社区家庭医生团队服务模式实践探索

家庭医生制度是我国社区卫生服务向纵深发展的重要举措.在武汉市某社区卫生服务中心开展家庭医生团队服务模式实践,总结家庭医生团队服务的经验,找出实施中存在的困难和问题,并提出相应措施和政策建议.     

基层护生带教的体会

护理带教工作中的强化计划带教、抓好各种带教、建立健全带教管理制度、因材施教、注重个性发展、充满爱心、热情带教、严格考核、逐项训练.     

肝病患者血清中AST与ALT比值的临床意义

目的：探讨AST和ALT比值在肝病患者血清之中的临床意义。方法抽选我院有肝病的患者200例，其中，35例（17．50％）肝癌，称为：肝病1组；40（20．00％）例肝硬化，称为肝病2组；45例（22．50％）非黄疸型肝炎，称为肝病3组；60（30．00％）例黄疸型肝炎，称为肝病4组；20例（10．00％）慢性肝炎，称为肝病5组。用全自动生化仪（ DXC800）对血清中的ALT、AST进行抽查。结果肝病1组、肝病3组和肝病4组血清中的ALT值比肝病2组、肝病5组高，P＜0．05。肝病1组、肝病2组、肝病3组和肝病4组的血清中的AST值比肝病5组高，P＜0．05。结论肝病增重的重要标志之一就是 AST和 ALT比值，临床医师可经AST和ALT比值情况来判定肝病的严重度以及病程，为预后提供情报，促进病情的优化，临床意义很大。     

Expression and significance of interleukin-18.12 and tumor necrosis factor-α in intrahepatic cholestasis of pregnancy

Objective To investigate the effect of Interleukin(IL)-18,IL-12 and tumor necrosis factor-α(TNF-α)in hepatic injury in intrahepatic cholestasis of pregnancy(ICP).Methods Sixty-two cases of ICP patients(ICP group),30 cases of normal pregnant women(control group)and 30 cases of hepatitis B(HBV) women (hepatitis group) were recruited. Serum IL-18, IL-12 and TNF-α were examined by ELISA. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were examined by automatic biochemical analysis instrument. Results ( 1 ) In hepatitis group, serum concentrations of IL-18,IL-12 and TNF-α were (256±51 ) ng/L, ( 122±96) ng/L and (207±3) ng/L; serum levels of ALT and AST were(363±174) U/L and (359 ±237) U/L, respectively. In ICP group, serum concentrations of IL18, IL-12 and TNF-α were (72±32) ng/L, (42 ±28) ng/L and (48±14) ng/L; serum levels of ALT and AST were (201 ±128) U/L and ( 132±87) U/L, respectively. While in control group, serum concentrations of IL-18, IL-12 and TNF-α were (43 ± 13) ng/L, ( 10±3) ng/L and (33±9) ng/L; serum levels of ALT and AST were (13 ~ 4) U/L and (15 ± 3) U/L, respectively. Serum IL-18, IL-12, TNF-α, ALT and AST levels in hepatitis group were significantly higher than those in ICP group and control group ( P ＜0. 05 ).Serum IL-18, IL-12, TNF-α, ALT and AST levels in ICP group were significantly higher than those in control group(P ＜ 0. 05 ). (2) In severe ICP subgroup, serum concentrations of IL-18, IL-12 and TNF-α were (81 ±32) ng/L, (50 ±25) ng/L and(50 ± 14) ng/L; serum levels of ALT and AST were (269 ± 111 ) U/L and (181±73) U/L In mild ICP subgroup, serum concentrations of IL-18, IL-12 and TNF-α were (48 ±18 ) ng/L, (17 ± 4 ) ng/L and (40 ± 10 ) ng/L; serum levels of ALT and AST were (87±46) U/L and (50 ±21 ) U/L, respectively. Serum IL-18, IL-12, TNF-α, ALT and AST levels in severe ICP subgroup were significantly higher than those in mild ICP subgroup and control group (P ＜ 0. 05). And serum ALT and AST levels in mild ICP subgroup were significantly higher than those in control group(P ＜0. 05). (3) There were 16 cases with preterm birth (50%, 16/32 ) and 10 cases with meconium-stained amniotic fluid( 31%, 10/32 ) in severe ICP subgroup, significantly higher than those in mild ICP subgroup ( P＜ 0. 05 ), which contained 2 preterm births ( 7%, 2/30) and 1 meconium-stained amniotic fluid (3%, 1/30). While in control group, the numbers were 1(3%, 1/30)and 1(3%, 1/30),respectively. As for the cases of neonates whose 1 minute Apgar score were not more than 7, there were 2 cases, 1 case and 1 case in severe ICP subgroup, mild ICP subgroup and control group, respectively,which showed no significant difference(P＞ 0. 05). Conclusion Serum IL-18, IL-12 and TNF-α may be involved in the process of hepatic injury of ICP.     

新生儿肺炎常见致病菌的临床分析

新生儿肺炎是新生儿期常见疾病，是引起新生儿死亡的重要原因，可发生在宫内、分娩过程中或出生后，可由细菌、病毒或原虫等病原体引起。为了解目前新生儿肺炎感染的致病菌及耐药情况，以指导临床合理选择抗生素，本研究回顾性分析了新生儿肺炎患儿120例，对其痰细菌培养及药敏检查结果进行分析，现报告如下。     

医学院校食品科学与工程专业本科生导师制的实施与探索

高院等校是创新型人才培养的摇篮,高校的培养形式和教育体制对学生素质培养与创新思维的形成起到决定性的作用。近几年,虽然大多数院校在教育体制上有了很大的提升,但仍然有部分高校存在一些问题,因此,本科生导师制应运而生。本科生导师制度是我国高等院校广泛实施的一种以提高大学生素质为目标的教育教学管理制度。本科生导师制的推行,为高校人才培养提供了高效、个性化的模式,为中国的本科教育开辟了一个新途径。及时发现本科生导师制度在我国各个高校实施过程中显现出的问题是提高其效果的关键之处。文章具体论述了医学院校食品科学专业实行本科生导师制度的必然性、重要途径及应注意的问题并提出建议,以进一步推进教学科研互相结合,完善教学质量监督管理体系、构建多方联动的管理模式,全面提升本科生导师制的作用,达到个性化人才培养的目的,为其他医学院校食品专业实施本科生导师制提供理论和实践借鉴。     

墨旱莲对香烟提取物杀伤NHBE细胞的保护作用及机制

目的:研究墨旱莲提取物对香烟烟雾提取物(cigarette smoke extract,CSE)作用的正常肺细胞NHBE细胞的保护作用及其机制。方法:MTT法检测墨旱莲提取物对CSE诱导的NHBE细胞增殖的影响,DTNB比色法测定GSH含量,CDNB比色法检测GST活力,NADPH与2,6-二氯靛酚钠(DCIP)测试NQO1活力,Western blot测定蛋白的表达。结果:墨旱莲提取物可以降低CSE对NHBE细胞增殖的抑制作用;恢复由CSE引起的细胞内GSH水平下降,降低诱导细胞中GST与NQO1活力及NQO1蛋白表达。结论:墨旱莲能够减少CSE对NHBE细胞的损伤,其机制可能与II相解毒酶相关。     

脑干三叉神经诱发电位对三叉神经根部分切断术的临床应用研究

目的 评价脑干三叉神经诱发电位对三叉神经痛病人三叉神经根切断术的临床应用价值.方法 作者研究了36例经术前MRTA及术中探查除外神经血管接触的三叉神经痛病人,在三叉神经感觉根大部切断术过程中,通过术前、中、后记录BTEP以监测三叉神经传导功能;测定BTEP潜伏期及波幅参量的变化指导手术的进程.结果 36例病人患侧BTEP潜伏期延长、波幅降低,提示三叉神经痛患者三叉神经传导功能损害,术中待BTEP呈一直线后,不再继续切断神经根,术后疼痛均缓解,未遗三叉运动功能障碍.结论 脑干三叉神经诱发电位可以指导选择性三叉神经根切断术并防止三叉神经眼支损害的发生.     

乌鲁木齐地区学龄儿童PPDS反应情况调查

新疆地处祖国西北边陲,经济不发达,人民生活水平相对较低,而乌鲁木齐作为新疆的首府,是新疆的政治、经济、文化中心,人口流动量大,多民族聚集,语言、文化、生活习惯有较大差异.结合这些因素,我们在2004年2月至2005年9月对乌鲁木齐地区居住人口较多的4个民族(汉、维、哈、回),7～14岁学龄儿童进行了PPD反应情况调查,现将调查结果报告如下.……