王晓燕教授分时间论治内伤杂病经验总结

文章总结王晓燕教授分时间论治失眠、头痛、发热的临床经验,从理论总结到典型病案举例,充分阐明王晓燕教授对分时间论治内伤杂病的认识,说明分时间论治疾病的有效性,扩展临床辨证思维,以进一步学习与研究。     

脊柱定点减压牵引治疗腰椎间盘突出症临床观察

目的 观察脊柱定点减压牵引治疗腰椎间盘突出症的临床疗效。方法 选取2016 年1 月～2018 年12 月在我院治疗的腰椎间盘突出症患者100 例,随机分为观察组和对照组,每组各50 例。两组均给予基础治疗、针灸治疗及中频超声透入治疗。观察组采用脊柱定点减压牵引疗法,对照组采用传统牵引疗法,比较两组患者的临床治疗效果,并检测两组患者治疗前后VAS 评分、JOA 评分、ODI 评分及突出椎间盘最大矢径（AB）。结果 治疗前后两组VAS 评分、JOA 评分及ODI 评分比较,差异有统计学意义（P＜0.001）,治疗前后突出椎间盘最大矢径（AB）比较,差异无统计学意义（P>0.05）。观察组总有效率为86%,明显高于对照组的72%（P＜0.05）。结论 脊柱定点减压牵引治疗对腰椎间盘突出症治疗效果更好,临床症状改善明显,临床应用价值高,适合推广使用。     

大黄外敷神阙穴联合胃肠起搏治疗功能性便秘疗效观察

目的 探讨大黄外敷神阙穴联合胃肠起搏治疗功能性便秘的疗效。方法 选取2018 年2 月～2019 年2 月在我院脾胃病科就诊治疗的88 例功能性便秘患者,将其随机分为观察组和对照组,每组各44 例,对照组采用大黄外敷神阙穴,观察组采用大黄外敷神阙穴联合胃肠起搏治疗,大黄外敷神阙穴同对照组,同时采用胃肠起搏器进行治疗,并进行相应护理,观察并比较两组便秘症状评分、治疗效果、生活质量评分。结果 治疗前两组便秘各症状评分比较,差异无统计学意义（P＞0.05）;治疗后观察组腹胀、排便费力、排便不尽感、直肠阻塞感评分低于对照组;观察组总有效率高于对照组（P＜0.05）;治疗前两组生活质量评分比较,差异无统计学意义（P＞0.05）;治疗后观察组生理不适、心理社会不适、担心焦虑、满意度及总分均低于对照组（P＜0.05）。结论 大黄外敷神阙穴联合胃肠起搏治疗功能性便秘效果良好,改善便秘各症状,提高生活质量及总有效,值得推广应用。     

风险护理对食管平滑肌瘤患者内镜下剥离电切术治疗效果与手术时间、术中出血量的影响

目的探讨风险护理对食管平滑肌瘤患者内镜下剥离电切术治疗效果与手术时间、术中出血量的影响。方法 选取2018 年5 月～2019 年5 月我院收治的食管平滑肌瘤患者98 例,随机分为研究组（n=49）与对照组（n=49）。对照组应用常规护理,研究组应用风险护理。比较两组患者的手术时间、术中出血量、满意度及不良事件发生率。结果 研究组患者的手术时间与术中出血量均少于对照组（P＜0.05）;研究组患者的满意度高于对照组（P＜0.05）;研究组食管穿孔、局部肿胀等不良事件发生率低于对照组（P＜0.05）。结论 在食管平滑肌瘤患者内镜下剥离电切术的护理过程中,应用风险护理,可以提高患者的临床治疗效果,且患者的满意度较高,不良事件发生率降低,可在临床推广应用。     

产后盆底康复时间选择对尿失禁及盆底肌的影响

目的 分析产妇产后尿失禁及盆底肌是否会受到盆底康复时间选择的影响。方法 选取2016年2月～2018年12月期间我院收治的90例产妇,经电脑随机法将其分为观察组和对照组两组,每组45例。观察组产妇在产后48 h进行产后盆底康复训练,产后42 d进行盆底康复治疗,对照组产妇在产后42 d进行产后盆底康复治疗,比较两组产妇的治疗效果。结果 观察组的尿失禁发生率(2.22%)明显低于对照组的22.22%,轻度、中度发生率也低于对照组,差异有统计学意义(P0.05);观察组Ⅰ类、Ⅱ类肌纤维肌力最大值与平均值均高于对照组,差异有统计学意义(P0.05)。观察组的治疗有效率为95.56%,对照组的治疗有效率为82.22%,组间比较差异有统计学意义(P0.05)。结论 产妇产后越早进行盆底康复训练,越有利于修复盆底肌,降低尿失禁的发生率,缓解盆底功能受损情况,提升治疗总有效率,加快疾病恢复,有临床实践意义。     

信息化物品管理系统的应用效果分析

目的利用信息化物品管理系统提高医院管理水平,保证护理工作安全。方法在移动护理工作站、医院信息系统和无线网络等设施的基础上,建立信息化物品管理系统。分析应用信息化物品管理系统的临床效果,比较物品交接时间,药品丢失数量及护士工作满意度情况。结果与传统护理物品管理方式相比,使用信息化物品管理系统进行物品交接的平均用时显著降低(t=10.66,P<0.001),药品丢失数量明显减少(χ2=4.215,P=0.040),体温计丢失数量明显减小(χ2=4.643,P=0.031),护士工作满意度明显提高(χ2=5.699,P=0.017)。结论信息化物品管理系统使物品管理更规范、更准确、更科学,提高护士工作效率,改进护理工作质量,保障医疗安全。     

彩色多普勒超声帧差伪像的成因与特征探讨

本文目的在于探讨超声帧差伪像的形成原因与声像图特征。通过分析医用超声诊断仪器所采用的设计模型与人体组织声学特性之间存在的矛盾、探头振元数与物理通道数之间的匹配关系、2D图像与彩色多普勒图像在显示屏上的“实时”复合方式,揭示出在图像复合显示过程中,因帧频不同而导致的人体解剖结构与血流信号在时间、空间上“错位”而导致的伪像,阐明它具有的必然性、复合性、隐蔽性、低关注度特点,为仪器设计开发和超声医生在工作中及时识别帧差伪像,减少误诊,提供思路。     

“卧”的姿势、时位与禁忌文献研究

养生之诀,以卧为先。通过从"卧"的姿势、时位以及禁忌归纳整理古代养生文献,发现古人所言睡方,应以侧卧为宜,面生气之位而居,四时应晨起于寅卯时,夜卧于戌亥时;卧须有向包括:恒东而卧——万物以生,东西而卧——调补阴阳,四向而卧——以应四季,依季而卧——顺时针卧;卧的禁忌包括:趋避不良环境(勿卧窗脊下,卧处勿当风,卧勿对炉灯),趋避不当行为(卧须闭口,不可言语;卧勿覆首,旦须暖腹;卧勿饱食,亦不可久;卧勿湿头,脚踏勿高)。以此为方,才能获得健康的睡眠,达到养生延寿的效果。     

From the Cover: Synchronization in human musical rhythms and mutually interacting complex systems

Though the music produced by an ensemble is influenced by multiple factors, including musical genre, musician skill, and individual interpretation, rhythmic synchronization is at the foundation of musical interaction. Here, we study the statistical nature of the mutual interaction between two humans synchronizing rhythms. We find that the interbeat intervals of both laypeople and professional musicians exhibit scale-free (power law) cross-correlations. Surprisingly, the next beat to be played by one person is dependent on the entire history of the other person’s interbeat intervals on timescales up to several minutes. To understand this finding, we propose a general stochastic model for mutually interacting complex systems, which suggests a physiologically motivated explanation for the occurrence of scale-free cross-correlations. We show that the observed long-term memory phenomenon in rhythmic synchronization can be imitated by fractal coupling of separately recorded or synthesized audio tracks and thus applied in electronic music. Though this study provides an understanding of fundamental characteristics of timing and synchronization at the interbrain level, the mutually interacting complex systems model may also be applied to study the dynamics of other complex systems where scale-free cross-correlations have been observed, including econophysics, physiological time series, and collective behavior of animal flocks.In his book Musicophilia, neurologist Oliver Sacks writes: “In all societies, a primary function of music is collective and communal, to bring and bind people together. People sing together and dance together in every culture, and one can imagine them having done so around the first fires, a hundred thousand years ago” (1). Sacks adds, “In such a situation, there seems to be an actual binding of nervous systems accomplished by rhythm” (2). These thoughts lead to the question: Is there any underlying and quantifiable structure to the subjective experience of “musical binding”? Here, we examine the statistical nature of musical binding (also referred to as musical coupling) when two humans play rhythms in synchrony.Every beat a single (noninteracting) layperson or musician plays is accompanied by small temporal deviations from the exact beat pattern, i.e., even a trained musician will hit a drum beat slightly ahead or behind the metronome (with a SD of typically 5–15 ms). Interestingly, these deviations are statistically dependent and exhibit long-range correlations (LRC) (3, 4). Listeners significantly prefer music mirroring long-range correlated temporal deviations over uncorrelated (white noise) fluctuations (5, 6). LRC are also inherent in the reproduction of both spatial and temporal intervals of single subjects (4, 7–9) and in musical compositions, such as pitch fluctuations (a simple example of pitch fluctuations is a melody) (10, 11) and note lengths (12). The observation of power law correlations in fluctuations of pitch and note length in compositions reflects a hierarchical, self-similar structure in these compositions.In this article, we examine rhythmic synchronization, which is at the foundation of musical interaction, from orchestral play to audience hand-clapping (13). More specifically, we show that the interbeat intervals (IBIs) of two subjects synchronizing musical rhythms exhibit long-range cross-correlations (LRCCs), which appears to be a general phenomenon given that these LRCC were found both in professional musicians and in laypeople.The observation of LRCCs may point to characteristics of criticality in the dynamics of the considered complex system. LRCCs are characterized by a power law decay of the cross-correlation function and indicate that the two time series of IBIs form a self-similar (fractal) structure. Here, self-similarity implies that trends in the IBIs are likely to repeat on different timescales, i.e., patterns of IBI fluctuations of one musician tend to reproduce in a statistically similar way at a later time—even in the other musician’s play. A variety of complex systems exhibit LRCCs; examples include price fluctuations of the New York Stock Exchange (where the LRCCs become more pronounced during economic crises) (14–16), heartbeat and EEG fluctuations (15, 17), particles in a Lorentz channel (18), the binding affinity of proteins to DNA (15), schools of fish (19), and the collective response of starling flocks (20, 21). The origin of collective dynamics and LRCCs based on local interactions often appears elusive (20), and is the focus of current research (19, 21). Of particular interest are the rules of interactions of the individuals in a crowd (22, 23) and transitions to synchronized behavior (16, 24). We introduce a stochastic model for mutually interacting complex systems (MICS) that generates LRCCs and provides a physiologically motivated explanation for the surprising presence of long-term memory in the cross-correlations of musical performances.Interbrain synchronization has received growing attention recently, including studies of interpersonal synchronization (see ref. 4 for an overview), coordination of speech rhythm (25), social interactions (26), cortical phase synchronization while playing guitar in duets (27, 28), and improvisation in classical music performances (29).Notably, the differences between the beats of two musicians are on the order of only a few milliseconds, not much larger than the typical duration of a single action potential (∼1 ms). The neurophysical mechanisms of timing in the millisecond range are still widely open (30, 31). EEG oscillatory patterns are associated with error prediction during music performance (32). Fine motor skills, such as finger-tapping rhythm and rate, are used to establish an early diagnosis of Huntington disease (33). The neurological capacity to synchronize with a beat may offer therapeutic applications for Parkinson disease, but the mechanisms are unknown to date (34). This study offers a statistical framework that may help to understand these mechanisms.     

Donor-site morbidity after harvesting of radial forearm free flaps—comparison of vacuum-assisted closure with conventional wound care: A randomized controlled trial

IntroductionRadial forearm free flaps (RFFF) are often used to replace tissue removed in head and neck surgery. In recent years, many attempts have been made to reduce donor-site morbidity and to prevent common complications such as infection, skin-graft necrosis, tendon exposure and subsequent impairment of hand function. One promising option is the use of vacuum-assisted-closure wound therapy (VAC). The objective of this study was to evaluate the effectiveness of VAC compared with a conventional bolster dressing (CBD).Material and methodsA randomized controlled trial was enrolled. Our study was prospective in design and included patients with a skin-grafted forearm defect after harvesting of RFFF. Patients who met the inclusion criteria were randomly assigned into two study arms. The predictor variable was the type of wound therapy (VAC therapy compared with CBD) and the outcome variables were (1) the size of the wound area, (2) wrist movement and (3) grip strength. Outcome variables were assessed 12 days, three weeks and eight weeks after surgery.ResultsFifty patients (33 males, mean age 61.7 years [SD 15.5]; 17 females, mean age 54.7 years [SD 10.5]) were included consecutively in the study. Patients in the VAC group experienced a faster postsurgical reduction of wound area and had better wrist movement; nonetheless, the differences between the VAC group and CBD group did not reach statistical significance. In contrast, the recovery of postsurgical grip strength was significantly faster in the VAC group.ConclusionsOur study failed to prove that VAC therapy is significantly superior to CBD for all the variable studied. Because VAC therapy has some positive effects, however, we recommend further development of this negative-pressure wound treatment, rather than the termination of its use.