改良大骨瓣联合软通道微创介入逐渐减压术治疗重型颅脑损伤的疗效分析

目的：探讨改良大骨瓣联合软通道微创介入逐渐减压术治疗重型颅脑损伤的疗效。方法方便选择自2009年12月—2014年11月该院收治的重型颅脑损伤病例70例,随机分为改良组和对照组2组,每组35例,改良组施行改良大骨瓣联合软通道微创介入逐渐减压术,对照组按标准大骨瓣开颅、硬脑膜一次性全切开,对比分析两组的并发症发生率及预后。结果改良组发生迟发性颅内血肿、大面积脑梗塞及弥漫性脑肿胀等并发症9例(25.7％,9/35),预后良好者23例(65.7％,23/35),对照组发生并发症19例(54.3％,19/35),预后良好者14例(40.0％,14/35),两组并发症发生率和预后差异具有统计学意义(P<0.05)。结论改良大骨瓣联合软通道微创介入逐渐减压术治疗重型颅脑损伤,效果良好,显著降低死亡率。     

改进时间差攻击疗法治疗多重耐药阴沟肠杆菌的探究

[目的]研究利用改进的时间攻击疗法治疗多重耐药阴沟肠杆菌引起的感染的效果，并考究其与亚胺培南/西拉司丁治疗及传统时间攻击疗法的药物经济学成本/效果比。[方法]将38例明确诊断为产ESBLs阴沟肠杆菌感染且药敏结果皆为：对哌拉西林、环丙沙星、氧氟沙星、左旋氧氟沙星、庆大霉素、妥布霉素、头孢他啶、头孢噻肟、头孢哌酮、头孢曲松、头孢哌酮/舒巴坦、替卡西林/克拉维酸等皆耐药，而对亚胺培南/西拉司丁敏感的患者随机分为改进组、对照组、传统组。改进组患者先与磷霉素4g＋5%葡萄糖100ml于30min静脉滴注完毕后，再过30min立即给予阿米卡星0.4g＋0.9%NS250ml静脉滴注，上述治疗每日1次。对照组患者给予亚胺培南/西拉司丁1g＋0.9%NS250ml静脉滴注，每日3次。传统组患者先与磷霉素2g＋5%葡萄糖50ml静脉给予1h完毕后，立即给予阿米卡星0.2g＋0.9%NS100ml静脉滴注，上述治疗每日2次。疗程最长限为10d，其余检查治疗3组相同。考察3组的细菌清除率以及细菌清除所需的药物费用、不良反应的比较。[结果]改进组细菌清除率与对照组、传统组差异无统计学意义，并且改进组、传统组无不良反应，对照组有1例二重感染；而且改进组与对照组、传统组的细菌清除药物治疗费用差异有统计学意义。[结论]利用磷霉素＋阿米卡星的改进时间攻击差疗法能很好的治疗多重耐药的阴沟肠杆菌引起的感染，并且与采用亚胺培南/西拉司丁治疗方案及传统的时间攻击疗法相比具有较好的成本/效果比。     

环指屈肌腱损伤吻接术前、后力学性能测试研究

研究正常环指屈肌腱拉伸力学性能和模拟屈肌腱损伤后吻接术后屈肌腱的力学性能,为临床提供生物力学参数。取10个手环指标本,解剖后暴露环指,将标本固定于电子万能试验机底座上,由钢丝绳吊钩沿屈肌腱纵行方向钩住、钢丝绳上端固定于试验机上夹头上,驱动机器,对标本进行拉伸实验,施加拉应力,直至屈肌腱断裂。对断裂后的屈肌腱模拟临床手术进行移位吻接,对10个标本做了腱与腱移位吻接。再对吻接后的标本进行拉伸实验。分别得出了正常组标本和吻接术后标本的拉伸最大载荷、应力、应变等数据。表明:屈肌腱腱与腱吻合组最大载荷、应力、应变均小于正常对照组,但模拟末端编织法吻接术腱与腱吻合组标本,仍具有较好的拉伸力学性能指标。     

药物的定量构效关系的方法学研究——改进的逐步回归算法

在定量的构效关系研究中,多重回归分析选人的参数,多是用穷举所有方程实现的。本文提出一种改进的逐步回归算法,计算实例表明,是个行之有效的方法。     

An Improved Method of Removing Polyurethane Foam-Covered Gel Prostheses

One of the advantages of polyurethane foam-covered prostheses has been that in the first 5 to 10 years after their use, the amount of capsular contraction was found much less than when similar ``slick' prostheses were used. Another advance was their fixation to the surrounding tissue thus giving a more natural appearance and movement with the muscles when the arms were moved in any direction. The formation of a thick capsule also acted as a protection against gel granuloma due to rupture of the prosthesis and has been thought to be a factor in the lower capsule contraction rate. The greatest disadvantage has been that its removal was extremely difficult and this has continued up until the technique described in this paper has been introduced.     

Gadolinium ring enhancement and mass effect in acute disseminated encephalomyelitis

A 9-year-old boy presented with a subacute history of optic neuritis followed by brainstem involvement, with fever and a lymphocytic pleocytosis in the cerebrospinal fluid. Gadolinium-enhancing ring lesions were demonstrate in the white matter of the cerebrum, brainstem and cerebellum on day 17 of the illness, all appearing simultaneously as part of a monophasic illness. A parietal lesion exerted mass effect. Needling and biopsy yielded no evidence of a pyogenic lesion, tumour or tuberculosis and showed vasculitis. There was insufficient material for myelin staining. Dexamethasone therapy lead to rapid improvement of the radiological lesions: MRI and CT on day 34 of the illness showed complete clearing of the lesions except for residual abnormality at the biopsy site.     

改良上颌平面导板矫正青少年深覆颌的临床观察

目的观察改良上颌平面导致矫正青少年深覆颌的效果。方法制作上颌平面导板,下颌双侧尖牙与其接触,后牙抬高3.0 mm。分为昼夜戴用导板及仅夜间戴用导板两组,观察疗效。结果深覆颌总矫正率72.2%,昼夜戴用该改良上颌平面导板组的深覆颌矫正率100%。结论改良上颌平面导板制作简单,戴用方便,效果明显。     

Computed tomographic findings in cerebral toxoplasmosis in adults

The clinical and computerized tomographic (CT) findings in 10 patients with cerebral toxoplasmosis are reviewed. All patients with cerebral toxoplasmosis were homosexuals and/or intravenous drug users, and all patients had other manifestations of AIDS. Two presented with focal seizures, 4 presented with focal neurological deficit which progressively worsened, and 4 had evidence of diffuse neurological dysfunction (altered consciousness, generalized seizures). CT showed a single lesion in 3 patients and multiple lesions in 7 patients. Two patients had hypodense nonenhancing lesions(s). Eight patients had hypodense lesions with peripheral or nodular enhancement. The lesions were more commonly located in the cerebral hemispheres and subcortical gray matter nuclear masses (thalamus, basal ganglia). The finding of a hypodense lesion with a central slightly hyperdense noncalcified region that showed dense nodular homogeneous enhancement was quite characteristic of cerebral toxoplasmosis, but this pattern may also be seen in other neurological conditions including brain lymphomas.     

改良前肩峰成形术治疗肩部撞击症23例的临床报告

目的分析、总结、改良前肩峰成形术治疗肩部撞击症的临床疗效。方法本组23例肩部撞击症患者为研究组,全部采用改良前肩峰成形术。另23例为对照组,采用传统手术方法。结果两组治疗结果经统计学处理具有显著意义(P<0.05),研究组23例肩部撞击症患者全部治愈。结论改良前肩峰成形术治疗肩部撞击症,使肩峰下间隙充分减压,以消除撞击因素,维持肩关节原有的解剖结构,保留第二肩关节的完整性,手术创伤小,早期功能锻练,肩关节功能恢复满意,明显优于对照组。