急性心肌梗塞患者红细胞磷脂水平测定

本文测定了第１－７天急性心梗塞患者红细胞磷脂主要组分含量。结果表明，急性心肌梗塞患者红细胞膜的神经鞘磷含量较正常人明显增高；磷酯酰胆硷，磷脂酰丝氨酸、磷脂酰乙醇胺含量却较正常人明显降低。这说明急性心肌梗塞患者存在红细胞磷脂代谢紊乱，这时心肌缺血的重可能产生不良影响。     

Preoperative Clinic Visits Reduce Operating Room Cancellations and Delays

Background: Anesthesiologist-directed preoperative medicine clinics are used to prepare patients for the administration of anesthesia and surgery. Studies have shown that such a clinic reduces preoperative testing and consults, but few studies have examined the impact of the clinic on the day of surgery. The authors tested whether a visit to an anesthesia preoperative medicine clinic (APMC) would reduce day-of-surgery case cancellations and/or case delays.

Methods: The authors conducted a retrospective chart review of all surgical cases during a 6-month period at the University of Chicago Hospitals. Case cancellations and rates of first-start case delay over the 6-month period were cross-referenced with a database of APMC attendees in both the general operating rooms and the same-day surgery suite. The impact of a clinic visit on case cancellation and delay in both sites were analyzed separately.

Results: A total of 6,524 eligible cases were included. In the same-day surgery suite, 98 of 1,164 (8.4%) APMC-evaluated patients were cancelled, as compared with 366 of 2,252 (16.2%) in the non-APMC group (P < 0.001). In the general operating rooms, 87 of 1,631 (5.3%) APMC-evaluated patients were cancelled, as compared with 192 of 1,477 (13.0%) patients without a clinic visit (P < 0.001). For both operating areas, APMC patients had a significantly earlier room entry time than patients not evaluated in the APMC.     

Proposal of a modified Child-Turcotte-Pugh scoring system and comparison with the model for end-stage liver disease for outcome prediction in patients with cirrhosis.

The model for end-stage liver disease (MELD) has a better predictive accuracy for survival than the Child-Turcotte-Pugh (CTP) system and has been the primary reference for organ allocation in liver transplantation. The CTP system, with a score range of 5-15, has a ceiling effect that may compromise its predictive power. In this study, we proposed a refined CTP scoring method and investigated its predictive ability. An additional point was given to patients with serum albumin < 2.3 g/dL, bilirubin > 8 mg/dL or prothrombin time prolongation > 11 seconds. The modified CTP system, containing class D, was compared to the MELD and original CTP system in 436 patients. There was a significant correlation between the MELD and modified CTP score (rho = 0.59, P< 0.001). Using mortality as the endpoint, the area under receiver operating characteristic curve for modified CTP system was 0.895 compared with 0.872 for MELD (P = 0.450) and 0.809 for original CTP system (P < 0.001) at 3 months; the area was 0.890, 0.837 and 0.756, respectively (P = 0.051 and < 0.001, respectively) at 6 months. The risk ratio per unit increase for the modified CTP score was 2.7 and 3.08 at 3 and 6 months respectively (P < 0.001). In conclusion, the modified CTP system can be proposed as an alternative prognostic model for cirrhotic patients. By extending the score range according to the influence of the laboratory-derived variables, the modified CTP system has a better performance than the original system and is as efficient as the MELD for outcome prediction.     

综合医院心理咨询门诊儿童咨客分析

目的；了解综合医院心理咨询门诊儿童咨客的特点。方法：总结中山大学附属三院心理咨询门诊近3年儿童咨客的资料。结果：咨客男女比例为1．96：1，咨客人数随着年龄的增长而增加，女童中13－16岁的比例男童大，5－8岁和9－12岁的比例较男童小。广州市内外的咨客比例为1．38：1，不同年龄儿童咨客的居住地构成是有差异的。最常见的病种是精神分裂症，神经症、精神发育迟滞，儿童多动症，单纯咨询和品行障碍，不同年龄，不同性别的儿童咨客的疾病构成是有差异的。结论：综合医院心理咨询门诊与儿童心理咨询门诊的儿童咨客是有差异的。     

胸水CYFRA21-1、CEA及NSE联合测定对肺癌的诊断价值

目的　通过胸水CYFRA2 1 1(细胞角蛋白片段 )、CEA(癌胚抗原 )及NSE(神经烯醇化酶 )的检测 ,探讨各指标对肺癌诊断特异性及联合分析对肺癌的诊断价值和临床意义。方法　对 12 3例肺良性疾病组患者和 15 6例肺癌组患者胸水进行上述肿瘤标志物测定。将肺癌患者又根据病理类型分成腺癌组 (81例 )、鳞癌组 (5 0例 )、小细胞癌组 (12例 )和未定性癌组 (13例 )对各指标分别进行对照分析。结果　肺癌组胸水CYFRA2 1 1、CEA及NSE含量 (ng/ml)分别为 5 5 34± 37 44、5 7 11± 5 2 6 5及 16 99± 2 9 2 2 ,而肺良性疾病组的含量则分别为 9 0 8± 7 5 4、9 92± 6 2 8和 7 30±6 2 9,各指标的统计学检验均有极显著差异 (P <0 0 0 1)。CYFRA2 1 1在肺鳞癌组最高 ,与小细胞肺癌组相比有显著差异 (P <0 0 5 ) ,而与腺癌组和未定型癌组相比无显著差异 (P <0 0 5 ) ;CEA主要在腺癌组的含量均比其他肺癌组有极明显增高 (P <0 0 0 1) ;NSE则在小细胞癌组最高 ,其含量与其他肺癌组相比有极明显增加 (P <0 0 0 1)。结论　胸水CYFRA2 1 1,CEA及NSE在不同组织类型肺癌中的含量明显不同 ;三者联合测定对肺癌的诊断有重要的临床参考价值     

中国蒙古族新生儿体格发育的研究

１９８８～１９９１年对内蒙古锡盟地区３８９例蒙古族新生儿进行了活体观察测量，取得了２２项总体发育指标及相应的各项性别指标的均值数据，并以其中体重、身长、顶臀长（坐高）、头围、胸围及上臂围等６项指标与国内外有关资料作了比较和性别间的对比分析，从结果来看，体重高于本地区平均水平１１０ｇ，高于国内某些城市１４０～２０２ｇ；身长及坐高分别矮于本地区平均水平５．１３ｃｍ及６．５４ｃｍ，分别矮于国内某些城市４．８８～４．８９ｃｍ及６．６０ｃｍ。呈圆头型、手足宽短、身躯宽短的粗壮体型。     

尿毒症患者的血小板聚集功能变化及血液透析的影响

本文应用 ADP、肾上腺素及复合诱聚剂对30例慢性肾功能不全(尿毒症期)病人的血小板聚集功能进行了检测,其中5例在血液透析前后分别测定。结果表明尿毒症患者血小板聚集功能障碍,血液透析有助于改善血小板功能。通过相关性检验,发现尿毒症病人的血小板聚集率与血肌酐值呈负相关性,其意义尚需进一步探讨。     

脑梗塞患者血清叶酸维生素B12浓度与同型半胱氨酸及血脂水平的研究

目的探讨本地区脑梗塞患者的血清叶酸、维生素B12（VitB12）与同型半胱氨酸（Hcy）水平及血脂水平的关系。方法应用全自动化学发光免疫法测定115例脑梗塞患者血清叶酸、维生素B12水平，采用荧光定量分析法测定血清同型半胱氨酸水平，采用免疫比浊法测定血脂水平。结果脑梗塞患者血清叶酸水平明显低于对照组（P〈0．001），血清Hcy及甘油三酯（TG）水平明显高于对照组（P〈0．01），而维生素B12及其余所测血脂指标与健康对照组无显著差异（P〉0．05）。结论即时监测血清叶酸、Hcy及TG水平，适当补充叶酸，可早期预防和及时治疗脑血管疾病，降低脑梗塞的发生率及复发率。     

高危人群微量乙肝疫苗免疫效果动态观察

采用微量乙肝疫苗（总剂量为６μｇ）对ＨＢＶ高流行区居民进行随机对照研究，免疫Ⅰ组（疫苗＜８℃保存）Ｔ１２抗体阳转率和保护率分别为９０．８％和８７．０％，和对照组相比，差异显著（Ｐ均＜０．００１）；和常规剂量（总剂量９０μｇ）比，其抗体阳转率和保护率基本相同。提示ＨＢＶ高流行区可用微量乙肝苗代替常量乙肝苗进行预防接种。免疫Ⅰ组和免疫Ⅱ组（乙肝疫苗室温保藏２８℃±）免疫效果和保护率基本相同，认为室温条件下乙肝疫苗６个月内效价不变。     

我国毒物中毒概况和预防对策

论述了我国生产性职业中毒、运输过程意外事故中毒、环境污染事故中毒、生产性和非生产性农药中毒、食物中毒以及药物中毒.还讨论了中毒的预防对策.