社会力量参与公立互联网医院建设激励与约束机制研究

社会力量具备相应的经济基础和技术条件,对于公立互联网医院体系建设具有积极的促进作用。但是实践中仍然存在商业模式不完善、监管制度不健全等问题。基于经济学契约理论要义,提出在坚持激励与约束机制并举、平衡公私益关系的前提下,通过完善医保政策、构建互联网医疗服务价格分类管理机制来促进社会力量向医疗服务公益性目标回归,并通过构建完善的监督体制来约束部分社会力量的盲目逐利性行为。     

Contribution of different somatosensory afferent input to subcortical somatosensory evoked potentials in humans

ObjectivesTo investigate the subcortical somatosensory evoked potentials (SEPs) to electrical stimulation of either muscle or cutaneous afferents.MethodsSEPs were recorded in 6 patients suffering from Parkinson’s disease (PD) who underwent electrode implantation in the pedunculopontine (PPTg) nucleus area. We compared SEPs recorded from the scalp and from the intracranial electrode contacts to electrical stimuli applied to: 1) median nerve at the wrist, 2) abductor pollicis brevis motor point, and 3) distal phalanx of the thumb. Also the high-frequency oscillations (HFOs) were analysed.ResultsAfter median nerve and pure cutaneous (distant phalanx of the thumb) stimulation, a P1-N1 complex was recorded by the intracranial lead, while the scalp electrodes recorded the short-latency far-field responses (P14 and N18). On the contrary, motor point stimulation did not evoke any low-frequency component in the PPTg traces, nor the N18 potential on the scalp. HFOs were recorded to stimulation of all modalities by the PPTg electrode contacts.ConclusionsStimulus processing within the cuneate nucleus depends on modality, since only the cutaneous input activates the complex intranuclear network possibly generating the scalp N18 potential.SignificanceOur results shed light on the subcortical processing of the somatosensory input of different modalities.     

Visualization of electrophysiological activity at the carpal tunnel area using magnetoneurography

ObjectiveTo establish a noninvasive method to measure the neuromagnetic fields of the median nerve at the carpal tunnel after electrical digital nerve stimulation and evaluate peripheral nerve function.MethodsUsing a vector-type biomagnetometer system with a superconducting quantum interference device, neuromagnetic fields at the carpal tunnel were recorded after electrical stimulation of the index or middle digital nerve in five healthy volunteers. A novel technique for removing stimulus-induced artifacts was applied, and current distributions were calculated using a spatial filter algorithm and superimposed on X-ray.ResultsA neuromagnetic field propagating from the palm to the carpal tunnel was observed in all participants. Current distributions estimated from the magnetic fields had five components: leading and trailing components parallel to the conduction pathway, outward current preceding the leading component, inward currents between the leading and trailing components, and outward current following the trailing component. The conduction velocity and peak latency of the inward current agreed well with those of sensory nerve action potentials.ConclusionRemoving stimulus-induced artifacts enabled magnetoneurography to noninvasively visualize with high spatial resolution the electrophysiological neural activity from the palm to the carpal tunnel.SignificanceThis is the first report of using magnetoneurography to visualize electrophysiological nerve activity at the palm and carpal tunnel.     

Using EMG to deliver lumbar dynamic electrical stimulation to facilitate cortico-spinal excitability

BackgroundPotentiation of synaptic activity in spinal networks is reflected in the magnitude of modulation of motor responses evoked by spinal and cortical input. After spinal cord injury, motor evoked responses can be facilitated by pairing cortical and peripheral nerve stimuli.ObjectiveTo facilitate synaptic potentiation of cortico-spinal input with epidural electrical stimulation, we designed a novel neuromodulation method called dynamic stimulation (DS), using patterns derived from hind limb EMG signal during stepping.MethodsDS was applied dorsally to the lumbar enlargement through a high-density epidural array composed of independent platinum-based micro-electrodes.ResultsIn fully anesthetized intact adult rats, at the interface array/spinal cord, the temporal and spatial features of DS neuromodulation affected the entire lumbosacral network, particularly the most rostral and caudal segments covered by the array. DS induced a transient (at least 1 min) increase in spinal cord excitability and, compared to tonic stimulation, generated a more robust potentiation of the motor output evoked by single pulses applied to the spinal cord. When sub-threshold pulses were selectively applied to a cortical motor area, EMG responses from the contralateral leg were facilitated by the delivery of DS to the lumbosacral cord. Finally, based on motor-evoked responses, DS was linked to a greater amplitude of motor output shortly after a calibrated spinal cord contusion.ConclusionCompared to traditional tonic waveforms, DS amplifies both spinal and cortico-spinal input aimed at spinal networks, thus significantly increasing the potential and accelerating the rate of functional recovery after a severe spinal lesion.     

Assessing the Effects of Geniculate Artery Embolization in a Nonsurgical Animal Model of Osteoarthritis

PurposeTo create a nonsurgical animal model of osteoarthritis (OA) to evaluate the effects of embolotherapy during geniculate artery embolization (GAE).Materials and MethodsFluoroscopy-guided injections of 700 mg of sodium monoiodoacetate were performed into the left stifle in 6 rams. Kinematic data were collected before and after induction. At 10 weeks after induction, Subjects 1 and 4–6 underwent magnetic resonance (MR) imaging with dynamic contrast enhancement (DCE) and Subjects 1, 3, and 4–6 underwent angiography with angiographic scoring to identify regions with greatest disease severity for superselective embolization (75–250-μm microspheres). Target vessel size was measured. At 24 weeks after angiography, DCE-MR imaging, angiography, and euthanasia were performed, and bilateral stifles were harvested. Medial/lateral tibial and femoral condylar, patellar, and synovial samples were cut, preserved, decalcified, and scored using the Osteoarthritis Research Society International criteria. The stifle and synovium Whole-Organ Magnetic Resonance Imaging Score and Multicenter Osteoarthritis Study score were determined. The volume transfer constant (K_trans) and extracellular volume fraction (v_e) were calculated from DCE-MR imaging along the lateral synovial regions of interest.ResultsThe mean gross and microscopic pathological scores were elevated at 38 and 61, respectively. Mean synovitis score was elevated at 9.2. Mean pre-embolization and postembolization angiographic scores were 5 and 3.8, respectively. Mean superior, transverse, and inferior geniculate artery diameters were 3.1 mm ± 1.21, 2.0 mm ± 0.50, and 1.6 mm ± 0.41 mm, respectively. Mean pre-embolization and postembolization cartilage and synovitis scores were elevated at 35.13 and 73.3 and 5.5 and 9.2, respectively. The K_trans/v_e values of Subjects 4, 5, and 6 were elevated at 0.049/0.38, 0.074/0.53, and 0.065/0.51, respectively. Altered gait of the hind limb was observed in all subjects after induction, with reduced joint mobility. No skin necrosis or osteonecrosis was observed.ConclusionsA nonsurgical ovine animal knee OA model was created, which allowed the collection of angiographic, histopathological, MR imaging, and kinematic data to study the effects of GAE.     

上颌骨有限元分析中边界约束条件的研究

目的：探讨上颌骨三维有限元分析中较合理的边界约束条件的设定。方法：建立完整无牙颌上颌骨种植全口覆盖义齿修复的三维有限元模型，根据在咬合面和咀嚼肌附丽处进行约束或加载的不同设定三种不同的边界约束条件，对各边界约束条件下模型内的应力分布情况进行观察。结果：对牙列咬合面进行加载还是进行约束其结果差异较大，而咬肌附丽处进行加载还是进行约束其结果无差异。结论：在对上颌骨的有限元研究中在咬合面加载，在咀嚼肌附丽处采用约束的方式来模拟咀嚼肌的影响，同时在枕骨大孔处也进行约束是较合理的。     

Comparative observation of the effect of electroacupuncture combined with heat-sensitive moxibustion and western medicine for premature ovarian failure

Objective

To compare the clinical efficacy between electroacupuncture combined with heat-sensitive moxibustion and western medicine for treatment of premature ovarian failure.

Optimal linear quadratic Gaussian control for discrete time-varying system with simultaneous input delay and state/control-dependent noises

This article focuses on the problem of linear quadratic Gaussian (LQG) control for discrete time-varying system with input delay and state/control-dependent noises. When the state variables can be exactly observed, first, we obtain the maximum principle by applying the method of variation. Second, a nonhomogeneous relationship between the state and the costate is developed in virtue of the obtained maximum principle and the mathematical induction. It is noted that the nonhomogeneous relationship is the solution to the forward and backward stochastic difference equations (FBSDEs). Finally, based on the solution to the FBSDEs, a necessary and sufficient condition for the optimal LQG control is derived in terms of coupled Riccati equations. Moreover, the analytical expression of the optimal controller is presented. The derived results are applied in networked control systems with packet dropout. Numerical examples are shown to illustrate the effectiveness of the proposed algorithm.     

Model predictive control of a collaborative manipulator considering dynamic obstacles

Collaborative robots have to adapt its motion plan to a dynamic environment and variation of task constraints. Currently, they detect collisions and interrupt or postpone their motion plan to prevent harm to humans or objects. The more advanced strategy proposed in this article uses online trajectory optimization to anticipate potential collisions, task variations, and to adapt the motion plan accordingly. The online trajectory planner pursues a model predictive control approach to account for dynamic motion objectives and constraints during task execution. The prediction model relates reference joint velocities to actual joint positions as an approximation of built-in robot tracking controllers. The optimal control problem is solved with direct collocation based on a hypergraph structure, which represents the nonlinear program and allows to efficiently adapt to structural changes in the optimization problem caused by moving obstacles. To demonstrate the effectiveness of the approach, the robot imitates pick-and-place tasks while avoiding self-collisions, semistatic, and dynamic obstacles, including a person. The analysis of the approach concerns computation time, constraint violations, and smoothness. It shows that after model identification, order reduction, and validation on the real robot, parallel integrators with compensation for input delays exhibit the best compromise between accuracy and computational complexity. The model predictive controller can successfully approach a moving target configuration without prior knowledge of the reference motion. The results show that pure hard constraints are not sufficient and lead to nonsmooth controls. In combination with soft constraints, which evaluate the proximity of obstacles, smooth and safe trajectories are planned.