目的 通过研究Graves甲亢患者血清中透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型胶原N端肽(PⅢPN-P)、Ⅳ型胶原(CⅣ)水平的变化,来探讨甲状腺功能亢进对肝纤维化的影响,并讨论抗甲状腺激素受体抗体(TRAb)与肝纤维化指标的相关性.方法 采用化学发光法检测65例Graves甲亢患者和65例健康体检者血清中HA、LN、PⅢPN-P、CⅣ的水平,电化学发光法检测甲功三项(TSH、FT3、FT4)及TRAb.组间差异性分析采用t检验,相关性分析采用Pearson检验.结果 HA、LN、PⅢP N-P、CⅣ在甲亢患者中的阳率性分别为1.50％、4.60％、63.10％和49.20％.甲亢患者血清中的PⅢP N-P及CⅣ平均水平分别为50.48±19.62ng/mL及33.78±16.06ng/mL,与对照组相比,差异有统计学意义(P<0.05),而HA与LN差异无统计学意义.研究还发现,随着TRAb水平的升高,PⅢP N-P及CⅣ的水平也随着升高,且差异有统计学意义(P<0.05).相关性检验结果显示,TRAb与PⅢP N-P与CⅣ均存在正相关.结论 甲亢患者中肝纤维化指标PⅢP N-P及CⅣ水平显著高于正常人,且TRAb与PⅢP N-P及CⅣ存在显著正相关性.因此,甲亢患者有必要关注肝纤维化的问题.

病例:患者,男,57岁.2017年10月17日因"全身多发骨痛伴乏力1年余,加重1周"而入院治疗.患者有乙肝病史5余年,4年前因生化肝功能异常,乙肝DNA明显增高(具体欠详),长期服用"阿德福韦酯胶囊(北京双鹭药业股份有限公司,批号:不详)每天10 mg"抗病毒治疗.1年余前患者无明显诱因出现双侧踝关节疼痛,伴口干、双下肢无力,伴夜尿增多,每晚4～5次,无畏冷、发热、腹痛、腹泻,无尿频、尿急、尿痛、无皮肤鳞屑样改变等不适.于当地医院就诊,予以消炎止痛、活血等治疗(具体用药不详),上述症状无明显好转.

The Department business learning credit system management was put into practice in the authors'hospital from the end of 2011.Quantitative assessment was used to realize the whole process of supervision and multi-dimensional evaluation.As a result, the department learning atmosphere became stronger, the develop-ment of personal growth and department were promoted, led to the comprehensive development of the hospital's medical, teaching, research, and the connotation construction.

Objective: To explore the application effects of opening the academic exchange forum on the local area network for hospital professional study. Method: Since January, 2013, the hospital has set an academic exchange forum on the local area network. Periodically upload some basic fundamental knowledge lessons, academic reports, the latest specialty analysis, the typical cases discussion and other posted contents so as to offer hospital staff a chance to download the materials and join the discussion, while the administrators periodically organize discussions and answer doubts. Collect and compare the average scores information of each staff who attended the three-fundamental knowledge examination organized in each season of 2013 and 2014. Results: Compared the average scores of the hospital staff in 2013 with those of the 2014, the latter have been improved greatly and their differences have statistical meanings(P<0.05). Conclusion: The establishment of the academic exchange forum on the local area network not only has improved the staff enthusiasms of studying the professional specialties, but also has enhanced the effectiveness of the academic professional specialties teaching. An uplifting, interesting, competing studying atmosphere has been built in the hospital, moreover the cooperation and mutual assistance of each teaching and research office and each department have been strengthened and promoted.

科技创新是医院持续发展的不竭动力，是医院转型发展的必由之路，军队中小医院目前正处于发展的机遇期和转型的关键期，机遇和挑战并存。本文从军队中小医院自身实际出发，阐述了科技创新在建设研究型医院中地位作用，提出了加强医院科技创新的着力点以及制度化、常态化推进办法，旨在探讨如何实现新形势下军队中小医院向研究型医院转型转变的发展。

Objective To discuss the application effect of WeChat group interaction teaching mode in the clinical department vocational study.Method We selected the neurology as the pilot department.We implemen-ted the centralized classroom teaching on every Tuesday night and WeChat group interactive questions and answers, discussion on every Wednesday night taken turns by members of the department from January 2013 to December 2013.We compared it with professional theory examination scores of each month under WeChat group of interactive teaching in 2012 and the examination results of each quarter’s hospital three kinds of basic theories (neurology pro-fessional knowledge).Results Each month specialized theoretical examination average scores of 2013 improved more obviously than 2012, and the difference was statistically significant ( P <0.05); every quarter’s average point of hospital three kinds of basic theories examination has increased significantly, and the difference was statisti-cally significant (P <0.05).Conclusion Our hospital implemented the model of instruction of WeChat group in-teraction on the basis of cyber interactive, which greatly improved the learning enthusiasm of medical personnel, significantly promoted the doctors’understanding of knowledge and learning and greatly improved the effectiveness of the business learning.It is worth popularizing widely.

本文介绍一种具有打捞带独立多气囊淡水袋式救生衣.该救生衣克服了目前国内外使用的泡沫填充式和单气囊气胀式救生衣穿着不舒适、水中阻力大、不方便打捞,海上易翻滚、易破损漏气、不能贮存淡水等缺点,具有体积小、重量轻、穿着舒适,多个独立气囊,打捞方便,落水后能保证头面朝天,延长漂浮时间等优点,从而为部队海上训练和作战、抗洪抢险、水上作业等提供有力保障.

在继续教育中,管理者能否维护良好的教学环境,严格管理,确保学分授予的严肃性,是继续教育的重要保障,也是保证继续教育良性发展的基础.在实践中,我们发现常规考勤模式不能很好保证出勤质量,不能满足继续教育管理的需求,存在许多管理者不可控制的人情考勤弊端,医院急需采用现代化的考勤手段保障继续教育的可持续开展.2010年以来,我院采用指纹考勤落实继续教育到课率,取得了良好效果.现分析报告如下.

便秘是指大便经常秘结不通,排便时间延长,或有便意而排便困难的一种常见病症.但排便习惯个体间差异较大,一般绝大多数人每日排便1次,但也有人2～3d排便1次而毫无痛苦,则不能称便秘,而有人即使每天都排便,但量少且伴有不适或不净者也称之为便秘.

我院于1999年10月研究了一种折叠式野战担架,其结构简单合理,体积小、重量轻、组装方便快捷,尤其适用于部队野战、紧急救护和伤病员搬运等,也可作为普通担架使用. 1 研制 该担架由担架主杠、横杠和布面(附图)组成.担架主杠由多节空心棒串连而成,每节空心棒的一端为束口,另一端为宽口,束口套入宽口中,主杠的空心内设置一弹性绳,其两端固定于主杠两端的空心棒中,用于拉紧主杠每节空心棒之间的连接,并可使空心棒快速回位.横杠套在主杠端部,并设有限位钮.内侧限位钮为横穿于管壁两端的销钉;外侧为弹性钮,可方便横杠的拆卸和安装.弹性绳固定在限位钮的销钉上.布面的两个侧边制成管状,主杠套入其中,并使布面可沿主杠滑动收起集于一端.