数字化虚拟可视技术在骨科的初步应用研究

目的探讨数字化可视技术在骨科建模及应用中的价值。方法①应用“虚拟中国人”（VCH）男性3号数据集，在薄层断面图像上观察膝部及小腿主要解剖结构，应用Amira 3．1软件对膝关节、小腿主要结构进行计算机三维重建并立体显示。②对明胶一氧化铅灌注的新鲜成人下肢标本进行连续CT扫描，观察足背动脉的分布及彼此间的吻合情况，应用Amira 3．1软件对足背皮瓣结构进行计算机三维重建并立体显示；③应用VCH女性1号、男性1号足踝CT扫描图像重建并立体显示其结构。④选取典型骨折患者的CT扫描图像重建并立体显示骨折情况。⑤选择典型胸椎CT连续断层扫描数据集，将断层扫描数据导入Amira3．1软件，三维重建各椎体数字解剖模型，模拟椎弓根的固定情况并立体显示。结果各薄层断面图像上可清楚地显示骨、主要血管、神经的分支和其它结构，重建的数字化模型可准确反映各自的解剖学结构特点。结论重建的图像可以提供骨关节正常三维动态解剖，为皮瓣设计、骨折分类及手术方式的选择提供了更多的解剖学依据，同时为下一步虚拟手术的设计奠定了良好的基础。     

腹部手术患者罗库溴铵不同给药方式肌松效应的比较

目的比较腹部手术患者罗库溴铵靶控输注(TCI)、持续输注(CI)和间断静脉注射(IBI)三种给药方式的肌松效应。方法择期全麻下行腹部手术患者45例,ASAⅠ或Ⅱ级,随机分为TCI组、CI组和IBI组(n=15)。麻醉诱导：三组均静脉注射咪唑安定0．1mg·kg~(-1)、瑞芬太尼1．5μg·kg~(-1)和TCI异丙酚2．5μg·ml~(-1),TCI组以效应室浓度3μg·ml~(-1)TCI罗库澳铵,CI组和IBI组均静脉注射罗库溴铵0．6 mg·kg~(-1)。麻醉维持：三组均维持T_1=5％,TCI组以效应室浓度增减0．1μg·ml~(-1)调控罗库溴铵TCI；CI组以初始速率为600μg·kg~(-1)·h~(-1),每隔5分钟以10％～20％幅度调整输注速率；IBI组间断静脉注射0．15mg·kg~(-1)。结果在肌松监测指导下,TCI组和CI组均可维持T_1=5％的肌松深度,TCI组效应室浓度呈下调趋势,CI组可达到稳态输注,调控次数高于TCI组,IBI组每间隔(27±7)min给药一次,每次间隔时间相似。TCI组罗库溴铵麻醉诱导用量多于CI组和IBI组(P＜0．05),三组维持用量差异无统计学意义。TCI组罗库溴铵诱导起效时间长于CI组和IBI组(P＜0．01)。恢复时间TCI组和CI组相似,短于IBI组(P＜0．01),但三组罗库溴铵的恢复指数差异无统计学意义。结论TCI罗库溴铵延长了起效时间,不适于麻醉诱导；但其肌松效应稳定,停止输注后恢复较快,适于麻醉维持。     

微创内固定系统治疗复杂股骨转子部骨折的初步报告

目的探讨微创内固定系统(LISS)治疗复杂股骨转子部骨折的可行性、手术技术及指征,并总结其近期临床治疗效果。方法自2005年6月～2006年5月,应用LISS治疗复杂股骨转子部骨折12例。骨折采用AO分类法,其中转子间骨折5例：31-A2．2型2例,31-A2．3型2例,31-A3．3型1例；转子下骨折7例：32-A3．1型1例,32-B1．1型3例,32-B2．1型1例,32-B3．1型2例。记录手术时间、术中出血量、术后住院时间,术后观察有无感染、下肢深静脉血栓、心肺疾患、应激性溃疡等并发症。术后1、2、3、6、12个月时常规随访。结果手术时间50～90 min,平均65 min；出血量50～400 mL,平均142 mL,术后住院时间6～15 d,平均9．3 d。无死亡病例。所有患者均未出现切口感染、下肢深静脉血栓、术后心肺疾患、应激性溃疡等并发症。12例均获得3～14个月(平均7．2个月)随访。10例在术后3个月复查骨折时达到临床愈合,1例假体周围骨折术后4个月、1例病理性骨折术后6个月达到临床愈合。所有患者在最后一次随访时均无骨折再移位、髋内翻畸形、内固定切出、内固定失败及股骨头坏死。结论微创反向使用股骨LISS从生物力学和解剖结构上都能满足股骨近端骨折内固定要求,并具有创伤小、操作简便、固定可靠、安全性高、并发症少的特点,尤其适用于老年人合并内科疾病、骨质疏松较重的转子间骨折及复杂的股骨近端骨折。熟练掌握间接复位技术,正确放置A孔导针,避免过早负重是手术成功的关键。     

多层界面液膜的研究

经过对多层界面液膜的实验探索,获得了四相物系双层界面液膜和五相物系三层界面液膜等一系列多层界面液膜。并且提出了多层界面液膜自动形成的一般式,由此,展示了多层界面液膜的广阔领域。其中每一种多层界面液膜在应用上都将有其广泛的发展前景。     

Analysis of the Ki-67 antigen at the invasive tumour front of human oral squamous cell carcinoma

BACKGROUND: It is hypothesised that cell proliferation, as measured by the Ki-67 labelling index (LI) at the invasive tumour front (ITF) was directly related to the histological grade in human oral squamous cell carcinomas (SCCs). METHODS: Tissues from 42 human oral SCCs were collected and stained with an antibody directed against the Ki-67 antigen using an advanced polymer staining system. Quantitation of the immunopositive cells was performed on two parallel sections at the invasive tumour front (ITF), using an image analyser. The Ki-67 LI was expressed as the number of positive nuclei/mm2 of epithelium. The control tissue used was normal epithelium at the excision margin. RESULTS: The mean Ki-67 LI for oral SCCs at the ITF was significantly greater than that for the excision margin tissue (P < 0.0001). There was a positive association between increasing Ki-67 LI and increasing Broders' grade (P < 0.05), with a well-differentiated tumour having the lowest mean Ki-67 LI (1549 +/- 806) and a poorly differentiated tumour having the highest value (2232 +/- 771). A similar trend was observed between the mean Ki-67 LI and Bryne's multifactorial grading system. CONCLUSIONS: It was concluded from this study that cell proliferation (as measured by the Ki-67 antigen) at the ITF had a strong positive relationship with histological grading in human oral SCC.     

DNA typing in cases of blood chimerism

A chimera is an organism whose cells derive from two or more distinct zygote lineages. and therefore two different blood cell populations circulate in one individual. To point out the potential pitfalls in forensic analysis, a set of triplets (a girl and two boys) who revealed blood chimerism was investigated with four STR systems using PCR. The results indicated that a DNA profile based on DNA extracted from blood can lead to a false determination because the band pattern of each triplet contained a mixture of the original genotype and the genotype of the siblings. Additional investigations on biological materials other than blood must be made in order to find out the real genetic characteristics of each child. Received: 17 July 1998 / Received in revised form: 27 November 1998     

Two Types of Health Care Systems and Their Influence on the Introduction of Perinatal Care: An Epidemiological Twin Model in Berlin from 1950 to 1990

Objectives: When perinatal medicine emerged as a new medical discipline in the 1960s, Berlin was as one of the world's leading centers. During that time, the city was separated into two parts, each fostering its own health care system. After the destruction of the Berlin Wall, it was possible to speak with the citizens of East Berlin and to access their database systems. This created the singular opportunity to objectively compare the development of perinatal care in both parts of Berlin. Methods: Rates of maternal, perinatal, and infant mortality as well as the rate of preterm deliveries were evaluated over time and between East and West Berlin. The timing of introduction of 20 specific perinatal interventions was evaluated across 18 hospitals with more than 500 deliveries (11 in West Berlin and 7 in East Berlin). Interviews were conducted with 100 gynecologists, 100 midwives, and 100 women who had recently delivered their first child from each side of the city regarding their opinions of the importance of these interventions for the quality of perinatal medicine and how they would distribute a budget to improve maternity care. Results: Maternal, perinatal, and infant mortality decreased in both parts of Berlin until 1990 (p<0.0001), without significant differences between East and West Berlin, though the preterm delivery rate was slightly lower in East Berlin compared with West Berlin (p<0.06). Some new clinical techniques and treatments—such as cardiotocography, ultrasound, tocolytic therapy, and peridural anesthesia—were introduced earlier in West Berlin. In contrast, certain public health measures—such as maternal transport, screening programs for diabetes, and support of breastfeeding—were introduced much earlier in East Berlin. There were significant differences between the beliefs of gynecologists, midwives, and mothers in East and West Berlin. In general, citizens of East Berlin were more enthusiastic about technological medical advances, whereas citizens of West Berlin were more supportive of public health and alternative methods. In addition, there were significant differences between female and male physicians in their beliefs about how to improve health care, regardless of whether they resided in East or West Berlin. Conclusions: The results of this study may serve as a basis for reflection on how different social circumstances and health care policies can influence the improvement of maternal and child health care.     

Public health services in Bangladesh with special reference to systems and trends of vital statistics

Health is one of the basic requirements for improvement in the quality of life. Since Bangladesh became independent, a policy for providing essential minimum health care to all has been actively pursued. An overview of Public Health Services in Bangladesh is presented in terms of: (1) a profile of the country, (2) an overview of public health, (3) medical care, and (4) environmental health. Under each of these headings observations are included on recent trends based upon relevant data and information. Finally the authors describe the importance of (1) promotion of health care and planning at the national, divisional, local, and community levels, (2) promotion of medical services at all levels, and (3) effective decentralization of health services to enhance the services of health facilities.     

医院制剂管理的文件系统

目的：为医院制剂达到ＧＭＰ要求提供参考建议。方法：分标准和记录两部分论述医院制剂管理文件系统。结果和结论：医院制剂室定应参照ＧＭＰ的要求,结合自己的特点和生产实际来制定“软件系统”。“软件系统”以人员、物料、设备、生产、质量等管理的文件系统为核心,是可以通过主观努力达到较高水准的。     

Solid-State Characteristics of Amorphous Sodium Indomethacin Relative to Its Free Acid

Purpose. Having previously studied the amorphous properties of indomethacin (IN) as a model compound for drugs rendered amorphous during processing, we report on the formation and characterization of its sodium salt in the amorphous state and a comparison between the two systems. Methods. Sodium indomethacin (SI) was subjected to lyophilization from aqueous solution, rapid precipitation from methanol solution, and dehydration followed by grinding to produce, in each case, a completely amorphous form. The amorphous form of SI was analyzed using DSC, XRD, thermomicroscopy and FTIR. The method of scanning rate dependence of the glass transition temperature, Tg, was used to estimate the fragility of the SI system. Enthalpy relaxation experiments were carried out to probe the molecular mobility of the SI system below Tg. Results. The amorphous form of SI formed by different methods had a Tg equal to 121°C at a scanning rate of 20°C/min. This compares with a Tgfor indomethacin of 45°C. Estimation of fragility by the scanning rate dependence of Tg indicates no significant differences in fragility between ionized and unionized forms. Enthalpy relaxation measurements reveal very similar relaxation patterns between the two systems at the same degree of supercooling relative to their respective Tg values. Conclusions. The amorphous form of SI made by various methods has a Tg that is about 75°C greater than that of IN, most likely because of the greater density and hence lower free volume of SI. Yet, the change of molecular mobility as a function of temperature relative to Tgis not very different between the ionized and unionized systems.