标准外伤大骨瓣开颅术在重型颅脑损伤中的应用

目的 探讨及评价标准大骨瓣开颅术在交通事故性重型颅脑损伤中的应用价值.方法 采用标准大骨瓣开颅术治疗交通事故后46例重型颅脑损伤患者,对其相关的临床资料进行分析总结,3个月后采用GOS评定治疗效果.结果 随访3个月后,患者恢复良好23例,中残5例,重残或植物生存8例,死亡10例.结论 标准外伤大骨瓣手术是治疗交通事故性重型颅脑损伤的有效方法,它具有操作方便、彻底减压的优点,能明显提高治愈率,减轻后遗症,提高患者生存质量.     

PET-CT在恶性肿瘤诊断中的初步应用

目的探讨PET-CT一体机在恶性肿瘤中的应用价值.方法收集已经明确诊断的全身不同部位的恶性肿瘤病例62例,经PET-CT检查后进行回顾性分析,采用目测和半定量分析方法.结果62例肿瘤病人共检出142个病灶,PET图像阳性率93.55%(58/62);PET图像阴性率6.45%(4/62);PET发现病灶而CT未完全发现病灶率19.4%(12/62);CT发现而PET未见浓聚率6.45%(4/62);原发灶未能找到率1.61%(1/62).标准化摄取值(SUV)大于2.5占78.2%(111/142);SUV2.5～2.0占14.8%(21/142);SUV小于2.0占7%(10/142).结论PET-CT与单纯PET,CT比较具有明显的优势,可以精确定位、定性,但PET-CT也有一定的局限性.     

对执行医学教育标准的思考

医学教育标准是对医学教育质量的规定：本文提出我国医学教育在应用两个国际标准中，应做到全球标准与国情相结合，规范过程的标准和考核结果的标准结合、内部评估与外部认证结合；并指出执行标准应掌握的13个要点。     

固体废物处理和处置设施的选址

新建废物处理和处置设施的选址是一项综合性很强的工作，涉及自然环境，社会政治和经济、安全和技术等诸多方面，选址的主要目标通过一系列的选址技术的步骤来具体体现。     

基于SP的CBL联合TBL教学在重症医学科临床教学中的应用

目的　研究在重症医学科临床教学中应用基于标准化病人（standardized patient,SP）的以案例教学法（case-based learning,CBL）联合以团队为基础（team-based learning,TBL）教学的教学效果。方法　将60名在重症医学科临床学习的医学生分为两组,各30名,分别接受以授课为基础的教学（lecture-based learning,LBL）和基于SP的CBL联合TBL教学。通过对两组学生的临床综合能力进行测评,以及学生对两种教学方法的满意度调查,对教学效果进行评价。采用SPSS 19.0进行卡方检验和t检验。结果　与LBL教学相比,接受基于SP的CBL联合TBL教学的学生的临床综合能力更优（P<0.05）,主要体现在临床思维能力[（4.18±0.55）vs. (3.66±0.47）]、临床技能能力[（4.03±0.61）vs. （3.59±0.52）]及与患者的沟通交流能力[（4.11±0.58）vs. (3.74±0.50）]方面;而且观察组学生对教学方法的满意度也更高（P<0.05）,主要体现在学习兴趣[（4.38±0.72）vs.（3.65±0.56）]、自主学习能力[（4.24±0.71）vs.（3.91±0.52）]、临床思维能力[（4.09±0.66）vs.（3.22±0.54）]、沟通交流能力[（4.42±0.60）vs.（3.67±0.48）]及团队合作精神[（4.15±0.58）vs.（3.78±0.51）]方面。结论　基于SP的CBL联合TBL教学在重症医学科的临床教学中切实可行,具有良好的教学效果。     

The instability of membrane markers expressed by human monocytes and macrophages in culture

Surface markers were tested on freshly isolated human monocytes and following their in vitro maturation to macrophages. The markers tested were HLA-DR antigens, receptors for the Fc of IgG and complement as well as membrane markers defined by monoclonal antibodies. The results revealed a dynamic expression of some of the markers on monocytes which was influenced by several variables. The expression of the markers was modulated by the presence of different sera, by treatment with lymphokines and interferon and following the in vitro maturation of monocytes to macrophages. The most unstable marker was found to be the HLA-DR, which was modulated by all these variables. The 63D3 was affected by different sera and culture supernatant, as well as following the maturation of monocytes to macrophages, but not by lymphokines and interferon. One of the markers, the Mac 120, was found to be relatively stable and did not change significantly following the maturation of monocytes to macrophages. The Fc and complement receptors were also stable in their expression under these conditions, but were probably partially blocked in the presence of human serum. These results indicated that at least some of the heterogeneity related to the monocyte population was probably not due to the occurrence of stable subsets of cells, but rather to reversible changes in marker expression.     

Real-time PCR检测风疹病毒方法学建立及临床应用

为了建立一种能广泛应用于临床快速、简便、灵敏度和特异性较好的风疹病毒(RV)定量诊断方法。针对RV基因保守序列设计两对引物和一条荧光双标记探针。将PCR扩增所得到的产物片段克隆,作为定量检测的标准品,进行Real-time PCR检测,绘制标准曲线。将此方法和ELISA试剂盒平行检测50份孕妇血清,评估两种方法检出阳性率的差异显著性。Real-time PCR法能较好地检出RVcDNA载量。曲线的相关系数(r)为0.998,可检测线性范围大约在103~109copies/μl,灵敏度接近103copies/μl;批间、批内CV值分别为3.36%、0.94%;也有较好的特异性。与经典的ELISA方法相比,有显著性差异。Real-time PCR方法操作简单、快速,并能避免PCR后处理导致的假阳性污染,实现实时定量。此方法对RV感染的临床诊断和疗效判断等方面有较大的指导意义。     

Osteotomy around the knee: Assessment of quality,content and readability of online information

BackgroundAs knee osteotomy surgery becomes increasingly accessible, more patients may turn to the Internet for information. This study examined the source, quality, content and readability of online information regarding osteotomy around the knee.MethodsThe first 70 websites returned by the top four search engines were identified using the key words: “knee osteotomy” and “high tibial osteotomy.” The websites were categorised by type and assessed using the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria and a novel Knee Osteotomy-Specific Score (KOSS). The presence of the Health On the Net (HON) code accreditation seal was noted. Readability of each website was assessed using eight readability formulae. The mean reading grade level (RGL) was compared to the 6th and 8th grade reading levels. The mean RGL of each category was also compared.ResultsOf the 45 unique websites analysed, the majority were Physician (33%) and Journal websites (31%). The mean DISCERN score was 36.7 (±8.9) which is classified as ‘poor.’ The mean JAMA benchmark criteria score was 2.04 (±1.5) and Physician websites were most likely to be scored zero. The mean KOSS was 15.4 (±5.7). The highest scoring website was a Commercial site but, overall, Journal category sites provided the best quality information. Websites that bore the HONcode seal obtained higher DISCERN, JAMA benchmark criteria and Knee Osteotomy - Specific Scores.The cumulative mean RGL was 13.2 (±2.2) which exceeded the 6th grade level by an average of 7.2 grade levels and the 8th grade level by an average of 5.2 grade levels. No website (0%) was written at or below either the 6th or the 8th grade reading levels. The mean Flesch Reading Ease Score of all websites was 41.13 (±14.7) which is classified as ‘difficult.’ Journal websites had the highest RGL.ConclusionThe information available online regarding osteotomy around the knee varies tremendously in quality and completeness. Physician sites predominate, but these were among the lowest scoring of all websites. Even where high quality information is available, it is set at too high a level to be easily understood.Level of evidenceSurvey of materials – Internet.     

所谓抗癫(癎)"中成药"中暗地添加抗癫(癎)西药成分的调查

目的:调查所谓抗癫癎“中成药”制剂中是否有西药成分。方法:对北大医院癫癎门诊1995-2005年口服“中成药”制剂就诊的癫癎患者进行苯巴比妥、苯妥英钠、卡马西平、丙戊酸钠四种药物的血药浓度监测,并对结果进行分析。结果:在所监测的患者服用的76种“中成药”中,暗中都添加了上述4种西药成分,其中含有一种西药成分有45种,含有二种西药成分有22种,含有三种西药成分有7种,含有四种西药成分有2种。有44种中药添加了苯巴比妥,占的比例最大,其余依次为苯妥英钠、卡马西平、丙戊酸钠。结论:在所谓抗癫癎的“中成药”中暗地里加西药已成为较普遍的现象,严重地侵犯了患者的权益,妨碍抗癫癎的正规治疗,损害了患者的健康。     

CORRELATION OF SKIN POTENTIAL AND SKIN RESISTANCE MEASURES

Simultaneous measurements of skin potential (SP) and skin resistance (SR) obtained from 20 male and 20 female adult subjects during 2 sessions held 2 to 9 days apart were used in studying (1) the correlation of change measurements and prestimulus level in the two measures, and (2) the amount of correlation between SP and SR using both simple difference and residual change scores in which the regression of poststimulus values on initial level (prestimulus) has been controlled. Correlations within Ss and correlations among Ss showed large individual variability, correlation differences between males and females, and high correlation between SP and SR change scores. Although the law of initial value (LIV) seemed to have little applicability to the measurement of electrodermal responses, the results underscored the need to control for contamination of change measures by initial level regardless of direction.