现阶段基层护理人力资源管理的难点分析及策略

目的：探讨提高基层医院护理人力资源管理的方法。方法：分析现阶段基层医院护理人力资源管理难点,提出积极应对的管理策略。结果：该院护士职业满意度和住院患者对护士的满意度均达到95%。结论：合理配置及调配护理人力资源,提高护理人员工作积极性,加强培训,可提高护士职业满意度和住院患者对护理工作的满意度。     

CT 联合超声对于甲状腺乳头状癌和腺瘤的影像表现探讨

目的：探讨 CT 联合超声对于甲状腺乳头状癌（PTC）和腺瘤（FAN）进行临床诊断及鉴别诊断的临床意义。方法：选取经术后病理证实诊断的45例,共53枚甲状腺病变的 CT 和超声资料,分别观察并对比超声及 CT 典型征象和超声联合 CT 典型征象在乳头状甲状腺癌诊断中的敏感性和特异性。结果：超声典型征象的敏感性为72.73%,特异性为54.76%;CT 典型征象的敏感性为63.64%,特异性为83.33%;超声联合 CT 典型征象的敏感性为90.91%,特异性为61.90%。结论：超声在诊断乳头状甲状腺癌中有较高的敏感性,而 CT 在诊断乳头状甲状腺癌中有较高的特异性,两者联合应用可以显著增高乳头状甲状腺癌诊断的敏感性,同时特殊的 CT 征象有助于乳头状甲状腺癌诊断。     

改良 Devine 术治疗儿童隐匿性阴茎治疗体会

目的：探讨采用改良 Devine 术治疗儿童隐匿性阴茎（CP）的临床效果及应用价值。方法：采用改良 Devine 术对46例CP 患儿进行矫治。结果：本组患儿的平均手术时间40.3±1.7min,术后平均阴茎长度较术前明显延长,手术有效率达100%,术后随访7～26个月,所有患儿的阴茎显露均明显改善,外观满意。结论：改良 Devine 术是治疗儿童 CP 的较佳手术方式,较好地克服传统 Devine 术式的缺陷,具有手术操作简单、安全,创伤小,并发症少,效果显著等特点。     

PBL与LBL在血管外科见习教学中效果的对比研究

目的：研究“基于问题式学习模式（PBL）”在血管外科临床见习教学中的应用。方法：选取见习学生100名作为研究对象,随机分为实验组与对照组,每组各50人。实验组采用PBL教学法带教,对照组采用以授课为基础的学习模式（LBL）带教。课后通过统一的出科理论考试和学习效果满意度的调查问卷,比较教学效果。结果：实验组学生的平均成绩高于对照组,两组比较差异有显著性（P〈0．01）。在调查问卷中,实验组的满意率显著高于对照组（P〈0．01）。结论：在血管外科临床见习教育中,PBL教学法能显著提高学生学习积极性和学习效率。     

2型糖尿病肾病患者血浆脂蛋白及尿微量蛋白的变化

目的：通过检测2型糖尿病患者脂蛋白及尿微量蛋白水平,为糖尿病肾病的早期诊断与预防提供依据。方法：按病程将糖尿病肾病病人分成三组：采用全自动生化分析仪检测空腹血糖、糖化血红蛋白（HbAlc）、血浆脂蛋白、肾功能及尿微量蛋白水平。结果：B组及c组病人之和占总糖尿病肾病病人71．43％,且年龄较大（P〈0．05）;病程较短的糖尿病肾病病人空腹血糖高于其它各组（P〈0．01）,TG、LDL-C、APOB及LPA高于病程较长组,且三组都低于单纯糖尿病组,而肾功能各项及尿微量蛋白均高于单纯糖尿病组（P〈0．01）,CysC水平无统计学意义（P〉0．05）。结论：糖尿病肾病患者存在糖及脂蛋白代谢紊乱,尿微量蛋白结合血脂检测有利于早期发现肾脏损伤。     

腋臭衣在小切口大汗腺清除术后的应用

目的：探讨腋臭衣应用于小切口大汗腺清除术对术后并发症的影响的总结。方法：180例小切口大汗腺清除术后应用腋臭衣加压的患者,术后包扎切口后穿上腋臭衣固定。密切观察切口及全身情况,做好术后指导。结果：180例行腋臭清除术后应用腋臭衣加压固定患者,切口全部I期愈合,未出现皮下血肿、皮瓣坏死等并发症。结论：腋臭衣应用于小切口大汗腺清除术后,减少并发症的发生率,减轻病人痛苦。     

Electrodiagnostic features of true neurogenic thoracic outlet syndrome

Introduction: We report the electrodiagnostic (EDX) features of 32 patients with surgically verified true neurogenic thoracic outlet syndrome (TN‐TOS). Methods: Retrospective record review. Results: We found uniform EDX evidence of a chronic axon loss process that affected the lower portion of the brachial plexus and disproportionately involved the T1 more than the C8 sensory and motor fibers. Because of this relationship, the medial antebrachial cutaneous sensory nerve (T1) and median motor (T1 > C8) study combination was abnormal in 89%, whereas response combinations that primarily assessed the C8 fibers were less frequently affected. Conclusions: The characteristic EDX features of TN‐TOS are T1 > C8 nerve fiber involvement. A comprehensive EDX examination of the lower plexus with contralateral comparison studies is imperative to diagnose this disorder accurately. Muscle Nerve 49 : 724–727, 2014     

Ipsilateral breast tumor recurrence after breast-conserving therapy

In the modern era of breast-conserving therapy for early-stage breast cancer, ipsilateral breast tumor recurrence (IBTR) represents an increasingly common clinical dilemma. Two kinds of IBTRs have been described: true recurrences, which represent regrowth of uneradicated initial disease, and new primaries, which may be distinct from the index lesion in histology and location. Whether these two entities have different biologies and survival prognoses remains unclear. This article will examine contemporary clinical and pathologic methods to distinguish true recurrence from new primary tumors, focusing on available published data from prospective and retrospective studies. Current challenges and future avenues are discussed for developing a standardized, reproducible classification system for different types of IBTR that may be used in the clinical setting to prognosticate and individualize treatment for patients following in-breast recurrences.     

Imaging bowel obstruction: a comparison between fast magnetic resonance imaging and helical computed tomography

AIM: To compare the accuracy of fast magnetic resonance (MR) imaging using the half-Fourier single shot turbo spin echo (HASTE) sequence with helical computed tomography (CT) in diagnosing bowel obstruction. MATERIALS AND METHODS: Prospective evaluation of 44 patients with clinical evidence of bowel obstruction was conducted using various investigations including HASTE MR and helical CT. MR was performed with a Siemens 1.5 Tesla MR Imaging System and CT was performed with one of two Siemens ARHP CT systems using helical technique. MR acquisition allowed data to be gathered in 6-10 minutes and no contrast media were administered. CT imaging consisted of consecutive helical CT through the abdomen and pelvis with oral and intravenous contrast medium used when indicated. Bowel dilation along with the presence and level of obstruction were determined. RESULTS: Twenty-eight patients had bowel obstruction confirmed at laparotomy or by radiographic assessment. Of these, 25 had small bowel obstruction and three had colonic obstructions. The obstruction was due to fibrous adhesions in nine patients, metastases or primary carcinoma in seven, Crohn's disease in four, hernias in two, and inflammation or abscess in two. Other causes of obstruction included lymphoma, intussusception and anastomotic stricture. The cause of obstruction was correctly diagnosed by CT in 71%, and by MR in 95% of cases. The sensitivity, specificity and accuracy for HASTE MR imaging was 95%, 100% and 96% respectively as compared to 71%, 71% and 71% for helical CT. CONCLUSION: Fast MR imaging using the HASTE sequence is more accurate than helical CT in diagnosing bowel obstruction.     

临证实痛辨治

痛之命名,始见<内经>.有<素问·举痛论>之专篇论痛,百病多痛,临证习之,辨证常用六法行气止痛、散寒止痛、活血止痛、化痰止痛、清热止痛、调神止痛.