电针阴部神经刺激疗法联合Kegel盆底康复训练对产后压力性尿失禁患者盆底肌力、尿流动力学和生活质量的影响

摘要 目的：探讨电针阴部神经刺激疗法联合Kegel盆底康复训练对产后压力性尿失禁（SUI）患者盆底肌力、尿流动力学和生活质量的影响。方法：选取2019年6月~2021年11月期间于我院就诊的产后SUI患者109例,按照入院就诊奇偶顺序分为两组,其中对照组54例,接受Kegel盆底康复训练,研究组55例,接受电针阴部神经刺激疗法联合Kegel盆底康复训练。对比两组疗效、漏尿量、尿失禁程度、盆底肌力、尿流动力学和生活质量。结果：研究组的临床总有效率高于对照组（P<0.05）。两组治疗后盆底肌肌力各指标（手测肌力和Ⅰ类肌纤维最大值、Ⅱ类肌纤维平均值）均升高,且研究组高于对照组（P<0.05）。两组治疗后漏尿量、尿失禁程度评分均下降,且研究组低于对照组（P<0.05）。两组治疗后尿流动力学相关指标[腹压漏尿点压（AL-PP）、最大尿流率（Qmax）和最大尿道闭合压力（MUCP）]均升高,且研究组高于对照组（P<0.05）。两组治疗后尿失禁生活质量量表（I-QOL）各维度（限制性行为、心理影响、社交活动受限）评分及总分均升高,且研究组高于对照组（P<0.05）。结论：电针阴部神经刺激疗法联合Kegel盆底康复训练可有效改善产后SUI患者的盆底肌肌力和尿失禁情况,减少漏尿量,同时可促进尿流动力学恢复,进而提高患者的生活质量。     

盆底肌功能训练联合阴茎夹对前列腺增生术后患者尿失禁的临床应用分析

目的:分析盆底肌功能训练联合阴茎夹对前列腺增生术后患者尿失禁的临床应用效果。方法:选取我院2017年4月～2019年4月收治的72例前列腺增生术后尿失禁患者,随机分为对照组和观察组各36例,两组均予盆底肌功能训练,观察组加用阴茎夹控制排尿。对比两组术后尿失禁改善情况、排尿改善情况、国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)评分变化、压力性尿失禁分度评价及经济费用情况。结果:两组干预后20 d、干预后30 d、干预后90 d尿失禁发生率均较干预后10 d下降,观察组干预后10 d、干预后20 d、干预后30 d、干预后90 d尿失禁发生率均低于对照组,差异均有统计学意义(P0.05)。两组干预后90 d每日总尿量较干预前升高,每日总排尿次数、每日总漏尿次数均较干预前下降;观察组干预后90 d每日总尿量高于对照组,每日总排尿次数、每日总漏尿次数均低于对照组,差异均有统计学意义(P0.05)。两组干预后90d ICI-Q-SF评分均较干预前下降,且观察组干预后90d ICI-Q-SF评分低于对照组,差异均有统计学意义(P0.05)。观察组患者干预后压力性尿失禁临床治愈率高于对照组,差异有统计学意义(P0.05)。两组患者压力性尿失禁分度情况比较差异无统计学意义(P0.05)。观察组阴茎夹使用费用为(70.26±8.51)元,低于对照组的(388.71±26.44)元,差异有统计学意义(P0.05)。结论:在盆底肌功能训练的基础上联合阴茎夹能够有效改善前列腺增生术后患者尿失禁症状及生活质量,且有助于降低患者经济负担,值得临床推广应用。     

旧石器时代考古与栖居及生计形态分析

由于打制石器本身所含的人类行为信息比较有限,我国旧石器时代考古研究应该引入文化生态学的理论方法,从宏观的生态位、中观的遗址域和微观的居住面分析来充分提炼古人类觅食方式和资源利用的信息。本文介绍了栖居(聚落)形态和遗址域概念的方法论及意义,并用墨西哥瓦哈卡河谷圭拉那魁兹的研究案例来说明这些概念在人地关系研究和农业起源研究中的重要性。文章呼吁旧石器时代考古研究要从低端的分类描述转向人类环境和行为的重建,以期令我们的研究水准跻身世界先进水平。     

The effect of floor type on the performance,cleanliness, carcass characteristics and meat quality of dairy origin bulls

The aim of this study was to evaluate the effect of using different floor types to accommodate growing and finishing beef cattle on their performance, cleanliness, carcass characteristics and meat quality. In total, 80 dairy origin young bulls (mean initial live weight 224 kg (SD=28.4 kg)) were divided into 20 blocks with four animals each according to live weight. The total duration of the experimental period was 204 days. The first 101 days was defined as the growing period, with the remainder of the study defined as the finishing period. Cattle were randomly assigned within blocks to one of four floor type treatments, which included fully slatted flooring throughout the entire experimental period (CS); fully slatted flooring covered with rubber strips throughout the entire experimental period (RS); fully slatted flooring during the growing period and moved to a solid floor covered with straw bedding during the finishing period (CS-S) and fully slatted flooring during the growing period and moved to fully slatted flooring covered with rubber strips during the finishing period (CS-RS). Bulls were offered ad libitum grass silage supplemented with concentrates during the growing period. During the finishing period, bulls were offered concentrates supplemented with chopped barley straw. There was no significant effect of floor type on total dry matter intake (DMI), feed conversion ratio, daily live weight gain or back fat depth during the growing and finishing periods. Compared with bulls accommodated on CS, RS and CS-RS, bulls accommodated on CS-S had a significantly lower straw DMI (P<0.01). Although bulls accommodated on CS and CS-S were significantly dirtier compared with those accommodated on RS and CS-RS on days 50 (P<0.05) and 151 (P<0.01), there was no effect of floor type on the cleanliness of bulls at the end of the growing and finishing periods. There was also no significant effect of floor type on carcass characteristics or meat quality. However, bulls accommodated on CS-S had a tendency for less channel, cod and kidney fat (P=0.084) compared with those accommodated on CS, RS and CS-RS. Overall, floor type had no effect on the performance, cleanliness, carcass characteristics or meat quality of growing or finishing beef cattle.     

Fine litter input to terrestrial humus forms in Colombian Amazonia

A comparative litter fall study was made in five rain forest stands along a gradient of humus form development and soils in the Amazon lowlands of eastern Colombia. The total fine litter fall was highest in a plot on a well drained soil of the flood plain of the Caquetá River (1.07 kg · m^-2 · y^-1), lower in three plots on well drained upland soils (0.86, 0.69, and 0.68 kg · m^-2 · y^-1), and lowest in a plot on a poorly drained, upland podzolised soil (0.62 kg · m^-2 · y^-1). In the four upland plots, leaf litter fall patterns were highly associated, which points at climatic regulation. Litter resource quality, as represented by nutrient concentrations and area/weight ratio of the leaf litter fall, was comparatively high in the flood plain plot. In the upland plots, concentrations and fluxes of Ca, Mg, K, and P were as low as in oligotrophic central Amazonian upland forests. This questions generalisations that the western peripheral region of the Amazon basin should be less oligotrophic than central Amazonia. The upland plot on the podzolised soil showed the lowest concentrations and fluxes of N. Mean residence times of organic matter and nutrients in the L horizons hardly differed between the five plots, suggesting that edaphic properties and litter resource quality are of little importance in the first step of decomposition. Mean residence time of organic matter in all ectorganic horizons combined (estimated on the basis of litter input and necromass on the forest floor, and uncorrected for dead fine root input) varied from 1.0 y in the flood plain forest, 1.1–3.3 y in the well drained upland forests, and 10.2 y in the forest on the podzolised soil.     

Review of root dynamics in forest ecosystems grouped by climate,climatic forest type and species

Patterns of both above- and belowground biomass and production were evaluated using published information from 200 individual data-sets. Data sets were comprised of the following types of information: organic matter storage in living and dead biomass (e.g. surface organic horizons and soil organic matter accumulations), above- and belowground net primary production (NPP) and biomass, litter transfers, climatic data (i.e. precipitation and temperature), and nutrient storage (N, P, Ca, K) in above- and belowground biomass, soil organic matter and litter transfers. Forests were grouped by climate, foliage life-span, species and soil order. Several climatic and nutrient variables were regressed against fine root biomass or net primary production to determine what variables were most useful in predicting their dynamics. There were no significant or consistent patterns for above- and belowground biomass accumulation or NPP change across the different climatic forest types and by soil order. Similarly, there were no consistent patterns of soil organic matter (SOM) accumulation by climatic forest type but SOM varied significantly by soil order—the chemistry of the soil was more important in determining the amount of organic matter accumulation than climate. Soil orders which were high in aluminum, iron, and clay (e.g. Ultisols, Oxisols) had high total living and dead organic matter accumulations-especially in the cold temperate zone and in the tropics. Climatic variables and nutrient storage pools (i.e. in the forest floor) successfully predicted fine root NPP but not fine root biomass which was better predicted by nutrients in litterfall. The importance of grouping information by species based on their adaptive strategies for water and nutrient-use is suggested by the data. Some species groups did not appear to be sensitive to large changes in either climatic or nutrient variables while for others these variables explained a large proportion of the variation in fine root biomass and/or NPP.     

Biogeochemical controls on aluminum chemistry in the O horizon of a red spruce (Picea rubens Sarg.) stand in central Maine,USA

This study examined the biotic and abiotic processes controlling solution chemistry and cycling of aluminum (Al) in the organic horizons of a northern coniferous forest ecosystem. A mass balance budget indicated that aboveground inputs of Al to the O horizon averaged 0.9 kg ha^–1 1 yr^–1, with major inputs accounted for by litterfall (69%), followed by precipitation (21%), and net canopy throughfall plus stemflow (10%). Estimated leaching losses of Al from the O horizon averaged 2.1 kg Al ha^-1 yr1. We hypothesize that the difference between measured Al inputs and outputs can be accounted for by Al release from weathering of soil minerals admixed into the O horizon. Variations in O horizon solution Al chemistry were influenced by a number of factors, including pH, Al equilibria with different solid-phase organic exchange sites, and Al complexation with humic ligands in soil solution.     

DE-3L型妇产科电脑综合治疗仪用于产后的效果观察

目的探讨DE-3L型妇产科电脑综合治疗仪应用于产后泌乳与机体康复效果。方法将我院收治的231例顺产妇依据产后康复方式差异进行分组,治疗组采用DE-3L型妇产科电脑综合治疗仪治疗,对照组产后进行母乳喂养宣教联合盆底肌训练,比较两组产后泌乳、子宫复旧与恶露量及盆底组织康复情况。结果治疗组促泌乳、子宫复旧与恶露量减少及盆底肌肉肌力恢复情况均明显优于对照组(P0.05)。结论 DE-3L型妇产科电脑综合治疗仪可有效促进产妇产后泌乳、恶露排出与盆底组织的康复,值得临床应用。     

3D finite element modeling of pelvic organ prolapse

Objectives: The purpose of this study is to develop a validated 3D finite element model of the pelvic floor system which can offer insights into the mechanics of anterior vaginal wall prolapse and have the ability to assess biomedical device treatment methods. The finite element results should accurately mimic the clinical findings of prolapse due to intra-abdominal pressure (IAP) and soft tissues impairment conditions. Methods: A 3D model of pelvic system was created in Creo Parametric 2.0 based on MRI Images, which included uterus, cervix, vagina, cardinal ligaments, uterosacral ligaments, and a simplified levator plate and rectum. The geometrical model was imported into ANSYS Workbench 14.5. Mechanical properties of soft tissues were based on experimental data of tensile test results from current literature. Studies were conducted for IAP loadings on the vaginal wall and uterus, increasing from lowest to extreme values. Results: Anterior vaginal wall collapse occurred at an IAP value corresponding to maximal valsalva and showed similar collapsed shape as clinical findings. Prolapse conditions exhibited high sensitivity to vaginal wall stiffness, whereas healthy tissues was found to support the vagina against prolapse. Ligament impairment was found to have only a secondary effect on prolapse.     

Effects of shielding on pelvic and abdominal IORT dose distributions

PurposeTo study the impact of shielding elements in the proximity of Intra-Operative Radiation Therapy (IORT) irradiation fields, and to generate graphical and quantitative information to assist radiation oncologists in the design of optimal shielding during pelvic and abdominal IORT.MethodAn IORT system was modeled with BEAMnrc and EGS++ Monte Carlo codes. The model was validated in reference conditions by gamma index analysis against an experimental data set of different beam energies, applicator diameters, and bevel angles. The reliability of the IORT model was further tested considering shielding layers inserted in the radiation beam. Further simulations were performed introducing a bone-like layer embedded in the water phantom. The dose distributions were calculated as 3D dose maps.ResultsThe analysis of the resulting 2D dose maps parallel to the clinical axis shows that the bevel angle of the applicator and its position relative to the shielding have a major influence on the dose distribution. When insufficient shielding is used, a hotspot nearby the shield appears near the surface. At greater depths, lateral scatter limits the dose reduction attainable with shielding, although the presence of bone-like structures in the phantom reduces the impact of this effect.ConclusionsDose distributions in shielded IORT procedures are affected by distinct contributions when considering the regions near the shielding and deeper in tissue: insufficient shielding may lead to residual dose and hotspots, and the scattering effects may enlarge the beam in depth. These effects must be carefully considered when planning an IORT treatment with shielding.