膝上假肢的智能控制方法

目前国际上已开发出了多种商品化的液压／气压智能膝关节假肢产品，包括Otto Bock的C-LEG、Blatchford的IP、SmartIP、AdaptiveKnee、Nabco公司的NI—C411、德林公司的Auto-Pilot电子膝关节和Ossur公司的Smart Magnetix Knee等．其中NI-C411和Auto—Pilot膝关节是四连杆电子膝关节。综观这些最新的微电脑控制膝关节，大部分可以通过控制液压／气压缸同时控制摆动相的速度和支撑相的稳定性，此外还可以适应不同的环境自动调整行走模式，如下坡／楼梯、绊倒、坐下等。不过这些关节的速度大多只有有限的几种，不能随意适应任意步速的变化。有些假肢关节还能模拟人体站立相的屈曲功能．如德林Auto—Pilot和Blatchford的AdaptiveKnee就可以在支撑相前期产生一定的弯曲，以缓冲腿的步行冲击。     

制约社区护理发展的关键问题及对策

随着我国经济的发展,人民的生活水平得到了极大的改善,但是,相应的科学合理的饮食结构、生活方式却并没有被广大群众所重视和掌握,加上我国老龄化进程的加快和人们生活节奏的加快,环境的污染,致使我国人群慢性非传染性疾病的发病率快速提升,特别是癌症、糖尿病、心脑血管等病对人群的健康造成了极大的危害.     

想你,是我的四季

在春寒料峭的夜晚,想你;在花香时隐时现的夜晚,想你。冬天已经走了,怀着春天已近的殷殷期盼,坐在已抽出粉红花苞的桃树下,想你,即将挂满绿叶的希望使抑制不住的欣喜在慢慢溢出。迎春花柔软的手臂轻揽着我,鹅黄色的热烈亦满满地舒展开来。一天一天的想你,一天一天的     

护士工作环境与护理人员流失的研究进展

综述了护士工作环境的定义,护士工作环境的构成,建立良好护士工作环境的意义,人员流失的概念,护理人员流失的现状及其负面的影响.重点介绍了护士工作环境与护理人员的关系.     

如何向SCI收录的优秀期刊投稿:怎样获得好的idea?!

Idea这一简单的英文单词,却似乎很难用一个对应的中文词来翻译,它应该包括了想法、思路、点子等多种意思,所以这个看似简单的单词代表的是相对复杂的意思,更代表了对于科研人员而言非常重要的问题:怎样获得好的idea?不少人,尤其是刚从事科研的研究生认为,撰写论文是在试验做完之后的事情     

中风恢复期的针灸治疗概况

中风病属于西医的脑血管病，具有很高的致死率和致残率。中风病所致的生活质量下降比其他任何一种疾病都要严重，同时它所带来的经济负担也是相当沉重的。据2000年美国国家卒中协会报道，每年约40万美国人发生脑梗死，每年约718亿美元用于治疗脑梗死。中风病恢复期是指发病后半个月至半年的一段时间。病人进入中风恢复期多有不同程度的神经功能障碍。大量的临床实践表明，这一时期是中风病恢复的关键阶段。采取积极有效的治疗，对病人的康复具有促进作用，有利于疾病的痊愈，反之，当病程进人中风后遗症期，若想取得治疗进展则非常困难。     

精神科护士应对方式与身心健康关系的调查分析

面对日益增多的精神病病人,精神科护士具有健康的心身是工作得以顺利进行的必备条件.而精神病医院的特殊性,在诸多方面影响着护士的心身健康,应对方式便是其中重要的因素之一.应对方式是个体面对有压力的情境和事件时所采取的认知和行为方式[1].     

护理的力量:跨越大海、心心相连——日本护士在中国工作的感受

2005年11月,我来到中国,在北京接受了1个月的语言培训之后,前往位于河北省的一家医院赴任.开始的时候,由于突然进入只有中文的世界,我每天都为无法表达自己的想法而困惑,为理解不了对方的想法而焦急,好像就要被害怕、不安、焦躁的情绪压垮了.但是,护理部主任不急躁,她抽出时间来耐心地帮助我,使我能够从容地面对后来的新生活.     

那逝去的美丽

她是一个12岁的小女孩,叫瑶瑶,曾经,她也是一个无忧无虑的孩子,有着每一个小孩的天真,有着每一个小孩的顽皮,有着每一个小孩的美好梦想,甚至她还有着很多小孩的坚强。一个噩梦的来临改变了她的美好童年,她患上了被称为血癌的白血病。看着她,我曾一次次的问老天爷为什么要这样,为什么要这样让那么可怕的病魔来折磨这个可爱的生命。当初确诊是白血病时,对于12岁的瑶瑶来说并不知道意味着什么,但是     

浅谈护士与疗养员交流的技巧

随着科学技术的不断发展,人民的生活水平逐渐提高,人类的平均寿命延长,老年人口的数量也不断增多,这给疾病的结构、医疗保健、社会福利等事业带来了巨大的影响.     

声辐射力脉冲成像技术评估肝移植术后缺血型胆道病变的临床应用价值

目的探讨声辐射力脉冲成像（ARFI）技术评估肝移植术后缺血型胆道病变（ITBL）的临床应用价值。方法选择2012年7月至2013年1月解放军总医院肝移植术后复查患者41例,其中15例超声诊断为ITBL。对所有患者进行常规超声检查,并采用ARFI技术测量检测深度为4、5cm的肝脏剪切波速度（SWV）值,同时检查患者肝功能。采用独立样本t检验比较ITBL患者与非ITBL患者同一检测深度SWV值差异;采用配对样本t检验比较同一ITBL患者不同检测深度SWV值差异。采用Pearson相关分析分别分析所有患者不同检测深度SWV值与肝功能指标的相关性。结果ITBL患者、非ITBL患者检测深度为4cm时SwV值分别为（1．561±0．425）、（1．121±0．160）m／s,差异有统计学意义（t=-3．173,P=0．01）;检测深度为5cm时SWV值分别为（1．608±0．545）、（1．175±0．173）m／s,差异也有统计学意义（t=-2．454,P=-0．034）。同一ITBL患者不同检测深度SWV值差异无统计学意义。所有患者不同检测深度SWV值均与碱性磷酸酶浓度相关（r值分别为0．656、0．667,P值均为0．000）;同时均与γ-谷酰转肽酶浓度相关（r=0．482,P=0．007;r=0．508,P=0．004）。结论ARFI技术对肝移植术后ITBL评估有一定的临床应用价值。     

MRI在肝移植术后缺血性胆管病变中的应用

目的 探讨MRI、磁共振胰胆管造影(MRCP)在肝移植术后缺血性胆管病变(ITBL)中的应用价值。方法 经PTC或ERCP及病理结果确诊的肝移植术后ITBL患者23例,对其平扫、增强MR和MRCP图像进行观察。结果 根据胆管病变累及的部位和范围,将ITBL分为肝门型(Ⅰ型)、弥漫型(Ⅱ型)和肝内型(Ⅲ型)。Ⅰ型13例,MRI示12例胆管壁增厚,11例供体肝总管及胆总管不扩张,且伴有供肝肝总管、汇合部及左和(或)右肝管管腔内胆泥形成;MRCP主要表现为胆总管、肝总管、汇合部、左右肝管及其二级分支胆管显影不良或不显影。Ⅱ型8例,MRI示7例管壁增厚,6例供体肝总管及胆总管不扩张,且伴有供肝肝总管、汇合部及左和(或)右肝管管腔内胆泥形成;MRCP主要表现为肝内、外胆管广泛的不规则狭窄或扩张,胆管间断显影。Ⅲ型2例,MRI示供体肝总管及胆总管管腔均不扩张,管壁未见增厚;MRCP主要表现为肝内胆管不规则、节段性扩张,扩张不成比例、粗细不均呈"串珠"样。结论 肝移植术后ITBL以Ⅰ型和Ⅱ型常见。MRI在观察肝门部胆管管壁,管腔扩张程度及腔内容物有一定优势,而MRCP可全面观察胆管病变的部位和范围,提供整体信息;二者结合有助于ITBL的诊断及分型。     

Complete bile duct sequestration after liver transplantation,caused by ischemic-type biliary lesions

Ischemic-type biliary lesions (ITBLs) are the most frequent cause of nonanastomotic biliary strictures in liver grafts, affecting about 2-19 % of patients after liver transplantation. ITBL is characterized by bile duct destruction, subsequent stricture formation, and sequestration. We report here the case of a patient affected by extremely severe ITBL, with sequestration and disintegration of the entire bile duct system, in which it was possible to extract the complete biliary tree endoscopically in a single piece. Histological examination revealed that all cells of the bile duct wall had been destroyed within 3 months after liver transplantation and replaced by connective tissue. Subsequently, biliary stricture formation occurred at the hepatic hilum, as well as the adjacent large bile ducts. It may be hypothesized that cellular rejection of small bile ducts leads to the vanishing bile duct syndrome, whereas cellular rejection of large bile ducts results in ITBL. The strictures were repeatedly dilated by endoscopic means, allowing successful control of stricture formation, as well as maintenance of liver function. At the time of writing, the grafted organ and the patient had survived for more than 3 years in good health. This is the first detailed report on a sequestration of the entire bile duct system caused by ITBL, successfully treated for several years by endoscopic means.     

肝移植缺血性胆道病变的超声造影研究

目的 探讨实时超声造影技术诊断肝移植术后缺血性胆道病变(ITBL)的临床应用价值.方法 25例经内镜下逆行性胰胆管造影或经皮肝穿刺胆道造影确诊,超声疑为胆道并发症的移植肝接受超声造影检查.以增厚最明显的肝门部胆管壁为观察目标,分析胆管壁增强特点.结果 胆管壁造影表现可分3类:①胆管壁无增强者6例,即胆管壁在动脉期、门脉期及延迟期均无增强;②胆管壁低增强水平者4例,即胆管壁在动脉期呈低增强,门脉期及延迟期持续低增强或消退为无增强;③胆管壁高增强水平者15例,即胆管壁在动脉期呈高或等增强,门脉期及延迟期消退为等或低增强.25例确诊病例中包括13例ITBL和12例非ITBL.ITBL组胆管壁无或低增强水平者10例(76.9%),高增强水平者3例(23.1%);非ITBL组均为高增强水平者,两组间差异有统计学意义(P=0.00).结论 超声造影检测胆管壁微循环灌注具有可行性,有可能为临床提供一种全新的从微血管层面诊断ITBL的影像学手段.     

Effects of exposure to morning bright light in the blind and sighted controls

Summary. Seven blind subjects and 11 sighted controls were exposed to 3300 lux of cool-white fluorescent light for either 1 h or 15 min in the morning for 2 weeks during the winter. Serum 25-hydroxyvitamin D₃ concentration, melatonin concentration in saliva, body temperature from the armpit, subjective sleepiness, and depressive symptoms were measured before and after the 2-week trial. The intervention resulted in a significant elevation in the concentration of melatonin at 21.00 hours in the healthy controls but at 23:00 hours in the blind subjects. The body temperatures measured were increased in the controls but decreased in the blind in the morning following the cessation of the intervention, and these opposite changes resulted in significant differences in the temperatures between the two groups. The decreases in the body temperature were associated with the increases in the levels of melatonin in the blind but not in the controls. Bright light administered in the morning decreased subjective sleepiness and improved mood in the healthy controls and in the blind subjects as well. The intervention had no effect on the levels of vitamin D in either of the two groups.     

Effects of Three Treatment Modes on Plasma Lipids and Lipoproteins in Uraemic Patients

Plasma lipids, chemical composition of various lipoprotein fractions, apolipoprotein B concentrations and apolipoprotein E phenotypes were studied in 12 uraemic patients on conservative treatment (CT), in 16 patients on haemodialysis (HD) and in 18 patients on continuous ambulatory peritoneal dialysis treatment (CAPD). Plasma total cholesterol and triglyceride concentrations were increased in the CAPD patients in comparison to the HD patients and the control subjects. Moreover, the CAPD patients had higher LDL cholesterol concentration than the CT and HD patients. The HDL cholesterol concentration was lower in the HD and CAPD patients than in the control subjects. The chemical composition of lipoproteins in all fractions of the CT and HD patients and in VLDL, IDL and LDL fractions of the CAPD patients differed from those of the control subjects. The main differences were the increased proportion of triglycerides in VLDL and LDL fractions of all the patient groups and in HDL fraction of the CT and HD patients in comparison to the control subjects. Moreover, the proportion of cholesterol was increased in VLDL and IDL fractions of the CT and the CAPD patients and decreased in HDL fraction of the CT and HD patients compared to the control subjects. In conclusion, in addition to the alterations in the lipoprotein concentrations in uraemic patients there are also marked changes in the chemical composition of the lipoprotein particles that may further contribute to the accelerated atherosclerosis among uraemic patients. The abnormalities are particularly prevalent in CAPD patients.     

Practices for caring in nursing: Brazilian research groups

ERDMANN A.L., DE ANDRADE S.R., FERREIRA DE MELLO A.L., KLOCK P., DO NASCIMENTO K.C., SANTOS KOERICH M. & STEIN BACKES D. (2011) Practices for caring in nursing: Brazilian research groups. International Nursing Review 58 , 379–385 Background: The present study considers the production of knowledge and the interactions in the environment of research and their relationships in the system of caring in nursing and health. Aim: To elaborate a theoretical model of the organization of the practices used for caring, based on the experiences made by the research groups of administration and management in nursing, in Brazil. Methods: The study is based on grounded theory. Twelve leaders of research groups, working as professors in public universities in the south and the south‐east of Brazil, distributed in sample groups, were interviewed. Findings: The core phenomenon ‘research groups of administration and management in nursing: arrangements and interactions in the system of caring in nursing’ was derived from the categories: conceptual bases and contexts of the research groups; experiencing interactions in the research groups; functionality of the research groups; and outputs of the research groups. The research groups are integrated in the system of caring in nursing. Conclusions: The activities of the Brazilian administration and management in nursing research groups are process oriented and in a process of constant renovation, socially relevant, operate in a complex scenario and contribute to the advancement of the organizations of the system of caring in nursing through strengthening the connection among academia, service and community.     

Colitis in Behçet's disease: Characteristics on double-contrast barium enema examination in 20 patients

We performed a retrospective review of double-contrast barium enema examinations of 20 patients with clinically proven Behçet's colitis. Main lesion was ovoid or geographic ulcers with a mean diameter of 2.7 cm. The number of ulcers was single in 15 cases and multiple in five. On six resected specimens, ulcers involved submucosa in three, muscle layer in one, and serosa in two cases with an undermining tendency and transmural inflammation. Aphthous ulcers were present in three cases. Neither perforation nor fistula was demonstrated. In all 20 patients, the ulcer was localized in the ileocecal area, with extension to the ascending colon in seven. Skip lesions were observed in the transverse colon and descending colon in three cases. Destruction of surrounding mucosa resulted in cecal contraction in 19 cases, widening of the ileocecal valve in 19, and fold thickening in the terminal ileum in 12. Six cases (30%) manifested as ileocecal mass accompanied by ulcer, fold thickening, and adjacent mucosal deformity. The appendix was visualized in only three (20%) of the 15 patients with no history of appendectomy. On follow-up study of 15 cases, the ulcers disappeared or decreased in size in 13 cases (86%) and the mucosal deformity was not improved in all cases. On the basis of our results, we believe that the characteristic findings of colitis in Behçet's disease in barium enema examination are ovoid or geographic, relatively large, and deep ulcerations with persistent surrounding deformity which tend to localize in the ileocecal area.     

Enhancement of osteoclastic bone resorption and suppression of osteoblastic bone formation in response to reduced mechanical stress do not occur in the absence of osteopontin

Reduced mechanical stress to bone in bedridden patients and astronauts leads to bone loss and increase in fracture risk which is one of the major medical and health issues in modern aging society and space medicine. However, no molecule involved in the mechanisms underlying this phenomenon has been identified to date. Osteopontin (OPN) is one of the major noncollagenous proteins in bone matrix, but its function in mediating physical-force effects on bone in vivo has not been known. To investigate the possible requirement for OPN in the transduction of mechanical signaling in bone metabolism in vivo, we examined the effect of unloading on the bones of OPN(-/-) mice using a tail suspension model. In contrast to the tail suspension-induced bone loss in wild-type mice, OPN(-/-) mice did not lose bone. Elevation of urinary deoxypyridinoline levels due to unloading was observed in wild-type but not in OPN(-/-) mice. Analysis of the mechanisms of OPN deficiency-dependent reduction in bone on the cellular basis resulted in two unexpected findings. First, osteoclasts, which were increased by unloading in wild-type mice, were not increased by tail suspension in OPN(-/-) mice. Second, measures of osteoblastic bone formation, which were decreased in wild-type mice by unloading, were not altered in OPN(-/-) mice. These observations indicate that the presence of OPN is a prerequisite for the activation of osteoclastic bone resorption and for the reduction in osteoblastic bone formation in unloaded mice. Thus, OPN is a molecule required for the bone loss induced by mechanical stress that regulates the functions of osteoblasts and osteoclasts.     

2017年1-2月我国南方重点省份媒介伊蚊监测研究

目的 分析2017年1-2月我国南方重点省份媒介伊蚊监测资料,为以登革热为代表的媒介伊蚊传播疾病防控提供参考依据。方法 依据我国登革热中转支付项目媒介伊蚊监测系统上报的媒介伊蚊监测数据,分析研究期内南方重点省份媒介伊蚊的幼蚊密度（布雷图指数,BI）,筛选不同省份登革热传播不同风险等级的市或县（区）,并计算出不同省份媒介伊蚊控制水平达标率。结果 截至2017年2月,我国海南省平均BI达到登革热传播中风险;云南省景洪市、勐腊县城区、澜沧县口岸、耿马县清水河口岸、景洪告庄口岸BI超过5,存在由输入登革热病例引起暴发的风险。2017年云南省平均BI高于2016年同期水平,而海南省平均BI低于2016年同期水平。我国云南省BI控制达标率超过90%,而海南BI控制水平达标率不超过20%。结论 2017年1-2月,我国海南省平均BI达到登革热传播中风险,云南省重点地区城区和部分口岸BI达到低度风险。建议以海南、云南为代表的南方重点省份应继续加强媒介伊蚊监测、风险评估和控制工作,为我国媒介伊蚊传播疾病的科学防控提供依据。