茎突CT薄层冠状扫描在诊断茎突过长综合征中的价值

目的 探讨“一点一线垂直法”茎突CT薄层冠状扫描在诊断茎突过长中的价值。方法测量72例双侧茎突的长度、方位、形态、厚度、尖端与咽侧壁距离,总结茎突过长病人的临床症状与诊断。 结果 ①41例67侧长度超过3.0cm,符合茎突过长的诊断;②12例12侧茎突虽未超过3.0cm(均在2.5～2.9cm),且茎突方位角>20°、末端与咽侧壁的距离<20mm,并有临床症状的应考虑茎突过长综合征;③按茎突的形态进行分型:锥型(分直锥、弧锥),束状型,分节型,发育不良型。其中分节型与临床症状有密切关系。结论 ①茎突CT薄层冠状扫描能清晰显示茎突的长度、形态、厚度、末端与咽侧壁距离,是诊断茎突过长的一种可靠方法;②“一点一线垂直法”茎突CT薄层冠状扫描无需进行图像重建,可操作性强、简捷易行、便于推广。     

枕下经颈-颈静脉突入路达颈静脉孔区的显微解剖研究

目的 研究一期切除颈静脉孔区复杂性肿瘤的微创手术人路。方法 选择经10％福尔马林固定成人头颈标本10具，显微镜下模拟枕下经颈一颈静脉突人路的手术操作，逐层显露颈静脉孔区，研究该区显微解剖特征及显露范围。结果 该人路直接沿乙状窦、颈内静脉的移行方向显露颈静脉孔区结构，其中后颅窝可经枕下显露，颞下窝藉寰椎与下颌升支间的自然间隙显露。通过切除颈静脉突和迷路下骨质分别自后、外、下和上方显露颈静脉孔。头侧直肌是界定颞下窝结构和枕下三角内结构的确切标志。后组颅神经，交感千和颈内动、静脉行于其前方，椎动脉寰椎上段及其周围的静脉丛行于其后方。结论 枕下经颈一颈静脉突人路可自多个方向充分显露颈静脉孔区结构，且可保护面神经、迷路、耳蜗和椎动脉等结构免受不必要的损伤。     

超声波作用下NaBH4/ZrCl4还原9(E)-红霉素肟制备9(S)-红霉胺

9(S)-红霉胺是合成地红霉素和CP-544372的中间体，此化合物可在超声波的作用下利用NaBH4／ZrCl4于室温下还原9(E)-红霉素肟制得，收率为69％，其结构经IR、NMR和MS确证。该方法是制备9(S)-红霉胺的方便、有效的途径。     

Contribution Ratio Assessment of Process Parameters on Robotic Milling Performance

Robotic milling has broad application prospects in many processing fields. However, the milling performance of a robot in a certain posture, such as in face milling or grooving tasks, is extremely sensitive to process parameters due to the influence of the serial structure of the robot system. Improper process parameters are prone to produce machining defects such as low surface quality. These deficiencies substantially decrease the further application development of robotic milling. Therefore, this paper selected a certain posture and carried out the robotic flat-end milling experiments on a 7075-T651 high-strength aeronautical aluminum alloy under dry conditions. Milling load, surface quality and vibration were selected to assess the influence of process parameters like milling depth, spindle speed and feed rate on the milling performance. Most notably, the contribution ratio based on the analysis of variance (ANOVA) was introduced to statistically investigate the relation between parameters and milling performance. The obtained results show that milling depth is highly significant in milling load, which had a contribution ratio of 69.25%. Milling depth is also highly significant in vibration, which had a contribution ratio of 51.41% in the X direction, 41.42% in the Y direction and 75.97% in the Z direction. Moreover, the spindle speed is highly significant in surface roughness, which had a contribution ratio of 48.02%. This present study aims to quantitatively evaluate the influence of key process parameters on robotic milling performance, which helps to select reasonable milling parameters and improve the milling performance of the robot system. It is beneficial to give full play to the advantages of robots and present more possibilities of robot applications in machining and manufacturing.     

Multi-Step Forming Simulation and Quality Control of Aluminum Alloy Automobile Rear Upper Control Arm

Aluminum alloy is widely used in automobile parts because of its light weight and good process performance. In view of the complex structure of aluminum alloy automobile rear upper control arms, multiple forming processes and the difficulty in quality control, in this paper, we propose a rolling-forging composite process to produce a rear upper control arm. Based on the reasonable volume distribution of the blank by cross-wedge rolling, multi-step forging was carried out. Finite element simulation of thermomechanically coupled multi-step forming was carried out using DEFORM software. Based on a comparison of the traditional process and the proposed rolling-forging composite forming process, we concluded that the rolling-forging composite process can greatly reduce the material cost and the forming force, resulting in superior product performance. The coarse-grain structure of products at different process temperatures was analyzed by a crystal-phase experiment. The results show that the process temperature of the multi-step process, as well as the heat treatment temperature and time have an important influence on the coarse-grain structure of the product. The optimal preheating temperatures for preforging and final forging dies were determined to be 335 °C and 350 °C, respectively; a preheating temperature of 530 °C and a solution time of 45 min resulted in the least coarse-grain surface structure. The research results provide a theoretical basis for improving the multi-step forming quality of automobile rear upper control arms.     

The Second Wave of COVID-19: Clinical Pharmacy Services During a Field Hospital Operation

The second wave of COVID-19 emerged in the late fall months in the state of Massachusetts and inadvertently caused a rise in the number of cases requiring hospitalization. With a field hospital previously opened in central Massachusetts during the Spring of 2020, the governor decided to reimplement the field hospital. Although operations were effectively accomplished during the first wave, the reimplementation of the field hospital came with its new set of challenges for operating a satellite pharmacy. Experiences gathered include new pharmacy operation workflows, the clinical role of pharmacy services, introduction of remdesivir treatment, and pharmacy involvement in newly diagnosed diabetes patients requiring insulin teaching. Pharmacy services were successful in adapting to the rapidly growing number in patients with a total of over 600 patients served in a course of 2 months.     

Management of the wound care clinic during the novel coronavirus pneumonia pandemic period: Sharing of management experience in a general hospital of China

With the surge in the confirmed cases of the novel coronavirus pneumonia, medical resources in many countries have been put on red alert levels. The operation management systems of hospitals, including wound care clinics, must be innovated to ensure the normal operation of the hospital and meet the medical care needs of the people. At the same time, scientific control measures are also required to prevent the spread of the novel coronavirus pneumonia in the hospital. Actually, during the novel coronavirus pneumonia pandemic, emergency management methods for wound care clinics such as online appointments and remote online diagnosis and treatment, the rational arrangement of human resources, the scientific implementation of epidemic prevention and control measures, and the strict implementation of the management of the clinic environment and item disinfection measures to strengthen the management of protective materials, wound care materials, and dressing equipment by partition have been introduced and innovated, thus helping reduce the gathering of people in wound care clinics, create a safe medical environment, and avoid the spread of the novel coronavirus pneumonia caused by diagnosis and treatment.     

成人下颌偏斜患者颞下颌关节形态及位置的变化

目的：研究下颌偏斜患者颞下颌关节形态及其位置的变化.方法：对21例下颌偏斜患者和20例个别理想[牙合]志愿者拍摄颞下颌关节中位断层片,选择描述髁突位置及髁突和关节窝形态的15个指标进行测量及统计分析.结果：下颌偏斜患者双侧关节结节高度、关节窝指数增大,髁突后斜面与水平基准线的夹角减小;偏斜侧的关节前间隙、关节前后间隙面积比,髁突高度、髁突上部高度减小;对侧的关节上间隙、髁突高度、髁突上部高度、髁突前斜面与水平基准线的夹角、关节窝后斜面与水平基准线的夹角增大.结论：下颌偏斜患者的双侧髁突和关节窝形态及髁突在关节窝中的位置都发生了改变,尤其以非偏斜侧髁突变化较为明显.     

医疗机构中药制剂创新和持续发展能力评价研究

目的 对医疗机构中药制剂创新和持续发展能力进行综合评价,为行政管理部门决策及各医院中药制剂可持续发展提供参考。方法 以浙江省133家医疗机构中药制剂调研数据为对象,利用层次分析法构建医疗机构中药制剂创新和持续发展能力评价体系,通过反向传播神经网络构建中药制剂室/中心评价体系预测模型。结果 构建的医疗机构中药制剂创新和持续发展能力评价指标体系包含4项二级指标以及19项三级指标,其中研发品种数、超百万品种数、注册品种数、研发方式、制剂室面积指标的权重值较高,分别为 0.15758、0.12928、0.09343、0.07879和0.07458。熵权法结合层次分析法的指标权重构建反向传播神经网络,Levenberg-Marquardt算法和Scaled Conjugate Gradient算法训练模型总体相关系数分别为0.98983和0.9348。结论 本研究构建了一个科学有效的医疗机构中药制剂创新和持续发展能力综合评价体系,可实现对医疗机构中药制剂综合能力的预测评价。     

多指标正交试验优选白术芍药散提取工艺

白术芍药散是中医传统名方,临床对于腹泻有确切的治疗效果.然而,目前有关白术芍药散的提取工艺报道较少.该试验利用正交试验的方法,以复方中10个指标性成分和浸出物的含量作为指标,采用综合加权评分法处理数据,对提取工艺中乙醇浓度、溶剂倍量、浸泡时间、提取时间4个因素进行考察,以优化白术芍药散提取工艺.结果得出白术芍药散的最佳提取工艺为加入12倍量70％乙醇,浸泡1h,提取2次,每次2h.其中提取时间有显著影响.优化后的提取工艺稳定可靠,可为进一步开发利用该处方提供参考.