骨科固定及植入器材的应用与发展

介绍了常用骨科固定及植入器材，并对其发展历史、作用及特点作简要概述。     

Colorectal cancer and the relationship between genes and the environment

Colorectal cancer (CRC) is a significant cause of morbidity and mortality in developed countries, with both genetic and environmental factors contributing to the etiology and progression of the disease. Several risk factors have been identified, including positive family history, red meat intake, smoking, and alcohol intake. Protective factors include vegetables, calcium, hormone replacement therapy, folate, nonsteroidal anti-inflammatory drugs, and physical activity. The interaction between these environmental factors, in particular diet and genes, is an area of growing interest. Currently, oncogenes, tumor suppressor genes, and mismatch repair genes are believed to play an essential role in colorectal carcinogenesis. When considering the genetics of CRC, only 10% of cases are inherited and only 2-6% can be ascribed to the highly penetrant genes, such as APC, hMLH and hMSH2. Lower penetrance genes combined with a Western-style diet contribute to the majority of sporadic CRCs. The purpose of this article is to give a brief overview of the epidemiologic studies that have been conducted and present the major findings. Here, we examine the molecular events in CRC, with particular focus on the interaction between genes and environment, and review the most current research in this area.     

Nutrition and health--vitamin supplementation and the vitality of the elderly

The increasing number of elderly people above 65 years of age is extremely heterogeneous with regard to sickness and health. As a result, the nutritional needs and food consumption also vary. 'Anorexia of aging', leading to nutritional deficiencies, is a common syndrome in the elderly people and may be either caused by or result in loss of functions and accelerated aging. Early detection of malnutrition and intervention with supplements or an adequate diet should stop the negative health spiral. A limited number of intervention trials, including Dutch ones, have demonstrated a positive effect on the nutritional and immune status. However, the improvement in physical and mental functions as a result of supplementation is less clear. The results of larger current trials on the effect of supplementation with, for example, vitamin D, folic acid, vitamin B12 and complete enriched products will provide more clarity in the future on the necessity of supplementation for elderly people.     

南北朝隋唐时代的金刀之谶与弥勒信仰

一种观念要影响政治大势,往往需要植根于大众广泛接受的思想或信仰系统。金刀之谶作为一种政治观念,发端于与今文经学结合紧密的谶纬之学,在汉朝灭亡前后与早期道教结合,北魏以后则转向与弥勒信仰结合,深刻地影响了南北朝隋唐时期的政治起伏。刘氏当王与李氏将兴反映的政治文化传统不同。道君出世与弥勒下生两种信仰的竞争,和由刘氏还是李氏统治天下的世俗权力之争纠缠在一起,制约了其时的政治走向。     

积极推进院务公开 促进医院改革发展

通过推进院务公开工作，加强社会公众监督和医院职工民主监督，提高医疗服务质量和服务水平，推动医院持续健康发展。     

浅析医疗设备验收中存在的问题及体会

医疗设备管理是医院管理工作的重要组成部份之一,而医疗仪器设备的“验收”,是经可行性论证、订合同到货后的第一个环节,主要有物资验收和性能验收两个方面。     

Home visit to the newborn and the post-natal mother. Role of the paediatrician and the nurse

Based on our experience over many years, and on the experience of others, we can deduce that home visits to the newborn and the mother are highly positive. In absolute terms, this is an efficient and necessary visit that is broadly accepted by the population, and its implantation amongst the services offered by the public health services has therefore been a correct move; carrying out such a visit should be obligatory and it should be considered as a basic aim within the health programs. The success of the visit depends not only on the personal treatment of the health personnel who take part, but also on their qualification and professionalism, since the visit requires a high level of preparation and dedication, as well as the support of the administration itself.     

The meaning of the opposition between the healthy and the pathological and its consequences

If the healthy and the pathological are not merely judgments qualifiers, but real phenomena, it must be possible to define both of them positively, which, in this context, means as factual contraries. On the other hand, only a privative definition, either of the pathological as ‘non-healthy’, or of the healthy as ‘non-pathological’, can rationally circumscribe all possible states of an organism. This fluctuation between two meanings of the ‘healthy’–‘pathological’ opposition, factual vs. rational, characterizes the ordinary usage of these concepts and puts all philosophical definitions in a hopeless situation. Although a scientific definition may conceal this equivocation by adequately setting out the terms of the problem of discriminating between the ‘healthy’ and the ‘pathological’, it could explain some of the difficulties met in determining ‘gold standards’, in the choice of separators, and in the assessment of the diagnostic qualities of tests.     

硫胺素、核黄素营养现况与中老年人抗氧化水平的相关性

目的分析硫胺素和核黄素营养状况与机体抗氧化水平及血糖、血脂水平的关系。方法选取上海市区314名中老年人作为调查对象,采用连续三日24小时膳食回顾法计算每日营养素摄入量,尿负荷实验测定机体硫胺素、核黄素营养水平,同时测定其血浆超氧化物歧化酶（SOD）活性、丙二醛（MDA）、空腹血糖（FBG）、总胆固醇（TC）和甘油三酯（TG）水平。结果膳食硫胺素平均摄入量为（0．82±0．36）mg／d,其中达到或超过推荐摄人量（RNI）的比例为11．8％,低于60％RNI的比例为51．3％;核黄素平均摄入量为（0．91±0．48）mg／d,其中达到或超过RNI的比例为17．2％,低于60％RNI的比例为49．4％。尿负荷实验结果显示,机体硫胺素缺乏的比例为65．0％,核黄素缺乏的比例为58．6％。与正常组相比,硫胺素、核黄素不足和缺乏组的MDA、FBG、Tc和TG水平呈升高趋势,SOD活性呈下降趋势,其中硫胺素缺乏组的MDA、FBG和Tc与正常组间差异有统计学意义（P〈0．05）。FBG、TC与尿硫胺素水平呈弱负相关（r=-0．246、r=-0．154,P〈0．05）,MDA、TG与尿核黄素水平呈弱负相关（r=-0．136、r=-0．297,P〈0．05）。结论上海部分地区中老年人硫胺素、核黄素营养水平较低,硫胺素、核黄素营养水平与机体抗氧化水平呈弱正相关趋势,与血糖、血脂水平呈弱负相关趋势。     

Health and welfare of the child,mother and the family

Women and their male partners may choose to bear fewer children if they expect their offspring to survive into adulthood. Great need therefore exists to reduce levels of perinatal and infant mortality. Maternal-child health (MCH) services are said to be integrated from the highest to the most peripheral level, but pregnant and sick mothers are really the concern of only obstetricians and gynecologists, while sick children are treated by pediatricians. The success of the Integrated Child Development Services has, however, demonstrated that integration can work. Educating mothers is important in India, but MCH care should not be delayed until systems of universal education are established. Instead, support should be given to the implementation of a system of education limited to the key problem of reproduction and MCH established within the framework of supervised maternity. The impact of education under such circumstances will be relatively greater due to the immediacy of having to treat a sick child or the pregnant mother. The author notes the improved status of women in India and considers the future of MCH and family welfare.     

Disorders of the cervical spine and the upper extremities and occupations

A chronological review of damage to the spine and upper extremities associated with work was carried out in a sample of 120 retired disabled workers. Examination of risk factors for cervicobrachial syndrome (CBS) showed that the forced, bent position of the body at work contributed significantly to the frequency of the disease, particularly in women (70.0% against 38% in controls P less than 0.01). The lifting of heavy loads was also frequently observed in women with CBS (12% compared to 6% in the control group (P less than 0.05). Repeated movements during work were claimed by 52.9% of the males and 80% of the females with CBS and by only 41.4% of the males and 50% of the females without it (P less than 0.01). The heaviest load lifted by subjects with CBS at work exceeded significantly that of control subjects. It is considered that there is a causal link between excessive burden and the occurrence of CBS in women. For early diagnosis of CBS, tiredness, pain in the cervical spine, reduced strength in the hands and poor ability to endure manual work are signs to be looked for. Early recognition of disease, improved working conditions and recreation can help prevent the disease or slow down its progress.     

Transnational industrial power,the medical profession and the regulatory state: adverse drug reactions and the crisis over the safety of Halcion in the Netherlands and the UK

Taking the controversy over the safety of the hypnotic, Halcion, in the Netherlands and the UK, as a case study, this article examines the problems for public health associated with responses to warnings about drug hazards by regulatory agencies, governmental expert advisers, the pharmaceutical industry and the medical profession. It is argued that regulators and the medical profession rely too heavily on manufacturers to investigate warnings from doctors' spontaneous reporting of adverse effects of drug products on the market. It is demonstrated that a pharmaceutical firm's commitment to search effectively for evidence against the safety of its own product in order to confirm doctors' warnings can have severe limitations. Deficiencies in the socio-institutional responses to post-market 'early warning systems' about drug hazards imply that the regulatory policies of 'early licensing' and minimal pre-market checks for new drugs are misconceived and threaten public health. To improve public protection from drug injury, the regulators should abandon their conviction that compelling evidence of drug hazards are required to confirm doctors' warning signals prior to regulatory intervention. Instead, they should adopt a policy of measured regulatory intervention as an immediate response to warning signals, while investigators, independent of the manufacturers, assess the significance of the signal.     

安徽省大学生体育锻炼与情绪和睡眠状况的相关性研究

研究体育锻炼与大学生的情绪和睡眠状态的相关,为改善大学生心理健康状况提供参考.方法 随机抽取安徽省3所高校556名在校本科生,采用自编体育锻炼调查问卷调查体育锻炼情况,采用匹茨堡睡眠质量指数量表、青少年亚健康多维评定问卷、抑郁自评量表、焦虑自评量表分别调查被试睡眠状况、心身健康和情绪状况.结果 在平时学习的时间花费上,锻炼组与非锻炼组分别为(4.16±2.70),(3.66±2.56)h,差异有统计学意义(P=0.02).锻炼组抑郁自评量表得分明显低于非锻炼组,主观睡眠质量和睡眠潜伏期分量表明显低于非锻炼组,差异均有统计学意义(P值均<0.05).睡眠在体育锻炼对情绪状态的预测中起到部分中介作用.结论 体育锻炼越积极的大学生情绪和睡眠状况越好.体育锻炼干预可通过影响睡眠对情绪产生积极的影响.     

Play and the role of the teacher

There is evidence to suggest that nursery school teachers tend to intervene infrequently in children's play in ways that are concerned with intellectual development. Studies are discussed which suggest, by contrast, that skilful adult interaction may facilitate and enhance the imaginative quality of representational play. Skilful interaction requires that three different kinds of relationships #opincidental, instrumental and intrinsic#cp between play and intellectual development are understood, and these are examined. Finally, two styles of interaction, the redirecting and extending styles, are discussed and it is argued that the extending style which synchronises with children's intentions is the one that is educationally profitable but at the same time values children's play in its own right.     

Cluster management and the role of concerned communities and the media

Public health services often have to deal with reported clusters of adverse health events. An important characteristic of disease clusters is that the involved community often is concerned about environmental factors influencing health. To facilitate cluster investigations, a stepwise protocol was developed in the Netherlands, based on international literature. Essential is the two-way approach, consisting of a disease-track and an environment-track. Attention to potential environmental exposures is as important as attention to the reported diseases, not only because environmental pollution often is the reason of public concern and thus relevant for risk communication, but also for deciding about the boundaries of the population at risk. Moreover, environmental information is necessary for judgement of the plausibility of a causal relation and for advising measures to prevent exposure. Within this two-way approach, three stages are distinguished: orientation stage, verification stage and quantification stage. Only if an increased risk as well as an elevated exposure is verified, under certain conditions a case–control study may be useful to study causality between exposure and adverse health events. During all stages of the investigation, good risk communication strategies have to be taken into account. However, even then it might be difficult to prevent conflicts, because of the differing interests between experts and the community involved. One of the most important aspects that determine judgements about risks by threatened people, is controllability; that is why community participation is essential. Therefore it can be concluded that cluster management is a mutual endeavour for experts, public and media, where experts are judged on three characteristics: expertise, credibility and empathy.     

Cytotec and abortion: the police, the vendors and women

This paper analyzes the illegal trade in misoprostol, the medication predominantly used for abortion in Brazil. The study analyzed ten cases that came to the attention of the Public Prosecution Service for the Federal District between 2004 and 2010. The cases were organized into three categories: 1. women's stories; 2. profile of the vendors; 3. maternal mortality cases. The research was reviewed by an ethics committee. The main outcomes were: 1. young women in steady relationships use misoprostol in the home or with the assistance of drug vendors. Of the seven women indicted, three were reported on arrival at the public hospital to finalize abortion; 2. the drug vendors work at the community drugstore and are local agents for the sale of misoprostol. They instruct women on how to use the drug and how to prevent infections, but refuse to provide them with care in case of emergency. Traffickers operate via the internet and have a larger inventory of drugs; 3. there were two cases of maternal mortality due to the combination of high risk methods, such as a vaginal probe and misoprostol. The main causes for maternal mortality are the delay in seeking medical care, as the women fear criminal prosecution, and the combined use of misoprostol with high risk methods.     

Dysmorphology and the spectacle of the clinic

Dysmorphology is the medical study of abnormal forms in the human and is concerned with the identification and classification of a variety of congenital malformations. Such diagnostic work rests on the inspection of images of affected individuals. Based on physical appearance individuals are classified in terms of a wide range of conditions, often with 'exotic' nomenclatures. This paper will describe the features of clinical dysmorphology and the process of classification. It derives from an ethnographic study of clinical consultations and meetings among medical geneticists in UK hospitals. We suggest that contemporary dysmorphology can be understood in terms of long-standing forms of medical knowledge, medical representations and medical discourse. Notwithstanding the new forms of technology provided by genetic science, 'the clinic' still asserts its symbolic and functional power: the 'gaze' of the clinician and the clinician's warrant of personal knowledge exert their influence. The adjudication of dysmorphology is a contemporary exemplar of the spectacular.     

铬对人体与环境的影响及防治

铬既是人和动物必需的微量元素之一,又是重要的环境污染物。分析探讨了铬对人体及环境的主要影响,包括积极有利作用和其严重危害作用,并提出了减少铬环境污染的途径和方法。