45°高速涡轮钻“三段法”在下颌近中及水平阻生智齿拔除中的临床评价

目的本文尝试用高速涡轮牙钻将牙齿劈成三段拔除阻生齿,与传统的涡轮“两段法”比较,以期能缩短下颌近中及水平阻生智齿的拔除时间,降低术后反应。方法中、低位近中及水平阻生齿患者186例随机分成2组,每组均为阻生齿93颗。一组采用涡轮“两段法”,一组采用涡轮“三段法”。比较2组拔牙时间及术后并发症的情况。结果 卡方检验显示,在近中及水平阻生齿的拔除中,两段法与三段法拔牙时间没有显著差异（P〉0．05）;利用三段法拔除阻生齿的术后反应明显小于两段法,两纰之间有显著性差异（P〈0．05）。结论在近中及水平阻生齿的拔除中,三段法可以减少牙槽骨的去除,对减少术中、术后出血和减轻术后肿胀、疼痛都有一定意义,是值得在临床中推广的拔牙术式。     

小儿支气管异物取出术的麻醉处理

目的 探讨小儿支气管异物取出术的麻醉处理方案.方法 回顾性分析112例小儿支气管异物取出术的麻醉处理.Ⅰ组,静脉注射丙泊酚,首剂量2 mg/kg,维持剂量4～8 mg·kg-1·h-1,辅以氯胺酮2 mg/kg;Ⅱ组,静吸复合麻醉,静脉注射氯胺酮2 mg/kg后,经面罩吸入七氟烷3%～4%;Ⅲ组,静脉注射τ-羟基丁酸钠50 mg/kg、氯胺酮2 mg/kg,术中追加氯胺酮每次1 mg/kg;所有患儿入睡后均以1%地卡因在咽喉部作喷雾表面麻醉;分别记录各组术中屏气呛咳、脉搏血氧饱和度(SpO2)降至90%以下、硬质支气管镜退出气道、气管插管以及喉水肿或喉痉挛等的发生率和苏醒时间.结果 Ⅲ组屏气呛咳、支气管镜退管以及喉痉挛或喉水肿的发生率均显著低于Ⅰ、Ⅱ组(P值均＜O.05).苏醒时间显著长于Ⅰ、Ⅱ组(P值均＜0.05).结论 小儿支气管异物取出术的麻醉选择以静脉注射τ-羟基丁酸钠、氯胺酮和1%地卡因局部表面麻醉为佳.     

Specific IgG antibodies in sera in patients with penicillin allergy

The role of IgG antibodies in inducing or modifying allergic reaction has not been sufficiently clarified. The objective of this investigation is to elucidate the relationship between IgG antibodies and penicillin allergy, between IgG and IgE antibodies in allergic patients. Enzyme-linked immunosorbent assay and Radioallergosorbent test were used to examine eight kinds of specific IgG and IgE antibodies, including major antigenic determinants: benzylpenicilloyl (BPO), ampicilloyl (APO), amoxicilloyl (AXO) and phenoxomethylpenicilloyl (PVO), and minor antigenic determinants: benzylpenicillanyl (BPA), ampicillanyl (APA), amoxicillanyl (AXA) and phenoxomethylpenicillany (PVA), in the sera of 249 patients with penicillin allergy. Except BPA-IgG, seven kinds of antigenic determinants IgG antibodies levels were significantly higher than that of control group (P < 0.05). Positive rates of specific IgG and IgE were 47.0 and 57.8%, while positive rate of IgE and IgG together was 77.9%. The positive rate of IgG antibodies to major antigenic determinants (42.2%) was significantly higher than that of minor antigenic determinants (8.8%) (P < 0.05). The positive rate of IgG antibodies of patients with typical clinical symptoms after penicillin administration when skin tests were negative was significantly higher than that of patients with positive skin test (P < 0.01). There were no differences between the IgG positive rates to three kinds of determinants and that of all of eight kinds. The study indicates that IgG may be important in penicillin allergy with negative skin test and IgG antibodies to major antigenic determinants probably play a more important role in the process of allergic reaction. This project was supported by the Science Foundation for Distinguished Young Scholars of Henan Province (No. 0312002100) and the Nature Science Foundation of Henan Province (No. 0211040100).     

Elastic properties of aorta in patients with primary hyperparathyroidism

In this study, we aimed to evaluate whether hyperpara thyroidism affects the elastic properties of aorta, calculated as aortic distensibility and aortic stiffness index. Eighteen patients with hyperparathyroidism were enrolled in the study. The control group consisted of 18 healthy subjects with similar baseline characteristics. All subjects underwent echocardiographic examination. Internal aortic root diameters were measured at 3 cm above the aortic valve by the use of two-dimensional guided M-mode transthoracic echocardiography, and arterial blood pressure was measured simultaneously from the brachial artery by sphygmomano metry. Two indexes of the aortic elastic properties were measured which are aortic distensibility and aortic stiffness index. The mean aortic stiffness index of hyperparathyroidic patients was higher (3.04 +/- 1.26 vs. 2.36 +/- 1.09; p = 0.048), and aortic distensibility was lower (15.62 +/- 5.84 vs. 22.64 +/- 14.54; p = 0.035) than the control group. The left ventricular (LV) mass index (242.44 +/- 46.3 vs. 212.8 +/- 43.97; p = 0.048), although it has failed to reach statistical significance, and LV wall stress (57.81 +/- 18.22 vs. 46.57 +/- 15.72; p = 0.08) of these patients was also higher than control group. Hyperparathyroidism increases aortic stiffness index and decreases aortic distensibility of primary hyper parathyroidic patients compared with normal population. The affected aortic elastic properties can be a factor in increased LV mass index and wall stress.     

托盘粘接剂对硅橡胶印模材料与不同粗糙度托盘材料间结合强度的影响

目的：研究托盘粘接剂对硅橡胶印模材料与不同粗糙度的托盘材料间结合强度的影响。方法：2种托盘材料：自凝树脂和不锈钢;分3种粗糙度：45目,220目,400目加自然表面分成4大组;每种材料每种粗糙度各分2组,一组涂布粘接剂,另一组不涂布,总计16组,每组6个试件,共96个试件。采用GC公司的加成型硅橡胶印模材料和专用粘接剂。拉力测试,所得数据用SAS软件进行统计分析。结果：在所有托盘材料中,都显示应用粘接剂的那组具有更高的结合强度（P〈0.05）。使用粘接剂前,托盘材料对结合强度的影响具有统计学意义（P〈0.05）。使用粘接剂前后,托盘材料的表面粗糙度对结合强度的影响都具有统计学意义（P〈0.05）。结论：应用托盘粘接剂能改善加成型硅橡胶印模材料和托盘的结合强度。应用粘接剂前,不同托盘材料对结合强度有影响,自凝树脂大于不锈钢材料。在应用粘接剂情况下,结合强度随托盘表面粗糙度的增加而增加。没有应用粘接剂时,则需要把托盘粗糙到一定程度才可以增加结合强度。     

免疫致敏结合局部乙酸刺激法建立大鼠溃疡性结肠炎模型

目的探讨高胆固醇血症大鼠不同时期性别间血脂指标的变化趋势。方法将20只SD大鼠，体重为160．180g，雌雄各半，饲喂高脂饲料，经血液生化检测CH01、TG、HDL、LDL指标，确认高胆固醇血症模型成功后再给予正常饲料，观察其血脂指标的变化。结果发现成模后饲喂正常饲料的大鼠血脂指标随时间的增加趋于正常，但两性之间存在较大差异（P〈0．01），雄性动物高胆固醇血症的维持时间比雌性动物要超出4周。结论成功地建立了类似人类高胆固醇血症的动物模型，雄性动物在患有高血脂疾病后预后情况比雌性动物要差，高血脂疾病相关研究方面要注意性别差异。     

遗传基因与精神分裂症的关系

目的探讨人类5q33区域内LOC345614基因位点与精神分裂症的关系。方法应用PCR-RFLP方法检测91个中国汉族精神分裂症患者及其健康父母双亲组成的核心家系单核苷酸多态性（SNP）rs154110。结果rs154110基因型频率的分布符合Hardy-Weinberg平衡；单倍型相对风险分析（HRR）显示，rs154110与精神分裂症无关联（0=0．011，P〉0．05）；传递不平衡检验（TDT）显示，杂合父母传递给受累子女与非传递等位基因频率分布差异无统计学意义（χ^2=0．011，P〉0．05）；该位点与精神分裂症阳性症状的被害妄想、自责自罪妄想及其他妄想密切相关。结论5q33LOC345614位点rs154110与精神分裂症无关联，但其位点多态性与精神分裂症的被害妄想、自责自罪妄想及其他妄想症状密切相关。     

Galectin-3和CD44v6在甲状腺细针穿刺标本上的表达及意义

目的探讨细针穿刺细胞学检查(FNA)联合Galectin-3和CD44v6的免疫组织化学检测能否更好地在术前鉴别甲状腺结节的良、恶性。方法采用S-P法检测55例甲状腺结节的细针穿刺细胞学标本Galectin- 3及CD44v6蛋白的表达,评价两项指标在鉴别甲状腺结节良、恶性方面的诊断准确率,并将结果与常规细胞学诊断结果作比较。结果Galectin-3和CD44v6在甲状腺癌细胞标本中单独及共同表达的阳性率(100．00%、80．00%和80．00%)明显高于其在甲状腺腺瘤(0%、16．67%和0%)、结节性甲状腺肿(5．88%、14．71%和2．94%)细胞标本中的表达率(P值均＜0．01)。细胞学标本上用免疫组织化学的方法单独或联合检测Galectin-3和CD44v6,在鉴别甲状腺结节良、恶性方面的诊断准确性(96．36%、83．64%和92．73%)均高于或等于常规细胞学诊断的准确性(83．64%)。结论Galectin-3免疫组织化学检测与FNA相结合,有助于进一步提高细胞学诊断的准确率。但联合检测CD44v6的价值有限。     

Effect of a second-year primary care preceptorship on medical students' career plans

BACKGROUND: Preceptorships with community physicians have been incorporated into medical curricula to foster interest in generalist careers. An evaluation of our preceptorship program was undertaken to determine this influence. METHODS: Students were asked about career interests before and after a second-year community preceptorship. When graduating, those students entering primary-care residencies were surveyed to validate whether they planned to become generalist or specialist. Associations between career choice at graduation and career interest before and after the preceptorship were examined. RESULTS: Of 73 students who maintained a generalist career plan after the community preceptorship, 57 (78%) continued with the same at graduation. After the preceptorship, 70 students reported a change in career interest toward generalism, compared with 9 who reported an interest in specialism. A significant relationship was found between career interest change and career choice at graduation. CONCLUSION: Our community preceptorship had a modest impact in stimulating students to consider generalist careers.     

经鼻内镜治疗鼻内型脑膜脑膨出（附4例病例）

目的探讨鼻内型脑膜脑膨出的诊断和鼻内镜微创外科治疗的方法。方法4例表现为鼻腔和鼻咽部肿块患者。例1．女性，11个月，患儿出生后反复右鼻流水样分泌物，经常高烧，且持续时间长，CT检查见右侧筛顶部有颅骨缺损，脑膜突入鼻腔。例2，男性，5岁，行CT及MRI检查，发现鼻腔有新生物，诊断为“鼻腔脑膜脑膨出”。例3，男性，49d，出生后发现患儿右鼻塞，鼻窦CT检查右侧筛顶部有颅骨缺损，诊断为“右鼻腔脑膜脑膨出（鼻内型）”。例4，男性，65岁，右鼻腔阻塞1年在当地医院就诊．拟诊为“鼻息肉”行鼻内镜手术，术中发现鼻腔新生物来源于筛顶，暂停手术，行鼻窦CT检查见右侧筛顶部有颅骨缺损，诊断为“右鼻腔脑膜脑膨出（鼻内型）”。4例患者病理脑组织检查符合脑膜脑膨出诊断。总结先天性鼻内型脑膜脑膨出的临床表现、影像学资料及外科治疗方法。结果患侧水样鼻漏、鼻塞、鼻腔肿块是鼻内型脑膜脑膨出的重要临床表现．尤其是有反复高热和脑膜炎表现的患儿，必须做影像学检查明确诊断。对鼻内型脑膜脑膨出．无论缺损部位在筛顶或颅底均可采用鼻内镜修补手术。结论CT和MRI在诊断鼻内型脑膜脑膨出具有重要价值。鼻内型脑膜脑膨出可选择经鼻内镜的鼻内进路手术方式．鼻内镜下经鼻进路手术修补鼻内型脑膜脑膨出具有安全、简便、微创、并发症少等优点。