国人牙直丝托槽定位值的测量研究

为建立适合国人牙直丝托槽定位值,选择符合Ａｎｄｒｅｗ ｓ 正常牙合成年人６０ 例,男女各３０ 例,１８～２１ 岁,平均１９．２ 岁,均具有协调的面部比例,未接受正畸治疗。弓丝平面定义为大多数牙临床牙冠中点所在的平面,用游标卡尺测量每一牙齿切缘（或牙合缘）,至弓丝平面的距离,为直丝托槽应就位的位置。结果显示,托槽并非全部位于每个牙的临床牙冠中点,在上颌双尖牙区,托槽位于临床牙冠中点龈方０．５ｍ ｍ 处,第二磨牙托槽位于临床牙冠中点偏牙合方０．５ｍ ｍ ～１．０ｍ ｍ 处,在下颌尖牙及第一、二磨牙处,托槽位于临床牙冠中点偏牙合方０．５ｍ ｍ 处。表明本研究建立的托槽定位值适合于国人,且可明显提高直丝托槽垂直置入精确度     

PTCA及血管支架治疗急性心肌梗死时机选择与心脏功能关系的研究

目的：研究PTCA及血管支架安装治疗急性心肌梗死的时机选择与心脏功能关系。方法：本组78例,分为两组。A组为6h以内急诊,直接行PTCA血管支架安装的病人29例,男：女为23：6,平均年龄51．6±12．7岁。B组为49例,男：女为38：11,年龄52．3±11．5岁。急性期静脉溶栓（6h内）后于24～72h补救PTCA及血管支架安装的病人。结果：术后1周、4周做超声心动图检查,其左室射血分数（LVEF）情况A组VSB组：第1周0．52±0．07VS0．51±0．07（P＞0．05）,第4周0.58±0.08VS0．52±0．06（P＜0．05）。结论：急性心肌梗死病人在发病6h内行PTCA及支架安装能及时地使血运重建,达到改善心脏功能的作用。     

镍钛合金支架治疗食管良、恶性狭窄(附10例报道)

目的;研究镍钛合金支架在食管良,恶性狭窄治疗中的应用,方法;本组１０例患者,食管癌９例,贲门失弛缓症１例,均采用镍钛合金支架,在Ｘ线监视下,经口腔进行置入术。结果：全组支架均一次置入成功,支架入后,患者吞咽困难明显改善,总有效率为１００％,追踪观察,有３例食管癌患者,肿瘤分别突向支架腔内及支架上,下端生长,再次引起狭窄,其中１例又加置一个支架,使食管狭窄再次开通。结论：采用镍钛合金支架治疗食管良,     

Variability in the stereotaxic position of cerebral points in the albino rat

An analysis of variability in the stereotaxic position of five cerebral points in rats revealed:

1. (1) that variability was less from the bregma skull point than from ear-bar-zero or the lambda skull point,

2. (2) that high correlations exist between the position of skull points and cerebral structures, and

3. (3) that the use of two external landmarks for predicting the position of cerebral targets produces a greater than 40% reduction in errors over that resulting from the use of single (ear-bar-zero or skull landmark) predictors.

食管支架治疗食管良恶性狭窄的临床应用

对16例食管良恶性狭窄患者采用食管支架置入进行治疗。其中食管-胃吻合口狭窄9例，食管癌7例，全部支架置入术均经口腔在X线监视下进行。支架置入后24小时随访观察，食管留置均获成功，未出现技术问题。支架置入后临床症状均得到缓解，所有病人摄食能力均有不同程度的改善。作者认为：食管支架对食管良恶性狭窄的治疗是一种方便、安全、有效的治疗方法，并可提高患者的生活质量。     

Stepwise interventional approach in a neonate with pulmonary valve atresia and intact ventricular septum

In neonates with pulmonary atresia and intact ventricular septum the aims of therapy are maintenance of pulmonary blood flow and right ventricular decompression in order to achieve right ventricular support of the pulmonary circulation. Recent developments in interventional heart catheterization with pulmonary radiofrequency-assisted balloon valvuloplasty and ductal stent implantation offer an alternative to the classical surgical approach. We report on a neonate with membranous pulmonary atresia and intact ventricular septum, in whom a large interatrial right-to-left shunt via the foramen ovale persisted after radiofrequency-assisted pulmonary balloon valvuloplasty on the 2nd day of life. The interatrial shunt prevented adequate right ventricular filling and antegrade pulmonary perfusion leading to severe cyanosis (transcutaneous oxygen saturation 40%). In order to increase pulmonary blood flow and raise left atrial pressure, the arterial duct was stented. After ductal stenting, prostaglandin was discontinued and the transcutaneous oxygen saturation remained stable around 89%. At follow up after 7 weeks the foramen ovale had decreased in size and only a small left-to-right shunt was present, documenting the effectiveness of this approach. Conclusion Based on the present case we propose a stepwise interventional approach for the neonate with pulmonary atresia and intact ventricular septum. If cyanosis persists after isolated pulmonary valvuloplasty despite adequate right ventricular function, ductal stent implantation can reduce interatrial shunting and thus improve oxygen saturation. Received: 12 January 1998 / Accepted: 15 February 1998     

颈动脉狭窄成形术中的支架和脑保护装置选择

颈动脉狭窄是缺血性脑卒中的主要发病原因之一，而颈动脉支架及其脑保护装置是经血管内治疗颈动脉狭窄的有益材料。通过了解和熟悉不同类型的支架和脑保护装置的特点、特性、应用方法和并发症预防．有助于提高颈动脉狭窄成形治疗的临床水平。     

Monitoring the development of clinical skills during training in a clinical placement

Background The education and training of health care practitioners has undergone recent reform, and indicate that curricula should place emphasis on the development of clinical skills and attitude. The purpose of this study was two‐fold: to define the key skills necessary for a competent dietetic student practitioner and to devise a reliable assessment tool to measure and track performance in these key skill areas throughout the period of clinical placement. Methods Key clinical skills were identified by a concensus group of experienced dietitians and academic practitioners. An assessment tool was then developed to measure these attributes in 43 students undertaking clinical placement at a number of training centres in Scotland. Development of skills was tracked for the entire duration of placements using the novel assessment tool. The assessment tool used a visual analogue scale (VAS) as the measuring score. Results A high level of skill attainment was equated with high VAS scores. Performance in three of the four key skills (written skills: r = 0.762, P ≤ 0.001; interviewing skills: r = 0.697, P < 0.001; and dietary assessment technique: r = 0.697, P ≤ 0.001) showed impressive correlation co‐efficients, indicating a striking and significant positive correlation with the length of training. A high skill performance level attainment was achieved by week 16/17 of training. Conclusion The authors are confident that the assessment tool is valid and reliable and measures skill performance objectively. A high level of skill attainment was observed in most students by about the mid‐point in training: this allows the student to consolidate these skills in the latter stages of training which is in keeping with educational and practice philosophy of placement learning outcomes.     

The testing of clinical skills in dietetic students prior to entering clinical placement

Background One of the most important requirements for contemporary education of a health care professional is to develop a framework for theory and practise which results in attainment of professional competencies suitably robust for a lifetime of practise ( Howe, 2002 ). In the context of those educating preregistration dietitians, this offers the challenge of presenting the student with innovative curricula designed to deliver the appropriate level of knowledge and understanding together with emphasis on skill and attitude development. The purpose of this study was to allow preregistration students the opportunity to practise key clinical skills prior to clinical placement and test skills acquisition using the model of an objective structured clinical examination (OSCE). Methods The learning experience of the student was altered to accommodate a more conceptually‐driven, problem‐centred, case‐based approach. The curriculum was adjusted to incorporate a short clinical skills programme where emphasis was deliberately placed on skill acquisition. At the conclusion of this clinical skills programme, and prior to the students entering clinical placement, skill performance by students was tested using the OSCE. The method of testing was also evaluated by students. Results The OSCE was delivered to 37 preclinical students. Four of the test candidates (11%) failed in at least one of the skill areas: these students performed similarly during clinical placement. Twenty‐one (57%) students returned the post‐OSCE questionnaire. Twenty (95%) students reported a positive experience; 20 (95%) students reported initial anxiety that diminished as the test progressed. Conclusion The Project Team was confident with the novel approach taken in re‐designing the curriculum: to include a dedicated clinical skills programme, together with addition of the testing of clinical skills using the OSCE model. These curriculum changes were deemed to be highly appropriate additions to the student experience in determination of skill performance of students prior to clinical placement.     

镍钛记忆合金支架管治疗尿道下裂术后尿道狭窄18例

目的:探讨镍钛记忆合金支架管治疗尿道下裂术后尿道狭窄手术方法及临床效果。方法:对18例I期尿道成形术后尿道狭窄患者采用氯胺酮麻醉加骶麻,以尿道扩张器对狭窄段尿道进行扩张后,放置记忆金属支架管。如扩张尿道时损伤尿道或出现夹道,则尿道切开直视下放置金属支架管。合金支架管在术后3个月取出。结果:本组治愈17例,治愈率83%(17/18).3个月内金属支架管脱落1例,再次出现尿道狭窄。结论:镍钛记忆金属支架管治疗尿道下裂术后尿道狭窄,是简便易行,安全性高,创伤小,疗效肯定的治疗方法。