血卟啉单甲醚激光诱发荧光光谱区分肺癌组织和正常支气管组织

目的　探讨应用国产新型光敏剂血卟啉单甲醚 (HMME)激光诱发荧光光谱分析方法诊断肺癌的可行性。方法　 15例肺癌患者肺切除前 3小时静脉注射HMME 2 .5mg/kg ,使用三倍频YAG激光 (波长 35 5nm)和光学多道分析仪 (OMA)对切除的癌组织和正常支气管组织行激光诱发荧光光谱测定。 43个检测点均行病理检查。结果　 15例患者术后 48小时后接受阳光照射 ,无一例发生皮肤光过敏副作用。肺癌组织的荧光强度 ( 314 4 6± 5 0 17)显著低于正常支气管组织 ( 75 430± 890 8) (P <0 .0 0 1)。正常支气管组织光谱在长波区5 80～ 6 0 0nm处有一个小坪 (I580nm/I6 0 0nm =1.0 81± 0 .0 90 ) ,而肺癌组织则平滑下降 (I580nm/I6 0 0nm=1.2 6 0± 0 .15 7)。肺癌组织于 6 2 3 .4nm± 1.6nm处有一明显的特征峰 (即药物峰 )。以I580nm/I6 0 0nm比值为判据 ,诊断肺癌的敏感性、特异性和符合率分别为 80 .0 %、73 .9%和 76 .7% ;以药物峰斜率为判据 ,诊断肺癌的敏感性、特异性和诊断符合率分别为 95 .0 %、91.3 %和 93 .0 %。结论　新型光敏剂血卟啉单甲醚 (HMME)激光诱发荧光光谱能够区分肺癌和正常支气管组织 ,与激光诱发自体荧光相比 ,能够提高诊断肺癌的敏感性、特异性和符合率     

葶苈子水提液对动物实验性心室重构的影响

目的研究葶苈子水提液对异丙肾上腺素(ISO)诱发小鼠,L-甲状腺素(L-Thy)诱发大鼠实验性心室重构的影响。方法小鼠每天scISO2mg/kg,连续7d;大鼠每天ipL-Thy0.3mg/kg,连续10d,制备心室重构动物模型。各组小鼠每天ig葶苈子水提液6、12g/kg和美托洛尔0.06g/kg,连续7d后,检测心脏指数、血浆环磷酸腺苷(cAMP)、心肌血管紧张素(Ang)量的变化;各组大鼠每天ig葶苈子水提液4、8g/kg和卡托普利0.02g/kg10d后,检测心脏指数、血浆中醛固酮(ALD)及左心肌Ang、羟脯氨酸(Hyp)量的变化。结果模型小鼠的心脏指数、cAMP、Ang量均明显升高,给予美托洛尔0.06g/kg或葶苈子水提液12g/kg均可抑制小鼠左心室重构和肥厚,降低心脏指数和血清cAMP水平及心肌Ang的量(P<0.05)。模型大鼠也出现心肌纤维化,心脏指数、心肌Ang、血浆ALD、心肌Hyp量均明显升高,给予卡托普利0.02g/kg或葶苈子水提液4、8g/kg均可降低大鼠心脏指数和Ang、ALD及心肌Hyp水平(P<0.05)。结论葶苈子水提液具有抑制实验动物心肌肥大、心室重构的作用,其作用机制可能与抑制交感神经系统兴奋性及抑制Ang、ALD等神经内分泌因子激活有关。     

The European I-MOVE Multicentre 2013–2014 Case-Control Study. Homogeneous moderate influenza vaccine effectiveness against A(H1N1)pdm09 and heterogenous results by country against A(H3N2)

BackgroundIn the first five I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe) influenza seasons vaccine effectiveness (VE) results were relatively homogenous among participating study sites. In 2013–2014, we undertook a multicentre case-control study based on sentinel practitioner surveillance networks in six European Union (EU) countries to measure 2013–2014 influenza VE against medically-attended influenza-like illness (ILI) laboratory-confirmed as influenza. Influenza A(H3N2) and A(H1N1)pdm09 viruses co-circulated during the season.MethodsPractitioners systematically selected ILI patients to swab within eight days of symptom onset.We compared cases (ILI positive to influenza A(H3N2) or A(H1N1)pdm09) to influenza negative patients. We calculated VE for the two influenza A subtypes and adjusted for potential confounders. We calculated heterogeneity between sites using the I² index and Cochrane's Q test. If the I² was <50%, we estimated pooled VE as (1 minus the OR) × 100 using a one-stage model with study site as a fixed effect. If the I² was >49% we used a two-stage random effects model.ResultsWe included in the A(H1N1)pdm09 analysis 531 cases and 1712 controls and in the A(H3N2) analysis 623 cases and 1920 controls. For A(H1N1)pdm09, the Q test (p = 0.695) and the I² index (0%) suggested no heterogeneity of adjusted VE between study sites. Using a one-stage model, the overall pooled adjusted VE against influenza A(H1N1)pdm2009 was 47.5% (95% CI: 16.4–67.0).For A(H3N2), the I² was 51.5% (p = 0.067). Using a two-stage model for the pooled analysis, the adjusted VE against A(H3N2) was 29.7 (95% CI: −34.4–63.2).ConclusionsThe results suggest a moderate 2013–2014 influenza VE against A(H1N1)pdm09 and a low VE against A(H3N2). The A(H3N2) estimates were heterogeneous among study sites. Larger sample sizes by study site are needed to prevent statistical heterogeneity, decrease variability and allow for two-stage pooled VE for all subgroup analyses.     

ISO 15189质量体系下智能结构化检验知识库系统的建立与应用

目的依据ISO 15189质量体系建立覆盖检验全流程的智能结构化检验知识库,满足各个医疗环节对检验知识库的需求。方法在ISO 15189质量体系下,引入检验认知计算理论,通过信息化方法实现对检验知识源的提取、挖掘,自定义知识节点,并持续对数据库信息进行更新。结果建立的智能结构化检验知识库可以从检验各业务节点采集知识,通过富文本编辑,自动生成服务手册、项目书册、项目操作规程、仪器操作规程、采集手册,再将形成的程序化文件各节点碎片化分布在实验室信息系统(LIS)中,支持工作站、移动终端对检验知识库的浏览、查阅和数据分享。结论通过建立结构化的检验知识库,将检验相关的基础信息进行分类编排,使信息和知识有序化,缩短了搜索时间,加快了知识和信息的流动,有利于检验知识的共享与交流。     

在住院药房推行ISO9001质量管理体系的体会

目的 :运用现代质量管理的科学理念和先进方法建立住院药房的质量管理体系。方法 :在我部推行ISO9001质量管理体系的条件下 ,住院药房要以病人为关注焦点 ,持续改进工作 ,向病人和临床科室提供优质、规范的服务。结果与结论 :推行ISO9001质量管理体系 ,既规范了住院药房的质量管理 ,又提高了医患满意度 ,可取得较好的经济效益和社会效益 ,实现住院药房管理的自我完善和持续改进     

Tricalcium silicate cement sealers: Do the potential benefits of bioactivity justify the drawbacks?

BackgroundGrossman described the ideal properties of root canal sealers. The International Organization for Standardization and American National Standards Institute and American Dental Association have codified some of his requirements in ISO 6876 and ANSI/ADA 57, respectively. In this narrative review, the authors combined the ideal Grossman properties and requirements of these standards, emphasizing the newer tricalcium silicate cement sealers. This chemical matrix for such sealers was developed on the basis of the success of bioactive mineral trioxide aggregate–type (tricalcium silicate cement) materials for enhanced sealing and bioactivity.MethodsThe authors searched the internet and databases using Medical Subject Heading terms and then conducted a narrative review of those articles involving the tricalcium silicate cement endodontic sealers.ResultsNinety-four articles were identified that discussed tricalcium silicate cement sealers. Tricalcium silicate cement sealers are partially antimicrobial and have bioactivity, which may presage improved biological sealing of the root canal system. Most other properties of tricalcium silicate cement sealers are comparable with traditional root canal sealers.ConclusionsWithin the limitations of this review, tricalcium silicate cement endodontic sealers met many of the criteria for ideal properties, such as placement, antimicrobial properties, and bioactivity, but limitations were noted in solubility, dimensional stability (shrinkage and expansion), and retrievability.Practical ImplicationsTricalcium silicate–based cements have been commercialized as bioactive, bioceramic endodontic sealers. Warm, cold, and single-cone obturation techniques are usable, depending on the commercial product. Some sealers can cause discoloration and are not easily retrievable, particularly when used to completely obturate a canal.     

药剂科的分级管理与ISO认证

通过医院分级管理和ISO9001质量管理体系在药剂科的运作,比较两种管理方法的优点,重点阐述ISO9001质量管理体系在医院药剂科的运作方法,体系ISO认证的四个特点,即按照过程审核,关注审核标准的全面性和完整性,文件的内容和结构要与组织的实际相适应,关注持续改进质量体系的有效性。实践证明,将医院分级管理和ISO质量管理体系进行有效融合,提升了药剂科的管理工作。     

IS09001基础上引入六西格玛管理法对优化急诊住院患者交接流程效果评价

目的:探讨实施IS09001质量管理体系的基础上引人六西格玛管理方法在护理流程改造中运用的效果.方法:2008年1月起采用IS09001质量管理体系的基础上引入六西格玛五步法即定义、测量、分析、改进、控制.对急诊患者入院交接流程中的质量关键点及流程中的缺陷进行识别.对比分析流程优化前后各120例急诊患者入院交接的缺陷情况、交接时间、患者满意度及急诊护士对病房护士的满意率,以评价应用IS09001质量管理体系的基础上引入六西格玛管理法,对急诊住院患者入院交接优化流程的效果.结果:流程优化后护理纠纷及缺陷率从1.60%降至0.48%(P＜0.05);交接患者等待时间由原来的(9.4±2.3)min缩短至(3.8±1.2)min(P＜0.05);患者满意度、急诊护士对病房护士满意度均有明显提高(P＜0.01),达到了预期目标.结论:IS09001质量管理体系的基础上实施六西格玛管理方法,能提高急诊护士工作质量和工作效率,降低工作缺陷率,在护理管工作中值得推广应用.     

西红花酸对异丙肾上腺素致大鼠急性心肌缺血损伤的保护作用

目的 研究西红花酸对异丙肾上腺素(ISO)致大鼠急性心肌缺血的保护作用及机制。方法 采用大剂量ISOsc诱导产生大鼠急性心肌缺血模型(1SO30mg／kg，每日一次，连续2d)，实验大鼠随机分为正常组、ISO模型组、阳性对照组和3个西红花酸给药组(25，50，100mg／kg)，测定心脏系数和血清中乳酸脱氢酶(LDH)、磷酸肌酸激酶(CK)和丙二醛(MDA)含量，观察心肌组织谷肮甘肤过氧化物酶(GSH—Px)、Na^ ，K^ —ATP酶和Ca^2 ，Mg^2 —ATP酶活性及心脏病理改变，观察西红花酸的保护作用。结果 西红花酸能显著降低血清中CK和LDH的释放；也能显著降低血清和心脏匀浆中MDA水平，心脏重量参数显示对心肌水肿有明显的抑制作用；保护心肌GSH—Px；Na^ ，K^ —ATP酶和Ca^2 ，M8^2 -ATP酶活性，心脏病理切片表明西红花酿对心肌坏死有显著的保护作用。结论 西红花酸对ISO所致急性心肌缺血有显著的保护作用。