应用激光扫描共聚焦显微镜观察晶体上皮细胞中的游离钙

目的用钙的荧光指示剂ｆｌｕｏ－３和激光扫描共聚焦显微镜（ｌａｓｅｒｓｃａｎｎｉｎｇｃｏｎｆｏｃａｌｍｉｃｒｏｓｃｏｐｙ，ＬＳＣＭ）观察大白鼠的晶体上皮细胞（ｌｅｎｓｅｐｉｔｈｅｌｉａｌｃｅｌ，ＬＥＣ）中的游离钙。方法ｆｌｕｏ－３着染细胞后，应用ＬＳＣＭ观察细胞内ｆｌｕｏ－３与钙螯合后的荧光分布，最后用钙离子载体Ａ２３１８７和重金属离子Ｍｎ＋＋作校正，将ｆｌｕｏ－３与钙结合显示的荧光强度转换为［Ｃａ＋＋］ｉ值。结果ＬＥＣ中的游离钙主要分布在细胞核中。大白鼠晶体上皮细胞中的［Ｃａ＋＋］ｉ为２５９．７９±４９．２４ｎｍｏｌ／Ｌ。结论ｆｌｕｏ－３与ＬＥＣ孵育后能着染细胞。用ＬＳＣＭ能直观地观察细胞内钙的分布，并能通过校正得到细胞内游离钙的绝对值。这种成熟的方法，为进一步对ＬＥＣ中游离Ｃａ＋＋的研究提供技术准备     

超声定量检查技术新进展

近年来，超声定量检查技术在临床的应用为心血管疾病患者的心功能评估提供了量化的依据，本文介绍了超声诊断仪的使用部分最新定量检查技术。     

贲门失弛缓症的超声诊断价值

目的:探讨超声在贲门失弛缓症诊断中的应用价值。方法:对临床拟诊为贲门失弛缓症病人首先采用超声检查,诊断贲门失弛缓症38例,同时进行了X线钡剂食管及胃肠造影,并与40例正常人进行了对照。结果:超声对贲门失弛缓症的诊断符合率为100%,失弛缓症的食管管径明显大于正常对照组(P<0.01),管壁厚度亦大于正常对照组(P<0.01)食管蠕动明显减弱,甚者消失,扩张的食管腔内见有潴留的内容物。结论:超声对贲门失弛缓症诊断具有重要的临床应用价值,可取代传统的X线钡剂造影检查。     

230例隐睾临床分析

目的　总结隐睾及其并发症的诊治经验 ,提高对隐睾合理治疗年龄的认识。　方法　回顾性分析 1996至 2 0 0 1年 2 30例 2 99侧隐睾患者诊治资料。就诊时年龄 1～ 5 9岁 ,平均 (9.5± 9.0 )岁。左侧 88例 ,右侧 73例 ,双侧 6 9例。合并尿道下裂 11例 ,隐匿性阴茎 2例。　结果　 2岁以内手术治疗患者 2 5例 (10 .9% )。手术治疗 2 89侧 ,其中行一期下降固定术 2 73侧 ,另外疑为萎缩或恶变而行手术切除送病理 15侧 ,探查缺如 1侧。手术 2 89侧中 2 73例下降固定术后随访 4个月～ 5年 ,2 70例未见睾丸回缩及萎缩 ,成功率 98.9% (2 70 / 2 73侧 )。腹外型 2 6 0侧 (90 .0 % ) ,腹内型 2 5侧 (8.7% ) ,缺如 4侧 (1.4 % )。合并斜疝 74侧 (2 5 .6 % ) ,鞘状突未闭 2 4侧 (8.3% ) ,睾丸附睾分离 33侧 (11.4 % )。14 6侧腹外型隐睾B超检查符合率 86 .3% (12 6 / 14 6 ) ,查体符合率 6 3.0 % (92 / 14 6 ) ,P <0 .0 0 5。　结论　 2岁以内最佳手术时机的隐睾患者诊治率明显偏低 ,应引起重视。B超对隐睾的定位诊断符合率较高。     

Intra-observer and inter-observer agreement of the manual examination of the lumbar spine in chronic low-back pain

Examination is a cornerstone in the manual procedures leading to mobilisation/manipulation of the low back. The observer variation of the more specific segmental tests remains to be investigated. Two skilled specialists in manual medicine examined the segmental changes in the lumbar spine. The patients were unknown to the examiners and no information of the case history was given. All test results were recorded by an observer present in the room who ensured that no conversation was allowed during the examination. The primary outcome measures were the kappa values for each test. The matching was defined as acceptable (acc) within two neighbouring levels and perfect (per) on the same level. Intra-observer variation (tested in 33 patients and 10 subjects without low-back pain): The agreement between first and second segmental diagnosis examination was 70% (per) and 82% (per + acc). Kappa values were: segmental diagnosis 0.60 (per) and 0.70 (per + acc), multifidus test 0.51 (per) and 0.60 (per + acc), sideflexion 0.57 (per) and 0.69 (per + acc), and ventral flexion 0.31 (per) and 0.45 (per + acc). Inter-observer variation (tested in 60 patients): The agreement for segmental diagnosis between the examiner A and B was 42% (per) and 75% (per + acc). Kappa values were: segmental diagnosis 0.21 (per) and 0.57 (acc), multifidus test 0.12 (per) and 0.48 (acc), sideflexion 0.22 (per) and 0.45 (acc), and ventralflexion 0.22 (per) and 0.44 (acc). By manual tests, skilled examiners seem to be able to diagnose segmental dysfunctions in the low back. The clinical implication of these dysfunctions remains to be clarified.     

介入法和无创法评价急性心肌梗死溶栓后心肌再灌注的一致性研究

目的 探讨急性心肌梗死（AMI）溶栓治疗后无创法评价心肌再灌注的可行性。方法选择AMI溶栓治疗后行冠状动脉造影的患者，溶栓后90min血浆肌红蛋白（Mb）浓度与溶栓前血浆Mb浓度比值≥2．4或心电图ST段回落≥50％定义为成功再灌注（阳性）。上述两项指标均阳性为完全再灌注，仅一项阳性为部分再灌注，两项均阴性为无再灌注。再根据冠状动脉造影结果将患者分为完全再灌注（TIMI3级）、部分再灌注（TIMI2级）、无再灌注（TIMI0～1级）。对无创法和介入法进行一致性检验。共入选45例患者。结果无创法和介入法评价心肌再灌注经一致性检验，符合率为84．4％，Kappa=0．75（P〈0．01）。结论．心电图ST段回落和血浆Mb浓度变化两项指标合用可提高评价心肌再灌注准确性，和介入法有很高的符合率，简便易行，且结果可靠。     

Coexistence of Neoplasia and Cortical Dysplasia in Patients Presenting with Seizures

Summary: Tumors and cortical dysplasia are associated with epilepsy, but few studies have examined the coexistence of neoplasia and dysplasia in these patients. We studied 13 patients (age 4–29 years) with recurrent seizures of 1 month to 21-year' duration (median 72 months). Ten patients were aged <21 years. Imaging studies localized the lesion to the temporal lobe (10 patients), parietal lobe (2 patients), and frontal lobe (1 patient). Tumors included ganglioglioma (8 patients), dysembryoplastic neuroepithelial tumor (DNT) (3 patients), and low-grade as- trocytoma (2 patients). Cortical dysplasia, including atypical aggregates of neurons (6 patients), multifocal loss of the cortical laminar architecture (7 patients), and neurons in the molecular layer of the cortex (3 patients) were observed near but separate from the tumor. Coexistence of certain tumors with cortical dysplasia, most frequently observed in the pediatric population, suggests a hamar-tomatous/dysplastic nature of the neoplasms.     

奥地利维也纳医科大学医学考试形式介绍及启示

医学生需要具备不同层次的能力,所以需要不同的考试形式来衡量能力的高低。不同考试方法的选择对于反映所选课程的学习效果至关重要。本文主要介绍了维也纳医科大学的考试设计及其作用,以及对我国医学教育评估的启示。通过学习奥地利先进的教学评估理念和方法,可为我国医学教育评估方式改革、培养高素质医学人才提供借鉴。     

基于贝叶斯多变量联合模型的体检人群脑卒中发病风险因素的纵向研究

背景 脑卒中是目前影响人类健康的主要公共卫生问题之一;健康体检纵向数据累积了大量的健康信息,由于缺失数据多、样本量小等诸多问题,导致其利用率低、重要信息未能得到充分挖掘,进而对常见慢性病的有效防控等工作带来一定困难。目的 基于贝叶斯多变量联合模型,探讨体检人群脑卒中发病风险因素,为慢性病风险因素分析提供新的方法。方法 本研究使用空军军医大学西京医院健康医学中心2008—2015年的体检资料。随访情况：以首次发生脑卒中为结局事件,发生结局事件立即停止随访;若未发生,到2015年体检信息收集完成后结束随访;体检间隔时间为1年。依据随访过程中是否发生脑卒中分为脑卒中组和非脑卒中组。纵向观察变量包括总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、体质指数（BMI）和收缩压（SBP）。采用多因素Cox回归模型分析基线情况对脑卒中结局事件的影响;采用贝叶斯多变量联合模型,分析随访过程中TC、TG、LDL-C、HDL-C、BMI和SBP的纵向变化轨迹对脑卒中发病的影响。结果 本研究共纳入234例研究对象,1 581条纵向随访记录,平均随访时间为...     

Noninvasive Electrocardiographic Imaging (ECGI): Application of the Generalized Minimal Residual (GMRes) Method

Electrocardiographic imaging (ECGI) is a developing imaging modality for cardiac electrophysiology and arrhythmias. It reconstructs epicardial potentials, electrograms, and isochrones from electrocardiographic body-surface potentials noninvasively. Current ECGI methodology employs Tikhonov regularization, which imposes constraints on the reconstructed potentials or their derivatives. This approach can sometimes reduce spatial resolution by smoothing the solution. Accuracy depends on a priori knowledge of solution characteristics and determination of an optimal regularization parameter. These properties led us to implement an independent, iterative approach for ECGI—the generalized minimal residual (GMRes) method—which does not apply constraints. GMRes was applied to experimental data during activation/repolarization of normal and infarcted hearts. GMRes reconstructions were compared to Tikhonov reconstructions and to measured gold standards in isolated hearts. Overall, the accuracy of GMRes solutions was similar to Tikhonov regularization. However, in certain cases GMRes recovered localized potential features (e.g., multiple potential minima), which were lost in the Tikhonov solution. Simultaneous use of these two complementary methods in clinical ECGI will ensure reliability and maximal extraction of diagnostic information in the absence of a priori information about a patient's condition.© 2003 Biomedical Engineering Society. PAC2003: 8719Hh, 8757Gg