慢性肝病患者血糖变化的临床观察及预见性护理

目的：探讨慢性肝病患者血糖变化情况及其预见性护理措施。方法选取我院2013年5月～2014年5月收治的40例慢性肝病患者为研究对象,利用全自动生化分析仪及ELISA法对患者肝功能及血糖情况进行检测和观察,根据观察结果采取针对性的预见性护理干预措施。结果慢性轻度肝炎血糖异常8.00%,慢性重度肝炎血糖异常率30.00%,肝硬化血糖异常率60.00%。血糖异常组电解质紊乱、感染发生率明显高于血糖正常组（P＜0.05）。结论慢性肝病程度越重,血糖浓度越高,更易出现血糖异常现象,引发感染等系列并发症。为此需全面监测血糖变化,严格控制血糖。     

TIMI危险积分与冠状动脉病变的相关性研究

目的　探讨冠心病患者TIMI (theThrombolysisinMyocardialInfarction)危险积分与冠脉病变范围、狭窄程度及病变性质的相关关系 ,明确TIMI危险积分对冠脉病变严重程度的评估价值。方法　选择 12 6例冠心病病人为研究对象 ,分析入院时病人TIMI危险积分与其冠脉病变范围、狭窄程度及病变性质的相关性 ;比较TIMI危险积分判别病人冠脉病变范围、狭窄程度及病变性质的ROC(residentoperationcharacter)曲线下面积大小的差异 ,评价TIMI危险积分对病人冠脉病变严重程度的判别价值。结果　TIMI危险积分与病人冠脉病变范围、狭窄程度及病变性质分级均成正相关 ,即TIMI积分越高 ,冠脉病变越重。冠脉病变狭窄程度的ROC曲线下面积最大 ,而冠脉病变性质的ROC曲线下面积最小 ,冠脉病变狭窄程度的ROC曲线下面积明显大于狭窄程度及病变性质的ROC曲线下面积 (P <0 .0 5 ) ,而狭窄程度和病变性质的ROC曲线下面积比较差异无显著性意义 (P >0 .0 5 )。结论　TIMI危险积分能间接反映冠脉病变的狭窄程度及一定程度上反映冠脉病变范围、病变性质的严重程度。TIMI危险积分对冠脉狭窄程度的判别价值较高 ,对冠脉病变性质及范围的判别价值相对较低。     

术后ICU患者精神障碍相关因素的分析

目的：应用精神紊乱评估方法及其它辅助检查方法诊断ICU术患者急性精神障碍的发生。方法：采用统计学方法评估各种危险因素与ICU术后急性精神障碍发生之间的相关性。结果：通过对218例患者的分析显示，有37例病人出现急性精神障碍。结论：相关因素分析显示年龄、手术类型、并发症以及围手术期低氧低血压状况等因素均与ICU术后急性精神障碍的发生密切相关。     

Nursing and politics: a South African perspective

The purpose of this paper is to provide a general introduction to politics, and to describe some political changes which have affected the rendering of multidisciplinary health care services in the Republic of South Africa since 1994. Political issues which will be addressed include: changed provincial borders; opening up of the Republic of South Africa's international borders; increased emphasis on primary health care services; enhanced international involvement of the Republic of South Africa; changes in the statutory bodies governing the nursing profession; and changed legislation affecting health care workers. Political know-how is essential for professional survival. Unless nurses in the Republic of South Africa collaborate proactively as a united group representing the largest proportion of health care professionals in the country, the nursing profession and nursing education might become irrelevant to the political realities of the country and its people. Unless nurses can succeed in engaging in successful political debates and in negotiating their rights, they might become an increasingly voiceless, faceless and powerless female profession in the Republic of South Africa. However, politically knowledgeable nurses may help to ensure that the people will get the nurses and the nursing care they deserve, whilst the nurses will enjoy the benefits to which they are entitled, including market-related salaries.     

建立该地区妊娠各期甲状腺激素参考范围及甲状腺激素变化的探讨

目的：建立徐州地区健康孕妇妊娠各期甲状腺激素的参考值,探讨其变化规律。方法整群选取2015年1—5月正常单胎妊娠孕妇,按孕早、中、晚期分组,以年龄匹配非妊娠健康妇女作为对照组,用电化学发光法测定其甲状腺激素水平并建立各自的参考范围。其中孕早、中、晚期各988、1734、1052例,非妊娠妇女1203例,孕期患甲状腺疾病的483例。结果早、中、晚期孕妇及非妊娠妇女的甲状腺激素水平均呈偏态分布,参考值选择95%可信区间。TSH在早[1.93(0.37~5.79）]、中[1.97(0.46~5.10）]、晚孕期[2.28(0.48~6.37）]逐渐上升,晚孕期略高于非妊娠妇女[2.14(0.79~5.30）]但差异无统计学意义(P>0.05）。 FT3和 FT4在早[5.71(4.03~6.26）;16.65(12.86~22.45）]、中[4.71(3.59~5.99）;15.24(9.89~20.63）]、晚孕期[4.28(3.36~5.54）;12.33(8.82~16.82）]逐渐降低,早孕期低于非妊娠妇女[5.95(4.17~6.60）;17.28(13.01~21.30）]且差异有统计学意义(P<0.05）。亚临床甲减、甲减和甲亢的发生率分别是9.07%、2.03%、0.23%。结论正常孕妇的甲状腺激素水平不同于非妊娠妇女,各孕期之间差异有统计学意义;妊娠期孕激素的变化不足以引起其甲状腺功能的紊乱。     

实用医院临床杂志近三年作者群变化分析

目的了解本刊作者群的分布及需求，有的放矢的组织稿源，加强和发展、培育稳定的作者群。方法对2004—2006年本刊出版发行的14期杂志的作者单位、地域、职称和学历的分布情况进行对比分析。结果14期杂志的作者分布在全国597个医疗单位；作者职称分布：每期专家约稿平均占19．65％；副高论文19．07％；中级论文49．98％；初级论文8．58％。作者学历分布：博士5．16％；硕士15．86％；本科61．76％；专科14．19％。作者地域分布：省外作者04年占25．99％，05年占29．70％，06年占35．61％，06年与04年比较，=6．9148，P=0．03；本院作者04年占33．04％，05年占23．31％，06年占24．70％，05年与04年比较x^2=19．91，P=0．000；06年与04年比较x^2=25．91，P=0．000。结论本刊作者涵盖全国28个省及地区的各级医疗单位，作者群基本稳定，省外作者呈逐年增多趋势，本院作者呈逐年下降趋势。     

Stability and change in physical activity in old age: the role of changes in disability

The objective was to examine whether stability and change in physical activity in older men and women are influenced by (1) changes in disability and by (2) social relations and psychological well-being. The study is based on baseline, 3 and 4.5 year follow-up data on 917 older men and women. Changes in physical activity were measured through self-reported frequencies of vigorous physical activity at the three measurement points. The analyses were carried out for two outcomes—decline in physical activity versus sustained high level of physical activity (from high to low) and sustained low physical activity versus improvement in physical activity (from low to high). The main results were: older adults with onset of tiredness or continuous tiredness in daily activities during 4.5 years are more likely to have a concurrent decline in their physical activities during the same period. Older adults with onset of need of help and sustained need of help are more likely to have a decline in physical activities or to sustain a low level of physical activities during the same period. The associations between the psychosocial factors and change in physical activity are attenuated by the concurrent changes in disability. The present study supports that health promotion projects should be aware that development of tiredness and continuous tiredness are strongly related to a decline in physical activity and that onset of and sustained need of help are strongly associated with both a decline in and sustained low physical activity.     

老年冠心病合并代谢综合征患者的冠状动脉病变特点

目的探讨老年冠心病合并代谢综合征患者的冠状动脉病变特点。方法检测54例老年冠心病合并代谢综合征患者与108例老年冠心病不合并代谢综合征患者的腰围、空腹血糖、血脂、血压及冠状动脉造影。结果合并代谢综合征组冠状动脉血管多支病变、弥漫性病变及闭塞性病变较不合并代谢综合征组多(P>0.05),且主要累及左主干和左回旋支(P>0.05);合并代谢综合征组左心室功能减退高于不合并代谢综合征组(P>0.05)。结论合并代谢综合征患者在多重心血管危险因素聚集下,冠状动脉呈多支病变且病变严重,积极干预心血管危险因素,对防止冠心病的发生、发展,改善预后有重要的意义。     

Origins of the Knife: Early Encounters with the History of Surgery

We evaluated the production of the interleukins (ILs) IL1- &;#103 , IL-6, and IL-10 in both the vasculature and pulmonary tissue before and after 24 h of lung preservation. The cardiopulmonary blocs of 21 Balb-c mice were divided into three study groups (7 mice/group) and were flushed through the pulmonary artery with Krebs-Henseleit buffer (K-Hb) at 4°C at a rate of 0.2 mL/min as follows: Group 1, lung washout: lungs were flushed until pulmonary effluent was clear. Group 2, perfusion: After lungs were flushed until pulmonary effluent was clear, lungs were perfused during 30 min. Group 3, preservation: Lungs were flushed until pulmonary effluent was clear, and the cardiopulmonary bloc was preserved immersed into (K-Hb) at 4°C. After 24 h of preservation, lungs were reperfused during 30 min. In all study groups the caudal lobe from the left lung was taken for microscopical study; all other lobes were homogenized with (K-Hb) and the supernatant was obtained. IL-1 &;#103 , IL-6, and IL-10 production in lung effluents (washout, perfusion, and reperfusion) and in lung tissue were measured by enzyme-linked immunosorbent assay (ELISA). In the lung effluent, there was no statistical difference between IL-1 &;#103 and IL-6 concentrations. In all study groups, IL-10 production was significantly higher than IL-1 &;#103 and IL-6 levels. IL-10 level was lowest in the 24-h preservation group when it was compared to the other groups. In group 1, there was a negative correlation ( r =-.599, p < .05) between IL-1 &;#103 and IL-10. In pulmonary tissue, IL-1 &;#103 was higher in group 2 when compared to groups 1 ( p = .001) and 3 ( p = .002), and it was significantly lower in group 3. IL-10 was lower in group 1 when compared to groups 2 ( p = .001) and 3 ( p = .004). In groups 1 and 2, IL-1 &;#103 was significantly higher than IL-6 and IL-10. In group 3, IL-10 was higher than IL-1 &;#103 ( p = .0001) and IL-6 ( p = .0001). Correlation of effluent/tissue index with histological findings showed a negative correlation between IL-10 effluent/tissue relation and inflammation ( r =-.68, p < .01). In conclusion, the main cytokine found in lung effluents was IL-10, followed by IL-6 and IL-1 &;#103 . On the other hand, cytokine concentration in lung tissue homogenates was mainly due to the presence of IL-1 &;#103 . However, this cytokine shows a significant reduction in lung tissue after prolonged preservation.