整脊手法治疗131例颈性眩晕疗效分析及对眩晕性疾病的再认识

目的：探讨整脊手法治疗颈源性眩晕的治疗机理,重新认识颈源性眩晕及眩晕性疾病的病因病理。方法：对131例颈源性眩晕患者进行整脊手法治疗,恢复其颈胸椎曲度,术前术后即刻TCD检查以比较椎动脉血流变化,再予拔罐和红外线治疗3天,之后间隔性调整治疗。结果：治愈121例,占92．37％,好转8例,占6．11％,无效2例,1．53％。即时缓解129例,占98．47％。结论：整脊手法治疗颈源性眩晕疗效明确,但椎动脉血流并未单纯增加或减少,故反思眩晕性疾病的中西医病因病理,提出眩晕性疾病结构异常和急慢损伤两大病因;病理和解剖方面的多机制变化,尤其颈部的结构变化在眩晕性疾病中的重要作用;治疗上凡眩晕者,必正其骨。     

新型农村合作医疗背景下的乡镇卫生院人力资源现状调查与分析——泸州市龙马潭区9所乡镇卫生院定量与定性研究

目的 了解四川省泸州地区乡镇卫生院人力资源的现状及影响因素,探讨新农合背景下乡镇卫生院人力资源变化情况,并对其发展提出对策建议.方法 设计调查问卷及访谈提纲,定量分析与定性分析相结合;文献检索与实地调查相结合.结果 2011年龙马潭区每千农业人口卫生人员数量为3.53人,数量相对缺乏;医护比为1.83：1,全科医师数量极少,专业结构不平衡;学历水平仍以大、中专学历为主,分别为41.7％和28.1％;职称水平初级及未评定占总体72.7％,整体仍然偏低.结论 改善乡镇卫生院卫生人力资源现状,应从以下几个方面入手：（1）合理解决卫生人员的收入、养老和福利待遇等问题,营造良好的工作环境,完善卫生人员流动机制.（2）鼓励和吸引本、专科毕业生到乡镇卫生院就业.（3）提高临床在职人员及医院管理人员的素质.（4）引进护理、药剂、检验和预防保健等急需人才,优化基层医疗卫生人才结构.     

在强制隔离戒毒所HIV/AIDS患者中开展结核病症状筛查和干预的研究

目的了解强制隔离戒毒所HIV/AIDS患者中结核病症状筛查阳性水平,提高结核病防治知识知晓率。方法采取典型调查的方法,确定四川省资阳市某强制隔离戒毒所为研究现场。使用"结核病可疑症状筛查问卷"对HIV/AIDS患者进行筛查,筛查阳性者通过痰涂片和X线检查确诊;同时使用《结核病/艾滋病防治宣传折页》对HIV/AIDS患者进行宣传教育的干预,并在干预前后进行知晓率调查。共纳入605例患者,使用χ2检验比较了宣传前后知晓率的改变。结果患者全部为男性,平均年龄(31.5±6.70)岁,99.5%(602/605)仅有初中及以下文化程度。结核病症状筛查阳性率为10.1%(61/605),主要症状为咳嗽、咳痰持续2周以上等。症状筛查阳性者结核病检出率为21.3%(13/61),HIV/AIDS患者结核病检出率为2.1%(13/605)。干预前后,患者总知晓率分别为20.8%和87.1%(χ2=2174.261,P=0.000),各单题知晓率也有显著性提高。结论强制隔离戒毒所应成为开展结核病/HIV防治工作的重点场所,今后需进一步规范强制隔离戒毒所HIV/AIDS患者结核病症状筛查流程,提高HIV/AIDS患者结核病防治知晓率。     

Risk of Exposure to Hepatitis A Virus among Day-Care Workers in Israel: Implications for Preventive Measures

Hepatitis A is an important infectious disease in Israel. The high incidence of hepatitis A, the declining prevalence of antibodies against hepatitis A virus throughout the past decade, and the availability of an active immunization for hepatitis A have engendered the identification of occupations in which workers are at increased risk of acquiring the disease. A prevalence study for hepatitis A antibodies was conducted during the first half of 1998 in a random sample of 37 day-care centers in different parts of Israel. A short interview was conducted, and serum samples were then collected from each worker. The control group comprised a sample of factory workers, blood donors, and women in maternity wards. Ninety percent (402 of 446) of the day-care workers had antibodies to hepatitis A. In a logistic-regression analysis, seropositivity was associated with increased age, minimal education, and lack of military service. When the authors compared a subsample of workers aged 18–40 yr with the control group, seropositivity was associated with the following: birth in Israel, duration of residence in Israel, very minimal education, military service, and employment in a day-care center. These results, together with earlier reports, indicate that day-care workers are at high risk of occupational exposure to hepatitis A. These results may imply that seronegative workers have a 2-fold chance of acquiring hepatitis A. Appropriate preventive measures should be considered, and active immunization of susceptible workers should be undertaken.     

Improving Front-End Flow in an Urban Academic Medical Center Emergency Department: The Emergency Department Discharge Facilitator Team

Length of stay (LOS) is an important determinant of patient satisfaction and overall emergency department (ED) operational efficiency. In an effort to reduce length of stay for low-acuity “treated and released” patients, our department created a discharge facilitator team (DFT) composed of an attending physician, physician assistant, and registered nurse. The DFT identified patients who could be rapidly treated and released in the low-acuity treatment Adult Urgent Care Center (AUCC) and provided them rapid treatment and discharge. To assess the efficacy of the DFT, linear regression was used to compare AUCC LOS at times the team was and was not active. Patients seen by the DFT had a LOS that was 35 % shorter than other AUCC patients. There was a 28-min reduction in AUCC LOS during periods where the DFT was active (95% CI 22 to 33 min). We conclude that the establishment of a DFT was associated with a significant reduction in LOS for all low-acuity patients. Other academic medical centers may consider implementing a similar program in order to reduce LOS and improve ED throughput for low acuity patients.     

临床治疗老年骨质疏松性股骨粗隆间骨折的疗效观察

目的：探讨不同方法治疗老年骨质疏松性股骨粗隆间骨折的临床疗效。方法：采用回顾性方法分析,选取我院自2009年3月~2012年3月3年以来收治的92例老年骨质疏松性股骨粗隆间骨折患者的临床资料。随机将其分为两组,各46例,应用股骨近端防旋髓内钉固定治疗为PENA组,采用动力髋螺钉固定治疗为DHS组,两组患者均给予中医药辨证治疗。比较两组患者的手术时间、术中出血量、骨折愈合时间以及术后并发症。结果：两组患者在术中以及术后情况比较,PENA组患者术中以及术后情况均优于DHS组,手术时间、术中出血量、术中以及术后并发症、骨折愈合时间以及髋关节功能评分上均有明显的差异,具有差异统计学意义（P〈0．05）。结论：股骨近端防旋髓内钉对老年骨质疏松性股骨粗隆间骨折患者有显著的疗效,同时操作方法比较简单,创伤小,固定牢固以及并发症少,并且结合中医药辨证治疗,有利于骨折的稳定以及早期进行功能锻炼,值得临床推广。     

梯度旋转下降法修复单侧完全性唇裂的初步研究

目的探讨梯度旋转下降法修复单侧完全性唇裂的术后效果。方法分析85例单侧完全性唇腭裂患儿的术前，术后即刻以及术后一年的面部石膏模型唇部指标，同时比较这85例单侧完全性唇腭裂患儿术后一年的唇部指标与相似年龄的45例单纯不完全性腭裂患儿的唇部指标。结果在术后即刻虽然健患侧唇高、健患侧唇宽的差值减小，但其健患侧仍不协调。术后一年，健患侧唇高和健患侧唇宽都达到协调。与对照组进行比较，唇高在术后一年恢复到正常值，而唇宽在一年后无论是健侧还是患侧，仍然低于正常值。结论采用梯度旋转下降法修复单侧完全性唇裂可以达到一个很好的唇部美观效果。     

Early endosseous integration enhanced by dual acid etching of titanium: a torque removal study in the rabbit

Textured implant surfaces are thought to enhance endosseous integration. Torque removal forces have been used as a biomechanical measure of anchorage, or endosseous integration, in which the greater forces required to remove implants may be interpreted as an increase in the strength of bony integration. The purpose of this study was to compare the torque resistance to removal of screw-shaped titanium implants having a dual acid-etched surface (Osseotite) with implants having either a machined surface, or a titanium plasma spray surface that exhibited a significantly more complex surface topography. Three custom screw-shaped implant types - machined, dual acid-etched (DAE), and titanium plasma sprayed (TPS) - were used in this study. Each implant surface was characterized by scanning electron microscopy and optical profilometry. One DAE implant was placed into each distal femur of eighteen adult New Zealand White rabbits along with one of the other implant types. Thus, each rabbit received two DAE implants and one each of the machined, or TPS, implants. All implants measured 3.25 mm in diameter x 4.00 mm in length without holes, grooves or slots to resist rotation. Eighteen rabbits were used for reverse torque measurements. Groups of six rabbits were sacrificed following one, two and three month healing periods. Implants were removed by reverse torque rotation with a digital torque-measuring device. Three implants with the machined surface preparation failed to achieve endosseous integration. All other implants were anchored by bone. Mean torque values for machined, DAE and TPS implants at one, two and three months were 6.00+/-0.64 N-cm, 9.07+/-0.67 N-cm and 6.73+/-0.95 N-cm; 21.86+/-1.37 N-cm, 27.63+/-3.41 N-cm and 27.40+/-3.89 N-cm; and 27.48+/-1.61 N-cm, 44.28+/-4.53 N-cm and 59.23+/-3.88 N-cm, respectively. Clearly, at the earliest time point the stability of DAE implants was comparable to that of TPS implants, while that of the machined implants was an order of magnitude lower. The TPS implants increased resistance to reverse torque removal over the three-month period. The results of this study confirm our previous results that demonstrated enhanced bony anchorage to dual acid-etched implants as compared to machined implants. Furthermore, the present results indicate that dual acid etching of titanium enhances early endosseous integration to a level which is comparable to that achieved by the topographically more complex TPS surfaces.     

生发中心型与非生发中心型弥漫性大B细胞淋巴瘤的影像学鉴别

目的 分析生发中心B细胞型(GCB)与非生发中心B细胞型(non-GCB)弥漫性大B细胞淋巴瘤(DL-BCL)各部位淋巴结大小及形态差异,并做出鉴别诊断.方法 搜集2008年1月至2014年6月间有明确病理诊断为DLBCL且有明确免疫组织化学分型及完整影像资料的患者46例,分别记录双侧颈部、双侧颌下、双侧腋窝、双侧锁骨上窝、双侧腹股沟、腹腔每侧最大两个淋巴结的垂直径乘积和长短径之比(L/S),将各部位垂直径乘积和L/S值按GCB和non-GCB两组进行独立样本t检验和Mann-Whiteny U检验,再计算出有统计学意义组的均数进行比较,并做ROC曲线尝试鉴别诊断.结果 垂直径乘积:全部组GCB型:0.88(0.31,1.00)cm2;全部组non-GCB型:0.84(0.44,1.44)cm2;颈部组GCB型:1.05 (0.47,1.13)cm2;颈部组non-GCB型:1.14(0.61,4.00)cm2;腹股沟组GCB型:(0.38±0.26)cm2;腹股沟组non-GCB型:0.72(0.44,0.98) cm2.GCB型患者和non-GCB型患者淋巴结的垂直径之积在全身(P =0.002)、双侧颈部(P =0.034)和双侧腹股沟(P =0.002)差异有统计学意义,ROC曲线测得临界值:全身0.490 cm2,双侧颈部0.925 cm2,双侧腹股沟0.490 em2.而双侧腋窝、双侧颌下、双侧锁骨上窝、腹腔淋巴结大小差异均无统计学意义(P＞0.05).L/S值:全部组GCB型:1.91±0.71;全部组non-GCB型:2.19±0.85;腋窝组GCB型:1.79±0.22;腋窝组non-GCB型:2.28±0.77;颌下组GCB型:1.62±0.25;颌下组non-GCB型;1.90±0.55.non-GCB型患者和GCB型患者淋巴结的L/S值在全身(P=0.012)、双侧腋下(P=0.042)和双侧颌下(P=0.033)差异有统计学意义,ROC曲线测得临界值:全身1.845,双侧腋窝2.055,双侧颌下诊断显著性水平P＞0.05.而双侧颈部、双侧腹肌沟、双侧锁骨上窝、腹腔淋巴结L/S值差异均无统计学意义(P＞0.05).结论 在DLBCL中non-GCB型患者淋巴结普遍较GCB型患者大,主要表现在双侧颈部及双侧腹股沟区,并可为鉴别诊断提供参考;在恶性度上低于GCB型,主要表现在双侧腋窝及双侧颌下,腋窝处数据可为鉴别诊断提供参考.