Subthalamic nucleus deep brain stimulation improves sleep in Parkinson's disease patients: a retrospective study and a meta-analysis

BackgroundMost Parkinson's patients suffered from sleep problems. There is increasing evidence that Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) has a positive effect on several sleep parameters, improving overall sleep quality in patients with PD. However, the results are controversial.MethodsWe performed a retrospective study and meta-analysis to assess the Parkinson's disease sleep scale (PDSS) in Parkinson's patients.ResultsWe reviewed our data of patients who underwent STN-DBS, and then extracted five other trials to perform a meta-analysis. The pooled results showed an advantage on post-operative PDSS in both our medical center and pooled results (MD = 20.41, 95% CI = [13.03, 27.79], I² = 61%, P < 0.001). There was a significant difference in Unified Parkinson's Disease Rating Scale (UPDRS)-Ⅲ score between pre and post-operation (MD = −12.59, 95% CI = [−14.70, −10.49], I² = 90%, P < 0.001). What's more, Parkinsonian medication was significantly lower in the post-operative groups after DBS (MD = −314.71, 95% CI = [−468.13, −161.28], I² = 53%, P < 0.001).ConclusionIn the retrospective study and meta-analysis of 6 trials, we found that DBS can significantly increase sleep quality. Furthermore, motor function improved and Parkinsonian medication was significantly decreased postoperatively. The sample size was enough and no further investigations would change the conclusion.     

Influence of early-life factors on the development of endometriosis

Objective: Our aim was to study the association between early-life factors and the development of endometriosis.

Methods: This case–control study included 440 women with surgically confirmed endometriosis (cases) and 880 women without endometriosis (controls). Information on early-life factors was ascertained retrospectively by in-person interviews with participants and their mothers. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between endometriosis and maternal and paternal characteristics and foetal and infant exposures were estimated using unconditional logistic regression, adjusting for frequency matching and confounding variables.

Results: We observed that women who were not breastfed as infants had twice the risk of endometriosis compared with women who were breastfed (adjusted OR 2.0; 95% CI 1.6, 4.5). Our data suggested an increased endometriosis risk with neonatal vaginal bleeding (adjusted OR 1.9; 95% CI 1.2, 4.3) and paternal smoking (adjusted OR 1.8; 95% CI 1.1, 4.9). Although the CIs included the null hypothesis value, caesarean section (adjusted OR 1.7; 95% CI 1.0, 3.5) and prematurity (adjusted OR 1.4; 95% CI 0.8, 3.7) were probably associated with the incidence of endometriosis.

Conclusions: Some early-life factors including breastfeeding, neonatal vaginal bleeding and paternal smoking were associated with subsequent, surgically confirmed endometriosis in this cohort of Chinese women.     

持续质量改进在降低ICU呼吸机相关肺炎感染管理中的作用

目的 针对ICU呼吸机相关肺炎(VAP)感染率较高和引起VAP感染的各种因素,探讨运用持续质量改进措施在降低VAP感染率和医务人员对VAP防控措施执行依从性的作用。方法 选择2017年7月1日—2018年6月30日,入住ICU行机械通气超过48 h且无肺部基础疾病的重症患者,用随机数字表法分为观察组(55例)和对照组(55例),对照组采取常规诊疗与护理措施,观察组运用持续质量改进法,比较2组VAP感染率及医护集束化控制措施执行依从率的变化。结果 观察组患者VAP千日感染率(11.3‰)明显低于对照组(27.5‰),差异有统计学意义(χ2=6.11,P<0.05)。医护人员对VAP预防措施执行项目的依从率,2组比较差异均有统计学意义(P<0.05)。结论 持续质量改进一方面能降低ICU VAP感染率,另一方面提高了医护人员对落实各项管理措施执行的依从性,提升了医护管理质量,保障了患者的诊疗安全。     

基于回转器理论的电流模式控制型DC-DC变流器统一大信号模型

随着新能源技术的大力发展，直流分布式系统以其独特的优势得到了越来越广泛的关注，逐渐成为业界的研究热点。虽然系统中每个模块都能够单独稳定运行，但由于模块之间复杂的相互作用，系统的稳定性特别是在大信号扰动下的暂态稳定性情况仍是令人困扰的一大难题，且目前该领域的理论研究成果相对缺乏。简单、有效、统一的大信号模型是进行大信号稳定性理论分析的基础。由于电流模式控制方法应用较为广泛，故本文基于回转器理论提出了一种适用于电流模式控制型DC-DC变流器的统一大信号模型。该模型实现了降阶，表达式简单，且仅需修改其中一个模型参数值即可实现对不同拓扑变流器的建模分析，为理论分析系统的大信号稳定性奠定了良好的基础，也为解析形式大信号稳定性判据的提出提供了可能。仿真和实验分别基于Buck、Boost及Buck-Boost变流器对该模型的有效性进行了验证。同时，为验证该大信号模型的完备性，对其稳态工作点附近的小信号特性也进行了分析，并与目前公认的比较精确的电流模式控制小信号模型进行了对比，得到了较好的结果。     

基于交直轴电流耦合的单电流调节器永磁同步电机弱磁控制

基于交直轴电流耦合的单电流调节器弱磁控制是一种新颖的永磁同步电机弱磁策略，能够解决双电流调节器在电机高速域相互冲突而易于饱和的问题。交轴电压指令如何确定是此方法的研究重点，直接影响电机的电压利用率、效率以及负载能力。该文基于电机电压方程对电流耦合调节弱磁控制基本原理进行描述，并提出改进的控制方法。利用id-iq坐标平面上的定子电流轨迹，对现有方法的缺点和所提出方法的预期控制效果进行了分析。在小信号范围内，对所提出方法的动态控制过程和可控性进行了阐述。所提出的电流耦合调节变交轴电压弱磁控制策略，交轴电压指令根据电机工况自行调节，无需查表，且不依赖电机参数，易于实现。仿真和实验结果验证了所提方法的可行性和性能优势。     

Share control of surgery robot master manipulator guiding tool along the standard path

Recently, minimally invasive surgery (MIS) robotics enters the phase of autonomous operation. However, because of the high variability of the environment, conducting a fully autonomous surgery is still extremely difficult. This paper presents a share control system, the objective of which is to suggest the optimum path of tool guidance through the use of force on the master manipulator (hereinafter as master), meaning the surgeon's hand. Owing to this type of control, the surgeon has full control over the position of the tool the entire time and is supported by the system to better and faster guide the tool during surgery. The force should be felt by the surgeon but, simultaneously, must not hinder or impact the surgical process. Furthermore, the share control system presented in the paper can be turned on or off at any moment during surgery.     

内镜室感染因素探讨及预防措施

目的：探讨内镜室感染因素，制定相应的预防控制措施。方法对比医院内镜室整体搬迁及更换全新清洗消毒中心前后各项细菌检测结果，制定减少内镜室感染的有效措施。结果2013年内镜室整体搬迁、更换全新清洗中心前、后操作间空气细菌检测分别为47.14%、87.50%，消毒后内镜细菌检测分别为88.75%、88.33%，工作人员手细菌检测为93.33%，差异均有统计学意义(P<0.05)。结论通过对内镜室进行科学规划、合理设置、整体搬迁，采用全新清洗消毒中心，标准、规范化清洗消毒内镜，认真组织学习医务人员手部卫生管理制度和手部卫生实施规范，能提高内镜室感染的合格率。