小型节能头灯的制做与应用

医院(特别是儿童医院)在日常的诊断和治疗护理工作中,需要在小局部范围、短时间光源照明.目前市场上各种医用头灯存在着价格昂贵,使用不方便;我院医护人员在加05年10月至2007年3月使用我院自行研制的节能头灯,采用现代电子技术,在夜间给病人注射、换药和其他治疗以及查房巡视等小范围用光场合,取得了良好的效果.     

Cervicogenic exophthalmos: Possible etiology and pathogenesis

BACKGROUND Unilateral exophthalmos is often caused by inflammation, neoplasm, infection,metabolic disease, vascular disorder and several other less common conditions.Reflex sympathetic dystrophy related to unilateral exophthalmos has not been reported in the past literature.CASE SUMMARY We describe a 45-year-old female with unilateral exophthalmos caused by reflex sympathetic dystrophy and its unexpected spontaneous disappearance after a standard anterior cervical discectomy and fixation operation with two PEEK interbody cages and a plate. To our surprise, the patient’s left unilateral exophthalmos improved spontaneously in the morning on postoperative day 2-with no relapse, without any further medication, as of seven years. We have named this condition "cervicogenic exophthalmos."CONCLUSION We would inform other clinicians that unilateral exophthalmos was caused not only by inflammation, vascular disorder, infection, neoplasm, or metabolic disease, but also by reflex sympathetic dystrophy related with cervicogenic spondylosis. To the best of our knowledge, ours is the first related case report and use of the term "cervicogenic exophthalmos" after reviewing previous literature.     

Photodynamic therapy as salvage therapy for residual microscopic cancer after ultra-low anterior resection: A case report

BACKGROUND The rate of positive resection margins(R1) in patients with low rectal cancer is substantial. Recommended remedies such as extended resection or chemoradiotherapy have their own serious drawbacks. It has been reported that photodynamic therapy(PDT) as a remedial treatment for esophageal cancer.Colorectal cancer and esophageal cancer has many similarities,however,PDT as a salvage therapy for rectal cancer is rare.CASE SUMMARY Here,we describe a 56-year-old man who was admitted to the hospital due to a 6-mo history of hemafecia,which had been aggravated for 1 mo. Colonoscopy revealed a 3 × 4 cm ulcerated mass in the rectum 4 cm from the anus.Preoperative pathological examination showed villous adenoma,moderate-tohigh-grade dysplasia,good differentiation,and invasion of the mucosal muscle.The patient had R1 after ultra-low anterior resection,but he refused extended resection and experienced severe liver function impairment after 3 cycles of chemotherapy. Ultimately,the patient underwent PDT to remove R1. After five years of follow-up,there was no liver function impairment,recurrence,metastasis,sexual dysfunction,or abnormal defecation function.CONCLUSION This is the first case worldwide in which R1 of rectal cancer were successfully treated by PDT.     

Endodontic management of the maxillary first molars with two root canals: A case report and review of the literature

BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively.Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography(CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope(DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition,each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.     

读片窗及答案

病例 男,62岁.以"发现尿黄5天"为主诉入院.无发热、恶心及厌食等伴随症状.查体:血压150/100mmHg,巩膜轻度黄染,腹软无压痛,肝区无叩击痛,肝肋下未触及.实验室检查:血WBC 13.1×109/L,EO 5.2×109/L,占39.7%.TBIL 36.6μmol/L,DBIL 21.5μmol/L,UDBIL 15.1μmol/L.ALT 88U/L,GGT 201U/L.AFP及CEA阴性.HBsAb阳性,其余4项均阴性.     

结合中医理论对上呼吸道感染的护理

上呼吸道感染一年四季均可发病,但以冬春季节为多.此类病人病程一般在10 d以上,易反复,有的甚至迁延不愈达1个月以上,造成门诊输液量增加、交叉感染机会增多,在医治过程中医护人员也易感染.此病虽然不像癌症使人恐惧,但它的发病率高,有的1年内可发病3次～5次,给身体和生活造成很大的不便.此类病人的症状为鼻塞、流涕、喷嚏、咳嗽、咽干、咽痛、头痛、发热、乏力、全身不适等,护理一般采取对症施护:休息、保持室内空气清新、多饮水、清淡饮食等,而应用中医理论施护则更具体、更有效,对于疾病的痊愈会有极大的促进作用.     

伸缩式垂直升降护理机的适用性探讨

昏迷病人、截瘫病人、慢性消耗性疾病及脑卒中后遗症病人常伴有肢体瘫痪而长期卧床,生活不能自理,大小便失禁,易发生压疮,给病人带来极大痛苦,给家属带来繁重的负担[1].为解决这一难题,人们研究了一些护理器械,如"升降护理装置",这种护理装置由铁床、软布带、支架杆、绑绳钢筋、软网布、定滑轮组件、动滑轮组件、万向节连接件和钢丝绳组成.     

世界疼痛日——中国镇痛周暨建立疼痛科新闻发布会隆重召开中华医学会疼痛学分会第七届年会胜利闭幕

世界疼痛日中国镇痛周暨建立疼痛科新闻发布会、中华医学会疼痛学分会第七届年会于2007年10月12～16日在北京九华山庄隆重举行.全国人大副委员长中科院韩启德院士、原全国人大副委员长中科院吴阶平院士、卫生部陈啸宏副部长、卫生部医政司王羽司长、卫生部科教司刘雁飞司长、中华医学会吴明江常务副会长、原卫生部副部长中国医师协会殷大奎会长及有关方面的领导、专家及参加大会的疼痛医学专家代表约五百人参加了新闻发布会.     

Seroconversion of HBsAG coincides with hepatitis A superinfection: A case report

BACKGROUND Hepatitis B virus(HBV)is a hepatotropic virus that can cause acute and chronic liver damage.According to the world health organization 257 million people are infected with chronic HBV infection worldwide.Super-infection with other hepadnaviruses,including hepatitis A virus(HAV),hepatitis C virus,hepatitis D virus,and hepatitis E virus is associated with increased risk of acute liver failure in patients with chronic HBV.CASE SUMMARY Here,we report a case of a 47-year old male patient with HBV-related compensated Child A cirrhosis,who presented with general fatigue,malaise and laboratory signs of acute hepatitis.Although the patient was regularly seen at a specialized university liver unit,the HAV vaccination status was unclear.Acute HAV super-infection was diagnosed by positive serological and polymerase chain reaction analysis.Following acute HAV super-infection,spontaneous HBsAg elimination and development of an anti-HBs titer were observed.CONCLUSION This case illustrates the importance of carefully checking the vaccination status.In our patient,unspecific immunological responses to HAV led to functional cure of HBV.     

Combined surgical and interventional treatment of tandem carotid artery and middle cerebral artery embolus: A case report

BACKGROUND The 2018 American Heart Association/American Stroke Association guidelines for early management of acute ischemic stroke recommend the use of retrievable stents for mechanical thrombectomy in patients with acute internal carotid artery or middle cerebral artery M1 occlusion that can be treated within 6 h from onset.For cases of carotid artery with ipsilateral middle cerebral artery tandem embolization, the operation is more complicated and challenging. We here report a case of a tandem embolism, and the anatomy of the aortic arch was complex.Direct carotid artery incision and thrombectomy can not only prevent the escape of the carotid embolus but also save time during establishment of the thrombectomy access.CASE SUMMARY The patient was a 70-year-old man. He was admitted to hospital due to sudden inability to speak and inability to move his right limb for 3 h. Imaging confirmed a diagnosis of a tandem embolism in the left carotid artery with left M1 occlusion.Carotid artery incision thrombectomy combined with stent thrombectomy was performed. The operation was successful, and 24 h later the patient was conscious and mentally competent but had motor aphasia. His bilateral limb muscle strength level was 5, and his neurologic severity scores score was 2.CONCLUSION Carotid artery incision thrombectomy combined with stenting for carotid artery plus cerebral artery tandem embolization is clinically feasible. For patients with a complicated aortic arch and an extremely tortuous carotid artery, carotid artery incision can be chosen to establish the interventional path.     

The relationship of transversus abdominis and lumbar multifidus clinical muscle tests in patients with chronic low back pain

Introduction

Previous research of transversus abdominis (TrA) and multifidus muscle function in the presence of chronic low back pain (LBP) has investigated these muscles in isolation. In clinical practice, it is assumed that a relationship exists between these muscles and so they are often assessed and rehabilitated together. However, no studies have tested or documented this association. This study aimed to examine the relationships between clinical muscle testing and other measures taken in the course of a clinical assessment at a back clinic.

Methods

This retrospective chart audit examined the files of 82 patients (40 Males, 42 Females) for results of clinical tests of TrA and multifidus muscle contraction, multifidus muscle size measurements and other clinical measures such as distribution of pain and pain on manual examination.

Results

The ability to contract multifidus was related to the ability to contract TrA with the odds of a good contraction of multifidus being 4.5 times higher for patients who had a good contraction of TrA. A poor ability to contract multifidus was related to poor TrA contraction. Patients with unilateral LBP had more multifidus muscle asymmetry (11.6%) than those with bilateral/central pain (0.01%) and had a poor multifidus contraction on the affected side (p < 0.01). No other significant relationships were found.

Discussion & conclusion

Current clinical practice of assessment and rehabilitation of both TrA and multifidus muscles in patients with chronic LBP is supported by the findings of this study. Future studies may investigate if a neurophysiological relationship exists between these muscles.     

The Importance of Muscle Relaxation in Dynamic Cardiomyoplasty

During the last decade dynamic Cardiomyoplasty has been introduced as a new method to treat patients with severe heart failure. This procedure consists of the wrapping of the latissimus dorsi (LD) muscle around the heart with electrical stimulation of the muscle synchronous to cardiac contraction. The optima] pacing mode of the muscle, during the conditioning and working period of the LD muscle, is still unclear. The pace protocol, currently used worldwide, has a maximal number of muscle tetanic contractions of 100 per minute. Data are presented on the LD muscle contraction characteristics using that protocol. Both force measurements from six in situ stimulated goat LD muscles and x-ray evaluation of the movement of metallic clips on wrapped LD muscles in two patients were used. Results demonstrate that LD muscle force is well maintained at the maximal rate of 100 contractions per minute but relaxation is severely hampered. This may lead to diminished support of the failing heart and damage of the wrapped muscle. A pacing protocol is proposed using a lower maximal stimulation rate.     

Are early and late rate of force development differently influenced by fast‐velocity resistance training?

This study examined the effect of fast‐velocity concentric isokinetic resistance training (FV) on the rate of force development (RFD) at early (<100 ms) and late phases (>100 ms) of rising muscle force. Nine men participated in a 6‐week resistance training intervention for the lower body, and nine matched subjects participated as controls (CON). During concentric isokinetic (180°s^?1) knee extension training, subjects were instructed to do each contraction ‘as fast and forcefully as possible’. Maximal muscle strength (MVC) and RFD (0–10, 0–20, …, 0–250 ms from the onset of contraction) were measured during maximal voluntary isometric contraction of the knee extensors (KE). There were no significant changes in MVC of KE in both groups after intervention (FV = 314·2 ± 101·1 versus 338·7 ± 88·0 N?m, P>0·05; CON = 293·3 ± 94·8 versus 280·0 ± 72·2 N?m, P>0·05). The RFD increased 39–71% at time intervals up to 90 ms from the onset of the contraction (P < 0·05), whereas no change occurred at later time intervals. Similarly, relative RFD (i.e.%MVC?s^?1) (RFDr) increased 33–56% at time intervals up to 70 ms from the onset of the contraction (P<0·05). It can be concluded that a short period of resistance training performed with concentric fast‐velocity isokinetic muscle contractions is able to enhance RFD and RFDr obtained at the early phase of rising muscle force.     

实时剪切波弹性成像测量女性耻骨直肠肌杨氏模量值

目的比较未育及已育初产妇耻骨直肠肌(PR)静息及最大收缩状态下的杨氏模量值差异。方法未育女性73例(未育组),已育初产妇45例(产后1~6年,已育组),利用剪切波弹性成像(SWE)分别在静息及最大收缩状态下测量PR前部、中部及后部的杨氏模量值,并计算差值,比较两组的差异。结果未育组及已育组双侧PR各部最大收缩状态下的杨氏模量值均较静息状态下增大(P均<0.01)。未育组静息及最大收缩状态下PR各部的杨氏模量值及各部收缩前后变化差值与已育组比较,差异均无统计学意义(P均>0.05)。结论 SWE可以定量评估耻骨直肠肌的弹性功能。未育及已育初产妇PR最大收缩状态下的杨氏模量值均较静息状态下大。在静息状态下、最大收缩状态下及收缩前后杨氏模量变化差值,已育初产妇与未育女性的杨氏模量值无差异,分娩对耻骨直肠肌弹性的影响不大。     

Measurement reliability and cooperative movement of the pelvic floor and transverse abdominal muscles

[Purpose] This study examined the measurement reliability and cooperative movement of the pelvic floor and transverse abdominal muscles. [Participants and Methods] The participants were seven healthy adult females. Transverse abdominal muscle thickness and bladder floor elevation were measured under the following conditions during active exercise and during resistance exercise: the resting state, maximum contraction of the transverse abdominal muscle, maximum contraction of the pelvic floor muscle, and maximum co-contraction of the transverse abdominal and pelvic floor muscles. Measurements were taken at rest and under each exercise condition. [Results] The intraclass correlation coefficients of transverse abdominal muscle thickness and bladder floor elevation showed high reproducibility under all conditions. The maximum contraction of the pelvic floor muscle showed a high correlation with the maximum co-contraction of the transverse abdominal muscle and pelvic floor muscle during resistance exercise. A significant regression line was found between transverse abdominal muscle thickness and bladder floor elevation under all conditions. The regression equation was as follows: transverse abdominal muscle thickness=0.113 bladder floor elevation+0.377 (r²=0.21). [Conclusion] This study demonstrated that the measurement reliability of the transverse abdominal and pelvic floor muscles is high, and that both muscles exhibit cooperative movement.     

The Use of Electrically Stimulated Skeletal Muscle to Pump Blood

Electrically stimulated skeletal muscle can be used in many ways to pump blood. The important physiological characteristics of skeletal muscle for use in a cardiac assist role are presented. The force developed by a twitch and tetanic contraction are quantitated and the considerations in the choice of the stimulus applied to the innervating motor nerve are discussed. The importance of stimulus frequency and duration of the stimulus train are presented in terms of the stroke volume produced by skeletal muscle contracting around a pouch. The effect that preload has on pouch stroke volume and muscle blood flow are demonstrated. Finally an example is given in which cardiac output is augmented by an untrained, electrically stimulated, canine rectus abdominis muscle wrapped around a pouch connected between the apex of the left ventricle and the aorta. In this study, the augmentation in cardiac output was measured when the skeletal muscle was contracted after each second, third, and fourth ventricular contraction. The augmentation was 46% +/- 4, 31% +/- 7, and 25% +/- 4, respectively, for the three contraction regimens. Although electrically stimulated skeletal muscle can be used as a power source to assist the failing heart, the optimum application is yet to be discovered. Important considerations in selecting the optimal application are preload, stimulus train duration, train rate, and muscle blood flow.     

肱二头肌收缩的剪切波声弹性成像动态测定及其生理学意义探讨

目的 连续测定肱二头肌肌腹在收缩过程中的杨氏模量值,探讨肱二头肌肌腹收缩过程中杨氏模量测值随时间变化曲线的生理学意义.方法 使用法国Supersonic Imagine公司的AixPlorer型实时定量剪切波弹性成像诊断仪,将L4-15线阵探头置于肱二头肌肌腹纵断面,启动仪器剪切波弹性成像(SWE)模式,连续记录肱二头肌收缩过程的组织弹性图,然后通过电影回放,使用其定量分析系统Q-BOX,取样区为直径3、8、10 mm同心圆,每隔10帧测量1次杨氏模量值,共测20次,其中前10次为收缩前,后10次为收缩时.根据20次测量值绘制出肱二头肌肌腹收缩过程中杨氏模量测值随时间变化的曲线.结果 Q-BOX取样区直径为3mm时,收缩前与收缩时杨氏模量均值分别为(31.48±2.25)、(83.10±23.46)kPa;Q-BOX取样区直径为8mm时,收缩前与收缩时杨氏模量均值分别为(34.19±2.26)、(94.41±27.73) kPa; Q-BOX取样区直径为13 mm时,收缩前与收缩时杨氏模量均值分别为(36.96±2.35)、(103,21±36.96) kPa.杨氏模量测值随时间变化的曲线表明,肱二头肌肌腹收缩过程中,杨氏模量测值逐渐增大,从最小值到最大值之间呈上升斜率.结论 肱二头肌肌腹收缩前与收缩时杨氏模量均值不同;剪切波弹性成像技术具有足够的灵敏度,可实时检测肱二头肌肌腹收缩过程中的杨氏横量值;肱二头肌肌腹收缩过程中,杨氏模量测值随时间变化的曲线与生理学从分子水平描述的骨骼肌收缩特征相符.     

Fusobacterium necrophorum haemolysin stimulates motility of ileal longitudinal smooth muscle of the guinea-pig

Fusobacterium necrophorum haemolysin (0.5-3.1 mg protein/mL) dose-dependently induced contractions of the isolated ileal longitudinal smooth muscle of the guinea-pig. The haemolysin (3.1 mg protein/mL) -induced maximum contraction of 75% of the response to 60 mM K+ declined within 17 min and the muscles then demonstrated rhythmic contractions. Tetrodotoxin (3.1 x 10(-6) M) had no effect on the contraction due to the haemolysin. After incubation in Ca(2+)-free medium, the ileal response to the haemolysin was lost. Verapamil, a Ca2+ channel blocker, dose-dependently inhibited the contraction to the haemolysin. The rabbit anti-serum against F. necrophorum haemolysin inhibited the haemolysin-induced contraction of ileal muscle. The bacterial haemagglutinin and the lipopolysaccharide had no effect on the response of ileal muscle. These findings suggest that the haemolysin-induced direct stimulation of ileal motility dependant on Ca2+ influx will increase the probability of contact of F. necrophorum and ileal mucosa and could increase the chances of colonization for F. necrophorum.     

Further clinical clarification of the muscle dysfunction in cervical headache

The Headache Classification Committee of the International Headache Society listed impairments in cervical muscle function as criteria for headaches of cervical spine origin. Fifteen subjects with cervical headache and 15 controls were tested for the frequency of abnormal responses to passive stretching and abnormal muscle contraction. A new test of cranio-cervical flexion was used to assess the contraction of the deep neck flexors. Results indicated a trend towards a higher frequency of abnormal response to passive stretching of the muscles examined in the cervical headache group but only the upper trapezius proved significantly different to the control group. Deep neck flexor muscle contraction was significantly inferior in the cervical headache group. From the perspective of physical characterization of cervical headache, it appears that response from passive stretch of muscle may not be a strong criterion for cervical headache but deep neck flexor performance may have potential to identify musculoskeletal involvement in headache. The finding may also provide positive directions for conservative treatment of cervical headache.     

Chlorpromazine at comparatively low concentrations potentiates carbachol-induced tonic contraction of ileal longitudinal smooth muscle of the guinea-pig

The neuroleptic phenothiazine derivative chlorpromazine (CPZ) at high concentration (1 x 10(-5) M) decreased either the phasic or tonic contraction in response to carbachol and the carbachol-induced increase in [Ca2+]i in both phases in ileal muscle. In contrast, CPZ at low concentrations (8 x 10(-7) - 5 x 10(-6) M) decreased only the phasic contraction and potentiated the tonic contraction induced by carbachol. However, CPZ at these concentrations dose-dependently decreased the carbachol-induced increase in [Ca2+]i in both phases. These results suggested that CPZ dose-dependently decreased the initial phasic contraction in response to carbachol by inhibition of Ca2+ release from the intracellular storage sites. CPZ at low concentrations appears to increase Ca2+ sensitivity to contractile proteins in the carbachol-induced tonic phase. CPZ dose-dependently reduced the 60 mM K(+)-induced phasic and tonic responses and a concomitant decrease in [Ca2+]i in ileal muscle.