一期外固定联合锁定钢板内固定术治疗 C 型 pilon 骨折的临床疗效

摘要 目的： 探讨外固定架联合锁定钢板分期治疗 C 型 pilon 骨折的临床疗效。 方法： 选取 2010 年 3 月至 2011 年 4 月在我院接受 治疗的 C 型 pilon 骨折患者 17 例。按照分期治疗的原则, 先行一期外固定架固定术, 待局部软组织恢复后切开复位, 再行锁定钢 板内固定术进行治疗, 术后对患者进行一年的随访, 定期检查患者的踝关节功能, 并借助影像学资料对临床疗效进行评价。结果： 全部患者获得随访, 平均愈合时间为(4.1± 1.6)月;平均 AOFAS 评分为(83.1± 12.4)分, 其中优 6 例(35.2 %), 良 8 例(47.1 %),一般 2 例(11.8 %), 差 1 例(5.9 %), 优良率为 82.4%; 术后 4 例患者出现出现轻度感染, 通过局部换药、 抗生素和钉道护理得到控制。结 论： 采用一期外固定联合锁定钢板内固定术分期治疗 C 型 pilon 骨折, 可以有效地提高治疗效果, 值得临床推广。     

石膏固定和外固定支架在老年骨质疏松性桡骨远端骨折中的疗效比较

目的:分析石膏固定和外固定支架在治疗老年骨质疏松性桡骨远端骨折中的治疗效果,为临床治疗提供参考依据.方法:选取在我院诊治的93例老年骨质疏松性桡骨远端骨折患者作为研究对象,根据治疗方法不同分为石膏固定组和外固定支架组,并采用Jakim评分系统对两组患者腕关节功能进行评价.结果:术后6个月,石膏固定组主观指标评分为(26.7±2.2)分,支架组为(22.3±2.6)分,经t检验,差异有统计学意义,P＜0.05;石膏固定组优良率为83.3％,支架组为86.3％,经卡方检验,差异无统计学意义,P＞0.05.结论:手法复位石膏固定固定和闭合复位外固定支架固定治疗老年骨质疏松性桡骨远端骨折均有较好的治疗效果,石膏固定疗法更易被老年患者接受.     

经会阴三维超声评价不同分娩方式初产妇肛门括约肌复合体和盆膈裂孔的临床应用价值

摘要 目的：探讨经会阴三维超声在不同分娩方式初产妇肛门括约肌复合体（ASC）和盆膈裂孔（PH）影响的评估价值。方法：选择2017年1月～2019年12月我院进行分娩的初产妇150例,按照分娩方式分成阴道分娩组71例,剖宫产组79例,比较两组基线资料。对所有受试者均实施经会阴三维超声检查,比较两组缩肛动作下肛门内括约肌（IAS）远端、中端及远端平面厚度,肛门外括约肌（EAS）远端平面及耻骨直肠肌（PRM）中端平面厚度,分娩前、产后6周、产后3个月PH左右径、PH前后径以及PH面积。结果：两组孕妇年龄、孕周及体质指数比较无差异（P＞0.05）,阴道分娩组IAS近端6点钟方向、12点钟方向平面厚度以及IAS中端、12点钟方向平面厚度均小于剖宫产组（P＜0.05）。阴道分娩组EAS远端12点钟方向平面厚度小于剖宫产组（P＜0.05）。阴道分娩组产后6周的PH左右径大于剖宫产组（P＜0.05）。阴道分娩组产后6周的PH前后径大于剖宫产组（P＜0.05）。阴道分娩组产后6周的pH面积大于剖宫产组（P＜0.05）。结论：经会阴三维超声可有效评估初产妇ASC和PH的影响情况,分娩会对初产妇ASC和PH产生影响,阴道分娩的初产妇产后存在明显的ASC厚度减小和PH增大现象。     

Estimation of external contact loads using an inverse dynamics and optimization approach: General method and application to sit-to-stand maneuvers

This paper presents a general method to estimate unmeasured external contact loads (ECLs) acting on a system whose kinematics and inertial properties are known. This method is dedicated to underdetermined problems, e.g. when the system has two or more unmeasured external contact wrenches. It is based on inverse dynamics and a quadratic optimization, and is therefore relatively simple, computationally cost effective and robust. Net joint loads (NJLs) are included as variables of the problem, and thus could be estimated in the same procedure as the ECL and be used within the cost function.     

Solution Microstructure of Confined Fluids with Directional Interactions under the Influence of an External Field: Mean Field Considerations

Lattice density functional theory (DFT) and Monte Carlo simulations are used to probe the phase behavior and equilibrium structure of molecules with directional interactions with and without the influence of body forces. It is found that the application of a position-specific external field can be used to control the microstructure of confined fluids. In the absence of an external field, a condensation transition can take place within the pore at sufficiently high densities. This phase transition results in a solution microstructure made up of chains of monomers oriented parallel to the pore walls. With the application of a weak field, it is possible to disrupt this solution microstructure. This type of effect could allow controlled mixing at a local level. Upon application of a stronger field, chains reform in a direction perpendicular to the walls.     

Post- and pre-synaptic action of isotocin in the upper esophageal sphincter muscle of the eel: its role in water drinking

Isotocin is a fish analogue of the mammalian hormone oxytocin. To elucidate sites of action of isotocin (IT) in the upper esophageal sphincter (UES) muscle, a key muscle in swallowing, IT was applied after treatment with tetrodotoxin (TTX). Even after blocking nerve activity with TTX, IT relaxes the UES muscle in a concentration-dependent manner, suggesting that IT receptor(s) is present on the muscle cells. Similar relaxation was also obtained by application of 3-isobutyl-1-methylxanthine (IBMX), forskolin (FSK) and 8-bromo-adenosine, 3′,5′-cyclic monophosphate (8BrcAMP) after pretreatment with TTX, suggesting that the relaxing effect (postsynaptic action) of IT may be mediated by cAMP. In contrast to such relaxing effect, IT enhanced the UES contraction induced by repetitive electrical field stimulation (EFS). Such enhancement was blocked by an IT receptor antagonist, suggesting that this effect is also mediated by IT receptor(s). Similar enhancement was also induced by IBMX, FSK and 8BrcAMP, suggesting the enhancing effect is also mediated by cAMP. However, no enhancing effect of IT was observed when the muscle was stimulated by carbachol, or after treatment with curare or TTX, denying the postsynaptic modulatory action of IT and suggesting presynaptic action for IT, i.e., accelerating acetylcholine release. Summarizing these results, role of IT in precisely regulating the drinking rate in the seawater eel is discussed.     

体外反搏机用心电和颞脉波发生器

以病员作为信号源对体外反搏装置的控制系统进行检测既不方便又不实际,本研究利用单片机模拟输出多种心电波形和反搏前、反搏中的颞脉波能解决此问题。实验表明研制出的体外反搏机用心电和颞脉波信号发生器运作良好,具有应用开发价值。     

Where are all the moms? External fertilization predicts the rise of male parental care in bony fishes

Parental care shows remarkable variation across the animal kingdom, but while maternal and biparental care are common in terrestrial organisms, male‐only care dominates in aquatic species that provide care. Using the most complete phylogenetic tree of bony fishes to date, we test whether the opportunity for external fertilization in aquatic environments can explain the more frequent evolution of male care in this group. We show that paternal care has evolved at least 30 times independently in fish and is found exclusively in externally fertilizing species. Male care is positively associated with pair spawning, suggesting that confidence in paternity is an important determinant of the evolution of care. Crucially, while female care is constrained by other forms of reproductive investment, male care occurs more frequently when females invest heavily in gamete production. Our results suggest that moving control of fertilization outside of the female reproductive tract raises male confidence in parentage and increases the potential for paternal care, highlighting that in an aquatic environment in which fertilization is external, paternal care is an effective reproductive strategy.     

体外反搏治疗急性重症病毒性脑炎的临床疗效观察

目的:探讨以体外反搏为主的康复手段治疗急性重症病毒性脑炎的临床疗效。方法:选择2015年6月～2016年6月在我院康复科就诊的42例急性重症病毒性脑炎患儿,按照家长治疗意愿分成治疗组和对照组,每组21例。治疗一个月和三个月后,分析和比较两组的治疗前后粗大运动功能评定量表(GMFM)、平衡功能测量(Berg量表)和修订的Glasgow意识障碍评分量表评分的变化。结果:两组患儿平衡能力总有效率(显效率与有效率之和)分别为85.7%和57.1%,以及95.2%和66.7%,治疗组疗效明显优于对照组(P0.05)。两组治疗后1、3个月,GMFM、Glasgow意识障碍评分均较治疗前明显提高(P0.01),且治疗组治疗1、3个月后GMFM显著高于对照组(P0.01)。结论:以体外反搏为主的早期康复治疗有助于急性重症病毒性脑炎患者促醒及运动功能恢复。     

美皮康在骨科外固定架患者护理中的应用

目的:探讨美皮康应用于外固定架针孔换药方式的临床效果。方法:将骨科50例四肢骨折行外固定架固定的患者随机分成实验组24例和对照组26例。实验组以美皮康有边型敷料换药,对照组以临床常用的络合碘纱布条进行换药,比较两组每天更换敷料频次,外固定针孔及周围皮肤红肿、渗出情况,护士更换污染床单被套频次及护士满意度。结果:实验组每天更换敷料频次少于对照组(P<0.05),外固定针孔及周围皮肤红肿、渗出等情况,实验组均优于对照组(P<0.05),实验组中护士更换污染床单被套频次明显少于对照组(P<0.05),护士满意度高于对照组(P<0.05)。结论:美皮康对保护骨科外固定针孔的治疗效果优于传统络合碘纱布条换药,对预防外固定针道感染有效,同时减轻护士维持床单位整洁、减少床单被套的更换频次,提高护士的满意度。