New non-cocaine-containing topical anesthetics compared with tetracaine-adrenaline-cocaine during repair of lacerations

OBJECTIVE: To compare the effectiveness of three new topical anesthetics that do not contain cocaine (prilocaine-phenylephrine, tetracaine-phenylephrine [tetraphen], and tetracaine-lidocaine-phenylephrine) to that of tetracaine-adrenaline-cocaine (TAC) during laceration repair in children. DESIGN: Prospective, randomized, double-blind clinical trial. SETTING: The emergency department of an urban children's hospital. PARTICIPANTS: Children 1 year of age or older with a laceration /= 5 years of age using a visual analogue scale (VAS). Suture technicians, research assistants, and parents also scored pain using a seven-point Likert scale. In addition, suture technicians completed an anesthetic effectiveness scale. RESULTS: There was consistently no difference demonstrated between the effectiveness of tetraphen and that of TAC for each outcome measure of each observer group. A statistically significant difference was seen among anesthetics when comparing VAS and Likert scale scores of suture technicians and Likert scale scores of research assistants. Based on post hoc analyses, these statistically significant differences were between TAC and prilocaine-phenylephrine (suture technician VAS and Likert scale) and between TAC and tetracaine-lidocaine-phenyl-ephrine (suture technician Likert scale), but not between TAC and tetraphen. When power analyses were performed using alpha = 0.05 and beta = 0.20, it was possible to detect a difference of 1.2 VAS units for each of the observer groups. Based on anesthetic effectiveness scale scores, the three new topical preparations collectively performed significantly better on the face and scalp than on the extremities (relative risk = 1.83; 95% confidence interval 1.20 < relative risk < 2.79). CONCLUSION: This study demonstrated the effectiveness and safety of three new non-cocaine-containing topical anesthetics. Consistently, there was no statistical difference demonstrated between the effectiveness of tetraphen and that of TAC for each outcome measure of each observer group. Tetraphen offers an effective alternative to TAC during laceration repair in children.     

尼尔雌醇作用下去势雌兔骨组织形态计量学改变

目的：评估尼尔雌醇对绝经后骨质疏松症的疗效，并探讨其机理。方法：将３０只雌性新西兰兔随机分成３组（每组１０只）：治疗组［摘除卵巢＋尼尔雌醇（每月２ｍｇ）］、模型组（摘除卵巢）和正常对照组（假手术），６个月后处死取材，并在处死前行四环素标记，ＶＩＤＡＳ图象分析系统下作骨组织形态计量学测定。结果：治疗组的单位体积骨小梁骨量（ＢＶ／ＴＶ）、相对类骨质量（ＯＶ／ＢＶ）、成骨细胞指数（ＯＢＩ）和组织水平的骨形成速率［ＢＦＲ（Ｔ）］明显高于模型组和（或）正常对照组。结论：尼尔雌醇能增加成骨细胞数量，可能是一种成骨细胞募集和（或）增殖的刺激剂。     

小儿咽侧间隙肿瘤4例报告

为探讨小儿咽侧间隙肿瘤的临床特征，报告４例小儿咽侧间隙肿瘤患者儿的诊治体会。结合临床提出诊断本病宜通过ＣＴ扫描，先确定肿瘤的大小和范围，再选择颈侧径路摘除肿瘤．结果治疗的４例患儿均获得了肯定的结果。并且提示手术中应保护重要的血管和神经。     

头颅X线测量在阻塞性睡眠呼吸暂停综合征诊治中的意义

OBJECTIVES: To study the value of cephalometric analysis in the diagnosis, treatment option and evaluation of prognosis. METHODS: A detailed cephalometric analysis was performed using lateral X-ray films from 50 cases with obstructive sleep apnea syndrome (OSAS) and 30 age- and sex-matched controls. RESULTS: Statistical results showed that OSAS patients were different from controls in the following aspects: 1. Their uvula, soft palate and tongue were significantly enlarged. 2. The hyoid bone was displaced inferiorly and posteriorly. 3. The posterior airway space (palatopharyngeal plane) was narrow. 4. The hard palate was elongated. 5. The mandibular body was retropositioned. Fifty unselected consecutive OSAS patients(mean AHI 51.42 +/- 3.96, Medilog SAC 847, Oxford UK) underwent LAUPP using CO2 laser. Twenty-five cases were followed-up for 4-8 months. 10/25 had obtained a reduction in AHI > 50%, 15/25 had AI < 20 times. The success rate was compared with cephalomentric findings. CONCLUSION: Cephalometry has an important diagnostic and predictive value in the clinical investigation of patients suspected of having OSAS.     

妊娠高血压综合征孕妇血浆一氧化氮和内皮素的变化及其意义

目的：探讨一氧化氮（ＮＯ）和内皮素（Ｅｎｄｏｔｈｅｌｉｎ，ＥＴ）在妊高征发病中的变化及其病理意义。方法：用分光光度法和放射免疫法分别定量检测正常妊娠３０例（对照组）和妊高征３７例（妊高征组）血浆ＮＯ和ＥＴ的变化。结果：妊高征组血浆ＮＯ水平低于对照组（Ｐ＜０．０１），ＥＴ水平则高于对照组（Ｐ＜０．０１）；妊高征组分娩前后相比，ＮＯ水平分娩后升高（Ｐ＜０．０１），ＥＴ水平则下降（Ｐ＜０．０１），ＮＯ、ＥＴ呈显著负相关（Ｐ＜０．０１），ＮＯ、ＥＴ与平均动脉压均有显著相关性（Ｐ＜０．０１）。结论：ＮＯ与ＥＴ在妊高征的发病机制中有重要作用，ＥＴ／ＮＯ失衡可以反映妊高征的病变程度，其病理变化在某种程度上呈可逆性。     

利用"分层法"评价中药复杂体系药效时有关权重设立的讨论

本文讨论了以分层法进行中药药效评价时权重设立的问题，主要由以下几部分组成：1．建立递阶层次结构；2．构造两两比较判断矩阵；3．计算单一准则下元素的相对权重；4．计算各层元素的组合权重。由于中药作用具有多途径、多靶点的特性，因此评价过程中权重的设立就占有重要位置。它直接影响对被评价对象药效作用的评判。全面解决中药作用多途径、多靶点药效学评价的数学方法，客观量化的评价中药的综合药效，是中药现代化进程中一个值得研讨的命题。     

Modulation of triceps surae H-reflexes as a function of the reflex activation history during standing and stepping

The facilitatory effectiveness of spindle afferent feedback is controlled by modulation of segmental reflex excitability such that the level of muscle activation is appropriate for the task. Phase-dependent modes of reflex modulation have been well-characterized. We hypothesized that segmental reflex excitability of the triceps surae was also modulated in a manner associated with the activation history of the spindle afferents and the segmental reflex pathway during isometric contractions, standing and stepping. In the first experiment. pairs of soleus (S) H-reflexes were evoked 80 ms apart with equal strength stimuli at rest and while subjects isometrically contracted their S against loads of 10%. 20%. and 50% of their maximum voluntary efforts. The percent depression of the second H-reflex relative to the first was used as a measure of the effect of reflex activation history. At rest, the second H-reflexes were depressed an average of 73% relative to the first. The degree of depression was progressively reduced as the plantarflexion torque increased. In the second experiment, paired H-reflexes were obtained from the S and medial (MG) and lateral gastrocnemii (LG) muscles while subjects were standing and during the stance phase of step initiation. The degree of depression of the second H-reflex during standing ( > 78%) was similar in magnitude to that produced at rest in Experiment I. At the end of the stance phase of stepping. depression of the second H-reflex of all three muscles was reduced to less than 25%. We conclude that the segmental reflex excitability is modulated as a function of the reflex activation history during these tasks.     

穿透性角膜移植术治疗坏死性基质角膜炎23例

目的:探讨穿透性角膜移植术(penetratingkeratoplasty,PKP)治疗坏死性基质角膜炎(necrotizingstromalkeratitis)的手术适应证及其临床效果。方法:按照Holland等的HSK新分类法,选择确诊坏死性基质角膜炎患者,予以局部及全身药物治疗。对病情不能控制,药物治疗无效的患者22例(23眼),其中角膜溶解穿孔3眼,用新鲜角膜组织行穿透性角膜移植术,并随访观察术后疗效。结果:随访3mo～3a,22例(23眼)中,术后视力提高者18眼,其中矫正视力达到0.1～0.5者12眼,0.05～0.1者6眼;无改善者5眼。角膜植片透明17眼,半透明2眼,植片混浊4眼,植片透明率为74%。术后3眼植片发生排斥反应,3眼原发病灶复发。2眼术后因排斥反应及原发病灶反复发作,植片完全混浊,行2次角膜移植术。结论:对坏死性基质角膜炎患者,药物保守治疗无效、角膜坏死穿孔或行将穿孔,及时用新鲜角膜组织行穿透性角膜移植术治疗,不仅能控制炎症,缩短病程,而且能保存眼球,恢复部分视力,因此具有重要临床应用价值。     

做公立医院产权制度改革的促进派

经过数年来政府各有关部委的协商努力，医疗卫生各界人士付出了相当的摩擦成本和交易成本，特别是在抗击非典战役的洗礼后，卫生部新领导的新思路发挥指导作用，公立医院的产权制度改革方向终于明确了。卫生部医政司吴明江司长在全国政协举行的一次研讨会上，就医院产权制度改革发表重要谈话，记者在《健康报》