针刺治疗腰椎间盘突出症的临床正交设计观察

目的 对腰椎间盘突出症的针刺治疗方案进行初步优选。方法 以48例腰椎间盘突出症患者为观察对象,以视觉模拟评分法（visual analogue scale,VAS）、日本骨科协会（Japanese orthopaedic association,JOA）评分系统为评价指标,以针刺腰夹脊穴为主要治疗方法,采用四因素二水平正交设计方案,对加强局部选穴、循经远端取穴、电针频率、针刺间隔时间的组合方案进行优选。结果 加强局部取穴、循经远端取穴、电针频率3个因素两水平间的VAS及JOA评分差异具有统计学意义（P<0.05）;针刺时间间隔两水平之间VAS及JOA评分差异无统计学意义（P>0.05）;交互作用中,加强局部取穴与电针频率4 Hz、循经远端取穴与电针频率4 Hz的交互作用最为显著。结论 腰椎间盘突出症宜针刺夹脊穴,配合加强局部取穴和循经远端取穴,电针频率4 Hz,隔日治疗1次。     

2型糖尿病周围神经病变动物模型的建立及检测指标分析

目的 通过阅读动物实验文献,对2型糖尿病周围神经病变(DPN)模型常用动物、造模方法、成模指标、适用指征等进行分析。方法 通过中国知网(CNKI)、PubMed、万方数据库检索近10年内与2型DPN相关的动物实验研究文献,并对其中相关指标及数据进行统计分析。结果 2型DPN动物模型常用动物为SD大鼠,常用方法为实验诱导建模,即高能饲料喂养结合低剂量链脲佐菌素(STZ)注射;判断动物模型成模指标分为2型糖尿病成模指标及周围神经病变成模指标。2型糖尿病成模指标:空腹血糖>11.1 mmol/L或随机血糖>13.8 mmol/L、胰岛素抵抗;周围神经病变成模指标:神经传导速度降低、热痛觉及机械痛觉异常、坐骨神经形态异常、表皮神经纤维减少。结论 2型DPN动物模型通常使用SD雄性大鼠,采用高糖高脂饲料(含10%猪油、20%蔗糖)或高脂饲料(含45%~60%猪油)喂养结合低剂量STZ(25~35 mg/kg)单次腹腔注射的诱导方式,具有成模率高、死亡率低、可操作性强等优势,结合行为学、病理形态学及神经电生理学检测为综合判定指标。该研究方案适用于研究2型DPN病变早期及肥胖相关2型DPN发病机制及干预措施起效途径的研究,具有一定参考价值。     

《黄帝内经》脉时相关理论与应用

[目的]探究《内经》脉时合参思想和经验,以期更全面地学习中医学脉学理论,提高临床疗效。[方法]撷选《内经》相关原文,对脉诊理论中的时间因素做简要分析,探讨昼夜、月相、季节等时间因素对脉象的影响,总结《内经》脉时合参思辨方法。[结果]昼夜、月相、季节等时间因素与脉象关系密切,自然界的阴阳消长等具有明显的时间性,人体脉象与其相适应。脉时合参不仅可以知晓脉象随昼夜、月相、季节等的生理变化,还可根据脉、脏、时的关联准确判定病位,通过脉逆四时与否细测病情轻重,依据脉象随病情发展的阶段性规律预判病势预后,以及因时制宜指导临床治疗。[结论]《内经》脉时合参思想,内容丰富,在临床中运用广泛,蕴涵着天人一体的整体观和中医学哲学思辨方法,值得深入挖掘和学习。     

全膝关节置换术对膝骨关节炎患者的近期疗效

目的 比较2种治疗方法对膝骨关节炎患者膝关节功能的改善效果。方法 选取2016年1月— 2018年1月天津医科大学总医院滨海医院收治的膝骨关节炎患者116例为研究对象。按随机抽签法将其分为观察组和对照组。对照组予以关节镜下清除术治疗,观察组予以全膝关节置换术治疗。对所有患者进行为期6个月的随访。比较两组手术前后患者膝关节功能评分（HSS）、视觉模拟法（VAS）、焦虑自评量表（SAS）评分变化情况,疗效以及生活质量情况。结果 观察组优良率[91.38%（53/58）]较对照组[72.41%（42/58）]高（P?<0.05）。观察组HSS评分比对照组高（P?<0.05）,而VAS、SAS评分比对照组低（P?<0.05）。术后观察组各项SF-36量表评分均比对照组高（P?<0.05）。结论 全膝关节置换术应用于符合适应证的膝骨关节炎患者中的效果显著,有利于改善患者膝关节功能,减轻疼痛,改善焦虑情绪,且有效提高生活质量,值得临床推广应用。     

基于模拟炮制法研究黄芩炒炭前后苷类成分的变化

目的:通过模拟炮制法探讨不同炒炭程度对黄芩饮片中苷类成分变化的影响。方法:采用Diamonsil C18(250 mm×4.6 mm,5μm)色谱柱;柱温箱温度25℃;进样量10μL;检测波长277 nm;流动相A为甲醇,B为0.4%磷酸,C为乙腈,使用梯度洗脱的方式,流速1 mL/min。通过模拟炮制的方法对黄芩苷与黄芩素、汉黄芩苷与汉黄芩素在炒炭温度下的转化进行初步研究。结果:黄芩炒炭后,黄芩苷以及汉黄芩苷的含量下降,而黄芩素以及汉黄芩素的含量均呈现先上升后下降的趋势。另外,在黄芩苷模拟样品中检出黄芩素,在汉黄芩苷模拟炮制品种检出汉黄芩素。结论:不同炒炭程度对黄芩中黄芩苷、汉黄芩苷、黄芩素、汉黄芩素含量有显著影响,模拟炮制法可较为真实地反映黄芩苷类成分在炒炭过程中的变化情况。     

全科医学临床诊疗思维研究——意识不清

本文介绍全科医生接诊意识不清的患者时,采用约翰?莫塔教授的临床安全策略--临床5问思维法,并结合RICE问诊,进行深入访谈：（1）导致意识不清的常见疾病有哪些？（2）哪些重要疾病不能忽视？（3）有什么容易被遗漏的病因吗？（4）是否患有潜在的常被掩盖的疾病？（5）是不是有什么话还没说？结合病史、查体和实验室检查,确诊低血糖症。本案例的启示：全科医生接诊意识不清患者时,获取有效的信息非常重要。本例患者在抢救阶段问诊得知有服用降糖药物史,因此首先考虑低血糖问题,速查血糖,证实诊断。全科医生的问诊不仅关注疾病,还关注发生问题的“人”,找到病因,明确诊断,展现全科医学整体性的临床诊疗思维。     

Fabrication of Metallic Biomedical Scaffolds with the Space Holder Method: A Review

Bone tissue engineering has been increasingly studied as an alternative approach to bone defect reconstruction. In this approach, new bone cells are stimulated to grow and heal the defect with the aid of a scaffold that serves as a medium for bone cell formation and growth. Scaffolds made of metallic materials have preferably been chosen for bone tissue engineering applications where load-bearing capacities are required, considering the superior mechanical properties possessed by this type of materials to those of polymeric and ceramic materials. The space holder method has been recognized as one of the viable methods for the fabrication of metallic biomedical scaffolds. In this method, temporary powder particles, namely space holder, are devised as a pore former for scaffolds. In general, the whole scaffold fabrication process with the space holder method can be divided into four main steps: (i) mixing of metal matrix powder and space-holding particles; (ii) compaction of granular materials; (iii) removal of space-holding particles; (iv) sintering of porous scaffold preform. In this review, detailed procedures in each of these steps are presented. Technical challenges encountered during scaffold fabrication with this specific method are addressed. In conclusion, strategies are yet to be developed to address problematic issues raised, such as powder segregation, pore inhomogeneity, distortion of pore sizes and shape, uncontrolled shrinkage and contamination.     

Effect of Sample Elevation in Radio Frequency Plasma Enhanced Chemical Vapor Deposition (RF PECVD) Reactor on Optical Properties and Deposition Rate of Silicon Nitride Thin Films

In this paper we investigate influence of radio frequency plasma enhanced chemical vapor deposition (RF PECVD) process parameters, which include gas flows, pressure and temperature, as well as a way of sample placement in the reactor, on optical properties and deposition rate of silicon nitride (SiN_x) thin films. The influence of the process parameters has been determined using Taguchi’s orthogonal tables approach. As a result of elevating samples above the electrode, it has been found that deposition rate strongly increases with distance between sample and the stage electrode, and reaches its maximum 7 mm above the electrode. Moreover, the refractive index of the films follows increase of the thickness. The effect can be observed when the thickness of the film is below 80 nm. It has been also found that when the deposition temperature is reduced down to 200 °C, as required for many temperature-sensitive substrate materials, the influence of the substrate material (Si or oxidized Si) can be neglected from the point of view of the properties of the films. We believe that the obtained results may help in designing novel complex in shape devices, where optical properties and thickness of thin plasma-deposited coatings need to be well defined.     

Fabrication of an Optical Fiber Micro-Sphere with a Diameter of Several Tens of Micrometers

A new method to fabricate an integrated optical fiber micro-sphere with a diameter within 100 µm, based on the optical fiber tapering technique and the Taguchi method is proposed. Using a 125 µm diameter single-mode (SM) optical fiber, an optical fiber taper with a cone angle is formed with the tapering technique, and the fabrication optimization of a micro-sphere with a diameter of less than 100 µm is achieved using the Taguchi method. The optimum combination of process factors levels is obtained, and the signal-to-noise ratio (SNR) of three quality evaluation parameters and the significance of each process factors influencing them are selected as the two standards. Using the minimum zone method (MZM) to evaluate the quality of the fabricated optical fiber micro-sphere, a three-dimensional (3D) numerical fitting image of its surface profile and the true sphericity are subsequently realized. From the results, an optical fiber micro-sphere with a two-dimensional (2D) diameter less than 80 µm, 2D roundness error less than 0.70 µm, 2D offset distance between the micro-sphere center and the fiber stylus central line less than 0.65 µm, and true sphericity of about 0.5 µm, is fabricated.     

《中国成人艰难梭菌感染诊断和治疗专家共识》解读

【摘要】艰难梭菌（Clostridium difficile,CD）为人类肠道的条件致病菌,是医院和社区感染性腹泻的重要病原菌。随着抗生素的滥用及高毒力菌株027/NAP1/BI型的流行,艰难梭菌感染（CDI）的发病率不断上升,已引起世界范围的关注。2017年发表的《中国成人艰难梭菌感染诊断和治疗专家共识》是首次针对CDI诊断和治疗的中国专家共识,在业界受到高度关注。本文就《中国成人艰难梭菌感染诊断和治疗专家共识》中艰难梭菌感染的诊断、检测及治疗进行解读。