超声造影规范化护理专家共识

为了实现超声对比剂（也称超声造影剂）高效、合理、安全、规范化输注，国内相关医护专家总结了国内外文献证据及临床经验，按照循证医学原则充分讨论后，制订了该共识，旨在为我国超声对比剂安全输注的规范化和标准化提供参考意见。共识介绍了超声对比剂的应用现状和安全性、相关法规与流程，造影前、中、后的规范化护理，并提出16条推荐意见。提出目前国内批准上市使用的超声对比剂安全性高，建议医护人员根据最新说明书或专家共识进行配药和给药，并从造影室管理、风险预案、人员资质等方面予以规范。     

Prevalence of human papillomavirus in esophageal carcinoma in Tangshan,China

AIM:to study the prevalence of human papillomavirus(HPV) in esophageal carcinoma in tangshan,China,a high-incidence area.METHODS:Formalin-fixed,paraffin-embedded tissue specimens from 198 patients who were pathologically diagnosed with esophageal squamous cell carcinoma from 2011 to 2013 were obtained from a pathology department in Tangshan.DNA was extracted from all198 specimens to detect HPV by polymerase chain reaction(PCR).β-globin PCR was performed to check the quality of the DNA extraction procedure.PCR was performed to detect a wide range of HPV types,and type-specific PCR was performed to detect HPV types16 and 18.Negative and positive controls were used for HPV 16 and 18 detection.RESULTS:the DNA extraction method in this study appeared to be more effective than other previously reported methods.After DNA extraction,more than98%of the tissue specimens had an acceptable result in the DNA qualification test(β-globin PCR).the overall prevalence of HPV in tumor tissues by GP6+/GP5+PCR was 79.79%,and the prevalence of HPV types16 and 18 was 40.40%and 47.47%,respectively.PCR demonstrated the presence of HPV,and direct sequencing confirmed the HPV genotypes.All HPVpositive PCR products were checked by DNA sequence analysis using DNAman and compared with the known HPV sequences listed in the basic Local Alignment Search tool database to evaluate the HPV types.this analysis confirmed the presence of HPV types 16 and18.CONCLUSION:DNA of high-risk HPV types 16 and 18is present in esophageal tumors,implicating HPV as a possible etiologic factor for esophageal squamous cell carcinoma.     

“Baby Heart Project”: The Italian Project for Accreditation and Quality Management in Pediatric Cardiology and Cardiac Surgery

Optimization of the relationship between the supply and the demand for medical services should ideally be taken into consideration for the planning within each national Health System. Although government national health organizations embrace this policy specifically, the contribution of expert committees (under the scientific societies’ guarantee in any specific medical field) should be advocated for their capability to collect and analyze the data reported by the various national institutions. In addition, these committees have the competence to analyze the need for the resources necessary to the operation of these centers. The field of pediatric cardiology and cardiac surgery may represent a model of clinical governance of particular interest with regard to programming and to a definition of the quality standards that may be extended to highly specialized institutions and ideally to the entire Health System. The “Baby Heart Project,” which represents a model of governance and clinical quality in the field of pediatric cardiology and cardiac surgery, was born from the spontaneous aggregation of a committee of experts, supported by duly appointed Italian Scientific Societies and guided by a national agency for accreditation. The ultimate aim is to standardize both procedures and results for future planning within the national Health System.     

颞下颌关节曲面体层的投照技术及临床应用

30例TMD患者同时拍摄颞下颌关节曲面体层片及髁状突经咽侧位片.结果显示:TMJ曲面体层摄影术显示髁状突骨质改变优于经咽侧位且投照技术容易掌握,作者建议使用TMJ曲面体层摄影术观察TMD患者的髁状突骨质改变.     

X线全颌曲面断层片与X线头颅侧位片相关性的研究

目的：研究X线全颌曲面断层片与头颅侧位片上对应的垂直向角度及线距是否具有相关性。方法：随机选取49名患者同期拍摄的X线全颌曲面断层片与头颅侧位片，测量每位患者两张X线片上对应的垂直向角度及线距，对测量结果进行统计分析。结果：X线全颌曲面断层片与头颅侧位片上的FH-MP角(下颌平面角)Go-FH距对Me-FH距比值呈高度线性相关；FH-PP角、FH-OP角(He平面角)呈弱相关，X线全颌曲面断层片上Go-FH对Me-FH距的比值与头颅侧位片上的Co-S距对Me-N距的比值(前后面高比)呈高度线性相关。结论：可通过X线全颌曲面断层片对垂直骨面型进行诊断。     

下颌骨骨折动力加压固定断面应力分析

实验采用反射光弹模拟应力分析法,通过受力模型等差线条纹图观测、分析、量化换算,对下颌骨骨折轴向和偏心动力加压固定作断面压应力比较研究.结果显示两种固定状态下骨折断面均表现为挤压应力,沿骨折线应力分布不均匀,板周区和牙槽区呈压应力高峰带,最大应力分量在轴向和偏心加压分别为1.8MPa和2.3MPa(板周区),以及0.5MPa和1.0MPa(牙槽区),中间区受力较弱.轴向动力加压总压力为100N,偏心动力加压总压力为140N,后者比前者断面应力分布稍趋合理.     

影响老年心血管病患者开髓治疗危险性的多因素分析

目的探讨老年心血管疾病患者开髓治疗过程中的潜在危险性及影响因素。方法对235例老年心血管疾病患者心电监护下开髓治疗的资料，按治疗时心率和血压的波动、心电图缺血性改变、心律失常的发生或加剧作为潜在的危险因素(y1～y5)及患者的年龄、性别、心血管病的种类、心功能、治疗时精神状态、麻醉效果6个自变量(x1～)x6)，应用电子计算机行多元逐步回归及logistic回归分析。结果老年心血在管疾病患者开髓治疗时潜在危险的影响因素依次为：治疗时精神紧张、麻醉效果差、心脏病种类、心功能、年龄、性别。结论通过对老年心血管疾病患者开髓治疗时潜在危险性影响因素的分析，指导临床采取有效的安全措施。     

下颌骨缺损自体骨移植术后种植床软组织条件的评估与准备

目的：对下颌骨缺损自体骨移植术后种植床软组织进行评估并外科修整。方法：对11例非血管髂骨移植和12例血管化腓骨瓣移植患者进行植骨床牙槽突软组织评估。其中4／23例Ⅱ期植入种植体，并于植入术后4-6月行腭粘膜移植术。结果：自体骨移植术后牙槽突软组织均活动游离，厚度不一，前庭沟和颌舌沟变浅。4例腭粘膜移植术后形成适宜厚度的理想附着龈。结论：下颌骨缺损自体骨移植术后种植床坎组织均需行外科修整。腭粘膜移植术是一种理想方法。     

腭隐裂患者头颅侧位X线片测量分析

目的　应用回顾性研究的方法对 50例腭隐裂患者X线片测量并与健康对照组对比分析 ,观察软腭在形态学、运动能力以及腭帆提肌附着位置等方面的特点 ,进一步研究腭隐裂患者腭咽闭合不全的原因 ,为其诊断提供依据。方法　腭隐裂患者 50例 (年龄 4～ 51岁 ,平均年龄 1 1 9岁 ,男性 2 0例 ,女性 30例 ,男∶女 =1∶1 5)。对术前头颅侧位定位X线片共 1 0 0张 (每例静止及发“i”音各 1张 )进行测量分析。结果　腭隐裂组的软腭相对长度较对照组短 ,患者的腭帆提肌附着点相对位置比对照组靠前 ,发音时软腭抬高角度较小 ,以上 3项指标经统计学分析 ,差异有显著性 (P <0 0 5)。两组间硬腭相对长度和发音时软腭伸长量的比较差异无显著性 (P >0 0 5)。结论　通过测量所得指标(包括软腭相对长度、腭帆提肌附着位置及发音时软腭抬高角度 )是诊断腭隐裂的重要指标