Role of the pelvic floor in bladder neck opening and closure I: Muscle forces

The aim of the study was to identify the striated muscle forces hypothesized to assist bladder neck opening and closure in females. Cadaveric dissection was used to identify the levator plate (LP), the anterior portion of pubococcygeus muscle (PCM), the longitudinal muscle of the anus (LMA), and their relation to the bladder, vagina and rectum. X-ray video recordings were made during coughing, straining, squeezing and micturition in a group of 20 incontinent patients and 4 controls, along with surface EMG, urethral pressure and digital palpation studies. During effort, urethral closure appeared to be activated by a forward muscle force corresponding to PCM, and bladder neck closure by backward muscle forces corresponding to LP and LMA. During micturition the PCM force appeared to relax, allowing LP and LMA to pull open the outflow tract. The data appear to support the hypothesis of specific directional muscle forces stretching the vagina to assist bladder neck opening and closure.     

Description of Heart-Rate Variability Data in Accordance With a Physiological Model for the Genesis of Heartbeats

A survey is presented of techniques which transform heart-rate variability data into a signal that is both visually informative and accessible for analysis. The Instantaneous Heart-Rate (IHR) signal is introduced, i.e. the signal having the value of the heart rate (inverse interbeat interval) during the interval concerned. The IHR signal differs from the standard Delayed Heart-Rate (DHR) signal, which is always one beat late. The relationship is discussed between the different representation methods and the Integral Pulse Frequency Modulation (IPFM) model, the latter being a physiologically plausible model for the transformation of a continuous input signal (e.g., nervous influence on the cardiac pacemaker) into a series of events (heartbeats). It is shown that when the IHR signal is used as input of the IPFM model, the event series from which the signal was derived appears at the output. Hence, if the IPFM model is accepted as a model of the pacemaker, the IHR signal may be considered as an approximation of the neural (sympathetic and parasympathetic) influence on the pacemaker. In addition we show that the appearance of the IHR signal is less affected by trigger errors or extrasystoles than the standard DHR signal. It is concluded that the most attractive time-domain representation of physiological event series consists of the IHR signal, because this signal, being conceptually and computationally simple, is consistent with the IPFM model.     

El Cuadro de Mando Integral como instrumento para la evaluación y el seguimiento de la estrategia en las organizaciones sanitarias

Both prior literature and reported managerial practices have claimed that the Balanced Scorecard is a management tool that can help organizations to effectively implement strategies. In this article, we examine some of the contributions, dilemmas, and limitations of Balanced Scorecards in health care organizations. First, we describe the evolution of Balanced Scorecards from multidimensional performance measurement systems to causal representations of formulated strategies, and analyze the applicability of Balanced Scorecards in health care settings. Next, we discuss several issues under debate regarding Balanced Scorecard adoption in health care organizations. We distinguish between issues related to the design of Balanced Scorecards and those related to the use of these tools. We conclude that the Balanced Scorecard has the potential to contribute to the implementation of strategies through the strategically-oriented performance measurement systems embedded within it. However, effective adoption requires the adaptation of the generic instrument to the specific realities of health care organizations.     

穴位贴敷联合八段锦功法对阳虚体质患者的护理效果

目的探讨穴位贴敷联合八段锦功法对阳虚体质患者的护理效果。方法选取2018年6月至2019年8月在我院门诊治疗的阳虚体质患者84例为研究对象,随机将其等分为对照组和观察组,对照组给予常规护理,观察组在对照组基础上给予穴位贴敷联合八段锦功法的护理方法。比较两组综合疗效、阳虚质积分和出现阳虚症状的情况。结果观察组总有效率高于对照组,阳虚质积分低于对照组,观察组阳虚症状出现例次明显少于对照组,差异有统计学意义(P<0.05)。结论穴位贴敷联合八段锦功法能有效改善阳虚质,提高阳虚患者的生活质量,值得推广应用。     

整体动物实验和组织细胞培养技术在温病学病毒实验研究中的运用和比较

与现代病毒学相比较,结合中医温病学的传统理论和特点,指出整体动物实验是温病学开展病毒实验研究的重要手段和方法,而组织细胞培养技术则是其有力的补充,二者的有机结合是温病学病毒实验研究的重要发展方向。     

分阶段多准则立体定向放射治疗计划研究

立体定向放射治疗计划是X-刀放射治疗的重要组成部分。提出了一种分阶段多准则立体定向放射治疗计划理论，将优化过程分三个阶段。第一阶段利用线性规划法缩小解空间；第二阶段采用复形调优法以获得肿瘤区均匀且高的剂量分布；第三阶段采用有约束模拟退火法以获得符合临床实际的治疗效果。与三个优化阶段相对应的三个优化准则分别为：最大化肿瘤区与周围正常组织的积分剂量之差、肿瘤体积内均匀的剂量分布和基于放射生物学效应、符合临床实际的放射治疗统计模型、文中的实验结果也证实了上述理论的正确性。     

Standardization of F using the 4π(β+γ) integral counting technique

Α 4π(β+γ) integral counting technique using a 4πβ−4πγ detector configuration was adopted for the standardization of ¹⁸F. In this technique, the β-detector is composed of two thin plastic scintillators sandwiching the source, coupled with a slender photomultiplier tube. The β-detector part with the source was inserted into a large well-type NaI(Tl) scintillation detector for γ-ray detection, making a 4πβ−4πγ coincidence counting system. In this work, positron particles were detected with high efficiency in the β-channel and annihilation quanta were also detected with high efficiency in the 4πγ channel. The very small inefficiency of the 4π(β+γ) integral counter for the β-plus branch has been confirmed by EGS5 Monte Carlo simulation. The result using this technique agreed within the uncertainties with the result obtained by the conventional 4πβ−γ coincidence counting with the efficiency extrapolation technique using the same detector configuration and a conventional 4πβ−γ coincidence counter.     

现代整体医疗环境的定位与特性

经历了古代整体保健环境、工业文明时代技术性功能突出的医疗环境等发展过程后，当代医疗环境建立在对患者人性深入认识，对自然环境、高科技人工环境与人类关系的深入理解基础之上，与城市、社区环境及高密度城市现实有机结合，既符合医学科技的发展，又顺应人的全面健康要求，是患者全面平衡与发展的整体环境。     

Effect of compression force on the crystal properties of erythromycin acistrate tablets

The crystal properties of compressed and powdered erythromycin acistrate tablets were studied by the X-ray powder diffraction (XRPD) method. Detailed analysis of X-ray powder diffraction line profiles was performed. Diffraction peak intensities and full width at half maximum (FWHM) values of the peaks corresponding to three different crystal lattice directions were determined. Crystallite size was calculated by Scherrer's equation using the data of integral breadth of the peaks. The preferred orientation of the crystallites is also discussed. According to the results, the crystallite size increased on the tablet surface after a small compression force (4 kN) in all crystal lattice directions studied. Even small compression forces caused recrystallization. With higher compression forces (8–18 kN) the crystallite size and the FWHM values remained rather constant. After the compression force of 18 kN the peaks in different crystal lattice directions behaved differently. In the lattice directions of diffraction maxima 2 and 3, the effect was the same with the small (4 kN) and the high compression force (22 kN). Further recrystallization occurred with 22 kN. However, in the crystal lattice direction of diffraction maximum 1 at the compression force of 8 kN the crystallite broke and crystallinity decreased. These were not seen in the powdered tablet samples. It could be concluded that the effect of compression force on the crystal properties of erythromycin acistrate tablets was seen on the tablet surface but not in the powdered tablets. Compression force also affected the preferred orientation of crystallites on the tablet surface and especially in the lattice direction of diffraction maximum 3. This was not seen in the powdered tablets.     

High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals

ObjectiveHigh-resolution manometry (HRM) is the current standard for characterization of esophageal body and esophagogastric junction (EGJ) function. We aimed to examine the prevalence of abnormal esophageal motor patterns in health, and to determine optimal thresholds for software metrics across HRM systems.DesignManometry studies from asymptomatic adults were solicited from motility centers worldwide, and were manually analyzed using integrated relaxation pressure (IRP), distal latency (DL), and distal contractile integral (DCI) in standardized fashion. Normative thresholds were assessed using fifth and/or 95th percentile values. Chicago Classification v3.0 criteria were applied to determine motor patterns across HRM systems, study positions (upright vs supine), ages, and genders.ResultsOf 469 unique HRM studies (median age 28.0, range 18–79 years). 74.6% had a normal HRM pattern; none had achalasia. Ineffective esophageal motility (IEM) was the most frequent motor pattern identified (15.1% overall), followed by EGJ outflow obstruction (5.3%). Proportions with IEM were lower using stringent criteria (10.0%), especially in supine studies (7.1%–8.5%). Other motor patterns were rare (0.2%–4.1% overall) and did not vary by age or gender. DL thresholds were close to current norms across HRM systems, while IRP thresholds varied by HRM system and study position. Both fifth and 95th percentile DCI values were lower than current thresholds, both in upright and supine positions.ConclusionsMotor abnormalities are infrequent in healthy individuals and consist mainly of IEM, proportions of which are lower when using stringent criteria in the supine position. Thresholds for HRM metrics vary by HRM system and study position.