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。     

Extended Synchronous Variational Integrators for Wave Propagations on Non-Uniform Meshes

This paper is concerned with the classical problem of wave propagation in discrete models of nonuniform resolution. We extend the traditional asynchronous variational integrators (AVIs) method to higher order and couple different spatial elements to adapt to nonuniform meshes. We show that the extension of AVIs method is stable, convergent and may reduce the spurious inter-grid reflection across meshes with different sizes. Numerical experiments are provided to verify the stability and convergence of the extended AVIs. The total energy is numerically conserved in our experiments.     

Contrast circulation in adult fontan patients using MR Time Resolved Angiography: Application for CT pulmonary angiography

BackgroundWhen patients with Fontan circulation require a computed tomographic pulmonary angiogram (CTPA), there are significant challenges in achieving adequate contrast opacification due to the altered anatomical connections. This study used Time Resolved Angiography with Interleaved Stochastic Trajectories (TWIST) Magnetic Resonance Angiography (MRA) to examine contrast circulation in a cohort of patients with Fontan circulation who were having routine MRI follow up to inform the contrast timing of any subsequent CT.MethodsThis is a single centre, cross-sectional, observational, retrospective study. The time to peak (TTP) signal intensity from the MRA was recorded using regions of interest on the aorta, pulmonary arteries, cavae and Fontan conduit. Patients were grouped by ejection fraction, global longitudinal strain, indexed stroke volume and cardiac index to examine if these cardiac performance parameters affected the mean TTP. Statistical analysis was performed to find the mean TTP for each of the vessels, which was consequently compared between the different cardiac performance parameters.Results35 patients were included in the study. Mean TTP contrast enhancement was 31s in the thoracic aorta, 46s in the right pulmonary artery, 41s in the left pulmonary artery and 55s in the Fontan conduit. Cardiac performance shows no statistically significant relationship to the peak contrast enhancement whether measured by ejection fraction, global longitudinal strain, stroke volume index or cardiac index.ConclusionThe mean optimal timing for a single-phase examination of the Fontan circulation, following an upper limb injection, was 55 s following start of contrast injection irrespective of cardiac performance. In TWIST MRA, the IV bolus is 4–5 s duration. A longer bolus is required for CTA, around 20s, suggesting an additional delay will be required. We propose that an optimal single phase CTPA to be protocolled at 70 s following the start of contrast injection, assuming adequate iodinated contrast dose.     

Is it necessary to place screws in the intervening vertebrae in two-level anterior cervical discectomy with fusion and plating?

ObjectiveThe clinical outcomes, radiological parameters, complication rate and the cost of implants in two-level ACDF with and without screws in the intervening segment were compared.MethodsA retrospective study of 68 patients who underwent 2-level ACDF from January 2014 to June 2016 was performed. The patients were divided into two groups: ACDF with screws in the intervening vertebra and those without screws in the intervening vertebra. Perioperative factors, clinical outcomes, postoperative complications, radiological parameters, and cost of the implants were evaluated in both groups.ResultsNo statistical differences in clinical outcomes, operative blood loss, hospital stay, restoration of cervical lordosis or segment height, postoperative complications, and fusion rate were found between the ACDF (middle vertebra with screw) and ACDF (middle vertebra without screw) groups (P > 0.05). But the operative time of added screw placement and cost of implants in the ACDF (middle vertebra without screw) group were significantly less than the ACDF (middle vertebra with screw) group (P < 0.05).ConclusionTwo kinds of screw placement with ACDF were found to be similar in terms of clinical outcomes. However, ACDF (middle vertebra without screw) was found to be superior to ACDF (middle vertebra with screw) in terms of the screw placement time and cost of implants.     

No association between postmenopausal time and the prevalence of newly discovered asymptomatic intracranial atherosclerotic stenosis: The APAC study

IntroductionAsymptomatic intracranial atherosclerotic stenosis (AICAS) is a common cause of stroke. Elderly women were more likely than men to develop AICAS, although it indicated that a lifelong exposure to estrogen could lower the risks of cardiovascular disease (CVDs).ObjectiveThe present study aims to ascertain whether postmenopausal time is a risk factor of AICAS. Fostering a correct perception of menopause is of great significance for the overall well-being of the elderly women.MethodsAll participants received a questionnaire, physical examination, laboratory testing and transcranial Doppler. The menopausal population (n = 701) was divided into three groups by tertiles of postmenopausal time. Two-tailed testing and trend test were used to reveal the relationship between postmenopausal time and newly discovered AICAS. Other potential risk factors were also analyzed to ascertain whether there was a relation between postmenopausal time and the newly discovered ICAS.ResultsBoth mean age and mean postmenopausal time were gradually increased from G0 to G2. The same trend occurred in hypertension, diabetes mellitus, total cholesterol, triglyceride, C-reactive protein and serum homocysteine. Adjusting for various confounding factors, postmenopausal time was not a risk factor for newly discovered AICAS. Multifactor analysis and stratifying analysis showed no correlation between newly discovered AICAS and postmenopausal time.ConclusionsPostmenopausal time is not an independent risk factor of AICAS. No relationship was detected between postmenopausal time and newly discovered AICAS, while vigorous control of body weight, blood pressure/glucose/lipids and smoke cessation are vital for preventing the occurrence of AICAS.     

Recent progress on the diagnosis of 2019 Novel Coronavirus

Coronavirus disease 2019 (COVID‐19) caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has become a global pandemic. Therefore, convenient, timely and accurate detection of SARS‐CoV‐2 is urgently needed. Here, we review the types, characteristics and shortcomings of various detection methods, as well as perspectives for the SARS‐CoV‐2 diagnosis. Clinically, nucleic acid‐based methods are sensitive but prone to false‐positive. The antibody‐based method has slightly lower sensitivity but higher accuracy. Therefore, it is suggested to combine the two methods to improve the detection accuracy of COVID‐19.