腹外斜肌的神经入肌点定位与肌内神经分布研究

目的　对人腹外斜肌的神经入肌点定位和肌内神经染色观察，为其临床应用提供形态学资料。 方法　成尸11具定位神经入肌点和5具行Sihler’s 肌内神经染色。 结果　腹外斜肌受下8对肋间神经外侧肌支支配，各个肌齿的神经入肌点距离相应肌齿起端中点(1.54±0.33)cm，位于锁骨中线与第5肋下缘的交界处至腋后线与第11肋下缘交界处的连线上。Sihler’s染色显示支配腹外斜肌的肋间神经外侧肌支入肌后分出小分支分布到各肌齿的起端1/3，然后约在各肌齿的近、中1/3交界处分出2支二级神经分支，即上支与下支，它们分出小分支分布到各肌齿的中间1/3，相邻两个肌齿的上支与下支在各肌齿中远部形成“U”形吻合，从“U”形吻合弓上分出小分支分布到各肌齿的止端1/3。在腹外斜肌上半部，各肌齿的神经分支分布到相应的肌齿，但在腹外斜肌下半部，上一肌齿的远侧下份是由下一肌齿的神经分支(上支)分布。 结论　①为临床上腹壁局部麻醉和术后切口疼痛的神经阻滞提供指导意义；②腹外斜肌中远部从上至下形成“波浪形”的神经分支密集区；③腹部手术切口建议不要超过四个肌齿。     

医保目录与医疗服务的错位

"脊柱内固定钢板"按医保目录可以报销,而固定钢板的钉子却由患者全额自付;五六年前制定的目录中仅有黑白超床旁检查项目,而未设床旁彩超项目,目前二级以上医院几乎全部淘汰黑白超,改用彩超,可彩超没有收费标准……诸如此类的问题让人难以理解。建议相关部门建立互通机制。     

水化疗法预防造影剂肾病的效果研究

目的研究水化疗法预防造影剂肾病的效果。方法随机选取2016年6月～2018年6月我院收治的造影剂肾病高危患者60例,依据预防方法分为两组,即氯化钠水化疗法组和复方氯化钠水化疗法组,每组30例,统计分析两组患者的Cr、pH、GFR、HCO3~-、K~+水平、造影剂肾病、二级终点事件发生情况。结果复方氯化钠水化疗法组患者的Cr水平显著低于氯化钠水化疗法组(P0.05),pH、GFR水平均显著高于氯化钠水化疗法组(P0.05),造影剂肾病、二级终点事件发生率为3.3%(1/30)、0,均显著低于氯化钠水化疗法组的13.3%(4/30)、10.0%(3/30)(P0.05)。结论复方氯化钠水化疗法预防造影剂肾病的效果较氯化钠水化疗法好,值得在临床推广。     

A novel compound heterozygosity in Southern China: IVS-II-5 (G > C) and IVS-II-672 (A > C)

β-Thalassemia (β-thal) is a common hereditary anemia due to decreased or absent synthesis of the β-globin chains. Here, we report a patient found to be a novel compound heterozygote for the rare IVS-II-5 (G?>?C) (NG_000007.3: g.71044G?>?C) and IVS-II-672 (A?>?C) (NG_000007.3: g.71711A?>?C) mutations, which may be silent mutations that are associated with consistent residual output of β chains, normal red blood cell (RBC) indices and normal or borderline Hb A₂ levels.     

Effects of visual-haptic asynchronies and loading-unloading movements on compliance perception

Spring compliance is perceived by combining the sensed force exerted by the spring with the displacement caused by the action (sensed through vision and proprioception). We investigated the effect of delay of visual and force information with respect to proprioception to understand how visual-haptic perception of compliance is achieved. First, we confirm an earlier result that force delay increases perceived compliance. Furthermore, we find that perceived compliance decreases with a delay in the visual information. These effects of delay on perceived compliance would not be present if the perceptual system would utilize all force-displacement information available during the interaction. Both delays generate a bias in compliance which is opposite in the loading and unloading phases of the interaction. To explain these findings, we propose that information during the loading phase of the spring displacement is weighted more than information obtained during unloading. We confirm this hypothesis by showing that sensitivity to compliance during loading movements is much higher than during unloading movements. Moreover, we show that visual and proprioceptive information about the hand position are used for compliance perception depending on the sensitivity to compliance. Finally, by analyzing participants’ movements we show that these two factors (loading/unloading and reliability) account for the change in perceived compliance due to visual and force delays.     

朱琏指针点按疗法联合自我管理模式在中风偏瘫患者中的应用研究

目的探讨朱琏指针点按疗法配合自我管理模式对中风偏瘫患者应对疾病和运动功能及日常生活活动能力的影响。方法将200例中风偏瘫患者按入院时间先后顺序随机平分为观察组和对照组,对照组接受卒中单元常规护理,观察组在此基础上实施朱琏指针点按疗法联合自我管理模式。连续干预4周后评价效果。结果干预后观察组MAS、MBI和MCMQ评分显著高于对照组,差异有统计学意义(P0.05)。结论将朱琏指针点按疗法联合自我管理模式运用于中风偏瘫患者,有利于患者建立战胜疾病的信心,自我管理疾病的主观能动性得到充分发挥,有助于帮助患者积极配合临床治疗护理,改善机体运动功能和日常生活活动能力,提高生活质量,促进疾病康复。     

腕踝针对腰痛止痛作用的针刺点特异性随机对照临床研究

目的研究腕踝针的"针刺点"与"身体分区"的对应关系是否具有特异性,即腕踝针针刺点作用的特异性。方法采用随机对照临床试验,将90例急性腰痛患者随机分为三组,每组30例。三组受试者均采用腕踝针治疗1次,留针30 min。特异针刺点组根据腕踝针"按身体分区选择针刺点"的理论针刺下6或下5针刺点;非特异针刺点1组和2组分别针刺下2和上5针刺点。治疗前3 min和治疗过程第5、10、15和第30 min,分别用简式Mc Gill疼痛问卷(SF-MPQ)评价受试者活动腰部时疼痛情况,用重复改良的Schober试验(MMS)观察腰椎活动度,用预期和治疗信任度问卷(ETCS)评价三组患者治疗前后预期的变化。结果三组治疗前SFMPQ、MMS和ETCS各项差异均无统计学意义(P0.05)。三组SF-MPQ评分在第5、10、15和30 min与治疗前相比均降低(P0.05)。在第5、10和15 min,特异针刺点组的SF-MPQ多项评分(除PPI外)与治疗前的差值高于非特异针刺点1组和2组(P0.05)。治疗30 min后,特异针刺点组的SF-MPQ所有项目评分与治疗前的差值均高于非特异针刺点1组和2组(P0.05)。三组MMS治疗后均高于治疗前(P0.05),特异针刺点组MMS治疗后与治疗前差值高于非特异针刺点1组和2组(P0.05)。特异针刺点组的ETCS所有项目评分在治疗后与治疗前相比均升高(P0.05)。非特异针刺点1组和2组的ETCS所有项目评分在治疗后与治疗前相比,差异无统计学意义(P0.05)。结论腕踝针针刺点对急性腰痛具有止痛和改善腰椎前屈活动度作用,具有一定的特异性。