Effects of supportive hand contact on reactive postural control during support perturbations

There are many everyday situations in which a supportive hand contact is required for an individual to counteract various postural perturbations. By emulating situations when balance of an individual is challenged, we examined functional role of supportive hand contact at different locations where balance of an individual was perturbed by translational perturbations of the support surface. We examined the effects of handle location, perturbation direction and perturbation intensity on the postural control and the forces generated in the handle.There were significantly larger centre-of-pressure (CoP) displacements for perturbations in posterior direction than for perturbations in anterior direction. Besides, the perturbation intensity significantly affected the peak CoP displacement in both perturbation directions. However, the position of the handle had no effects on the peak CoP displacement. On the contrary, there were significant effects of perturbation direction, perturbation intensity and handle position on the maximal force in the handle. The effect of the handle position was significant for the perturbations in posterior direction where the lowest maximal forces were recorded in the handle located at the shoulder height. They were comparable to the forces in the handle at eye height and significantly lower than the forces in the handle located either lower or further away from the shoulder.In summary, our results indicate that although the location of a supportive hand contact has no effect on the peak CoP displacement of healthy individuals, it affects the forces that an individual needs to exert on the handle in order to counteract support perturbations.     

糖化血红蛋白样品前处理取样方式的比较

糖化血红蛋白（HBA1C）是监控糖尿病患者重要的指标之一，由于能反映以前的血糖水平，对于评估当前血糖的浓度具有重要意义。有报道免役比浊法与HPLC相比，检测结果偏低，也有报道免役比浊法和国际公认的参考方法结果具有良好的比例关系但全自动生化仪器的大量使用，简单、快速的特点，使免役比浊法成为检测HBA1C的主要方法之一。目前试剂厂家众多，检测过程基本相同，样品加溶血素，红细胞溶解完毕上机检测。前处理肝素锂抗凝样品有两种方式，一种是全血标本缓慢混匀吸取样品，另外一种是标本离心后吸取红细胞样品，虽然多数试剂说明书说明使用不离心混匀全血样品，但不少单位仍检测离心后的红细胞样品，不同取样方式是否存在误差，我们特此实验：     

应用计算机辅助光法研究楔状缺损牙的形成原因

目的　研究楔状缺损牙牙合接触力学特征及其与楔状缺损牙临床状况的关系 ,探讨牙楔状缺损形成的原因。方法　采用临床物理检查和石膏模型测量 ,确定楔状缺损牙轴倾度、磨损指数、牙缺失等指标 ;采用计算机图像处理技术 ,自行编制软件程序及硬件系统 ,测试被检光牙合片 ,分析并提取楔状缺损牙接触牙合力、面积、接触点牙合应力等数据和图形信息。结果　楔状缺损牙牙合接触数据和图形符合创伤牙合特征 ,42 .97%轴倾度增大 ,96 .0 9%有不同程度的磨损 ,46 .2 9%前牙缺失 ,5 7.0 3%后牙缺失 ;楔状缺损牙中接触牙合力增大者占 78.91%。结论　研究结果说明 ,牙轴倾度增大、牙列不完整和牙齿磨损导致的牙合力异常分布 ,可能是楔状缺损形成和发展的主要因素。     

Design and evaluation of a new ergonomic handle for instruments in minimally invasive surgery

Background

Laparoscopic surgery techniques have been demonstrated to provide massive benefits to patients. However, surgeons are subjected to hardworking conditions because of the poor ergonomic design of the instruments. In this article, a new ergonomic handle design is presented. This handle is designed using ergonomic principles, trying to provide both more intuitive manipulation of the instrument and a shape that reduces the high-pressure zones in the contact with the surgeon's hand.

Materials and methods

The ergonomic characteristics of the new handle were evaluated using objective and subjective studies. The experimental evaluation was performed using 28 volunteers by means of the comparison of the new handle with the ring-handle (RH) concept in an instrument available on the market. The volunteers' muscle activation and motions of the hand, wrist, and arm were studied while they performed different tasks. The data measured in the experiment include electromyography and goniometry values.

Results

The results obtained from the subjective analysis reveal that most volunteers (64%) preferred the new prototype to the RH, reporting less pain and less difficulty to complete the tasks. The results from the objective study reveal that the hyperflexion of the wrist required for the manipulation of the instrument is strongly reduced.

Conclusions

The new ergonomic handle not only provides important ergonomic advantages but also improves the efficiency when completing the tasks. Compared with RH instruments, the new prototype reduced the high-pressure areas and the extreme motions of the wrist.     

小切口白内障摘出术中后囊破裂的分析及处理

目的探讨小切口非超声乳化白内障摘出术中后囊破裂的原因及处理措施。方法对1320例（1470眼）老年性白内障行小切口非超声乳化摘出术联合人工晶状体植入术发生后囊破裂79例进行分析总结。结果后囊破裂79例（79眼）中,切口不当的2例,撕囊不当的12例,水分离不当的2例,娩核不当42例,冲洗皮质不当17例,植入人工晶状体不当4例。根据不同情况,采取人工晶状体囊袋内植入37例,睫状沟植入32例,缝线固定10例。结论术中晶状体后囊破裂是白内障摘出术联合人工晶状体植入术中常见的并发症,及时发现并正确处理,仍能取得良好的效果。     

新式剖宫产术娩头困难相关因素及预防处理对策

目的：探讨新式剖宫产术胎头娩出困难的相关因素和预防处理对策。方法：1999年9月至2003年9月新式剖宫产胎头娩出困难病例分析。结果：新式剖宫产胎头娩出困难占10．19％。结论：新式剖宫产胎头娩出困难由多种因素造成。麻醉满意及切口选择适当;取头时适当改进手术技巧及时机选择是取头成功关键。     

SK302-1型X线机故障

<正>1 302-1型500 mAnX线机开机后烧RD6/5安保险管故障维修1.1故障现象透视中通过监视器发现束光器X线窗口大小不受调节,检查后发现,开机后烧RD 6/5安保     

浸泡法与擦拭法对磁致伸缩式超声洁牙机手柄消毒效果的研究

目的 比较浸泡法与擦拭法对磁致伸缩式超声洁牙机手柄消毒效果,从而选择更优的消毒方法用于临床实践,预防交叉感染.方法 将100支临床使用后的磁致伸缩式超声洁牙机手柄,随机分为浸泡法及擦拭法两组,每组各50支手柄,对比两组的消毒效果.结果 浸泡法组洁牙机手柄消毒合格率为96.00%,擦拭法组洁牙机手柄消毒合格率82.00%(P<0.05).结论 浸泡法消毒效果与擦拭法相比,能更有效降低菌群数量,提高手柄消毒后合格率,较为安全可靠,可应用于临床实践.     

导尿管嵌顿的处理

目的探讨临床常见的导尿管嵌顿病例处理方法。方法收集整理2004年8月以来成功处理的62例病例,分析嵌顿原因和处理结果。结果借助导尿管嵌顿病例的处理经验,提出临床处理的方法和步骤。结论归纳总结导尿管嵌顿的处置特点,指导今后临床处理。     

手把区域多肽及氯沙坦抑制左旋谷氨酸钠大鼠腹部脂肪组织还原型烟酰胺腺嘌呤二核苷酸磷酸氧化酶亚单位的表达

目的 探讨手把区域多肽（HRP）及氯沙坦对左旋谷氨酸钠（MSG）大鼠胰岛素敏感性的影响及探讨其对腹腔脂肪组织局部肾素血管紧张素系统（RAS）和还原型烟酰胺腺嘌呤二核苷酸磷酸（NADPH）氧化酶亚单位基因表达的影响.方法 将8周龄体重在250～300 g的MSG大鼠共24只采用完全随机法分为MSG对照组（MSG组,n=6）、HRP干预组（MSG-HRP组,n=6,1.0 mg·d-1·kg-1）、氯沙坦干预组（MSG-L组,n=6,450 mg/L于饮用水中）、HRP及氯沙坦联合干预组（MSG-HRP-L组,n=6）,干预4周,正常SD大鼠为对照组（Con组,n=6）.12周龄时予以行胰岛素耐量试验评估大鼠胰岛素敏感性,计算胰岛素注射后30 min与0 rain时血糖比值.测定单位质量腹腔脂肪组织（前）肾素、（前）肾素受体[（P）RR]和选择性血管紧张素Ⅱ1型受体（AT1R） mRNA的表达及血管紧张素-Ⅱ（Ang-Ⅱ）蛋白水平,测定NADPH氧化酶亚单位P47phox和P22phoxmRNA的表达情况.采用方差分析及LSD两两比较法进行统计学分析.结果 外源性胰岛素注射后计算30 min血糖与基础血糖的比值,MSG组最高（92％±12％）,与Con组（66％±8％）、MSG-HRP组（76％±5％）、MSG-L组（78％±5％）、MSG-HRP-L组（75％±10％）比较均有统计学差异（F=6.875,P＜0.05）.本研究未能检测到腹腔脂肪组织中（前）肾素mRNA的表达.MSG-HRP组、MSG-L组、MSG-HRP-L组（P） RR mRNA表达量分别是MSG组大鼠的1.92、3.19和1.90倍（F=9.805,P＜0.05）.MSG-HRP组、MSG-L组、MSG-HRP-L组AT1 R mRNA分别是MSG大鼠组表达量的72％、45％和53％（F=14.508,P＜0.05）.与MSG组比较,MSG-HRP组脂肪局部Ang-Ⅱ水平下调[分别为（36±8）比（56±4） ng/g蛋白,P＜0.05],但是MSG-L组和MSG-HRP-L组水平均明显升高[分别为（79±14）比（70±16）比（56±4） ng/g蛋白,F=14.864,均P＜0.05].MSG-HRP组、MSG-L组、MSG-HRP-L组腹腔脂肪组织中P47phox mRNA分别是MSG大鼠组表达量的65％、51％和43％（F=7.082,均P＜0.05）.p22pho mRNA分别是MSG大鼠组表达量的57％、40％和41％（F=9.810,均P＜0.05）.结论 HRP和氯沙坦均可改善MSG大鼠胰岛素敏感性,其机制可能是其减少脂肪组织局部Ang-Ⅱ的数量或抑制脂肪组织中局部Ang-Ⅱ的效应,抑制氧化应激,从而改善脂肪胰岛素抵抗.