观察调神针法对慢性失眠症患者过度觉醒状态的影响＊

目的 观察调神针法治疗慢性失眠症的疗效，并基于“过度觉醒”探讨针刺治疗慢性失眠症的潜在机制。方法 将60例慢性失眠症（Chronic insomnia， CI）患者，随机分为调神针刺组（试验组）30例和假针刺组（对照组）30例。调神针刺组选用百会、印堂、神门（双）、三阴交（双），假针刺组采用非病症相关穴位浅刺的方法。两组均隔日治疗1次，每周3次，连续4周。比较两组患者治疗前后及结束治疗1月随访时匹兹堡睡眠指数量表（Pittsburgh sleep quality index， PSQI）总积分及各因子积分、过度觉醒量表（Hyperarousal scale， HAS）积分、血清皮质醇（Cortisol， CORT）浓度变化。结果 治疗后与随访时比较，调神针刺组各量表积分较治疗前均明显下降（P < 0.01）；治疗后血清CORT较治疗前明显下降（P < 0.01）。治疗后，假针刺组PSQI总分及血清CORT与治疗前比，均明显下降（P < 0.05）；随访时假针刺组各量表积分与治疗前比较，均无统计学意义（P > 0.05）。调神针刺组各量表积分及血清CORT降低均明显优于假针刺组（P < 0.01）。结论 调神针法可明显改善慢性失眠症患者睡眠质量、过度觉醒状态，降低血清CORT浓度可能是潜在作用机制之一。     

浅谈应用红外热成像技术早期诊断糖尿病足的策略

糖尿病足早期症状不明显,待明确诊断时病程多已步入中后期阶段,严重威胁民众健康。红外热成像技术作为一种医用功能性检测技术,能在人体组织发生结构性病变之前,敏感地发现其功能性改变导致的体表温度异常。基于中医学视角,借用计算机辅助诊断系统及属性篇序结构图,可以为糖尿病足红外热图的多角度、多维度解读提供全新思路,突破传统西医解剖学视角难以全面解读热图异常规律的瓶颈,也为红外热成像技术的应用拓宽视野。     

形成性评价法在新入职护士规范化培训中的应用研究

目的探讨形成性评价法在新护士规范化培训中应用效果。方法将2016年42名新入职护士作为对照组,将2017年38名新入职护士作为试验组,对照组实施终结性评价法,试验组实施形成性评价和终结性评价相结合的方法,比较两组护士四次出科理论和操作考核成绩和新护士岗位胜任力。结果试验组护士的出科理论、操作考核成绩及岗位胜任力指标均优于对照组(P<0.05)。结论通过对新护士规范化培训全程的观察、记录、反馈,帮助他们端正职业态度、明确职业职责、提高职业技能等岗位胜任力,促进了新入职护士规范化培训目标的完成。     

Electroacupuncture improves learning and memory functions in a rat cerebral ischemia/reperfusion injury model through PI3K/Akt signaling pathway activation

Electroacupuncture has been widely used to treat cognitive impairment after cerebral ischemia, but the underlying mechanism has not yet been fully elucidated. Studies have shown that autophagy plays an important role in the formation and development of cognitive impairment, and the phosphoinositide 3-kinase(PI3 K)/Akt signaling pathway plays an important role in autophagy regulation. To investigate the role played by the PI3 K/Akt signaling pathway in the electroacupuncture treatment of cerebral ischemia/reperfusion rat models, we first established a rat model of cerebral ischemia/reperfusion through the occlusion of the middle cerebral artery using the suture method. Starting at 2 hours after modeling, electroacupuncture was delivered at the Shenting(GV24) and Baihui(GV20) acupoints, with a dilatational wave(1–20 Hz frequency, 2 mA intensity, 6 V peak voltage), for 30 minutes/day over 8 consecutive days. Our results showed that electroacupuncture reduced the infarct volume in a rat model of cerebral ischemia/reperfusion injury, increased the mRNA expression levels of the PI3 K/Akt signaling pathwayrelated factors Beclin-1, mammalian target of rapamycin(mTOR), and PI3 K, increased the protein expression levels of phosphorylated Akt, Beclin-1, PI3 K, and mTOR in the ischemic cerebral cortex, and simultaneously reduced p53 mRNA and protein expression levels. In the Morris water maze test, the latency to find the hidden platform was significantly shortened among rats subjected to electroacupuncture stimulation compared with rats without electroacupuncture stimulation. In the spatial probe test, the number of times that a rat crossed the target quadrant was increased in rats subjected to electroacupuncture stimulation compared with rats without electroacupuncture stimulation. Electroacupuncture stimulation applied to the Shenting(GV24) and Baihui(GV20) acupoints activated the PI3 K/Akt signaling pathway and improved rat learning and memory impairment. This study was approved by the Animal Ethics Committee of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, China(approval No. 8150150901) on March 10, 2016.     

孙远征教授运用循经远取动法治疗痛症举隅

痛症是临床上较为常见的症状之一,往往影响患者的工作与生活,近年来得到了人们的广泛重视。孙远征教授在明辨痛症病因、针灸镇痛机理的基础上,根据传统经络循行及疼痛部位的特点,结合"标本根结"理论,遵循"经脉所过,主治所及"和"上病下治,下病上治"的选穴原则,同时配合运动疗法,提出了循经远取动法治疗痛症。尤其在治疗软组织痛症方面,疗效显著,值得临床上加以总结应用。     

扶正法治疗精神疾病的心悟

慎察精神疾病患者之症象,准确辨证,若系正气虚匮或不足,予相应之扶正方药、针灸等主治或辅治之,收效颇佳。反之,审证不清,“实而误补,固必增邪”(《顾氏医镜》)。同时,宜鼓励患者多做活动锻炼,增强体质,提高正气,亦可谓一种较好的扶正辅助疗法。     

影像后处理技术在神经外科教学查房中的应用

目的  评价以问题为基础的教学法(problem-based learning,PBL)联合影像后处理技术在神经外科教学查房中的应用效果。方法  选择神经外科典型病例，以病例为基础，以问题为导向布置课前预习内容，联合影像后处理技术在教学查房中以导向问题为主线实施教学培训，与传统教学方法相比评价教学效果。结果  PBL联合影像后处理技术教学查房模式和传统讲授教学查房模式的学员理论考试成绩分别为92.53±2.17分、81.40±6.17分，临床诊疗考核成绩分别为91.10±1.97分、79.60±3.27分，P值分别为<0.001、<0.001，差异有统计学意义。接受PBL联合影像后处理技术教学模式的学员对教学方式的认可度、增加学习兴趣、利于神经科思维，P值分别为0.013、0.024、0.035。结论  PBL联合影像后处理技术可有效提高教学查房效果，帮助学员提高对基础知识的理解能力，抓住神经外科疾病的关键点加速神经外科诊疗思维能力的形成。     

Primary-school-based art therapy: exploratory study of changes in children’s social,emotional and mental health

ABSTRACT

AIM: This exploratory mixed methods study aimed to inform future research by investigating if teachers and children from one primary school perceived any changes in children’s social, emotional and mental health difficulties following art therapy and if so, what the children perceived as helpful about the sessions. METHODS: The study included 45 children and 10 class teachers within one UK primary school. The researchers analysed routine questionnaires from teachers and a children's evaluation interviews, triangulating these with data from a teacher focus group. RESULTS: The findings show significant and medium effect sizes for positive teacher-rated changes in children’s overall stress, conduct, hyperactivity, and procsocial behaviour and a large effect on perceived impact of children’s difficulties on their lives. Teacher-rated emotional distress and peer problems showed small changes that did not reach statistical significance. The positive changes were corroborated by the teachers' and children's qualitative reports. Aspects of art therapy which children found particularly helpful were; making and thinking about art; expressing, thinking and learning about thoughts and feelings; and sessions being fun. CONCLUSION: The study highlighted perceived positive changes and no negative changes in children’s SEMH difficulties. However, future research is necessary to examine clinical effectiveness.

Plain-language summary

In this article we describe a research study which aimed to explore if teachers and children perceived any changes to children’s social, emotional or mental health difficulties after the children attended art therapy within their primary school. We were also interested in learning from the children if they thought anything in particular had been helpful about their art therapy sessions in order to inform future research and the development of this particular approach to art therapy.

The art therapists asked the class teachers to fill out a Strengths and Difficulties Questionnaires at the beginning and end of art therapy. The class teachers also attended a focus group so we could learn more about their general observations of the children before and after attending art therapy. The art therapists also interviewed the children to learn if they perceived any changes since coming to art therapy and if so, what in particular they thought had helped bring about these changes.

We found that statistical analysis of the questionnaire scores mostly agreed with what the teachers and children said and that there was generally some positive change to the social, emotional and mental health difficulties the children had been experiencing. The teachers also let us know that some of the children still had residual problems. The children emphasised that making and thinking about art along with expressing, thinking and learning about thoughts and feelings had been particularly helpful. It was also important to the children that the sessions were fun.

In conclusion, the teachers and children in this primary school perceived art therapy as helpful to the children and that it merits further research in order to develop the approach used by the art therapists and to see if it is effective in larger research studies including more children, schools and art therapists.