脂蛋白相关磷脂酶A2活性和急性冠脉综合征的相关性研究

目的:探讨国人血浆脂蛋白相关磷脂酶A2(Lp-PLA2)活性与急性冠脉综合征(ACS)不同临床类型以及冠脉病变严重程度之间的关系.方法:对80例疑诊为ACS的患者行冠状动脉造影,按造影结果分为冠心组和正常对照组,再以冠心病临床类型、冠脉病变支数、Gensini积分将冠心病组患者分成不同的亚组,用统计学方法比较各组之间Lp-PLA2水平的不同.结果:不稳定型心绞痛组和心肌梗死组Lp-PLA2活性均显著高于正常对照组(P<0.05).Lp-PLA2活性随着冠脉病变支数和Gensini积分的增加而升高.结论:Lp-PLA2活性能反应冠脉病变的稳定性,与冠脉病变严重程度有关.     

低分子肝素治疗老年不稳定性心绞痛临床观察

不稳定性心绞痛(UA)是介于稳定性心绞痛(SA)与心肌梗塞(MI)之间的一组急性心肌缺血综合征,有向MI转化的倾向。冠脉粥样硬化斑块破裂基础上的血小板聚集和血栓形成是UA的最重要发病机制。目前,多数研究结果     

单纯收缩期高血压与双期高血压的情绪障碍临床观察

目的：比较单纯收缩期高血压与双期高血压情绪障碍的差异。方法：分别收集老年单纯收缩期高血压及双期高血压患者各100例,治疗前两组病人均用焦虑及抑郁量表评估情绪状态并进行组间比较,同时与正常人的常模比较。结果：两组高血压病人治疗前焦虑及抑郁均值高于常模,尤其是单纯收缩期高血压组与双期高血压相比焦虑指数有显著差异（P〈0.001）。结论：单纯收缩期高血压患者中抑郁及焦虑患病率高,尤其是焦虑障碍明显高于双期高血压,提示临床医师应对其情绪障碍进行有效干预,以提高临床疗效。     

胸壁多导联心电图标测在下壁心肌梗塞中的意义

54例急性下壁心肌梗塞胸壁36导联系列心电图标测的结果,具有5个导联以上ST段压低的患者梗塞范围大,临床死亡率高,梗塞后心绞痛,心律失常较多。     

冠心病患者及健康人血浆脂蛋白(a)水平

本文以酶联免疫吸附法(ELISA)测定了54例不同类型及不同并发症的冠心病患者与30名健康人的血浆Lp(a)浓度。心肌梗塞组和心绞痛组的Lp(a)浓度均高于对照组,并发糖尿病组Lp(a)浓度显著高于其他各组,无并发症且年龄较轻者Lp(a)浓度显著高于年龄较高者。表明血浆高Lp(a)水平是冠心病的遗传危险因素,但其升高的程度不能反映冠心病的临床类型或严重程度;并发糖尿病是老年冠心病患者血浆Lp(a)浓度升高的原因之一。     

冠心病患者及健康人血浆脂蛋白(a)水平

本文以酶联免疫吸附法(ELISA)测定了54例不同类型及不同并发症的冠心病患者与30名健康人的血浆Lp(a)浓度 心肌梗塞组和心绞痛组的Lp(a)浓度均高于对照组,并发糖尿病组Lp(a)浓度显著高于其他各组,无并发症且年龄较轻者Lp(a)浓度显著高于年龄较高者,表明血浆高Lp(a)水平是冠心病的遗传危险因素,但其升高的程度不能反映冠心病的临床类型或严重程度;并发糖尿病是老年冠心病患者血浆Lp(a)浓度升高的原因之一。     

歌唱疗法对老年高血压患者的康复作用

目的:探索歌唱疗法对老年高血压患者康复中的效果。方法:老年合唱团中62例高血压患者作为治疗组,另筛选某社区医院老年高血压患者58例作为对照组,两组均保持用抗高血压药物的种类和剂量不变,治疗组同时辅以歌唱训练,两组均观察三个月,并就治疗前、后的血压、主要症状指标及生活质量指标进行评定。结果:治疗后治疗组与对照组比较,收缩压下降非常显著(P<0.01),舒张压下降显著(P<0.05),主要临床症状(心悸除外)、生活质量(性能力、记忆力除外)的改善均高于对照组(P<0.05)。结论:歌唱疗法有助于老年高血压患者的康复及生活质量的提高,给予歌唱疗法半年以上才有巩固疗效。     

瑞替普酶与尿激酶在急性ST段抬高心肌梗死溶栓治疗中的临床对比分析

目的:评价瑞替普酶与尿激酶治疗急性ST段抬高心肌梗死(STEMI)的临床疗效及不良反应,并比较二者的差异.方法:2011年1月-2012年10月我院收治的48例STEMI的病人均采用静脉溶栓,随机分为对照组(尿激酶)和研究组(瑞替普酶).研究组(22例)和对照组(26例),观察两组的溶栓冠脉再通率、再通时间、射血分数、不良反应发生率及急性期病死率.结果治疗组临床疗效明显改善,临床疗效总有效率高于对照组,两组相比较差异有统计学意义(P<0.05),两组胸痛症状缓解及再通率比较:治疗组开始溶栓后2h胸痛症状缓解率及再通率明显改善,与对照组比较差异有统计学意义(P<0.05),出血并发症及过敏反应的比较:溶栓治疗过程中,治疗组出现轻度出血4例(5.0%);对照组出现轻度出血7例(7.5%);两组均未出现重度或致命性出血及过敏反应.两组溶栓后60、90、120 min血管再通率比较,瑞替普酶组血管再通早、再通比例高,差异有统计学意义(P<0.05).结论:瑞替普酶治疗急性心肌梗死(AMI)冠脉再通时间早、冠脉再通率高、给药方便、药物维持时间长、不良反应少,是一种高效而安全的治疗AMI的理想溶栓药物.     

梗死前心绞痛对急性心肌梗死患者近期预后影响的临床分析

目的了解梗死前心绞痛对AMI患者近期预后的影响.方法选择96例首发AMI患者,根据梗死前1周内有无心绞痛病史,分为有心绞痛病史组和无心绞痛病史组,进行统计学处理.结果梗死前有心绞痛病史组患者的早期并发症心功能不全、心源性休克、严重心律失常、早期住院死亡率明显低于梗死前无心绞痛病史组患者(P＜0.05).结论梗死前心绞对冠心病患者具有一定的"保护价值",因此,临床工作中对梗死前无心绞痛发作的AMI患者应加强监护及治疗.     

动态心电图在高血压病中的临床价值

目的研究原发性高血压与心律失常的关系。费料与方法将襄樊市中心医院住院确诊为原发性高血压的80例患者进行24h动态心电图（DCG）检测,并把同期门诊诊治的高血压前期且伴有头晕心悸的31例患者作为对照组进行检测。结果高血压组DCG除2例外均有心律失常发生（98％）。结论：高血压患者进行动态心电图监测易发现心律失常。对高血压患者而言,在有效控制血压的基础上,防止左房左室扩大,改善心肌供血状况,是降低心律失常发生率的一个重要手段。     

潘南金对急性心肌梗塞心律失常影响的对比研究

目的观察潘南金(门冬氨酸钾镁)对急性心肌梗塞后心律失常、泵功能及死亡率的影响.方法本文对我院1998.3～1999.10月收入CCU病房的40例患者进行单盲、随机分为治疗组和对照组,治疗组第1～5天给予潘南金静脉输注,第6～15天改为口服,检测两组治疗前、第5、10天的血清钾、镁离子浓度,记录治疗前后血压及第一天24hHolter,统计两组并发症及死亡率,所得数据进行统计学处理.结果两组间在年龄、性别、发病时间及合并用药等方面无差异,所有资料具有可比性.治疗组第5、10天的血镁较治疗前及对照组显著增高(P＜0.01),治疗组的心衰、室早、室速较对照组明显减少(P值分别为＜0.05、＜0.01及＜0.05),治疗组再灌注心律失常发生率较对照组减少(P＜0.05),死亡率两组间无显著差异(P＜0.05).治疗组治疗前后血压变化较对照组明显(P＜0.05).结论潘南金可以减少AMI后心衰的发生,改善心功能,减少AMI后室性心律失常的发生.在溶栓的患者,潘南金能减少再灌注心律失常的发生,减小再灌注损伤.但潘南金对血压有较大的影响,尤其血压在正常低限时,静脉输注潘南金可使低血压发生率增加,因此临床应用时需注意.     

The Student Actions Coding Sheet (SACS): An instrument for illuminating the shifts toward student‐centered science classrooms

This study describes the development of an instrument to investigate the extent to which student‐centered actions are occurring in science classrooms. The instrument was developed through the following five stages: (1) student action identification, (2) use of both national and international content experts to establish content validity, (3) refinement of the item pool based on reviewer comments, (4) pilot testing of the instrument, and (5) statistical reliability and item analysis leading to additional refinement and finalization of the instrument. In the field test, the instrument consisted of 26 items separated into four categories originally derived from student‐centered instruction literature and used by the authors to sort student actions in previous research. The SACS was administered across 22 Grade 6–8 classrooms by 22 groups of observers, with a total of 67 SACS ratings completed. The finalized instrument was found to be internally consistent, with acceptable estimates from inter‐rater intraclass correlation reliability coefficients at the p < 0.01 level. After the final stage of development, the SACS instrument consisted of 24 items separated into three categories, which aligned with the factor analysis clustering of the items. Additionally, concurrent validity of the SACS was established with the Reformed Teaching Observation Protocol. Based on the analyses completed, the SACS appears to be a useful instrument for inclusion in comprehensive assessment packages for illuminating the extent to which student‐centered actions are occurring in science classrooms.     

150例高血压病患者并发症临床观察

目的:探讨单纯收缩期高血压、收缩压与舒张压高血压并发心脑血管病的机率。方法:将150例高血压患者分成3组:52例舒张压升高患者;15例单纯收缩期高血压;54例收缩期、舒张期均高的高血压并发心脑血管病发症的患者进行临床分析。结果:单纯舒张期高血压预后良好,而单纯收缩期高血压及收缩压合并舒张压升高者有较大的发生心脑血管病的危险性。结论:对单纯收缩期高血压、及收缩压合并舒张压升高的患者应给予足够重视,并积极治疗。     

老年急性非结石性胆囊炎临床特点及手术治疗

目的:探讨老年人急性非结石性胆囊炎(AAC)临床特点与手术治疗.方法:通过设立病例对照,对48例老年人AAC和急性结石性胆囊炎(ACC)的并发症、胆囊病理改变及术后结果进行比较.结果:与老年人ACC相比,AAC患者以心血管疾病为主的并发症明显增多(P＜0.01);胆囊化脓、坏疽与穿孔率明显增高(P值＜0.01,＜0.01,＜0.05);术后并发症发生率明显上升(P＜0.01).结论:老年人AAC并存病多、胆囊病变重、术后并发症发生率高;宜在症状出现48h内手术治疗.     

CT引导下经皮肺穿刺活检并发气胸行管引流治疗效果观察

目的:研究CT引导下经皮肺穿刺活检术后并发气胸的细管胸腔闭式引流治疗效果。方法:对某院自2001年1月至2005年9月CT引导下经皮肺穿刺活检术后发生的53例气胸患者中有较明显胸闷、气促的6例患者进行细管(选用16号20cm长中心静脉导管)胸腔闭式引流的疗效观察。结果:6例患者气胸全部治愈,肺复张时间(指插管至肺完全复张所需时间)1～3天,效果满意,未出现并发症。结论:CT引导下经皮肺穿刺活检使用细针(20G切割针),并发气胸时胸膜破裂口较小,往往形成闭合性气胸,使用细管胸腔闭式引流治疗不仅取材容易,操作简便,病人痛苦少,而且疗效满意,无并发症,值得临床推广使用。     

Community College Employee Wellness Programs

This paper describes the prevalence and characteristics of employee wellness programs in public community colleges accredited by the Southern Association of Colleges and Schools (SACS). A random sample of 250 public community colleges accredited by SACS was mailed a 46-item employee-wellness program survey. The survey solicited program information regarding funding, activities offered, program administration, participation rates, and incentives. The results indicated that the majority of the employee wellness program administrative bodies were either the health and physical education departments or wellness committees. The main coordinators of the wellness programs were either part-time directors within the institutions, wellness committees, or full-time directors within the institutions. Of the institutions surveyed, 27 out of 64 (42.2%) offered employee wellness programs. The findings indicate that the prevalence of employee wellness programs in public community colleges accredited by SACS is below previous research findings in community colleges and universities and do not meet the national health goals of employee health promotion prevalence set forth by the U.S. Department of Health and Human Services.     

复肾方结合血液透析治疗慢性肾衰的临床疗效分析

目的 :观察复肾方配合血液透析治疗慢性肾功能衰竭的临床疗效。方法 :通过随机对照法将 4 8例进行维持性血透的慢性肾衰患者分为两组 :治疗组 (复肾方加血透组 ) 2 8例 ,对照组 (单纯血透组 ) 2 0例 ,观察两组治疗前后尿毒症的临床表现、肾功能、机体营养状况、血脂、血磷和电解质等各项指标 ,并进行治疗后两组血透充分性比较。结果 :复肾方能明显地改善临床症状 ,而且能提高内生肌酐的清除率 ,更有效地降低血尿素氮BUN和血肌酐SCr,并能提高血清蛋白和血红蛋白、血红细胞数 ,治疗后血透充分性高于对照组 ,并能降低血磷 ,在一定程度上防治血透患者的血脂代谢紊乱。结论 :复肾方切合慢性肾衰及维持性血透患者的基本病机 ,组方合理 ,具有提高血透充分性 ,更好地改善临床症状和肾功能 ,改善患者机体营养状况和生活质量 ,降低血透副反应的作用。     

美国高等教育质量认证的运行模式——以美国南部院校协会(SACS)为例

美国高等教育的质量保障在很大程度上是通过认证来进行的。美国南部院校协会(SACS)作为美国六大地区性认证机构之一,在美国高等教育质量保障体系中发挥着重要作用。总结和分析美国南部院校协会的组织结构、运行机制、认证标准及认证程序,可以为我国高等教育评估和质量保障提供有益的启示。     

ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft

Objective: To analyze the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with irradiated bone-patellar tendon-bone (BPTB) allograft compared with non-irradiated allograft and autograft. Methods: All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 mrad of irradiation prior to distribution. A total of 68 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into one of the two groups (autograft and irradiated allograft groups). The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months of follow-up (ranging from 24 to 47 months), patients were evaluated by the same observer according to objective and subjective clinical evaluations. Results: Of these patients, 65 (autograft 33, irradiated allograft 32) were available for full evaluation. When the irradiated allograft group was compared to the autografi group at the 31-month follow-up by the Lachman test, the anterior drawer test (ADT), the pivot shift test, and KT-2000 arthrometer test, statistically significant differences were found. Most importantly, 87.8% of patients in the autograft group and just only 31.3% in the irradiated allograft group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%). The anterior and rotational stabilities decreased significantly in the irradiated allograft group. According to the overall International Knee Docu-mentation Committee (IKDC), functional and subjective evaluations, and activity level testing, no statistically significant dif-ferences were found between the two groups. Besides, patients in the irradiated allograft group had a shorter operation time and a longer duration of postoperative fever. When the patients had a fever, the laboratory examinations of all patients were almost normal. Blood routine was normal, the values of erythrocyte sedimentation rate (ESR) were 5-16 mm/h and the contents of C reactive protein (CRP) were 3-10 mg/L. Conclusion: We conclude that the short term clinical outcomes of the ACL reconstruction with irradiated BPTB allograft were adversely affected. The less than satisfactory results led the senior authors to discontinue the use of irradiated BPTB allograft in ACL surgery and not to advocate using the gamma irradiation as a secondary sterilizing method.     

万托林、爱喘乐治疗婴幼儿毛细支气管炎30例分析

目的:探讨毛细支气管炎患儿在全身治疗的基础上,配合局部治疗的临床疗效.方法:随机选择毛细支气管炎患儿30例,对照组28例,两组均采用相同的综合性治疗,治疗组用万托林溶液、爱喘乐溶液,由德国百瑞公司PARI Junior BOR 038压缩泵雾化吸入治疗.结果:治疗组30例,其中显效21例,有效7例,无效2例,比较差异有显著性.结论:毛细支气管炎是婴幼儿最常见的喘息性疾病,传统治疗方法疗效较长,配合万托林(β2-肾上腺素能受体兴奋剂)溶液、爱喘乐溶液(抗胆碱药),两组药物合用可以更好地发挥平喘解痉作用,缩短疗程,提高疗效.