269例10万元以上住院费用及影响因素分析

目的分析高额住院费用的成因及影响因素,以控制医疗费用的过快增长.方法选择某综合医院2002年住院费用在10万元以上的病例共269例,分析其费用构成,并对其影响因素进行多元回归分析.结果269例病人的平均费用为159 765元,以治疗费最高,所占比例为51.32%,药费其次,所占比例为36.25%.住院费用的影响因素为:住院天数、院内感染和预后.结论降低过高的住院费用要缩短无效住院日、控制院内感染以及减少无效的治疗和用药.     

巩膜环扎加压术后眼轴与屈光状态的改变

目的：探讨视网膜脱离巩膜环扎加压术后眼部屈光状态的改变。方法：用眼科A超、检影验光等对86例原发性视网膜脱离患者的86只患眼手术前1d及术后1、4、12w时的眼轴长度、眼屈光度等进行测量并将结果进行比较。结果：眼轴长度在术后1、4、12w时均较术前增长(P＜0．01)。眼屈光度在术后1、4、12w时均较术前增加，且向负值偏移(术后1、4w，P＜0．015术后12w，P＜0．05)。结论：巩膜环扎加压术后眼轴长度和屈光状态的变化与眼内嵴有关，术后眼轴增长是眼屈光度负值增加的主要因素。     

A small angle light scattering device for planar connective tissue microstructural analysis

The planar fibrous connective tissues of the body are composed of a dense extracellular network of collagen and elastin fibers embedded in a ground matrix, and thus can be thought of as biocomposites. Thus, the quantification of fiber architecture is an important step in developing an understanding of the mechanics of planar tissues in health and disease. We have used small angle light scattering (SALS) to map the gross fiber orientation of several soft membrane connective tissues. However, the device and analysis methods used in these studies required extensive manual intervention and were unsuitable for largescale fiber architectural mapping studies. We have developed an improved SALS device that allows for rapid data acquisition, automated high spatial resolution specimen positioning, and new analysis methods suitable for large-scale mapping studies. Extensive validation experiments revealed that the SALS device can accurately measure fiber orientation for up to a tissue thickness of at least 500 μm to an angular resolution of∼1^o and a spatial resolution of±254 μm. To demonstrate the new device’s capabilities, structural measurements from porcine aortic valve leaflets are presented. Results indicate that the new SALS device provides an accurate method for rapid quantification of the gross fiber structure of planar connective tissues.     

三种基牙材料对铸造玻璃瓷冠碎裂影响的研究

目的:研究不同种类和强度基牙材料与瓷冠破折碎裂的内在关系.方法:选用计算机建立上颌中切牙的三维有限元模型,模拟陶瓷层、牙本质、核桩等结构.分析在天然齿基牙、钴铬合金基牙及复合树脂基牙情况下,铸造玻璃陶瓷全冠的瓷层内及残余牙本质的应力分布情况.结果:高弹性模量的钴铬合金能够降低瓷层及残余牙本质内的最大主应力和最小主应力峰值,防止瓷层破折碎裂;而弹性模量与牙本质相近的复合树脂桩降低应力峰值的作用不明显.结论:对于有牙髓活力的牙本质基牙,尽量保存牙髓活力后行全冠修复.对于行根管治疗术后的无髓牙,进行核桩冠修复时,采用高弹性模量的高熔合金,尽量避免使用弹性模量较小的复合树脂核.     

红色素基因RFLP及其与情感性精神病关系的研究

以红色素基因全长ｃＤＮＡ作探针，２０例正常人，２６例双相型情感性精神病患者进行ＲＦＬＰ分析。ＳａｃＩ酶切显示：部分正常人和部分患者基因组ＤＮＡ产生的７．５ｋｂ，４．８ｋｂ，４．５ｋｂ呈多态性改变的片段。正常人具多态改变的占４５％，患者为４６．２％，按Ｘ染色体数计，正常人出现７．５ｋｂ限制性片段的频率为１４．３％，患者为３２．４％，但两者差异不显著。     

HLA-DR, DQ genotypes of celiac disease patients and healthy subjects from the West of Ireland

Celiac disease (CD) has one of the strongest class II HLA associations of any human illness. We used DNA-RFLP typing to study the class II HLA genotypes of celiac disease patients from the West of Ireland, the geographic area with the highest rate of celiac disease in the world. We confirmed the high frequency of HLA-DR3 in this population, and we were also able to demonstrate the additional risk of developing celiac disease imparted by HLA-DR7. This was done by clearly distinguishing DR7, DQ2 haplotypes from DR7, DQ9 haplotypes, and by "subtraction analysis" of haplotype frequencies. As reported in other populations, most of the patients without DR3 were heterozygous for DR7 and DR11 or 12 (DR5), or had DR4. We used PCR-RFLP and direct sequencing of amplified DNA to examine HLA-DR4 subtypes. The frequency of HLA-DR4 was markedly decreased in patients compared with controls (p=0.000001) and there was a significant alteration of DR4 subtypes of the patients compared with controls (p=0.0227). Moreover, all of the CD patients (5 of 5) with DR4 had a haplotype associated with the DQB1*0302 allele compared with only 11 of 23 control subjects with DR4. Our results in this population with exceptionally high risk of CD strongly support the DQ heterodimer hypothesis and suggest that the recently described sequence difference between the DQB1*02 alleles of DR3 and DR7 may contribute to a synergistic increased risk when these haplotypes are inherited together. In addition, our findings suggest a role for HLA-DQ in DR4-associated CD.     

Special issue: Group treatment after child and adolescent sexual abuse: Introduction

This introduction traces the increasing awareness of the prevalence of child sexual abuse over the last 20 years, examines the nature and consequences of such abuse and summarizes current information on the use of group treatment and its evaluation with sexually abused children and adolescents and their parents. Four examples of group treatment with different populations of abused children are described in this issue.     

The relation between conduction velocity and axonal length

Motor evoked potentials (MEPs) obtained by electrical root stimulation and F waves were used to examine the proximal nerve conduction velocity (CV) to tibialis anterior (TA), extensor digitorum brevis (EDB), flexor carpi radialis (FCR), and abductor pollicis brevis (APB) muscles in 40 humans. By subtracting motor latencies obtained by stimulating the peripheral nerve at the same point from the F-wave and MEP latencies, we could measure the CV over identical proximal segments. It was found that proximal CV to TA and FCR was significantly higher than to EDB and APB, respectively. Combining the data of the proximal CV to all four muscles in relation with axonal length resulted in a highly significant inverse relationship (r² = 0.77). Thus the axonal length explained to a large extent the higher CV of the arm nerves and also the inverse relation between body height and CV. The distal CV was always lower than proximal CV; however, there was no support for an additional effect of this gradient in explaining the relationship between CV and height since it was constant for all body heights. © John Wiley & Sons, Inc.     

Work at sea: a study of sleep,and of circadian rhythms in physiological and psychological functions,in watchkeepers on merchant vessels

Summary Sleep length and sleep quality scores were collected on board ships over periods of up to two weeks from 38 watchkeepers working a 4-on/8-off routine and 29 dayworkers. All watchkeepers exhibited fragmented sleeping patterns, which indicated a lack of adaptation of the sleep/wakefulness cycle to the hours of work. There were only slight differences in total sleep length between watchkeepers and dayworkers, however, both groups did not obtain an adequate amount of sleep. Within the watchkeeping crews the 3rd Officers had by far the shortest sleep length. Concerning sleep quality, daytime sleep was generally given the lowest ratings, whereas sleep starting before midnight was on average evaluated as the best, both by watchkeepers and dayworkers. Watchkeeping personnel do not normally have any days off during a voyage so that missed sleep might even amount to a sleep deficit. A solution for this problem could perhaps be a new, stabilized system that allows a single uninterrupted sleep, which is required for full recuperation, to be taken each day.Dedicated to Professor J. Aschoff on the occasion of his 75th birthdayPartly supported by a grant from the Ministry for Technology and Research, Federal Republic of Germany, Project Schiff der Zukunft, Part ET83b     

Frequency and Output-Dependent Change in Conduction Over Slow Pathways in a Patient with Sustained Ventricular Tachycardia Unrelated to Coronary Artery Disease

In a patient with sustained ventricular tachycardia, we obtained two different paced QRS morphologies from a single pacing site. In one QRS morphology the stimulus to the QRS complex was long, 150 msec, and in the other it was 100 msec. At the paced cycle length of 600 msec and the stimulus output of 4 V, one QRS morphology with the stimulus to the onset of QRS activation (St-QRS) interval of 150 msec was observed. At the paced cycle length of 400 msec, the other QRS morphology with a St-QRS interval of 100 msec was observed alternatively with the former. At the paced cycle length of 353 msec or 316 msec, the latter with a shorter St-QRS interval was exclusively observed. When the stimulus output was increased from 4 to 10 V, keeping with the paced cycle length at 400 msec, the St-QRS interval was shortened from 100 to 80 msec. For the two QRS morphologies with two St-QRS intervals, two slowly conducting pathways would be responsible. The site of the block in the faster pathway must be located at the proximity of the pacing site and the conduction at a shorter paced cycle length would be explained by "supernormal conduction."