New Zealand Emergency Medicine Network: A collaboration for acute care research in New Zealand

The specialty of emergency medicine in Australasia is coming of age. As part of this maturation there is a need for high‐quality evidence to inform practice. This article describes the development of the New Zealand Emergency Medicine Network, a collaboration of committed emergency care researchers who share the vision that New Zealand/Aotearoa will have a world‐leading, patient‐centred emergency care research network, which will improve emergency care for all, so that people coming to any ED in the country will have access to the same world‐class emergency care.     

用视诱发电位和富里叶变换作视力客观估计

目的:研究用图形视觉诱发电位(PVEP)和离散富里叶变换(DFT)作视力客观估计的方法。方法:检测对象为33只正常眼。用翻转频率为10次/秒,条纹张角分别为30、20、18、12、10、6、4和2弧分的垂直方波光栅图形刺激,记录相应的稳态图形视诱发电位。用离散富里叶交换提取WEP频谱中10Hz成分的幅值。以光栅条纹张角为横坐标、相应的VEP频谱幅值为纵坐标作关系曲线,取阈值附近的近似线性部分的数据点作直线回归,用外推法求得阈值和视力。结果:比较VEP所测之视力与用国际标准视力表所测之视力,可见在本研究中70％的受检眼VEP视力估计较准确。结论:用本研究中的VEP技术客观地测量视力可靠性较高。眼科学报1997;13:59～61。     

过度训练的病理生理及康复 Ⅰ.大鼠过度训练模型的建立

实验表明,运用大鼠跑台运动,以心电图、体重、饮食量、精神状况、毛发脱落、尿蛋白、血清睾酮、皮质醇等为监测指标建立大鼠过度训练模型的方法是可行的。本文并首次模拟出大鼠运动性心律失常心电图。     

人晶体 γ-晶体蛋白的研究:Ⅳ.近紫外线对胚 γ_2-晶体蛋白的光氧化作用

对人胚胎晶体γ_2-晶体蛋白溶液用近紫外线(γmax 365nm)照射,不同时间取样分析。利用巯基(-SH)特异性试剂 DACM[N-(7-甲基氨基-4-甲基-3-邻羟苯烯基)-马来酰亚胺],经 SDS-聚丙烯酰胺凝胶电泳观察光照射后的γ_2-晶体蛋白及其聚合物的游离巯基,同时检测照射后的蛋白溶液的紫外吸收光谱、光散射强度、色氨酸荧光发射光谱,以及丙烯酰胺对色氨酸荧光的猝灭效应。结果显示:人胚胎γ_2-晶体蛋白经紫外线照射,使其游离-SH 减少,蛋白聚合和分解,蛋白溶液的光散射增强,其二聚体不含游离-SH,γ_2-晶体蛋白的色氨酸荧光减少,这些变化随照射时间的延长而更明显;而对丙烯酰胺对蛋白分子中的色氨酸荧光猝灭效应影响不大。说明人胚胎γ_2-晶体蛋白通过光氧化,损伤及含游离-SH 的氨基酸残基、色氨酸残基,光氧化促使蛋白聚合和分解.提出通过进一步定量分析,可能在较深层次揭示紫外光氧化损伤含-SH 氨基酸、色氨酸残基,进而影响整个蛋白质分子结构的差异。眼科学报 1993;9:85-89。     

新加坡亚洲人的基底细胞癌特征及完全与不完全切除肿瘤的比较

背景：大多数已报道的基底细胞癌（BCCs）的特征主要是依据高加索患者。而关于亚洲人中不完全切除BCCs的特征少见报道。目的：本研究调查了新加坡亚洲居民的BCCs特征，并对常规外科切除术后完全切除与不完全切除肿瘤进行了比较。患者和方法：收集1991--1995年间在国家皮肤病中心行肿瘤切除术的原发性BCC患者的病历进行回顾性研究。结果：166例BCC患者（男女比0．95；平均年龄70．9岁）的185个组织病检确诊的BCCs记录在案。发病最高比例（27．1％）在8l～90岁年龄组。与普查资料相比，华人BCCs患者的比例明显增高（P〈0．001）。肿瘤平均直径为12．0mm，且大多数（84．3％）位于头颈部。28处（15．1％）皮损被不完全切除，多位于鼻部及鼻唇沟。不完全切除的基底细胞癌较完全切除的基底细胞癌更多发生于面中部及躯干部（P=0．003），但与肿瘤大小、肿瘤持续时间、患者年龄、种族及性别无显著相关。平均随访74个月，     

头颈部恶性肿瘤诊断治疗指南

恶性肿瘤是威胁人类生存的第一杀手,就头颈肿瘤来说虽然发病率在我国并不高,但由于我国人口众多,发病率的绝对数字也是不可忽视的。当今提倡晚期头颈肿瘤的综合序列治疗,患者的生存率及生存质量已有很大的提高,由于我国的地域差异和医学发展水平的不平衡,对于头颈肿瘤的治疗难以形成统一的治疗标准,目前国内也缺少头颈肿瘤的诊断治疗指南,客观存在着肿瘤的诊断治疗欠规范,延误诊治、过度治疗、治疗不够等现状,这不仅导致医疗资源的浪费和国家及个人的经济负担加重,而且由此导致的医患纠纷时有发生。鉴于此,本期刊出由上海交通大学医学院附属第九人民医院·口腔医学院郭伟等医师编译的2005年美国国立癌症综合信息网(National Comprehensive Cancer Network,NCCN)公布的由NCCN头颈肿瘤专家组31位专家撰写的关于头颈部恶性肿瘤诊断治疗指南的有关内容,旨在结合我国实际情况供专业人员参考。     

Integrating children's services in England: national evaluation of children's trusts

Background Poor co‐ordination of services can have severe consequences for disadvantaged children with complex needs. Since 2003 national and local governments in England embarked on sweeping reforms aimed at improving and integrating local health, education and social services for children. These were to be organized locally by children's trusts and piloted by 35 children's trust pathfinders. Methods This study described and compared the experience of integrating children's services in all 35 children's trust pathfinders, covering 20% of children in England. It had a prospective mixed‐methods design. Over 3 years we interviewed 147 managers and professionals working in the children's trusts, including 172 semi‐structured interviews, carried out two questionnaire surveys of the 35 children's trusts and analysed official documents. Results In most areas different agencies jointly commissioned children's services, especially for mental health, disabilities and multi‐purpose children's centres, and increasingly pooled finances. Provision of multi‐agency and multi‐professional services was increasing. Professionals generally supported these changes but found them stressful. All children's trusts appointed directors of children's services and established boards representing multiple agencies. Systems for sharing information about individual children were mostly in place but were still underused. Health services were generally less involved in joint work than were local authorities' education and social care services, with notable exceptions. Areas where local authorities and health authorities shared geographical boundaries made most progress. Some children's trusts made few changes beyond their statutory obligations. Conclusion Children's trusts enabled major changes to services in areas where local actors and organizations were motivated and empowered. In other areas the remit of children's trusts was often too broad and vague to overcome entrenched organizational and professional divisions and interests. Policymakers need to balance facilitation of change in areas with dynamic change agents with methods for ensuring that dormant areas and agencies are not left behind.     

Pharmacokinetics of Controlled Release and Immediate Release Morphine Sulphate Tablets after a Single Dose and Multiple Doses in Chinese Volunteers

健康志愿者１０名，随机交叉口服硫酸吗啡控释片（ＣＲＭＳ）３０ｍｇ（３０ｍｇ×１）和硫酸吗啡普通片（ＩＲＭＳ）２０ｍｇ（１０ｍｇ×２），分别于服药前后各时点取静脉血，用ＧＣＭＳ测定血浆中吗啡含量。以药代软件程序处理，分别求得ＣＲＭＳ和ＩＲＭＳ的Ｃｍａｘ为１９．３８±３．８０和２１．２７±６．２１ｎｇ／ｍｌ；ｔｍａｘ为２．３６±０．３７ｈ和０．５５±０．１６ｈ；ｔ１／２β为３．５３±０．８７ｈ和３．０３±０．７４ｈ，曲线下面积ＡＵＣ为１４５．１５±１７．６５和９３．０８±１６．６５ｎｇ·ｈ／ｍｌ。癌症病人多次口服硫酸吗啡至稳态，ＣＲＭＳ和ＩＲＭＳ的峰浓度分别为２７．４３±０．３３ｎｇ／ｍｌ，２２．６８±０．１６ｎｇ／ｍｌ；谷浓度分别为１９．４５±１．４４ｎｇ／ｍｌ；１８．１４±０．４９ｎｇ／ｍｌ。     

连续射精对正常男性精液分析参数的影响

目的 :探讨连续射精对正常男性精液分析参数的影响。　方法 :8名正常男性逐日手淫取精 ,共 8d。采用世界卫生组织人类精液检验手册方法测定精液体积、pH值、精子密度、总精子数、存活率和活动率 ,进行统计学分析。　结果 :精液体积、总精子数逐日下降 ,从第 5d起至第 8d非常显著低于第 1d(P <0 .0 1)。精子密度亦呈逐渐下降趋势 ,但无显著性差异。精子存活率和精子活动率 (a +b级 )均呈逐渐上升趋势 ,但是仅第 7d显著高于第1d(P <0 .0 5 )。　结论 :人类精液体积、总精子数随射精频度增加而显著降低 ,精子存活率和活动率增加。频繁射精并不影响正常男性精液质量。