宋若会主任医师以郑氏喉科护元学说论治小儿鼻鼽经验总结

宋若会主任医师为新安郑氏喉科流派主要传承人,认为小儿鼻鼽与禀赋体质密切相关,肺脾肾不足是致病之本,邪热郁肺为致病之标,根据郑氏喉科流派的"护元"学说对小儿鼻鼽进行辨证论治,提出以黄芪和党参为君药的"顾护元气,补脾益肺"配合"清热宣肺,散邪通窍"的治疗方法,并根据发病阶段及兼证不同随症加减,临证疗效显著。附医案3则,以资验证。

护宫保元袋治疗痛经、经前期紧张综合征临床及实验研究

护宫保元袋治疗痛经、经前期紧张综合征临床及实验研究驻北京海军总医院（１０００３７）江海身山东医科大学云门制药厂（２６２５００）刘泳，刘兰菊，石岩，杨兴文，马全龙关键词护宫保元袋，痛经，经前期紧张综合征，临床研究，实验研究护宫保元袋是专门为妇科月经疾患...

医养结合—四元联动整合照护在老年脑梗死患者护理中的应用

目的探讨医养结合—四元联动整合照护在老年脑梗患者护理中的应用。方法利用随机数表法将本院2019年1月~2020年2月完成治疗后正常出院的108例老年脑梗死患者分为对照、观察两组,两组各54例,对照组进行常规护理干预,观察组进行医养结合—四元联动整合照护,连续进行干预5个月后,使用卒中量表(NIHSS)与生活质量量表(SF-36)分别测定两组患者干预前后神经功能与生活质量,同时评估两组患者护理满意度。结果两组患者NIHSS得分均有明显下降,且观察组干预后得分降低明显多于对照组(P<0.05);两组患者SF-36量表中八个维度得分与干预前相比均明显上升,且躯体疼痛、生理机能、精神健康、情感职能、生活活力、社会功能、健康状况、生理职能方面观察组得分明显高于对照组,有统计学意义(P<0.05);通过对患者满意度测评,观察组对护理技术、护理态度、健康教育满意度均明显高于对照组,两组相比存在统计学差异(P<0.05)。结论医养结合—四元联动照护能有限改善老年脑梗死患者神经功能,且能明显改善患者生活质量,同时对护理满意度良好,有助于改善医护患关系。

从保护残余肾功能角度探析吕勇护肾元辨治慢性肾衰竭经验

该文从保护残余肾功能角度出发,总结吕勇主任医师以"护肾元"为核心辨治慢性肾衰竭的学术经验。吕勇认为肾元虚衰为慢性肾衰发病之本,因虚致实,而导致浊毒潴留内蕴为标。故辨治法则以固护肾元为本,泄浊解毒为标,以达保护残余肾功能的目的。祛邪主要以泄浊排毒、化瘀通络为法,扶正则从补益肺、脾、肾三脏着手辨治。

医养结合-四元联动整合照护模式对胃癌化疗患者的影响

目的探讨医养结合—四元联动整合照护模式对胃癌化疗患者癌因性疲乏及不良情绪的影响。方法2018年8月—2020年8月选取本院肿瘤科收治的胃癌化疗患者94例,根据患者入院时间将患者分为对照组(2018年8月—2019年8月,n=47)和观察组(2019年9月—2020年8月,n=47),对照组行常规延续性护理指导,观察组应用医养结合—四元联动整合照护模式实施护理,干预时间为3个月,比较两组干预前后癌因性疲乏、不良情绪及应对方式。结果干预后观察组癌因性疲乏总评分、简明心境问卷(POMS)总评分、屈服应对、回避应对等评分较对照组显著下降(P<0.05),而面对应对评分高于对照组(P<0.05)。结论医养结合—四元联动整合照护模式可减轻胃癌化疗患者不良情绪及癌因性疲乏,促使患者以积极的方式面对疾病。

郑日新教授治疗鼻鼽经验拾遗

鼻鼽是耳鼻咽喉科常见病、多发病,多表现为鼻痒、鼻塞、喷嚏、流清涕等,具有阵发性、反复性。郑日新教授作为新安医学郑氏喉科嫡传后学,基于新安郑氏喉科流派学术思想,结合丰富的临床经验在治疗鼻鼽方面有其独特见解,认为其发病多与肺脾肾三脏虚损及外邪有关,提出“护元扶正”“养阴清肺”“益气健脾”治法。在选方用药上,肺肾虚寒者多用黄芪、党参、白术、附子;肺经伏热者加生地黄、牡丹皮、麦冬;肺脾气虚者多用茯苓、白术、陈皮、黄芪等,临床应用时随证加减,疗效显著。通过总结郑日新教授治疗鼻鼽的临床经验,并举验案,予以例证,为中医治疗鼻鼽提供新的思路。

Influence of confined water on the limit support pressure of tunnel face in weakly water-rich strata

In the process of shield tunneling through soft soil layers,the presence of confined water ahead poses a significant threat to the stability of the tunnel face.Therefore,it is crucial to consider the impact of confined water on the limit support pressure of the tunnel face.This study employed the finite element method(FEM)to analyze the limit support pressure of shield tunnel face instability within a pressurized water-containing layer.Subsequently,a multiple linear regression approach was applied to derive a concise solution formula for the limit support pressure,incorporating various influencing factors.The analysis yields the following conclusions:1)The influence of confined water on the instability mode of the tunnel face in soft soil layers makes the displacement response of the strata not significant when the face is unstable;2)The limit support pressure increases approximately linearly with the pressure head,shield tunnel diameter,and tunnel burial depth.And inversely proportional to the thickness of the impermeable layer,soil cohesion and internal friction angle;3)Through an engineering case study analysis,the results align well with those obtained from traditional theoretical methods,thereby validating the rationality of the equations proposed in this paper.Furthermore,the proposed equations overcome the limitation of traditional theoretical approaches considering the influence of changes in impermeable layer thickness.It can accurately depict the dynamic variation in the required limit support pressure to maintain the stability of the tunnel face during shield tunneling,thus better reflecting engineering reality.

基于扩展物元模型的客户动态评价

针对传统客户评价方法存在的静态性、片面性和主观性等缺点,提出一种基于扩展物元模型的客户动态评价方法.在基本物元模型的基础上,扩展构建了客户动态评价的3种扩展物元模型.根据物元模型的可拓性和物元变换原理,定义了扩展物元集合及拓展运算法则.以构建的3种扩展物元模型为基础,通过拓展运算可得到多种多维组合客户评价物元模型,增加了评价方法的动态性和可拓性.结合熵权理论,给出了客户的动态评价算法.通过某电梯公司客户动态评价的应用实例,分析和预测了客户的价值和消费行为,为企业进行经营决策和市场预测提供了重要依据.

Preparation of Nitrogen-Doped Carbon Catalyst to Oxygen Reduction Reaction and Influence of Protective Gas Flowing on Its Activity

A non-precious metal catalyst MnHMTA/C to oxygen reduction reaction was prepared by py- rolyzing a precursor from manganese chloride, hexamethylenetetramine and acetylene black in nitrogen gas atmosphere. The effect of heat treatment temperature and flowing of nitrogen gas were investigated. A catalyst with the highest activity can be obtained at 700 ℃. Mn（Ⅱ） ion was changed to MnO in heat treatment, which improved the catalytic activity of the catalyst. Hexamethylenetetramine takes part in the formation of active site of the catalyst as its decomposed gases. The flowing of protective gas takes the decomposed gases out of the tube furnace and brings negative effect on the catalytic activity of the MnHMTA/C catalyst.

医养结合-四元联动整合照护在晚期肝癌患者院外护理中的应用

目的探讨医养结合-四元联动整合照护模式在晚期肝癌患者院外护理中的应用.方法采用便利抽样法,选取2015年1月-2016年4月在郑州大学第一附属医院完成院内治疗后正常出院的42例晚期肝癌患者为对照组,给予常规延续性护理;选取2016年8月-2017年12月完成院内治疗后正常出院的44例晚期肝癌患者为观察组,给予医养结合-四元联动整合照护.持续干预6个月后,对比两组患者简明心境问卷(POMS)、社会支持评定量表(SSRS)得分变化.结果干预前,两组患者POMS、SSRS量表各维度得分比较,差异无统计学意义(P>0.05);干预后,观察组POMS量表中紧张-焦虑、愤怒-敌意、迷惑-混乱、疲乏-迟钝维度得分均低于对照组,两组比较差异均有统计学意义(P<0.05);SSRS量表中客观支持、对支持的利用度得分均高于对照组,两组比较差异均有统计学意义(P<0.05).结论医养结合-四元联动整合照护模式能够有效改善晚期肝癌院外护理患者不良情绪,提升其社会支持,具有良好的应用价值.

Protective effect of selenium-enriched lactobacilluson CCI_4-induced liver injury in mice and its possible mechanisms

AIM： To study the protective effects and mechanisms of Se-enriched lactobacillus on liver injury caused by carbon tetrachloride （CCl4） in mice. METHODS： Seventy-two ICR mice were randomly divided into four groups： normal group, CCl4-induced model group, low Se-enriched lactobacillus treatment group （L-Se group）, and high Se-enriched lactobacillus treatment group （H-Se group）. During a 3-wk experimental period, the common complete diet was orally provided daily for normal group and model group, and the mice in L-Se and H-Se groups were given a diet with 2 and 4 mg of organoselenium from Se-enriched lactobacillus per kg feed, respectively. From the 2nd wk of experiment, the model group, L-Se group, and H-Se group received abdominal cavity injection of olive oil solution containing 500 mL/L CCl4 （0.07 mL/100 g body mass） to induce liver injury, and the normal group was given olive oil on every other day for over 2 wk. In the first 2 wk post injection with CCl4, mice in each group were killed. The specimens of blood, liver tissue, and macrophages in abdominal cavity fluid were taken. Then the activities of the following liver tissue injury-associated enzymes including glutathione peroxidase （GSH-Px）, superoxide dismutase （SOD）, alanine aminotransferase （ALT） and aspartate aminotransferase （AST） as well as malondialdehyde （MDA） content were assayed. Changes of phagocytic rate and phagocytic index in macrophages were observed with Wright-Giemsa stain. Plasma TNF-α level was measured by radioimmunoassay. The level of intracellular free Ca^2＋ （[Ca^2＋]i） in hepatocytes was detected under a laser scanning confocal microscope. RESULTS： During the entire experimental period, the AST and ALT activities in liver were greatly enhanced by CCl4 and completely blunted by both low and high doses of Se-enriched lactobacillus. The Se-enriched lactobacillus- protected liver homogenate GSH-Px and SOD activities were higher or significantly higher than those in model group and were close to those in normal group. CCl4 significantly increased MDA content in liver homogenates, while administration of Se-enriched lactobacillus prevented MDA elevation. Phagocytic rate and phagocytic index of macrophages decreased after CCl4 treatment compared to those in normal control, but they were dramatically rescued by Se-enriched lactobacillus, showing a greatly higher phagocytic function compared to model group. CCl4 could significantly elevate plasma TNF-α and hepatocyte [Ca^2＋]i level, which were also obviously prevented by Se-enriched lactobacillus. CONCLUSION： Se-enriched lactobacillus can intervene in CCl4-induced liver injury in mice by enhancing macrophage function activity to keep normal and beneficial effects, elevating antioxidant-enzyme activities and reducing lipid peroxidation reaction, inhibiting excessive release of TNF-α, preventing the dramatic elevation of [Ca^2＋]i in hepatocytes.

Numerical simulation of freezing effect and tool change of shield machine with a frozen cutterhead

A shield machine with freezing function is proposed in order to realize tool change operation at atmospheric pressure. Furthermore, the transformation project of freezing cutterhead and tool change maintenance method are put forward. Taking the shield construction of Huanxi Power Tunnel as an example, a numerical analysis of the freezing cutter head of the project was carried out. The results show that when the brine temperature is-25 °C, after 30 d of freezing, the thickness of the frozen wall can reach 0.67 m and the average temperature drops to-9.9 °C. When the brine temperature is-30 °C, after 50 d of freezing, the thickness of the frozen wall can reach 1.01 m and the average temperature drops to-12.4 °C. If the thickness of the frozen wall is 0.5 m and the average temperature is-10 °C, as the design index of the frozen wall, the brine temperature should be lower than-28 °C to meet the excavation requirements in 30 d. Analyzing the frozen wall stress under 0.5 m thickness and-10 °C average temperature condition, the tensile safety factor and compressive safety factor are both greater than 2 at the most dangerous position, which can meet the tool change requirements for shield construction.

Trust Model Based on Structured Protection for High Level Security System

In order to ensure the security of information systems, it's essential to make sure that system behaviors are trusted. By analyzing threats that exist in executing procedures, a trust model based on structured protection is proposed. We consider that functional components, system actions and message flows between components are three key factors of information systems. Structured protection requirements on components, connections and action parameters are also provided. Four trusted properties of the model are deducted through formal analysis, and trusted system behavior is defined based on these properties. Furthermore, decision theorem of trusted system behavior is proved. The developed prototype system indicates the model is practical. It is a general theory model built on logic deduction and independent on specific environment and the behaviors of the system designed and implemented following the model are trusted.

Gastro-protective action of lafutidine mediated by capsaicin-sensitive afferent neurons without interaction with TRPV1 and involvement of endogenous prostaglandins

AIM： Lafutidine, a histamine H2 receptor antagonist, exhibits gastro-protective action mediated by capsaicinsensitive afferent neurons （CSN）. We compared the effect between lafutidine and capsaicin, with respect to the interaction with endogenous prostaglandins （PG）, nitric oxide （NO） and the afferent neurons, including transient receptor potential vanilloid subtype 1 （TRPV1）. METHODS： Male SD rats and C57BL/6 mice, both wildtype and prostacyclin IP receptor knockout animals, were used after 18 h of fasting. Gastric lesions were induced by the po administration of HCl/ethanol （60% in 150 mmol/L HCl） in a volume of 1 mL for rats or 0.3 mL for mice. RESULTS： Both lafutidine and capsaicin （1-10 mg/kg, po） afforded dose-dependent protection against HCI/ ethanol in rats and mice. The effects were attenuated by both the ablation of CSN and pretreatment with NG-nitro- L-arginine methyl ester, yet only the effect of capsaicin was mitigated by prior administration of capsazepine, the TRPV1 antagonist, as well as indomethacin. Lafutidine protected the stomach against HCl/ethanol in IP receptor knockout mice, similar to wild-type animals, while capsaicin failed to afford protection in the animals lacking IP receptors. Neither of these agents affected the mucosal PGE2 or 6-keto PGF1α contents in rat stomachs. Capsaicin evoked an increase in [Ca^2＋]i in rat TRPV1-transfected HEK293 cells while lafutidine did not. CONCLUSION： These results suggest that although both lafutidine and capsaicin exhibit gastro-protective action mediated by CSN, the mode of their effects differs regarding the dependency on endogenous PGs/IP receptors and TRPV1. It is assumed that lafutidine interacts with CSN at yet unidentified sites other than TRPV1.

Discrete Element Modeling of Debris Avalanche Impact on Retaining Walls

In China,gravity retaining walls are widely used as protection structures against rockfalls,debris flows and debris avalanches along the roads in mountainous areas.In this paper,the Discrete Element Method(DEM) has been used to investigate the impact of granular avalanches and debris flows on retaining walls.The debris is modeled as two dimensional circular disks that interact through frictional sliding contacts.The basic equations that control the deformation and motion of the particles are introduced.A series of numerical experiments were conducted on an idealized debris slide impacting a retaining wall.The parametric study has been performed to examine the influences of slope geometry,travel distance of the sliding mass,wall position,and surface friction on the impact force exerted on the wall.Results show that:1) the force achieves its maximum value when slope angle is equal to 60°,as it varies from 30° to 75°;2) an approximate linear relationship between the impact force and the storage area length is determined.

Science Letters:A robust polysilicon-assisted SCR in ESD protection application

A novel polysilicon-assisted silicon-controlled rectifier （SCR） is presented and analyzed in this paper, which is fabricated in HHNEC＇s 0.18μm EEPROM process. The polysilicon-assisted SCRs take advantage of polysilicon layer to help bypass electro-static discharge （E S D） current without occupying extra layout area. TLP current-voltage （I-V） measurement results show that given the same layout areas, robustness performance of polysilicon-assisted SCRs can be improved to 3 times of conventional MLSCR＇s. Moreover, one-finger such polysilicon-assisted SCRs, which occupy only 947 [3mz layout area, can undergo 7-kV HBM ESD stress. Results further demonstrate that the S-type I-V characteristics of polysilicon-assisted SCRs are adjustable to different operating conditions by changing the device dimensions. Compared with traditional SCRs, this new SCR can bypass more ESD currents and consumes smaller IC area.

Effect of Physical Environment on the Behaviors of Residents with Dementia： A Comparison between a Small-Group Unit and a Traditional Care Unit

This is a comparative study examining the influence of a small-scale dementia unit and a traditional dementia unit on behaviors of the residents. The small-scale unit and the traditional unit were selected through two phases in Vancouver, Canada. Seven residents from each facility completed the study. Physical environmental assessments were performed using two tools： PEAP （professional environmental assessment protocol） and TESS-NH （therapeutic environment screening survey for nursing homes）. For the assessment of residents＇ behaviors, three assessment tools were used： MOSES （multidimensional observation scale for elderly subjects）, MDS （minimum data set） and DCM （dementia care mapping）. The study found that the residents living in a small-scale environment were more engaged in activities and more likely to respond in understanding their fellow residents. Residents living in a traditional long-term care exhibited fewer signs of social interaction. The findings suggest that a small-scale homelike environment could positively influence people with dementia to be more engaged in social exchanges and activities, and consequently help in reducing their withdrawn behavior.

Maintaining cholesterol homeostasis: Sterol regulatory element-binding proteins

The molecular mechanism of how hepatocytes maintain cholesterol homeostasis has become much more transparent with the discovery of sterol regulatory element binding proteins (SREBPs) in recent years. These membrane proteins aremembers of the basic helix-loop-helix-leucine zipper (bHLHZip) family of transcription factors. They activate the expression of at least 30 genes involved in the synthesis of cholesterol and lipids. SREBPs are synthesized as precursor proteins in the endoplasmic reticulum (ER), where they form a complex with another protein, SREBP cleavage activating protein (SCAP). The SCAP molecule contains a sterol sensory domain. In the presence of high cellular sterol concentrations SCAP confines SREBP to the ER. With low cellular concentrations, SCAP escorts SREBP to activation in the Golgi. There, SREBP undergoes two proteolytic cleavage steps to release the mature, biologically active transcription factor, nuclear SREBP (nSREBP). nSREBP translocates to the nucleus and binds to sterol response elements (SRE) in the promoter/enhancer regions of target genes. Additional transcription factors are required to activate transcription of these genes. Three different SREBPs are known, SREBPs-1a, -1c and -2. SREBP-1a and -1c are isoforms produced from a single gene by alternate splicing. SREBP-2 is encoded by a different gene and does not display any isoforms. It appears that SREBPs alone, in the sequence described above, can exert complete control over cholesterol synthesis, whereas many additional factors (hormones, cytokines, etc.) are required for complete control of lipid metabolism. Medicinal manipulation of the SREBP/SCAP system is expected to prove highly beneficial in the management of cholesterol-related disease.

Decline of Traditional Landscape in a Protected Area of the Southwestern Alps:the Fate of Enclosed Pasture Patches in the Land Mosaic Shift

【Title】【Author】【Addresses】1Traditional landscape elements such as pasture patches enclosed in a forest matrix are progressively disappearing throughout the European Alps. We assessed the land mosaic shift of a protected area located in the western Italian Alps. In particular, the dynamics of pasture patches were studied at both landscape and stand level. Land-cover mapping through object-oriented analysis of historical aerial photographs was used to assess land-cover changes between 1954 and 2000. Spatial statistics were used to quantify landscape patterns, and field samplings within pasture patches were used to explore tree regeneration structure and composition. Our results showed a significant increase in the number of pasture patches caused by their fragmentation following forest expansion. The total surface area of pasture patches decreased by 43% and their core area decreased by 94%. The encroachment of trees on less accessible areas of the pasture patches caused a reduction of patch shape at landscape scale. The gap filling process started 40-50 years ago and began with an early invasion of light demanding species like sycamore maple （Acer pseudoplatanus L.） and common ash （Fraxinus excelsior L.）, followed by European beech （Fagus sylvatica L.） and secondarily silver fir （Abies alba Mill.）. Traditional land-use and population decline in the Pesio Valley led to a reduction in ecotone areas. A transition to a more homogeneous landscape is expected in the next decades. Given the cultural and productive nature of these mountain meadow-pasture communities, extensive livestock grazing systems could be used to manage their future conservation.

Segmental Bridges under Combined Torsion, Bending and Shear

Segmental bridges with unbonded prestressed tendons have some advantages, such as the weather independence and the corrosion protection of prestressing tendons. This paper analyzed the behavior of a prestressed segmental bridge with unbonded tendons under combined loading of torsion, bending and shear. According to the experiment research, a modified skew bending model was developed to calculate the bearing capacity of segmental bridges subjected to combined bending, shear and torsion. The finite element method was used to investigate the deflection behaviors of such structure, also to check the theoretical model. The theoretical and FEM research results were compared favorably with the test results from Technical University of Braunschweig, Germany. Finally, suggestion for the design and construction of segmental bridges with external prestressing was made.