效益评价中指标筛选及其假设检验

西文介绍了综合效益评价中指标的逐步筛选及其假设检验方法，用该法选出的指标具有独立性强、代表性好的优点。同是分析处理了全国３４家县级医院的投入指标，从中筛选出５个指标参与评价。     

益母草防治初发期急性肾小管坏死的实验研究

ＳＤ成年雄性大鼠，禁止１６小时，肌注甘油引起急性肾小管坏死（ＡＴＮ），于其初发期给予不同药液，观察到益母草组３、２４及４８小时Ｂｃｒ升高值，２４及４８小时ＢＵＮ升高值均明显低于自来水组和单纯禁水组，而与校正对照异搏停组近似，肾组织损伤程度亦明显减轻。结果表明，益母草对初发期急性肾小管坏死（ＩＡＴＮ）有一定的防治作用。     

成核效应蛋白在泡凝聚融合过程中作用的初步研究

为了探讨成核效应蛋白在泡凝聚、融合过程中的作用，作者研究了胆汁中主要的促成核蛋白系统—ＣｏｎＡ结合蛋白对模拟胆汁泡的形态与脂类组成的影响，发现ＣｏｎＡ结合蛋白在加快泡凝聚与融合的同时，也使泡胆固醇增加，磷脂减少，泡胆固醇／磷脂比增高，认为成核效应蛋白促泡凝聚与融合的本质是改变了泡胆固醇饱和度。作者的初步研究还发现泡相蛋白虽量微却具有强的促成核活性；几种已知的成核效应蛋白在泡相与微胶粒相的分布有差异；胆固醇结石患者与色素结石患者相比，泡蛋白的量与促成核活性均增高。通过泡蛋白亲和染色技术，还发现ＣｏｎＡ结合蛋白能与模拟胆汁泡形成脂质－蛋白复合体。作者认为，泡中成核效应蛋白的存在或量与质的改变，在泡凝聚与融合过程中起重要作用。     

儿童阻塞性睡眠呼吸暂停低通气综合征的治疗

目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome，OSAHS)患儿的治疗方法和疗效观察。方法经多道睡眠监测(polysomnography，PSG)确诊的4～12岁OSAHS患儿59例：扁桃体切除和(或)经口内镜(内窥镜，下同)引导下腺样体刮除54例；选择长期正压通气治疗(continue positive airway pressure，CPAP)2例；保守治疗3例。采用儿童OSAHS生活质量调查表(quality of life for children with obstructive sleep apnea 18 items，OSA-18)对患儿进行治疗前后的随访。结果围手术期无术后出血、急性呼吸道梗阻发生。随访12～18个月，手术患儿无鼻咽闭锁、咽鼓管功能障碍、腺样体残留等并发症；OSA-18调查评分显示：治疗后76．3％(45例)的患儿生活质量总体指标，88．1％(52例)的患儿睡眠呼吸障碍，67．8％(40例)的患儿身体症状得到显著改善。长期CPAP治疗的有效治疗压力在5．6～7．8cm H2O左右。3例保守治疗者略有改善。结论手术切除引起上气道阻塞的肥大的扁桃体和(或)腺样体是儿童OSAHS有效的治疗手段之一，纤维鼻咽镜检查、头颅侧位X线摄片有助于手术适应证的确定。经口内镜引导下腺样体刮除术具有直视下操作，视野清晰，切除彻底，可避免损伤周围重要结构的特点。     

关于课堂多媒体教学的思考

多媒体教学已成为课堂教学的一种常用手段，多媒体教学应从实际需要出发，以提高教学效果为目标；需要教师掌握多种计算机及多媒体知识技能，科学地进行教学设计；教学过程中应发挥多媒体的优势，注重师生交流。对此本文进行了探讨。     

Tuimorigenic activity of fluoranthene, 2-methylfluoranthene and 3-methylfluoranthene in newborn CD-I mice

Fluoranthene (FA) is frequently among the more abundant componentsdetected in environmental mixtures of polycyclic aromatic hydrocarbons.Several methylated fluoranthenes, although less prevalent thanFA, have also been detected as environmental pollutants. WhileFA is inactive as a tumorigenic agent on mouse skin, it doesinduce lung and liver tumors in newborn mice. Among the fiveisomers of methylfluoranthene, only 2-methylfluoranthene (2-MeFA)and 3-methylfluoranthene (3-MeFA) are active as tumor initiatorson mouse skin. A comparative bioassay was performed to determinethe relative tumorigenic activity of FA, 2-MeFA and 3-MeFA innewborn CD-1 mice. All three compounds were assayed at dosesof 3.46 and 17.3 µmol. The bioassay was terminated whenmice were 1 year old. At a dose of 17.3 µmol, FA and 2-MeFAinduced a similar incidence of lung tumors (65–96%) inboth male and female mice. However, tumor multiplicity in thelung was different between FA and 2-MeFA. At a dose of 17.3µmol, the multiplicity of lung tumors observed for miceadministered 2-MeFA ranged from 3.04 to 3.94 tumors per mouse.In contrast, animals treated with FA developed only an averageof 1.12–2.45 tumors per mouse. 3-MeFA did not induce astatistically significant incidence of lung tumors in eithermale or female mice. All three compounds when administered tonewborn mice did induce a significant incidence of liver tumorsamong male mice. The relative tumorigenic potency observed wasFA 5     

Influence of blood supply of the esophageal and gastric stumps on anastomotic healing after esophagogastrostomy in rabbits]

OBJECTIVE: To study how blood supply of the esophageal and gastric stumps influences the anastomotic healing after esophagogastrostomy in rabbits. METHODS: Twenty-seven New Zealand rabbits were randomly divided into 3 groups to receive esophagogastrostomy, followed by different procedures. Except for those in group I, all the rabbits were subjected to procedures of reducing the blood supply either of the esophageal or the gastric stump (group II and group III, respectively), followed by single-layer esophagogastric anastomoses using interrupted 5-0 polypropylene sutures. Ten days after operation, all the rats were killed and the anastomotic sites excised for measurement of the inner diameter, tensile strength, and hydroxyproline concentration. RESULTS: Healing of the esophagograstric anastomosis was obtained in all the rabbits but one with anastomotic leakage in group I and one with perforation of the gastric fundus in group III. The anastomotic inner diameters were similar in all the three groups, whereas the tensile strength and hydroxyproline concentration at the anastomoses decreased in group III in comparison with the other two groups (P<0.05) that had similar measurements (P>0.05). CONCLUSIONS: Extended length of the free esophageal stump does not significantly affect anastomotic healing as decrease of blood supply in the gastric stump.     

The effect of vascular endothelial growth factor on the healing of ischaemic skin wounds.

The effect of exogenous vascular endothelium growth factor (VEGF) on wound healing in an ischaemic skin flap model was evaluated in this study. Seventy-two Sprague-Dawley rats were used. Normal incisional wound and H-shaped double flaps were used as the wound models. The study was divided into two parts. In Part I, VEGF protein levels were determined from the incisional and H-shaped ischaemic wounds at 12 and 24 h, postoperatively. In Part II, tensile strength and immunohistochemical stains were examined to determine the level of microvessel density (MVD) at 1 and 2 weeks, postoperatively in simple incisional wounds, ischaemic wounds, and ischaemic wounds following 1 ml (1 microg/ml) exogenous VEGF injections into the subcutaneous tissue. The results showed a significantly higher level of VEGF protein in the ischaemic wounds than the incisional wounds. Tensile strength was statistically higher in the incisional wound group and in the ischaemic flap wounds with VEGF treatment compared to the ischaemic flaps with no treatment at 1 week, postoperatively (p>0.05). MVD data indicated that ischaemic wound repair with VEGF treatment had significantly higher MVD than the normal incisional wounds and ischaemic wounds without treatment. We conclude that exogenous application of VEGF can increase early angiogenesis and tensile strength in the ischaemic wound.     

Dislocation of an upper third molar into the maxillary sinus after a severe trauma: a case report

Abstract – Dental injuries are common following facial trauma. This article presents a rare injury: the dislocation of a third molar into the maxillary sinus after complex mandibular and maxillary tuberosity fractures. The possible mechanism and clinical treatment are discussed.