新时期临床医护者中医人文精神自觉性培养探讨

新时期临床医护者应该有融汇自然与社会生态的人本观、“医乃仁术”的道德观、勇于创新的时代观、“悬壶济世”的使命观在内的中医人文精神。通过对新时期临床医护者中医人文精神现状分析,提出新时期医护者中医人文精神自觉培养路径：在医院文化建设中,提升医护人员的中医人文精神自觉性;在医院继续教育中融入中医人文精神教育;强化医护者与患者交流的能力。     

Microglial cell population dynamics in the injured adult central nervous system

Reactive microgliosis is characteristic of trauma and stroke as well as inflammatory and chronic neurodegenerative disease. A conspicuous feature of the microglial reaction to acute neural injury is a massive expansion of the microglial cell population which peaks a few days following injury. New data based on the use of radiation bone marrow-chimeric mice suggest this expansion also involves recruitment of bone marrow-derived cells, which migrate into the neural parenchyma and differentiate into microglia. Here, we discuss the contribution of bone marrow-derived cells to the injury-induced expansion of the microglial cell population, seen in the dentate gyrus with ongoing anterograde axonal and terminal synaptic degeneration, subsequent to transection of the entorhino-dentate perforant path projection. In this paradigm of minor brain injury, the bone marrow-derived cells are grossly outnumbered by activated resident microglia, which express the stem cell antigen CD34 concurrent to a marked capacity for self-renewal. The observation of a mixed origin of lesion-reactive microglia, consisting of a smaller subpopulation of exogenous bone marrow-derived microglia, and a larger population of activated resident microglia, the majority of which express CD34 and undergo proliferation, suggests that lesion-reactive microglia consist of functionally distinct cell populations. The demonstration of an injury-enhanced recruitment of bone marrow-derived cells into the perforant path-denervated dentate gyrus, raises the possibility of using genetically manipulated cells as vectors for lesion-site-specific gene therapy even in minimally injured areas of the central nervous system.     

Angular displacement perception modulated by force background

We had recumbent subjects (n = 7) indicate the amplitude of imposed, passive yaw–axis body rotations in the 0, 1, and 1.8 g background force levels generated during parabolic flight maneuvers. The blindfolded subject, restrained in a cradle, aligned a gravity-neutral pointer with the subjective vertical while in an initial position and then tried to keep it aligned with the same external direction during a body rotation, lasting less than 1.5 s about the z-axis 30°, 60°, or 120° in amplitude. All the rotations were above semicircular threshold levels for eliciting perception of angular displacement under terrestrial test conditions. In 1 and 1.8 g test conditions, subjects were able to indicate both the subjective vertical and the amplitude of the body rotation reasonably accurately. By contrast in 0 g, when indicating the subjective vertical, they aligned the pointer with the body midline and kept it nearly aligned with their midline during the subsequent body tilts. They also reported feeling supine throughout the 0 g test periods. The attenuation of apparent self-displacement in 0 g is discussed in terms of (1) a possible failure of integration of semicircular canal velocity signals, (2) a contribution of somatosensory pressure and contact cues, and (3) gravicentric versus body-centric reference frames. The significance of the findings for predicting and preventing motion sickness and disorientation in orbital space flight and in rotating artificial gravity environments is discussed.     

医院流程再造及临床路径实施中的量化研究

本文通过对医院流程化管理及临床路径研究过程中影响或贯穿整个过程的信息,提出精确化数据化定量分析,通过对个别流程的数据收集,利用计算机软件模拟,以达到揭示、改进流程瓶颈的目的。     

一种颅脑外科手术路径规划系统的研制

系统以病人的ＣＴ／ＭＲＩ断层图像为依据,通过方便灵 交互式勾边功能,使医生可以方便的勾画出感兴趣的区域,用快速的判别手段,给出路径的代价值,最手用灵活多样的显示手段,提供直接的路径三维显示。     

深化医疗卫生事业改革的伦理底蕴探析

过去医疗改革中所暴露出的一系列突出问题和矛盾凸显出我国医疗卫生事业改革伦理底蕴的缺失。全面深化医疗卫生事业改革应当坚持正确的伦理价值取向和伦理原则；明确界定政府、医疗单位和医务工作者、患者及其家属各自应负的伦理责任；走中国特色社会主义医疗卫生事业改革道路，推动和保障医疗卫生事业健康持续发展。     

大学生自杀意念的社会心理影响因素研究

目的 探讨影响大学生自杀意念的社会心理因素。方法 采用多阶段分层随机整群抽样方法,应用Beck自杀意念量表、自杀态度问卷、青少年生活事件量表、防御方式问卷、社会支持评定量表、症状自评量表(SCL-90)、简易应对方式问卷、艾森克人格问卷,对山西省普通高校一至三年级本专科大学生4882名进行现场调查,采用非条件logistic回归及通径分析探索自杀意念与各类社会心理因素之间的关系。结果 心理疾病倾向是自杀意念的主要直接影响因素,负性事件不能对自杀意念产生直接作用,只间接通过心理疾病倾向微弱地作用于自杀意念;人格等因素总是直接或间接通过应对、防御等中间变量对自杀意念产生影响作用;应对、防御、支持作为中间环节对自杀意念产生直接或间接的微小作用。结论 人格是自杀意念的基础性因素,负性生活事件对自杀意念作用虽小却起到“扳机”作用,而心理疾病倾向则是自杀意念的直接作用因素,三者依次递进有机整合最终产生自杀意念。     

Understanding recovery: Changes in the relationships of the International Classification of Functioning (ICF) components over time

The International Classification of Functioning, Disability and Health framework describes human functioning through body structure and function, activity and participation in the context of a person's social and physical environment. This work tested the temporal relationships of these components. Our hypotheses were: 1) there would be associations among physical impairment, activity limitations and participation restrictions within time; 2) prior status of a component would be associated with future status; 3) prior status of one component would influence status of a second component (e.g. prior activity limitations would be associated with current participation restrictions); and, 4) the magnitude of the within time relationships of the components would vary over time. Participants from Canada with primary hip or knee joint replacement (n = 931), an intervention with predictable improvement in pain and disability, completed standardized outcome measures pre-surgery and five times in the first year post-surgery. These included physical impairment (pain), activity limitations and participation restrictions. ICF component relationships were evaluated cross-sectionally and longitudinally using path analysis adjusting for age, sex, BMI, hip vs. knee, low back pain and mood. All component scores improved significantly over time. The path coefficients supported the hypotheses in that both within and across time, physical impairment was associated with activity limitation and activity limitation was associated with participation restriction; prior status and change in a component were associated with current status in another component; and, the magnitude of the path coefficients varied over time with stronger associations among components to three months post surgery than later in recovery with the exception of the association between impairment and participation restrictions which was of similar magnitude at all times. This work enhances understanding of the complexities of the ICF component relationships in evaluating disability over time. Further longitudinal studies including evaluation of contextual factors are required.     

江苏省不同地区平均活产数影响因素的研究——多元分类分析和通路分析

本文应用多元分类分析和通路分析法研究了江苏省不同地区平均活产数的影响因素。结果表明,30年来平均活产数均是苏南低于苏北,但两地差距逐年缩小。苏南地区初婚年龄推迟1岁平均减少0.27个活产,而苏北地区可减少0.40个活产。文化水平对于平均活产数的作用也是苏北地区明显,但随着经济的发展,苏南苏北均有初婚年龄提早及平均活产数增加的现象,苏北地区更明显。     

输氧湿化瓶微生物污染及污染途径调查

目的调查输氧湿化瓶的污染途径,了解其微生物污染情况及所检出致病菌的抗生素敏感度。方法对正在使用的输氧设施345套次的不同部位及痰和病房空气等处分别取样做细菌培养;针对致病菌铜绿假单胞菌进行药敏试验。结果湿化液严重污染占37.1%;湿化瓶和湿化液连续使用时间越长细菌检出率越高,且严重污染者亦随之升高,使用时间〉3d与〈1d对比差异显著（P〈0.05）;湿化瓶盖、鼻导管、咽拭子、痰及病房空气培养检出的细菌种类与湿化液检出的细菌种类相似。结论湿化液的常见污染菌多为条件致病菌。本研究提示湿化液的污染途径为经鼻导管的逆行污染。