Auditing paediatric diabetes care and the impact of a specialist nurse trained in paediatric diabetes

AIMS: To define outcome measures for auditing the clinical care of children and adolescents with insulin dependent diabetes mellitus (IDDM) and to assess the benefit of appointing a dedicated paediatric trained diabetes specialist nurse (PDSN). METHODS: Retrospective analysis of medical notes and hospital records. Glycaemic control, growth, weight gain, microvascular complications, school absence, and the proportion of children undergoing an annual clinical review and diabetes education session were assessed. The effect of the appointment of a PDSN on the frequency of hospital admission, length of inpatient stay, and outpatient attendance was evaluated. RESULTS: Children with IDDM were of normal height and grew well for three years after diagnosis, but grew suboptimally thereafter. Weight gain was above average every year after diagnosis. Glycaemic control was poor at all ages with only 16% of children having an acceptable glycated haemoglobin. Eighty five per cent of patients underwent a formal annual clinical review, of whom 16% had background retinopathy and 20% microalbuminuria in one or more samples. After appointing the PDSN the median length of hospital stay for newly diagnosed patients decreased from five days to one day, with 10 of 24 children not admitted. None of the latter was admitted during the next year. There was no evidence of the PDSN affecting the frequency of readmission or length of stay of children with established IDDM. Non-attendance at the outpatient clinic was reduced from a median of 19 to 10%. CONCLUSIONS: Outcome measures for evaluating the care of children with IDDM can be defined and evaluated. Specialist nursing support markedly reduces the length of hospital stay of newly diagnosed patients without sacrificing the quality of care.     

肾上腺素诱导兔血小板聚集的实践与理论探讨

目的创建以Ａｄｒ诱导兔血小板聚集的方法，并对受体分子特性作初步探讨。方法以高Ｋ＋缓冲液等取代兔ＰＲＰ中血浆，以Ａｄｒ诱导聚集，以Ａｐｙｒ证实结果。结果兔血小板悬浮于高Ｋ＋缓冲液时Ａｄｒ能单独诱导真正的聚集。结论由此推测血小板膜上α２肾上腺素受体分子可能为由两种亚单位组成：促聚亚单位和辅助亚单位。人辅助亚单位当Ａｄｒ浓度高达聚集阈值以上时可被激活，与促聚亚单位结合为活性的二聚体，与Ａｄｒ进一步结合发生聚集作用。兔辅助亚单位则还需要高Ｋ＋方能被激活     

氯硝安定与安定溶液直肠给药用于惊厥急救的对照研究

目的以安定为对照，探讨氯硝安定溶液直肠给药对惊厥急救的实用价值。方法在２８例儿童中对比观察直肠注入氯硝安定与安定溶液的吸收速度和对脑电活动的影响，并比较两药对大鼠实验性惊厥的疗效。结果氯硝安定与安定溶液均能从直肠迅速吸收，皆于用药５分钟后达有效血浓度，分别于３～８分钟及２～８分钟对脑电活动产生显著影响，明显抑制癫痫样波发放，使美解眠诱发的惊厥致死率从对照组的７０％降为０。结论氯硝安定与安定溶液直肠给药，均能作为小儿惊厥抢救的有效措施。     

喉腔及喉咽部平滑肌肉瘤3例报告

为了解发生于喉腔及喉咽部的平滑肌肉瘤的临床特点，报告１例喉咽部平滑肌肉瘤和２例喉腔平滑肌肉瘤患者早期症状都不明显，且无特异性，临床表现与该部常见鳞癌极为相似，术前明确诊断有一定困难。     

咽旁间隙肿瘤及手术入路

为探讨咽旁间隙肿瘤的手术方法及入路的选择。报告６６例经各种手术入路治疗的良、恶性肿瘤。结果表明，经颈或经颈合并下颌及正中裂开外旋入路较之其他几种手术入路具有手术适应证广、安全、术后并发症少等优点。认为经颈或经颈合并下颌正中裂开外旋入路是一种安全、彻底切除咽旁间隙原发肿瘤效果最好的入路。     

组织蛋白酶D在ⅡB型骨肉瘤中的表达及其临床意义

目的探讨组织蛋白酶Ｄ（ＣＤ）与骨肉瘤患者预后的关系。方法应用免疫组化技术检测３４例骨肉瘤组织标本中的ＣＤ表达水平，并结合患者临床病案记录和随访资料进行分析。结果ＣＤ高表达与低表达之间的肿瘤转移人数和２年生存人数差异显著，且ＣＤ低表达患者的平均生存时间较高表达者为长。经Ｋａｐｌａｎ┐Ｍｅｉｅｒ分析，两组间生存率有显著差异。结论ＣＤ高表达的骨肉瘤易发生转移，预后不良，应加强治疗。     

刺五加注射液治疗脑出血的临床评价

30例高血压脑出血患者在常规疗法基础上加用紫外线辐射血液疗法作为对照组,另30例在上述疗法基础上加用刺五加注射液静脉滴注为治疗组。结果治疗组显效率96.7％,总有效率100％,对照组显效率60.0％,总有效率83.3％,治疗组明显优于对照组(P<0.01)。表明刺五加注射液不仅用于缺血性脑梗塞的治疗,而且也可用于脑出血,对出血量在30ml以下的病例,疗效较好。     

Hydrocephalus in the H-Tx rat: a monogenic disease?

The H-Tx rat is a genetic model of hydrocephalus for which thereis a poor understanding of the mode of inheritance.Previous studies suggested a polygenicmode of inheritance but the breeding data to supportthis hypothesis have not been reported. In an attempt to clarify the hereditary mode we have analyzed the data from eight generations of H-Tx rats and four generations of cross-matings between H-Tx rats and Sprague-Dawley (SD) rats. In the H-Tx rat colony 113 of 129 random brother-sister matings (87.60%) produced hydrocephalic offspring, with males and females being equally affected. The overall incidence varied greatly with an average of 30. 35%. In matings with more than three litters, all mating pairs yielded hydrocephalic pups. In cross-matings both hydrocephalic and normal H-Tx rats were mated with normal SD rats. No hydrocephalus was observed in the first generation of 124 pups (F1). Subsequent brother-sister matings of F1 animals generated hydrocephalic pups in the F2 generation with a lower incidence (4.67% in hydrocephalic HTx/SD matings and 5.11% in normal HTx/SD matings, respectively) than in the H-Tx rat colony (30.35%). Back-cross-matings between F2 rats and normal H-Tx rats yielded an incidence of hydrocephalus higher than that of the cross-matings but lower than that of the H-Tx colony. These data strongly suggest that the H-Tx rat is a homozygous carrier of an autosomal recessive hydrocephalus gene with incomplete penetrance. Furthermore, the data clearly rule out sex-linked and polygenic modes of inheritance and provide further insight with respect to genetic inheritance of hydrocephalus.     

人工耳蜗植入者音乐感知能力的初步研究

目的　建立测试人工耳蜗植入者音乐感知能力的体系 ,研究语后聋成人和语前聋儿童人工耳蜗植入后对音乐感知的能力。方法　构建测试用的标准钢琴音调和乐曲测试素材库 ,运用该素材库在CakewalkPro 8.0平台上进行音调和乐曲的感知能力测试 ,测试对象包括已植入多导人工耳蜗的 2名语后聋成人、8名语前聋儿童和各自的正常对照组。结果　建立了一个可用于人工耳蜗植入者音乐感知能力测试的系统。音调差异感知阈 (df/f)在植入人工耳蜗的语后聋成人和语前聋儿童分别为 7.78%± 6 .6 3%和 14 .4 9%± 11.2 0 % ,与各自正常人对照组比较有显著性差异 ;但两组间无显著性差异。植入人工耳蜗的语后聋成人在熟悉乐曲测试中 ,对正确乐曲的感知差异度为 - 2 .75± 0 .35 (半音 ) ,离散度为 1.5 0± 0 .71(半音 ) ,都与正常成人有显著性差异。结论　运用数字音乐技术和MIDI软件建立的这一测试系统能够方便的测试人工耳蜗植入者的音乐感知能力。人工耳蜗植入者音乐感知能力不及正常人