避免高频电刀灼伤手术部位皮肤的方法

目前,外科手术中常用的电刀是Valleylab电刀.这种电刀的金属刀头长一般有2.5cm,工作面往往在前端1 cm,这样,非工作面在电刀工作时易碰到皮肤而引起皮肤灼伤,灼伤的皮肤在术后很难愈合,给患者带来很大的痛苦,且皮肤灼伤易引起医疗纠纷,所以医生在手术时特别注意对手术切口周围皮肤的保护.我们通过多年的临床护理实践总结出一种新的方法,经200例患者临床应用,效果满意,现介绍如下.     

上海中山医院手术室楼空调水系统设计

在一般的空调系统设计中,冷热源设备只是在同一系统内共用一套备用的冷热源;本工程中1号、3号楼、手术室楼分为相互独立的三个空调水系统,但三个空调系统跨系统共用一套备用的冷热源。在设计中,这种跨系统共用一套备用的冷热源的形式比较少见,因此在设计中要合理地设置各系统之间的管路,使各系统能够不间断运转,以满足各楼对空调系统的要求。     

Psychosexual outcomes in women of reproductive age at more than two-years from excisional cervical treatment – a cross-sectional study

Purpose: To investigate the long-term psychosexual outcomes in women following excisional cervical treatment.

Materials and methods: Women with cold-knife conization (CKC) or large loop excision of the transformation zone (LLETZ) treatment were interviewed after a follow-up colposcopy visit. Their demographics, treatment and psychosexual characteristics were recorded.

Results: One hundred and forty six women with a mean age of 35.2?±?5.4 years underwent either LLETZ (68.5%) or CKC (31.5%) treatment within 4.7?±?2.7 years (range: 2–15) before the interview. 27.4% of women were less interested in sexual intercourse following treatment in comparison with their interest before. Those women with less interest in sexual intercourse after treatment had higher anxiety and depression scores and were more worried about disease progression. Women with post-treatment complications were at risk of less interest in sexual intercourse and of greater anxiety and depression. Women with abnormal smears at follow-up were at risk of greater anxiety. The type of treatment and grade of dysplasia did not affect their interest in sexual intercourse or the anxiety and depression scores.

Conclusions: Approximately, one-third of women at more than two years post-treatment may suffer from less interest in sexual intercourse, have relatively greater anxiety and depression, and might still be concerned about the possibility of disease progression.     

针刀结合局部阻滞治疗陈旧性半月板损伤的探索

陈旧性慢性半月板损伤在临床上为多发病,常见病,一直得不到有效的治疗,长期以往,患者的伤侧膝关节的力学平衡失调,膝关节退变速度加快,严重的出现膝关节破坏,关节僵直.我院门诊在2009年2月至2010年2月这期间采用小针刀疗法结合局部阻滞治疗陈旧性半月板损伤55例,取得了较为理想的效果,现报告如下.     

激光针刀对椎动脉型颈椎病模型兔椎动脉磷脂酰肌醇3-激酶mRNA表达的影响

目的探讨激光针刀对椎动脉型颈椎病(CSA)模型兔椎动脉磷脂酰肌醇3-激酶(PI-3K)mRNA表达的影响。方法建立家兔CSA模型,采用随机数字表法将造模成功的30只CSA模型兔分为模型组、针刺组和激光针刀组,每组10只,另取10只正常家兔为正常组。针刺组兔给予针刺"风池穴"、"颈夹脊穴"治疗,激光针刀组兔给予第五颈椎棘突旁夹脊穴激光针刀治疗,模型组和正常组仅给予相同的固定,实验前后观察各组家兔行为学体征,分别于造模前1天、造模后第14天(治疗前)、24天(治疗10天后)、34天(治疗20天后)称取兔体质量。采用实时荧光定量PCR检测各组兔椎动脉血管PI-3K mRNA表达情况。结果治疗后针刺组和激光针刀组兔行为学体征有不同程度的改善。与正常组比较,造模后14天,模型组、针刺组和激光针刀组兔体质量显著降低[(2.49±0.12)kg、(2.48±0.13)kg、(2.48±0.10)kg比(2.62±0.13)kg,P均0.05];造模后24天、34天,模型组兔体质量均明显低于正常组[(2.42±0.13)kg比(2.69±0.13)kg,(2.37±0.12)kg比(2.77±0.14)kg,P均0.01]。与模型组比较,造模后24天、34天,针刺组、激光针刀组兔体质量明显增加[(2.57±0.13)kg、(2.56±0.09)kg比(2.42±0.13)kg,(2.66±0.12)kg、(2.67±0.11)kg比(2.37±0.12)kg,P0.05或P0.01]。与正常组比较,模型组兔颈动脉PI-3KmRNA表达量明显低于正常组[(1.15±0.17)比(1.59±0.19),P0.01),与模型组比较,针刺组和激光针刀组兔颈动脉PI-3KmRNA表达明显上调[(1.89±0.42)、(2.16±0.48)比(1.15±0.17),P0.05或P0.01),针刺组与激光针刀组比较,差异无统计学意义(P0.05)。结论激光针刀能有效干预CSA模型兔椎动脉PI-3KmRNA表达。     

海扶刀治疗子宫肌瘤60例的MR影像分析

目的 分析海扶刀治疗子宫肌瘤（uterine fibroids，UF）的磁共振（magnetic resonance，MR）影像。方法 回顾性分析2019年11月至2021年10月新余市妇幼保健院收治的60例UF患者的病历资料，所有患者均采用海扶刀治疗。于患者术前、术后1个月时采用MR检查。分析手术前后T1加权成像（T1–weighted imaging，T1WI）、T2加权成像（T2–weighted imaging，T2WI）信号变化特点及血流灌注情况，比较手术前后UF患者的表观扩散系数（apparent diffusion coefficient，ADC）值。结果 60例UF患者中，术前T1WI以等信号为主，术后T1WI以高信号为主；术前T2WI以低信号为主，术后T2WI以高信号为主；60例UF患者经海扶刀治疗后，T1WI序列中增高的41个信号肌瘤均出现无灌注区，T1WI序列中无变化的19个信号肌瘤均出现无灌注区；T2WI序列中增高的60个信号肌瘤均出现无灌注区；术后UF患者的ADC值为（1.39±0.35）×10–3mm2/s，高于术前（1.24±0.22）×10–3mm2/s，差异有统计学意义（P<0.05）。结论 UF患者术后MR检查T1WI、T2WI以高信号为主，术后ADC值高于术前，通过观察MR显示的肌瘤无灌注区，能够对海扶刀治疗UF效果进行评估，判断肿瘤凝固坏死范围，预测肌瘤消融率，为海扶刀的治疗效果评估提供依据。     

《伤寒杂病论》眩晕辨治规律探析

眩晕作为《伤寒杂病论》中的常见症状,其病因各异,病机复杂,分析《伤寒杂病论》中眩晕有关的条文,按照病机将眩晕分为风火相煽,三焦饮停,膀胱气化阻遏、水湿停聚,阴阳两虚、清空失养,阳气郁闭过重,阴竭阳脱、阴阳离绝六个类型论述,以探讨张仲景对眩晕的辨证论治规律及理法方药特点,眩晕病机复杂多变,病性有阴阳虚实之分:实证多是水湿痰饮为患,虚证多责之脾肾阳虚、精血亏虚。张仲景对于眩晕一证主要从痰饮立论,采用三焦辨证方法治疗痰饮型眩晕,重视中焦脾胃的运化作用,创立了苓桂术甘汤、五苓散、真武汤等多首治疗痰饮型眩晕的经方。     

The origins of the vaccine cold chain and a glimpse of the future

International efforts to eradicate smallpox in the 1960s and 1970s provided the foundation for efforts to expand immunization programmes, including work to develop immunization supply chains. The need to create a reliable system to keep vaccines cold during the lengthy journey from the manufacturer to the point of use, even in remote areas, was a crucial concern during the early days of the Expanded Programme on Immunization. The vaccine cold chain was deliberately separated from other medical distribution systems to assure timely access to and control of vaccines and injection materials. The story of the early development of the vaccine cold chain shows how a number of challenges were overcome with technological and human resource solutions. For example, the lack of methods to monitor exposure of vaccines to heat during transport and storage led to many innovations, including temperature-sensitive vaccine vial monitors and better methods to record and communicate temperatures in vaccine stores. The need for appropriate equipment to store and transport vaccines in tropical developing countries led to innovations in refrigeration equipment as well as the introduction and widespread adoption of novel high performance vaccine cold-boxes and carriers. New technologies also helped to make injection safer. Underlying this work on technologies and equipment was a major effort to develop the human resources required to manage and implement the immunization supply chain. This included creating foundational policies and a management infrastructure; providing training for managers, health workers, technicians, and others. The vaccine cold chain has contributed to one of the world’s public health success stories and provides three priority lessons for future: the vaccine supply chain needs to be integrated with other public health supplies, re-designed for efficiency and effectiveness and work is needed in the longer term to eliminate the need for refrigeration in the supply chain.