《医林改错》拾遗

《医林改错》全书分为上下2卷,记载了王清任42年的医学心得和临床经验.该书立论新颖,深入浅出,通俗易懂,实用,深受中医界的推崇,深刻的反映了王氏勇于创新的学术思想.全书有方33首,用药87味,这些药方有很好的疗效,至今仍在临床中采用.王氏最擅长活血化瘀立法与组方思路,如活血化瘀药与行气药、清热药、化痰药等配伍,随证加减提高疗效.《医林改错》是在博览群书后客观的纠正和升华,是科学的、严谨的为医之道,此书适合中医初学者,同时也是中医临床研究重要的参考书籍.     

Social jetlag and sleep deprivation are associated with altered activity in the reward-related brain areas: an exploratory resting-state fMRI study

ObjectiveThe aim of this research was to assess the effect of social jetlag (SJL) and its interaction with partial sleep deprivation on resting-state brain activity using the fractional amplitude of low-frequency fluctuation (fALFF) during free-living conditions.MethodsA total of 28 normal weight healthy subjects were enrolled in four study groups (with SJL [with sleep deprivation and without sleep deprivation] and without SJL [with sleep deprivation and without sleep deprivation]), matched 1:1:1:1 for age, gender, and body mass index (BMI). Resting-state functional magnetic resonance imaging (fMRI) scans were collected with SIEMENS 3T scanner while subjects were in a fasting state.ResultsParticipants with SJL had significantly higher fALFF values in right lingual gyrus and right putamen and significantly lower fALFF values in left and right inferior parietal lobe in comparison with participants without SJL and without sleep deprivation. Subjects with sleep deprivation had significantly higher fALFF in the thalamus and left superior frontal gyrus. In those with both SJL and sleep deprivation, we observed higher fALFF values in right Brodmann Area (BA)18 and lower values in left and right parietal inferior lobe. Subjects with SJL alone had significantly lower fALFF values in left frontal mid gyrus (BA6) than those with sleep deprivation alone.ConclusionsSJL was associated with altered resting-state brain activity in regions that have been shown to be involved in hedonic feeding. The effect of SJL was independent of effects induced by short sleep duration. These alterations might represent the substrate for the increased risk of obesity observed in those with SJL.     

矫治性可摘局部义齿在牙列缺损中的应用

目的探讨应用矫治性可摘局部义齿的效果。方法采用矫治性活动义齿治疗中青年重度深覆牙合患者36例,评价其临床效果。结果 2例患者放弃治疗,其余34例患者均解除了重度深覆牙合,后牙完全接触。结论矫治性可摘局部义齿对中青年重度深覆牙合患者有良好的治疗效果。     

Evaluation of the efficiency of Boston brace on scoliotic curve control: A review of literature

Context: Bracing is one of the most important treatment approaches that have been utilized in patients with scoliosis. Boston brace used to manage a scoliotic curve especially in lumbar and thoracolumbar areas.Objective: The aim of this review was to evaluate the efficiency of Boston brace to control the progression of the curve based on the available literature.Methods: A search was carried out using the following databases including Scopus, ISI Web of knowledge, PubMed, Ebsco, and Embasco. The key words used for the search were Boston brace, Boston orthosis which were used in combination with scoliosis. Articles identified were screened based on titles and abstracts. The quality of the studies was evaluated using Black and Down tool. Data were summarized based on PICO style.Results: Based on the aforementioned key words, 18 papers were selected, in which 7 studies focused on efficiency of Boston brace, 3 papers focused on quality of life, 5 papers on finite element analysis and 3 papers on comparison of efficiency of Boston with other available braces. The quality of the selected studies varied between 14 and 21.Conclusion: The results of most of the studies support the efficiency of this brace to control the progression of scoliotic curve, especially for the curve between T6 and L2. The efficiency of this brace may be due to its rigid structure and also location and direction of the straps.     

经右外侧小切口矫治室间隔缺损合并复杂畸形技术的应用

目的:分析经右外侧小切口剖胸矫治合并需行心底部操作的室间隔缺损(VSD)手术方法及临床疗效。方法:比较经右外侧小切口剖胸矫治需行心底部复杂操作(干下型VSD或右心室流出道狭窄或主动脉瓣下狭窄)的VSD 84例(A组),和经右外侧小切口剖胸矫治不合并心底部畸形的VSD450例(B组),A组在矫治心内畸形的同时需切开主动脉、肺动脉或者右心室流出道。通过对比体外循环时间、主动脉阻断时间、术后机械通气时间、术后引流量、监护室时间以及术后住院时间,观察在心底部进行复杂操作对手术的影响和治疗效果。结果:尽管A组比B组需要更长的体外循环时间[(60.68±16.12)vs.(47.07±16.55)分,P<0.05]和主动脉阻断时间[(37.68±12.84)vs.(25.16±12.60)分,P<0.05],但在术后评价指标,机械通气时间9.18vs.8.51小时、术后引流量(96.98 vs.92.30m L)、监护室停留时间(1.44 vs.1.40)天、术后住院时间[(7.00±1.76)vs.(7.06±2.23)天,P<0.05]。两组均无死亡及严重并发症。A组有3例血痰、肺部感染1例,室上性心动过速1例。B组有9例患儿术后血痰,2例肺部感染,临时起搏器4例。结论:经右外侧小切口剖胸矫治VSD的同时行心底部复杂操作安全可行。     

Analysis of factors that affect shoulder balance after correction surgery in scoliosis: a global analysis of all the curvature types

Purpose

To identify factors that can affect postoperative shoulder balance in AIS.

Method

89 adolescent idiopathic scoliosis patients with six types of curvatures who underwent surgery were included in this study. Whole spine antero-posterior and lateral radiographs were obtained pre- and postoperatively. In radiograms, shape and changes in curvatures were analyzed. In addition, four shoulder parameters and coronal balance were analyzed in an effort to identify factors significantly related to postoperative shoulder balance.

Result

In general, all the four shoulder parameters (CHD, CA, CRID, RSH) were slightly increased at final follow up (t test, P < 0.05), although there was a decrease in Lenke type II and IV curvatures. However, pre- and postoperative shoulder parameters were not significantly different between each curvature types (ANOVA, P > 0.05). Moreover, no significant differences of pre- and postoperative shoulder level between different level of proximal fusion groups (ANOVA, P > 0.05) existed. In the analysis of coronal curvature changes, no difference was observed in every individual coronal curvatures between improved shoulder balance and aggravated groups (P > 0.05). However, the middle to distal curve change ratio was significantly lower in patients with aggravated shoulder balance (P < 0.05). In addition, patients with smaller preoperative shoulder imbalance showed the higher chance of aggravation after surgery with similar postoperative changes (P < 0.05).

Conclusions

Significant relations were found between correction rate of middle, and distal curvature, and postoperative shoulder balance. In addition, preoperative shoulder level difference can be a determinant of postoperative shoulder balance.