新生儿听力筛查研究及其评价

我国每年有两千万新生儿出生，约有2万～6万新生儿患有听力障碍，远高于目前已开展的两病筛查（先天性甲状腺功能低下1：7000，苯丙酮尿症1：16500）。开展新生儿听力筛查，是一项社会意义重大的优生工程。本院已将新生儿听力筛查作为重点工作，由专职听力筛查的儿科医生和主管护师共同承担此项工作，并对患儿进行追踪随访，为早诊断、早干预提供帮助，同时调查家长对筛查结果的评价。现介绍如下。     

李振华教授调理脾胃用药规律探讨

李振华教授，生于1924年，河南省洛宁县人。著名中医脾胃学专家，全国片批名老中医。国务院特殊津贴专家，原中华中医药学会常务理事、第七届全国人大代表，曾任河南中医学院院长，从事中医临床与教学六十余载，长于内科杂病，晚年潜心于脾胃学说研究，著有《中国传统脾胃病学》等，并负责研究河南省重点科研项目“脾胃气虚本质的研究”及“七五”国家重点科技攻关项目“慢性萎缩性胃炎脾虚证临床及实验研究”，且均荣获河南省科技进步成果奖。经过多年临床实践，李老整理总结出调理脾胃的用药规律。提出通过药物件味归经，以及药效应用与脾胃的生理、病理特点相结合的川药大法。     

临床护士针刺伤调查及职业安全管理探讨

目的 了解护士的职业安全意识，以探讨职业安全管理模式。方法 采用随机抽样方法对100名临床护士进行针刺伤经历及相关问题的回顾性问卷调查。结果97．0％被调查护士在工作期间发生过针刺伤，77.30／被针刺伤〉1次／年，71．6％在操作和处置中被污染针头所伤，54．6％的针刺伤不能确定感染源；与针刺伤有关的主要操作有清洗、处置注射器、回套针帽、处置临床医疗废物等；在针刺伤发生后40．0％护士不知道报告的程序和处理措施；所有护士都希望获得针刺伤相关的知识及帮助与支持。结论 临床护士针刺伤发生率高．防护意识不强，职业安全制度不健全。建议卫生行政管理部门及医疗单位管理部门建立、健全职业安全制度，加强医护人员职业防护培训，以促进医疗职业安全．     

Obesity in Diabetic Patients Undergoing Coronary Artery Bypass Graft Surgery Is Associated with Increased Postoperative Morbidity

Background: Despite the fact that obesity is a known risk factor for cardiovascular disease, many studies have failed to demonstrate that obesity is independently associated with an increased risk of cardiovascular morbidity and mortality in nondiabetic patients undergoing coronary artery bypass graft surgery. The authors investigated the influence of obesity on adverse postoperative outcomes in diabetic and nondiabetic patients after primary coronary artery bypass surgery.

Methods: A retrospective cohort study of patients undergoing primary coronary artery bypass surgery (n = 9,862) between January 1995 and December 2004 at the Texas Heart Institute was performed. Diabetic (n = 3,374) and nondiabetic patients (n = 6,488) were classified into five groups, according to their body mass index: normal weight (n = 2,148), overweight (n = 4,257), mild obesity (n = 2,298), moderate obesity (n = 785), or morbid obesity (n = 338). Multivariate, stepwise logistic regression was performed controlling for patient demographics, medical history, and preoperative medications to determine whether obesity was independently associated with an increased risk of adverse postoperative outcomes.

Results: Obesity in nondiabetic patients was not independently associated with an increased risk of adverse postoperative outcomes. In contrast, obesity in diabetic patients was independently associated with a significantly increased risk of postoperative respiratory failure (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.41-3.61; P < 0.001), ventricular tachycardia (OR, 2.27; 95% CI, 1.18-4.35; P < 0.02), atrial fibrillation (OR, 1.56; 95% CI, 1.03-2.38; P < 0.04), atrial flutter (OR, 2.38; 95% CI, 1.29-4.40; P < 0.01), renal insufficiency (OR, 1.66; 95% CI, 1.10-3.41; P < 0.03), and leg wound infection (OR, 5.34; 95% CI, 2.27-12.54; P < 0.001). Obesity in diabetic patients was not independently associated with an increased risk of mortality, stroke, myocardial infarction, sepsis, or sternal wound infection.     

激光荧光检测仪对乳牙合面患龋敏感位点的流行病学研究

目的：定量分析乳牙合面的龋病敏感点位，为指导临床预防和治疗龋病提供依据。方法：采用激光荧光检测仪（DIAGNOdent）检测156名5～6岁儿童共561颗患龋的乳磨牙合面，记录合面龋坏最严重的位点。结果：在上颌第2乳磨牙中，龋坏最严重的位点有60．1％发生在远中窝。在下颌第2乳磨牙中，龋坏最严重的位点有51．2％发生在舌沟；而在下颌第1乳磨牙中，龋坏最严重的位点则易发生在远中窝，占该牙记录位点的34．9％。结论：不同的牙合面患龋严重部位具有统计学规律，提示这些位点是龋坏容易发生和发展的地方，是临床上预防和治疗不可忽略的重要部位。     

Relationship between Mandarin speech reception thresholds and pure-tone thresholds in the geriatric population.

BACKGROUND/PURPOSE: In the geriatric population, the reliability of pure-tone threshold (PTT) is sometimes poorer than that in young adults because of various reasons. This study assessed the relationship between Mandarin speech reception thresholds (SRTs) and PTTs in the aged and developed SRT as a measure for corroborating PTT. METHODS: This prospective study enrolled 46 consecutive subjects over 60 years of age. The results of SRT and PTT were collected from one ear randomly selected from each subject. Simple linear and multiple regressions were used to determine the correlation and linear regression coefficients between SRTs and PTTs at various frequencies. RESULTS: In the simple regression analysis, the correlation coefficient was highest at 1000 Hz (r = 0.949) and 500 Hz (r = 0.922), followed by 250 Hz (r = 0.850) and 2000 Hz (r = 0.792). In the multiple regression model with SRT as the dependent variable and PTTs as predictor variables, the resultant multiple correlation coefficient R was 0.967, while R2 was 0.936. In this model, PTTs at the frequencies of 500 Hz and 1000 Hz contributed significantly to the variance in SRTs with p values of 0.029 and < 0.001, respectively. These results demonstrated that the Mandarin SRT is strongly associated with PTTs at the frequencies of 500 Hz and 1000 Hz. CONCLUSION: This study established the agreement between Mandarin SRTs and PTTs in the low tone area of speech frequencies in the geriatric population. In clinical settings, SRT test can be rapidly and easily performed and is relatively inexpensive. It is a vital indicator of the accuracy of PTT measurement.     

过一种没有恐慌的幸福生活

飓风要来了，你的第一感觉是什么？恐慌！“苏丹红”混迹在孩子们最爱吃的食品里，你的第一感觉是什么？恐慌！致癌物竟然和我们每天用的牙膏如影随形，你的第一感觉又是什么？还是恐慌！ 问问自己，为什么我们会产生如此强烈的反应？[编者按]     

横窦和窦汇的浅表解剖学标志

目的为神经外科手术准确定位横窦的下缘和窦汇确定出一个可靠的浅表解剖学标志。方法对10例经10%甲醛溶液固定的尸头标本进行逐步解剖,测量各相关解剖结构到横窦下缘的距离。结果实验所收集的数据表明在定位横窦下缘和窦汇时,上项线及枕外隆凸尖不是一个可靠的浅表解剖学标志。而以半脊肌附着点作为浅表解剖学标志比以上项线作为浅表解剖标志更准确、可靠。本组10例标本中,无1例的半脊肌附着点超过横窦下部边界3mm,并且它可以作为一个可靠的浅表解剖学标志用以定位接近中线部分的横窦。结论这些发现可以帮助神经外科医生在治疗后颅窝和颅颈接合处病变而进行的各种中线入路手术时更准确的定位横窦。     

在音乐缭绕中痊愈

你是否曾经因为它血脉贲张浑身发抖过．你是否因为它心潮起伏热泪盈眶过？如果这世界上没有它．你怕么？当天堂的圣歌响起．即使面对死亡．你也无所畏惧，它以它温柔的手．抚平你心里和肉体的伤……它让你不痛。[编者按]