2001年与2004年抗菌药物应用情况比较

目的　了解抗菌药物应用的基本情况。方法　将 2 0 0 1年 3月 14 3 0例住院患者病历与 2 0 0 4年 3月的 2 0 66例住院患者病历进行回顾性调查和对比分析。结果　 2 0 0 1年的 14 3 0例中有 948(66 3 % )例 ,和 2 0 0 4年的 2 0 66例有 10 60例 (5 1.3 % ) ,应用了抗菌药物。结论　定期检查考评 ,严格掌握用药指征 ,是加强抗菌药物应用管理的关键。     

Clinical observations on the use of the Chinese herbTripterygium wilfordii Hook for the treatment of nephrotic syndrome

A preparation of extracts from the root of the Chinese medicinal herbTripterygium wilfordii Hook was administered orally at a dose of 1 mg/kg body weight per day to 13 children with idiopathic nephrotic syndrome. Eight children, including 4 who were steroid resistant, went into remission which was maintained in 4 for up to 3 years after withdrawal of treatment. In 3 children the proteinuria lessened with the return of plasma protein concentration to normal, and in 1 child this improvement was maintained for 4 years after treatment ceased. No serious side-effects were noted, but a temporary anti-fertility activity has been noted in other studies of both men and women.     

How do clinicians learn to request permission for autopsies?

A postal survey of 434 clinicians at four local hospitals was undertaken in order to identify the methods by which clinicians learn how to request permission for hospital autopsies and to assess the preferred techniques and timing of relevant communication skills training. The majority of 128 responding clinicians had learnt through personal experience with some assistance from senior colleagues and peers. Few clinicians appeared to have learnt through formal training. The preferred methods for the provision of communication skills training were training in small groups (such as seminars or tutorials) and observation of clinicians at work. The most desirable time for the provision of this training was considered to be between the beginning of the final undergraduate year and the end of the pre-registration house officer year. The communication skills training provided within medical education is in need of improvement. More emphasis should be given to clinical-task- or situation-specific applications such as requesting permission for autopsies.     

Why do long-distance runners not have more bone? A vital biomechanical explanation and an estrogen effect

Inanimate structures cannot detect and repair their fatigue damage or microdamage, so to minimize it they need more structural material and strength. Living bone handles this matter differently. Bone modeling drifts adapt bone architecture and strength to the loads on bones in ways that tend to keep strains from exceeding a “modeling threshold” range. Strains (or equivalent features) above that threshold switch mechanically controlled modeling ON. Where strains stay below that threshold, this modeling goes OFF. Repeatedly loading-deloading a bone causes microdamage in it, and basic multicellular unit (BMU)-based bone remodeling normally repairs it. Where strains stay below an operational “microdamage threshold,” remodeling can repair whatever microdamage happens for as long as it happens. Strains above that threshold can cause too much microdamage to repair completely and lead to fatigue fractures of trabeculae or whole bones. The modeling threshold normally lies comforably below the microdamage threshold. Since modeling normally adjusts bone architecture to keep strains from exceeding the modeling threshold, this keeps strains below the microdamage threshold, too, and voluntary activities do not cause more microdamage than remodeling can repair. Therefore, long-distance runners do not need more bone mass and strength than nonrunners of comparable age, sex, and body size.     

激光雾化治疗机的研制

介绍一种新型激光治疗装置.它利用超声波产生的雾化气体通道作为光学传导媒介,将激光束汇同雾化药雾通过患者的深呼吸一起传导至患者的呼吸道及肺部,进行治疗.     

几种中草药复配杀虫剂的急性毒性实验研究

为有效开发植物杀虫剂资源及今后的推广应用提供科学依据。用两种粉剂和两种醇剂的杀虫应用浓度给小白鼠灌,而家兔则行皮肤刺激试验。结果显示,除醒剂Y-13经口有中毒情况发生外,其它3种制剂均无中毒现象,醇剂Y-13的家兔皮肤也无刺激反应发生。作者认为:4种制剂在有杀虫效果的前提下,杀虫应用浓度对人和动物都较安全。有开发和推广应用价值。     

Visual evoked potentials relating to imagery: Words for concrete objects versus absolute concepts

Summary We recorded visual evoked potentials (VEPs) elicited with high or low imaginable Chinese characters (HIC or LIC), representing concrete objects or absolute concepts, respectively. A closed circle (CC) acts as control stimulus. These were displayed (at 1.6° visual angle) for 35 ms on a TV monitor. Twenty-one channel VEPs (band-pas filter: 0.05–60 Hz), using balanced non-cephalic electrodes, were recorded from –100 to 924 ms for 11 right-handed male volunteers. The VEPs were analyzed by multivariate analysis of variance (MANOVA) and comparison of topographies at four remarkable peaks (P110, N160, P230 and N320). MANOVA showed significant differences (p< 0.001) for both conditions of channel and stimuli (HIC, LIC or CC). P100 for the CC-VEPs, N160 for the HIC-and LIC-VEPs, P230 for the CC-VEPs, and N320 for the HIC-VEPs were remarkable in the posterior scalp regions. Topographies at P100 and N160 showed no difference between the HIC-and LIC-stimuli. However, those at N320 showed difference between the HIC-and LIC-stimuli over the occipital and posterior temporal areas. Those results suggest that the responses at P100 and N160 might segregate Chinese characters from non Chinese characters. N320 suggested certain processes in imagery on recognizing Chinese characters over the occipital and posterior temporal areas.We are grateful to Dr. Yoshiji Kojima of Hamamatsu University for helpful comments.     

The evolution of today's hospital emergency departments —Current problems and challenges

The announcement of the National Heart Attack Alert Program by the National Heart, Lung and Blood Institute in June of 1991 prompted leaders of the Florida Chapter of the American College of Cardiology to develop a statewide program to reduce the morbidity and mortality from acute myocardial infarctions within Florida. It became apparent that the success of such a program would require the prompt institution of thrombolytic agents or other revascular-ization procedures in appropriate patients. No longer could the decision regarding institution of therapy await discussion by telephone and/or the arrival at the emergency department (ED) of the patient's primary care physician or cardiologist. Efforts to establish appropriate protocols for therapy revealed that many of the 25,000 or more physicians currently staffing the 5,600 or so EDs in this country were moonlighting residents or practitioners from a variety of specialties or subspe-cialties with limited or no formal EM training. Furthermore, it was learned that there were in the entire country only about 800 postgraduate, year-one Council for Graduate Medical Education accredited training positions. There were only 21 such training positions in the entire state of Florida. The reasons for these deficiencies are discussed and a challenge to correct this person power crisis is issued, not principally to the leadership of EM, but to the entire medical profession.     

The therapeutic value of vasodilator prostaglandins in multiple organ failure associated with sepsis

There is considerable evidence from animal and human studies of sepsis and acute lung injury that prostacyclin and PGE₁ may have a beneficial effect on tissue perfusion with a reduction in the severity of tissue damage associated with these disorders. As yet, there are no good data from controlled clinical trials that these agents improve survival and it is not clear whether in the future such data will be forthcoming. Nevertheless, using various physiological end-points, both prostaglandins seem to be beneficial in sepsis and when used in combination with the whole process of Intensive Therapy, may contribute to the survival of some cases. Although the assessment of combinations of agents designed to inhibit mediator release might be more useful, it remains to be seen whether the relatively insensitive controlled clinical trial, with survival as its endpoint, is the appropriate tool for assessing efficacy in the ITU. Perhaps, the consensus approach has something to offer in this situation!