大型医用设备成本效益分析在HIS上的实现

介绍了大型医疗设备成本效益分析应用系统挂接HIS(“军字一号”)上的设计、功能实现及应用。该应用系统部分实现了大型医用设备的现代经济管理。     

Failure of intensive chemotherapy in poor prognosis non-Hodgkin's lymphoma

In an attempt to improve response and survival rates in patients with non-Hodgkin's lymphoma, a relatively intense six drug regimen MATCOP was developed comprising four-weekly cycles of methotrexate (100mg/m², IV_Y day 8), Adriamycin (30mg/m², IV_Y days 1,2), teniposide (75 mg/rn², IV, day 1), cyclophophamide (300 mg/m², po, days one to five), Oncovin (1.4 mg/m², IV: maximum 2 mg, days 8,15) and prednisolone (100 mg, po, days one to five). A randomised trial was conducted comparing MATCOP with the standard CHOP regimen, comprising three-weekly cycles of cyclophosphamide (750 mg/m², IV, day 1), Adriamycin (50 mg/m², IV, day 1), Oncovin (1.4 mg/m² IV: maximum 2 mg, day 1) and prednisolone (100 mg, PO, days two to six). Eighty patients with large cell lymphoma, diffuse mixed small cleaved and large cell lymphoma or diffuse small cleaved cell lymphoma were randomised, 47 to MATCOP and 33 to CHOP. MATCOP patients experienced increased granulocytopenia, thrombocytopenia (p 0.0001), mucositis (p= 0.002) and infections (p= 0.01) compared to CHOP patients. Complete response rates were similar: 66% for MATCOP patients and 61% for CHOP patients. There were no apparent differences in the time to relapse for patients achieving CR, the time to treatment failure or the overall survival time. Thus despite an increase in toxicity, the more intense regimen MATCOP failed to confer any therapeutic benefit compared with the standard CHOP regimen. Survival was not influenced but toxicity was increased by dose intensification. (Aust NZ J Med 1992; 22: 123–128.)     

对LASIK手术中游离瓣的处理

目的 探讨LASIK手术中出现游离瓣的原因及处理方法。方法 对1500例（2900眼）LASIK手术中出现的9例（9眼）游离瓣进行随访观察。结果 术后1天，9例（9眼）角膜瓣复位良好，边缘整齐，瓣下干净。术后3天取出角膜接触镜，其中7眼视力≥1．0，2眼视力≥0．6。1月视力均达到最佳矫正视力，6月～1年视力稳定。结论LASIK手术中出现游离瓣只要及时正确处理，仍能获得最佳矫正视力。     

HIV-1膜抗原部分糖基化位点改造对免疫原性及假病毒形成的影响

目的 研究HIV-1膜蛋白(Env)特定糖基化位点改造对Env免疫原性及功能性假病毒形成能力的影响.方法 采用环形诱变,DpnⅠ筛选的方法对Env进行定点突变,单周期感染试验检测功能性假病毒形成能力,免疫小鼠,利用假病毒中和试验与ELISPOT分别检测突变对中和抗体和T细胞分泌Env特异的IFN-γ的影响.结果 N197Q突变体使Env诱导中和抗体的能力提高而诱导T细胞分泌Env特异的IFN-γ的能力降低,并使Env不能形成功能性假病毒;G2突变体(N624Q,N637Q)诱导的中和抗体能更好地中和假病毒74-2,仉中和假病毒Wt的能力下降,对Env诱导T细胞分泌Env特异的IFN-γ的能力和功能性假病毒形成无明显影响.结论 特定糖基化位点的改造影响假病毒的形成及Env的免疫原性.     

带蒂皮瓣修复关节损伤的实验研究

目的：将家兔带蒂皮瓣移植于破坏掉关节软骨的股骨头上,探讨皮肤成纤维细胞的成软骨潜能。方法：用家兔２０只,每只任选一侧股骨头作为实验组,对侧作为对照组。将带蒂皮瓣移植于破坏掉了关节软骨的股骨头上后,将股骨头复位,作为实验组。对侧则以游离全厚皮片作对照。分别在术后８ｗｋ、１６ｗｋ时各探查１０只动物,通过肉眼观察,光镜观察移植物的转归。结果：实验组皮瓣成活并以骨头愈合,表皮逐渐变性消失,真皮纤维组织增生     

Screening, Detection and Management of Depression in Elderly Primary Care Attenders. II: II: Detection and Fitness for Treatment: a Case Record Study

Case note data were obtained for 186 elderly primary care attenderswho also completed the 15 item Geriatric Depression Scale (GDS15).The presence or absence in the case notes of a current or pastdiagnosis of depression, of current treatment of depression,and of a number of clinical features of depression were noted.Case notes were also rated for the presence or absence of contraindicationsto the use of tricyclic antidepressants (TCAs) and to serotonin-specificreuptake inhibitors (SSRIs). Whereas 65 (35%) patients wererated as ‘cases’ of depression on the GDS15, only28 (15%) had a current case note diagnosis of depression and37 (20%) had one or more current symptoms of depression recordedin the case notes. Patients rated by their GP as having oneor more current symptoms of depression scored higher on theGDS15 (P < 0.05) and were more likely to be categorized asa GDS case (P = 0.05). There was no significant relationshipbetween GDS caseness and a current case note diagnosis of depression.Seventy-three patients (39%) had a past history of depressionand 53 (28.5%) patients had previously been treated with antidepressants.The former was significantly associated with GDS caseness (P< 0.05). Twenty-four patients (13%) were currently on antidepressants,19 of them receiving adequate doses (equivalent to at least75 mg of amitriptyline). Current antidepressant treatment wasnot associated with GDS ‘caseness’. A significantlyhigher proportion of patients (both in the sample as a wholeand in the subgroup of GDS15 depression ‘cases’)had a medical condition or were taking a drug that mitigatedagainst the use of TCAs than was the case for SSRIs.