早期目标血糖管理下严重脓毒症患者HMGB1的变化及其临床意义

探讨早期目标血糖管理对严重脓毒症患者HMGB1变化的影响.严重脓毒症患者随机分为血糖控制A（4.4mmol/L~6.1mmol/L）、B（6.2mmol/L~8.3mmol/L）、C（8.4mmol/L~10.0mmol/L）三组.给予早期目标血糖管理,入ICU后0d、1d、3d、5d、7d采血测TNF-α、HMGB1浓度.三组TNF-α、HMGB1浓度及APACHEⅡ评分均呈下降趋势,A组HMGB1浓度及APACHEⅡ评分在第7d较B、C组明显降低（P＜0.05）.A组28d病死率较B、C组降低（P＆gt;0.05）.严重脓毒症患者在早期目标血糖管理下,显著降低HMGB1浓度,降低病死率和改善预后,HMGB1可用来评价脓毒症的严重程度及预后.     

妊娠合并结核临床诊治的决策

妊娠合并结核是一种对母婴健康危害极大的妊娠期疾病。在妊娠期结核病中,多数患者无明显症状,早期症状与妊娠期某些生理反应相似,加之妊娠与结核病的相互影响,x线、CT等重要的影像学检查受限,致使本病易被误诊或误治。某些抗结核药物对母婴的不良影响,使其治疗难以实施,由于结核病本身及治疗后可能对胎儿的影响,在临床上是否终止妊娠往往难以决策。本文就妊娠合并结核诊治过程中的相关问题进行综述,以期为临床诊治决策提供帮助。     

A Draft for Unifying Controversies in Philosophy of Science

The basic (negative and positive) methodological maxims of three currents of philosophy of science (logical empiricism, falsificationism, and postpositivism) are formulated. Many of these maxims (stratagems) are controversial, e.g., the stance about the nonsense of metaphysics, and that of its indispensability. The restricted validity of these maxims allows for their unification. Within the framework of most of them there may be a relationship of (synchronic, or diachronic) subordination of the contradicting desiderata. In this vein ten stratagems are formulated. This revised version was published online in August 2006 with corrections to the Cover Date.     

New Philosophies of Science in North America – Twenty Years Later

This survey of major developments in North American philosophy of science begins with the mid-1960s consolidation of the disciplinary synthesis of internalist history and philosophy of science (HPS) as a response to criticisms of logical empiricism. These developments are grouped for discussion under the following headings: historical metamethodologies, scientific realisms, philosophies of the special sciences, revivals of empiricism, cognitivist naturalisms, social epistemologies, feminist theories of science, studies of experiment and the disunity of science, and studies of science as practice and culture. A unifying theme of the survey is the relation between historical metamethodologists and scientific realists, which dominated philosophical work in the late 1970s. I argue that many of the alternative cognitive naturalisms, social epistemologies, and feminist theories that have been proposed can be understood as analogues to the differences between metamethodological theories of scientific rationality and realist accounts of successful reference to real causal processes. Recent work on experiment, scientific practice, and the culture of science may, however, challenge the underlying conception of the field according to which realism and historical rationalism (or their descendants) are the important alternatives available, and thus may take philosophy of science in new directions. This revised version was published online in August 2006 with corrections to the Cover Date.     

甲型H1N1流感大流行2周年记

2009年4月,墨西哥暴发甲型H1N1流感疫情,并迅速蔓延至全球。2009年6月11日,世界卫生组织宣布进入流感大流行,直到2010年8月10日世卫组织宣布世界步入流感大流行后期。自流感暴发已经2年过去了,回顾整个过程我们从中可以学到许多经验和教训,并随时准备应对将来可能发生的新的流感疫情。     

生长激素对心血管系统的影响

生长激素（GH）是出生后主要刺激生长的激素,GH相当高比例的促生长作用是由胰岛素样生长因子-I（IGF—I）介导完成的。不同的代谢功能如碳水化合物和脂类代谢也受GH的直接影响。GH还对心血管及大脑有影响,本文拟对其分泌机制及作用和对心血管及大脑的影响作一综述。     

2009年-2011年广州市甲型H1N1流感监测定量研究

本文对广州市2009年7月～2011年1月的发热呼吸道监测数据进行了定量分析,并在此分析的基础上提出了相关政策建议,比如加强人群分类管理、加快疫苗研制、避免抗病毒药物的滥用、重视健康管理和健康教育以及遵循预防控制原则等。     

肝脏X受体研究在心血管疾病中的应用展望

肝脏X受体(Liver X Receptor,LXR)是新近研究比较深入的一个热点话题,LXR主要参与胆固醇代谢和转运、脂肪代谢、糖原异生和炎症等过程。本文在LXR的结构、功能、其激动剂及其可能的临床作用、未来的研究方向等多个方面进行了详细的阐述。     

不同机械通气模式下吸痰对ARDS患者肺通气及顺应性的影响

为探讨不同机械通气模式下吸痰对ARDS患者肺通气及顺应性的影响。选择20例ARDS机械通气患者,随机分为A/C组与SIMV组;分别给予开放式吸痰,记录吸痰前后肺通气指标及呼吸系统顺应性指标的变化。结果吸痰后各时间点呼吸频率均显著增加(P0.01);潮气量、分钟通气量在0s显著降低,吸痰后15s、1min显著增加(P0.01);两通气模式比较SIMV组呼吸频率、分钟通气量增加显著(P0.01)。吸痰前后动静态顺应性、动态P-V曲线斜率差异不显著(P0.05),通气模式之间亦无统计学差异。提示开放式吸痰引起呼吸频率显著增加,潮气量及分钟通气量先是下降然后显著增加;SIMV模式呼吸频率、通气量增加较为显著。不同通气模式下吸痰对呼吸系统顺应性影响不显著。     

从技术创新看负压封闭引流技术的发展

负压封闭引流技术(vacuumsealing drainage,VSD)是近几年来发展起来的一项新的创口引流技术,其操作方便,应用简单,在临床各个科室得到广泛应用和发展,作者介绍了这一新的引流技术的发展历史、技术原理及临床应用情况。并对负压封闭引流技术的创新特点和创新方法进行了简要论述及展望。