体的含量

动物实验证实协同刺激分子CD80(B7-1)是促进抗肿瘤免疫应答的重要分子.本文应用RT-PCR,FACS技术检测了人肿瘤细胞系及EBV转化的B细胞CD80的表达,结果表明除Raji细胞、EBV转化的B细胞CD80阳性外,3AO、MCF-7、MDA-453、MKN-45、Hela细胞均为阴性.用我室建立的CD80逆转录病毒载体转染包装细胞PA317,筛选高滴度病毒上情感染人肿瘤细胞,得到CD80阳性表达的肿瘤细胞克隆.利用转染前后的人乳腺癌细胞系MDA-453作ICAM-I、HLA class Ⅰ、classⅡ分子表达的分析,结果表明转染有CD80基因的MDA-453细胞ICAM-Ⅰ、HLA classⅠ分子表达上调,class Ⅱ分子的表达未见改变.     

维生素C对阿司匹林的血药浓度及药物动力学的影响

 采用一阶导数光谱法测定水杨酸的血药浓度，研究了口服维生素Ｃ对阿司匹林在兔体内血药浓度及药物动力学的影响。结果表明：水杨酸血药浓度在１０～１４０ｕｇ·ｍｌ－１范围内呈良好的线性关系（ｒ＝０．９９７４），维生素Ｃ对水杨酸血药浓度测定无影响。阿司匹林加维生素Ｃ组的药动学平均参数与单独使用阿司匹林组比较：Ｔ＿（ｍａｘ）值减少（Ｐ＜０．０５），Ｋａ值增大（Ｐ＜０．０１）。维生素Ｃ能加快阿司匹林的吸收，两者联合使用能提早达到治疗浓度，加快了阿司匹林发挥作用。     

Right Aortic Arch with Retroesophageal Left Aberrant Innominate Artery

Right aortic arch with a left retroesophageal innominate artery (type D double aortic arch) is rare. The diagnosis is made by aortography. The present case is the first known patient to undergo a magnetic resonance imaging study that outlined the anomaly clearly.     

Parental recall of birthweight: A good proxy for recorded birthweight?

Recent evidence suggests potential associations between birthweight and disease in later life. For resource or other reasons recorded birthweight may be unavailable to researchers who have access to uniquely relevant outcome data. The present study examined the validity of parental recall of birthweight. Parents of 1015 males and females aged 12 and 15 years participating in the Young Hearts Study (a cluster random sample of 1015 males and females aged 12 and 15 years from post-primary schools in Northern Ireland) completed a questionnaire which included a question about their child's birthweight. The answer provided was compared with recorded birthweight obtained from archived computerised child health records with a cut-off point for inaccurate reporting set at ±227 g (1/2 lb). The influence of social class and weight at birth on accuracy of recall was also determined. A total of 84.8% of parents accurately recalled their child's birthweight to within 227 g. Parents from non-manual occupation social classes recalled birthweight more accurately than those from manual occupation social classes (88.0 vs. 82.6% accurate: ² = 4.81, p = 0.03). Parents of low birthweight infants tended to recall their birthweight less accurately than parents of normal weight infants: 76.1% accurate compared to 86.1% accurate: ² = 3.54, p = 0.06. Parents of high birthweight infants recalled their birthweight less accurately than parents of normal weight infants: 78.5% accurate: ² = 3.94, p = 0.05. In conclusion, parentally recalled birthweight may be a suitable proxy for recorded birthweight for population based research into disease in childhood and adolescence.     

Gender differences of symptom reporting and medical health care utilization in the German population

Aim: Gender differences in morbidity have been widely confirmed in representative health surveys in North America and Europe. Significantly more women than men suffer from somatic complaints. It is less clear whether differences in symptom reporting provide an impact on health care utilization and to which degree psychosocial factors exhibit confounding influence. Methods: We analyzed data from a representative health examination survey in Germany with 7466 participants in the age range of 25 to 69 years. Results: The analysis confirmed an overall excess in female symptom reporting, both in the total sample (n = 7460; p 0.001) and in the healthy subsample (n = 906, p 0.01). Also, female utilization of medical services was higher (p 0.0001). A simultaneous age related increase in the prevalence of symptom reporting in both groups peaked in the age group of 55–59 years followed by a subsequent slight decrease in higher age groups whereas utilization steadily increased over the adult life span in both sexes. As expected, more medical utilization was associated with higher symptom reporting levels. Nevertheless, females constantly exhibited more medical utilization than males in all symptom reporting groups. Age and marital status had no univariate influence on symptom reporting whereas low social class status (p = 0.001), poor perceived/self assessed health (p < 0.0001), and high levels of chronic distress (p < 0.0001) were associated with more symptom reporting. In multivariate analysis, the female gender lost its significance on heightened symptom reporting. Poor perceived/self assessed health had the most pronounced impact on symptom count (F-value 59.1; p < 0.001). Conclusions: The present study confirms a female excess of symptom reporting and utilization of medical services. Nevertheless, symptom reporting and utilization are not closely related. The gender gap in symptom reporting may be largely explained by low social class status, high levels of chronic distress and poor perceived/self assessed health.     

早期妊娠胎盘绒毛植入——附一例报道及文献复习

总结和探讨早期妊娠胎盘绒毛植入的发生。临床特点和处理方法。方法对１例早期妊娠胎盘绒毛植入,人工流产术中发生大出血者的资料进行回顾性分析并复习文献。结论剖宫产术是早期妊娠胎盘绒毛植入的高危因素。