要注意中药对肝的损伤作用

含有生物碱类、皂苷类、萜类、毒蛋白类、重金属类成分的中药易致急性肝损伤.中药对肝脏损伤的原因及机制较为复杂,可能与药物对肝脏的直接毒性或特异性体质有关.此外,中药炮制方法、给药途径、剂型、剂量、疗程及配伍不当也会引起药物性肝损伤.中药所致的药物性肝损伤的诊断主要依据用药史、发病的时间、过程和临床表现并排除其他因素.治疗可选用还原型谷胱甘肽、S-腺苷蛋氨酸、多烯磷脂酰胆碱、熊去氧胆酸、水飞蓟素等药物,重症可选择人工肝脏支持治疗.     

CBL、PBL及Seminar结合的立体教学模式的应用和思考——临床医学八年制呼吸科床旁教学实践中的应用

临床医学八年制内科学床旁教学应用传统的教学模式及基于案例的学习（CBL）单一教学方法难以满足教学要求.将CBL与基于问题的学习（PBL）及研讨会（Seminar）结合的立体教学模式应用于呼吸科的床旁教学实践中,激发了学生学习的积极性、创新性,培养了学生良好的团队合作精神和临床思维模式,提高了学生们解决临床问题的能力,并能加深师生互动交流,达到教学相长的目的.     

血红素氧合酶-1与动脉粥样硬化和高血压的关系

血红素氧合酶-1（HO-1）是血红素分解的起始酶和限速酶,它分解血红素最终生成胆红素、一氧化碳和铁.这三种产物通过抗炎症损伤、抗氧化应激、抗细胞增殖、抗细胞凋亡、抑制血小板聚集、调节血管张力及细胞内信号传递等途径对心血管系统起着重要的保护作用.研究显示,HO的诱导剂及多种能降低心血管病风险的药物能诱导 HO-1表达增加,从而起到抗动脉粥样硬化的发生发展及调节血压的作用.因此开发临床可应用的HO诱导剂,甚至开发HO的基因治疗方法是目前研究的方向.     

新生儿重症监护病房患儿家属心理状况分析

探讨新生儿重症监护病房（NICU）住院患儿家属的心理状况及影响因素。采用焦虑自评量表（SAS）及自行设计的调查问卷对190名NICU住院患儿家属进行调查。结果显示患儿家属表现出不同程度的焦虑,与全国常模（29．78±0．46）相比,其焦虑情绪标准分49．54±1．07,高于常模组（P〈O．05）。影响因素主要包括文化水平、家庭人均收入及患儿病情严重程度等。患儿父母关注的主要问题包括：病情严重程度、预后、医护人员解释病情满意度及病房探视制度。笔者认为医护人员应加强与患儿家属的有效沟通,满足其心理需求,提高医疗护理质量,促进医患关系和谐。     

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。     

急性泪囊炎不同排脓途径的疗效观察

由于急性泪囊炎的一期处理过程中经泪小管引流脓液与经皮肤切开排脓对治疗效果的影响不同,将我院2007年以来接诊的急性泪囊炎患者随机分为观察组与对照组:患者抗感染治疗后经泪小管引流脓液,成人行经鼻内镜泪囊开窗引流术,先天性泪囊炎患儿行泪道探通;对照组患者急性期经皮肤切开排脓、放置引流条和消炎处理后再行泪囊鼻腔吻合术.观察组患者治疗成功率98.46％,外观满意率98.25％;对照组患者治疗成功率89.11％,外观满意率54.35％.观察组患者较对照组患者疗程缩短约7天～10天.急性泪囊炎经全身抗感染治疗后行泪小管引流脓液能更有效地控制炎症,不给患者带来新的创伤,值得临床推广应用.     

Short‐term cognitive‐behavioral treatment in multicultural primary care of patients with longstanding backache

The efficacy of cognitive‐behavioral therapy in multi‐cultural primary care patients with longstanding backache is not evaluated. The purpose of this study was to investigate the outcome of a four weekly‐treatment given by primary care physicians regarding pain‐related worry, depression and severe pain and to determine which social, clinical or gender factors were associated with outcome.The study group consisted of 245 patients in consecutive order from 19 countries, 18 to 45 years, entering rehabilitation program because of longstanding backache. Prevalences of pain‐related worry and depression and severe pain was counted and compared before and after. Logistic regression was used to calculate the odds (OR; 95% CI) for persistent pain‐related worry and/or persistent depression and severe pain (VAS ≥ 50). The prevalences of pain‐related worry and depression were both significantly lower after treatment (pain‐related worry 83% before vs. 38% after; depression 43% before vs. 31% after). Also the number of patients scoring ≥ 50 VAS was a little, but significantly, fewer (68% vs. 61%). Use of interpreter doubled the risk of having persistent pain‐related worry (OR 2.1; 95% CI 1.1–4.1) but the risk was not significant regarding persistent depression (OR 1.8; 0.6‐5.4). The rating of VAS rating ≥ 50 after treatment was twice as high, OR 2.3 (95% CI 1.1–4.6) in the 38–45 year old age group. To conclude, a focus on pain ideas reduced pain‐related worry and depression in these patients with various sociocultural backgrounds and longstanding backache.     

Formation of FeNi with L10-ordered structure using high-pressure torsion

FeNi with the L1₀-ordered structure is formed over an astronomical timescale in meteorites. In this study, severe plastic deformation using high-pressure torsion (HPT) is employed for the production of the L1₀ structure in the laboratory. Its formation is confirmed by X-ray diffraction analysis and transmission electron microscopy. Processing of elemental nanopowders by HPT is an effective method for the formation of the L1₀ phase, which is enhanced by the addition of Co to FeNi or annealing after HPT. The formation of the phase must be associated with enhanced diffusion through HPT.