外者

Results In those patients with marrow invasion , 4 cases in I phase（4.2%）,12 cases in II phase（12.6%）,36 cases in Ⅲ phase（37.9%）and 43 cases in Ⅳ phase(47.4%);small lymphocytic、diffuse cleaved cell、lymphoblastic lymphoma are main pathologic types;patients with mediastinal lymphadenectasis、splenomegaly and spleen violations are prone to catch bone marrow involvement;56 cases of anemia in patients with bone marrow involuement(58.9%), 42 patients with thrombocytopenia (44.2%),27 cases with leukopenia (28.4%),49 cases of patients leukocyte increased (51.6%),so,anemia is common;three were 30 cases with three items abnormal（31.6％）and 65 cases with one item abnormal at least (68.4%),the incidence of abnormal peripheral blood in leukocythemia patients were higher than that in patients with bone marrow infiltration,Particularly the patients with increased leukocyte or three items abnormalities were more common in leukemia; Abnormal cells in peripheral blood were observed in 66 cases (69.5%); chemotherapy efficiency reached 65.2% in the patients with bone marrow involuement,the median survival time was 11.5 months.

结果发生骨髓侵犯病例中I期4例（4.2%）， II期12例（12.6%），Ⅲ期36例（37.9%），Ⅳ期43例(47.4%)；病理类型以小淋巴细胞性，弥漫型裂细胞性（改为：弥漫性大B细胞型淋巴瘤）和淋巴母细胞性淋巴瘤多见；纵隔淋巴结肿大、脾脏肿大和脾受侵患者易发生骨髓侵犯；骨髓侵犯患者外周血中贫血56例(58.9%)，血小板减少42例(44.2%)，白细胞减少27例(28.4%)，白细胞增高49例(51.6%)，以贫血多见；三项均异常30例(31.6%)，至少一项不正常65例(68.4%)，淋巴瘤细胞白血病患者外周血象异常发生率高于骨髓浸润患者，尤其是白细胞增高或三项均异常者更常见于白血病；66例(69.5%)外周血分类中发现异常细胞；骨髓侵犯化疗有效率65.2%，中位生存期11.5个月。

Results In those patients with marrow invasion , 4 cases in I phase（4.2%）,12 cases in II phase（12.6%）,36 cases in Ⅲ phase（37.9%）and 43 cases in Ⅳ phase(47.4%);small lymphocytic、diffuse cleaved cell、lymphoblastic lymphoma are main pathologic types;patients with mediastinal lymphadenectasis、splenomegaly and spleen violations are prone to catch bone marrow involvement;56 cases of anemia in patients with bone marrow involuement(58.9%)恶性淋巴瘤症状, 42 patients with thrombocytopenia (44.2%),27 cases with leukopenia (28.4%),49 cases of patients leukocyte increased (51.6%),so,anemia is common;three were 30 cases with three items abnormal（31.6％）and 65 cases with one item abnormal at least (68.4%),the incidence of abnormal peripheral blood in leukocythemia patients were higher than that in patients with bone marrow infiltration,Particularly the patients with increased leukocyte or three items abnormalities were more common in leukemia; Abnormal cells in peripheral blood were observed in 66 cases (69.5%); chemotherapy efficiency reached 65.2% in the patients with bone marrow involuement,the median survival time was 11.5 months.

结果发生骨髓侵犯病例中I期4例（4.2%）， II期12例（12.6%），Ⅲ期36例（37.9%）恶性淋巴瘤分期，Ⅳ期43例(47.4%)；病理类型以小淋巴细胞性，弥漫型裂细胞性（改为：弥漫性大B细胞型淋巴瘤）和淋巴母细胞性淋巴瘤多见；纵隔淋巴结肿大、脾脏肿大和脾受侵患者易发生骨髓侵犯；骨髓侵犯患者外周血中贫血56例(58.9%)，血小板减少42例(44.2%)，白细胞减少27例(28.4%)，白细胞增高49例(51.6%)，以贫血多见；三项均异常30例(31.6%)，至少一项不正常65例(68.4%)，淋巴瘤细胞白血病患者外周血象异常发生率高于骨髓浸润患者，尤其是白细胞增高或三项均异常者更常见于白血病；66例(69.5%)外周血分类中发现异常细胞；骨髓侵犯化疗有效率65.2%，中位生存期11.5个月。

objective to elucidate the choice of three defferent ways as well as the clinical efficacy in the treatment of pilon fracture and different damages of skin and tissue.methods 29 cases were treated with calcaneum bone traction and small splinting,23 cases were treated with internal fixation,11 cases were treated with external fixation of ilizarov.results all cases were followed up for 8～31 months (15.3 months average).according to helfet criterion,the results were evaluated as the total excellent and good outcome accounted for 90.5％.conclusion the key point of treatment is rational selection of three defferent ways in the treatment of pilon fracture according to the typle of pilon fracture and different damages of skin and tissue.

目的 探讨pilon骨折的三种不同治疗方法临床适应证及其疗效评价。方法对2000年2月至2006年3月间治疗的63 例pilon骨折患者进行回顾性分析。其中开放性损伤15 例，闭合性损伤48 例。根据骨折类型与周围软组织损伤程度，分别采用三种不同治疗方法：跟骨牵引加小夹板固定组(29 例)均为闭合性骨折，内固定组(23 例)，外固定器组(11 例)。结果所有患者均获得随访，随访8～31个月(平均15.3个月)，骨愈合时间8～14周，平均10周。按helfet疗效评价标准，本组优良者57 例(90.5％)，其中ⅰ型骨折优良者26 例，ⅱ型骨折优良者15 例，ⅲ型骨折优良者16 例。

The results showed that:(1) compared with never smokers, former smokers used more medical services of all types with the except of herb doctor care. but only differences in number of emergency visits (by 4.5%), rate of and number of days of self-medication with western drugs (by 1.39 times and 18.7%, respectively) were statistically significant after adjusting for other sociodemographic variables; and (2) compared with never smokers, current smokers used more hospital care, emergency care and self-medication with western drugs, but only differences in rate of and number of days of self-medication with western drugs (by 0.63 times and 6.6%, respectively) were statistically significant after adjusting for other socio-demographic variables.

结果显示：(1)已戒菸者除中医门诊外，其他各类医疗服务的利用率与利用量皆高於从不吸菸者，但在控制其他自变项以后，只有急诊次数（增加4.5%）以及自服西药的比率（增加1.39倍）与天数（增加18.7%）上的差异具统计显著意义；(2)目前吸菸者则只在住院、急诊以及自服西药的利用率与利用量上皆高於从不吸菸者，但控制其他自变项以后，亦只有自服西药的比率（增加0.63倍）与天数（增加6.6%）上的差异具统计显著意义。

Jesus is the son of Abraham, the son of David, the virgin-born promised Son, the newborn King, the object of gentile worship, the Anointed of God, the Serpent-Crusher, the great healer, and the proclaimer of Good News.

耶稣是"亚伯拉罕的子孙，大卫的子孙"、童贞女所生应许中的儿子、新生的君王、受外邦敬拜、由上帝所膏立、打伤古蛇者、伟大的医治者、也是福音的宣讲者。

Method］from january 2003 to may 2006,32 patients were corrected with qin si-he's orthotics devices on the ilizarov principle of tension-stress,which involved 15 males and 17 females,the age ranged from 10 to 25 years.among these patients,2 were caused by peroneal nerve injury,l by tumor in the vertebral canal,5 by meningocele,11 were caused by poliomyelitis,13 by congenital talipes equino-varus.in accordance with deformities,external fixator and limitied operative methods were dertermined.the limited release of soft tissue were performed in 7 patients,limited osteotomy in 25 patients.the dynamic muscle balance operation were performed in 9 patients with imbalance of muscle strength.according to the ilizarov technique,the fixative rods were installed.the telescopic rods on the apparatus were rotated one week after the operation,the divices had corrective function in three-dimensional directions.the deformity of talipes equinovarus,internal rotation and drooping of the forefoot were gradually corrected,and the patients could bear weight and walked on the deformed foot.the mean duration of traction were 42 days,then removed the external fixator maintained with plaster for a site time.

方法］2003年1月～2006年5月，根据ilizarov张力应力法则，应用秦泗河改良的外固定矫形器，遵循ilizarov穿针固定的基本原则，共手术治疗马蹄内翻足32例，男15例，女17例；年龄10～25岁，平均17岁。病因：腓总神经损伤2例，腰椎管内肿瘤1例，硬脊膜膨出5例，小儿麻痹后遗症11例，先天性马蹄内翻足13例。术前用足掌的前外缘负重行走者11例，用足的外缘或足背外侧负重者21例。根据马蹄内翻足畸形程度、性质和患者年龄，确定实施有限矫形手术的方法和外固定矫形器治疗。本组7例同期实施有限的软组织松解术，25例同期实施了有限的截骨术和跗骨间关节融合术，9例合并踝关节内外翻肌力明显失衡者，同期行足部肌腱转移的肌力平衡术。然后安装外固定矫形器。术后按作者制定的管理程序，7 d开始旋转相应的螺纹牵拉杆，对器械进行三维空间的缓慢调整，先矫正前足内收和后足内翻，后矫正足下垂畸形，直至达到矫形要求的标准。在矫形的过程中定期进行x线检测，以防止发生踝关节前后移位，治疗期间允许患足负重行走。术后平均牵伸42 d，拆外固定器后患足再上石膏固定适当时间。

To pay attention to carry out effective cardiopulmonary resus-citation,hemostasis by compression and deep vein intubation rapidly in the initial stage of emergency.The carotid shunt tube plays an important role in severe carotid injury and re-establishment process.We use external jugular vein to transplant and re-establish,which are rungwith artificial blood vessels for the long distance carotid injury and achieved the best result.We expose as fully as possible for the hepatic venae and the posthepatic post caval injury,and adopt effective methods to stop bleeding and repair.The application of blood shunt pump could raise the success rate for those severe patients.The self-double vastransplantation with both ends being all trousers-style one opening solve some problems such as there are no suitable caliber self-transplantation blood vessels and the artificial blood vessels are easy to occur obliteration for long-term and so on for the great or middle blood vessels.We use improved Fogarty duct and anterograde intubation to eliminate thrombus could eliminate thrombus effectively and avoid accessory injury for the deep vein injury and extensive thrombosis.

抢救初期要注意进行有效的心肺复苏、压迫止血和快速进行深静脉插管；颈动脉转流管在严重颈动脉损伤重建过程中有重要作用；对长距离颈动脉损伤用颈外静脉移植外环包人造血管重建，可取得最佳效果；对肝静脉及肝后下腔静脉损伤，要充分暴露，采用有效方法止血和修复，对病情极危重的凶险性出血者，血液转流泵的应用可提高成功率；对大、中血管损伤，两端均为裤式单开口自体双血管移植，解决了无适宜口径自体移植血管和应用人造血管远期易闭塞等问题；对深静脉损伤并广泛血栓形成者，应用改进的Fogarty导管和顺行插管取栓法，可有效取栓并避免了副损伤。

The edgewise technique was used to align and level the upper and lower arches gradually and upright the lower incisors. Then, modified LeFort Ⅰ osteotomy was operated with 4 cases pterygomaxillary disjunction and the other 2 cases not. The maxillas were not moved during the operation and sutured mucoperiosteum at the same place. After 3-5 days latency period, elastic distraction about 700g/side and increasing to 1400g/side gradually, was started with two cases which the maxillas were not cut off totally.

术后经过3—5天的延迟期即开始牵引，2例行不完全截开术者，采用弹性牵引，力量从700g／侧逐渐增加至1500g／侧；4例行完全骨截开术者，首先采用刚性牵引和口外牵引钩，每天缩短牵引钢丝1mm，2例直接达到矫治要求，其余2例达到浅覆盖后，截去口外牵引钩，换弹性牵引和口内牵引钩继续前牵上颌骨。

Proctor walked two in the inning, and the most frustrating of which was a two-out walk given to Curtis Granderson. He fouled off consecutive full-count pitches before ball four, and then Monroe hit a first-pitch slider up in the zone over the leftfield wall.

这一局，天天P保送了2打者，而最令人沮丧的是2出局后保送Curtis Granderson，在满球数保送前，他不断把球打出界外，之后Monroe将第一球，一颗滑不下的滑球，捞出左外野全垒打墙外。

Q2 L5 ^' f* G Wang had been outstanding in the past couple of months. Since the start of July, he was 6-1 with a 2.76 ERA in seven starts. But Wednesday night's outing was ugly from the start, as the first four Blue Jays hitters picked up hits. Matt Stairs led off with a double to right-centerfield, Lyle Overbay singled to leftfield, Alex Rios hit a two-run double to right-centerfield and Vernon Wells hit an RBI single up the middle.

y4 F* K7 d6 '0 }：|王建民加油站王小民在过去2个月以来表现优异，由7月份开始算起，他过去的7次先发拿下6胜1负、自责分率2.76的成绩，但在星期3晚上的出赛中，他从一开始就很难堪，因为前4名蓝鸟打者都敲出安打，第1棒Matt Stairs就打出中右外野2垒安打，Lyle Overbay 打出左外野1垒安打，Alex Rios打出中右外野2分打点的2垒安打，Vernon Wells打出中外野1分打点的1垒安打。

Do you know, i need you to come back

你知道吗，我需要你回来

Yang yinshu、Wang xiangsheng、Li decang,The first discovery of haemaphysalis conicinna.

1〕 杨银书，王祥生，李德昌。安徽省首次发现嗜群血蜱。