47,XY,+22和46,XX,-21,ter rea(21;21)两例染色体异常

例1男，2个月，因“新生儿败血症，26小时无大小便”入院。患儿系第2胎，42周孕，因羊水少行剖腹产，否认窒息抢救史。查体：体温38．5℃，脉搏130次／分，呼吸60次／分。神清，小头，下颌内收，面部怪异。皮肤中度黄染，双眼内眦可见红斑及赘皮，斜视，口唇微绀，腭弓高拱。双耳位低，耳前赘生物，两肺呼吸音粗，心前区可闻及Ⅲ Sm杂音，脐周红，无物分泌。小阴茎，右侧未触及睾丸，右手肘外翻，肌张力低下，双手通贯掌。     

巨细胞病毒肝炎患儿一例

病例：患儿，女，13岁，患儿平素身体健康，发热7天，体温39℃左右，发热3天后出现腹痛，巩膜黄染，在当地医院未确定诊断来我院．查体精神不振，巩膜轻度黄染，咽部红肿，浅表淋巴结不肿大，心率80次／min，心音有力，双肺呼吸音清，腹软：肝左肋下2．0cm，脾未及，皮肤未见有皮疹及出血点，神经系统检查脑膜刺激症阴性，病理反射未引出射出．     

脑面部血管瘤病1例报告

病例：患儿，女，6月，主因间断抽搐1天，于2007—06—29来我院就诊。患儿于2007—03—29无明显诱因出现抽搐，表现为双眼向左斜视，口角向左歪斜，左侧肢体抽动，右侧肢体无抽动，意识尚清晰，无口周青紫，无二便失禁，抽搐持续2～3min后自行缓解，共间断抽搐5次，无发热，无呕吐、腹泻，未治疗即来我院就诊，门诊以“癫痫”收住我科。患儿发病以来，精神不振，饮食、睡眠尚可，大小便正常。患儿为足月顺产，无外伤及手术史。入院时查体：体温36．8℃，体格发育正常，意识清晰，前囟平坦，张力正常，右侧面部可见大片状血管痣，无隆起于皮肤，呈紫红色，压可褪色，其余皮肤处未见血管痣，颈软无抵抗，心肺腹及神经系统无阳性体征。     

地震救护专业知识（三）

1出血：小出血，不可怕，可包扎；大出血，先压迫，再结扎；休克者，先输血，再转运。 2颅脑损伤：清口腔，头偏侧，防窒息；鼻出血，勿填塞，免感染；勤观察，先神志，再体征。 3颈髓损伤：颈髓伤，必固定，勿摆动。     

血液透析治愈鱼胆中毒引起急性肾功能衰竭一例

患者，男性，28岁。因“乏力、纳差伴呕吐、尿黄5d”入院。患者于5d前食入一颗鱼胆，约3h后出现恶心，呕吐，腹痛，解黄色稀水便，继之出现尿黄，尿少，在当地医院拟胆囊炎治疗效果不好。查体：体温37．3℃，脉搏102次／min，呼吸20次/min,血压100／70mmHg，神志清，精神萎，面色黄，全身皮肤有黄染，巩膜有黄染，双肺呼吸音清晰，心率102次／min，心律齐。腹平软，肝肋下1．0cm，剑突下2．50m，质I°表面光滑，边钝，肝区叩痛明显，     

儿童嗜酸性粒细胞增多症合并哮喘一例报告

病例：患儿，男，9岁，因“发热，咳嗽3天”，于当地医院查外周血白细胞43．74×10^9／L，门诊以“败血症？”收入院，入院后查体：精神不振，体温38．5^℃，咽红肿，双肺可闻及大量干湿性哕音，以哮呜音和中小水泡音为多见，心音有力，节律规整，心率96次／分，腹软，肝脾不大，全身皮肤未见有黄染及皮疹，浅表淋巴结未触及肿大，神经系统未见著征。     

小婴儿心肌酶异常增高1例

1临床资料 患儿女，3个月。主因腹泻3d，发热2d入院，患儿于3天前出现腹泻，7—8次／d，为蛋花汤样便，量中，无粘液及脓血，发热，体温最高40℃，呕吐3次胃内容物，呈非喷射状，量少。静滴”头孢噻肟钠、炎琥宁等（用量不详）”2d，呕吐及腹泻缓解，仍高热不退，体温39．5℃左右。精神可，进奶稍差，尿量少。查体：体温39℃，呼吸50次／分。营养发育可，皮肤弹性可，面色红。前囟稍凹陷，咽红，双肺呼吸音粗，     

我们都是有缺口的苹果

9月1日，这一天不值得纪念却令我终身难忘。因为这一天，我遭遇了车祸。那一天的车祸，使我这个无辜的受害者受到重伤，头破血流，遍体鳞伤。经抢救，我死里逃生，性命是保住了，但颈椎（七）破裂性骨折，颈髓严重受损，我昏迷了。醒后发现自己不会动了，不会坐起，也不会翻身了，大小便控制不了，脖子以下没有感觉了，当我手术后看到医生潦草但可辨的“截瘫”二字时，我真的“傻”了。     

一个案例，十种技术

男同学小江，15岁，初中三年级学生，家庭经济情况一般，特别聪明，成绩—直不错，也没有任何违纪的情况。初二下学期开始，因为玩游戏，在课堂上无精打采，成绩下滑明显。我刚担任这个学生的班主任一周，想了解—下情况，下面是我们的沟通交流过程，结合这个案例，介绍十种常见的心理辅导技术的应用：     

职业因素对产房护士健康的影响及防护对策分析

妇产科产房工作者是一个在特殊环境中，从事特殊护理专业的群体，是体力劳动与脑力劳动相结合的工作，服务对象是产妇，虽然工作平凡，但又神圣而伟大，担负着两条生命的崇高使命，担负着“促进健康，预防疾病，减轻痛苦，恢复健康”的崇高使命。因此，     

三叉神经节经皮射频热凝术进针安全深度的解剖与CT对照研究

目的：探讨三叉神经节经皮射频热凝术（PRT）进针安全深度,为颅内进针避免损伤血管神经提供解剖学依据。方法：选择21例成人颅底解剖标本,用游标卡尺从颅内测量卵圆孔内侧缘中点至破裂孔外侧缘中点的距离（A）和卵圆孔内侧缘中点至三叉神经压迹上缘最高点的距离（B）;同时从颅外同一方向测量卵圆孔内侧缘至破裂孔外侧缘的距离（c）和破裂孔外侧壁垂直深度（D）;用螺旋CT扫描颅底,测量颅底水平位颅中窝最大密度投影（MIP）图像上同一方向卵圆孔内侧缘至破裂孔外侧缘的距离（E）。然后对距离c和安全距离及距离E进行统计分析,确定距离E是否可以作为指导不同患者进行PRT治疗时个体化的颅内安全进针深度。结果：①颅内卵圆孔内侧缘中点至破裂孔外侧缘中点的距离为右侧（1．19±0．15）cm,左侧（I．20±0．14）cm;②颅内卵圆孔内侧缘中点至三叉神经压迹顶点的距离为右侧（1．51±0．17）cm,左侧（1．49±0．16）cm;③颅外卵圆孔内侧缘中点至破裂孔外侧缘中点的距离为右侧（0．92±0．09cm）,左侧（O．92±0．10）cm;④破裂孔外侧壁中点垂直深度为右侧（0．55±0．07）cm,左侧（0．55±0．07）cm;⑤中颅底水平位螺旋CT最大密度投影（MIP）图像上同一方向卵圆孔内侧缘中点至破裂孔外侧缘中点的距离为右侧（1．00±0．17）cm,左侧（1．00±0．17）cm,与距离C差异无统计学意义（P〉0．05）。结论：三叉神经节PRT治疗时颅内进针深度不应超过1．00Gm,临床上可用中颅底水平位螺旋CT最大密度投影（MIP）技术显示与相同方向卵圆孔内侧缘中点至破裂孔外侧缘中点的距离的一致性,来指导不同患者进行PRT治疗时个体化的颅内安全进针深度。     

基于XML技术的电子药历初步探讨

从目前医疗信息系统的实际应用出发,为提高临床药师药学服务质量,释放药学服务潜能,促进临床合理用药,根据临床药师的具体工作细节从而提出采用XML技术实现电子药历的方法。文章详细介绍了XML的特点及优势,并就基于XML技术构建电子药历的结构、保储、操作、集成、信息处理、交换和安全问题进行讨论。     

The Central Nucleus of the Amygdala Modulates Gut-Related Neurons in the Dorsal Vagal Complex in Rats

Using retrograde tract-tracing and electrophysiological methods, we characterized the anatomical and functional relationship between the central nucleus of the amygdala and the dorsal vagal complex. Retrograde tract-tracing techniques revealed that the central nucleus of the amygdala projects to the dorsal vagal complex with a topographic distribution. Following injection of retrograde tracer into the vagal complex, retrogradely labelled neurons in the central nucleus of the amygdala were clustered in the central portion at the rostral level and in the medial part at the middle level of the nucleus. Few labelled neurons were seen at the caudal level. Electrical stimulation of the central nucleus of the amygdala altered the basal firing rates of 65 % of gut-related neurons in the nucleus of the solitary tract and in the dorsal motor nucleus of the vagus. Eighty-one percent of the neurons in the nucleus of the solitary tract and 47 % of the neurons in the dorsal motor nucleus were inhibited. Electrical stimulation of the central nucleus of the amygdala also modulated the response of neurons in the dorsal vagal complex to gastrointestinal stimuli. The predominant effect on the neurons of the nucleus of the solitary tract was inhibition. These results suggest that the central nucleus of the amygdala influences gut-related neurons in the dorsal vagal complex and provides a neuronal circuitry that explains the regulation of gastrointestinal activity by the amygdala.     

Scanning electron microscopy of the connective tissue along the lateral wall of the mouse cochlear duct with special reference to the external sulcus cells

The external sulcus cells in the lateral wall of the cochlear duct insert cell cords into the connective tissue. To examine the shape, arrangement, and distribution of the sulcus cell cords in the cochlear duct in adult mice, the external sulcus cells were removed by chemical maceration methods, and the connective tissue exposed. The holes for the insertion of the sulcus cell cords along the entire course of the cochlear duct could thus be observed by scanning electron microscopy. A zone perforated with the holes was seen in the lateral region of the area between the stria vascularis and the lateral edge of the basilar membrane, this zone extending from the basal end of the hook to the helicotrema. In the hook and basal half turn, the holes possessed large fusiform openings and branched in the connective tissue toward the outer bony wall. In the apical turn, the holes displayed small round openings and were shallow, having a small number of branchings. The width of the perforated zone, the population density of the openings of the holes and the area proportion of the openings per unit surface area in the lateral wall decreased from the base to the apex of the cochlear duct. The regional differences in the organization of the sulcus cell cords suggest that the external sulcus cells function in close relation to regional auditory functions in the cochlear duct.     

基于有限元模型的踝关节生物力学分析*

背景：有限元力学分析在生物力学领域广泛应用。 目的：采用大型有限元软件ANSYS对踝关节三维有限元数字模型进行生物力学分析,探讨踝关节各组成骨的应力分布规律及其发生形变、位移情况。 方法：把经MIMICS、Geomagic和ANSYS处理后生成的踝关节三维数字模型导入软件ANSYS中,经过约束条件、施加载荷、求解试算等阶段,对其各组成骨进行有限元分析。 结果与结论：①静止直立位时,踝关节各组成骨最大应力区集中在内踝与距骨相关节处、胫骨远端关节面髁间线前部、胫骨中下段前缘皮质区及距骨滑车外侧部;最小应力区集中在外踝、胫骨远端内侧皮质区、距骨头、距骨颈;最大位移发生在距骨头,位移自下而上逐步减小;最小位移发生在胫骨、腓骨中下段1/3处。②高空坠落时,最大应力区集中在胫骨中下段前缘皮质区、距骨滑车前外侧、内踝内侧皮质区以及胫骨远端关节面髁间线前部。其中胫骨中下段应力集中区随着压力的增加,稍向内侧移位。距骨滑车外侧部最大应力集中区位置无明显变化,范围逐渐加大。最小应力区集中在外踝、胫骨远端关节面外侧部、距骨头、内踝的外侧皮质;随着压力不断加大,内踝外侧皮质的小应力蓝色区域范围逐渐减小;外踝逐渐出现应力稍大的淡蓝色区域,提示所受应力加大。最大位移发生的部位自距骨头向上,经距骨颈、胫距关节面到胫腓骨中下段逐渐减小,到胫腓骨中下段时减到最小。     

Developmental differences in the ossification process of the human corpus and ramus mandibulae

A correlation was sought between the organization of the dental crest and the ossification of the corpus mandibulae in 14 human embryos and 13 human fetuses. The different types of ossification between the corpus and the ramus mandibulae suggest that the cartilago mandibularis (meckeliensis) guides the formation of the mandibula, while the dental crest acts as a coorganizer. In the area of the foramen mentale, the lamina dentalis begins to invaginate (to give rise to the dental crest), and at this level intramembranous ossification of the corpus mandibulae commences. These findings, together with the presence of the cartilago mandibularis before the appearance of the dental crest, and the fact that the former is seen along the entire length of the mandibula (from the symphysis mandibulae to the capsula otica), support the hypothesis that the dental crest, rather than the cartilago mandibularis, acts as the coorganizer in the corpus mandibulae. © 1993 Wiley-Liss, Inc.     

不同载荷条件对后牙单种植体义齿下颌骨应力的影响

目的探讨垂直和斜向载荷作用于下颌后牙单种植体支持式义齿不同载荷点对下颌骨应力分布的影响。方法应用部分下颌骨CT扫描图像建立下颌骨的三维有限元模型,根据测量数据建立种植体的三维有限元模型,建立半解剖式种植义齿牙冠的三维有限元模型;在下颌第一恒磨牙种植体义齿各咬合点分别加垂直和斜向载荷,计算下颌骨所受的最大等效应力。结果在垂直和斜向载荷作用下,下颌骨的最大等效应力位于颈周骨皮质的上方;在相同的垂直斜向载荷下,不同咬合点加载时,下颌骨上所产生的最大等效应力有明显差异;同一载荷点在大小相同、方向不同的载荷作用下,下颌骨的最大等效应力有明显差异。结论在垂直和斜向载荷作用下,下颌骨的最大等效应力位于颈周骨皮质的上方,向根尖部递减;远中尖斜向加载时颈周骨皮质的上方的等效应力最大;载荷方式是影响颈周骨皮质应力分布的重要因素。     

卵巢的淋巴流向

本文在90例女性新生儿及婴儿尸体上,用器官内淋巴管注射方法,观察了卵巢的淋巴流向。实验材料分为3组,每组各30例(60侧)。第1组:由卵巢注入普鲁士蓝氯仿溶液。每个卵巢发出4～10条集合淋巴管,沿卵巢动、静脉上行,注入腰淋巴结。右侧卵巢的集合淋巴管多是注入主动脉腔静脉间淋巴结,一部分人腔静脉外侧淋巴结、腔静脉前淋巴结及主动脉下淋巴结。左侧卵巢的集合淋巴管多是注入主动脉外侧淋巴结;一部分入主动脉前淋巴结。第2组:先结扎两侧卵巢悬韧带,然后进行注射。有26侧(43％)卵巢发出的1～2条集合淋巴管,经过子宫阔韧带,注入髂间淋巴结、髂内淋巴结及髂外淋巴结。第3组:同时结扎两侧卵巢悬韧带和卵巢固有韧带,然后再进行注射。有19侧(31％)卵巢的1条集合淋巴管,经过子宫阔韧带,注入髂间淋巴结、髂外淋巴结及髂内淋巴结。本文研究表明,卵巢的淋巴可通过上、下两条路径。在正常情况下,都向上汇入腰淋巴结;当结扎卵巢悬韧带后,则可向下进入盆部的淋巴结。     

Characteristics of the Time Course of Evoked Secretion of Transmitter Quanta in Different Parts of the Motor Nerve Ending in the Frog

Experiments were performed on neuromuscular preparations from frogs, in which three extracellular microelectrodes were used to record nerve ending currents and single-quantum endplate currents simultaneously from the proximal, central, and distal parts of single synaptic contacts. The rate of propagation of excitation across terminals was measured, along with the minimum synaptic delay, the intensity, and the degree of synchronicity of the secretion of transmitter quanta in different parts of the nerve ending, and the relationships between these factors and the calcium ion concentration in the medium. These studies showed that along with gradients in the rate of conduction of excitation and the intensity of secretion in different parts of the ending, there were also differences in the kinetics of the release of transmitter quanta. As the distance from the end of the myelinated part of the axon increased, the rate of conduction of the nerve impulse and the duration of the synaptic delay decreased, while the synchronicity of the release of quanta increased. Increases in the calcium concentration in the medium produced greater increases in the synchronicity of transmitter quantum release in the distal parts of the synapse than in the proximal parts. Mathematical modeling of multiple-quantum endplate currents showed that the characteristics of the kinetics of the secretion process observed here in different parts of the nerve ending represent a factor which partially compensates for the decrease in the amplitude and extending of the duration of the leading front of the multiple-quantum endplate current which are associated with the low rate of conduction of excitation across the nerve ending. The contribution of this compensation increases as the intensity of secretion of transmitter quanta increases in the distal parts of the synaptic contact.     

Double-barrelled connections between the striatum and substantia nigra in the light and electron microscopy picture in the cat]

Following coagulation of either the substantia nigra or the caudate nucleus and fundus caudati of the cat, the distribution of degenerating terminals in the sections of the striatum has been determined especially in the fundus caudati on one side and in the various cell groups of the substantia nigra compacta on the other side; and the types of synapses have been described. There are reverberating circuits between the fundus caudati and the medial groups of the nigra characterized by their small cells, between the putamen and the postero-lateral cell groups of the nigra, between the caudatum and the rostral cell groups of the nigra, presumably with the specialization that the lateral caudatum is in two-way connection with the rostro-lateral cell groups of the nigra as is the medial caudatum with the rostro-medial cell group. The transmitter for the striatofugal terminals in the nigra which have pleomorphic synapses is probably GABA. Dopamine is the transmitter of the axo-spinous synapses of the nigrostriatal neurons with the small striatal nerve cells for which the transmitter seems to be Acetylcholine. The nigro-striatal reverberating circuits have three outputs available; 1. from parts of the striatum to the entopeduncular nucleus (internal segment of pallidum) and from there through the H2 and H1 fields of Forel to the oral ventral nucleus of the thalamus (V.o.a) which directly projects to the area 6 a alpha of motor cortex; 2. also from parts of the striatum to the pallidum (outer segment) and continuing through the descending pallido-reticulospinal pathway and 3. from the postero-lateral cell groups of the nigra probably through descending fibers which cross the midline in the commissura colliculi superioris and extend through the reticular formation directly or indirectly to the spinal cord.