时滞系统鲁棒稳定性的新判据

基于Ｌｙａｐｎｕｏｖ泛函方法，研究了满足匹配条件的不确定性时滞系统的鲁棒稳定性及具有稳定度β〉０鲁棒稳定性，给出了已有结果不能推出的新判据。这些新判据对已有结果难以使用的情况下也可有是有效的，或有时减少了已有结果的保守性。     

Inter-rater reliability of the original and modified Barthel Index,and a comparison with the Functional Independence Measure

The Barthel Index (BI), the Modified Barthel Index (MBI) and the Functional Independence Measure (FIM) are all widely used by occupational therapists as assessment tools for clinical decision-making and outcome measurement. All of these tools have demonstrated validity and the BI and the FIM have demonstrated inter-rater reliability. The MBI has been modified to increase sensitivity; however, there have been no publications on the inter-rater reliability of this tool following the changes. The purpose of this research was to examine the inter-rater reliability of two versions of the Barthel Index, and draw some comparisons between this assessment tool and the FIM. Twenty-five patients with neurological and orthopaedic conditions were assessed by three occupational therapists using the three tools. The method of analysis selected was percentage agreement and intraclass correlation coefficient. The results indicated that both the original and modified versions of the Barthel Index possess good inter-rater reliability. As all three tools have demonstrated adequate reliability and validity, it is suggested that clinicians select the most sensitive tool that best meets their clinical needs, and use this assessment tool in its standardized format.     

92例跟骨骨折后足部畸形功能障碍治疗探讨

本文对92例106足波及距下关节的跟骨骨折治疗后1～6年遗留足畸形、功能障碍的病例(PALey:舌型17足,中央压陷型53足,严重粉碎型36足)进行了分析和总结。作者强调解剖复位、牢靠固定、一期植骨、早期关节持续被动运动及不过早负重是预防跟骨骨折众多并发症的重要措施。     

RNA干扰（RNAi）技术及其在功能基因组学研究中的应用

近年来的研究表明 ,一些小的双链RNA可以高效、特异的阻断体内某些基因致使mRNA降解 ,诱使细胞表现出特定基因缺失的表型 ,称为RNA干扰 (RNAinterference ,RNAi)。由于可以作为代替基因敲除的遗传工具 ,RNAi技术正在改变着功能基因组学 (functionalgenomics)领域的研究步伐。《科学》杂志和美国科学促进会将RNAi技术评选为2 0 0 2年十大重大科学成就之首。1　RNAi及其作用机制1.1　RNAi回顾首次发现双链RNA (doublestrandRNA ,dsR NA)能够导致基因沉默的现象来源于对线虫Caenorhabditiselegans的研究。1995年 ,康乃尔大学的…     

Deep brain stimulation for Parkinson's disease dissociates mood and motor circuits: a functional MRI case study.

Behavioral disturbances have been reported with subthalamic (STN) deep brain stimulation (DBS) treatment in Parkinson's disease (PD). We report correlative functional imaging (fMRI) of mood and motor responses induced by successive right and left DBS. A 36-year-old woman with medically refractory PD and a history of clinically remitted depression underwent uncomplicated implantation of bilateral STN DBS. High-frequency stimulation of the left electrode improved motor symptoms. Unexpectedly, right DBS alone elicited several reproducible episodes of acute depressive dysphoria. Structural and functional magnetic resonance imaging (fMRI) imaging was carried out with sequential individual electrode stimulation. The electrode on the left was within the inferior STN, whereas the right electrode was marginally superior and lateral to the intended STN target within the Fields of Forel/zona incerta. fMRI image analysis (Analysis of Functional NeuroImages, AFNI) contrasting OFF versus ON stimulation identified significant lateralized blood oxygen level-dependent (BOLD) signal changes with DBS (P < 0.001). Left DBS primarily showed changes in motor regions: increases in premotor and motor cortex, ventrolateral thalamus, putamen, and cerebellum as well as decreases in sensorimotor/supplementary motor cortex. Right DBS showed similar but less extensive change in motor regions. More prominent were the unique increases in superior prefrontal cortex, anterior cingulate (Brodmann's area [BA] 24), anterior thalamus, caudate, and brainstem, and marked widespread decreases in medial prefrontal cortex (BA 9/10). The mood disturbance resolved spontaneously in 4 weeks despite identical stimulation parameters. Transient depressive mood induced by subcortical DBS stimulation was correlated with changes in mesolimbic cortical structures. This case provides new evidence supporting cortical segregation of motor and nonmotor cortico-basal ganglionic systems that may converge in close proximity at the level of the STN and the adjacent white matter tracts (Fields of Forel/zona incerta).     

功能性矫治器在正畸矫治中运用的伦理思考

功能性矫治器是正畸临床中常用的一种矫治器，作者从口腔正畸学理论基础出发，探讨了功能性矫治器在正畸矫治作用中存在的伦理道德问题，主要有（1）不能正确的诊断、制定周密的矫治计划。（2）操作不规范、不细致、缺乏敬业精神。（3）态度简单，粗曝，缺乏与患者良好的交流。并提出解决方法（1）刻苦学习专业知识，不断提高诊疗水平及个人修养。（2）建立高度的道德责任感，以严谨的作风，规范的操作为病人服务。（3）尊重、善待青少年，建立良好的医患关系。     

Effects of different perfusates on functional parameters of isolated perfused dog kidneys.

BACKGROUND: The isolated perfused canine kidney has been established as a valid model for conducting both renal physiology and transplantation research. This model is of particular importance for developing new strategies to improve graft function after renal transplantation. In the present study, a newly developed method using isolated haemoperfused porcine kidneys was adapted for use in canine kidneys. In contrast to haemoperfusion, synthetic perfusion media can be standardized and can prevent the initiation of blood-mediated reperfusion reactions. Thus, an additional aim was to determine whether blood could be replaced by synthetic cell-free perfusion solutions. METHODS: Canine kidneys (n = 30) were harvested from donors euthanized in veterinary practices for causes unrelated to the present study. The kidneys were isolated and perfused with autologous blood or cell-free synthetic electrolyte buffer (Tyrode solution). During perfusion, we monitored renal perfusate flow (RPF), glomerular filtration rate (GFR), electrolyte and glucose reabsorption, oxygen consumption and urine concentration. RESULTS: Changes in perfusion medium did not affect the RPF. In contrast, GFR, urine concentration and oxygen consumption were significantly higher, whereas fractional excretion of sodium and glucose were significantly lower in blood- than in Tyrode-perfused kidneys. CONCLUSIONS: This system offers a simple model for studying whole-organ functional alterations after acute renal ischaemia. Renal function indicators were below values reported during in vivo physiological conditions. These functions were better conserved when kidneys were perfused with autologous blood than with Tyrode.     

现代医院手术室建设中的问题及动态研究

手术室是医学技术与工程技术结合的产物。随着医疗技术和新的手术工具的不断涌现,带动了手术量的迅猛上升。旧的手术室空间布局、实施标准、功能配置等方面已经无法满足新技术的应用要求,同时人们对手术环境和手术质量也提出了更高的标准。而今第四代手术室已开始步入我们的时代。洁净化、数字化和人性化则是其主要代表特征。本文分别从洁净手术室、数字化手术室和人性化手术室三个方面来探讨现代医院手术室建设中应注意的问题及动态研究。层流手术室已经是手术室建设不可逆转的发展趋势,除了按照《医院洁净手术部建筑技术规范》来建造外,其布局、人流、物流、质量监控等等都要进行合理的安排才能达到最优的手术环境。数字化手术室是将温度、湿度、压力、通风量、新风量等一切参数系统的由计算机来分配统筹,从而实现精确高效的手术管理。人性化手术室则是手术室建设的软件部分,是一种“以病人为中心”的服务理念,它打破了传统的生物医学模式,转变为生物—心理—社会模式,这是病人需求与市场竞争的必然选择。