低位直肠癌保肛手术中弧形切割缝合器的应用

目的:探讨应用弧形切割缝合器在治疗低位直肠癌(距肛缘3～7 cm)中的保肛效应。方法:14例低位直肠癌患者,遵循全直肠系膜切除治疗原则,应用弧形切割缝合器行保肛手术。随访6个月,观察其根治性、术后排便功能、手术并发症及局部复发率情况。结果:本组无手术死亡,术后病理学检查无切端癌残留,无大便失禁,无吻合口漏发生,吻合口狭窄1例,发生率为7.1%(1/14),局部无复发,患者术后肛门功能恢复较满意。结论:保肛手术可获得较好的手术根治与保肛门功能的效应。在狭窄骨盆中应用弧形切割缝合器保肛治疗安全、有效。     

A longitudinal investigation of sports‐related risk factors for disordered eating in aesthetic sports

Previous studies have indicated a higher risk of disordered eating in certain types of elite sports such as aesthetic sports (e.g., rhythmical gymnastics, figure skating). But even though some studies on risk factors for disordered eating in sports exist, most research on this topic is based on cross‐sectional data with limitations on causal inferences. We examined sports‐related risk factors for disordered eating in a 1‐year longitudinal study with two assessment points. The participants were 65 adolescent athletes from aesthetic sports (mean age 14.0 ± 2.2 years) who completed measures of disordered eating, social pressure from the sports environment, sports‐related body dissatisfaction, desire to be leaner to improve sports performance, and emotional distress resulting from missed exercise sessions. All variables were relatively stable in the mean. Individual changes in the desire to be leaner to improve sports performance were associated with individual changes in disordered eating. Furthermore, a cross‐lagged partial correlation analysis showed that the desire to be leaner to improve sports performance was predictive of disordered eating and not vice versa. The results of our study indicate that athletes are more at risk for disordered eating if they believe it is possible to enhance their sports performance through weight regulation.     

护士站分时段现场预约在门诊管理中的应用

目的：探讨护士站分时段现场预约的优势及效果。方法通过采集医院护士站现场预约诊疗系统及网上预约系统数据，分析2013年10月1日—12月31日血液科门诊预约取号情况，比较患者通过护士站现场预约与网上预约的应诊率。结果护士站现场预约的应诊率为94．57％，明显高于网上预约的71．64％，差异有统计学意义（χ^2＝601．96，P＜0．05）。结论护士站分时段现场预约有效保证了患者预约后的应诊率，降低了爽约率。     

Hamstring muscle elasticity differs in specialized high-performance athletes

The effect of training on hamstring flexibility has been widely assessed through the measurement of the maximal range of motion or passive torque. However, these global measures do not provide direct information on the passive muscle mechanical properties of individual muscle. This characterization is crucial to better understand the effect of interventions as selective adaptations may occur among synergist muscles. Taking advantage of shear wave elastography, we aimed to determine whether elite sport athletes exhibit different passive shear modulus of hamstring heads compared to controls. Passive shear modulus was measured on semitendinosus (ST), semimembranosus (SM), and biceps femoris (BF) using shear wave elastography with the knee flexed at 60° and 90°, and 90° of hip flexion. A total of 97 elite athletes from various sports including running sprint, figure skating, fencing, field hockey, taekwondo, basketball, and soccer and 12 controls were evaluated. The shear modulus measured at 60° of knee flexion was lower in SM for figure skating (P < .001; d = 1.8), taekwondo (P < .001; d = 2.1), fencing (P = .024; d = 1.0), and soccer (P = .011; d = 0.9) compared to controls, while no difference was found for athletic sprinters, field hockey, and basketball players. Shear modulus of the BF and ST muscle was not significantly different between controls and elite athletes, regardless of the sport specialization (all P values = 1). We provide evidence that the shear modulus of the SM is altered in athletes involved in elite sport practice performed over large range of motion and/or including substantial stretching program in training content (taekwondo, figure skating, fencing, and soccer).     

Variability in hemoglobin mass response to altitude training camps

The present study investigated whether athletes can be classified as responders or non‐responders based on their individual change in total hemoglobin mass (tHb‐mass) following altitude training while also identifying the potential factors that may affect responsiveness to altitude exposure. Measurements were completed with 59 elite endurance athletes who participated in national team altitude training camps. Fifteen athletes participated in the altitude training camp at least twice. Total Hb‐mass using a CO rebreathing method and other blood markers were measured before and after a total of 82 altitude training camps (1350‐2500 m) in 59 athletes. In 46 (56%) altitude training camps, tHb‐mass increased. The amount of positive responses increased to 65% when only camps above 2000 m were considered. From the fifteen athletes who participated in altitude training camps at least twice, 27% always had positive tHb‐mass responses, 13% only negative responses, and 60% both positive and negative responses. Logistic regression analysis showed that altitude was the most significant factor explaining positive tHb‐mass response. Furthermore, male athletes had greater tHb‐mass response than female athletes. In endurance athletes, tHb‐mass is likely to increase after altitude training given that hypoxic stimulus is appropriate. However, great inter‐ and intra‐individual variability in tHb‐mass response does not support classification of an athlete permanently as a responder or non‐responder. This variability warrants efforts to control numerous factors affecting an athlete's response to each altitude training camp.     

新型医疗设备管理方法设想

为解决部分医院医疗设备供不应求、部分医院医疗设备使用率不高这一矛盾,本文提出了一种新型医疗设备管理方法。该方法通过引进专业管理团队和系统平台,可以在不增加资金投入的情况下,改善医疗设备使用不均、缩短病人等待检查时间,从而提高医院的整体服务质量,并在一定程度上缓解医患矛盾。     

利用国际留学生教育优势拓展医学双语精英多途径培养模式

双语教学是我国高等教育与国际接轨和教育改革发展的必然趋势,也是提高我国本科教学工作和教学质量的重要举措,本文作者从教学效果的三个影响因素——教师、学生和教材的角度,分析了积极调动国际留学生的独特教育优势,通过多种途径培养双语精英,推进双语教学在医学高校中的持续开展,力争进一步与国际医学教育的接轨。     

Cognitively elite,cognitively normal,and cognitively impaired aging: Neurocognitive status and stability moderate memory performance

Objective: Although recent theories of brain and cognitive aging distinguish between normal, exceptional, and impaired groups, further empirical evidence is required. We adapted and applied standard procedures for classifying groups of cognitively impaired (CI) and cognitively normal (CN) older adults to a third classification: cognitively healthy, exceptional, or elite (CE) aging. We then examined concurrent and two-wave longitudinal performance on composite variables of episodic, semantic, and working memory. Method: We began with a two-wave source sample from the Victoria Longitudinal Study (VLS; source n = 570; baseline age = 53–90 years). The goals were to: (a) apply standard and objective classification procedures to discriminate three cognitive status groups, (b) conduct baseline comparisons of memory performance, (c) develop two-wave status stability and change subgroups, and (d) compare of stability subgroup differences in memory performance and change. Results: As expected, the CE group performed best on all three memory composites. Similarly, expected status stability effects were observed: (a) stable CE and CN groups performed memory tasks better than their unstable counterparts, and (b) the stable (and chronic) CI group performed worse than its unstable (variable) counterpart. These stability group differences were maintained over two waves. Conclusion: New data validate the expectations that (a) objective clinical classification procedures for cognitive impairment can be adapted for detecting cognitively advantaged older adults, and (b) performance in three memory systems is predictably related to the tripartite classification.     

腹腔镜下微创手术治疗单纯性胆囊结石的临床疗效分析

目的了解腹腔镜保胆取石术和腹腔镜胆囊切除术治疗单纯性胆囊结石的优缺点。方法选取2007年1月-2011年12月在微创外科就诊的148例单纯胆囊结石患者为研究对象,分别就腹腔镜保胆取石术治疗（观察组,n=68例）和腹腔镜胆囊切除术治疗（对照组,n=80例）方式及效果进行分析,比较两组患者的手术成功率、结石取净率、手术时间、术中出血量、术后肠蠕动恢复时间、住院时间、术后并发症及随访情况。结果观察组手术成功率为100.0%（68/68）,对照组为98.8%（79/80）,两组结石取净率均为100%。术后2周B型超声检查,观察组患者的胆囊壁均光整无增厚,胆囊收缩率均〉30%。观察组和对照组的手术时间分别为（49.6±5.2）、（50.5±6.2）min,出血量分别为（9.5±1.4）、（50.2±8.1）mL,手术时间差异无统计学意义（P〉0.05）,出血量两组差异有统计学意义（P〈0.05）;观察组和对照组术后肠蠕动恢复时间分别为（33.9±2.2）、（34.4±2.6）min,住院时间分别为（3.4±1.0）、（3.6±1.2）d,两组比较差异无统计学意义（P〉0.05）;两组术后均无出血、胆瘘、切口感染等并发症发生。门诊随访6～12个月,均无结石复发;观察组37例患者随访3年,仅有1例（2.7%）出现胆囊结石复发。结论腹腔镜保胆取石术和腹腔镜胆囊切除术治疗单纯性胆囊结石均安全可行,但前者不仅保全了胆囊,而且具有术中出血少等优点。