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提出了一个有关组合梁结构性能的全面数值分析,针对剪切变形效应、不同施工方法、不同程度的钢构件截面应变硬化等情况下,对简支组合梁结构性能进行了一系列的数值分析。使用先进的三维有限元方法,模拟输入特定的材质、几何尺寸、非线性的界面,分析和讨论了24组简支组合梁的承载能力和变形特性。通过分析和考虑两种不同的施工方法,包括混凝土浇筑组合梁时仅采用端部支撑及混凝土浇筑组合梁时采用全支撑,发现剪切连接件滑移的要求在前者的情况下相对较小。另外,若同时考虑欧洲规范第3及第4部分中提及的钢构件截面应变硬化效应后,在全剪切连接情况下,组合梁承载能力有8.5%的显著提升。然而,随着剪切连接程度的减少,截面应变硬化作用减弱,同时,对剪切连接件滑移的要求也会随之减少,因此这样的变化对于组合梁里允许应变而非延性的剪切来说是非常重要的。

【目的】分析Cushing综合征各种病因的临床特征，评估诊断和病因鉴别诊断的方法和效率。【方法】回顾分析我院1996年~2006年住院经临床和病理确诊为Cushing综合征的154例病例的临床资料和实验室检查资料。【结果】85%左右的病人有典型的Cushing外貌，肾上腺腺瘤占33.8%，其中85％为育龄女性。约半数病人出现低血钾和糖尿病。血糖异常、高血压及高脂血症的发生率分别为68.7%，72.6% and 67.6%。Cushing综合征诊断的敏感性从高到低依次为不被午夜1 mg地塞米松抑制、24 h 尿游离皮质醇升高、血皮质醇昼夜节律消失、清晨血皮质醇升高。在Cushing病和肾上腺腺瘤的鉴别诊断中，8 mg地塞米松抑制试验的特异性和敏感性分别为86.8％和90.8％，ACTH的特异性和敏感性分别为97.2％％和65.1％。【结论】本组病例肾上腺腺瘤比例高,糖尿病发生率高。需结合多种现有常用实验检测方法，方可对Cushing综合征的病因进行准确的鉴别诊断。

【目的】探讨低场强四肢关节磁共振在膝关节骨挫伤中的应用价值。【方法】回顾性分析30例经临床证实的膝关节骨挫伤MR影像和临床资料。【结果】30例外伤膝关节共检出43处骨挫伤,28处关节其他结构损伤。根据骨挫伤MR表现可分为3型：Ⅰ型（13例）;表现为干骺端和骨干区内的弥漫性信号改变,Ⅱ型（8例）;表现为软骨下骨皮质的连续性中断。Ⅲ型（9例）;表现为软骨下骨内见局限性的信号改变区。【结论】膝关节是骨挫伤的好发部位;X线平片、CT对骨挫伤的诊断价值有限,低场强四肢关节MR对骨挫伤检出率较高,并可观察关节其他结构的损伤,为临床治疗及预后的评估提供依据。

【目的】了解热压成型模板在眶部种植术前应用计算机体层摄影（∞扫描及图像分析中的指导效果。【方法】利用热压成型机对薄塑胶板加热、真空加压，按时钟方式制作成带标记孔的CT模板。将该模板佩戴人12具干颅标本和4例眶部缺失的患者。通过常规眶部CT扫描和CT工作站Advanced Workstation（AW）4．0图像分析，观察眶部受植区骨量和骨解剖结构。【结果】带标记点的放射模板准确地定位了眶部受植区的骨结构，能够方便的测量受植区的骨量。【结论】热压成型CT模板可以精确分析眶部受植区骨量和骨结构．在眶部种植术前分析受植区骨量时值得推广应用。

【目的】探讨婴儿期腭裂修复术的可行性及其临床效果。【方法】对184例7-12个月的先天性腭裂患儿采用气管插管全麻下行腭裂整复术，观察其术中、术后情况，并对102例术后1-5年的患儿进行随访．对其语音进行了初步的评价。【结果】全部患儿均能很好地耐受麻醉及手术，手术时间为（105．2±14．5）min，手术失血量为（35±5．4）mL。除1例双侧腭裂患儿术后发生腭瘘外，其余全部愈合良好。语音评价优良率达93．1％。【结论】婴儿期腭裂整复术是安全可行的，早期手术可获得良好的语音效果。

摘 要:【目的】应用Endopore 系统种植体行即刻种植, 并对种植效果进行临床分析。【方法】对具有即刻种植适应症18 例患者行26 个人工牙种植体植入, 牙槽窝较宽者加用人冻干脱钙骨植入或联合超薄钛膜覆盖, 3 ～ 6 个月后, 行种植义齿修 复。【结果】26 个种植体植入后, 伤口一期愈合, 义齿修复后行使咀嚼功能3 ～ 36 月, 未发现种植失败。【结论】即刻种植应严 格掌握适应症, 避免牙槽骨损伤, 保证充分的骨组织与种植体结合, 软组织要充分松弛, 伤口无张力缝合。

【目的】研究观察生物可吸收内固定系统(夹板与螺钉)植入人体后的各类反应及对机体内环境的可能影响并评 价其临床效果。【方法】对16 位颌面部骨折的病人在植入可吸收夹板与螺钉内固定后的3 个月、6 个月、9 个月、12 个月时均 检测血常规、血生化和血清酶学指标并按时间段总结, 同时复查病人的伤口愈合、骨端固定、咬合关系恢复等情况。【结果】16 位病人术后3 个月、6 个月、9 个月、12 个月的检测血常规、血生化和血清酶学指标均无异常发现, 临床检查局部伤口、骨段愈 合均恢复良好, 咬合关系正常。【结论】生物可吸收内固定系统(夹板与螺钉)具有良好的骨断端内固定作用, 可吸收内固定系 统可满足颌面部骨折内固定的生物力学要求, 完全达到临床治疗上的生理骨愈合。

【目的】改进体外成肌细胞培养方法。【方法】取20 只小鼠分4 组, 取股骨肌用肌块法进行成肌细胞原代培养, 并重复利用肌块6 次。对培养的成肌细胞进行生长状态观察及免疫的组化鉴定。【结果】重复6 次使用肌块培养的成肌细胞 生长、分化良好;一次差速贴壁纯化后, 经免疫组化方法鉴定, 96 %以上的细胞呈肌细胞特异抗体阳性反应。【结论】重复肌块

摘 要:【目的】观察上颌前部牙槽骨内圆柱洞形扩宽后行同期人工牙种植的临床效果。【方法】选择11 例上颌前部失 牙的患者, 经螺旋CT 多层面重建图像检查确定为牙槽骨高度足够, 宽度不足, 采用扁尖刃圆柱形扩宽器械增宽牙槽骨并形成 骨内圆柱洞形, 植入17 个圆柱形牙种植体。【结果】全部牙种植伤口一期愈合, 经3～ 55 个月观察全部成功。【结论】该技术 适用于牙槽骨宽度不足的牙种植, 比较牙槽骨劈开术有明显的优点。

【目的】观察羟基磷灰石(HA)/脱矿骨复合物骨膜下植入增高牙槽嵴的成骨反应。【方法】在犬下颌体部及下颌 磨牙区无牙颌牙槽骨顶部, 骨膜下植入羟基磷灰石/ 脱矿骨复合物为实验组, 并设单独羟基磷灰石植入为对照组。经3 周、6 周、12 周和24 周后处死动物, 取材作大体观察、组织学观察和扫描电镜观察。【结果】实验组术后3 周即见类骨质产生, 材料 和基骨界面开始结合;术后6 周材料和基骨大部分结合;12 ～ 24 周新骨增多, 相互连接, 充满羟基磷灰石间隙并与之结合。对 照组术后3 周未见新骨形成;术后6 周材料与基骨始见结合;术后12 ～ 24 周只见新骨从界面少许形成。【结论】骨膜下植入羟 基磷灰石/ 脱矿骨复合材料较之单纯的羟基磷灰石植入可见较快的新骨形成, 材料和基骨界面较早结合, 较多的新骨形成充 满羟基磷灰石间隙。

【目的】探讨婴幼儿腮腺血管瘤手术治疗的效果。【方法】对23 例(年龄40 d～ 2 岁)婴幼儿腮腺血管瘤施行保留 面神经的腮腺及血管瘤切除术, 随访3 个月至3 年。【结果】全部创口Ⅰ 期愈合;22 例随访期间未见肿瘤复发, 1 例术后3 个 月复发, 再次手术后至今未复发;所有病例均无感染、涎瘘、永久性面瘫等并发症。【结论】婴幼儿腮腺血管瘤早期手术治疗可 获得满意效果。

【目的】应用两种螺旋 CT 多层面图象重建( MPR)技术检查颌骨, 考察这些图象用于牙种植所达到的临床效果。【方 法】用螺旋 CT 对牙种植术前术后的临床病例之颌骨作 1mm 厚层连续扫描后, CT 主机将扫描图象数据传送入工作站, 以牙科 颌骨多区域MPR 软件,和普通颌骨单区域 MPR 软件处理数据。【结果】多区域 MPR技术可同时显示数张整体颌骨弓的 CT 全 景片和数十张任意间隔的颌骨弓多区域横断面图象。普通颌骨单区域 MPR 技术可显示颌骨单区域数张任意平面和任意曲面 的图象。【结论】两种螺旋 CTMPR 分别适用于牙种植术前设计的颌骨检查, 和植入后牙种植体的检查。两种技术的联合应用 可较全面检查牙种植术前术后的颌骨形态、结构和骨质、牙种植体与骨结合情况, 以及牙种植体与颌骨内重要结构的关系。

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Objective To identify early Klebsiella pneumoniae (KP) infection after liver transplantation and its impact on prognosis. Methods Clinical data of 171 liver transplant recipients were retrospectively analyzed, and they were divided into the non-infection (n=52) and infection groups (n=119) according to the bacterial culture results at postoperative 2 weeks. In the infection group, KP was not detected in 86 cases (non-KP infection group), and KP was cultured in 33 cases (KP infection group). Preoperative, intraoperative and postoperative data were statistically compared between the non-infection and infection groups, and between the non-KP infection and KP infection groups. The risk factors of early KP infection after liver transplantation and the influencing factors of long-term survival of the recipients were analyzed.Results Compared with the non-infection group, model for end-stage liver disease (MELD) score and total bilirubin level were higher, the operation time was longer, the length of postoperative intensive care unit (ICU) stay and the length of hospital stay were longer, the amount of intraoperative red blood cell transfusion was higher, the hospitalization expense was higher, the incidence of severe complications was higher, white blood cell count, absolute neutrophil cell count and neutrophil-to-lymphocyte ratio at postoperative 14 and 30 d were higher, absolute lymphocyte count at postoperative 14 d was lower and hemoglobin level at postoperative 30 d was lower in the infection group. The differences were statistically significant (all P<0.05). Compared with the non-KP infection group, MELD score, total bilirubin level and aspartate aminotransferase (AST) level were higher, the operation time and the length of postoperative ICU stay were longer, the hospitalization expense was higher, the 90-d fatality was higher, the albumin level at postoperative 14 d was lower, and total bilirubin level at postoperative 30 d was higher in the KP infection group. The differences were statistically significant (all P<0.05). Among 33 recipients with KP infection, 16 cases were resistant to carbapenem antibiotics, and 7 of them died within postoperative 90 d. Seventeen cases were intermediate or sensitive to carbapenem antibiotics, and 4 of them died within postoperative 90 d. Preoperative MELD score ≥17 and operation time≥415 min were the independent risk factors for KP infection after liver transplantation (both P<0.05). The length of postoperative ICU stay ≥44 h and KP infection were the independent risk factors for long-term prognosis of liver transplantation (both P<0.05). Conclusions KP infection is an independent risk factor for death after liver transplantation. High preoperative MELD score and long operation time are the independent risk factors for early KP infection after liver transplantation. [ABSTRACT FROM AUTHOR]

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本文对40例糖尿病患者的血小板聚集、血栓烷B2生成和cAMP含量进行测定并探讨其与微血管病变的关系。结果表明:糖尿病患者血小板聚集增强、血栓烷B2生成增加,血小板cAMP含量降低。上述改变在无合并微血管病变组已存在,参与微血管病变的发生和发展。血小板血栓烷B2生成增加可能与血小板膜磷脂酶活性有关。

Objective To construct a measurement tool for atrial fibrillation (AF) patients’ experience of catheter ablation, in order to provide quantifiable basis for improving the patients’ perioperative experience. Methods From Jun 2022 to Apr 2023, literature analysis, qualitative research, Delphi expert consultation, and analytic hierarchy process were used to determine the content and weight of various indicators of the measurement tool. Results The enthusiasm of experts in 3 rounds was 100%. The authority coefficient of experts was 0.946, 0.961 and 0.976. The Kendal harmony coefficients of the 2 and 3 rounds of expert consultation was 0.130 and 0.370 (P<0.001). The final measurement tool included 46 items and 5 dimensions, including operational and technical quality experience, comfort management experience, information and communication experience, emotional support experience, service process and response experience. Conclusion The preliminary construction of measurement tool for AF patients’ experience of catheter ablation, which were based on the features of specialty, could not only evaluate the patients’ experience accurately, but also provide a basis for targeted improvement of medical and nursing service quality. [ABSTRACT FROM AUTHOR]

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