液体衰减翻转恢复序列在颅脑MRI中的应用

目的：探讨１．５ＴＭＲ颅脑液体衰减翻转恢复（ＦＬＡＩＲ）序列的合理扫描参数及其临床应用价值。材料和方法：首先对１８名健康志愿者行１．５ＴＭＲ的颅脑ＦＬＡＩＲ序列的参数选择试验，然后用筛选出的合理参数对２４例脑部疾病患者行ＦＬＡＩＲ序列与ＳＥ序列的对照扫描。结果：在１．５ＴＭＲ颅脑ＦＬＡＩＲ扫描中，当ＴＲ＝６０００ｍｓ时，ＴＩ为１７００－１８００ｍｓ接近脑脊液的无效值，ＴＥ以１６０ｍｓ为宜。ＦＬＡＩＲ序列与ＳＥ序列的对照扫描中，ＦＬＡＩＲ序列显示病变为７５／７６（９８．６８％），ＳＥ序列为６５／７６（８５．５３％），两者显示病变的敏感度有显著性差异（Ｐ＜０．０１）。结论：ＦＬＡＩＲ序列对靠近脑脊液的病变、脑组织水肿、室管膜下漏液、脑室和脑池内病变的检出较ＳＥ序列更敏感。     

高频超声应用在手部肌腱断裂缝合术中的作用

目的：探讨高频超声在手部肌腱断裂缝合术中的应用价值。方法选择2009年3月~2013年6月在东阳市横店集团医院手外科就诊并术前进行超声定位的98例手部肌腱断裂患者为实验组,2014年1~6月就诊未行超声定位的48例患者为对照组,分别记录两组患者手术时间,术后高频超声探查肌腱修复效果和评估术后手指康复情况,并进行统计分析。结果两组最终完成全部超声监测检查的为实验组76例、对照组40例。实验组平均手术时间明显少于对照组[(30±20)min比(60±30)min],差异有高度统计学意义(P<0.01);实验组术后腱性连接率高于对照组[(72.4豫,55/76)比(52.5豫,21/40)],实验组瘢痕形成率低于对照组[(27.6%,21/76)比(47.5%,19/40)],差异均有统计学意义(P<0.05);实验组TAM手部功能康复评估良好率高于对照组[(86.8%,66/76)比(67.5%,27/40)],差异有统计学意义(P<0.05)。结论采用高频超声可明显降低手术时间和术后瘢痕连接,术后高频超声持续监测肌腱修复水平可明显提高术后手部功能康复。     

Modelling of the Flow in the Process of Washing Out Automotive Catalyst Carriers with the PbLi Alloy

The process of platinum recovery from used car catalysts is highly desirable for both economic and environmental reasons. From the many available methods of processing used car catalysts, the article conducted both numerical and experimental studies using a device based on the collector metal method with lead as a modified medium through a magnetohydrodynamic pump for washing platinum from the channels of the ceramic catalyst carrier. It was assumed that lead alloys with the addition of lithium increase the extraction of platinum from thin catalytic layers and accelerate the platinum dissolution reaction in the Pb-Li alloy, which is the result of a greater affinity of lithium for platinum compared to lead. This assumption was verified by numerical simulations as well as laboratory tests. Tests were carried out for the secondary supply voltage range between 40 and 60 V and the catalyst flushing time between 240 and 480 s. Graphical results of the research were discussed.     

Experimental Study on Self-Centering Performance of the SMA Fiber Reinforced ECC Composite Beam

The combination of superelastic shape memory alloy fibers and ECC materials can form a new SMA fiber reinforced ECC composite material (SMAF-ECC) with good self-centering performance. In order to study the self-centering performance of the new composite material, 6 groups of pre-notch beam specimens were made for three-point bending cyclic loading tests, and the failure phenomenon, hysteresis curve, self-centering effect and influencing factors of the specimens were analyzed. The research results show that when the SMA fibers are effectively anchored in the ECC matrix, the SMA fibers can exert the superelastic properties to provide the ECC beams with recoverying force, and realize the crack self-closure and deflection self-recovery function for the beams, with the minimum residual crack width and deflection is only 0.9 mm and 1.3 mm respectively. Increasing fiber content can cause a small increase in the self-centering ability of the beams. However, only when the fiber diameter is appropriate, better self-centering effect can be achieved, but the difference caused by fiber diameter in the test was only 5%. SMA Fiber end forms have significant influence on self-centering performance. The knotted end beam can get a more than 70% self-centering ratio, while the straight end beams and bended end beams have no self-centering ability. The research results provide important reference for the research and application of this new self-centering materials and their structures.     

膝关节手术后功能锻炼时机的实验研究

目的:探讨膝关节手术后最佳的功能锻炼时机。方法:采用新西兰兔制成膝关节创伤模型,然后按功能锻炼时机不同分为术后不固定组(A组);术后固定24 h组(B组);术后固定72 h组(C组)3组,30 d后测量膝关节活动度,观察滑膜上皮细胞以及细胞增生、胶原纤维增生情况。结果:A组膝关节活动范围更大,滑膜上皮细胞光滑细胞增生和胶原纤维增生均不明显,较B、C组有统计学差异(P<0.05)。结论:通过动物实验,我们发现:在膝关节手术后,麻醉消退后即刻开始功能锻炼,确能较术后24 h和72 h才开始锻炼在减轻膝关节的粘连,减少关节内瘢痕组织增生,最大限度地恢复膝关节的功能等方面有着明显的优点。     

Pre-stroke socioeconomic status predicts upper limb motor recovery after inpatient neurorehabilitation

BackgroundLower socioeconomic status (SES) is associated with higher mortality rates and the likelihood of receiving less evidence-based treatment after stroke. In contrast, little is known about the impact of SES on recovery after discharge from inpatient rehabilitation. The aim of this study was to investigate the influence of SES on long-term recovery after stroke.Patients and methodsIn a prospective, observational, multicentre study, inpatients were recruited towards the end of rehabilitation. The 12-month follow-up focussed on upper limb motor recovery, measured by the Fugl-Meyer score. A clinically relevant improvement of ≥5.25 points was considered recovery. Patient-centric measures such as the Patient-reported Outcomes Measurement Information System-Physical Health (PROMIS-10 PH) provided secondary outcomes. Information on schooling, vocational training, income and occupational status pre-stroke entered a multidimensional SES index. Multivariate logistic regression models calculating odds ratios (ORs) and corresponding confidence intervals (CIs) were applied. SES was added to an initial model including age, sex and baseline neurological deficit. Additional exploratory analyses examined the association between SES and outpatient treatment.ResultsOne hundred and seventy-six patients were enrolled of whom 98 had SES and long-term recovery data. Model comparisons showed the SES-model superior to the initial model (Akaike information criterion (AIC): 123 vs. 120, Pseudo R²: 0.09 vs. 0.13). The likelihood of motor recovery (OR = 17.12, 95%CI = 1.31; 224.18) and PROMIS-10 PH improvement (OR = 20.76, 95%CI = 1.28; 337.11) were significantly increased with higher SES, along with more frequent use of outpatient therapy (p = .02).ConclusionsHigher pre-stroke SES is associated with better long-term recovery after discharge from rehabilitation. Understanding these factors can improve outpatient long-term stroke care and lead to better recovery.

KEY MESSAGE

• Higher pre-stroke socioeconomic status (SES) is associated with better long-term recovery after discharge from rehabilitation both in terms of motor function and self-reported health status.
• Higher SES is associated with significantly higher utilization of outpatient therapies.
• Discharge management of rehabilitation clinics should identify and address socioeconomic factors in order to detect individual needs and to improve outpatient recovery.
• Article registration: clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT04119479","term_id":"NCT04119479"}}NCT04119479.

     

小儿扁桃体腺样体手术麻醉苏醒期并发症分析

目的 分析小儿扁桃体腺样体手术麻醉苏醒期并发症发生情况,探讨预防和减少其发生的措施.方法 对110例小儿扁桃体腺样体手术资料进行分析,观察与手术、麻醉、治疗药物等有关的并发症发生情况.结果 麻醉苏醒期总的并发症发生率为29%(32/110).其中与手术有关的并发症发生率为4.5%(5/110),与麻醉有关的并发症发生率为22.7%(25/110),无苏醒延迟和呕吐,与治疗药物有关的并发症发生率为1.8%(2/110).结论 术前控制感染、术中精细操作、气管导管拔出时机的恰当选择,可预防或减少小儿扁桃体腺样体手术麻醉苏醒期并发症的发生.     

An HIT Solution for Clinical Care and Disaster Planning: How One health Center in Joplin,MO Survived a Tornado and Avoided a Health Information Disaster

Since taking office, President Obama has made substantial investments in promoting the diffusion of health information technology (IT). The objective of the national health IT program is, generally, to enable health care providers to better manage patient care through secure use and sharing of health information. Through the use of technologies including electronic health records, providers can better maintain patient care information and facilitate communication, often improving care outcomes. The recent tornado in Joplin, MO highlights the importance of health information technology in the health center context, and illustrates the importance of secure electronic health information systems as a crucial element of disaster and business continuity planning. This article examines the experience of a community health center in the aftermath of the major tornado that swept through the American Midwest in the spring of 2011, and provides insight into the planning for disaster survival and recovery as it relates to patient records and health center data.     

Identity Development's Impact on Peer-Supported Recovery Among African American Women

The emerging trend of peer-to-peer supported recovery and identity development among African American women in early- and middle-stage recovery has significant clinical implications. In peer-supported recovery, assisting African American women in finding their voices presents special challenges in the recovery-oriented system of care. This article explores the importance of identity development among African American women in early and middle-stage recovery. The core principles of recovery including gender responsive treatment, empowerment, and alumni support within this special population are discussed.     

Multiple Pathways of Recovery for African American Men

For decades, tension has existed between addictions counselors and clients based upon a widely held belief by counselors that there is only one way to recover, leading to client resistance to treatment, premature termination, and relapse, as the client's approach to recovery has been commonly ignored. This article outlines multiple pathways of recovery among African American men and also offers clinical recommendations for service providers who work with these men.