捻转刺法溯源

通过复习历代文献,追溯捻转手法的发展历史,分析在各个历史时期捻转刺法的操作方法,总结捻转手法的演变经过.结果发现民国以前的捻转刺法以单向捻转为主,民国时期受到日本针刺手法的影响,逐渐演变为往复捻转,之后往复捻转成为捻转手法的主流.与往复捻转相比,单向捻转具有更强的刺激作用和软组织松解作用,能够用于治疗多种疾病.     

Comparison between universal adhesives and two‐step self‐etch adhesives in terms of dentin bond fatigue durability in self‐etch mode

This aim of this study was to compare universal adhesives and two‐step self‐etch adhesives in terms of dentin bond fatigue durability in self‐etch mode. Three universal adhesives – Clearfil Universal, G‐Premio Bond, and Scotchbond Universal Adhesive – and three‐two‐step self‐etch adhesives – Clearfil SE Bond, Clearfil SE Bond 2, and OptiBond XTR – were used. The initial shear bond strength and shear fatigue strength of resin composite bonded to adhesive on dentin in self‐etch mode were determined. Scanning electron microscopy observations of fracture surfaces after bond strength tests were also made. The initial shear bond strength of universal adhesives was material dependent, unlike that of two‐step self‐etch adhesives. The shear fatigue strength of Scotchbond Universal Adhesive was not significantly different from that of two‐step self‐etch adhesives, unlike the other universal adhesives. The shear fatigue strength of universal adhesives differed depending on the type of adhesive, unlike those of two‐step self‐etch adhesives. The results of this study encourage the continued use of two‐step self‐etch adhesive over some universal adhesives but suggest that changes to the composition of universal adhesives may lead to a dentin bond fatigue durability similar to that of two‐step self‐etch adhesives.     

Production and manipulation of elevated temperatures in pig abdomen with a three-electrode capacitive heating device

The ability of a three-electrode capacitive heating device operating at 13·56 MHz to produce and effect spatial redistribution of hyperthermic temperatures is demonstrated through abdominal heating studies conducted with 80 kg female and 65 kg male pigs. Temperature-time profiles over the respective heating periods were obtained in anterior and posterior superficial tissue and in selected abdominal organs. At selected times during heating, spatial redistribution of elevated temperatures was effected through adjustment of power settings for one or more of the three electrodes, i.e. through manipulation of the specific absorption rate (SAR) in-vivo.     

经皮肾一步扩张法在结石所致梗阻性肾功能不全中的应用

目的 探讨超声引导下经皮肾一步扩张法在结石性梗阻性肾功能不全中的临床效果.方法 选择我院2009年7月～2011年7月因结石所致上尿路梗阻,合并梗阻性肾积液、肾功能不全患者68例,随机分为一步扩张法( One-step)组和逐步式(Multi- step)组分别行经皮肾穿刺微造瘘引流术,每组各34例.One-step组在超声引导下一步式经皮肾穿刺微造瘘(PCN)直接穿刺引流,Multi-step组采用传统Seldinger法逐级扩张经皮肾通道实施造瘘引流.对比观察两组患者建立经皮肾通道的手术时间、术中出血量、成功率、术后并发症及肾功能的变化情况.结果 One-step组手术时间、扩张次数、术中出血量均少于Multi-step组,差异有显著性(P＜0.05).One-step组一次穿刺置入造瘘管的成功率明显高于Multi-step组,而术后并发症发生率明显低于multi-step组,差异均有显著性(P＜0.05).两组患者术后肾功能明显改善,术后2周尿素氮(BUN)、血肌酐(Cr)与术前相比,差异有显著性(P＜0.05),但术后2周两组间BUN、Cr比较,差异无显著性(P＞0.05).结论 一步扩张法经皮肾穿刺微造瘘操作简便、创伤小、出血量少和并发症少,有助于改善梗阻性肾功能不全.     

Spatial accessibility to colonoscopy and its role in predicting late‐stage colorectal cancer

ObjectiveTo better determine the relationship between spatial access to colonoscopy and colorectal cancer (CRC) outcomes, our objective was to examine the agreement of the classic, enhanced, and variable two‐step floating catchment area (2SFCA) methods in evaluating spatial access to colonoscopy and to compare the predictive validity of each method related to late‐stage CRC. 2SFCA methods simultaneously consider supply/demand of services and impedance (ie, travel time).Data SourcesColonoscopy provider locations were obtained from the South Carolina Ambulatory Surgery Database. ZIP code tabulation area (ZCTA) level population estimates and area‐level poverty level were obtained from the American Community Survey. Rurality was determined by the United States Department of Agriculture''s Rural‐Urban Commuting Area codes. Individual‐level CRC data were obtained from the South Carolina Central Cancer Registry.Study DesignUsing the classic, enhanced, and variable 2SFCA methods, we calculated ZCTA‐level spatial access to colonoscopy. We assessed agreement between the three methods by calculating Spearman''s rank coefficients and weighted Kappas (Κ). Global and Local Moran''s I were used to assess spatial clustering of accessibility scores across 2SFCA methods. We performed multilevel logistic regression analyses to examine the association between spatial accessibility to colonoscopy, area‐ and individual‐level factors, and late‐stage CRC.Principal FindingsWe found strong agreement (Weighted Κ = 0.82; 95% CI = 0.79‐0.86) and identified similar clustering patterns with the classic and enhanced 2SFCA methods. There was negligible agreement among the classic/enhanced 2SFCA and the variable 2SFCA. Across all 2SFCA methods, regression models showed that spatial access to colonoscopy, rurality, and poverty level were not associated with greater odds of late‐stage CRC, though Black race was associated with late‐stage CRC across all models.ConclusionsNone of the 2SFCA methods showed an association with late‐stage CRC. Future studies should explore which elements (spatial or nonspatial) of access to care have the greatest impact on CRC outcomes.     

Wrongful Life Cases and The Courts

No abstract available for this article.     

Pairwise‐comparison estimation with non‐parametric controls

The purpose of this paper is the presentation of distribution theory for generic estimators based on the pairwise comparison of observations in problems where identification is achieved through the use of control functions. The controls can be specified semi‐ or non‐parametrically. The criterion function may be non‐smooth. The theory is applied to the estimation of the coefficients in a monotone linear‐index model and to inference on the link function in a partially‐linear transformation model. A number of simulation exercises serve to assess the small‐sample performance of these techniques.     

Balance abilities and gait characteristics in post-traumatic brain injury,cerebral palsy and typically developed children

Objectives: To quantify the differences in gait variability and balance performance between children with cerebral palsy (CP), children with post-traumatic brain injury (TBI) and typically developed (TD) children and to determine the association between gait variability and functional balance in these groups.

Design: Cross-sectional study.

Setting: Physical therapy department of a paediatric and adolescent rehabilitation hospital.

Participants: A convenience sample of 15 children post-TBI, 15 children with CP and 30 TD age- and sex-matched controls.

Intervention: Not applicable.

Main outcome measure: Step length and step time variability measured by an electronic walkway; timed up and go (TUG) test and functional reach test (FRT) were used as functional balance tests.

Results: The functional balance abilities of children post-TBI and children with CP were significantly limited compared to TD children. Children post-TBI had significantly greater variability in step length in comparison to healthy controls. A significant linear inverse correlation between balance performance and step length variability was found only among children with TBI.

Conclusion: Brain damage is associated with restricted balance performance and increased step variability. It might be that in a child born with brain damage, as opposed to acquired damage, the developmental process has a restraining effect on gait variability.     

Numbers and Letters: Exploring an Autistic Savant’s Unpractised Ability

This paper describes an individual with autism and high-level calendar calculation ability who could perform a set of unpractised letter/number association tasks. The savant’s performance was compared with that of two control participants, one a departmental secretary and the other a professor of mathematics. The facility with which the savant could master the rules governing the relationships between the series of items suggests that he possessed a flexibility of mental processing transcending his ability of calendar calculation. Furthermore, he could recalibrate previous knowledge to solve new hitherto unpractised tasks. When presented with novel problems, the savant, unlike the mathematician, made no initial errors at all on any of the presented tasks, thereby indicating his fast and spontaneous recognition of new rules and of new relationships between items. It is concluded that a cognitive style of ‘weak central coherence’ as adopted by autistic savants may protect single representations from being retained in the form of stable enduring wholes, and that such a segmentation strategy may allow for the transformation, reorganization and reconstruction of the relationship between single items of information.     

The ALERRT® instrument: a quantitative measure of the effort required to compromise prescription opioid abuse-deterrent tablets

Background: US FDA guidance recommends measuring the degree of effort needed to manipulate abuse-deterrent (AD) opioids. The ALERRT^® instrument (PinneyAssociates; Bethesda, MD) uses visual analog scales to assess the labor, effort, and resources necessary to physically compromise AD product candidates in standardized settings. Objective: Use the ALERRT^® instrument for testing morphine abuse-deterrent, extended-release, injection-molded tablets (ADER-IMT) 60 and 100 mg and the comparators immediate-release (IR) morphine sulfate 30 mg and extended-release (ER) morphine sulfate 60 mg. Methods: Four technicians tested the products using 10 household tools. The ALERRT instrument quantified effort (all tools) and time (3 preselected tools) required for manipulation. Results: Morphine-ADER-IMT 60 and 100 mg were difficult to manipulate, as demonstrated by high scores (mean range, 71.0?99.0 and 77.0?99.5, respectively). IR and ER morphine sulfate were easy to manipulate (low scores; mean range, 2.0?14.8 and 2.3?17.5, respectively). Statistically significant mean differences between morphine-ADER-IMT and comparators’ ALERRT scores were observed. Manipulations of morphine-ADER-IMT 60 and 100 mg for 300 seconds failed to produce substantial powdering. Manipulations of IR morphine sulfate (mean range, 65.5?175.8 seconds) and ER morphine sulfate (49.3?163.0 seconds) produced substantial to complete powdering in 92% of tablets. Conclusions: Morphine-ADER-IMT was extremely difficult to manipulate versus non-AD formulations of morphine. The ALERRT system differentiated the degree of effort for manipulation of morphine-ADER-IMT and non-AD morphine formulations, indicating sensitivity of this instrument as part of Category 1 testing. By measuring the degree of effort required for manipulation, the ALERRT instrument provides an empirical assessment into the relative difficulty of manipulating opioid analgesics for abuse.