吴师机外治经验浅探

吴师机在精心研究前贤外治经验的基础上,结合自己的临床实践,对外治法的特色、机理、适应证、组方制剂等进行了系统的整理论述,提出"内病外治,须判三焦"的主张,其治病以膏为主。在具体应用膏药时,吴氏又提出审阴阳,察四时、五行,求病机,度病情,辨病性的五大原则,在医学史上被誉为"外治之宗"。     

地方医学院校本科人才培养质量分析及提升对策-以川北医学院为例彭洪,林中超,彭明沙

医学院校的首要职能是培养高质量的医学人才。但是随着社会的不断发展,目前高等医学院校的人才培养质量,与医学生对未来的期望不相符,与国家和社会的要求还有不小的差距,因此提高医学生的培养质量是当前高等医学院校改革和发展的努力方向。本研究以川北医学院为例分别从学生、老师、外界因素和学校环境这4个方面对医学本科人才培养质量进行解析,分析影响医学人才培养质量的相关因素,并提出医学院校人才培养质量的提升对策,进一步促进高等医学院校的人才培养质量。     

Effects of 1-stage revascularization and temporary external fixation combined with 2-stage Ilizarov technique in the treatment of bone defects in lower limb destruction injury: A case report

Rationale:To evaluate the clinical effects of 1-stage revascularization, vacuum sealing drainage covering the wound, temporary external fixation and 2-stage Ilizarov bone transport for the treatment limb destruction injury.Patient concerns and diagnosis:Nine patients with limb destruction injury between September 2014 and June 2019 at our institute were evaluated retrospectively. The age of patient was 21 to 51 years with an average of 33 years. The injuries were caused by vehicle accidents in 4 patients, gunshot in 1 patient, and crushing injuries in 4 patients. All of them had vascular injury. The average length of bone defect was 9.5 (8.3–10) cm. Regular follow-up was performed on wound healing, bone transport time, bone healing time, external fixation index, and limb function.Interventions:All patients underwent 1-stage revascularization and temporary external fixation during emergency surgery, and then gradual bone transport by Ilizarov fixator was performed until the broken fracture site was reunited.Outcomes:Nine patients were followed up for 12 to 48 months (average 30 months). Six patients were treated with autogenous cancellous bone graft for the second time, and 2 patients healed spontaneously. The mean wound healing time was 86 (73–90) days. The bone transport time was 97 (88.3–105.3) days, and the bone mineralization time was 164.5 (156.8–181.3) days, and the healing time of the docking sites was 6.8 (6.1–8.3) months. The external fixator time was 14.5 (12.5–17) months with the external fixation index was 1.5 (1.4–1.8) m/cm. At the last follow-up, according to the Association for the Study of the Method of Ilizarov functional scores, excellent functional outcomes were obtained in 5 patients, good in 1 patients, moderate in 2 patients. According to the Association for the Study of the Method of Ilizarov Radiological System, excellent functional outcomes were obtained in 6 cases and good in 2 cases.Lessons:One-stage revascularization and temporary external fixation combined with 2-stage Ilizarov bone transport technique for the treatment of bone defects in limb destruction injury have satisfactory clinical effects and few complications, and can be applied under the condition of strict understanding of surgical indications.     

电针联合中药外敷治疗特发性面神经麻痹的临床疗效观察

[目的] 评价电针联合中药外敷治疗特发性面神经麻痹的临床疗效和安全性。[方法] 符合纳入与排除标准的 180 名特发性面神经麻痹患者按 1∶1∶1 比例被随机分为治疗 1 组、治疗 2 组和对照组,治疗 1 组采用电针治疗,治疗 2 组采用电针联合中药外敷治疗,对照组采用西药口服治疗,3 组患者均接受 3 周的治疗。主要结局指标为Sunnybrook 面部分级系统（SFGS）评分,次要结局指标为 House-Brackmann 分级量表（HBGS）评分,NottinghamSystem 评分和不良事件发生率。[结果] 164 人完成了 3 周的治疗,其中治疗 1 组 56 例,治疗 2 组 53 例,对照组 55 例,3 组患者的基线特征一致。治疗 3 周后,3 组患者的 SFGS 评分、HBGS 评分和 Nottingham System 评分均优于治疗前（P<0.01）,且治疗 2 组的各评分优于治疗 1 组和对照组（P<0.05）,差异均具有统计学意义;研究过程中 3 组患者均未出现不良反应。[结论] 电针联合中药外敷是一种安全有效的特发性面神经麻痹治疗方案,可以促进面神经功能的恢复,为进一步改善特发性面瘫患者的预后提供了新的治疗思路。     

体外反搏对动脉粥样硬化猪血管舒张功能的影响

目的 探讨长期体外反搏对动脉粥样硬化猪内皮依赖和非内皮依赖血管舒张功能的影响.方法 猪龄20 d雄性乳猪18头随机分为正常饲养组(n=6)、高脂饲养组(n=6)及高脂饲养+体外反搏组(n=6).后两组通过高脂饲养复制动脉粥样硬化猪疾病模型,对高脂饲养+体外反搏组进行为时36 h的长期体外反搏治疗,取各组动物颈动脉血管环,测定离体颈动脉血管环对不同浓度梯度乙酰胆碱和硝普钠的舒张反应,用单因素方差分析法比较三组动物血管舒张率的差异.结果 在乙酰胆碱10-8～10-5mol/L浓度范围内,高脂饲养组和高脂饲养+体外反搏组的血管舒张率较正常饲养组显著降低(P＜0.05);在10-7～10-5mol/L浓度范围内,高脂饲养+体外反搏组的血管舒张率较高脂饲养组明显提高(P＜0.05).在硝普钠10-8～10-5mol/L浓度范围内,高脂饲养组和高脂饲养+体外反搏组的血管舒张率较正常饲养组显著降低(P＜0.05);在10-8～10-5mol/L浓度范围内,高脂饲养+体外反搏组的血管舒张率较高脂饲养组明显提高(P＜0.05).结论 高脂饲养组和高脂饲养+体外反搏组内皮依赖血管舒张功能和非内皮依赖血管舒张功能较正常饲养组明显受损,长期体外反搏干预可以显著改善动脉粥样硬化猪内皮依赖和非内皮依赖血管舒张功能,这可能是长期体外反搏具有抗动脉粥样硬化作用的机制之一.     

Charge Storage and Reliability Characteristics of Nonvolatile Memory Capacitors with HfO2/Al2O3-Based Charge Trapping Layers

Flash memories are the preferred choice for data storage in portable gadgets. The charge trapping nonvolatile flash memories are the main contender to replace standard floating gate technology. In this work, we investigate metal/blocking oxide/high-k charge trapping layer/tunnel oxide/Si (MOHOS) structures from the viewpoint of their application as memory cells in charge trapping flash memories. Two different stacks, HfO₂/Al₂O₃ nanolaminates and Al-doped HfO₂, are used as the charge trapping layer, and SiO₂ (of different thickness) or Al₂O₃ is used as the tunneling oxide. The charge trapping and memory windows, and retention and endurance characteristics are studied to assess the charge storage ability of memory cells. The influence of post-deposition oxygen annealing on the memory characteristics is also studied. The results reveal that these characteristics are most strongly affected by post-deposition oxygen annealing and the type and thickness of tunneling oxide. The stacks before annealing and the 3.5 nm SiO₂ tunneling oxide have favorable charge trapping and retention properties, but their endurance is compromised because of the high electric field vulnerability. Rapid thermal annealing (RTA) in O₂ significantly increases the electron trapping (hence, the memory window) in the stacks; however, it deteriorates their retention properties, most likely due to the interfacial reaction between the tunneling oxide and the charge trapping layer. The O₂ annealing also enhances the high electric field susceptibility of the stacks, which results in better endurance. The results strongly imply that the origin of electron and hole traps is different—the hole traps are most likely related to HfO₂, while electron traps are related to Al₂O₃. These findings could serve as a useful guide for further optimization of MOHOS structures as memory cells in NVM.     

Influence of Factors in the Photopolymerization Process on Dental Composites Microhardness

The aim of the present paper is to investigate the influence of factors in photopolymerization process that govern microhardness of three types of dental composites—universal (UC), bulk-fill (BC), and flowable (FC). Cylindrical specimens with different thicknesses are made and light cured. The significance of light intensity, irradiation time, and layer thickness on Vickers microhardness is evaluated by experimental design, analysis of variance, and regression analysis. It is found that the main factor influencing the microhardness on the top surface of the three composites is light intensity. The second factor is layer thickness for the UC and FC, while for BC, it is curing time. The third factor is curing time for the first two composites and layer thickness for bulk-fill. The significance of factors’ influence on the microhardness of the bottom surface is the same for the UC and FC, but different for BC. The main factor for the first two composites is layer thickness, followed by curing time and light intensity. For bulk-fill, curing time is main factor, light intensity is second, and layer thickness is last. Different significance of factors influencing the microhardness on top and bottom surfaces of investigated composites is revealed for the first time in the present study.     

Influence of the Carbidized Tungsten Surface on the Processes of Interaction with Helium Plasma

This paper presents the results of experimental studies of the interaction of helium plasma with a near-surface tungsten carbide layer. The experiments were implemented at the plasma-beam installation. The helium plasma loading conditions were close to those expected in the ITER divertor. The technology of the plasma irradiation was applied in a stationary type linear accelerator. The impact of the helium plasma was realized in the course of the experiment with the temperatures of ~905 °C and ~1750 °C, which were calculated by simulating heat loading on a tungsten monoblock of the ITER divertor under the plasma irradiation at the load of 10 MW/m² and 20 MW/m², respectively. The structure was investigated with scanning microscopy, transmitting electron microscopy and X-ray analysis. The data were obtained showing that the surface morphology changed due to the erosion. It was found that the carbidization extremely impacted the plasma–tungsten interaction, as the plasma–tungsten interaction with the carbide layer led to the carbon sputtering and partial diffusion towards to the depth of the sample. According to these results, WC-based tungsten carbide is less protected against fracture by helium than W and W₂C. An increase in temperature leads to much more extensive surface damage accompanied by the formation of molten and recrystallized flanges.     

Interfacial Adhesion of Thick NiTi Coating on Substrate Stainless Steel

Interfacial adhesion of thick NiTi coating on substrate stainless steel is investigated here. NiTi coating was deposited on the substrate by using the thermal plasma spraying method. Deposition of NiTi coating was carried out by using various levels of input power under an Ar atmosphere. Multiple coating layers were deposited on the stainless steel surface for a specific thickness. The cross-section of the plasma-sprayed samples were prepared and characterized by using various techniques. The hardness of the coating layers on the surface and cross-section was examined. The thickness of the coating increased with the increase in power. No cracks were detected in the interface for the NiTi coating deposited at 12 kW power. However minor pores were observed at some regions along the interface at the sample prepared at 9 kW power. A good-quality coating layer was formed at the interface of the substrate. Primary phases of austenite and martensite were confirmed from the EBSD and XRD investigations. There was the presence of intermetallic and oxide phases in the coating layers. A less heat-affected zone of 10 µm of along the interface was confirmed without any diffusion of elements from the substrate to the coating layers. There was homogenous distribution elemental composition of Ni and Ti throughout the coating layers.