消化内科十二指肠溃疡临床整体护理干预

目的探讨临床消化科十二指肠溃疡临床整体护理干预的应用效果,为临床护理提供可靠的参考数据。方法选择我院2012年1月。2013年1月消化内科收治的十二指肠溃疡患者80例,根据护理方法不同分为对照组及观察组,对照组进行常规护理,观察组在常规护理基础上辅以整体护理干预,对两组疗效进行回顾性分析。结果观察组疗效明显优于对照组,观察组总有效率为87．5％,对照组总有效率为67．5％,差异具有统计学意义（P〈0．05）。结论对于消化内科十二指肠溃疡患者,进行整体性的护理干预,可大幅度地提高患者的疗效,保证良好的预后效果,提高患者的生活质量,值得临床上大力推广应用。     

生精合剂对不育男性精子运动参数及精子膜完整性的影响

目的:观察生精合剂对不育男性精子运动参数及精子膜完整性的影响。方法:108例患者随机分为治疗Ⅰ组34例,给予维生素E和辅酶Q10口服,治疗Ⅱ组37例给予生精合剂口服,治疗Ⅲ组37例给予维生素E、辅酶Q10和生精合剂口服,均连续用药3个月(1个生精周期)。观察比较3组的临床疗效,精子活动率、前向运动率(a+b级%)、直线速度(VSL)、平均路径速度(VAP)、精子活力指数(AI),以及精子膜的完整性。结果:与治疗前比较,3组的精子活动率、运动速度和活力指数均明显改善(P<0.05,P<0.01);治疗后治疗Ⅱ、Ⅲ组的活动率、运动速度和活力指数明显优于治疗Ⅰ组(P<0.05,P<0.01),其中尤以治疗Ⅲ组改善最显著;治疗后3组精子质膜完整性均显著改善,与治疗前比较,差异有统计学意义(P<0.01);治疗Ⅱ、Ⅲ组精子总膨胀率显著高于治疗Ⅰ组(P<0.05,P<0.01),治疗Ⅲ组高于治疗Ⅱ组(P<0.05);治疗Ⅲ组g型精子膨胀率显著高于治疗Ⅰ、Ⅱ组(P<0.01)。结论:生精合剂能显著改善不育男性精子运动参数,对精子膜功能有保护作用,与抗氧化剂联合应用能提高疗效。     

Establishing the reproducibility of two approaches to quantify white matter tract integrity in stroke

Diffusion tensor imaging can provide unique and detailed information about white matter anatomy following stroke. Fiber tract reconstruction using tract-based techniques and cross-sectional region of interest delineation are two common approaches to quantify white matter integrity. After stroke, white matter tract integrity can be affected both locally and distally to the primary lesion location. It has been shown that tract disruption is associated with degree of functional impairment and response to skill training in participants with stroke. However, the reliability and validity of these approaches has not been systematically evaluated nor have the two approaches been directly compared in individuals with chronic stroke.Ten well-recovered individuals with chronic, right-sided, ischemic stroke in the sub-cortex and ten age-, gender- and handedness-matched healthy participants were studied. Semi-automated tractography of the ipsi- and contralesional corticospinal tract and cross-sectional region of interest drawing of the posterior limb of the internal capsule were performed bilaterally. Fractional anisotropy (FA) values and the hemispheric asymmetry in FA were the primary measures of tract integrity. Two raters performed each analysis method twice to evaluate inter- and intra-rater reliability. Participants with stroke were compared to healthy individuals to determine validity of each analysis approach. Correlational analyses were conducted to examine the relationships between the two approaches and the association between approaches and upper extremity motor impairment.Both analyses methods generally demonstrated good to excellent intra- and inter-rater reliability in each group (p < 0.05). Stroke participants demonstrated lower mean FA values in both ipsi- and contralesional tract integrity, and larger FA hemispheric asymmetry as compared with healthy individuals (p < 0.05). Comparison between the analysis approaches revealed significant associations between approaches across both groups and within each group (p < 0.05). In stroke, individual tract integrity was not correlated between approaches for ipsilesional (r = 0.26) or contralesional (0.15) tracts, nor was FA hemispheric asymmetry (r = 0.18). Additionally, contralesional mean FA quantified with the cross-sectional approach correlated with upper extremity motor impairment (r = 0.69).Importantly, this study is the first to systematically characterize the reliability of tract-based and cross-sectional DTI analysis approaches in well-recovered individuals with chronic stroke and matched healthy participants. Results suggest both tract-based and cross-sectional approaches to evaluate white matter tract integrity are reliable, can differentiate between groups of stroke and healthy participants, and are associated with one another. However, only mean FA values for the contralesional side derived using the cross-sectional approach were related to upper extremity impairment. Our findings suggest that each approach provides complimentary rather than redundant information regarding integrity and support the use of both approaches in combination in future investigations in well-recovered individuals with stroke.     

初中生诚信度及影响因素研究

目的 探讨初中生的诚信度及影响因素.方法 采用自编问卷对大连市480名初中生进行调查.结果 初中生诚信认知水平较高,对他人和社会诚信水平评价较低,显著低于平均得分(t=14.98,P＜0.001);年级之间差异显著,初一、初二、初三分数逐渐递减(56.47＞55.25＞53.97,F=17.528,P＜0.001);年...     

Sustaining program effectiveness after implementation: The case of the self-management of well-being group intervention for older adults

ObjectiveThe Self-Management of Well-being (SMW) group intervention for older women was implemented in health and social care. Our aim was to assess whether effects of the SMW intervention were comparable with the original randomized controlled trial (RCT). Furthermore, we investigated threats to effectiveness, such as participant adherence, group reached, and program fidelity.MethodsIn the implementation study (IMP) 287 and RCT 142 women participated. We compared scores on self-management ability and well-being of the IMP and RCT. For adherence, drop-out rates and session attendance were compared. Regarding reach, we compared participants’ baseline characteristics. Professionals completed questions regarding program fidelity.ResultsNo significant differences were found on effect outcomes and adherence between IMP and RCT (all p ≥ 0.135). Intervention effect sizes were equal (0.47–0.59). IMP participants were significantly less lonely and more likely to be married, but had lower well-being. Most professionals followed the protocol, with only minimal deviations.ConclusionThe effectiveness of the SMW group intervention was reproduced after implementation, with similar participant adherence, minimal changes in the group reached, and high program fidelity.Practice implicationsThe SMW group intervention can be transferred to health and social care without loss of effectiveness. Implementation at a larger scale is warranted.     

Providing Integrity,Authenticity, and Confidentiality for Header and Pixel Data of DICOM Images

Exchange of medical images over public networks is subjected to different types of security threats. This has triggered persisting demands for secured telemedicine implementations that will provide confidentiality, authenticity, and integrity for the transmitted images. The medical image exchange standard (DICOM) offers mechanisms to provide confidentiality for the header data of the image but not for the pixel data. On the other hand, it offers mechanisms to achieve authenticity and integrity for the pixel data but not for the header data. In this paper, we propose a crypto-based algorithm that provides confidentially, authenticity, and integrity for the pixel data, as well as for the header data. This is achieved by applying strong cryptographic primitives utilizing internally generated security data, such as encryption keys, hashing codes, and digital signatures. The security data are generated internally from the header and the pixel data, thus a strong bond is established between the DICOM data and the corresponding security data. The proposed algorithm has been evaluated extensively using DICOM images of different modalities. Simulation experiments show that confidentiality, authenticity, and integrity have been achieved as reflected by the results we obtained for normalized correlation, entropy, PSNR, histogram analysis, and robustness.     

《医学衷中参西录》张锡纯论治心病理论探析

本文以《医学衷中参西录》为出发点,深入探讨清末民初时期医学大家张锡纯在诊治中医心病方面的重要学术思想,对书中涉及心病理论做一深度挖掘.本书阐明张锡纯先生通过临证辨治构建多种治疗心病的理论框架,从心与神明论诠释心在机体中的重要地位,以君相火论、火不归原论来探讨中医心病临床实践中的重要病机及症状,通过枢机亢进及麻痹论逐个剖...     

中西医结合治疗老年溃疡性结肠炎的研究概况

目的老年溃疡性结肠炎患者逐渐成为溃疡性结肠炎患者中的第二大群体,国内外相关研究逐步展开,发病率的统计、临床特征的总结等方面趋于完善,本研究针对近5年老年溃疡性结肠炎的研究,以中西医结合治疗为出发点,探讨目前老年UC的治疗和研究现况。方法检索PubMed、Cochrane、CNKI等数据库中老年溃疡性结肠炎(elderly/older-onset UC、UC in elderly patients/population)中西医结合(Integrated Traditional Chinese Medicine&Western Medicine、Integrated/combined therapy)的随机临床试验,观察性研究、系统评价和/或荟萃分析及所选文章的参考文献、相关研究和评估中的参考文献。结果英文文献检索命中117条,筛选审查后选定27篇(含临床指南)。中文文献命中69条,筛查后选定18篇(含临床指南与专家共识)。所有纳入文献中,临床试验8篇(含2篇protocol),综述及观察性研究31篇。结论近5年国内对于老年UC研究并不多见,治疗方面临床试验以中成药联合西药为主,针对调节炎性因子及凝血功能。国外更多使用草药提取物联合用药治疗UC。     

片剂药品说明书完整服用信息标注情况的调查分析

目的:调查片剂药品说明书中完整服用信息,为合理用药提供参考。方法:应用新编临床用药参考软件,在药品说明书"用法用量"项、"注意事项"项输入"碎"、"掰"或"整片"等检索词,检索、统计并分析结果。结果:缓释片、肠溶片药品说明书片剂完整服用信息标注率最高分别为26.67%、21.74%。结论:缓释片、肠溶片等片剂药品说明书完整服用信息标注率低,可能会导致临床用药的风险。临床用药需要破坏片剂完整结构时,必须仔细阅读说明书。     

多层螺旋CT后处理技术对人工听骨链重建术前听骨链完整性的诊断价值分析

目的研究多层螺旋CT(MSCT)后处理技术对中耳炎患者人工听骨链重建术前听骨链完整性的诊断价值。方法选取2015年10月至2018年10月我院人工听骨链重建术前行MSCT检查的慢性或胆脂瘤中耳炎患者74例临床资料进行回顾性分析,所有患者均完成MSCT检查和手术治疗,将扫描数据进行多平面重组(MPR)、仿真内窥镜(VE)及容积重现(VR)等重建处理,并以手术结果为金标准分析三种处理技术对听骨链各部位完整性的术前诊断价值。结果 MPR、VE及VR对锤骨和砧骨畸形诊断准确性大致相近,均显示出良好准确性,其中VR对锤骨颈准确率优于MPR,对锤骨头准确率优于VE;同时MPR对砧镫关节和镫上畸形诊断效果较VE和VR具有一定优势。结论MPR、VE及VR均为常用MSCT后期处理技术,用于慢性中耳炎患者听骨链术前完整性评估均具有良好价值,在常规图像基础上结合多种后期处理技术可提升诊断准确率。