克氏针持续牵引法治疗乳头内陷的临床效果

目的探讨应用克氏针自制S形矫正器持续牵引治疗乳头内陷的临床效果。方法局部麻醉下,以缝线或布巾钳将内陷的乳头牵出并尽量提起,用直径为0．5～1．0mm、长约10cm的克氏针横穿乳头基底部,由乳头中心向两侧各1．5cm处将克氏针分别沿顺时针方向向两侧弯曲成半环形,然后将两侧半圆环呈合页状向下折叠,将中间横贯轴撑起牵引乳头向前。术后持续佩戴本牵引装置6个月,复诊期间可通过调整折叠角度以维持牵引力度。结果用克氏针持续牵引法治疗中度、重度乳头内陷32例58侧,经初步观察治疗效果满意,牵引治疗期间未见局部感染,治疗后乳头形态自然,随访3～6个月,乳头形态稳定,未见复发。结论克氏针持续牵引法简单易行,不影响哺乳功能,矫正治疗后乳头形态自然、稳定持久。     

Impact of Power Transformer Oil-Temperature on the Measurement Uncertainty of All-Acoustic Non-Iterative Partial Discharge Location

In this paper, the influence of the variation in transformer oil temperature on the accuracy of the all-acoustic non-iterative method for partial discharge location in a power transformer is researched. The research can improve power transformers’ testing and monitoring, particularly given the large transformer oil temperature variations during real-time monitoring. The research is based on quantifying the contribution of oil temperature to the standard combined measurement uncertainty of the non-iterative algorithm by using analytical, statistical, and Monte Carlo methods. The contribution can be quantified and controlled. The contribution varied significantly with different mutual placements of partial discharge and acoustic sensors. The correlation between the contribution and the mean distance between partial discharge and acoustic sensors was observed. Based on these findings, the procedure to quantify and control the contribution in practice was proposed. The procedure considers the specificity of the method’s mathematical model (the assumption that the oil temperature is constant), the non-iterative algorithm’s nonlinearity, and the large variations in transformer oil temperature. Existing studies did not consider the significant effect of the oil temperature on the combined measurement uncertainty of partial discharge location influenced by those phenomena. The research is limited to partial discharge located in the transformer oil.     

基于精益管理理论的出院带药流程再造实践与体会

目的 运用精益管理（lean management,LM）理论,对出院带药进行流程再造。方法 通过使用价值流图（Value Stream Mapping）和7种浪费（Seven Wastes）2种LM工具对原出院带药流程进行分析,通过多部门协作对流程进行再造。结果 新流程的实施减少了出院带药流通环节,降低出错机率,保证了患者用药安全;减轻了医护人员的工作强度,减少了人力资源成本,缩短了患者的出院时间,提高了患者和医务人员的满意度,并让患者享受到药师专业的用药指导服务。结论 新流程提供了高品质、方便快捷的出院带药服务,保证了患者用药安全。     

Handgrip Strength at Admission and Time to Discharge in Medical and Surgical Inpatients

Background and Objective: Handgrip strength is a relevant marker of functional status and is also a component of nutrition assessment. The simplicity of this measurement supports its usefulness as a tool to predict who will likely take longer to hospital discharge. The aim of this study was to quantify the association between sex‐specific handgrip strength at hospital admission and time to discharge alive. We intended to include a group of diverse diagnoses and to compare medical and surgical wards, taking into account the potential confounders’ effect of patients’ characteristics and severity of disease. Subjects and Methods: Prospective study in 2 public acute‐care general hospitals in Porto, Portugal, in 2004. Handgrip strength was evaluated using a handgrip dynamometer in a probability sample of 425 patients from medical and surgical wards. The association between baseline handgrip strength and time to discharge was evaluated using survival analysis with discharge alive as the outcome and deaths and transfers being censored. Results: In medical wards, women with high admission handgrip strength had a very short hospital stay (all had been discharged by the sixth day), and among men, patients with low handgrip strength had a particularly longer stay (approximately 50% were discharged after 15 days of hospitalization). In surgical wards, an increasing length of stay with decreasing handgrip strength quartiles was also observed in both sexes. Conclusions: Lower handgrip strength at hospital admission was associated with a longer time in the hospital, in patients of both sexes, in medical and surgical wards. Although this association was explained in part by age, height, education level, cognitive status, and disease severity, its direction remained unchanged regardless of the aforementioned factors.     

Patient follow-up after discharge after COVID-19 pneumonia: Considerations for infectious control

Coronavirus disease 2019 (COVID-19) represents a significant global medical issue, with a growing number of cumulative confirmed cases. However, a large number of patients with COVID-19 have overcome the disease, meeting hospital discharge criteria, and are gradually returning to work and social life. Nonetheless, COVID-19 may cause further downstream issues in these patients, such as due to possible reactivation of the virus, long-term pulmonary defects, and posttraumatic stress disorder. In this study, we, therefore, queried relevant literature concerning severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19 for reference to come to a consensus on follow-up strategies. We found that strategies, such as the implementation of polymerase chain reaction testing, imaging surveillance, and psychological assessments, starting at the time of discharge, were necessary for long-term follow-up. If close care is given to every aspect of coronavirus management, we expect that the pandemic outbreak will soon be overcome.     

Activity-related features of synapse morphology: A study of endbulbs of Held

The myelinated fibers of the auditory nerve can be divided into two separate populations on the basis of sensitivity to sound, average levels of spike activity, and central branching patterns. The synaptic endings of these populations were investigated for the presence of structural specializations that might correlate with levels of neural activity. We applied intracellular recording and staining methods in cats to analyze directly the relationship between spike activity and the structure of synapses using endbulbs of Held, the large synaptic endings in the anteroventral cochlear nucleus. Endbulbs from fibers having low or high levels of activity were examined and compared using light and electron microscopic methods. All endbulbs exhibited relatively large but incomplete coverage by one-to-several lamellae of glial processes. Endbulbs of high activity fibers were large and contained larger mitochondria than endbulbs of low activity fibers. Furthermore, the synapses of high activity endbulbs were on average smaller but more numerous, possessed greater numbers of associated synaptic vesicles, and exhibited greater curvature of their postsynaptic densities. These structural features are hypothesized to reflect specializations that optimize synaptic transmission. © 1996 Wiley-Liss, Inc.