在《脉搏》的律动中探寻生命之真——评《脉搏》中的象征主义手法

本文对朱利安·巴恩斯的作品《脉搏》进行文本细读,指出巴恩斯在《脉搏》里通过象征主义手法阐释他对生命的理解、对世界的洞察,展示了后现代主义时期人类的生存困境,表现出深切的人文关怀。不同象征之间形成对照与暗示、丰富的思想和情感借象征予以表达,象征更深刻地揭示了小说的主题。象征主义手法使观念和哲理形象化和感性化,极大地丰富了文学形象和作品内容。

温情又彷徨的人生体察——读朱利安·巴恩斯的《脉搏》

朱利安·巴恩斯在短篇小说集《脉搏》中注入了饱满且敏锐的人生体察,在平凡的情感关系与细微的情感变化中表现出脉脉温情,在人生态度、婚恋价值观等方面表现出反复的游移与彷徨,在焦虑的情绪中继续对人生与人性进行执着探索,凸显了一位作家所应具有的人文主义关怀。

《脉搏》中的疾病叙事和中医形象研究

在《脉搏》中,朱利安·巴恩斯通过疾病叙事和塑造中医形象,对如何帮助老年人应对疾病展开文学思考。在疾病叙事中,巴恩斯主要采用恢复型叙事和追索型叙事分别对一对老年夫妇面临的嗅觉丧失症和运动神经元病进行书写。通过塑造父亲的爱妻形象和母亲圣地亚哥式的英雄形象,作者说明关爱和抵制隐喻性思维在面对疾病时的重要性。与此同时,巴恩斯以去妖魔化的方式塑造具有诸多中国传统美德的针灸师罗兹夫人:一方面,强调这种良好的医者形象可以赢得患者的信任,有益于激发患者恢复健康的美好心境,从而有助于患者积极面对疾病;另一方面,阐明其世界主义文化观——肯定东方文化,反对文化霸权主义并倡导文化多元论。

朱利安·巴恩斯短篇小说的衰老与死亡叙事分析

英国作家朱利安·巴恩斯的短篇小说集《柠檬桌子》与《脉搏》共同探讨了衰老与死亡主题,讲述了人在年老时对待生命纷繁复杂的态度。为了消解文本在这一敏感主题上的道德说教意味,巴恩斯着重就叙事话语层进行了设置:采用了变换式内聚焦、自由间接引语和直接引语、互文式的信件,建构出可供读者就衰老与死亡主题进行思辨的文本空间。巴恩斯意在告诫人们应该直面衰老与死亡,同时找寻生活中的爱,如此才能确认个体存在的意义与价值。

朱利安·巴恩斯短篇小说的历史叙事分析

在发表于千禧年之后的短篇小说集《柠檬桌子》与《脉搏》中,步入晚年的朱利安·巴恩斯将写作的笔触更多地聚焦人生感悟。与此同时,他延续了早期作品中对历史主题的关注,主要采用了叙事越界、戏仿传记和文类拼贴等后现代主义的写作手法,希冀读者借由历史人物反观现实生活。通过这些叙事技巧,一方面,作者表达了自我的历史观:历史是众声喧哗、颠覆严肃并且由诸多零散片段组合而成的;另一方面,巴恩斯又试图引导读者跨越历史而反观自我、烛照内心,表现借古鉴今的深刻意味。

Ambulatory blood-pressure monitoring, antihypertensive therapy and the risk of fall injuries in elderly hypertensive patients

Background Fall injuries are common among the elderly. The aim of this study was to investigate whether blood-pressure patterns, as measured by 24-h ambulatory blood pressure monitoring （ABPM）, or intensification of antihypertensive therapy following the 24-h ABPM, may be associated with fall injuries in hypertensive elderly patients. Methods In a retrospective study, community-based elderly patients （age ≥ 70 years） who were referred to 24-h ABPM were evaluated for fall injuries within one-year post-ABPM. We compared the clinical characteristics, 24-h ABPM patterns and the intensification of hypertensive therapy following 24-h ABPM, between patients with and without a fall injury. Results Overall 1032 hypertensive elderly patients were evaluated. Fifty-five （5.3%） had a fall injury episode in the year following ABPM. Patients with a fall injury were significantly older, and with higher rates of previous falls. Lower 24-h diastolic blood-pressure （67.3 ± 7.6 vs. 70.7 ± 8.8 mmHg; P 〈 0.005） and increased pulse-pressure （74.7 ± 14.3 vs. 68.3 ± 13.7 mmHg; P 〈 0.005）, were found in the patients with a fall injury, compared to those without a fall injury. After adjustment for age, gender, diabetes mellitus and previous falls, lower diastolic blood-pressure and increased pulse-pressure were independent predictors of fall injury. Intensification of antihypertensive treatment following the 24-h ABPM was not associated with an increased rate of fall injury. Conclusions Low diastolic blood-pressure and increased pulse-pressure in 24-h ABPM were associated with an increased risk of fall injury in elderly hypertensive patients. Intensification of antihypertensive treatment following 24-h ABPM was not associated with an increased risk of fall injury.

A novel approach for extracting pulse rate,respiratory rate and heart rate from photoplethysmogram

Photoplethysmogram(PPG)is a noninvasive method for detecting human cardiovascular pulse wave using optical technology.The PPG containing a lot of physiological information is from the MIMIC database.This paper proposes a combinatorial method of ensemble empirical mode decomposition(EEMD),cepstrum,fast Fourier transform(FFT)and zero-crossing detection to improve the robustness of the estimation of pulse rate(PR),heart rate(HR)and respiratory rate(RR)from the PPG.First,the PPG signal was decomposed into finite intrinsic mode functions(IMF)by EEMD.Because of its adaptive filtering property,the different signals were reconstructed using different IMFs when estimating different physiological parameters.Second,the PR was obtained by zero-crossing detection after rejecting low frequency IMFs containing artifacts.Third,IMFs with frequency between 1.00 Hz to 1.67 Hz(60 beats/min to 100 beats/min)were selected for estimating HR.Then,the frequency band that reflects the heart activity was analyzed by the cepstrum method.Finally,the respiratory signal can be extracted from PPG signal by IMFs with frequency between 0.05 Hz to 0.75 Hz(3 breahts/min to 45 breaths/min).Then the spectrum of signal was obtained by FFT analysis and the RR was estimated by detecting the maximum frequency peak.The algorithm has been tested on MIMIC database obtained from 53 adults.The experiment results show that the physiological parameters extracted by this integrated signal processing method are consistent with the real physiological parameters.And the computation load of this method is small and the precision is high(not larger than 1.17%in error).

Investigation of blood pulse PPG signal regulation on toe effect of body posture and lower limb height

Objective: To study the regulation of blood pulse volume via photoplethysmography (PPG) signal detected from toe, while the lower limb is passively raised in different height positions. Methods: Use a modified non-invasive PPG technique to detect the blood pulse signal on toe with infrared (IR) photo sensor. A protocol consisting of two postures, i.e., supine and 45° reclining, was designed to conduct laboratory trial in this study. During the period of performing the protocol of these postures, the lower limb was passively raised from the heights of 10 cm to 60 cm randomly and individually with sponge blocks underneath the foot. Results: In the supine posture, the higher the foot was passively raised, the more the blood PPG signal decreased. In the 45° reclining posture, the blood PPG signal increased at the beginning and then decreased in the foot height position from 10 cm to 60 cm. In both postures the normalized AC signal changes significantly while the normalized DC signal changes little. Conclusion: The toe PPG signals can obviously indicate the regulated blood volume change with the designated postural procedures due to the heart level position.

Structure and design method for pulse-triggered flip-flops at switch level

A kind of structure and a design method using transmission voltage-switch theory for pulse-triggered flip-flops were proposed,which are suitable for all kinds of pulse-triggered flip-flops and no extra techniques are needed to eliminate the switching activities of internal nodes.Based on the proposed structure and design technique,two pulsed flip-flops were implemented and simulated.The proposed pulsed flip-flops have simple circuit structures.HSPICE simulation shows that the proposed pulsed D flip-flop outperforms the conventional pulsed D flip-flop by 17.2% in delay and 30.1% in power-delay-product(PDP) and the proposed pulsed JK flip-flop has low power and small PDP compared with pulsed D pulsed flip-flops,confirming that the proposed structure and design technique are simple and practical.

Brachial-ankle pulse wave velocity is an independent predictor of carotid artery atherosclerosis in the elderly

Objective Brachial-ankle pulse wave velocity （baPWV） is widely used as a simple noninvasive measure of arterial softness. The aim of this study was to evaluate the usefulness of baPWV as a predictor of the carotid artery atherosclerosis in the elderly. Methods A total of 721 elderly participants （mean ~ SD age, 70.3 -4- 5.6years） were enrolled in the current study. All participant underwent both baPWV measurement and B-mode ultrasound for the intima-media thickness. Carotid atherosclerosis （CAS） was defined as the present of carotid plaque or and/or intima media thickness for at least 1.1 mm. Results A multivariate logistic regression analysis reveals that age, sex, brachial-ankle pulse wave velocity, smoking and LDL-C level showed a significant correlation with the presence of CAS. The odds ratios of CAS associated with a 500cm/s increase of brachial-ankle pulse wave velocity were 2.378 [95% confidence interval, 1.36 to 4.00, P〈0.05], 3.733 [95% confidence interval, 1.729 to 8.058, P〈0.01], 4.438 [95% confidence interval, 1.659 to 11.803, P〈0.01]. The baPWV significantly correlated with IMT by bivariate correlation analysis （r=-0.39; p=0.001）. After adjusting for factors influencing, baPWV all the same correlated with IMT （r=-0.35; p=0.001）.Conclusion These results indicate that brachial-ankle PWV is an independent predictor of CAS in the elderly.It also means that the direct measurement of arterial stiffness by this simple method may be of great help for the evaluation of carotid artherosclerosis, at least in the elderly

Hemodynamics in the portal vein evaluated by pulse wave Doppler ultrasonography in patients with chronic hepatitis C treated with interferon

AIM: To employ pulse wave Doppler ultrasonography to evaluate the changes in portal blood flow velocity in patients with chronic hepatitis C (CHC) receiving interferon (IFN) treatment. METHODS: The subjects in this study were 14 patients (13 men and l woman) with CHC who received IFN treatment. Portal blood flow velocity was measured in the vessels at the porta hepatis at four time points: before IFN administration (pre-IFN), 2 wk after the start of administration (wk 2), 24 wk after the start of administration (wk 24, i.e., the end of IFN administration), and 24 wk after the end of administration (wk 48). RESULTS: The patients with CHC in whom IFN treatment resulted in complete elimination or effective elimination of viruses showed a significant increase in portal blood flow velocity at the end of IFN treatment compared with that before IFN treatment. In contrast, when IFN was ineffective, no significant increase in portal blood flow velocity was observed at wk 24 or 48 compared with the pre-IFN value. In addition, the patients with CHC in whom IFN was ineffective showed significantly lower portal blood flow velocity values than control subjects at all measurement time points. CONCLUSION: Pulse wave Doppler ultrasonography is a noninvasive and easily performed method for evaluating the effects of IFN treatment in patients with CHC. This technique is useful for measuring portal blood flow velocity before and 24 wk after IFN administration in order to evaluate the changes over time, thus assessing the effectiveness of IFN treatment.

Anticoagulation therapy in intra-aortic balloon counterpulsation： Does IABP really need anti-coagulation ？

Objective: To investigate if intra-aortic balloon pump(IABP) is contraindicated without anticoag-ulation therapy. Methods: Some 153 IABP patients in the King Abdulaziz Cardiac Center(KSA) were random-ly assigned into two groups. Anticoagulation group( Group A) consisted of 71 patients who were given heparin intravenously with target aPTT 50 - 70 seconds. Non-anticoagulation group( Group B) consisted of 82 patients without intravenous heparin during balloon pumping. Hematological parameters including platelet count, D-dimer, Plasminogen activator inhibitor-1 (PAI-1) and fibrinogen degradation products(FDP) were checked respectively at the point of baseline, 24 hours, 48 hours and 24 hours post IABP counterpulsation. Clot deposits on balloon surface, vascular complications from IABP including bleeding and limb ischemia were recorded.Results: Platelet count and PAI-1 level decreased at 24 hours and 48 hours in both groups ( P < 0.05) . D-dimer and FDP level increased at 24 hours and 48 hours in both groups( P < 0.05), but returned to the baseline level 24 hours post IABP removal( P > 0.05) . Three patients in Group A and 2 patients in Group B developed minor limb ischemia( P > 0.05). No major limb ischemia in either group. Two patients in Group A suffered major bleeding and required blood transfusion or surgical intervention, whereas no patient had major bleeding in Group B. Eight patients had minor bleeding in Group A, but only 2 patients in Group B ( P <0.05). No clot deposit developed on IABP surface in either group. Conclusion: IABP is safe without routine anticoagulation therapy. Selecting appropriate artery approach and early detection intervention are key methods for preventing complications.

A new interpretation of TCM pulse diagnosis based on quantum physical model of the human body

Following the quantum theory-based physical model of the human body,a new interpretation of the traditional Chinese medicine(TCM)principle of"Cunkou reads viscera"is presented.Then,a Gaussian pulse wave model as a solution to the Schrodinger equation is shown to accurately describe 19 different pulse shapes,and to quantitatively capture the degree of YinYang attributes of 13 pulse shapes.Furthermore,the model suggests using pulse depth and strength as leading-order quantity and pulse shape as first-order quantity,to characterize the hierarchical resonance between the human body and the environment.The future pulse informatics will focus on determining an individual’s unique quantum human equilibrium state,and diagnose its health state according to the pulse deviation from its equilibrium state,to truly achieve the high level of TCM:"knowing the normal state and reaching the change".

Carbon dioxide accumulation during analgosedated colonoscopy: Comparison of propofol and midazolam

AIM: To characterize the profiles of alveolar hypoventilation during colonoscopies performed under sedoanalgesia with a combination of alfentanil and either midazolam or propofol. METHODS: Consecutive patients undergoing routine colonoscopy were randomly assigned to sedation with either propofol or midazolam in an open-labeled design using a titration scheme. All patients received 4 μg/kg per body weight alfentanil for analgesia and 3 L of supplemental oxygen. Oxygen saturation (SpO 2 ) was measured by pulse oximetry (POX), and capnography (PcCO 2 ) was continuously measured using a combined dedicated sensor at the ear lobe. Instances of apnea resulting in measures such as stimulation of the patient, a chin lift, a mask maneuver, or withholding of sedation were recorded. PcCO 2 values (as a parameter of sedation-induced hypoventilation) were compared between groups at the following distinct time points: baseline, maximal rise, termination of the procedure and 5 min after termination of the procedure. The number of patients in both study groups who regained baseline PcCO 2 values (± 1.5 mmHg) five minutes after the procedure was determined.RESULTS: A total of 97 patients entered this study. The data from 14 patients were subsequently excluded for clinical procedure-related reasons or for technical problems. Therefore, 83 patients (mean age 62 ± 13 years) were successfully randomized to receive propofol (n = 42) or midazolam (n = 41) for sedation. Most of the patients were classified as American Society of Anesthesiologists (ASA) Ⅱ [16 (38%) in the midazolam group and 15 (32%) in the propofol group] and ASA Ⅲ [14 (33%) and 13 (32%) in the midazolam and propofol groups, respectively]. A mean dose of 5 (4-7) mg of Ⅳ midazolam and 131 (70-260) mg of Ⅳ propofol was used during the procedure in the corresponding study arms. The mean SpO 2 at baseline (%) was 99 ± 1 for the midazolam group and 99 ± 1 for the propofol group. No cases of hypoxemia (SpO 2 < 85%) or apnea were recorded. However, an increase in PcCO 2 that indicated alveolar hypoventilation occurred in both groups after administration of the first drug and was not detected with pulse oximetry alone. The mean interval between the initiation of sedation and the time when the PcCO 2 value increased to more than 2 mmHg was 2.8 ± 1.3 min for midazolam and 2.8 ± 1.1 min for propofol. The mean maximal rise was similar for both drugs: 8.6 ± 3.7 mmHg for midazolam and 7.4 ± 3.2 mmHg for propofol. Five minutes after the end of the procedure, the mean difference from the baseline values was significantly lower for the propofol treatment compared with midazolam (0.9 ± 3.0 mmHg vs 4.3 ± 3.7 mmHg, P = 0.0000169), and significantly more patients in the propofol group had regained their baseline value ± 1.5 mmHg (32 of 41vs 12 of 42,P = 0.0004). CONCLUSION: A significantly higher number of patients sedated with propofol had normalized PcCO 2 values five minutes after sedation when compared with patients sedated with midazolam.

Some nonlinear parameters of PP intervals of pulse main peaks

The PP intervals of pulse main peaks from healthy and unhealthy people(arrhythmia) have different nonlinear char-acteristics. In this paper,the extraction of PP intervals of pulse main peaks is achieved by picking up P peaks of pulse wave with wavelet transform. Furthermore,several nonlinear parameters(correlative dimensions,maximum Lyapunov exponents,com-plexity and approximate entropy) of the PP intervals of pulse main peaks extracted from normal and unhealthy pulse signals are calculated,with the results showing that these nonlinear parameters calculated from the main wave interval signals are helpful for analyzing human's health state and diagnosing heart diseases.

Information Fusing Recognition of Traditional Chinese Medicine (TCM) Pulse State Based on Stochastic Fuzzy Neural Network

Based on the fuzzy characteristic of the pulse state and syndromes differentiation thinking mode of TCM, an information fusing recognition method of pulse states based on SFNN (Stochastic Fuzzy Neural Network) is presented in this paper. With the learning ability in parameters and structure, SFNN fuses the measurement information of three pulse-state sensors distributed in Cun, Guan, and Chi location of body for the pulse state recognition. The experimental results show that the percentage of correct recognition with new method is higher than that by single-data recognition one, with fewer off-line train numbers.

Analyses of Characteristics of Long-Term Monitoring of Arterial Pressure and Pulse

Long-term observations of pulse and arterial blood pressure taken from a patient＇s daily self-control diary have been analyzed in the paper. The diary was kept in the morning and in the evening. It contains regular observational data collected during over 13 years. Statistical estimates of series and their spectral responses were obtained. A difference between the morning and evening series was noted. Spectral harmonics with the period of 7 days was typical of the evening series. The morning series are characterized by a ＂lunar＂ component with the -27.35-day period. The examined series were also compared with the daily series of atmospheric pressure and daily Wolf numbers. Seasonal pulse and arterial pressure pattern and average monthly self-control tabulated data obtained during 13 years are presented in the paper.

Effect of verapamil on nitric oxide synthase in a portal veinligated rat model: Role of prostaglandin

AIM： To investigate the effects of verapamil on nitric oxide （NO） synthesis in a portal vein-ligated rat model. METHODS： Systemic and splanchnic hemodynamics were measured by radiolabeled microspheres in portal hypertensive rats after acute administration of verapamil （2 mg/kg） on chronic treatment with N^W-nitro-L-arginine （NNA）（80 mg/kg） and/or indomethacin （2 mg/kg） . RESULTS： Verapamil （2 mg/kg） caused a marked fall in both arterial pressure and cardiac output accompanied by an insignificant change in the portal pressure and no change in portal venous inflow. This result suggested that verapamil did not cause a reduction in portal vascular resistance of portal hypertensive rats, which was similar between N^w- nitro-Loarginine-treated and indomethacin-treated groups. CONCLUSION： In portal hypertensive rats pretreated with NNA and/or indomethacin, acute verapamil administration can not reduce the portal pressure, suggesting that NO and prostaglandin play an important role in the pathogenesis of splanchnic arterial vasodilation in portal hypertension.

INFLUENCES OF TWO CARIES REMOVAL METHODS ON BLOOD PRESSURE AND PULSE IN CHILDREN

Objective To compare the effect of chemomechanical caries removal （CMCR） to traditional drilling （TD） on blood pressure and pulse in children. Methods Of all 105 subjects, 53 were randomly assigned to CMCR group; 52, to TD group. For each subject, the systolic pressure （SP）, diastolic pressure （DP） and pulse （ P ） were measured at five time-point： pre-treatment, initiation of carious removal, the end of carious removal, the end of the cavity restoration, and the end of the dental care. They were recorded as To, T1 , T2, T3, and TE, respectively. The difference of SP, DP, and P within each group were analyzed. Results Of all 105 subjects, 14 were administered local anesthesia. Since local anesthesia may be a confounding factor for changes in blood pressure and pulse, only the data of the other 91 subjects that local anesthesia were not administered were analyzed. Regarding the SP, DP, and P for TD, the difference between TO and T1 was significant （ P = 0. 013, 0. 015, 0. 012 respectively）, while not significant between T1 and T2, T2 and T3, T3 and TE（ P 〉0. 05）. Regarding the SP, DP, and P for CMCR, the differences were not significant between every two consecutive time-points （ P 〉 0. 05）. The differences of the SP, DP, and P between CMCR and TD were not significant for time-points T0, T3 and Te （p 〉 0. 05 ）, while significant for T1 and T2 （ P 〈 0. 05 ）. Conclusion In general, CMCR induces less increase of blood pressure and pulse in children compared to traditional drilling （TD）. It may be inferred that CMCR is less distressing than TD.

Prediction of pulmonary arterial wedge pressure from arterial pressure or pulse oximetry plethysmographic waveform

Objective To assess the possibility of using arterial pressure waveform or pulse oximetry plethysmographic waveform variation to estimate the pulmonary arterial wedge pressure (PAWP) Methods Fourteen American Society of Anesthesiologists grade Ⅰ-Ⅱ patients aged 33-69 years and weighing 62 0±9 5 kg scheduled for elective abdominal tumor surgery were studied Their hemoglobin exceeded 120 g/L and hematocrit exceeded 35% Pre operative acute hypervolemic hemodilution was applied immediately after general anesthestic induction and tracheal intubation PAWP, systolic pressure variation (SPV), delta down (dDown), SPV plet , dDown plet and other hemodynamic parameters were measured and recorded when total fluid volume (crystalloid and colloid) infused reached 10 ml/kg and 20 ml/kg and again at the end of the operation Central venous pressure was maintained at 10-12 mm Hg during operation Systolic blood pressure at the end of Valsalva maneuver (airway pressure was kept at 22 mm Hg) and the systolic pressure before the Valsalva manoeuvre during apnea were used to calculate arterial pressure ratio (APR) Results APR, SPV, dDown, SPV plet and dDown plet all correlated well with PAWP ( r =0 717, -0 695, -0 680, -0 522 and -0 624 respectively, P <0 01) There was a closer linear correlation between APR and PAWP than between the other parameters The regression equation was PAWP (mm Hg)=0 207×APR (%)-0 382 Conclusion During positive pressure mechanical ventilation, APR, SPV, dDown, SPV plet and dDown plet can be used to estimate PAWP effectively