一次手术治愈外直肌全麻痹

过去，为了保证前段的血液供应，外直肌全麻痹的手术治疗要分２～３次完成，考虑到全麻痹的外直肌已无功能，我们提出在这种条件下可以不动含睫状前动脉的外直肌，只退后内直肌和将上，下直肌的外侧１／２移到外直肌的附着处，如此安排，可以一次手术完成治疗，这样可以缩短治疗时间，减少病人的痛苦和负担，我们治疗了７例８眼，结果比较满意。     

Comparison between laser and electrical ablation of ventricle in dogs: Hemodynamic,pathologic and electrocardiographic observations

Summary To characterize and compare the pathologic, hemodynamic and electrocardiographic changes of both transeatheter laser and electrical energy on ventricle, 33 subendocardial myocardium lesions were induced at energy 60, 120 and 240 Joules by either transcatheter laser irradiation or electrical shock in 7 anesthetized dogs. The following results were observed: 1) Both laser and electrical ablation on myocardium created nonhomogeneous myocardium injury, but laser ablation caused mainly focal tissue vaporization and necrosis, while electrical shock induced widespread tissue degenerations; 2) Both laser and electrical induced-lesion dimensions increased parallel to the total dosage of energy; 3) Laser ablation caused mainly (90%) single ventricular premature beats and 86 % of them occurred within the first minute after energy discharged, while ventricular tachycardias were found in any electrical energy groups; ventricular fibrillations occurring during laser and electrical ablation were 5 % and 13 % respectively (P< 0.01): 4) A decrease in aortic blood pressure and an increase in central verous pressure induced by laser ablation were significantly less than that produced by the same amount of electrical energy (P<0.0l). Our preliminary results have shown that transeatheter laser ablation has great potential for becoming a practical method in the management of refractory tachycardias.     

Preexpanded distant "super-thin" intercostal perforator flaps for facial reconstruction without the need for microsurgery.

BACKGROUND: Concept of the 'super-thin perforator flap' was introduced in 1994 by authors. Since then, various types of 'super-thin perforator flaps' were applied successfully especially for contour sensitive reconstruction such as face and neck. METHODS: Eleven patients requiring large flaps who presented with extensive disfiguring facial scar (male: seven cases, female: four cases). On the consideration of flaps' colour, texture and thickness requirements, the authors selected 'super-thin' anterior intercostal perforator flaps (AICP, range from 4 x 14 cm to 25 cm x 9 cm) for reconstruction purpose. First, tissue expanders (volume range from 800 cc to 1200 cc) were carefully inserted under the AICP. After the flaps were expanded for 2 months, distant scars were removed and the covering super-thinned flaps were transferred into recipient site. Two weeks later, pedicles in the anterior chest were cut down and flaps were transferred to replace all the left scars. RESULTS: Flap were survived without any complications. The colour, texture and thickness of the transferred flap were satisfactory, shrink of flaps were not observed after long term follow-up. The authors present a method of facial reconstruction that has the advantages of creating a large amount of thin tissue of both good colour and texture, without the need of microsurgery and few disadvantages of donor-site morbidity. The disadvantages are three-staged procedures, complications of tissue expansion and uncomfortable compulsory posture for patients. In our opinion, this is an alternative method of choice for reconstructing all large defects in the lower two-thirds of the face.     

Global attraction and stability for Cohen–Grossberg neural networks with delays

We consider a class of Cohen–Grossberg neural networks with delays. We prove the existence and global asymptotic stability of an equilibrium point and estimate the region of existence. Furthermore, we show that the trajectories of the neural networks with positive initial data will stay in the positive region if the amplification function satisfies a divergent condition. We also establish the existence of a globally attracting compact set for more general networks. We estimate this compact set explicitly in terms of the network parameters from physiological and biological models. Our results can be applied to neural networks with a wide range of activation functions which are neither bounded nor globally Lipschitz continuous such as the Lotka–Volterra model. We also give some examples and simulations.     

海岩我的生命并不多情

随着海岩一系列新戏的热播，海岩的名字又一次成为热点话题，诸如女琼瑶之类的形容词已经不新鲜了，人们关注的是：为什么海岩的名字就这样形成了一个品牌，他的每部戏都有可能热播？海岩是怎样一个人？他为什么会成为一个文学＋影视＋畅销的必然模式？     

胰岛素样生长因子-Ⅰ对软骨细胞凋亡的抑制

目的:探讨胰岛素样生长因子-Ⅰ(IGF-Ⅰ)对软骨细胞增殖及白细胞介素-1(IL-1)诱导软骨细胞凋亡的影响,揭示其抗损伤作用机制,为关节软骨损伤治疗提供理论依据。方法:分离培养人胚胎关节软骨细胞,采用四氮甲基唑蓝(MTT)法测定不同含量软骨细胞增殖活性的变化,利用光镜、电镜、DNA电泳及流式细胞仪测定作为凋亡检测指标。结果:IGF-Ⅰ呈剂量依赖式促软骨细胞增殖,当IGF-Ⅰ含量达50μg/L时,促软骨细胞增殖作用达最大值。IL-1组光镜、电镜下可见典型的细胞凋亡形态学改变,琼脂糖凝胶电泳示特征性的DNA梯状条带,IGF-Ⅰ处理组未见明显凋亡征象。流式细胞仪检测发现,IGF-Ⅰ处理后软骨细胞凋亡率显著降低。结论:IGF-Ⅰ能促进软骨细胞增殖,对IL-1诱导的软骨细胞凋亡具有保护作用。     

路志正教授"知常达变"辨治妇科病经验撷萃

路志正教授从事中医临床多年,不仅对内科杂病有丰富的临床经验,对妇科疾病的诊疗,亦很有特色。笔者于2003年有幸侍诊左右,耳濡目染,略有所得,不揣浅陋,举述验案二则。健脾祛湿行水治疗闭经、不孕患者某,女,32岁,已婚,2003年10月9日初诊。主诉:月经稀少10余年,闭经2年。患者15岁     

界定需要急诊入院的高危人群单纯依据既往的入院率会造成误导

预测哪些人可能因急性发病而需要急诊入院，已成为英国国家医疗卫生服务体系（NHS）的一个重要话题。卫生部门将那些患有复杂的慢性疾病，经常不定期地去二级医疗机构就医的人们视为高危人群。确定这些人之后，社区护理员或其他卫生人员将通过“个案管理”的方法照顾他们。“个案管理”此前被定义为“对疾病尚未控制或所需费用昂贵的患者进行加强医疗计划”。社区护理人员可来自任何护理部门，但一般认为社区护士更能胜任这一角色。此方法能够减少可避免的急诊入院患者数量，并有助于实现到2008年3月减少5％急诊住院床位日的公共医疗服务目标。但是，如何才能界定需要急诊入院的高危人群呢？     

烧伤创面切削痂植皮对纠正烧伤后肾脏损害的价值

目的　探讨烧伤合并肾脏损害的治疗方法。方法　对 47例烧伤合并肾损害进行烧伤创面切削痂植皮 ,以减少烧伤毒素、促进创面修复、促进肾脏功能恢复。结果　术后 1周观察 ,3 6例肾损害治愈、9例好转、2例无效 ;完成手术后 ,最快 3d肾损害即可控制。本组最后治愈41例、死亡 6例。结论　对于烧伤合并肾损害 ,及时采用手术治疗 ,不仅利于肾功能的恢复 ,也是保证患者最终康复的重要手段。一旦烧伤病人出现肾功能损害 ,应尽早进行烧伤创面切削痂植皮术修复深度创面。