一个乡镇范围内卫生服务站点选址问题的数学模型及求解

目的为适应农村卫生体制改革，为农村乡镇卫生服务站点的选址提供依据。方法建立该问题的数学模型，并利用启发式算法求解。结果依据该模型得到：在有13个行政村的一个乡镇可设3个站点。结论既方便了群众就医，又节约了国家资源。     

海洋病原细菌的氯霉素耐药菌株筛选鉴定及质粒消除

目的 从污染海域筛选非临床氯霉素耐药株，研究耐药基因定位及耐药机制多样性。方法 TCBS和EMB选择平板筛选，结合16S rDNA序列分析鉴定耐药株。MIC测定、基因组DNA．RAPD分型和质粒消除评估多样性。结果 评估187株氯霉素耐药株的MIC值分布、属种分布、耐药基因定位及耐药机制。发现80株耐药MIC 25-128μg／ml是CLSI／NCCLS（1995年）定义临床标准（MIC 12．5μg／m1）的2-10倍，分布在弧菌科和肠杆菌科主要属种；58株MIC〉25μg／ml基因组DNA-RAPD分型与菌落表型分组结果吻合，显示多样性丰富。采用多轮高温（-43℃）和高浓度（-1％）SDS双重处理和交替培养，77株MIC〉25μg／m1分离株的质粒消除效率为28．6％；55株不能消除耐药表型，暗示染色体编码耐药基因；22株可消除氯霉素耐药表型，其中16株完全消除，暗示质粒独立编码耐药基因，6株部分消除，暗示质粒和染色体分别编码耐药基因。结论 来自污染海域环境的非临床氯霉素耐药株可作为新模型，提供耐药基因定位及耐药机制多样性的新视野。     

显微镜下放液、定位、冷凝治疗视网膜脱离

目的总结显微镜直视下治疗非复杂性裂孔性视网膜脱离手术的临床经验。方法对27例非复杂性裂孔性视网膜脱离27只患眼，先预置硅胶块和（或）环扎带，然后在显微镜直视下完成排视网膜下液、视网膜裂孔定位、视网膜冷凝、检查裂孔位置，术后观察视力、视网膜复位情况及并发症。结果一次手术后视网膜视网膜复位率92％（25只眼），仅有两只眼由于视网膜脱离需再次手术。末次随诊最佳矫正视力和术前相比有明显的提高：〈0．1者5只眼，占（18．5％），0．3-0．5者15只眼，占（55．5％），〉0．5者7只眼，占（25．9％）。未见到严重的并发症发生。结论显微镜下放液、定位、冷凝治疗非复杂性裂孔性视网膜脱离手术具有操作简单、方便、直视、效果良好等优点，尤适于初学者应用。     

鼻部大出血的介入栓塞止血最佳位置及最佳栓塞剂的探讨

目的 探讨鼻部大出血的介入栓塞止血的最佳位置.方法 经股动脉入路,对23例鼻部大出血患者进行双侧或单侧颈外动脉造影,采用颌上动脉、颞浅动脉起始点进行造影及应用弹簧钢圈作栓塞剂进行栓塞止血.结果 23例经造影诊断明确,且靶血管显示清晰情况下进行血管栓塞,栓塞效果十分肯定,栓塞术后再出血只有1例.结论 应用弹簧钢圈作较高位栓塞是更为安全及止血效果更佳的方式.     

毫针针刺深度“规矩”初探

在临床针刺意外事故中,以针刺深度或角度不当而致者最为常见且最为严重。古今医籍中所载穴位的针刺深度和角度很不统一,为了保证针灸临床操作的准确性和规范性,提高针灸临床疗效,在针灸经穴已有国家标准定位的基础上,针刺安全深度和角度也亟待国家制定相关标准。笔者认为“骨度同身寸”之思想,活体计算机断层扫描摄影(CT)定位针刺深度和角度与医学统计学相结合的方法确有其科学性和临床应用价值。另外,古人“授人以渔”的科学方法也应引起今人重视。     

TC指数在改良LONGA线栓法局灶性脑缺血/再灌注动物模型制备中的应用

目的观察TC指数定位血管线栓法对大鼠局灶性脑缺血模型制备的影响。方法300只雄性SD大鼠随机分为预试验组30只、原始方法组120只(按LONGA氏血管线栓法)、改良方法组150只(按动物门齿根部T点距颈总动脉分叉点C点长短而定,简称TC指数定位法)；比较两种不同造模法对血管线栓局灶性脑缺血/再灌注实验大鼠的成功率及形态学的变化。结果TC指数定位法改良的LONGA氏血管线栓再灌注制模法,比原始的LONGA氏血管线栓法大鼠脑缺血/再灌注模型成功率高,直线相关分析及统计学上均具有显著性意义；形态学表现差异无显著性。结论TC指数定位法的LONGA氏血管线栓法大鼠脑缺血/再灌注模型是一种较好的制模方法,值得实验研究中推广应用。     

Prognostic variables for response and outcome in patients with extragonadal germ-cell tumors.

BACKGROUND: This investigation evaluates prognostic variables in patients with seminomatous and non-seminomatous extragonadal germ-cell tumors (EGCT) in order to identify relevant factors for long-term outcome following cisplatin-based chemotherapy. PATIENTS AND METHODS: Patients from six countries treated at 11 centers in Europe and the USA from 1975 to 1996 were evaluated retrospectively. Uni- and multivariate analyses of prognostic variables for survival and for response to chemotherapy were performed. RESULTS: Data were available for 635 EGCT patients, 104 with seminomatous and 524 with non-seminomatous EGCT (n = 7 not specified). For non-seminomatous EGCT the following independent adverse factors were identified: presence of either liver, lung or central nervous system metastases, primary mediastinal tumor or elevation of pretreatment beta-human gonadotropin; for extragonadal seminoma (only univariate) adverse factors were: presence of liver metastases, two or greater metastatic sites or International Germ Cell Cancer Collaborative Group (IGCCCG) grouping (intermediate versus good). Integration of these variables produced the following prognostic risk groupings: 'excellent prognosis', all seminomatous EGCT (89% 5-year survival rate); 'intermediate low', 'intermediate high' and 'poor', all non-seminomatous EGCT with a 69, 55 and 17% 5-year survival rate, respectively. The decreased survival among the different groups was due to a lower rate of favorable objective remissions and a higher rate of relapses. Classification and regression tree (CART) modeling confirmed histology and location of primary tumor as the major prognosticators. For the subgroup of patients with mediastinal non-seminoma, the 2-year survival rate ranged from 34 to 84%. Multivariate testing for the probability to respond to chemotherapy revealed non-seminomatous histology, primary mediastinal tumor site, and the presence of liver, lung or CNS metastases as independent adverse factors. CONCLUSIONS: In EGCT, prognostic variables for the outcome and for the response to chemotherapy could be identified, which in part differ from gonadal GCT. The proposed model might help to better understand the specific prognosis of EGCT and to tailor risk-adapted treatment strategies. In addition, CART analysis demonstrated the heterogenous prognosis of patients with mediastinal non-seminoma.     

CT定位微创治疗高血压脑出血95例疗效分析

目的：探讨微创治疗高血压脑出血的方法、适应证及疗效。方法：回顾分析95例高血压脑出血微创清除术病例的治疗及效果。结果：术后2d血肿基本清除10例，3d56例，7d29例。预后按GOS分类：良好33例，中残40例，重残11例，睁眼昏迷2例，死亡9例。结论：CT定位微创治疗高血压脑出血具有操作简单、效果确切、经济安全、病死率低的优点，适合基层医院开展。     

Investigations on Epileptogenic Lesions in Relation between Ages of the Patients and Seizure Manifestation

Abstract: The purpose of this report is to extract the age factor from multiple contributing factors to seizure manifestations in 357 cases of the various intracranial lesions, of which the locations and the pathological types had already been proven. The age distribution of the intracranial lesions depended largely upon their biological properties. Nevertheless, it had been proven that the seizure manifestation differed by ages of the patients even in the identical lesions. The younger patients were apt to lapse into seizures which became more frequent than in the older patients. The types of seizures seemed to be converted from the generalized to the partial, as the patients go through a transition from childhood to adulthood. Recognition of such a seizure manifestation is especially important in order to detect as soon as possible epileptogenic lesions as a surgically treatable cause of chronic epilepsy.     

A 10-year study of snowboard injuries in Lapland Sweden

Snowboard injuries in a Swedish ski area were evaluated from 1989 to 1999. All injured skiers (alpine, telemark, snowboarders) who sought medical attention at the local Medical Center within 48 h of the accident, were asked to answer an injury form. Physicians assessed and treated the injured skiers. There were a total of 1775 injured skiers; 568 injured snowboarders mean age 19 years. The female/male ratio was 34/66%, the injury rate 3/1000 skier days, three times higher than that of alpine skiers. The skill level of the injured snowboard riders improved during the period. The fall/run ratio of the beginners was higher (1.0) and their risk behavior lower (3.9 on visual analogue scale 1-10) in comparison to the advanced riders (0.4 and 6.6, respectively). Injuries were in 54% located to the upper extremity, 35% were wrist/lower arm injuries. Beginners had significantly higher frequency of lower arm/wrist injuries (46%), than average (32%) and advanced riders (20%). The most frequent single diagnosis was wrist/lower arm fracture (20%). Advanced riders tend to have more head/neck injuries than beginners, 17% vs. 13% (NS). Thus, with elevated skill level the injury pattern changed. For injury prevention, wrist guards and helmets are recommended for snowboard riders.