8年间剖宫产率及指证变化的临床分析

近年来，我国各地的剖宫产率均呈明显的上升趋势，部分地区的剖宫产率甚至高达60％。居高不下的剖宫产率已引起了广大产科工作者和全社会的广泛关注。对我院近8年来剖宫产病例的临床资料进行回顾性分析，以寻求剖宫产率逐年上升的原因及探讨降低剖宫产率的途径与方法。     

Assessing ethical problem solving by reasoning rather than decision making

Context The assessment of ethical problem solving in medicine has been controversial and challenging. The purposes of this study were: (i) to create a new instrument to measure doctors’ decisions on and reasoning approach towards resolving ethical problems; (ii) to evaluate the scores generated by the new instrument for their reliability and validity, and (iii) to compare doctors’ ethical reasoning abilities between countries and among medical students, residents and experts. Methods This study used 15 clinical vignettes and the think‐aloud method to identify the processes and components involved in ethical problem solving. Subjects included volunteer ethics experts, postgraduate Year 2 residents and pre‐clerkship medical students. The interview data were coded using the instruments of the decision score and Ethical Reasoning Inventory (ERI). The ERI assessed the quality of ethical reasoning for a particular case (Part I) and for an individual globally across all the vignettes (Part II). Results There were 17 Canadian and 32 Taiwanese subjects. Based on the Canadian standard, the decision scores between Taiwanese and Canadian subjects differed significantly, but made no discrimination among the three levels of expertise. Scores on the ERI Parts I and II, which reflect doctors’ reasoning quality, differed between countries and among different levels of expertise in Taiwan, providing evidence of construct validity. In addition, experts had a greater organised knowledge structure and considered more relevant variables in the process of arriving at ethical decisions than did residents or students. The reliability of ERI scores was 0.70–0.99 on Part I and 0.75–0.80 on Part II. Conclusions Expertise in solving ethical problems could not be differentiated by the decisions made, but could be differentiated according to the reasoning used to make those decisions. The difference between Taiwanese and Canadian experts suggests that cultural considerations come into play in the decisions that are made in the course of providing humane care to patients.     

ISOLATION OF VIRULENT TREPONEMA PALLIDUM FRQM HUMAN AORTA THIRTY-TWO HOURS AFTER DEATH FROM CARDIOVASCULAR SYPHILIS

After a comprehensive rernew of the literature on syphilitic aortitis, Longcope, (1) stated in 1913; ": . . . the presence of spiro: chetes in these lesions, as might be expected, cannot by any means be constantly demonstrated with Levaaiti stain. . . . . . . That these organisms are ''Treponema pallidum seems almost certain thouS:h actual proof of such by culture from the arterial lesions, a most difficult task, or direct inoculation into animals, has not as yet been accomplished."     

中药内外合治治疗类风湿性关节炎的研究进展

类风湿性关节炎(RA)是以慢性对称性多关节无菌性炎症为主要表现的一种全身性自身免疫性疾病。其发病机制尚未完全明确,因而临床上还缺乏特异性治疗措施。而中医在治疗痹症上有悠久的历史,特别是中药内外合治疗效明显,有其独特的优越性。目前,中药内外合治RA主要集中在以下方面。1.中药内服和中药熏洗合治。史永博[1]介绍陕西中医学院李彦民主任医师运用仙龙颗粒(威灵仙、川乌、秦艽、乌梢蛇、细辛、穿山甲等)口服治疗寒湿阻络型痹症,并在上述内服药渣中加透骨草、红花、花椒、艾叶等,共煎水外洗,热敷患处,作为外用药配合使用。120例病例中…     

Low HDL‐cholesterol is common in European Type 2 diabetic patients receiving treatment for dyslipidaemia: data from a pan‐European survey

Aims To measure the prevalence of low high‐density lipoprotein (HDL)‐cholesterol (men < 1.03 mmol/l; women < 1.29 mmol/l) in European Type 2 diabetic patients receiving treatment for dyslipidaemia. Methods The pan‐European Survey of HDL‐cholesterol measured lipids and other cardiovascular risk factors in 3866 patients with Type 2 diabetes and 4436 non‐diabetic patients undergoing treatment for dyslipidaemia in 11 European countries. Results Diabetic patients were more likely to be obese or hypertensive than non‐diabetic patients. Most patients received lifestyle interventions (87%) and/or a statin (89%); treatment patterns were similar between groups. Diabetic patients had [means (SD)] lower HDL‐cholesterol [1.22 (0.37) vs. 1.35 mmol/l (0.44) vs. non‐diabetic patients, P < 0.001] and higher triglycerides [2.32 (2.10) vs. 1.85 mmol/l (1.60), P < 0.001]. More diabetic vs. non‐diabetic patients had low HDL‐cholesterol (45% vs. 30%), high triglycerides (≥ 1.7 mmol/l; 57% vs. 42%) or both (32% vs. 19%). HDL‐cholesterol < 0.9 mmol/l was observed in 18% of diabetic and 12% of non‐diabetic subjects. Differences between diabetic and non‐diabetic groups were slightly greater for women. LDL‐ and total cholesterol were lower in the diabetic group [3.02 (1.05) vs. 3.30 mmol/l (1.14) and 5.12 (1.32) vs. 5.38 mmol/l (1.34), respectively, P < 0.001 for each]. Conclusions Low HDL‐cholesterol is common in diabetes: one in two diabetic women has low HDL‐cholesterol and one diabetic man in four has very low HDL‐cholesterol. Management strategies should include correction of low HDL‐cholesterol to optimize cardiovascular risk in diabetes.     

Carotid surgery in stroke prevention

Extracranial carotid disease accounts for up to 50 percent of strokes. Transient ischemic attacks are associated with a 30 to 35 percent risk of stroke within five years of the initial episode. Carotid endarterectomy is a safe and effective way of reducing the risk of stroke in patients with TIAs. It is also helpful in patients with amaurosis fugax, and may benefit selected patients with acute stroke or those with asymptomatic but hemodynamically significant stenosis.     

老年人急性阑尾炎的腹腔镜手术治疗

目的 探讨老年人急性阑尾炎的临床特点，更好地把握腹腔镜阑尾切除（LA）术的方法和特点。方法 回顾分析50例老年人急性阑尾炎LA的临床资料。结果 LA均获成功，患者全部治愈，无严重的并发症发生，肠功能恢复时间及住院时间均缩短。结论 老年人反应迟钝，阑尾炎进展快，易发生坏疽及穿孔，合并症多，手术风险较高，LA是安全、可行的，除个别腹膜后阑尾炎外，其余均可施行LA。     

The fit of fixed partial dentures joined by infrared soldering.

This study determined the accuracy of fit of three-unit fixed partial dentures joined by an infrared soldering technique compared with one-piece fixed partial denture castings and individually cast crowns. Wax patterns of prepared Ivorine teeth, maxillary left central incisor and maxillary left canine, were injection molded; a plastic rod was used as a pontic. One group of patterns was cast as one-piece dentures; the other group was sectioned in the connector area, cast individually and then joined by infrared soldering. Castings were seated on their respective dies, embedded in epoxy resin, and sectioned. Gap distances between the casting and the die were measured at specified marginal sites with a profile projector. Results showed that the fit of infrared-soldered fixed partial dentures was significantly better than that of one-piece castings and was comparable with the fit of single crowns. The gap openings measured in all castings were within the range of clinical acceptability.