让核心价值观成为员工的精神追求

血站文化建设的核心是促使全体职工形成统一的核心价值观。采用小组讨论、专题讲座、座谈沟通、问卷调查、专题研讨等方法提炼了组织核心价值观,并采用多种形式促进核心价值观落地。使核心价值观真正内化为职工的精神追求,外化为职工的自觉行动,有力地推动了无偿献血事业健康、可持续发展。     

值班和交接班制度问题分析与改进建议

值班和交接班制度是诊疗过程连续性的重要保障。若落实不到位,可能发生患者伤害的不良后果。采用案例分析结合问卷调查方式,阐述值班和交接班制度存在问题,包括值班人员不在岗,值班人员资质不符,医院总值班能力不足,交接班记录不完整等。提出针对性改进建议:加强医务人员依法执业培训;严格管理值班医师资质;健全医疗值班体系;规范记录交接班内容等。     

户外活动时间与学龄前文化课学习情况对中小学生视力不良的交互作用

目的 分析户外活动时间与学龄前参加文化课学习情况的交互作用与中小学生视力不良的关系,为制定防控中小学生视力不良的策略和措施提供科学依据。方法 采用分层整群随机抽样法于2018年9-11月在湖南省抽取8 467名小学四年级到高中三年级学生进行体格检查和问卷调查。相乘交互作用建立多因素Logistic回归模型,并计算交互作用超额危险度(RERI)、交互作用归因比(API)及交互作用指数 S (Index S)探讨户外活动时间与学龄前文化课学习对视力不良的相加交互作用。结果 8 467名调查对象中视力不良检出人数为5 612名,检出率为66.28%。学龄前参加过文化课学习者,视力不良的发生风险是不参加学习者的1.500倍(95%CI:1.331~1.689,P<0.001),每日户外活动<2 h的学生发生视力不良的风险是每日户外活动≥2 h者的1.247倍(95%CI:1.103~1.409,P<0.001)。户外活动时间与学龄前文化课学习的交互作用项具有统计学意义(P_交互=0.003)。在调整相关因素后,户外活动时间与学龄前文化课学习的RERI、API、Index S分别为0.529、0.310、3.973。结论 中小学生户外活动时间、学龄前文化课学习均与视力不良发生风险相关,并两者对视力不良有交互作用。因此,应加强学龄前儿童的户外活动,以预防视力不良发生。     

Culture-Expanded Autologous Adipose-Derived Mesenchymal Stem Cell Treatment for Osteonecrosis of the Femoral Head

BackgroudOutcomes of traditional treatment for osteonecrosis of the femoral head (ONFH) are not always satisfactory. Hence, cell-supplementation therapy has been attempted to facilitate necrotic-tissue regeneration. Adipose-derived mesenchymal stem cell (ADMSC) transplantation is potentially advantageous over bone marrow-derived MSC implantation, but its outcomes for ONFH remain unclear. The aim of this study was to determine 2-year radiological and clinical outcomes of culture-expanded autologous ADMSC implantation for ONFH.MethodsEighteen hips with necrotic lesions involving ≥ 30% of the femoral head were included. ADMSCs were harvested by liposuction and culture expanded for 3 passages over 3 weeks. With a 6-mm single drilling, ADMSCs were implanted into the necrotic zone. All patients underwent magnetic resonance imaging (MRI), single-photon emission computed tomography/computed tomography (SPECT/CT) at screening and 6 months, 12 months, and 24 months postoperatively. The primary outcome was the change in the size of necrotic area on MRI. Secondary outcomes were changes in clinical scores and radioisotope uptake on SPECT/CT. Conversion total hip arthroplasty (THA) was defined as the endpoint.ResultsPreoperatively, the necrotic lesion extent was 63.0% (38.4%–96.7%) of the femoral head. The mean Harris hip score was 89.2, the University of California at Los Angeles (UCLA) score was 5.6, and Western Ontario and McMaster Universities Arthritis index (WOMAC) was 79.4. Three patients underwent THA and 1 patient died in an accident. Finally, 11 patients (14 hips) were available for ≥ 2-year follow-up. At the last follow-up, no surgery-related complications occurred, and 14 of 17 hips (82%) were able to perform daily activities without THA requirement. There was no significant decrease in lesion size between any 2 intervals on MRI. However, widening of high signal intensity bands on T2-weighted images inside the necrotic lesion was observed in 9 of 14 hips (64%); 11 of 14 hips (79%) showed increased vascularity on SPECT/CT at 2 years postoperatively. No significant differences were observed between preoperative and 24-month mean Harris hip score (89.2 vs. 88.6), WOMAC (79.4 vs. 75.7), and UCLA score (5.6 vs. 6.2).ConclusionsOur outcomes suggest that culture-expanded ADMSC implantation is a viable option for ONFH treatment without adverse events.     

Behavioral and autonomic responses to intermittent social stress: differential protection by clonidine and metoprolol

The present study investigated physiological and pharmacological characteristics of socially stressed animals. Specifically, we examined (1) to what degree autonomic and behavioral stress reactions during intermittent confrontations between an intruder male adult Long-Evans rat with an aggressive resident undergo habituation, and (2) to what extent the defeat-experienced animal can be protected against these stress reactions with clonidine or metoprolol, two adrenergic agents with clinical anxiolytic effects. We developed an acute social stress situation that consisted of initially placing an experimental rat as an intruder into the homecage of a resident while the resident was not present, thereafter permitting brief physical agonistic interactions with the reintroduced resident until the intruder was forced into a submissive supine posture and emitted ultrasonic vocalizations (USV), and eventually exposing the intruder to the resident's threats for one hour, while being shielded from potentially injurious attacks (threat encounter). Over the course of the initial 4-weekly threat encounters the acute tachycardia but not the hyperthermic stress responses decreased in magnitude. Following the first three threat encounters core temperature (T_c) was significantly elevated for at least 3 h. The T_c was already elevated when the repeatedly defeated intruder was confronted with the olfactory cues of the resident's cage. This conditioned anticipatory hyperthermia developed in the course of the first three confrontations and was paralleled by a decrease in exploratory and motor behavior and by an increase in defensive behaviors and in both types of USV emitted in the low (20–30 kHz) and the high (31–70 kHz) frequency range. Clonidine (0.01–0.1 mg/kg, IP), an ₂-adrenergic agonist and metoprolol, a -adrenergic blocker (1.0–10.0 mg/kg, IP), dose-dependently prevented the tachycardic response to stress. Only clonidine, but not metoprolol, also attenuated the rise in T₀ during the 1-h agonistic interaction. Clonidine decreased those aspects of motor behavior (e.g. rearing, walking) that are of lesser cost for the individual but maintained high levels of defensive reactions and increased the duration of low USV. The high doses of clonidine (0.06, 0.1 mg/kg) attenuated the homeostatic regulation and sedated the intruder while exposed to threats during a social confrontation. The absence of attenuation of the high level of defensive behavior and the prolonged low USV suggest a stress intensification by the higher doses of clonidine. In conclusion, after the fourth encounter, the autonomic, behavioral and vocal response pattern prior to and during repeated weekly confrontations show no evidence for habituation for the following 6 weeks. Moreover, adrenergic therapeutic agents that are applied to treat symptoms of anxiety block the tachycardic response but may actually intensify defensive behavior and certain stress vocalizations.     

Profil psychopharmacologique d'un nouvel agoniste Dopaminergique,le RU 24213

The psychopharmacological properties of RU 24213 were compared to those of other dopaminergic agonists (apomorphine, dexamphetamine, bromocriptine and l-dopa) in various behavioural tests. In naive mice the drug reduced the locomotor hyperactivity in the primary exploratory phase and produced stimulation in the subsequent stabilized activity period. In rats it provoked dose-related stereotypies, specially gnawing and sniffing. It delayed the cataleptic state induced by prochlorperazine without affecting its intensity. In animals unilaterally lesioned with 6-OHDA in the nigro-striatal pathway, RU 24213 caused contralateral turning. It exhibited relatively weak emetic and anorexic effects in dogs. Core temperature recordings in rats revealed a biphasic hypo- and hyperthermic activity. In drug interaction studies it was observed that stereotypies and rotations induced by RU 24213 were blocked by haloperidol and decreased by MT. Reserpine respectively decreased stereotypies and increased ipsilateral rotations in rats with unilateral electrolytical striatal lesion.The results obtained suggest that RU 24213 stimulates dopamine receptors both directly and indirectly. In this respect it could be compared to bromocriptine but unlike this latter compound it has an immediate effect which is of shorter duration.

     

人才建设是构建军队医院核心竞争力的根本保障

核心竞争力属于知识范畴,而人才是知识的载体.文章在对12所军队医院及其特色科室人才情况调研的基础上,提出人才建设是军队医院构建核心竞争力的根本保障,必须优化人才结构,建立合理人才梯队,创新人才机制,如科主任管理机制、人才使用机制、人才培养机制和人才组合机制等.     

知识型县级医院核心人才素质的立体模糊评估

在构建知识型县级医院核心人才素质评价指标体系的基础上。综合运用模糊数学、概率论、空间两点距离等理论进行核心人才素质立体模糊量化评估．帮助县级医院有效鉴别核心人才，促进县级医院人力资源管理工作和县级医院发展。     

医学院校法学课程教学方法探讨

现行医学院校法学课程教学方法存在许多不足,应该建立以课堂理论讲授为基础,采用多种教学手段传授学生法律知识的教学方法体系,其中具有基础性地位和方法论意义的是课堂讲授教学法和课堂讨论教学法。