五步推拿法辅治小儿腹泻经验

运用五步推拿法加减辅助内服中药治疗小儿腹泻，据证之虚实运用相应的补泻手法，有促进药物吸收、增强疗效、缩短疗程的作用，而且无痛苦，无毒副作用，患儿容易接受，更宜于服药困难的小儿，并举验案五则以证之。     

颈部推拿对兔颈动脉粥样硬化重度狭窄病变的#br# 血管拉伸力学特性的影响 颈部推拿对兔颈动脉粥样硬化重度狭窄病变的血管拉伸力学特性的影响

目的　探讨颈部推拿手法对兔颈动脉粥样硬化（CAS）重度狭窄的血管拉伸力学特性的影响。 方法　45只新西兰兔随机分为颈椎旋转组（n=12）、推桥弓组（n=12）、模型对照组（n=12）和空白对照组（n=9），在颈椎旋转组、推桥弓组和模型对照组建立左侧CAS模型，并分别接受颈椎旋转手法、推桥弓手法干预3周，模型对照组和空白对照组不作手法干预。取左侧颈动脉进行单轴拉伸试验和病理观察，比较四组兔颈动脉的拉伸力学特性。 结果　（1）26只兔造模成功，其中颈椎旋转组、推桥弓组、模型对照组兔颈动脉的最大载荷显著高于空白对照组，同时最大应变显著低于空白对照组(P<0.05)；（2）颈椎旋转组兔颈动脉的弹性模量显著高于模型对照组、推桥弓组和空白对照组（P<0.05），而推桥弓组兔颈动脉的弹性模量与模型对照组相比差异无统计学意义(P>0.05)。 结论　动脉粥样硬化病变可致兔颈动脉血管拉伸力学特性下降，而颈部旋转推拿治疗可导致严重粥样硬化病变并重度狭窄的兔颈动脉弹性下降，为临床安全应用颈部推拿手法提供了参考。     

温针灸配合手法治疗第三腰椎横突综合征

目的：探讨温针灸配合手法治疗第三腰椎横突综合征的疗效.方法：将100例第三腰椎横突综合征患者随机分为对照组（50例）和治疗组（50例）,治疗组采用温针灸配合手法治疗,对照组则单纯采用针灸治疗,一个疗程后观察疗效.结果：治疗组治愈率高于对照组（P＜0.01）,两组总有效率无显著性差异（P＞0.05）.结论：温针灸配合手法治疗第三腰椎横突综合征疗效显著.     

Outcome of manipulation under anesthesia with or without intra-articular steroid injection for treating frozen shoulder: A retrospective cohort study

Manipulation under anesthesia (MUA) combined with intra-articular steroid injection (ISI) is preferred in management of the refractory frozen shoulder (FS). This study aimed to evaluate the effect of MUA with ISI or not on pain severity and function of the shoulder.Data on 141 patients receiving MUA with primary FS refractory to conservative treatments for at least 1 month were retrospectively obtained from medical records. We performed propensity score matching analysis between patients receiving MUA only and those receiving MUA plus ISI, and then conducted logistic regression analysis to identify the risk factors for the need to other treatments during 6-month follow-up.More improvement in terms of the SPADI pain scores and passive ROM at 2 weeks after first intervention remained in patients receiving MUA plus ISI after matching. The need to other treatments during 6-month follow-up occurred in 10.6% patients (n = 141). Logistic regression analysis revealed that a repeat MUA 1 week after first intervention was a protective factor (OR 0.042; 95% CI 0.011–0.162; P = .000) and duration of disease was the only one risk factor (OR 1.080; 95% CI 1.020–1.144; P = .008) for the need to other treatments during follow-up.ISI immediately following MUA provided additional benefits in rapid relief of pain and disability for patients with refractory FS. Pain and disability of the shoulder may be rapidly alleviated by an earlier MUA from the onset of the symptoms and a repeat MUA 1 week after first intervention.     

关节弹响与推拿所致“咔哒”声响的研究进展

关节弹响是人们熟悉却又不常注意的现象,有关节病症状的患者常将其作为主诉之一。临床医生在进行推拿手法时常出现的"咔哒"声响,多被认为是手法整复过程中的标志,但这与手法治疗成功、患者症状缓解的临床意义不尽相同,在临床操作中主要取决于医生的经验和习惯,使临床推拿手法具有一定的主观性。     

Characterization of Acoustic Droplet Vaporization for Control of Bubble Generation Under Flow Conditions

This study investigated the manipulation of bubbles generated by acoustic droplet vaporization (ADV) under clinically relevant flow conditions. Optical microscopy and high-frequency ultrasound imaging were used to observe bubbles generated by 2-MHz ultrasound pulses at different time points after the onset of ADV. The dependence of the bubble population on droplet concentration, flow velocity, fluid viscosity and acoustic parameters, including acoustic pressure, pulse duration and pulse repetition frequency, was investigated. The results indicated that post-ADV bubble growth spontaneously driven by air permeation markedly affected the bubble population after insonation. The bubbles can grow to a stable equilibrium diameter as great as twice the original diameter in 0.5–1 s, as predicted by the theoretical calculation. The growth trend is independent of flow velocity, but dependent on fluid viscosity and droplet concentration, which directly influence the rate of gas uptake by bubbles and the rate of gas exchange across the wall of the semipermeable tube containing the bubbles and, hence, the gas content of the host medium. Varying the acoustic pressure does not markedly change the formation of bubbles as long as the ADV thresholds of most droplets are reached. Varying pulse duration and pulse repetition frequency markedly reduces the number of bubbles. Lengthening pulse duration favors the production of large bubbles, but reduces the total number of bubbles. Increasing the PRF interestingly provides superior performance in bubble disruption. These results also suggest that an ADV bubble population cannot be assessed simply on the basis of initial droplet size or enhancement of imaging contrast by the bubbles. Determining the optimal acoustic parameters requires careful consideration of their impact on the bubble population produced for different application scenarios.     

Experimental manipulation of avoidable feelings of uncertainty: Effects on anger and anxiety

Though anger and anxiety are related, putative explanations for this association remain unclear. Beliefs about one’s state of uncertainty may be a pathway—the belief that one’s uncertain state is unavoidable might lead to anxiety, whereas the belief that one’s uncertain state is avoidable might lead to both anxiety and anger. To test this hypothesis, participants experienced an uncertainty induction and were then assigned to the avoidable uncertainty condition (experimental group) or the unavoidable uncertainty condition (control group). State anger and anxiety were assessed at baseline, following the uncertainty induction, and following the “avoidableness” manipulation. The uncertainty induction was successful; participants reported higher levels of anxiety at post-induction compared to baseline. As expected, the experimental group reported increases in anger from post-induction to post-manipulation whereas the control group reported decreases in anger. These findings suggest that when one’s state of uncertainty is avoidable, anger is experienced alongside anxiety.     

The ALERRT® instrument: a quantitative measure of the effort required to compromise prescription opioid abuse-deterrent tablets

Background: US FDA guidance recommends measuring the degree of effort needed to manipulate abuse-deterrent (AD) opioids. The ALERRT^® instrument (PinneyAssociates; Bethesda, MD) uses visual analog scales to assess the labor, effort, and resources necessary to physically compromise AD product candidates in standardized settings. Objective: Use the ALERRT^® instrument for testing morphine abuse-deterrent, extended-release, injection-molded tablets (ADER-IMT) 60 and 100 mg and the comparators immediate-release (IR) morphine sulfate 30 mg and extended-release (ER) morphine sulfate 60 mg. Methods: Four technicians tested the products using 10 household tools. The ALERRT instrument quantified effort (all tools) and time (3 preselected tools) required for manipulation. Results: Morphine-ADER-IMT 60 and 100 mg were difficult to manipulate, as demonstrated by high scores (mean range, 71.0?99.0 and 77.0?99.5, respectively). IR and ER morphine sulfate were easy to manipulate (low scores; mean range, 2.0?14.8 and 2.3?17.5, respectively). Statistically significant mean differences between morphine-ADER-IMT and comparators’ ALERRT scores were observed. Manipulations of morphine-ADER-IMT 60 and 100 mg for 300 seconds failed to produce substantial powdering. Manipulations of IR morphine sulfate (mean range, 65.5?175.8 seconds) and ER morphine sulfate (49.3?163.0 seconds) produced substantial to complete powdering in 92% of tablets. Conclusions: Morphine-ADER-IMT was extremely difficult to manipulate versus non-AD formulations of morphine. The ALERRT system differentiated the degree of effort for manipulation of morphine-ADER-IMT and non-AD morphine formulations, indicating sensitivity of this instrument as part of Category 1 testing. By measuring the degree of effort required for manipulation, the ALERRT instrument provides an empirical assessment into the relative difficulty of manipulating opioid analgesics for abuse.