尖端扭转型室性心动过速的快速识别和治疗

目的:分析快速识别和治疗尖端扭转性室性心动过速（Tdp）的方法及疗效。方法:对36例Tdp的临床资料、心电图特征及治疗情况进行分析。结果:先天性长QT间期综合征（LQTS）伴发Tdp者3例,获得性长QT间期致Tdp（LQTT）者29例,伴有极短联律间期的Tdp4例。先天性LQTS治疗的重点是使用β受体阻滞剂;获得性LQTT治疗的重点是去除病因,增快心率,纠正心室复极异质性;伴极短联律间期的Tdp治疗的重点是使用钙拮抗剂。结论:尽快获取病史和诱发因素,详细甄别心电图和针对性治疗,对Tdp的快速识别和及时处理具有重要意义。     

Characteristics and Impact of Life Turning Points for Older Adults

This research examines the characteristics of turning points, events considered as being significant in one’s life. One hundred and forty-nine turning points, as reported by 53 older adults were investigated. They were characterized according to: age at occurrence of turning point, domain, specific or thematic nature, and areas of functioning on which the turning point had an impact. Compared to men, women reported significantly more turning points related to the health domain. Turning points were distributed through the life span, with some concentration at midlife. Family was the sphere most influenced by turning points. The different domains of turning points corresponded to the specific spheres of impact. Turning points were more often related to discrete events than to a series of events clustered under a theme. Identity and social role processes appear most influential in leading older adults to identify particular life circumstances as turning points in their lives.

Optimal medical therapy is a proven option for chronic stable angina

The authors of the meta-analysis of a percutaneous coronary intervention (PCI)-based invasive strategy for improving prognosis for the treatment of angina conclude that a pooling of data from various studies can be sufficiently powered to evaluate the impact of PCI on long-term mortality. However, most randomized coronary artery patient trials have insufficient power to detect significant differences in hard end points. Randomized trials in patients with chronic stable angina enroll few patients who are over age 65 years, have depressed ventricular function, have clinical instability, or who have undergone previous coronary artery bypass grafting (CABG) or PCI. "Medical therapy" today no longer means the absence of PCI, but rather the presence of intensive, evidence-based pharmacologic intervention. The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation) trial randomized 2,287 patients to optimal medical therapy alone or optimal medical therapy plus PCI. Optimal medical therapy consisted of antiplatelet therapy, anti-ischemic therapy, and aggressive lipid and blood pressure control. Based on the strength of the evidence, the author of this commentary recommends more-aggressive medical therapy for patients with moderate-to-severe angina, and PCI or CABG for many patients in whom symptoms persist. Optimal medical therapy is a proven option for chronic stable angina.     

Comparison of isometric and anatomical graft placement in synthetic ACL reconstructions: A pilot study

Correct graft placement is critical to the success of anterior cruciate ligament reconstructions (ACLR). Whilst current trend is to insert the graft in an anatomical location, synthetic grafts have shown to better perform when they are located in an isometric position. Placement, however, is largely dependent on the surgeon and no consensus has been reached for synthetic grafts.Kinematic flexion-extension data of four separate cadaveric knees was obtained using an optical tracking system. Knees were CT-scanned and computer models were developed for each specimen. Three different graft insertion techniques were simulated in each of the computer models. Kinematic data obtained from the optical tracking was applied to the 3D computer models to simulate knee flexion-extension, and virtual change in ACL graft length was measured over the cycle for each insertion technique. Length changes were plotted onto the Radiological-Quadrant.The isometric region on the femur was found to be a band spreading from the mid to deep end of the Blumensaat's line down to the shallow-inferior end of the femoral condyle. The JP Laboureau isometric point technique was consistently located in the isometric zone, with the following coordinates on the Radiographic-Quadrant: t=0.375 (SD 0.0066), h=0.227 (SD 0.0266). The Bernard–Hertel and Charlie Brown anatomical placement methods were located (13%, ?6%) and (8%, ?15%) away, from the JP Laboureau isometric point, respectively, based on t- and h- coordinates of the Radiographic-Quadrant.This study has determined the isometric region using three-dimensional analysis relative to the Radiographic-Quadrant. The JP Laboureau method best finds the isometric point. This information is useful for synthetic graft placement.     

《御纂医宗金鉴》伤科内治原则及方药应用特色探研

[目的]探求《御纂医宗金鉴》伤科内治原则及方药应用特色。[方法]运用文献法对《御纂医宗金鉴》伤科内治法相关内容进行研究,从辨治原则和方药应用两个角度进行归纳和分析,并举医案一则探讨该治法对临床的指导作用。[结果]《御纂医宗金鉴》伤科内治法以辨瘀血出血、辨病位为辨证要点;伤科的治疗原则包括瘀血从肝论治、分阶段论治、调畅情志、兼症施治;书中用方经典,多在用方时加用引药,并提出了"假其热以行其寒"的用药思想。所举验案诊为骨折脾虚肝郁、瘀血阻滞证,基于该理论,从肝论治伤科疼痛,治以疏肝健脾、活血通络,注重情志调节与兼症施治,故见收效。[结论]《御纂医宗金鉴》系统总结了伤科内治的辨治原则和方药应用,伤科内治注重辨瘀血出血及辨病位,治疗原则包括瘀血从肝论治、分阶段论治、调畅情志、兼症施治,用方时多加用引药,对于指导临床治疗伤科病症具有重要的参考价值。     

卡尔曼滤波在盾构姿态测量中的应用

三点法是一种传统的实时计算刚体三姿态角（滚动角、俯仰角和水平角）的方法。在盾构掘进过程中,观测点测量不同步会导致较大的姿态测量误差。采用卡尔曼滤波对观测点的坐标进行预测补偿来提高测量精度。建立系统运动的状态方程和量测方程,对系统噪声和量测噪声的协方差进行估计,通过递归运算对观测点坐标进行预测,蒙特卡洛仿真结果表明,这种处理方式优于传统三点法测量效果。仿真实验和测量实验结果都表明卡尔曼滤波算法既可以明显减小姿态角测量误差,又对随机系统噪声和量测噪声引起的姿态角误差具有抑制作用。     

宫腔声学造影技术操作要领及临床应用价值

目的:探讨宫腔声学造影技术操作要领及临床应用价值。方法:常规消毒铺巾后,在双腔子宫造影管内注水排出管内气体后置入宫腔,向球囊内注入1～2ml生理盐水,经造影管向宫腔内缓慢注入生理盐水10～30ml使子宫前后壁分离,在宫腔液性无回声背景下采用纵、横、斜各切面连续、动态观察宫腔充盈形态、宫内膜、宫内病灶以及宫壁情况。结果:本组宫腔声学造影239例,病灶显示满意212例,基本满意21例,不满意6例。造影诊断子宫内膜息肉236例,子宫黏膜下肌瘤2例,妊娠物残留1例;显示病灶5mm×5mm×3mm～40mm×33mm×14mm;单发157例,多发82例。术后病理结果子宫内膜息肉231例,子宫黏膜下肌瘤5例,增生期内膜改变2例,妊娠物残留1例。结论:宫腔声学造影具有简便、无创、并发症少等优点,对宫内病变诊断的敏感性和特异性接近宫腔镜诊断,具有较大临床应用价值。     

公立医院改革难点与对策探讨

在认真学习和贯彻领会国务院《关于公立医院改革试点的指导意见》的基础上,结合医院管理工作实际,分析和探讨当前公立医院改革存在的一些难点问题,包括坚持公立医院的公益性质需要各级政府转变执政理念和承担责任;改革公立医院的管理体制需要有关职能部门理清管办职责;政府在财力有限的情况下需要转变补偿政策和调整补偿方式;因人事制度改革中编制和岗位绩效工资难以解决的原因而造成广大医护人员参与改革积极性不高等等。提出了转变政府职能、完善投入机制、维护公立医院公益性质;实施区域卫生规划、优化布局、实行属地化管理;完善补偿政策、加强监管、解决“以药补医”问题;科学设置岗位、切实实施绩效工资、规范医师多点执业等对策建议。     

婴幼儿腹泻致心肌损伤相关因素及评估

目的:探讨应用心肌酶和肌钙蛋白I评估婴幼儿腹泻发生心肌损伤的相关因素及评估要点.方法:对216例婴幼儿腹泻的心肌酶及肌钙蛋白I分年龄及临床症状、病因组进行分类对比分析.结果:轮状病毒肠炎心肌酶及肌酸激酶同工酶(CK-MB)、肌钙蛋白I改变明显,轮状病毒肠炎心肌酶异常达76.32 %;并发CK-MB升高达59.21%;肌...     

不同强度按压背俞穴对CFS大鼠行为学及体重的影响

目的 探讨不同强度穴位刺激对慢性疲劳综合征(CFS)大鼠行为学及体重的影响.方法 将60只SD大鼠随机分为轻压组、中压组、重压组、抚摸组、模型组和空白对照组,采用剥夺睡眠和力竭游泳制作CFS模型,动态观测不同阶段各组大鼠行为表现和体重的变化.结果 4周的剥夺睡眠和力竭游泳导致大鼠行为学和体重发生变化,基本符合CFS的临...