病人自主选择医生的伦理学思考

随着卫生系统的改革向纵深处发展 ,全国不少医院开展了病人自主选择医生的举措 ,医院把看病就医的自主权 ,把生命的主宰权还给了病人。这种推进改革的重大举措给医院带来了新的机遇 ,注入新的活力 ,使得医务人员积极改善服务态度 ,提高服务质量 ,一切以病人为中心 ,一切围着病人转 ,一切满足病人的要求。病人的事再小也是大事 ,应该提到重要议事日程上来已经成为不少医院领导的自觉行动。有些医院还作出明文规定对于病人选择率低的医生采用末位淘汰制。病人自主选择医生带来了医院内部的竞争 ,使平静的医院内部产生了躁动 ,有些医院还开展了…     

HPLC法研究盐酸环丙沙星胶囊的相对生物利用度

目的：为了比较盐酸环丙沙星胶囊及片剂口服吸收的相对生物利用度。方法：采用交叉实验设计，高效液相色谱、荧光检测法研究10的健康志愿者口服胶囊及片剂后的相对生物利用度。结果：口服片剂和胶囊剂后，环丙沙星在体内很快吸收，二药达峰时间及峰浓度分别为Tmax1．65±0.6h、1．03±0．35h，Cmax3．33±1.57μg／ml5．16±1．60μ／ml；滞后时间分别为0．21±0．15h，0.15±0．08h；消除半衰期分别为4．75±1．62h及5．06±0．81h；胶囊和片剂的AUC分别为25．9±8.32（μg／ml）h，19．96±6.13（μg／ml）h。相对生物利用度130．1％。结论：口服二药后，盐酸环丙沙星均较快吸收，但相比之下，胶囊剂吸收更快、更完全。     

四理汤对厌食儿童发锌、铁、铅、镁、钙元素的影响

四理汤对厌食儿童发锌、铁、铅、镁、钙元素的影响张宁，聂惠民，王庆国，傅延龄，何基渊，梁茜（北京中医药大学１０００２９，北京市中西医结合医院）关键词四理汤，厌食症，锌，钙，铁，铅，镁儿童厌食症，是指小儿食物摄入量过少，食欲不振，厌食、拒食及异食，并伴有...     

紫外线、“音频电”综合治疗带状疱疹疗效观察

我科自 1996年 10月至 1999年 10月间 ,应用紫外线、“音频电”综合疗法治疗带状疱疹 72例。经与药物治疗组进行对照 ,其疗效明显高于药物治疗组 ,现报告如下。1　临床资料1 1　病例资料　在本项观察中 ,共有 135例带状疱疹患者 ,均为我院门疹病人。随机将患者分为治疗组和对照组 ,治疗组共有 72例 ,其中男 43例 ,女 2 9例 ,年龄 17～ 6 4岁 ,平均 42 .3± 8.7岁 ,病程 2～ 10天 ,平均 4.3± 1.2天。病变部位 :胸部 2 7例 ,腹部 15例 ,上肢 19例 ,下肢 11例。对照组 6 3例 ,其中男 32例 ,女 31例。年龄 19～ 5 8岁 ,平均 40 .6± 7.9岁 ,病…     

去除血性胸腹水、血尿中红细胞方法的探讨

我院送检的血性胸腹水 ,血尿标本 ,大多是临床疑为恶性肿瘤所致 ,这类标本制作涂片的经典方法是离心后直接涂片 ,结果ＨＥ染色后镜下发现背景深红 ,红细胞较多 ,这有时给查找肿瘤细胞带来一定的困难。为此 ,我们采用 5 0 %乙醇去除其中红细胞后再涂片 ,取得良好的效果 ,现介绍如下。 1　材料与方法我院送检的临床疑为恶性肿瘤所致的血性胸腹水、血尿标本 5 8份 ,这些标本分别同时按如下两组分法处理 :Ａ组 :离心后直接涂片 ;Ｂ组 :离心后倾去上清液再用 5 0 %乙醇冲洗摇匀后再离心 ,之后倾去上清液涂片。两组方法的离心转速均为 2 0 0 0ｒ …     

柴胡类方剂对两种抑郁症模型的抗抑郁样作用

抑郁症是一个严重影响人类健康的疾病.据世界卫生组织估计目前抑郁症已经成为世界第四大疾患.随着国内对抑郁症认识的不断深入,中医药用于治疗抑郁症的报道也不断增多.但在基础方面,相关复方药理实验研究仍然较少,本实验就几种柴胡类方剂抗抑郁效果进行了筛选,现将结果报道如下.     

三日龄大鼠缺氧缺血性脑损伤对大脑MRI影像和学习记忆能力的远期影响

Objective To investigate the activation of apoptotic genes of the brain with hypoxia- ischemia (HI) in newborn SD rats, and MRI changes and memory and learning ability in adulthood. Methods HI was induced by right carotid artery ligation followed by 2.5 h of hypoxia (6% O2) on 3-day-old SD rats (n=36). Control pups were sham-operated (n = 27). Right brain hemisphere was collected at 12 h and 7 d after HI and subjected to an apoptosis Oligo GEArrayR. MRI and Morris water maze test were performed on both groups at 42 and 44 days old, respectively. Results Comparing to 12 h after HI, up-regulated apoptotic genes included TNF, Caspase and pro-apoptotit genes of Bcl2 families, whereas the anti-apoptotic genes of Bcl2 family were down-regulated at 7 d after HI. The MRI assessment of the rats in HI group demonstrated that the area of the right cerebra l cortex was significantly smaller than the left side and control [periventricular layer: (23.5±3.6) mm2 vs (33.0±4.3) mm2, (34.5±3.9) mm2; hippocampus layer: (18.9±4.4) mm2 vs (29.1±5.0) mm2,(30.8±4.5) mm2, both P<0.01]. During the navigation trial, the HI rats demonstrated longer escape latency (4th day: (52.7±35.9) vs (17.8±8. 9) s, P<0.01). HI rats passed the platform less times than the control ones (T= 292.5, P<0.05) in space probe trial. Conclusions The activation of apoptotic genes induced by HI brain injury remains until 7 days later, involving intrinsic and extrinsic apoptotic pathway. The apoptosis of neural cells may lead to poor development of the cortex and impair the memory and learning ability in the adult rats after neonatal hypoxia- ischemia injury.     

鼻腔NK/T细胞淋巴瘤临床病理分析

目的:探讨鼻腔NK/T细胞淋巴瘤误诊原因及预后.方法:对16例鼻腔NK/T细胞淋巴瘤的临床及病理资料进行回顾性分析.结果:鼻腔NK/T细胞淋巴瘤好发于中年男性,农民占69%(11/16),有农药接触史13例.临床表现为发热、鼻塞,流脓涕,鼻衄,鼻腔中线部黏膜糜烂、溃汤形、恶臭等.病理组织学特点为肿瘤组织坏死明显,瘤细胞大小不等,并血管浸润及炎性细胞反应.免疫组化特点为肿瘤细胞表达:LCA、CD56等.结果:4例失访;3例随访8个月～78个月,现存活;9例死亡,平均存活期为26个月.结论:鼻腔NK/T细胞淋巴瘤有特征性的临床表现及病理特点,长期接触化学杀虫剂史可能是其致病因素之一.病理误诊与临床取材不当及病理医师对本病认识不足有关,除Ⅰ期病例外,即使经恰当的治疗后,此病预后差.     

三日龄大鼠缺氧缺血性脑损伤对大脑MRI影像和学习记忆能力的远期影响

Objective To investigate the activation of apoptotic genes of the brain with hypoxia- ischemia (HI) in newborn SD rats, and MRI changes and memory and learning ability in adulthood. Methods HI was induced by right carotid artery ligation followed by 2.5 h of hypoxia (6% O2) on 3-day-old SD rats (n=36). Control pups were sham-operated (n = 27). Right brain hemisphere was collected at 12 h and 7 d after HI and subjected to an apoptosis Oligo GEArrayR. MRI and Morris water maze test were performed on both groups at 42 and 44 days old, respectively. Results Comparing to 12 h after HI, up-regulated apoptotic genes included TNF, Caspase and pro-apoptotit genes of Bcl2 families, whereas the anti-apoptotic genes of Bcl2 family were down-regulated at 7 d after HI. The MRI assessment of the rats in HI group demonstrated that the area of the right cerebra l cortex was significantly smaller than the left side and control [periventricular layer: (23.5±3.6) mm2 vs (33.0±4.3) mm2, (34.5±3.9) mm2; hippocampus layer: (18.9±4.4) mm2 vs (29.1±5.0) mm2,(30.8±4.5) mm2, both P<0.01]. During the navigation trial, the HI rats demonstrated longer escape latency (4th day: (52.7±35.9) vs (17.8±8. 9) s, P<0.01). HI rats passed the platform less times than the control ones (T= 292.5, P<0.05) in space probe trial. Conclusions The activation of apoptotic genes induced by HI brain injury remains until 7 days later, involving intrinsic and extrinsic apoptotic pathway. The apoptosis of neural cells may lead to poor development of the cortex and impair the memory and learning ability in the adult rats after neonatal hypoxia- ischemia injury.