循证护理在糖尿病皮肤损害临床实践中的应用

目的　应用循证护理 (EBN) ,探索糖尿病皮肤损害有效干预方法 ,减少残疾及死亡率 ,提高病人生活质量。方法　通过临床评估确定护理诊断 ,查阅文献 ,选择最佳护理证据 ,制定护理干预措施。结果　通过治疗及护理干预 ,2 2例糖尿病患者皮肤损害 ,显效 2 1例 ,有效 1例 ,转科 1例 ,出院时患者无并发症。结论　循证护理应用于临床 ,使传统护理经验走向护理科学发展 ;促进护士主动学习 ,提高护士综合素质 ;优质护理服务于个体化 ;解决患者现存的、潜在的护理问题 ,提高患者生存质量。     

电子对生物分子DNA损伤可能性的分析

目的研究电子在人体组织等效材料中形成的“簇点”能量分布情况，以及簇点的产生对生物效应发生的意义。方法针对电子与人体组织等效介质作用的物理机理，利用蒙特卡罗(MC)方法，按一个个相互作用事件(电离、激发、弹性散射、Auger电子发射)方式真实模拟电子在介质中的径迹，通过对这些事件进行统计分析，得到相关结论。结果电子在穿过介质过程中，主要以簇点(大于30％)形式沉积能量，并且80％以上的簇点中的能量沉积在50eV以上；簇点的密集程度与电子能量、簇点直径密切相关，簇点中能量沉积也取决于辐射类型和能量。结论簇点中的能量沉积是诱发组织细胞核内DNA分子各种损伤的最主要因素。     

Stenting of coronary bifurcation lesions by using modified crush technique with double kissing balloon inflation (sleeve technique): immediate procedure result and short-term clinical outcomes.

BACKGROUND: Sleeve technique is a modified version of crush technique. It is specifically designed to increase the success rate of final kissing balloon inflation, which used to be a major limitation of the latter. OBJECTIVES: The aim of this study was to examine the feasibility, safety, and early clinical outcomes of sleeve technique in stenting different types (de novo, in-stent restenotic or in-stent bifurcation) of coronary bifurcation lesions at different locations. METHODS: From August 2005 to May 2006, 41 consecutive patients with symptomatic, nonleft-main coronary bifurcation stenoses of diameter narrowing >or=50% were treated with two-stent strategy, using sleeve technique. RESULTS: The mean age was 63.6 +/- 11.6 years with male predominance (70.7%). High prevalence of diabetes mellitus (31.7%), total occlusion (22.0%), and multi-vessel disease (65.9%) was observed in this cohort. Intravenous abciximab was given in 35 (85.4%) patients. Final kissing balloon inflation was successfully performed in all patients. The minimal luminal diameter in main vessel and side branch was increased from 0.97 +/- 0.53 mm and 0.81 +/- 0.45 mm to 2.76 +/- 0.34 mm and 2.22 +/- 0.35 mm, respectively. The mean procedure time was only 66.6 +/- 24.6 min. There was one (2.4%) case of subacute stent thrombosis presented as non-Q-wave myocardial infarction at day 3 postprocedure. The resultant in-hospital and 30-day major adverse cardiac event rate were both 2.4%. CONCLUSIONS: Sleeve technique is a feasible and efficient approach in stenting of coronary bifurcation stenoses.     

Possible injury to the branches of the peroneal nerve during fibular osteotomies

Conclusions The peroneal nerves and their blood supply are at risk during high tibial osteotomies. Fixation of nerves by fibrous tissues, compression by tendinous arcades of the peroneus longus tendon, and narrow passages for nerves crossing dense fibrous septa are all factors which favor the development of peroneal nerve lesions. Intraoperative soft tissue retraction and pull by retractors may damage nerves and vessels. The muscle branch for the extensor hallucis longus muscle is particularly at risk during the fibular osteotomy since it runs directly on the bone.     

高原环境下大鼠对硒制剂耐受力的实验研究

本实验将大鼠从上海空运至兰州，很快转至高海拔地区，用光镜及电镜观察了亚硒酸钠对大鼠的影响。结果发现在高原环境下大鼠对硒的耐受力减低，引起了大鼠猝死半加得高原缺氧对心肌的损伤，降低了大鼠高原适应性。本文还对其耐受机理进行了初步讨论。     

Diagnosing intramuscular myxoma by fine-needle aspiration: A multidisciplinary approach

The gross and microscopic appearances of aspirates from ten intramuscular myxomas are reported. The specimens were obtained from seven women and three men, ages 43 to 75, who had tumors involving the muscles of the thigh (7), upper arm (2), and forearm (1). Magnetic resonance (MR) imaging performed in six of the ten cases revealed well-defined, sharply demarcated tumors exhibiting low signal intensity relative to muscle on the T1-weighted images. The tumors were hyperintense to muscle on T2-weighted images. All aspirated tissues were clear, tenacious, and viscous. Smears contained few spindled and histiocytoid cells in an abundant mucoid background. Spindle cells demonstrated long cytoplasmic processes that in areas intertwined to form fibrillar tangles. Nuclei were oval to spindled with fine chromatin and inconspicuous nucleoli. Capillaries were sparse with simple (nonplexiform) branching. The differential diagnosis of myxoid lesions of the extremities includes benign entities such as myxoid schwannoma and neurofibroma, mesenchymal repair, and ganglion cyst, as well as malignant neoplasms such as myxoid liposarcoma, fibrosarcoma, malignant fibrous histiocytoma, and extraskeletal chondrosarcoma. The findings of this study revealed that, although the cytologic features were suggestive of intramuscular myxoma, a definitive diagnosis was often difficult, owing to scant cellularity and lack of distinctive cytologic features. The MR imaging findings may be utilized as an adjunct to the cytologic features to more confidently suggest a diagnosis of intramuscular myxoma. Diagn Cytopathol 1994;11:255–261. © 1994 Wiley-Liss, Inc.     

MAGNETIC RESONANCE IMAGING IN POSTERIOR CIRCULATION INFARCTION: IMPACT ON DIAGNOSIS AND MANAGEMENT

To compare the diagnostic yield of magnetic resonance imaging (MRI) with computed tomography (CT) in posterior circulation infarction, we used proton MRI with a 0.3 Tesla magnet and a 3rd generation CT scanner in 25 patients. Age-matched controls were compared in a blinded fashion. Seventeen patients (68%) showed relevant pathology on MRI not seen on CT, 11 with normal CT and six with more extensive lesions, chiefly in the brain stem. Evidence of abnormal vertebrobasilar blood flow was seen in 8/25 (32%) of patients, suggested by vascular high intensity signals on MRI. Two tissue and one flow abnormality were seen in the control group. MRI provides additional information concerning infarct site, extent and pathogenesis in posterior circulation infarction.     

Gadolinium ring enhancement and mass effect in acute disseminated encephalomyelitis

A 9-year-old boy presented with a subacute history of optic neuritis followed by brainstem involvement, with fever and a lymphocytic pleocytosis in the cerebrospinal fluid. Gadolinium-enhancing ring lesions were demonstrate in the white matter of the cerebrum, brainstem and cerebellum on day 17 of the illness, all appearing simultaneously as part of a monophasic illness. A parietal lesion exerted mass effect. Needling and biopsy yielded no evidence of a pyogenic lesion, tumour or tuberculosis and showed vasculitis. There was insufficient material for myelin staining. Dexamethasone therapy lead to rapid improvement of the radiological lesions: MRI and CT on day 34 of the illness showed complete clearing of the lesions except for residual abnormality at the biopsy site.     

Soluble Fcγ receptors in periodontal lesions

Soluble Fcγ-binding components were detected in gingival fluid from periodontal lesions by incubation with biotinylated human Fcγ fragments. FcγIII receptor was identified by incubation of gingival fluid with monoclonal antibody. Sodium dodecyl sulfate-polyacrylamide gel electophoresis and Western transfer showed that most of the Fcγ-binding components had minimal mobility in a 4–15% gradient gel under nonreducing conditions. Under reducing conditions, the main band of Fcγ-binding components in gingival fluid migrated corresponding to protein A of 49 kDa. The pattern of Fcγ-binding components was similar in serum and gingival fluid except for the observation in gingival fluid of Fcγ-binding components migrating like standard proteins of 19 to 20 kDa, a size that corresponds to the polypeptide part of FcγII receptor and FcγIII receptor.     

视交叉后损害的临床与图形视觉诱发电位分析

图形视觉诱发电位(P—VEP)是眼接受图形的刺激时,视路及大脑皮质枕区所产生的一系列电位变化。在视交叉后病变的诊断,病情估计及预后推测中有比较肯定的价值。 本文对17例视交叉后损害的病人进行分析。发现视交叉后病变以视皮质损害为主,表现为视物模糊,视力下降,视野改变。P—VEP检查的异常率与病变部位大小及病变性质有关。同时检查半视野刺激有助于提高阳性率。