人正常下颌升支区应力分布的三维有限元法分析

目的：对正常人下颌升支在不同咀嚼力作用时应力分布情况进行三维有限元分析。方法：采用三维有限元应力分析的方法，对正常离体人下颌升支在不同加载条件下的应力分布特征进行对比定量分析。结果：(1)所有载荷形式的各种应力值，随着单元距加载点的距离的增大，其应力值相对减小。(2)下颌骨下颌角、升支后缘的应力梯度变化较大。结论：下颌骨下颌角、升支后缘是应力相对集中的区域，也是临床上常见的下颌骨骨折区，同时还是下颌升支矢状骨劈开术后加强固定以及防止骨段移位的区域。     

广州港1997～2002年中小学生营养状况分析

目的 了解广州港中小学生的营养状况。方法 收集1997-2002年广州港4所中小学生的体检资料。结果 广州港4所中小学生平均营养不良发病率为23．39％，肥胖发病率为6．34％。营养不良发病率有逐年下降的趋势，而肥胖发病率则有逐年上升的趋势。男女性别间差异有显性意义(P＜0．01)。结论 中小学生营养不良与肥胖同时存在。今后的学生营养工作应防治中小学生营养不良与肥胖并举，全面推行以学校为中心的全民营养教育。     

锌及复合微量营养素的营养干预对学龄前儿童蛋白质营养状况的影响

选择重庆市近郊农村学龄前儿童１４０名，男、女各半，随机分为单纯补锌组、补锌及复合微量营养素组和单纯补充微量营养素组，另一组为对照。实验组每组４０人，对照组为２０人，进行１０周营养干预实验。结果显示，在补锌的同时服用硒、锰、维生素Ａ等多种微量营养素或单纯补充多种微量营养素均能有效改善受试儿童体内锌营养状况，使血浆中前白蛋白、转铁蛋白、铜蓝蛋白含量增加，血清中多种必需及非必需氨基酸，３甲基组氨酸浓度下降。提示，儿童营养状况改善后其体内蛋白质合成代谢加强，而分解减少，这种变化除缘于血清锌含量增加外，可能还与其它微量营养素的作用有关。而单纯补锌儿童血清锌变化并不显著，血清中几种转运蛋白与对照均无明显差异。     

Nutritional considerations in intravenous drug misusers: a review of the literature and current issues for dietitians

Poor nutritional status and inadequate dietary intake in intravenous drug misusers (IVDMs) is a well-recognized problem among those involved in their care. However, there are very few published studies to substantiate these observations. This paper provides a review of the current literature and outlines the aims of dietary advice for IVDMs.     

Does the health status of chronically ill patients predict their judgements of the quality of general practice care?

Patients' health status as well as patients' judgements of care are used for assessing patients' perspectives, but the relation between those two concepts is unclear. In this study we explored whether health status predicts patients' judgements of the quality of general practice care. Hand-distributed and mailed surveys were performed by 28 general practitioners in The Netherlands. Chronically ill patients were approached when visiting the general practice or drawn from the practice registers. Health status was measured by WONCA/COOP charts, and patients' judgements by the CEP, a previously validated questionnaire. The response rate was 63% (n=762). When controlled for other patient characteristics, a poor overall health predicted less positive judgements of medical care, information, counselling, relation and communication, continuity of care and the organization of appointments (p[lessthan]0.01). Poor mental well-being predicted less positive judgements of the cooperation between care providers and a stronger need for more care (p[lessthan]0.001). The four other aspects of health status did not predict the patients' judgements. Judgements about the premises and the availability for emergencies were not predicted by health status. It can be concluded that a multidimensional approach should be used for interpreting the relations between patients' health status and their judgements of general practice care.     

Factors determining the performance of medical students of the Faculty of Medicine, University of Kuwait

An investigation was undertaken to determine the factors influencing performance of medical students at the Faculty of Medicine, University of Kuwait. Data were collected for the first batch of 42 candidates who successfully passed the 7-year medical programme. Results showed high correlations between high-school admission grades and subsequent performance during the medical programme. Similar results were also obtained with English proficiency. A partial correlation controlling for English proficiency, however, showed a systematic decline in the magnitude of the correlations between high-school grades and performance during the medical programme. In fact the relationship between high-school GPA and clinical GPA was non-significant. A prominent influence of English proficiency on performance is indicated.     

Assessment of nutritional status in children with cystic fibrosis: conventional anthropometry and bioelectrical impedance analysis. A cross-sectional study in Dutch patients

BACKGROUND: Assessment of nutritional status in children with cystic fibrosis (CF) is clinically relevant. Methods to measure nutritional status should be reliable and non-invasive, and reference values should be available. AIM: To compare weight and height measurements and measurements of specific body compartments in children with CF. METHODS: In a cross-sectional survey of 58 children with CF (28 females), we compared height and weight (expressed as: weight-for-height, body mass index (BMI), height-for-age and weight-for-age) with fat mass (skinfold sum (SFS)), muscle mass (upper arm circumference (UAC)) and bioelectrical impedance analysis (BIA). Results were expressed as Z-scores, using Dutch reference values. RESULTS: BMI and weight-for-height were within the normal range (mean Z-score (range): -0.13 (-1.5, 2.7) and -0.02 (-1.7, 2.8)). Weight and height corrected for age were below normal (mean Z-score (range): -0.79 (-2.4, -0.05) and -1.2 (-2.8, 1.4) (P<0.01)). Lean body mass by skinfold sum (LBM(sfs)), UAC and BIA were also significantly below reference values (mean Z-score (range): -0.9 (-2.2, 1.8), -0.95 (-2.4, 1.8) and -1.1 (-3.6, 1.0) (P<0.01)). Lean body mass (LBM) by BIA correlated with LBM(sfs). BIA systematically underestimated LBM in both CF patients and in control subjects. CONCLUSION: Nutritional status of children with CF must be evaluated, using age-corrected weight and height expressed in Z-score. LBM estimated by SFS, UAC and by BIA appear to be useful, although longitudinal studies in CF children should be performed to evaluate their clinical significance in detecting changes in nutritional status.     

老年病人鼻饲营养调查

对11名69～83岁不能自然进食的男性鼻饲病人进行了全面的营养调查,平均每人每日热能摄取为1722kcal,而热能消耗在1300～1700kcal之间。蛋白质、脂肪和碳水化物每人每日平均摄入82.4、72.5、185.0g,分别占总产热量19.1、37.9、和43.0％。动物蛋白质和动物脂肪分别占总蛋白和总脂肪的71.9和69.3％,蛋白质量较优。脂肪总量虽不太高,但占总产热量偏大,碳水化物嫌少,而(?)(?)(?)投入939mg,摄入过多。钙、磷、铁摄入充裕,可满足需要。维生素A、核黄素也可满足需要,但硫胺素、尼克酸和抗坏血酸摄入量不足。这些都还需要改进。     

No correlation between number of MRI-evident lesions in cerebrum and the soleus stretch reflex in multiple sclerosis patients

The aim of the study was to investigate if the stretch reflex of the soleus muscle was useful in quantifying upper motor neuron lesions. The soleus stretch reflex was recorded in 10 healthy subjects and 20 patients with active relapsing-remitting multiple sclerosis and correlated to the number of MRI lesions in cerebrum and clinical scores (expanded disability status scale and regional functional scoring system). The short latency stretch reflex was elicited by rotating the left ankle joint 4 degrees with a rise time in the interval of 40-640 ms. The amplitude of the stretch was larger in multiple sclerosis patients being 88.5 microV in patients and 12.8 microV in controls, P = 0.007. The sensitivity of the stretch reflex expressed as the slope of the best linear fit was increased in MS patients to 2.6 microVs/degree compared with 0.6 microVs/degree (0.1-2.2) in controls, P = 0.009. There was no correlation between amplitude of the stretch reflex and number of MRI lesions (r = -0.03). In conclusion, the soleus stretch reflex might be useful to quantify spasticity but is not useful in detecting dysfunction of upper motor neurons in MS.     

How large must an epileptic focus be to cause an electrographic status epilepticus--a case report.

Based on experimental data from animal studies different theories regarding the size of an epileptic focus have been postulated which range from single pacemaker cells to extended neuronal networks. We report a case which gives further information about the size of a human epileptic focus which can trigger manifest epileptic seizures. We report a 22-year-old man with medically refractory temporal lobe epilepsy. This patient suffered from brief complex partial seizures and frequent epigastric auras. To differentiate a mesiotemporal from a temporolateral seizure origin the patient was implanted with a 10 contact depth electrode from a posterior approach into the right hippocampus, and additional temporobasal/temporolateral subdural strip electrodes. Depth recordings revealed an electrographic status with continuous rhythmic sharp wave activity (1 Hz), the field of which was confined to a diameter of less than 1 cm in the anterior hippocampus, whereas temporobasal subdural strip electrodes did not display this activity. Periodically, spread of this activity occurred to the amygdala, to the posterior part of the hippocampus, and less often to the temporobasal cortex. Most seizure patterns remained subclinical, few of them became symptomatic as partial seizures. This case demonstrates that a hippocampal epileptic focus causing electrographic focal status epilepticus may be limited to a volume of less than 1 cm in diameter. This observation is discussed with regard to implantation strategies and to possible superselective resective or modulatory approaches in the treatment of such limited epileptogenic areas.