The Mini Rhytidectomy

A technique is described in which superficial musculoaponeurotic system (SMAS) is plicated from the deep temporal fascia above the zygoma to the level of the earlobe. This procedure requires only an extended preauricular incision. The neck is dealt with by liposuction. This technique is ideally suited to the younger patient requesting facelift and is based on a sound understanding of the anatomy of SMAS. The outcome of 35 patients who underwent this procedure during a 3.5-year period are described. There were no cases of facial nerve paresis or hair loss. There were no cases of skin necrosis but two patients developed small hematomas and one patient complained of a stretched preauricular scar. The mini facelift leads to a satisfactory result in the younger patient requesting rhytidectomy. The technique is simple and safe and can easily be performed on an ambulatory basis. Complications are uncommon and of a minor nature.     

Objective morphological assessment of macular hole surgery by scanning laser tomography

AIM—To assess the morphological change in retinal topography using a scanning laser tomographer following macular hole surgery. To compare the results of scanning laser tomography with clinical evaluation and visual function assessment.
METHODS—The sample for this pilot study comprised four eyes exhibiting different stages of macular hole formation preoperatively. Subjects were assessed preoperatively and at 1 and 3 months postoperatively. Each assessment included visual acuity, letter contrast sensitivity, clinical examination (including automated static perimetry), and scanning laser tomography. The Heidelberg retina tomograph (HRT) was used to acquire digitised scanning laser tomography images of the macula (10° and 20° fields). Surgery essentially comprised vitrectomy, peeling of the posterior hyaloid face, if still attached, and intraocular gas tamponade. The magnitude and significance of topographic change were determined postoperatively using the HRT topographic difference facility.
RESULTS—Topographic difference analysis of the right and left eyes of case 1 showed a significant reduction in the height of the retina postoperatively. Topographic difference analysis of case 2 showed no significant change in topography. Topographic difference analysis of case 3 showed a significant increase in the height of the retina postoperatively. Scanning laser tomography agreed with clinical assessment based upon fundus biomicroscopy in three of the four eyes studied; the postoperative closure of the stage 2 macular hole (as noted by clinical assessment) proved to be too small to reach statistical significance. Scanning laser tomography agreed with the assessment of visual function in two eyes; the agreement between scanning laser tomography and visual function depends, in part, on the stage of development of the macular hole.
CONCLUSION—Scanning laser tomography provides an objective evaluation of the outcome of macular hole surgery. Studies employing larger sample sizes are required to fully determine the clinical worth of the technique.

     

雷达员的目标跟踪能力测验

目的:建立雷达操作员心理选拔系统. 方法:在分析雷达任务的基础上,设计计算机化的目标跟踪能力模拟雷达测验任务,对334名相关被试施测,分析实验结果,评价测试任务的性能指标. 结果:测验结果的数据分布接近正态,变异系数为38%,区分度较好;重测信度系数为0.764(P<0.05);对专家和被试的主观调查表明有较高的内容效度;分别以机械作图和计算机学绩成绩、学习新技术的能力、工作绩效作效标,效度系数为0.273, 0.247, 0.309, 0.445(P<0.05). 结论:本测验可作为雷达员心理选拔的测试项目.     

不同针刺手法调节体温效应机制研究概况

目的:介绍近年不同的针刺手法对体表温度调节效应的研究,并探讨其产生体温效应的机制。方法:从临床研究、实验研究等方面进行综述。结论:针刺穴位的作用及其疗效,随着手法引起的温度变化而不同,针刺补法引起体温升高,而泻法则引起体温下降。体表温度是由血液循环状态、交感神经兴奋程度和组织新陈代谢状态等多方面决定的,不同的针刺手法引起的皮肤温度变化与影响上述3个环节状态有关。     

Important risk factors of allograft survival in cadaveric renal transplantation. A study of 426 patients.

Multiple risk factors contribute to the allograft survival of patients who have cadaveric renal transplantation. A retrospective review of 19 such factors in 426 patients identified race, DR match, B + DR match, number of transplants, and preservation time to have a significant influence. The parametric analysis confirmed the effect to be primarily in the early phase, i.e., first 6 months. All patients received cyclosporine with other methods of immunosuppression resulting in an overall 1-year graft survival rate of 66%. The overall 1-year graft survival rate in the white race was 73% and in the black race was 57% (p = 0.002). Allograft survival and DR match showed white recipients with a 1 DR match to have 75% survival at 1 year compared with 57% in the black patient (p = 0.009). If HLA B + DR match was considered, the white recipient allograft survival increased to 76%, 84%, and 88% for 1, 2, and 3 match kidneys by parametric analysis. Patients receiving first grafts had better graft survival (68%) than those undergoing retransplantation (58%) (p = 0.05). Organ preservation less than 12 hours influenced allograft survival with a 78% 1-year survival rate compared with 63% for kidneys with 12-18 hours of preservation. Despite the benefits of B + DR typing, short preservation time, and first transplants to the white recipient, the allograft survival in the black recipient remained uninfluenced by these parameters.     

SLE小鼠高IgG血症Fcgr2b基因序列分析

目的: 测定系统性红斑狼疮(SLE)小鼠模型-NZB/WF1双亲NZB,NZW小鼠 Fcgr2b基因启动子区核酸序列,明确Fcgr2b基因启动子区的突变性质.方法:扩增NZB,NZW小鼠Fcgr2b基因启动子DNA进行核酸序列分析.采用ELISA法测定、比较(NZB×NZW )F1×NZW回交小鼠Fcgr2b基因B/W型与W/W型组间血清总IgG 水平.结果:NZB小鼠Fcgr2b基因启动子区与正常鼠Balb/C相比存在2个部位碱基缺失,分别为13 bp及3 bp.NZW小鼠除有3个碱基置换外,与Balb/C鼠该基因启动子区序列相同.回交小鼠Fcgr2b基因B/W型组血清总 IgG水平明显高于W/W型组(P<0.0001).结论:NZB小鼠Fcgr2b基因启动子区存在碱基缺失,且该缺失突变可能与血清总IgG水平升高有关.     

左旋精氨酸与维生素B6对低密度脂蛋白抑制兔胸主动脉内皮舒张功能的影响

目的观察正常人的低密度脂蛋白(native low density lipoprotein,nLDL),人工氧化的低密度脂蛋白(oxidized lowdensity lipoprotein,ox-LDL)及非胰岛素依赖型糖尿病(Non-insulin dependent diabetes mellitus,MDDM)患者的低密度脂蛋白(diabetic low density lipoprotein,dLDL)对兔胸主动脉环内皮的损伤作用及左旋精氨酸(L-arginine,L-Arg),维生素B6(pyridoxine,VB6)的拮抗效应.方法采用离体动脉环灌流的方法,观察兔胸主动脉环对乙酰胆碱(acetycholine,Ach),钙离子载体A23187的舒张反应.结果3种LDL均抑制动脉环对Ach及A23187的舒张,损伤强度为ox-LDL＞dLDL＞nLDL,并具有浓度依赖性;L-Arg、VB6能明显拮抗LDL的抑制作用,但并不能完全逆转.以SOD作为保护药对照,250 U/ml的浓度能够显著抑制dLDL对内皮的损伤.结论3种低密度脂蛋白主要可能通过降低NO生物活性损伤内皮,L-Arg、VB6具有内皮保护作用.     

临床医学专业学位教育的困境与发展走向

自临床医学研究生、临床医学专业学位教育实施以来，社会评价并不高，甚至存在相当数量的负面评价。究其因，一是源于对临床医学专业学位教育的认识误区，二是源于我国目前临床医学专业学位教育制度本身的缺陷。目前，我国高等医学教育体系尚不完善，专业学位教育、研究生教育及毕业后职业技能基本培训之间关系错综复杂，功能定位不清，形成相互干扰和冲突。建议进一步梳理思路，正确认识专业学位教育、研究生教育和住院医师规范化培训的教育特征与功能定位，建立各自恰当的培养目标与培养模式，最终实现在全国建立先进、科学、完善、与国际接轨的完整的医学教育体系。     

腹腔镜下置管灌洗引流在重症急性胰腺炎早期治疗中的应用

目的探讨腹腔镜下置管灌洗引流(LPLD)在重症急性胰腺炎(SAP)早期治疗中应用的可行性、临床价值与技术特点。方法用LPLD的方法早期治疗21例SAP病人,对治疗结果进行回顾性分析。结果LPLD手术时间(654±276)min,术后灌洗引流时间(113±86)d,术后住院时间(325±146)d。LPLD同期完成腹腔镜胆囊切除术5例,腹腔镜经胆囊管胆总管取石1例,胆总管切开取石、T管引流术2例。1例术后4d死于多脏器功能障碍综合征(MODS),余20例治愈出院。术后随访2～22个月,发现假性胰腺囊肿1例,行内引流手术治愈。结论LPLD是SAP早期治疗中一种安全可行的方法,它用微创的方法达到开腹手术全面探查、充分灌洗引流治疗SAP的目的,值得临床推广应用。