完全型阴囊转位手术治疗改良的临床体会

目的：探讨改良Glenn-anderson术式在完全型阴囊转位患儿中的效果。方法对38例完全型阴囊转位患儿行Glenn-anderson术式过程中进行睾丸及鞘膜周围组织粘连松解。结果所有患儿术后外观满意,无明显并发症。结论改良Glenn-anderson术式治疗完全型阴囊转位,可使阴囊外观更加接近正常状态。     

基于数据挖掘对李佃贵教授治疗消化性溃疡的用药特点分析

通过使用中医传承辅助系统软件,对李佃贵教授在治疗消化性溃疡药-证及四气五味归经方面进行整理,分析其内在用药规律,为临床辨证论治提供参考。方法收集整理李佃贵教授门诊治疗消化性溃疡的经验处方,通过将符合标准的150首中药处方依次录入系统中,来探索并分析出消化性溃疡用药规律。结果经分析得出,150首处方中,核心用药为炒白术,其次为黄连、陈皮、茵陈、乌药、砂仁、枳实、茯苓、川芎、厚朴;药性大多为辛、苦、寒,主归脾、胃、肝经,主要证型为胃气壅滞证、湿浊中阻证、浊毒内蕴证、胃络瘀阻证、胃阴不足证、脾胃虚弱证。最常用药类型为清热解毒、健脾芳香化浊、清热化湿和活血化瘀药。结论通过对李教授治疗消化性溃疡用药规律的分析,总结出其善于将芳香药与苦寒药结合使用,芳香以化浊,苦寒以清热;行气药与活血化瘀药相结合,行气可止痛,活血以化瘀。     

闫慧敏基于络病理论治疗儿童顽固性便秘经验

功能性便秘是儿童常见疾病,可影响儿童生活质量及体格发育。西医将经过积极内科治疗而无法缓解症状的便秘称为顽固性便秘,现代中医学认为其病机主要是脏腑气机升降失常以及肠道津液亏损。闫慧敏教授从络病理论出发论治本病,认为顽固性便秘患儿具有病程长、以功能失常为主导、难治性、缠绵性、易复发等特点,符合络病的临床特点,病机以大肠络瘀滞阻塞,津液不布,肠燥津亏为主,具有“瘀”“虚”“燥”的病理特点,治疗以疏通为要。闫老师治疗顽固性便秘以活血润燥通络,健脾运化津液为法,自拟“通络润燥汤”,全方由桃仁、火麻仁、当归、白术、白芍组成,方中桃仁、麻仁活血润肠,当归、白芍养血润燥,白术健脾化津,临证加减,应注意遵循以辛润为要,不可过于攻伐、滋腻。     

于作洋从肺论治小儿遗尿症经验

于作洋教授致力于中医临床和教学30余年,具有丰富的临床经验,其认为疾病的发生离不开气机的紊乱,故在治疗上注重理肺调气。小儿遗尿症是儿童时期常见疾病,中医治疗此疾病优势显著。多数医家将其病因病机归于肾脾肺虚,提及肺于片瓦之地,并多从虚证论治,从实证论者寥寥无几。于教授治疗小儿遗尿症,重视从肺论治,提倡肺肾同治。肺主通调水道,为“水之上源”,且主一身气,调理气的升降出入,在水液代谢中起到枢纽作用;且肺为肾之母,母病及子,故从肺论遗尿不可小觑。根据小儿肺脾肾常不足的生理特点,以及易寒易热、易虚易实的病理特点,小儿遗尿症不能单责虚证,往往虚实夹杂,实证亦不得忽视。在治疗上强调辨证论治,推崇肺肾同治、虚实兼顾,以补肾为本,理气为重。多用缩泉丸、桑螵蛸散等补肾固摄,常选麻黄宣肺利水,柴胡、前胡、杏仁调理气机,兼有肺热者加减麻杏石甘汤、泻白散等清泻肺热,兼有肺虚者配伍补中益气汤等补肺益本,诸药合用,肺气得调,肾气得固,而遗尿自止。     

Adverse drug and device reactions in the oral cavity: Surveillance and reporting

BackgroundAccording to the U.S. Centers for Disease Control and Prevention, 48 percent of Americans (roughly 144 million people) used at least one prescribed medication in the preceding month; 11 percent used five or more. The authors describe the U.S. Food and Drug Administration's (FDA's) MedWatch program, the safety surveillance system for drugs and devices in the United States, and the dentist's role with regard to voluntary reporting of adverse effects (AEs). They also identify the most frequent AEs in the oral cavity as reported in the FDA Adverse Event Reporting System (FAERS).MethodsThe authors reviewed the literature regarding MedWatch, and they mined data in the FAERS public database for the 100 most commonly prescribed medications and their associated AEs.ResultsPharyngitis was the most common AE. Cough, dysgeusia and dysphagia also were common.ConclusionThe MedWatch program and its related databases contain useful information about AEs of pharmaceuticals and devices manifested in the oral cavity. Increased participation in the reporting of suspected adverse reactions will improve the national surveillance system and ultimately will protect patients' safety.Practical ImplicationsAs pharmaceutical consumption increases exponentially for a growing segment of the population, and as innovation in dental technology and devices flourishes, dentists have a distinct role in safeguarding patients' well-being. Promptly reporting AEs in the oral cavity improves quality of care and protects patients' well-being.     

Multisensory integration across exteroceptive and interoceptive domains modulates self-experience in the rubber-hand illusion

Identifying with a body is central to being a conscious self. The now classic “rubber hand illusion” demonstrates that the experience of body-ownership can be modulated by manipulating the timing of exteroceptive (visual and tactile) body-related feedback. Moreover, the strength of this modulation is related to individual differences in sensitivity to internal bodily signals (interoception). However the interaction of exteroceptive and interoceptive signals in determining the experience of body-ownership within an individual remains poorly understood. Here, we demonstrate that this depends on the online integration of exteroceptive and interoceptive signals by implementing an innovative “cardiac rubber hand illusion” that combined computer-generated augmented-reality with feedback of interoceptive (cardiac) information. We show that both subjective and objective measures of virtual-hand ownership are enhanced by cardio-visual feedback in-time with the actual heartbeat, as compared to asynchronous feedback. We further show that these measures correlate with individual differences in interoceptive sensitivity, and are also modulated by the integration of proprioceptive signals instantiated using real-time visual remapping of finger movements to the virtual hand. Our results demonstrate that interoceptive signals directly influence the experience of body ownership via multisensory integration, and they lend support to models of conscious selfhood based on interoceptive predictive coding.     

Predictors of trait dissociation and peritraumatic dissociation induced via cold pressor

Understanding which factors predict individual dissociative response during stressful situations is important to clarify the nature of dissociation and the mechanisms associated to its use as a coping strategy. The present study examined (1) whether experiential avoidance (EA), anxiety sensitivity (AS), depressive symptoms, and state anxiety concurrently predicted trait dissociation (TD)—absorption, amnesia, depersonalization, and total TD scores—and laboratory induced dissociation (LID); and (2) whether TD and catastrophizing predicted LID. We also examined whether catastrophizing mediated the relationships between both AS and depressive symptoms and LID. A total of 101 female undergraduate students participated in a cold pressor task, which significantly induced dissociation. Results of hierarchical regression analyses showed that AS at Time 1 (9 months before the experimental session), as well as depressive symptoms and catastrophizing at the time of the experiment (Time 2), predicted LID at Time 2. Depressive symptoms at Time 2 predicted total TD, absorption, and amnesia scores. AS at Time 1 and depressive symptoms at Time 2 predicted depersonalization. AS, depressive symptoms, and catastrophizing seem to facilitate the use of dissociative strategies by healthy individuals, even in response to non-traumatic but discomforting stress.     

Women's experience of low back and/or pelvic pain (LBPP) during pregnancy

Objectiveto explore the experiences of women suffering low back and/or pelvic pain during pregnancy.Designa qualitative design using focus groups. Each group was recorded with a digital audio recorder and analysed using the Newell and Burnard framework for thematic analysis.Settingan urban maternity hospital.Participantsa self-selecting sample of 14 women who had taken part in a pilot randomised controlled trial investigating reflexology for pregnancyrelated low back and / or pelvic pain.Measurements and Findingsthe group discussions were guided by a pre-determined schedule of questions designed to investigate women's experiences of pregnancyrelated low back and / or pelvic pain. Three main themes emerged:

• (1)The physical and emotional impact that pregnancy-related low back and / or pelvic pain had on women's lives

• (2)Women's attitudes towards, and knowledge about pregnancy-related low back and/or pelvic pain

• (3)Women's use of treatments to manage their symptoms and levels of dissatisfaction with standard advice and treatment.

Key conclusionslow back and/ or pelvic pain affected women physically and emotionally during pregnancy. Their attitudes towards, and knowledge about the conditions differed. Women used a range of self-help strategies for their symptoms and there was a general sense of dissatisfaction with routine advice and treatment, a finding supported by a growing body of research.Implications for practicegiven that pregnancy-related low back and/ pelvic pain occur across the world, and affects the majority of pregnant women, heath care providers need to ensure that standard care provided is meeting women's needs.Health care professionals may require specific training in order to effectively provide individualised and evidence-based advice and support to pregnant women experiencing this pain.     

Exhaustion and endocrine functioning in clinical burnout: an in-depth study using the experience sampling method

The current study investigates the relationship between HPA-axis functioning and burnout symptoms by employing an electronic symptom diary. This diary method circumvents the retrospection bias induced by symptom questionnaires and allows to study relationships within-in addition to between-subjects. Forty two clinically burned-out participants completed the exhaustion subscale of the Maslach burnout inventory and kept an electronic diary for 2 weeks to assess momentary exhaustion and daily recovery through sleep. On 3 consecutive weekdays within the diary period, saliva was sampled to determine the cortisol awakening response (CAR), levels of dehydroepiandrosterone-sulphate (DHEAS) on the first 2 weekdays, and to conduct the dexamethasone suppression test (DST) on the third weekday. We found significant relationships between endocrine values and general momentary symptom severity as assessed with the diary, but not with the retrospective questionnaire-assessed burnout symptoms. Simultaneous assessments of endocrine values and burnout symptoms assessed with the diary after awakening rendered significant associations between persons, and a trend within persons. More severe burnout symptoms were consistently associated with a lower level and smaller increase of CAR, higher DHEAS levels, smaller cortisol/DHEAS ratios and a stronger suppression after DST. Burnout symptoms were significantly related to endocrine functioning in clinical burnout under the best possible conditions of symptom measurement. This adds support to the view that severity of burnout symptoms is associated with HPA-axis functioning.     

56例急性胰腺炎内科治疗临床体会

目的：探究急性胰腺炎的内科治疗方法。方法选取该院2011年6月-2013年3月收治的内科治疗的56例急性胰腺炎患者,观察治疗时间、治疗效果和治疗前后乳酸脱氢酶, C反应蛋白,白细胞和血淀粉酶水平。结果56例急性胰腺炎患者内科治疗的时间为5～13（7．9±1．6）d;56例患者中治愈42例（75．00％）,明显好转11例（19．64％）,无好转3例（5．36％）,治疗有效率为94．64％;患者治疗后乳酸脱氢酶较治疗前明显上升,C反应蛋白、白细胞、血淀粉酶明显下降,差异均有统计学意义（P＜0．05）。结论急性胰腺炎采用内科治疗效果良好,治疗安全、可靠,当患者使用内科手段治疗无好转时需及时将其转入外科治疗,保证患者的治疗效果。