腹外斜肌的神经入肌点定位与肌内神经分布研究

目的　对人腹外斜肌的神经入肌点定位和肌内神经染色观察，为其临床应用提供形态学资料。 方法　成尸11具定位神经入肌点和5具行Sihler’s 肌内神经染色。 结果　腹外斜肌受下8对肋间神经外侧肌支支配，各个肌齿的神经入肌点距离相应肌齿起端中点(1.54±0.33)cm，位于锁骨中线与第5肋下缘的交界处至腋后线与第11肋下缘交界处的连线上。Sihler’s染色显示支配腹外斜肌的肋间神经外侧肌支入肌后分出小分支分布到各肌齿的起端1/3，然后约在各肌齿的近、中1/3交界处分出2支二级神经分支，即上支与下支，它们分出小分支分布到各肌齿的中间1/3，相邻两个肌齿的上支与下支在各肌齿中远部形成“U”形吻合，从“U”形吻合弓上分出小分支分布到各肌齿的止端1/3。在腹外斜肌上半部，各肌齿的神经分支分布到相应的肌齿，但在腹外斜肌下半部，上一肌齿的远侧下份是由下一肌齿的神经分支(上支)分布。 结论　①为临床上腹壁局部麻醉和术后切口疼痛的神经阻滞提供指导意义；②腹外斜肌中远部从上至下形成“波浪形”的神经分支密集区；③腹部手术切口建议不要超过四个肌齿。     

医保目录与医疗服务的错位

"脊柱内固定钢板"按医保目录可以报销,而固定钢板的钉子却由患者全额自付;五六年前制定的目录中仅有黑白超床旁检查项目,而未设床旁彩超项目,目前二级以上医院几乎全部淘汰黑白超,改用彩超,可彩超没有收费标准……诸如此类的问题让人难以理解。建议相关部门建立互通机制。     

水化疗法预防造影剂肾病的效果研究

目的研究水化疗法预防造影剂肾病的效果。方法随机选取2016年6月～2018年6月我院收治的造影剂肾病高危患者60例,依据预防方法分为两组,即氯化钠水化疗法组和复方氯化钠水化疗法组,每组30例,统计分析两组患者的Cr、pH、GFR、HCO3~-、K~+水平、造影剂肾病、二级终点事件发生情况。结果复方氯化钠水化疗法组患者的Cr水平显著低于氯化钠水化疗法组(P0.05),pH、GFR水平均显著高于氯化钠水化疗法组(P0.05),造影剂肾病、二级终点事件发生率为3.3%(1/30)、0,均显著低于氯化钠水化疗法组的13.3%(4/30)、10.0%(3/30)(P0.05)。结论复方氯化钠水化疗法预防造影剂肾病的效果较氯化钠水化疗法好,值得在临床推广。     

A novel compound heterozygosity in Southern China: IVS-II-5 (G > C) and IVS-II-672 (A > C)

β-Thalassemia (β-thal) is a common hereditary anemia due to decreased or absent synthesis of the β-globin chains. Here, we report a patient found to be a novel compound heterozygote for the rare IVS-II-5 (G?>?C) (NG_000007.3: g.71044G?>?C) and IVS-II-672 (A?>?C) (NG_000007.3: g.71711A?>?C) mutations, which may be silent mutations that are associated with consistent residual output of β chains, normal red blood cell (RBC) indices and normal or borderline Hb A₂ levels.     

Effects of visual-haptic asynchronies and loading-unloading movements on compliance perception

Spring compliance is perceived by combining the sensed force exerted by the spring with the displacement caused by the action (sensed through vision and proprioception). We investigated the effect of delay of visual and force information with respect to proprioception to understand how visual-haptic perception of compliance is achieved. First, we confirm an earlier result that force delay increases perceived compliance. Furthermore, we find that perceived compliance decreases with a delay in the visual information. These effects of delay on perceived compliance would not be present if the perceptual system would utilize all force-displacement information available during the interaction. Both delays generate a bias in compliance which is opposite in the loading and unloading phases of the interaction. To explain these findings, we propose that information during the loading phase of the spring displacement is weighted more than information obtained during unloading. We confirm this hypothesis by showing that sensitivity to compliance during loading movements is much higher than during unloading movements. Moreover, we show that visual and proprioceptive information about the hand position are used for compliance perception depending on the sensitivity to compliance. Finally, by analyzing participants’ movements we show that these two factors (loading/unloading and reliability) account for the change in perceived compliance due to visual and force delays.     

朱琏指针点按疗法联合自我管理模式在中风偏瘫患者中的应用研究

目的探讨朱琏指针点按疗法配合自我管理模式对中风偏瘫患者应对疾病和运动功能及日常生活活动能力的影响。方法将200例中风偏瘫患者按入院时间先后顺序随机平分为观察组和对照组,对照组接受卒中单元常规护理,观察组在此基础上实施朱琏指针点按疗法联合自我管理模式。连续干预4周后评价效果。结果干预后观察组MAS、MBI和MCMQ评分显著高于对照组,差异有统计学意义(P0.05)。结论将朱琏指针点按疗法联合自我管理模式运用于中风偏瘫患者,有利于患者建立战胜疾病的信心,自我管理疾病的主观能动性得到充分发挥,有助于帮助患者积极配合临床治疗护理,改善机体运动功能和日常生活活动能力,提高生活质量,促进疾病康复。     

HBB: c.316-125A>G and HBB: c.316-42delC: Phenotypic Evaluations of Two Rare Changes in the Second Intron of the HBB Gene

We report two very rare changes in the second intron of the HBB gene, a substitution at nucleotide (nt) 726 [IVS-II-726 (A>G) (β⁺), NM_000518, HBB: c.316-125A>G] and a deletion of a cytosine at nt 809 [IVS-II-809 (–C) (β), NM_000518, HBB: c.316-42delC] identified during the screening program for hemoglobinopathies in the resident Sicilian population. The purpose of this study was to evaluate the clinical implication of these rare changes, particularly in coinheritance with known mutations in the globin clusters, in order to conduct an appropriate genetic counseling for at-risk couples. Molecular analysis detected the first rare nt substitution in two cases in simple heterozygosity and in two cases in association with other known mutations on globin genes, while the deletion was identified in a pregnant woman, carrier of β-thal, and in her fetus at prenatal diagnosis (PND) for hemoglobinopathies. The present study emphasizes the importance of sharing the observed changes in the globin gene cluster, especially in the case of new or rare undefined mutations, in order to facilitate the determination of their phenotypic expression and possible interactions with known molecular defects.     

Relationship among Cervical Spine Degeneration,Head and Neck postures,and Myofascial Pain in Masticatory and Cervical Muscles in Elderly with Temporomandibular Disorder

ObjectivesThe aim of the study was to verify associations among degenerative changes in the cervical spine, head and neck postures, and myofascial pain in the craniocervical musculature in elderly with myofascial temporomandibular disorders (TMDs).MethodsA total of 120 participants (mean age, 68.3 ± 7.5 years) were included: 45 participants had no signs of orofacial or cervical pain, 26 participants had myofascial TMD only (mTMD), and 49 participants had both myofascial TMD and cervical pain (cerTMD). Participants were diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Cervical spine degeneration and head and neck postures were identified using the lateral cephalogram. Myofascial trigger points (TrPs) were evaluated in the temporalis, masseter, trapezius, sternocleidomastoid, sub-occipitalis, and splenius capitis muscles. Relationships among number of TrPs, head postures, and cervical degeneration were investigated using repeated-measure analysis of variance and Pearson’s correlation coefficient.ResultsThe cerTMD showed higher number of active TrPs in the masticatory and cervical muscles, greater forward head posture, and more severe degenerative changes in the cervical spine than mTMD did. The degenerative changes in each level of the cervical spine had complex interactions with head postures. Cervical degeneration, particularly at level of second to third vertebra appeared to be linked to the development of active TrPs in the masticatory and cervical muscles.ConclusionsThe results of this study demonstrated that degenerative changes in the cervical spine were related to altered head postures and the development of active TrPs in the craniocervical musculature in elderly with myofascial TMD.