医院管理"四部曲"

结合医院管理实际,实施管理四部曲。即:完善机制、教育先行、督察到位、奖惩分明。阐明持续改进是完善机制的内在需求;及时清理是完善机制的有力保障;易于操作是完善机制的必备条件。同时,突出教育的基础性地位;强调监督的关键性环节;放大奖惩的激励性效应。     

丹霞地貌生境中铁皮石斛的繁殖生物学研究

目的:揭示丹霞地貌生境中铁皮石斛的繁育系统及濒危机制.方法:对该地区铁皮石斛的生境、生长特性、开花物候、繁殖特性以及资源破坏状况等进行了调查.结果:丹霞地貌铁皮石斛生长环境恶劣,春季为其生长高峰;2～3年生茎开花,花后及时授粉,结实率较高;授粉后4～5 d子房开始膨大,果实成熟期为185 d左右;自然有性繁殖的结实率(0.31%)极低;无性克隆繁殖1丛仅1年生1茎.结论:丹霞地貌生境下铁皮石斛群体自然更新主要是通过分蘖繁殖实现的;人为掠夺性采集是该地区铁皮石斛野生资源濒危的主要因素.     

Controlled Release of Substituted Benzole and Naphthoic Acids Using Carbopol ® Gels: Measurement of Drug Concentration Profiles and Correlation to Release Rate Kinetics

Purpose. The objective of this study is to correlate drug release mechanism with measured drug concentration profiles in gel layers of Carbopol^® matrices containing mesalamine or benzoic acid. Methods. Release rate experiments with Carbopol^® matrices were performed using a rotating disk apparatus. Matrices were frozen and the gel layer in the matrices was sliced using a microtome in a cryostat. Drug concentration profiles were determined by direct measurement of the concentration of the drug in the gel slices. The pH of the slices was measured using microelectrodes, and water content was measured by Karl Fisher titration. Results. The concentration gradient in mesalamine matrices decreased over time and correlated with square root of time release rate kinetics. The concentration profiles of benzoic acid were unchanged over time and correlated with zero order release rate kinetics. Carbopol gel layers were highly hydrated (93–95% water). Gel layers in matrices with mesalamine had a more alkaline microenvironmental pH. This higher pH resulted in increased growth of the thickness of the gel layer and a reduction drug diffusivity in comparison to benzoic acid matrices. Conclusions. The release rate kinetics of mesalamine and benzoic acid correlated to the measured concentration profiles. The shape of the concentration profiles is determined by the rate of growth of the Carbopol^® gel layer and drug diffusivity.     

Muscle spasm induced sympathetic reflex bursts on microneurography in a case with pontine demyelination

Microneurography was performed in a 39-year-old woman with demyelination of the pontine white matter associated with muscle spasms in the lower extremities. Single bursts on the microneurogram were observed immediately after cessation of the spasm with no systemic changes in the blood pressure or heart rate. Voluntary tonic flexion of the lower extremities induced similar bursts with small amplitudes. These reflex bursts possessed a characteristic of muscle sympathetic nerve activity, because the latency between the peak of each burst and the prior R-wave on the electrocardiograph was constant. The occurrence of these bursts suggests that a segmental compensatory mechanism in the spinal cord may stabilize the muscle blood flow influenced by muscle contraction.     

关于军工研究所发展民品产业的几点思考

探索军工研究所发展民品产业之路.本文对军工研究所发展民品产业进行了优劣势分析,继而从机制转换,组织结构,产品战略,市场营销,人才队伍建设等方面提出了一些改革措施.     

实施绩效考核的实践和体会

介绍绍兴市人民医院实施绩效考核的经验和体会.其经验在于:明确考核定位,把考核的首要目的定位于医院管理目标的实现和对管理过程的一种控制;运作方式是:制定考核标准、确立考核周期、明确考核部门及人员,使绩效考核真正落到了实处,收到了显著效果.     

一氧化氮与胚胎异常发育的相关性研究

为了解开一氧化氮（ＮＯ）是否与畸胎发生有关这一谜团和进一步阐明砷致畸作用机理，本实验应用诱生型ＮＯ合成酶（ｉＮＯＳ）组织化学、扫描电镜（ＳＥＭ）及体内致畸试验等方法研究了砷对小鼠卵黄囊胎盘（ＹＳＰ）和胚胎发育的影响。结果表明ＹＳＰ细胞ｉＮＯＳ表达与砷浓度之间存在明显的剂量—反应关系（Ｐ＜０．０５）；ＳＥＭ观察可见ＹＳＰ内皮层和间皮层细胞受损；光镜下可见ＹＳＰ变小、萎缩和微血管分化不良；随着染毒剂量的升高，畸胎率和死胎率亦逐步增加，最高分别达到５６．８％和２４．７％；畸胎的主要表现是神经管未闭，心包积液和体位异常等。研究结果率先提示过量ＮＯ与畸胎发生及致畸机理关系密切；推荐在致畸研究中ｉＮＯＳ可作为一种有效的生物标志物。     

电化学人工龋的电化学腐蚀机制研究

目的 研究电化学人工龋的电化学腐蚀机制。方法 采用循环伏安法研究牙片电极在K2SO4溶液中的氧化还原反应；以失重法并结合SPSS统计软件统计分析，评价牙片在KCl和K2SO4介质中恒电位腐蚀情况，并现场监测电解液氢离子浓度的变化情况。结果 在0.0-2.5V电位范围内，牙片电极与石墨电极具有波形类似的循环伏安曲线；在KCl和K2SO4介质中牙片的腐蚀速度无显著差异；2.0V恒电位腐蚀牙片8h后，阳极池本体溶液pH值由7.0平均下降到3.87，阴极池则由7.0平均升高到10.65。结论 在外电场作用下，牙片的阳极腐蚀与介质无关；水的阳极氧化引起阳极区氢离子浓度升高，致使牙齿发生酸溶是电化学人工龋形成的主要决定因素。     

Comparative inotropic effect of calcium, endothelin-1, and forskolin on ferret papillary muscles during acidosis

Summary— Acidosis affects multiple steps in the excitation-contraction coupling pathway of myocardium, producing decreased calcium sensitivity of myofibrils and modification of the function of the sarcoplasmic reticulum. Our aim was to evaluate the effectiveness of three different classes of inotropic agents under acidotic conditions: 1) forskolin, an adenylate cyclase activator that enhances cellular cyclic AMP concentrations, 2) elevated extracellular Ca²⁺ and 3) endothelin-1, an activator of the inositol triphosphate, diacylglycerol pathway. Ferret papillary muscles were mounted in organ baths containing normal physiological solution (pH = 7.4). After baseline tension was measured, the muscles were bathed in an acidotic solution (pH = 6.98) that decreased tension to 40% of the control; subsequently, the muscles were washed with normal physiological solution until they returned to baseline. Each inotropic agent was added to the bathing solution in a concentration sufficient to increase tension by 40% above the baseline. Then the solution was made acidotic (pH = 6.98) in the continuous presence of that concentration of inotropic agent and the resultant steady-state developed tension measured. The increases in tension induced by each inotropic agent at normal pH were adjusted to be similar; in contrast, the response to each drug in acidosis was significantly different. Under acidotic conditions, endothelin-1 was the most effective inotropic agent in restoring the depressed developed tension. This was possibly due to enhancement of the myofilament sensitivity to Ca²⁺, which was more effective than increasing [Ca²⁺]_i through elevating extracellular Ca²⁺ or the addition of forskolin which increased [Ca²⁺]_i but desensitized the myofilaments to Ca²⁺.     

我国医疗保障制度改革中医院配套改革措施探讨

论述了医疗保障制度改革给医院带来的机遇与挑战,认为医院应采取调整结构,转换运行机制;完善补偿机制;加大宏观调控力度,制订和实施区域卫生规划等配套措施,来适应医疗保障制度的改革。