银杏内酯B柔性纳米脂质体的制备及体外透皮研究

目的：制备银杏内酯B(GB)柔性纳米脂质体，并对其体外透皮规律进行研究。方法：采用薄膜分散法制备银杏内酯B柔性纳米脂质体，并对其形态及粒径大小进行分析；采用改良的 Franz 扩散池进行体外透皮吸收试验，比较银杏内酯B醇溶液、银杏内酯B柔性纳米脂质体及普通银杏内酯B纳米脂质体的经皮累积渗透量及渗透速率。结果：此方法制得的脂质体平均包封率为(89.52±1.76)%，平均粒径为(208.3±25.49) nm，Zata电位为-49.2 mV。柔性纳米脂质体8 h的累积透过量为189.97 μg·cm^-2，8 h的渗透速率为23.75 μg·cm^-2·h^-1。结论：柔性纳米脂质体包封率较高，稳定性良好，可显著促进银杏内酯B的透皮吸收。     

弹性义齿修复的临床效果观察

目的：了解弹性义齿修复的临床效果，为临床应用提供参考。方法：152例门诊缺牙患者，制作弹性义齿修复体188件，上颌130件，下颌58件。Kennedy一类缺损修复6件，Kennedy二类缺损修复4件，Kennedy三类缺损修复102件，Kennedy四类缺损修复76件。通过1－4年的观察，从形态和功能、固定和稳定、颜色和美观以及对组织保健判断对义齿的满意程度，并进行临床效果评价。结果：79例95件弹性义齿具有良好的美观效果，颜色满意，感觉舒适，满意和较满意率达100％，Kennedy三、四类缺损修复率为94．74％。弹性义齿对Kennedy一类缺损修复的满意和比较满意率为66．67％；对Kennedy二类缺损修复的满意和比较满意率为50．00％；对Kennedy三类缺损修复的满意和比较满意率为96．15％；对Kennedy四类缺损修复的满意和比较满意率为84．21％。结论：(1)弹性义齿是一种美观、舒适、对基牙预备甚少的可摘局部义齿修复形式。（2）弹性义齿较适合咀嚼压力小而缺牙数目不多的前牙和前磨牙缺失的修复。     

吸氧对纤维支气管镜检查患者相关血气指标的干预和影响

目的:了解中等浓度吸氧在纤维支气管镜(FB)检查中的安全性和价值。方法:在行FB检查人群中随机选择25例，分别观察FB置人气道(置镜)前后及中等浓度吸氧前后患动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)和血氧饱和度(SpO2)的变化。结果:置镜使患SpO2和Pa02有显下降(P＜0．001)，而PaCO2差异无显性(P＞0．05)。接着吸氧5L／min后，Sp02和PaO2与置镜后比较，有明显提高(P＜0．001)，而PaCO2变化无统计学意义(P＞0．05)。l3例患置镜前和吸氧后PaO2及SpO2比较，差异均具明显显性(P＜0．01)，而PaCO2无明显变化(P＞0.05)。结论:吸中等浓度氧对普通行FB检查的患是安全的，可完全补偿因FB置入所引起的PaO2下降，而对PaCO2影响很小，对于有原发PaCO2升高的患，安全性尚有待进一步研究。     

Inadvertent removal of foreign body via a flexible fiberoptic bronchoscope in a 4-year-old boy

We report the case of a 4-year-old child with an atypical presentation of an aspirated unwitnessed foreign body in the airway. During an attempt to obtain a biopsy of what appeared to be a mucosal growth, the foreign body was removed. This may be the first report of foreign body removal in a child this young, using a flexible fiberoptic bronchoscope. Pediatr Pulmonol. 1994; 18:51–52. © 1994 Wiley-Liss. Inc.     

输尿管镜技术治疗梗阻性急性肾功能衰竭(附13例报告)

目的探讨输尿管镜技术在治疗急性梗阻性肾功能衰竭的应用。方法在输尿管镜直视下置DJ管治疗由结石、血块及晚期盆腔肿瘤引起的急性梗阻性肾功能衰竭13例。结果术后2-7d肾功能恢复正常，无术后并发症。血肌酐和尿素氮均在正常范围，尿量正常。结论应用榆尿管镜技术治疗急性梗阻性肾功能衰竭是一种安全、有效、微创的方法。     

3种微创手术治疗复杂性输尿管上段结石的疗效比较

目的比较经尿道输尿管镜钬激光碎石(URSL)联合体外冲击波碎石(ESWL)、微创经皮肾镜取石(mini-PCNL)、后腹腔镜输尿管切开取石术(RLU)治疗复杂性输尿管上段结石的疗效。方法153例复杂性输尿管上段结石患者按治疗方法分为三组:URSL联合ESWL(联合组)治疗60例,mini-PCNL治疗65例,RLU治疗28例。结果联合组有5例转开放手术取石,余50例患者平均手术时间(65.45±16.39)min,术后并发症发生率为23.64%(13/55),1个月后结石清除率为90.91%(50/55)。mini-PCNL组无中转,平均手术时间(50.38±12.91)min,术后并发症发生率为9.23%(6/65),1个月后结石清除率为100%。RLU组有2例转开放取石,平均手术时间(81.73±17.89)min,术后并发症发生率为15.38%(4/26),1个月后结石清除率为100%(26/26)。mini-PCNL组的手术时间、术后住院时间均显著短于联合组和RLU组;并发症发生率明显低于联合组;1个月后结石清除率明显高于联合组。结论mini-PCNL治疗复杂性输尿管上段结石具有手术时间短、结石清除率高、术后并发症少、恢复快的优点。     

Eigenstructure assignment with control gains optimization

Eigenstructure assignment using output feedback is reformulated using an auxiliary principle of minimization of control effort. In the general eigenstructure assignment procedure, the feedback gain matrix is uniquely determined for a set of explicitly specified desired eigenvalues and eigenvectors. However, for the controller design proposed in this paper, only the most necessary constraints are imposed on the desired eigenvalues and eigenvectors, and the unspecified model parameters of the closed-loop system are determined by minimizing the control effort. Numerical examples are presented for comparison of the proposed method with standard eigenstructure assignment methods, and an experimental example gives an insight into the feasibility of the proposed control algorithm with application to the vibration control of flexible structures undergoing forced vibration.     

COLONOSCOPY: HOW FAR IS ENOUGH?

Total colonoscopy is arguably the best method available for examination of the colon and rectum. Colonoscopy costs are high and rising and it may be that in the future practitioners will be unable to afford to colonoscope all of the patients presently being examined. This retrospective study was undertaken in an attempt to examine the cost, in terms of lesions missed, of a limited endoscopy programme. During a 15 year period, 1426 colonoscopies were performed at Wellington Hospital, New Zealand. Total colonoscopy was possible in 79% of all patients. Three perforations occurred. Nine patients bled and two required blood transfusion after biopsy or ‘snaring’ of polyps. After exclusion of patients with continuous inflammatory bowel disease (IBD) 75% of all lesions were found in or distal to the descending colon. More cancers were found in patients colonoscoped because of bleeding. Thirty-two of 93 cancers diagnosed were proximal to the descending colon but 18 presented with bleeding. A further seven had a radiological abnormality. Only 7.5% of colorectal cancers would be missed by flexible sigmoidoscopy (65 cm) and 758 of the costs of total colonoscopy would be avoided if only patients presenting with bleeding and IBD were offered total colonoscopy and patients with radiological abnormalities were treated according to the abnormality. This compromise, based on the data presented, may represent a rational way to reduce colonoscopy costs.     

Effectiveness and cost-effectiveness of colorectal cancer screening: Selecting the ideal strategy

Abstract Colorectal cancer is the second most common cancer killer of Americans. Recently developed and tested methods of screening and surveillance can effectively diagnose and treat the disease in most patients before symptoms develop when the chance of cure is high. It is also possible to prevent colorectal cancer by detecting and resecting premalignant adenomatous polyps. Evidence-based guidelines recommend that the average-risk population greater than age 50 be screened with annual faecal occult blood tests plus periodic flexible sigmoidoscopy. This approach is feasible, efficacious, affordable and cost-effective in a high-risk country such as the US. Widespread compliance with these recommendations could reduce the mortality from this malignancy by more than 50%.