2616例肠癌死亡率分析及预防对策探讨

通过对成都市七区两县监测点中２６１６例肠癌死亡率的统计学分析,总死亡率为７．００／１０万,标化死亡率为６．６７／１０万（其中,大肠癌死亡１６７４例,占肠癌死亡例数构成比６４％,其总死亡率４．８８／１０万,标化死亡率４．２７／１０万）,均呈逐年上升趋势。男性死亡率７．６７／１０万,标化死亡率７．２９／１０万,女性死亡率６．２９／１０万,标化死亡率６．００／１０万,男性明显高于女性（Ｐ＜０．０１）;城区死亡率９．３０／１０万,郊（区）县死亡率４．９４／１０万,二者有显著性差异,城区高于郊（区）县（Ｐ＜０．０１）;在２６１６例肠癌死亡例数中,工人、农民、干部、离退休人员占８２．６５％,且以４５岁以上的男性居多。     

Smoking behaviour and compensation: a review of the literature

Rationale: Compensation or compensatory smoking, accurately defined, deals with the question of whether switching to cigarette brands with different smoke yields is associated with a change in smoke uptake proportional to the change in machine-derived yields. The issue of compensation is important because it bears on whether switching to ”lighter” brands means lower overall smoke intake or not. Objectives: The present review investigated whether and to what extend low yield cigarettes are smoked more intensively. In addition, published data on whether nicotine, ”tar”, or any other smoke constituent or property influence compensational smoking are summarized. Methods: The studies on compensation were classified as follows: (1) studies on smoking behaviour in relation to cigarette yields (with and without brand switching); (2) studies on compensation for nicotine (switching between cigarettes which differ ”only” in their nicotine yield, nicotine supplementation, manipulation of renal nicotine excretion, administration of nicotine agonists or antagonists); (3) studies on compensation for other factors (influence of tar, taste, irritation, draw resistance). In order to quantify the degree of compensation, an index is defined and applied to selected brand switching studies. This compensation index determines, in relative units, the degree to which a smoker responds to a change in smoke yields with a change in smoke uptake measured by suitable biomarkers. The role of vent blocking is also briefly discussed. Results: Most of the studies which compare the smoking behaviour when smoking cigarettes with different smoke yields supply evidence for ”partial” compensation, suggesting that cigarettes with lower yields are smoked more intensively than those with higher yields. These studies also show that a change in the daily number of cigarettes is not a common mechanism of compensation. Effective vent blocking during smoking is a rare event and can therefore also be regarded as an uncommon mechanism of compensation. Evaluation of a suitable subset of brand-switching studies revealed an average compensation of 50–60% of the nicotine yield. Compensation tended to be more complete when changing to cigarettes with higher yields than when changing to cigarettes with lower yields. In general, brand-switching studies do not supply information on the underlying causal factors responsible for compensatory smoking. Results of the nicotine supplementation studies are not conclusive: some report evidence of nicotine titration, others do not. A general problem with this type of investigation is that continuous nicotine application does not mimic the spike-wise application with cigarette smoking, and may lead to nicotine tolerance. There is limited evidence that cigarettes were smoked more intensively when the urinary clearance of nicotine was increased. A small number of studies provide some evidence that smoking intensity increased after smokers were administered a nicotine antagonist. Several reports indicate that tar, taste and sensory properties of the smoke as well as the draw resistance of the cigarette may play a role in compensatory smoking. Low-yield cigarettes usually have reduced pressure drops which smoke researchers have suggested leads to increased puff volume. This effect seems to be independent of the smoke yield of the cigarette. There is also some evidence that some smokers maintain a consistent pattern of smoking which works independent of any changes in nicotine or tar yields, taste or design features of the cigarette (”functional autonomy”). Conclusions: The available data suggest that smokers partially compensate for a different smoke yield. While the factors and their interaction responsible for compensational smoking are not fully understood, there are data suggesting that a subgroup of smokers may partially compensate for nicotine. Even in this subgroup of smokers, however, the relative importance of the pharmacological versus the sensory effects of nicotine in smoke remains to be determined. Received: 4 January 1999 / Final version: 22 March 1999     

急性脑肿胀去大骨瓣减压术后迟发性血肿

目的探讨外伤后急性脑肿胀去大骨瓣减压术后迟发性血肿的发病机制及临床表现，以提高该类病人的手术疗效。方法回顾性分析28例急性脑肿胀去大骨瓣减压术后迟发性颅内血肿病人的临床表现。结果外伤后急性脑肿胀去大骨瓣术后迟发性血肿的发生率为19．56％，术区继发硬膜外血肿10．87％。死亡率为32．12％。结论急性脑肿胀去大骨瓣术后迟发性血肿的发生率较高，多见于脑肿胀缓解病例，对术中出现的急性脑膨出和术后病情恶化应考虑到迟发性血肿的可能，早期的诊断是提高疗效的关键。     

评价家用水质处理器标准化试验装置的研制

目的 研制评价家用水质处理器卫生安全性与功能性的标准化试验装置。方法 设计并研制由纯水制造系统、配水系统与家用水质处理器的通水系统组成试验装置。结果 该装置配制的通水试验用水均匀、稳定，可满足设计要求，整套试验装置设计合理、操作简便、可连续运行。结论 本实验装置可为家用水质处理器卫生安全性与功能性评价方法的标准化提供依据。     

食管引流型喉罩和标准型喉罩在腹腔镜胆囊切除手术麻醉中通气和呼吸力学的比较

目的比较食管引流型喉罩(PLMA)和标准型喉罩(SLMA)在腹腔镜胆囊切除手术中的应用,观察通气效果及气腹前、中、后呼吸力学的变化,为临床安全有效地使用喉罩提供参考。方法选择美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、择期行腹腔镜胆囊手术的患者60例,随机均分为PLMA组和SLMA组,两组均应用4号喉罩；PLMA组沿食管引流孔插入14号胃管。观察两组喉罩一次置入的成功率、漏气率、呼吸道密封压及胃胀气情况。以BicoreCP100多功能呼吸监护仪监测气腹前、后10 min及放气腹后5 min的呼气末二氧化碳分压(PETCO_2)、气道峰压(PIP)、气道阻力(Raw)和胸肺顺应性(CL)。结果SLMA组一次置入的成功率为96．7%,PLMA组为93．3%。插入时间SLMA组为(28±10)s,PLMA组为(39±15)s；呼吸道密封压SLMA组为(16±3)cm H_2O,PLMA组为(26±4)cm H_2O。PLMA组均成功插入胃管。SLMA组8例患者出现胃胀气,PLMA组无一例出现胃胀气。SLMA组漏气率明显高于PLMA组(P＜0．05),但气腹前、后漏气率的差异无显著性。两组患者气腹后PETCO_2、PIP、Raw均较气腹前明显升高(P＜0．05),CL明显降低(P＜0．05),但两组间差异无显著性。结论PLMA完全适用于腹腔镜胆囊切除手术,且与SLMA相比密封性更好,安全性更高。     

医院如何做好电子病案的规范化管理

本文阐述了该院在当今病案信息电子化快速发展的年代,如何使电子病案的管理能同步走向规范化,重点从三大方面进行了经验介绍。1、建立规范的电子病案管理组织架构,做到组织保证；2、从制度建立、质量监控、系统保存、归档管理、分级管理、使用管理等方面积极探讨电子病案管理规范化的内涵；3、探索制定基于数字签名认证中心(CA)的电子签名工作规范。通过上述各方面的探讨和实践,取得了较好的电子病案管理成效。     

论医学教学实施创新教育 培养创新人才的必要性

素质教育可分为规范教育和创新教育两部分。规范教育包括知识规范和道德规范，解决的是知识与道德的继承；创新教育则包括知识创新与能力创新两个方面内容，解决的是知识发展与人类发展的问题，因此，笔者认为，为了适应知识经济发展的要求，医学教学应注重实施创新教育，重点研究如何解决培养学生创新意识、创新精神和创新能力等问题，以使学生作为独立的个体，能够主动着手发现、认识有意义的新知识、新事物、新思想、新方法，并掌握其中蕴涵的基本规律及相应的各种能力。     

新公布的卫生检疫行业标准存在的问题探讨

〔目的〕了解新公布卫生检疫行业标准的总体情况,以便更好地执行标准。〔方法〕对部分卫生检疫行业标准进行归类比较以及在实际使用标准过程中发现的问题进行综合评价。〔结果〕发现存在着标准名称的命名未尽规范、格式不统一、内容重复、个别条款过于理论化、标准之间衔接不足、对同一术语或定义的表述有差异等问题。〔结论〕应加强对卫生检疫行业标准的起草和评审工作的管理,及时对存在问题的标准进行修订,以充分发挥标准的作用。     

《中国药典》2005年版新增品种“蜜炼川贝枇杷膏”质量标准的修订（Ⅰ）

本文对企业提出的用高效液相色谱法测定橙皮苷含量的方法,进行了修订.修订后的方法,较好地去除了糖等强极性成分对样品中橙皮苷的测定的干扰,提高了样品的检测浓度,经方法学验证,方法可行.     

银翘颗粒质量标准的研究

目的:建立银翘颗粒质量标准.方法:采用高效液相法对银翘颗粒中主要成分连翘苷进行定量分析,采用Nova-pakC18(250mm×4.6mm,10μm)色谱柱,流动相为乙腈-水(23:77),流速为1.0ml·min-1,检测波长为277nm;同时对制剂中主要药味连翘、荆芥、薄荷、甘草进行薄层鉴别.结果:连翘苷在0.28～2.24μg范围内呈良好的线性关系,回归方程为Y=659.93X-3.843,r=0.9999,平均回收率为97.29%,RSD为2.15%,重现性RSD为2.40%.结论:本法简便,快速,灵敏,准确,重现性好,可作为制剂颗粒连翘苷的质量标准.