The bipartite tarsal navicular bone: Radiographic and computed tomography findings

Two cases of bipartite tarsal navicular bone are presented. The radiographic and computed tomography (CT) findings of this anatomical variant are described. Correct recognition of this entity is important, both because it may be the cause of symptoms perse, and because it may be misdiagnosed as a fracture. When plain films are not diagnostic, CT scanning is helpful in distinguishing between a fracture and this variant.     

Rupture of the posterior tibial tendon: CT and surgical findings

Computed tomography (CT) was performed in 42 patients with 49 clinically suspected tears of the posterior tibial tendon. Twenty-eight of the 49 suspected tears were subsequently surgically explored and repaired. Three patterns of tendon abnormalities were recognized on CT scans: type I-intact, hypertrophied, heterogeneous tendon; type II-attenuated tendon; and type III-absence of a portion of a tendon. Types I and II correlated with partial rupture seen during surgery, and type III correlated with complete rupture of the tendon. CT findings were accurate in 96% of the patients who underwent surgery. In four cases (14%), tendon rupture was seen on CT scans, but the extent of the injury was underestimated and the rupture was misclassified. Reactive periostitis of the distal tibia was seen in 71% of diseased tendons and may represent an important factor in the diagnosis of tendon rupture.     

拉米夫定抗乙型肝炎病毒治疗中耐药突变的后续治疗

拉米夫定(lamivudine)抗乙型肝炎病毒治疗中耐药突变发生率高,文献报道在拉米夫定治疗1,2,3,4,5a时分别为14%,38%,49%,66%,69%.耐药突变可导致血清HBVDNA水平阳转或明显上升,肝功能严重受损,甚至病情恶化死亡.关于拉米夫定抗乙型肝炎病毒治疗中耐药突变的后续治疗目前国内外尚无统一用药方案,单药治疗(如:继续使用拉米夫定、阿德福韦、恩替卡韦)在临床使用中已经取得了一定疗效,联合抗病毒治疗和中医药治疗是今后研究的方向.     

6-(4-酰基-1-哌嗪乙酰氨基)-3,4-二氢-2(1H)-喹啉酮类化合物的合成及正肌力活性初探

目的 :寻找具有正性肌力活性的化合物。方法 :根据文献报道的二氢喹啉酮类正性肌力药物的结构特点 ,设计、合成了其类似物。以苯胺为起始原料经多步合成 ,对所得化合物用离体豚鼠心脏与主动脉观察了心肌收缩力、扩血管作用及心率。结果 :合成了 1 0个 6 ( 4 酰基 1 哌嗪乙酰氨基 ) 3 ,4 二氢 2 ( 1H) 喹啉酮类化合物 ( 4a～ 4j) ,均为未见文献报道的化合物。结论 :初步药理试验表明 ,化合物 ( 4h)显示了正性肌力及扩血管活性。     

Postamputation neuromas and other symptomatic stump abnormalities: detection with CT

One of the potentially troublesome sequelae of limb amputations is the development of stump neuromas at the severed ends of major nerves. The ability to define them and to distinguish them from other causes of stump pain is of considerable clinical significance. Computed tomography was performed on ten lower limb amputees with stump pain. Five patients had neuromas that were manifest as focal or generalized alteration in the caliber, size, or contour of the nerve trunk in the affected stump. The remaining five patients each had an abnormality detected; these abnormalities included heterotopic bone formation, popliteal artery aneurysm, lipoma, scar tissue, and abscess in the contralateral limb.     

普通教师与特殊教育教师职业倦怠和教学效能感的比较

目的:比较普通教育教师和特殊教育教师的职业倦怠与教学效能感特点,分析其影响因素。对象:①采用Maslach教师职业倦怠问卷和教师教学效能感量表于2006-06/09根据年龄、性别、教龄及是否担任班主任等对重庆市200名普通教育教师、100名特殊教育教师的职业倦怠和教学效能感的现状进行调查。Maslach教师职业倦怠问卷包括22个条目共3个维度:情绪衰竭、去人性化、低成就感。教师教学效能感量表共27个条目,包括一般教育效能感和个人教学效能感,各个维度总分相加形成总效能感。两个量表/问卷各题项均采用5点计分,分数越高,表示职业倦怠感越严重,教学效能感越强。②计量差异比较采用t检验和方差分析,并应用相关分析以及逐步回归分析统计学方法。结果:普通中小学共发放200份问卷,收回有效问卷176份,有效率占91.7%;特殊教育学校共发放100份问卷,收回有效问卷76份,有效率为80%。①职业倦怠和教学效能评分差异:普教与特教教师之间的职业倦怠感存在着显著的差异(t=2.837,P<0.01),普教教师与特教教师职业倦怠感的差异主要体现在情感衰竭维度上[普教:(3.16±0.71)分,特教:(2.63±0.65)分,t=5.535,P<0.01];去人性化和低成就感维度上无显著差异。普教教师的一般教育效能感得分显著低于特教教师[(3.40±0.66),(3.70±.57)分,t=-3.391,P<0.01]。②职业倦怠感和教学效能的人口学差异:除5年及以下教龄的教师外,普教与特教教师在性别、教龄及是否班主任等方面存在着情感衰竭方面的显著差异(P<0.05～0.01)。除6～10年教龄的教师之间外,普教与特教之间的一般教育效能感也存在明显差异(P<0.05～0.01),普教低于特教。同时,女教师之间的个人教学效能感存在着显著差异,普教女教师高于特教女教师。③相关性:普教与特教教师的教学效能感与职业倦怠都呈明显负相关(r=-0.515,-0.502,P<0.01),但特教在情感衰竭维度上的相关性不如普教强(r=-0.320,-0.240,P<0.01,0.05)。④逐步回归分析结果:一般教育效能感对普教的情感衰竭和去人性化程度、对特教教师的低成就感预测性较强(Beta=-0.321,-0.274,-0.404,P<0.01);个人教学效能感同时预测着普教和特教的去人性化和低成就感(普教:Beta=-0.286,-0.360,P<0.01;特教:Beta=-0.480,-0.585,P<0.01)。是否班主任因素对普教教师的情感衰竭和去人性化预测作用明显(Beta=-0.283,-0.179,P<0.01,0.05),而教龄对特教教师的去人性化和低成就感的预测作用明显(Beta=0.258,0.212,P<0.05)。结论:①普教与特教教师的职业倦怠感中的情感衰竭维度和教学效能感中的一般教育效能感有明显差别。②普教与特教教师的职业倦怠感和教学效能感存在性别、教龄及是否班主任的差别。③教学效能感在普教与特教教师中对职业倦怠各因素的预测作用不尽相同。是否班主任因素对普教教师的情感衰竭和去人性化预测作用明显,而教龄对特教教师的去人性化和低成就感的预测作用明显。