河北省怀来县农村儿童车祸伤害及其预防

本文对河北省怀来县农村0～14岁儿童车祸发生情况进行了调查,调查年限为1990年1月1日～1991年12月31日.结果表明.在上述调查年间因车祸死亡10人,受重伤30人.年均死亡专率和受伤率(1990～1991)分别为5.6/10万和14.7/10万,男女比例为1:0.6.75％的肇事车辆为机动车,儿童居住在公路附近、小年龄儿童无成年人看护、不遵守交通规则是车祸发生的高危因素,而气候、道路类型、家庭经济收入及家长年龄则与车祸的发生无关.调查年间车祸导致的潜在寿命损失为570年,学龄儿童因车祸受伤而致缺课1500节。儿童期车祸的预防,关键在于普及交通法规、对小年龄儿童进行集体管理、对学龄儿童及家长强化安全意识。     

A Comparison of the Kampala Trauma Score (KTS) with the Revised Trauma Score (RTS), Injury Severity Score (ISS) and the TRISS Method in a Ugandan Trauma Registry

Abstract Background: The public health significance of injuries that occur in developing countries is now recognized. In 1996, as part of the injury surveillance registry in Kampala, Uganda, a new score, the Kampala Trauma Score (KTS) was instituted. The KTS, developed in light of the limited resource base of sub-Saharan Africa, is a simplified composite of the Revised Trauma Score (RTS) and the Injury Severity Score (ISS) and closely resembles the Trauma Score and Injury Severity Score (TRISS). Patients and Methods: The KTS was applied retrospectively to a cohort of prospectively accrued urban trauma patients with the RTS, ISS and TRISS calculated. Using ROC (receiver operating characteristics) analysis, logistic regression models and sensitivity and specificity cutoff analysis, the KTS was compared to these three scores. Results: Using logistic regression models and areas under the ROC curve, the RTS proved a more robust predictor of death at 2 weeks in comparison to the KTS. However, differences in screening performance were marginal (areas under the ROC curves were 87% for the RTS and 84% for the KTS) with statistical significance only reached for an improved specificity (67% vs. 47%; p < 0.001), at a fixed sensitivity of 90%. In addition, the KTS predicted hospitalization at 2 weeks more accurately. Conclusion: The KTS statistically performs comparably to the RTS and ISS alone as well as to the TRISS but has the added advantage of utility. Therefore, the KTS has potential as a triage tool in resource-poor and similar health care settings.     

重症肌无力病人的临床绝对评分法和相对评分法

提出并详细描述一种对重症肌无力（ＭＧ）病人的临床绝对和相对评分法。方法运用统计学方法对这一评分法的可靠性和敏感性做了检验，对２０例ＭＧ病人的临床绝对评分结果做Ｋａｐｐａ检验；对１２例ＭＧ病人的相对评分结果做ｔ检验。结果表明本方法可重复性较好，且能敏感地反映出临床病情变化，是一种评价ＭＧ病人受累肌群肌肉无力情况及临床治疗效果的较为精确和稳定的量表化方法。结论临床绝对评分法和相对评分法对判断重症肌无力患者的病情和疗效具有一定的必要性和可行性。     

广东省不同经济水平地区住院伤害患者情况的比较

目的:探索经济因素对伤害发生、死亡的影响。方法:对因伤害就诊并住院于广东省经济水平不同的3个地区综合医院的患者进行调查，了解并比较伤害发生的外部原因、死亡、医疗结局、经济花费等情况。结果:在1997—2001年，不同经济水平的3个地区的机动车交通事故在住院伤害患者中所占比重均为最大。不同经济水平地区对伤害的治疗疗效不同。A地区的疗效呈上升趋势，B与C地区的疗效未呈现出变化迹象。A与B地区的医疗费用有逐年上升趋势。C地区未显示伤害医疗费用有随时间的变化趋势。结论:不同经济发展水平的地区主要伤害类型的分布不同，对住院伤害患者的治疗疗效也不同。住院伤害患者医疗费用的变化趋势也不同，因此应根据地区的经济发展水平．确定不同的伤害预防策略。     

GDNF, Ret, GFRα1 and 2 in the adult rat retino-tectal system after optic nerve transection

In the present study, we have studied the expression of glial cell line-derived neurotrophic factor (GDNF) and its receptors Ret, GFRα1, and GFRα2 in the retino-tectal system before and after optic nerve transection. Using retrograde neuronal tracing in combination with in situ hybridization, we found that Ret and GFRα1 are expressed by 13–14% of the retinal ganglion cells (RGCs). These Ret-expressing RGCs could not be identified as belonging to any particular of the RG_A, RG_B, and RG_C sub types. Ret is co-expressed with the brain-derived neurotrophic factor receptor TrkB in these RGCs. Optic nerve transection resulted in reduced Ret mRNA levels in retina, while the levels of GDNF, GFRα1, and 2 mRNA increased. Administration of GDNF protein supported the axotomized RGCs. Analysis of normal superior colliculus (SC) did not show any expression of GDNF mRNA, yet GDNF mRNA levels in SC increased after injury. Together, these findings identify a portion of RGCs as being possible targets for pharmacological treatment with GDNF in a direct mode of action. The absence of detectable GDNF mRNA in normal SC questions the role for GDNF as being a target-derived factor produced in the SC for adult RGCs. The results support a function for GDNF locally in the retina and as part of an injury-induced system that may act to enhance neuroprotective and neuroregenerative responses both to endogenous GDNF ligands and those administered exogenously.     

体外震波碎石前后血浆和尿液PGI2与TXA2的变化及其临床意义

应用放射免疫技术，对１４例非梗阻性单纯肾结石患者ＳＥＷＬ前后血浆和尿液中ＴＸＢ２和６－ｋｅｔｏ－ＰＧＦ１ａ水平进行了动态检测。结果显示，血浆ＴＸＢ２在ＥＳＷＬ后第一天明显升高（Ｐ＜０．００１），而６－ｋｅｔｏ－ＰＧＦ１α无显著意义的改变（Ｐ＞０．０５），两者的比值也随ＴＸＢ２而升高（Ｐ＜Ｏ．００１），第三天时都降至基础水平；尿液中上述指标也出现类似变化。我们认为，ＥＳＷＬ后早期肾脏内ＴＸＡ２合成与释放增加，ＴＸＡ２与ＰＧＩ２平衡失调，有可能参与了肾损害的病理生理过程。     

医源性胆管损伤的预防及治疗

本文报告医源性胆管损伤２５例，其中急诊手术损伤９例，择期手术损伤１６例（１例系腔镜胆囊切除术中损伤）。文中重点对胆囊切除术中胆管损伤常见的５种原因与预防、损伤时术中及术后的临床特点和早期诊断、以有损伤后的处理原则与方法进行讨论。     

齿状突螺钉加压固定治疗齿状突骨折

目的：探讨颈前路齿状突螺钉加压固定治疗齿状突骨折的临床效果。方法：对15例齿状突骨折采用牵引复位后行前路单枚齿状突螺钉加压内固定方法治疗。结果：随访6个月－4年2个月，平均11个月，X线片及临床检查骨折均获得骨性愈合，均无明显颈部活动受限。无螺钉移位、断裂等并发症。临床症状完全消失13例，明显减轻2例。结论：前路齿状突螺钉固定牢靠，同时最大限度地保存了寰枢椎的生理活动功能。术前良好的复位是本手术成功的重要前景。     

锁骨下动脉损伤的外科处理

目的 探讨锁骨下动脉损伤的外科治疗特点。方法 1990年7月～2006年1月，对12例锁骨下动脉损伤患者，取锁骨上下联合切口，充分显露锁骨下动脉全段，分别采用动脉破口修补、包裹修复、血管吻合及人造血管移植修复重建损伤动脉。均为男性，年龄18～36岁，平均22.6岁。损伤部位：锁骨下动脉第1段1例，第2段4例，第3段7例。损伤类型：均为不完全断裂及破损，其中动脉破损区小于动脉周径1／3者4例，小于动脉周径2／3者5例，大于动脉周径2／3者3例。伴全臂丛神经损伤1例，神经干缺损5cm；部分臂丛神经损伤3例，其中2例仅前束损伤，神经缺损分别为4cm和6cm；正中神经完全损伤及尺神经不完全损伤1例，神经缺损4cm。损伤至手术时间3h～1.5个月。结果 术后无死亡及肢体坏死。获随访2个月～12年，平均5年2个月。10例桡动脉搏动恢复良好，2例桡动脉搏动不明显，均为动脉直接吻合者。4例合并臂丛神经损伤患者，前束损伤者术后肢体功能基本恢复正常，屈肘肌力Ⅳ级；全臂丛神经完全损伤者术后上肢功能基本无改善。结论 锁骨下动脉解剖位置特殊，动脉损伤后显露、修复均较困难。锁骨上下联合切口可在直视下显露动脉全段，修复重建安全可靠。     

Effect of administration mode (patient vs physician) and patient''s educational level on the Turkish version of the International Prostate Symptom Score

OBJECTIVES: To compare the effectiveness of the International Prostate Symptom Score (IPSS) when administered by the physician to when self-administered by the patient. The effect of the patient's educational level on the IPSS was also evaluated. METHODS: One hundred and seven previously untreated patients with symptomatic benign prostatic hyperplasia (BPH) completed the Turkish version of the International Prostate Symptom Score (Turkish I-PSS) and quality of life (QOL) questionnaires during a single office visit, first on their own and then with an interviewing physician. The patients were categorized into three groups according to their educational levels. Paired t-tests were performed to compare the total IPSS (tIPSS) and QOL results between the two testing modes. IPSS and QOL scores resulting from both modes were compared using a kappa test. Differences between the physician-assisted and self-administered scores among the different educational groups were further compared using a one-way anova test and Post Hoc Multiple Comparisons. To compare the objective effectiveness of tIPSS and QOL between the two testing modes, we selected the positive actual state, which was maximum urine flow (Qmax) of 15 mL/s or less and constructed receiver operating characteristics (ROC) curves for all patients. This estimation was constructed for each educational level. RESULTS: There were no statistical differences in IPSS and QOL values obtained by the patients or physicians (P > 0.05). The ROC areas for tIPSS were 0.94 and 0.93, and the ROC areas for QOL scores were 0.97 and 0.91 for information obtained by physicians and patients, respectively. When IPSS answers and QOL scores were evaluated separately, consistency was found across both modes of administration. However, there were lower levels of consistency in answers to IPSS questions 2, 5 and 6 (P = 0.59;0.42; 0.52, respectively). There was no significant difference among the aforementioned data in the educational groups. CONCLUSION: Although the total IPSS and QOL scores were not affected by the different modes of administration, we recommend that the physicians should evaluate answers to questions 2, 5 and 6 carefully. The present study demonstrates that the educational level did not affect the IPSS and QOL when administered either by the physician or the patient.