Gliomatosis peritonei: the value of a "second look" operation.

The case history of a 10-year-old black girl with gliomatosis peritonei, Grade 0, is presented. The primary tumour was resected and a "second look" operation carried out 3 months later. The glial implants demonstrated distinct circumferential and intra glial fibrosis (resolution). Because the peritoneal implants had undergone resolution, further therapy became unnecessary. We believe gliomatosis peritonei fully justifies a second laparotomy in order to be able to accurately grade the implants. The grade of the peritoneal implants influences the prognosis and therefore determines the type of therapy to be instituted.     

Bilateral stapedotomy in patients with otosclerosis: a disability-orientated evaluation of the benefit of second ear surgery

This study reports the evaluation of the results of 80 stapedotomies in patients with bilateral otosclerosis. All pre- and postoperative audiological data, together with all relevant information of the operations, were stored in a database and analysed retrospectively. A new approach has been developed in order to evaluate the benefit of second ear stapes surgery in a more disability-orientated way using the AMA-criteria in the Guides to the Evaluation of Permanent Impairment. In all patients the percentage of Binaural Hearing Impairment (BHI) and the percentage of Impairment of the Whole Person (IWP) were determined according to the AMA-criteria. In patients who had both operations at the Academic Medical Centre it was found after the first operation that there was an important decrease in the BHI-percentage (from 26% to 10%) as well as for the IWP-percentage (from 9% to 4%). In addition, the percentages dropped significantly after the second operation (from 11% to 7% and from 4% to 2%, respectively). During follow-up there were no serious complications. It is concluded that bilateral stapedotomy is a safe procedure with good results.     

Eureka-project: ‘totally implantable artificial larynx’: progress report

Objective. The European Eureka project ‘Artificial larynx’ aims at realizing an implantable artificial larynx, consisting of artificial vocal folds, artificial epiglottis, tissue connector for tracheal fixation and valve mechanism to switch between breathing and speaking. The last part has been realized. Because its functioning is identical to a tracheostomal valve, it was tested as such. Materials and methods. The device consists of two valves: a speech valve, that will be open during normal breathing and closed by strong expiration and a cough valve that opens during coughing and closes automatically during inhalation. Magnets keep the valves in the breathing position. The magnetic force can be varied. Several prototypes have been tested in vitro and in situ. Results. The prototypes showed good in vitro behaviour. The range of adjustability of speech and cough was wide enough, flow resistance acceptable. This was confirmed by preliminary in vivo experiments. Patients were enthusiastic; hands-free speaking and coughing is possible. Conclusion. Numerous problems have to be solved to produce an artificial larynx. Each solution generated up till now, however, can already be applied to improve the existing rehabilitation process of laryngectomized patients.     

Ocular torsion induced by static visual stimulation and static whole body roll

Objective. This study was aimed to improve the reliability of clinical statolith testing by quantifying the influence of visual orientation and stimulation on the statolith-ocular reflex. Materials and methods. Ocular torsion was induced in 12 healthy adults by visual stimulation and by static whole body roll with and without simultaneous visual orientation. Visual stimulation was achieved by a horizontal grating oscillating sinusoidally in a frontal plane. Visual orientation during whole body roll was established by mounting an illuminated horizontal grating either on a tilting device (head-fixed) or on the wall in the frontal plane (earth-fixed). Results. No eye torsion was observed in static visual tilts of the grating. Dynamic visual stimulation elicited substantial eye torsion. Static whole body roll in the dark induced static ocular counter-rolling. Visual orientation either head- or earth-fixed did not affect the amplitude or gain of the body roll induced ocular counter-rolling. Conclusion. Dynamic visually induced torsional eye movements can be used to test the ability of the oculomotor system to generate torsional eye movements prior to quantifying the statolith-ocular reflex. Simultaneously visual information does not affect the gain of the static statolith-ocular reflex.     

谈日语二外教学中实际运用能力的培养

学习外语的第一目的是与人交流，二外亦是如此。特别是当前中国经济快速发展，对日语人才的需求越来越大的环境下，如何提高日语二外学习者的语言实际运用能力成为一个重要课题。结合笔者的实践，本文着重从听、说以及跨文化交际三方面探讨了日语实际运用能力的培养。     

Caesarean delivery at full cervical dilatation versus caesarean delivery in the first stage of labour: comparison of maternal and perinatal morbidity

OBJECTIVE: To compare perinatal and maternal morbidity associated with caesarean sections performed in the first with that performed in the second stages of labour. PATIENTS AND METHODS: Comparative analyses between nulliparous women with singleton term pregnancies who had a caesarean section in the first stage of labour and those who had a second stage caesarean section were completed using standard statistical methods. A subgroup analysis, according to indication for caesarean section, was also performed. RESULTS: Of 627 women, 81% had caesarean delivery in the first stage and 19% had caesarean delivery in the second stage of labour. Women undergoing caesarean delivery at full cervical dilatation were 1.9 times more likely to have an augmented labour (95% CI 1.2-3.4, P < 0.001) and 2.8 times more likely to have epidural anaesthesia in labour (95% CI 1.5-5.2, P < 0.001) than those in the first stage. Compared with caesarean delivery in the first stage of labour, women undergoing caesarean delivery at full cervical dilatation were 4.6 times more likely to have composite intraoperative complications (95% CI 2.7-7.9, P < 0.001), 3.1 times more likely to have blood loss greater than 1,000 ml (95% CI 1.3-7.4, P = 0.01), and 2.9 times more likely to have a blood transfusion (95% CI 1.5-5.6, P < 0.001). The risk of neonatal morbidity was higher in first stage caesareans when they were performed for presumed fetal compromise (66.3 vs. 26.3%, P = 0.002), and lower when they were performed for failure to progress (18.4 vs. 42%, P = 0.02). CONCLUSION: Caesarean section in the second stage of labour is associated with a higher risk of maternal but not perinatal morbidity.     

半紧闭装置低流量时的第二气体效应

目的　研究半紧闭装置低流量时可能存在的第二气体效应。方法　 4 0例ASAⅠ～Ⅱ级全麻患者随机分为A、B两组 ,各 2 0例 ,分别在新鲜气流量 (A组O2 0 .4L min +N2 O 0 .6L min ,B组O2 1L min)下接受 1%异氟烷。用Datex气体监测仪校正挥发罐输出浓度 (Fd) ,使异氟烷输出浓度为 1% ,气管导管连接处连续监测麻醉气体吸入浓度 (Fi)、呼气末浓度 (FA)、呼气末二氧化碳分压 (PETCO2 )、吸入氧浓度。观察 30min。比较 2组各相同时间点异氟烷FA Fi 和FA Fd。结果　异氟烷的FA Fi 上升速率 2组无明显差异 (P >0 .0 5 ) ,FA Fd 上升速率 2组有差异 ,但不显著 (P >0 .0 5 )。结论　第二气体效应在低流量时表现不明显。     

以第二课堂为载体培养学生科研创新能力探讨

营养与食品卫生教研室在学校深化教育改革倡导下,为提高预防医学专业学生综合素质和培养创新思维,将科研课题精心设计并移植到第二课堂教学中,依托学院开展的“预防论坛”形式积极参与打擂。该次有益的尝试为医学生提前介入科学研究,提高对科研的认知,培养高素质科研专才起到了积极作用。     

解整合素-金属蛋白酶12在染色体非整倍体筛查中的应用

解整合素-金属蛋白酶12（A disintegrin and metalloprotease 12,ADAM12）是细胞膜表面具备多功能的糖蛋白家族成员之一,具有金属蛋白酶的特性,可以水解类胰岛素样生长因子结合蛋白（insulin-like growth factor binding proteins,IGFBP）。妊娠妇女血清中有分泌性/可溶性形式的ADAM12,即ADAM12-S,非妊娠妇女血清中则不存在。妊娠正常胎儿时,ADAM12-S的浓度随妊娠周的增加而升高。ADAM12-S在妊娠妇女血清中浓度的高低有种族差异。ADAM12浓度的高低与妊娠妇女的体质量有关,但与年龄无关。吸烟的妊娠妇女血清中ADAM12浓度低于非吸烟者。在妊娠早期尤其在10周前,妊娠唐氏综合征（DS）患儿妇女的ADAM12浓度明显低于妊娠正常胎儿者,在妊娠中期则高于妊娠正常胎儿者。在早期妊娠18-三体综合征、13-三体综合征、45,X和三倍体胎儿的妇女血清中,ADAM12浓度明显低于妊娠正常胎儿者。ADAM12作为一个新的血清标记物还需进行深入研究。     

抑郁症神经生化机制的研究进展

抑郁症是一种病因相当复杂的疾病,近年来发现抑郁症患者在神经生化方面有许多改变。该文就近年来在抑郁症的神经递质及其受体和转运蛋白、G蛋白和第二信使系统以及神经内分泌系统等方面的研究进展加以综述。