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“八步教学法”促进医学人文教育多元渗透

南方医学教育 2011年第1期 33-34页

作者：屠军波虎小毅宋勇白岫峰李兴强杜良智文抑西西安交通大学口腔医院口腔颌面外科

实习前教学是口腔颌面外科理论学习和临床实践联系的桥梁,通过PBL教学、病历书写、医患沟通、参观手术、动物实验、心肺复苏、教学查房、病案讨论等八个步骤进行实习前教学,层层推进,从临床思维转换开始,中间结合专业特色融入相关法律... 详细信息

实习前教学是口腔颌面外科理论学习和临床实践联系的桥梁,通过PBL教学、病历书写、医患沟通、参观手术、动物实验、心肺复苏、教学查房、病案讨论等八个步骤进行实习前教学,层层推进,从临床思维转换开始,中间结合专业特色融入相关法律、伦理、心理沟通等人文素质教育,到脚踏实地的专业基本技能培养,最后理论与技能真正联系临床实际,完成医学生到医生角色的转换,实现质的飞跃。

关键词：口腔颌面外科人文教育实践技能教育

儿童下肢割草机创伤性截肢术后长期使用假肢的成本

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世界核心医学期刊文摘（儿科学分册） 2005年第5期1卷 34-35页

作者： Loder R. T. Dikos G. D. Taylor D. A. 虎小毅 James Whitcomb Riley Hosp. Children 702 Barnhill Dr Indianapolis IN 46202 United StatesDr.

Objectives: To evaluate prosthetic costs of pediatric lawnmower amputations; t o see if reducing the incidence of pediatric lawnmower amputations could result in significant cost savings; and to consider if a cost analysis could be useful to implement more safety features (voluntarily or legislatively). Design: Pediat ric lawnmower amputees from 1980 to 2000 were reviewed to determine age at time of injury, level of amputation, number of prostheses, and lifetime per prosthesi s. A standard prosthetic program beginning at amputation and ending at age 18 ye ars was constructed. An aggregate cost was calculated according to the proportio n of amputation levels. The cost burden for prosthetic care was estimated from t he statistics of US pediatric lawnmower injuries. Setting: Referral pediatric or thopedic center. Patients: Fifty-three lower extremity amputees with 58 lower e xtremity amputations at a mean ±SD age of 4.7 ±2.5 years were reviewed. Resu lts: The percentage of amputee children injured by riding lawnmowers was 80%; t he percentage injured by riding lawnmowers engaged in reverse was 39%. Prosthet ic costs from the time of injury to the age of 18 years range from ＄73140 to ＄ 116040 per single lower extremity amputation. With 600 to 650 new childhood ampu tations per year due to lawnmowers, the new annual burden for prosthetic costs t hus ranges from ＄43.88 to ＄75.42 million, or (600) (＄73140)-to (650) (＄11 6040). Conclusions: Further encouragement of lawnmower manufacturers to install improved safety devices (such as those to disengage power while in reverse mode of operation), new research on improved safety measures, and continued promotion of educational campaigns regarding the dangers of children being around and/or operating riding lawnmowers and garden tractors should be pursued. This will res ult in significant cost savings aswell as incalculable health savings.

关键词：创伤性截肢术截肢患者假体修复截肢者实验设计美国儿童统计分析

新生儿脑病:细胞因子与磁共振波谱分析的关系及结果

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世界核心医学期刊文摘（儿科学分册） 2005年第7期1卷 50-51页

作者： Bartha A.I. Foster-Barber A. Miller S.P. D.M.Ferriero 虎小毅 Department of Neurology Univ.of California San Francisco 521 Parnassus Ave. C-215 San Francisco CA 94143-0663 United States Dr.

In term neonatal encephalopathy, little is known about the relationship between early inflammatory markers, neonatal brain injury, and long-term neurodevelopmental *** goal was to determine whether neonatal serum cytokine levels are associated with cerebral metabolism assessed by proton magnetic resonance spectroscopy (MRS), with magnetic resonance imaging (MRI) abnormalities, and with neurodevelopmental outcome at 30 mo of *** of seven cytokines [IL-1/3, IL-6, IL-8, IL-9, IL-12, IL-13, and tumor necrosis factor (TNF)-α] were measured in dried neonatal blood by immunoaffinity chromatography in a prospective cohort of 62 term newborns at risk of neonatal *** images (n = 61) were scored and lactate/choline and N-acetyl-aspartate (NAA)/choline were measured by MRS (n = 42) on median day of life 6 in the deep gray nuclei (DGN) and in the watershed/cortical zone (WS).Neurodevelopmental outcome (n = 54) was considered abnormal if the infant died or if cognitive delay and/or functional motor deficit were detected at 30 ***-1β, IL-6, IL-8 and TNF-αwere significantly associated with lactate/choline in the DGN (p = 0.03, 0.02, 0.03, and 0.01 respectively), but not in the WS (all p > 0.1).Cytokines were not associated with NAA/choline in any region or with MRI *** with abnormal neurodevelopmental outcome had higher neonatal levels of IL-1β, IL-6, IL-8, and lower levels of IL-12 (p = 0.04, 0.03, 0.01, 0.03 respectively).Elevated inflammatory cytokines were associated with impaired cerebral oxidative metabolism, but not with detectable MRI changes in the neonatal *** the link between elevated cytokines and outcome would inform novel strategies of cerebral protection.

关键词：磁共振波谱分析脑病细胞因子乳酸盐影像学异常神经发育认知功能婴儿死亡质子磁共振波谱炎性标志物

与流感病毒和呼吸道合胞病毒感染相关的呼吸系统疾病

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世界核心医学期刊文摘（儿科学分册） 2005年第11期1卷 29-30页

作者： FlemingD.M. Pannell R.S. Elliot A.J. Cross-K.W. 虎小毅 Birmingham Research Unit Royal College of General Practitioners Lordswood House 54 Lordswood Road Harborne Birmingham B17 9DB United Kingdom Dr.

Aims: To estimate excess morbidity during periods of influenza and respiratory syncytial virus (RSV) activity. Methods: Retrospective analysis of a sentinel practice network database in active and non-active virus periods. Main outcome measures: clinical diagnoses of new episodes of influenza-like illness (ILI), acute bronchitis, asthma, and otitismedia. Results: The clinical diagnosis of ILI was consistent with influenza virus activity and acute bronchitis with RSV. During periods of virus activity, estimates of excess morbidity in children aged 1-4 and 5-14 years diagnosed as having acute otitis media exceeded those diagnosed with each of the other three conditions; in children < 1 year estimates for acute bronchitis were highest. Using a broad definition of virus activity and summarising the data for all children diagnosed with ILI, 60%was attributable to influenza (40%RSV) as were 37%of episodes diagnosed as ocute bronchitis, 9%of those with asthma and 48%of those with otitis media. Using a narrow definition, corresponding proportions were: for ILI diagnoses 77%(23%RSV), acute bronchitis 32%, asthma zero, and otitis media 45%. Acute bronchitis was diagnosed twice as frequently in association with RSV as with influenza in all age groups: excess asthma episodes were only evident in RSV active periods. Conclusions: Except in relation to ILI, RSV caused more illness than the influenza virus in the respiratory diagnoses examined, emphasising the need for RSV prevention and treatment. Influenza was not associated with excess asthma episodes.

关键词：呼吸系统疾病流感病毒呼吸道合胞病毒临床诊断年龄组网络数据库概括总结

对两个22q11缺失综合征家族遗传分析:心外表征的重要性

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世界核心医学期刊文摘（儿科学分册） 2005年第8期1卷 26-27页

作者： Shooner K.A. Rope A.F. Hopkin R.J. D.W. Benson 虎小毅 Cardiology ML 70 42 Children's Hospital Medical Center 3333 Burnet Ave Cincinnati OH 45229 - 3039 United States Dr.

Objectives: Cardiovascular malformations (CVMs) are reported to be common (～ 75% ) in patients with deletion 22q11.2 (del22q11) syndrome. To better underst and why deletions go unrecognized, we characterized the phenotype in deleted ind ividuals in two large kindreds with particular emphasis on the presence or absen ce of CVM. Study design: After the diagnosis of del22q11 in two unrelated proban ds with CVM, we sequentially evaluated family members with clinical evaluation a nd cytogenetic analysis. Results: Del22q11 was identified in 13 individuals; all exhibited characteristic dysmorphic facial features, but a CVM was present in o nly 6 of 13 (46% ) individuals. Conclusions: We speculate that in the absence o f CVM, diagnosis of del22q11 is hampered by a failure to recognize extracardiac features of the del22q11 syndrome spectrum. The data highlight the need for prim ary care physicians and specialists to familiarize themselves with the extracard iac stigmata of del22q11 to ensure timely diagnosis in all family members.

关键词：家族遗传 q11 染色体缺失遗传学分析先证者表型特征接诊医师心血管畸形同质异形临床评估

传统方法在改善营养不良的青少年及成人囊性纤维化的营养状况方面的失败

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世界核心医学期刊文摘（儿科学分册） 2006年第2期2卷 30-31页

作者： Kalnins D. Corey M. Ellis L. P.R. Durie 虎小毅 Division of Gastroenterology/Nutrition Hospital for Sick Children 555 University Ave Toronto Ont. M5G 1X8 Canada Dr.

The use of oral dietary supplements was compared with dietary counseling in 13 malnourished patients (3 males, mean age 18.1 years) with cystic fibrosis. Energy intake and nutritional status were evaluated over 3 mont... 详细信息

关键词：营养状况评估囊性纤维化营养不良青少年成人能量摄入对照研究饮食指导平均年龄摄入状况

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基于残冠根不同治疗方案的伦理解析

中国医学伦理学 2006年第3期19卷 85-87页

作者：宋勇屠军波虎小毅李国光杨壮群西安交通大学口腔医院口腔颌面整形外科陕西西安710004

残冠根有其重要的生理学意义,但是目前在临床上对残冠根的治疗存在许多的问题,如过度医疗、防御性医疗等。本文分析了出现这些问题的背景及原因,并提出了相应的解决办法。

关键词：残冠残根过度医疗防御性医疗医学伦理学

脂质体鱼肝油酸钠作用于人血管瘤内皮细胞的实验研究

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脂质体鱼肝油酸钠作用于人血管瘤内皮细胞的实验研究

2007'全国口腔颌面部脉管性疾病学术研讨会

作者：屠军波王正辉杨壮群李国光宋勇虎小毅汤晓雨西安交通大学口腔医院口腔颌面整形外科西安交通大学口腔医院口腔颌面整形外科西安交通大学口腔医院口腔颌面整形外科西安交通大学口腔医院口腔颌面整形外科西安交通大学口腔医院口腔颌面整形外科西安交通大学口腔医院口腔颌面整形外科西安交通大学口腔医院口腔颌面整形外科

目的:研究鱼肝油酸钠的普通剂型和脂质体剂型对人增殖期血管瘤内皮细胞的病理作用。方法:以体外原代培养的人增殖期血管瘤内皮细胞为试验对象,分别加入鱼肝油酸钠的普通剂型和脂质体剂型,通过形态学（倒置显微镜、Giemsa 染色、透射电... 详细信息

目的:研究鱼肝油酸钠的普通剂型和脂质体剂型对人增殖期血管瘤内皮细胞的病理作用。方法:以体外原代培养的人增殖期血管瘤内皮细胞为试验对象,分别加入鱼肝油酸钠的普通剂型和脂质体剂型,通过形态学（倒置显微镜、Giemsa 染色、透射电镜观察）、细胞毒性试验（MTT）及流式细胞仪检测来探讨两种剂型的药物对血管瘤内皮细胞的作用及其机制。结果:鱼肝油酸钠组出现了细胞水肿,线粒体肿胀、内质网扩张,细胞膜破裂等变化,最终导致细胞坏死;脂质体鱼肝油酸钠组出现了染色质凝集,碎裂并向胞膜移动,最终离开细胞形成典型的凋亡小体。细胞活性测定显示鱼肝油酸钠组活细胞数目下降速度很快;脂质体鱼肝油酸钠组活细胞数目下降速度较慢。结论:鱼肝油酸钠的普通刺型对人血管瘤内皮细胞表现为剧烈的毒性作用,呈现坏死性变化;而脂质体鱼肝油酸钠制剂对人血管瘤内皮细胞表现为渐进性的缓释作用,诱导细胞发生凋亡性变化。

关键词：血管瘤内皮细胞鱼肝油酸钠脂质体

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早产儿的心血管自主调节:阿托品的作用

世界核心医学期刊文摘（儿科学分册） 2005年第7期1卷 49-50页

作者： Andriessen P. Janssen B.J.A. Berendsen R.C.M. 虎小毅 Dr.M'axima Medical Center Neonatal Intensive Care Unit P.O.Box 7777 Veldhoven 5500 MB Netherlands

To study cardiovascular autonomic control, we assessed the effect of atropine on heart rate (HR) and blood pressure (BP)-variability in 12 preterm infants (range 26-32 wk) before intubation for respiratory *** power analysis of R-R interval and systolic BP (SBP) series were estimated in a low-frequency (LF; 0.04-0.15 Hz) and high-frequency (HF; 0.4-1.5Hz) band and evaluated for a 10-min period before and a 10-min period after atropine sulfate (0.01 mg/kg).Baroreceptor reflex (BR) functioning was estimated using transfer function analysis at LF (coherence, gain, and phase).Atropine resulted in a significant 12%increase in steady-state HR (p < 0.01) and unchanged *** R-R interval series, the total spectral power decreased 6-fold (p < 0.01), which was predominantly due to a reduction in the LF band (16-fold; p < 0.01).In contrast, we observed a significant increase (25%; p < 0.05) in total spectral power of SBP series partly as a result of an increase in HF *** LF power of SBP series was not *** median LF transfer gain (BR sensitivity) between SBP and R-R interval decreased from 4.2 to 1.4 ms/mm Hg (p < 0.01) after *** LF phase relationship (BP leads R-R interval fluctuations by ～4 s) was not changed after *** conclusion, even in preterm infants in distress, atropine modulates HR and BP variability, suggesting that BR-mediated parasympathetic control of heart rate is of significance for cardiovascular control at that age.

关键词：自主调节低频带心率控制函数分析能量分析呼吸窘迫压力感受器高频能量高频带低频能量