中国针灸腧穴与尼泊尔传统医学生命点的对比研究

中国和尼泊尔的传统医学理论体系都有悠久的历史, 且两者的治疗手段都源自相同的哲学和理论基础。在使用自然疗法治疗疾病的过程中, 两种医疗体系均提出了人体的重要位置点的理论, 即中医的经络腧穴理论和尼泊尔传统医学中的生命点理论。初步将中国针灸腧穴以及尼泊尔传统医学中的生命点的进行对比研究, 为今后两者的结合应用提供依据。     

穴位注射、针刺结合康复训练对痉挛型小儿脑瘫的临床观察

目的：观察研究穴位注射、针刺结合康复训练对痉挛型小儿脑瘫的临床效果。方法选取2009年7月—2013年7月该院收治并确诊的84例痉挛性小儿脑瘫患儿作为研究对象,并随机分为观察组和对照组各42例。对照组患儿进行传统康复训练,观察组患儿在对照组基础上结合穴位注射、针刺治疗,6个月后比较临床疗效。结果观察组患儿总有效率为92.86%,明显高于对照组的57.14%的有效率,差异有统计学意义（P＜0.05）;观察组患儿治疗后的关节活动度、痉挛程度、以及步行能力相对于对照组均有显著疗效（P＜0.05）。结论穴位注射、针刺结合康复训练能有效改善痉挛型脑瘫患儿关节活动度、减少患儿痉挛发作,且增强患儿的步行能力,疗效显著。     

黄芪足三里穴位注射治疗急性胰腺炎并发肠麻痹的临床随机对照研究

目的 评价黄芪足三里穴位注射治疗急性胰腺炎并发肠麻痹的疗效.方法 204例符合纳入标准的急性胰腺炎患者按随机数字表分为A、B和C组.A组患者给予禁食、胃肠减压、抑制胰酶活性药物、抗感染、营养支持、中药汤剂管喂及灌肠等基础治疗.B组在基础治疗上加用生理盐水穴位注射;C组在基础治疗上加用黄芪注射液穴位注射.比较3组患者肠道功能恢复、治疗总有效率、住院时间、中转手术率和死亡率等情况.结果 C组肛门排气时间和排便时间以及肠鸣音恢复时间与A、B两组比较均缩短,组间差异有统计学意义(P＜0.05).C组总有效率高于A、B组,组间差异有统计学意义(P＜0.05).C组住院时间较A、B组短,组间差异有统计学意义(P＜0.05).C组的中转手术率、多器官衰竭发生率和死亡率均低于A、B组,但组间差异无统计学意义(P＞0.05).结论 黄芪足三里穴位注射治疗胰腺炎能缩短患者的肛门排气时间、肛门排便时间及肠鸣音恢复时间,促进肠道功能的恢复,改善肠麻痹;能提高胰腺炎治疗的总体有效率,缩短患者住院时间.     

Gas Exchange and Ventilatory Efficiency During Exercise in Pulmonary Vascular Diseases

Background and ObjectiveVentilatory inefficiency (high V′_E/V′CO₂) and resting hypocapnia are common in pulmonary vascular disease and are associated with poor prognosis. Low resting PaCO₂ suggests increased chemosensitivity or an altered PaCO₂ set-point. We aimed to determine the relationships between exercise gas exchange variables reflecting the PaCO₂ set-point, exercise capacity, hemodynamics and V′_E/V′CO₂.MethodsPulmonary arterial hypertension (n = 34), chronic thromboembolic pulmonary hypertension (CTEPH, n = 19) and pulmonary veno-occlusive disease (PVOD, n = 6) patients underwent rest and peak exercise arterial blood gas measurements during cardiopulmonary exercise testing. Patients were grouped according to resting PaCO₂: hypocapnic (PaCO₂ ≤34 mmHg) or normocapnic (PaCO₂ 35–45 mmHg). The PaCO₂ set-point was estimated by the maximal value of end-tidal PCO₂ (maximal P_ETCO₂) between the anaerobic threshold and respiratory compensation point.ResultsThe hypocapnic group (n = 39) had lower resting cardiac index (3.1 ±0.8 vs. 3.7 ±0.7 L/min/m², p < 0.01), lower peak V′O₂ (15.8 ± 3.5 vs. 20.7 ± 4.3 mL/kg/min, p < 0.01), and higher V′_E/V′CO₂ slope (60.6 ± 17.6 vs. 38.2 ± 8.0, p < 0.01). At peak exercise, hypocapic patients had lower PaO₂, higher V_D/V_T and higher P_(a-ET)CO₂. Maximal P_ETCO₂ (r = 0.59) and V_D/V_T (r = −0.59) were more related to cardiac index than PaO₂ or PaCO₂ at rest or peak exercise. Maximal P_ETCO₂ was the strongest correlate of V′_E/V′CO₂ slope (r = −0.86), peak V′O₂ (r = 0.64) and peak work rate (r = 0.49).ConclusionsResting hypocapnia is associated with worse cardiac function, more ventilatory inefficiency and reduced exercise capacity. This could be explained by elevated chemosensitivity and lower PaCO₂ set-point. Maximal P_ETCO₂ may be a useful non-invasive marker of PaCO₂ setpoint and disease severity even with submaximal effort.     

Foraging trade-offs,flagellar arrangements,and flow architecture of planktonic protists

Unicellular flagellated protists are a key element in aquatic microbial food webs. They all use flagella to swim and to generate feeding currents to encounter prey and enhance nutrient uptake. At the same time, the beating flagella create flow disturbances that attract flow-sensing predators. Protists have highly diverse flagellar arrangements in terms of number of flagella and their position, beat pattern, and kinematics, but it is unclear how the various arrangements optimize the fundamental trade-off between resource acquisition and predation risk. Here we describe the near-cell flow fields produced by 15 species and demonstrate consistent relationships between flagellar arrangement and swimming speed and between flagellar arrangement and flow architecture, and a trade-off between resource acquisition and predation risk. The flow fields fall in categories that are qualitatively described by simple point force models that include the drag force of the moving cell body and the propulsive forces of the flagella. The trade-off between resource acquisition and predation risk varies characteristically between flow architectures: Flagellates with multiple flagella have higher predation risk relative to their clearance rate compared to species with only one active flagellum, with the exception of the highly successful dinoflagellates that have simultaneously achieved high clearance rates and stealth behavior due to a unique flagellar arrangement. Microbial communities are shaped by trade-offs and environmental constraints, and a mechanistic explanation of foraging trade-offs is a vital part of understanding the eukaryotic communities that form the basis of pelagic food webs.

Unicellular flagellated protists play a key role in the biogeochemical cycles of the global ocean. Their photosynthetic activity and grazing on microbes are major processes in the microbial food web, and they may control the populations of bacteria and cyanobacteria (1). By being grazed, they transfer primary production to higher trophic levels (2–4). Thus, flagellates are both consumers and prey, but we do not understand how their resource acquisition trades off against predation mortality, or how this trade-off shapes their foraging behavior.In the low Reynolds number (Re) world of protists, viscosity impedes predator-prey contact. The physical mechanisms that nevertheless allow flagellates to daily clear a volume of water for prey that corresponds to approximately 10⁶ times their own cell volume (5, 6) are not well understood. Many marine flagellates are mixotrophic and can acquire resources both through photosynthesis and by eating other organisms (7). Their demand for inorganic mineral nutrients is also constrained by viscosity that retards the advective enhancement of diffusive uptake (8).To encounter prey and enhance advective transport of nutrients, protists may swim or create a feeding current through the beating of one or several flagella (9, 10). However, the beating of flagella produces fluid disturbances that exposes the flagellate to its rheotactic (flow-sensing) predators (11). Small flagellates are grazed by microzooplankton, many of which perceive their prey from the fluid disturbance that the prey generates (12, 13). Thus, there are fundamental foraging trade-offs. Such trade-offs are largely unexplored among the eukaryotic microbes that form the basis of aquatic food webs. This is crucial, because the diversity of microbial communities is determined by such trade-offs in concert with environmental constraints (14–17). Microbial diversity in turn governs the functionality and “services” of microbial communities, and hence also their role in ocean biogeochemistry (18, 19).Here we explore the trade-off between resource acquisition and predation risk in marine nanoflagellates and microflagellates by describing the flow fields produced by the action of their flagella. The quantification of near-cell feeding currents has been reported in only a few species of free-swimming protists (10, 20). The kinematics, wave patterns, and arrangement and number of flagella are highly diverse among flagellated protists (Fig. 1). Theoretical models suggest that the feeding currents and fluid signal generated by a swimming cell depends on the arrangement of the flagella (11, 13, 21, 22). We use microparticle image velocimetry (µPIV) to visualize and quantify the flow fields generated by free-swimming planktonic protists with diverse flagellar arrangements and beat patterns. We show how the different modes of swimming produce very different flow architectures and demonstrate a trade-off between resource acquisition and predation risk in flagellated protists.Open in a separate windowFig. 1.Schematic overview of the diverse flagellar arrangements and beat patterns represented in this study. Latin names below each taxonomic group indicate the species (or other taxonomic unit) examined. Flagellar hairs are drawn when feasible, but some flagellar morphologies (e.g., the dinoflagellates) are deliberately simplified (25, 63). Redrawn from several sources; not to scale.     

Accuracy and safety of dry needle placement in the piriformis muscle in cadavers

Objectives: The purpose of this anatomic investigation is to (1) establish accuracy of dry needle placement into the medial third of the piriformis muscle as it exits the pelvis from the greater sciatic notch in unembalmed cadaveric specimens, while avoiding puncture of the sciatic nerve, and (2) establish guidelines for dry needle length selection.

Methods: Dry needles were placed in nineteen unembalmed cadaveric posterior hips. Dissection of the posterior hip musculature was performed to confirm location of the needle. A binary decision (yes/no) was made to determine whether the needle reached the piriformis muscle, went through the piriformis muscle, and/or pierced the sciatic nerve. Additionally, mean adipose tissue thickness, gluteus maximus muscle thickness, and perpendicular distance from the needle to the exiting sciatic nerve were recorded.

Results: The needle reached the medial third of the piriformis in 16 out of 19 hips (84.2% accuracy) and never punctured the sciatic nerve. There was a fair (r = 0.493) and good (r = 0.759) correlation between the needle length and the mean fat thickness for the left and right hips, respectively.

Discussion: A physical therapist was able to use bony landmark palpation to locate the piriformis muscle and use estimated adipose tissue thickness to choose a sufficient needle length to reach the medial third of the piriformis muscle. While the needle placement technique was safe and no sciatic nerve puncture occurred, the proximity of the piriformis muscle to the sciatic nerve warrants caution during needle placement.

Level of Evidence: 2c     

Optimal survival time‐related cut‐point with censored data

In biomedical research and practice, continuous biomarkers are often used for diagnosis and prognosis, with a cut‐point being established on the measurement to aid binary classification. When survival time is examined for the purposes of disease prognostication and is found to be related to the baseline measure of a biomarker, employing a single cut‐point on the biomarker may not be very informative. Using survival time‐dependent sensitivity and specificity, we extend a concordance probability‐based objective function to select survival time‐related cut‐points. To estimate the objective function with censored survival data, we adopt a non‐parametric procedure for time‐dependent receiver operational characteristics curves, which uses nearest neighbor estimation techniques. In a simulation study, the proposed method, when used to select a cut‐point to optimally predict survival at a given time within a specified range, yields satisfactory results. We apply the procedure to estimate survival time‐dependent cut‐point on the prognostic biomarker of serum bilirubin among patients with primary biliary cirrhosis. Copyright © 2014 John Wiley & Sons, Ltd.     

A three‐dimensional point process model for the spatial distribution of disease occurrence in relation to an exposure source

We study methods for how to include the spatial distribution of tumours when investigating the relation between brain tumours and the exposure from radio frequency electromagnetic fields caused by mobile phone use. Our suggested point process model is adapted from studies investigating spatial aggregation of a disease around a source of potential hazard in environmental epidemiology, where now the source is the preferred ear of each phone user. In this context, the spatial distribution is a distribution over a sample of patients rather than over multiple disease cases within one geographical area. We show how the distance relation between tumour and phone can be modelled nonparametrically and, with various parametric functions, how covariates can be included in the model and how to test for the effect of distance. To illustrate the models, we apply them to a subset of the data from the Interphone Study, a large multinational case‐control study on the association between brain tumours and mobile phone use. Copyright © 2015 John Wiley & Sons, Ltd.     

推拿局部镇痛机制的概述

既往对推拿镇痛的研究多集中在脊髓或中枢水平对疼痛的调制方面,而中医经筋疾病的治疗原则是"以痛为腧",在患者的局部给予推拿治疗后,其疼痛往往能够得到减轻或消除,而其局部的某些物质究竟发生了如何的变化值得研究者进行观察,本研究就是探讨推拿手法与局部镇痛物质和致痛物质之间的关系,为中医"以痛为腧"的理论提供客观的依据。     

婴幼儿心力衰竭血浆氨基末端B型利钠肽前体检测及诊断截断点的探讨

目的:对婴幼儿心力衰竭血浆氨基末端B型利钠肽前体检测(NT-proBNP)的价值及诊断截断点进行探讨,为临床诊断提供指导.方法:选取2012年6月～2014年6月间佛山市顺德区妇幼保健院诊治的心力衰竭患者及体检的健康人员各76例为研究对象,分为观察和对照组.所有研究对象行NT-proBNP及心脏射血指数(LVEF)检测,并进行组间比较.观察组患者采用改良Ross标准进行评价,并按照分级对NT-proBNP结果进行比较.同时采用ROC曲线对观察组研究对象检测的敏感性、特异性及诊断截断点予以分析,并就婴幼儿及成人进行组间比较及数据分析.结果:观察者组研究对象中成年人、婴幼儿及平均NT-proBNP含量分别为(1 325.5±148.8)、(3 106.4±593.9)、(2 548.7±368.2)ng/L,均高于对照组(P＜0.05);对两组研究对象的NT-proBNP及LVEF进行组间比较,均具有统计学差异(P＜0.05);观察组在轻、中、重3个级别的NT proBNP含量比较有统计学差异(P＜0.05);组内按年龄组比较,婴幼儿NT-proBNP含量高于成年,且具有统计学差异(P＜0.05);根据ROC曲线分析得出婴幼儿心衰阳性的NT-proBNP参考指标为500ng/L.结论:血浆氨基末端B型利钠肽前体检测在心力衰竭诊断中具有重要的价值,且婴幼儿与成人患者的诊断截断点存在差异,可以500 ng/L作为婴幼儿心衰诊断的参考值.