聚醚醚酮/羟基磷灰石/碳纤维复合材料的生物力学分析

目的利用有限元分析法比较聚醚醚酮/羟基磷灰石/碳纤维复合材料（75PEEK/10HA/15CF）与钛合金的生物力学。方法建立C4～C6有限元模型,于C5～C6间植入75PEEK/10HA/15CF或钛合金人工椎间盘和椎间融合器,计算在前屈、后伸、侧弯和旋转时临近椎体、椎间盘的wonMises应力变化和C5～C6节段的活动度及植入物上的应力分布。结果在正常情况下,钛合金人工椎间盘置换模型在前屈时C5椎体、C4~5椎间盘平均won Mises应力改变率分别为75PEEK/10HA/15CF人工椎间盘模型的1.50倍和1.67倍;在侧弯时C6椎体的平均won Mises应力改变率为75PEEK/10HA/15CF人工椎间盘置换模型的1.33倍。融合器模型,在前屈时C5椎体、C4~5椎间盘应力改变率前者为后者的1.48倍和1.87倍;在侧弯时C6椎体应力改变率,前者为后者的1.67倍。钛合金植入物的最大应力为75PEEK/10HA/15CF的4.5倍,并出现应力集中。结论与钛合金相比,75PEEK/10HA/15CF能更好地将负荷传递,增加融合率,能有效地减少临近椎体的应力,减少植入物沉降的发生。     

探讨案例教学法在口腔美学修复实习教学中的应用

目的:探讨案例教学法应用在口腔美学修复临床实习教学中的效果。方法:选取39名在北京大学口腔医学院进行一阶段口腔修复临床实习的本科生,按实习编号分为两组;实验组(19名)采用案例教学法,选择以口腔美学修复为主的病例进行学习;对照组(20名)采用传统实习方法,并对两组学生进行临床考核和问卷调查。结果:实验组学生临床考核总分为41.87±3.92,显著高于对照组(38.30±4.62分)(,t=2.596,P=0.013);问卷调查显示,实验组满意度评分显著高于对照组(P<0.05),但学习负担两组无明显差异。结论:案例教学法应用于本科生口腔美学修复实习中,能够有效地训练学生口腔美学修复的临床思维,提高临床综合能力,辅助临床实习教学。     

Segment-embedded frame definition affects the hip joint centre precision during walking

Due to marker-specific soft tissue artefacts, the choice of the markers defining the segment-embedded frame affects the functional joint centre location, with subsequent error propagation to joint kinematics and kinetics in gait analysis. Our aim was to assess the effect of the number and placement of markers on the precision of the hip joint centre (HJC) location during walking.Twelve markers (2 x 6) were attached to the pelvis and left thigh of 15 young male subjects. Set-up movements were collected to locate an optimised functional HJC. For all permutations of three from six markers, a HJC was located and subsequently reconstructed in a static trial and during walking. Precision measures with two different definitions of the origin, namely a single maker or their mean-point, and using three, four, five and six were calculated. Finally, marker triads that reduced the variability of the HJC location were determined. Both the number of markers and method for defining the origin significantly affected the HJC precision during static and walking trials. For walking, precision of 39 mm using three markers improved to 5 mm using redundant markers and the mean marker position as the segment origin. Markers placed close to the joint gave more consistent results.     

mCIM与eCIM在产碳青霉烯酶肠杆菌科细菌表型筛查中的价值

目的分析改良碳青霉烯灭活试验(mCIM)与乙二胺四乙酸碳青霉烯灭活试验(eCIM)对产碳青霉烯酶肠杆菌科细菌表型筛查的效能及应用价值。方法收集碳青霉烯类耐药肠杆菌科细菌(CRE)117株(实验组)、碳青霉烯类敏感肠杆菌科细菌50株(对照组)。分别采用改良Hodge试验(MHT)、mCIM和eCIM进行表型筛查,采用聚合酶链反应(PCR)检测常见碳青霉烯耐药基因,统计表型筛查试验结果与基因检测结果的一致性。结果以PCR检测出碳青霉烯酶基因为金标准,MHT筛查碳青霉烯酶的敏感性为87.0%、特异性为100.0%,mCIM筛查碳青霉烯酶的敏感性、特异性均为100.0%,eCIM筛查金属酶的敏感性为82.4%、特异性为100.0%。结论mCIM筛查碳青霉烯酶的敏感性比MHT高,mCIM与eCIM联合检测能更有效地筛查碳青霉烯酶,且可区分碳青霉烯酶类型,从而有效指导临床用药。     

基于德尔菲法和层次分析法构建护理模拟教学质量评价指标体系

目的构建护理模拟教学质量评价指标体系,确定各指标权重。方法于2018年1月1日成立研究小组,基于大量文献资料和Jeffries仿真理论模型构建护理模拟教学质量评价指标体系初稿,应用德尔菲法对27名专家进行2轮咨询。计算专家的积极系数、权威系数、肯德尔和谐系数和意见集中程度。采用层次分析法确定指标体系的各指标权重。结果2轮专家咨询的有效问卷回收率分别为96.30%和100.00%,专家权威系数为0.89。第2轮专家咨询中二、三级指标的肯德尔和谐系数分别为0.515和0.589,差异有统计学意义(P<0.01)。最终构建的护理模拟教学质量评价指标体系包括5个一级指标,14个二级指标和62个三级指标。结论护理模拟教学质量评价指标体系的权重分配是科学可靠的,该体系对高质量的护理模拟教学具有指导意义,是评价护理学模拟教学质量的有效工具。     

基于信息化平台的糖尿病患者自我管理质量评价指标体系的构建

目的构建基于信息化平台的糖尿病患者自我管理质量评价指标体系,为开展依托信息化平台的糖尿病管理提供借鉴。方法2018年8—11月,在文献回顾和专家会议法的基础上拟定指标体系初稿,通过德尔菲法对28名从事糖尿病诊疗、糖尿病护理、慢病管理、护理管理、护理教育等方面的专家进行2轮函询并构建最终指标体系。计算专家的积极性、权威性,专家意见的一致性、协调性。结果2轮专家函询问卷的有效回收率分别为93.33%和100.00%,专家权威系数分别为0.911和0.945。第2轮专家函询中,一、二、三级指标的肯德尔协调系数分别为0.478、0.478和0.537(P<0.01),变异系数均<0.25。最终构建的基于信息化平台的糖尿病患者自我管理质量评价指标体系包含3项一级指标、9项二级指标和69项三级指标。结论基于信息化平台的糖尿病患者自我管理质量评价指标构建过程严谨科学,指标内容比较合理、可靠性好,可为完善以信息化平台为支撑的糖尿病患者自我管理干预内容、提升糖尿病综合管理质量提供一定参考。     

基于ARCS模型视角下跨文化护理临终关怀微课程内容框架的构建

目的基于ARCS模型视角构建具有科学性和实用性的跨文化护理临终关怀微课程内容框架。方法2018年11月成立课题小组,采用Delphi法,对16名跨文化护理、临终关怀、护理管理、护理教育等领域的专家进行3轮函询,根据专家打分计算指标权重,形成ARCS模型视角下跨文化护理临终关怀微课程教学内容框架。结果问卷函询专家的积极系数为100%,专家权威系数均值为0.81,确定的一、二级指标重要性赋值均大于4.00,变异系数为0~0.12,均小于0.25,符合要求。最终形成包含专业理念类、专业知识类和专业能力类3个一级指标和19个二级分类跨文化护理临终关怀微课程内容框架。结论基于ARCS模型视角下跨文化护理临终关怀微课程内容框架构建过程科学,设置合理,对于开展临终关怀护士培训具有较好的指导意义。     

从宣阳法论小续命汤的妙用

小续命汤出自《备急千金要方·卷八》,功效为祛风扶正。主治中风卒起、筋脉拘急、半身不遂、口目不正、舌强不能语或神志闷乱等。李世杰教授在运用小续命汤加味治疗中风的同时,亦用其治疗高血压、恶性肿瘤如肺癌、头颈部恶性肿瘤、抑郁症等疑难杂症,且疗效显著。     

Evaluation of an automated superimposition method for computer-aided cephalometrics

ObjectivesTo evaluate a new superimposition method compatible with computer-aided cephalometrics and to compare superimposition error to that of the conventional Sella-Nasion (SN) superimposition method.Materials and MethodsA total of 283 lateral cephalometric radiographs were collected and cephalometric landmark identification was performed twice by the same examiner at a 3-month interval. The second tracing was superimposed on the first tracing by both the SN superimposition method and the new, proposed method. The proposed method not only relied on SN landmarks but also minimized the differences between four additional landmarks: Porion, Orbitale, Basion, and Pterygoid. The errors between the landmarks of the duplicate tracings oriented by the two superimposition methods were calculated at Anterior Nasal Spine, Point A, Point B, Pogonion, and Gonion. The paired t-test was used to find any statistical difference in the superimposition errors by the two superimposition methods and to investigate whether there existed clinically significant differences between the two methods.ResultsThe proposed method demonstrated smaller superimposition errors than did the conventional SN superimposition method. When comparisons between the two superimposition methods were made with a 1-mm error range, there were clinically significant differences between them.ConclusionsThe proposed method that was compatible with computer-aided cephalometrics might be a reliable superimposition method for superimposing serial cephalometric images.     

Dentinal tubule penetration and root canal cleanliness following ultrasonic activation of intracanal‐heated sodium hypochlorite

This study investigated the effect of ultrasonic activation of intracanal‐heated sodium hypochlorite (NaOCl) on its dentinal tubular penetration and root canal cleanliness in vitro. In experiment 1, mandibular premolars were randomly allocated to three groups (n = 8): group A, ultrasonic activation; group B, ultrasonic activation of intracanal‐heated NaOCl and group C, syringe‐and‐needle irrigation. Penetration of the fluorescent‐labelled NaOCl was investigated using light microscopy. In experiment 2, mandibular premolars were randomly allocated to group B or C (n = 10), for histological analysis of the remaining pulp tissue and debris. Data were statistically analysed using Kruskal–Wallis and Mann–Whitney tests (P = 0.05). The highest penetration of NaOCl was observed in group B, followed by group A (P < 0.05). Group B showed significantly less amount of debris than group C (P < 0.05). Dentinal tubule penetration of NaOCl and root canal cleanliness were significantly improved by ultrasonic activation of intracanal‐heated NaOCl.