概念式教学法实施中临床教师态度与行为调查

目的探讨概念式教学法实施中临床教师的态度与行为状况。方法将2001级33名护生分为对照组，2002级、2003级27名护生分为观察组。对照组采用传统教学法，即理论授课毕后再行临床实习；观察组采用概念式教学法，即理论授课与临床实习同期进行。采用临床教师态度和行为调查问卷评价临床教师的态度与行为。结果观察组专业胜任、人际关系、人格特质、教学能力等4项内容评价结果．显著低于对照组（均P〈0．01）。结论概念式教学模式给临床护理教师提出了更高的要求，临床教师应从专业胜任、人际关系、人格特质、教学能力等方面进行态度与行为的修正和自我完善。     

青少年特发性胸椎侧凸患者的脊髓偏移及临床意义

[目的]揭示青少年胸椎特发性侧凸患者椎管内脊髓的偏移，明确其变化趋势，并探讨其可能的发生机制和临床意义。[方法]本研究包括39名以右胸弯为主弯的青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者。测量主胸弯节段内（T5-12）椎管内脊髓与凸凹侧椎弓根之间的距离，计算脊髓的偏移，揭示其变化趋势，并分析顶椎区脊髓偏移与主胸弯Cobb＇s角和顶椎相对偏移之间的相关性。[结果]在T5-12节段椎管内，脊髓与凸侧椎弓根之间的距离显著大于与凹侧椎弓根之间的距离（P〈0．05），即脊髓向凹侧椎弓根偏移，且以顶椎区最为显著，而逐渐向两侧端椎区递减。顶椎区脊髓偏移与主胸弯Cobb’s角和顶椎相对偏移存在显著的正相关（相关系数分别为0．631和0．546）。[结论]胸椎特发性脊柱侧凸患者存在侧凸节段椎管内脊髓偏移的现象，且以顶椎区最显著。研究结果提示脊髓偏移可能与脊椎偏移后凹侧脊神经的牵拉有关，而且凹侧置钉的风险高于凸侧。     

38例视网膜母细胞瘤的临床和误诊分析

目的 探讨视网膜母细胞瘤（retinoblastoma，RB）的临床特征、病理分类和误诊原因，尽可能减少错误的临床诊治。方法 对我科于1999-2004年间收集的38例临床诊断为视网膜母细胞瘤（retinoblastoma，RB）的病例资料进行回顾性分析。结果在38例疑似病例中，34例病理诊断为视网膜母细胞瘤，4例为Coats病。结论掌握相关的影像学知识和综合分析疑难病例的临床资料将有助于视网膜母细胞瘤的正确诊断和处理。     

Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort

Abstract   We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing vs. insulin-providing treatments for diabetes. A total of 2,368 patients with type 2 diabetes and CAD was evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression adjusted for multiple covariates including age, sex, hemoglobin A1c (HbA1c), and diabetes duration. Fifty-one percent of BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR = 1.57, 95% CI: 1.15–2.13). Patients on sulfonylurea (SU) or combination of SU/metformin (Met)/thiazolidinediones (TZD) had marginally higher rates of DPN than the Met/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control, and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN.     

Lipid extract from completely sporoderm‐broken germinating Ganoderma sinensis spores elicits potent antitumor immune responses in human macrophages

Ganoderma sinensis has been used widely in Oriental countries for the prevention and treatment of various diseases including cancer. Previous studies have shown that the lipid extract from Ganoderma exhibits direct cytotoxicity against tumor cells. Here, it is reported that the lipid extract from germinating G. sinensis spores, at lower concentrations that have no direct tumoricidal activity, induce potent antitumor immune responses in human monocytes/macrophages. Upon stimulation with the lipid extract, monocytes/macrophages exhibited markedly increased production of proinflammatory cytokines and surface expression of costimulatory molecules. Conditioned medium from stimulated cells effectively suppressed the growth of tumor cells. Apparently, the lipid extract triggered macrophage activation via a mechanism different from that associated with LPS. Moreover, it was observed that the lipid extract could partially re‐establish the antitumor activity of the immunosuppressive tumor‐associated macrophages. These results indicated that in addition to its direct tumoricidal activity, the lipid extract from G. sinensis spores could exert antitumor activity by stimulating the activation of human monocytes/macrophages. Copyright © 2008 John Wiley & Sons, Ltd.     

心脾综合征的多普勒超声心动图诊断

目的:探讨多普勒超声心动图对心脾综合征的诊断价值,分析其心脏伴随畸形漏诊及误诊原因,提高对心脾综合征诊断的准确率。方法:本文总结了221例心脾综合征患儿的超声检测结果,并与其心血管造影或磁共振检查结果进行对照。结果:超声心动图诊断为心脾综合征与心导管或磁共振结论符合者199例(占90.0%),诊断不符合者22例(占10.0%)。结论:多普勒超声心动图可以较准确地诊断心脾综合征,但对其心脏伴随畸形检出的准确率尚待进一步提高。     

肥胖类型与脑卒中亚型的相关性研究

目的探讨肥胖类型与脑卒中亚型的相关性。方法将573例急性脑卒中患者分为脑出血组126例,脑梗死组447例,脑梗死组再分为脑血栓形成组(215例)和腔隙性脑梗死组(232例),另外选择277例无脑卒中者为对照组。测量腰围、臀围和体重,计算体重指数和腰臀比(WHR),分析肥胖参数与脑卒中各亚组的关系。结果脑卒中各亚组与对照组肥胖发生率差异无显著性意义(P>0.05);各组WHR明显大于对照组(P<0.05)。WHR增大明显增加脑卒中各亚组的危险性(P<0.05);女性腹围增大患腔隙性脑梗死危险性升高(P<0.05);男性体重增加患脑出血的危险性升高(P<0.01)。结论腹型肥胖是脑出血、脑血栓形成和腔隙性脑梗死的危险因素之一。     

Changes in T .lymphocyte subsets after severe traumatic brain inJury

BACKGROUND： Besides local changes of cranial parenchymal cells, hemorrhage, etc., severe traumatic brain injuries also cause the changes of total body fluid and various functions, and the changes of lymphocytes and T lymphocyte subsets should be paid more attention to. OBJECTIVE： To reveal the changing laws of T lymphocyte subsets after severe traumatic brain injury, and compare with mild to moderate brain injury. DESIGN： A comparative observation. SETTINGS： Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City; Central Laboratory of Shenzhen Hospital of Prevention and Cure for Chronic Disease. PARTICIPANTS： All the subjects were selected from the Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City from August 2002 to August 2005. Thirty patients with severe brain injury, whose Glasgow coma score （GCS） was ≤ 8 points, were taken as the experimental group, including 21 males and 9 females, aging 16 - 62 years. Meanwhile, 30 patients with mild traumatic brain injury were taken as the control group （GCS ranged 14- 15 points）, including 18 males and 12 females, aging 15 -58 years. All the subjects were in admission at 6 hours after injury, without disease of major organs before injury Informed consents were obtained from all the patients or their relatives. METHODS： （1） The T lymphocytes and the subsets in peripheral blood were detected with immunofluorescent tricolor flow cytometry at l, 3, 7 and 14 days after injury in both groups. （2） The conditions of pulmonary infections were observed at 4 days after injury. The differences of measurement data were compared with the t test. MAIN OUTCOME MEASURES： Changes of T lymphocytes subsets at 1 - 14 days after severe and mild or moderate traumatic injury. RESULTS： Finally, 28 and 25 patients with mild to moderate traumatic brain injury, whereas 25 and 21 patients with severe traumatic brain injury were analyzed at 7 and 14 days respectively, and the missed ones died due to the development of disease. （1） Changes of T lymphocyte subsets： At 1 and 3 days after injury, CD3, CD4, CD8, CD4/CD8 began to decrease, whereas CD8 increased in the experimental group, which were very significantly different from those in the control group （t =2.77 - 3.26, P 〈 0.01）, and began to recover at 7 days, which were significantly different from those in the control group （t = 2.06 - 2.24, P 〈 0.05）, and generally recovered to the normal levels at 14 days （P 〉 0.05）. （2） Conditions of pulmonary infections： At 4 days after injury, the rate of pulmonary infection was significantly different between the experimental group and control group [73% （22/30）, 0, x2=37.29, P 〈 0.01]. CONCLUSION： Patients with severe traumatic brain injury suffer from damages of cellular immune function at early period （within 7 days）, and they are easily to be accompanied by pulmonary infections.     

复合矫治弓丝接头的力学性能及接头组织观察

目的　测试复合矫治弓丝接头的机械性能及分析接头、接头断口变化。方法　测试复合矫治弓丝接头的拉伸强度、剪切强度、扭转强度、弯曲形变残余角,TiNi形状记忆合金丝超弹性,扫描电镜观察及分析接头、断口组织变化。结果　复合矫治弓丝接头抗拉伸强度为32 0～36 0MPa ,剪切强度为2 2 0～2 5 0MPa ,抗扭转强度为30～4 0N·m、断裂时扭转角度不小于1 4 4 0°,弯曲形变残余角为1 2～1 7°;钎焊异质接头中TiNi形状记忆合金丝超弹性几乎没有破坏;接头钎料与TiNi形状记忆合金界面不存在扩散层,与不锈钢丝界面之间有一较宽的扩散层,接头断裂多发生在钎料与TiNi形状记忆合金超弹界面处,部分发生在钎缝中心。结论　复合矫治弓丝机械性能符合正畸临床要求,可应用于临床。