基于Reho方法和DTI技术对强迫症脑静息态功能磁共振的研究进展

神经影像学的研究表明强迫症患者存在脑结构和功能异常，并提出了皮质一纹状体一丘脑一皮质一通路异常。本文对近年来应用局部一致性方法和扩散张量成像技术对强迫症患者脑静息态磁功能磁共振的研究结果进行了总结，结果显示强迫症患者存在异常脑功能区及异常脑白质纤维束，所发现的异常脑功能区及异常脑白质纤维束与强迫症皮质一纹状体一丘脑一皮质一通路相重叠，证实局部一致性方法和扩散张量成像技术可应用于强迫症神经生理病理通路的研究。

基于ReHo方法的针刺合谷穴静息态脑功能磁共振研究

目的采用局部一致性(regional homogeneity,Re Ho)方法观察针刺合谷穴的静息态脑功能活动特性。方法选取12名健康志愿者,采集针刺合谷穴前及拔针后5 min、25 min的静息态脑功能磁共振数据,采用Re Ho方法分析针刺合谷穴后的全脑活动情况。结果针刺后Re Ho值升高脑区主要有双前扣带回和双额内侧回,Re Ho值下降脑区主要有双丘脑、左苍白球、右额下回等;随着针刺后时间延长,双前扣带回、双额上回Re Ho值升高强度降低,Re Ho值降低脑区明显增多。结论合谷穴功效与边缘系统存在密切联系,并涉及多个脑区协同整合;针刺合谷穴能对相关脑区产生持续性影响。

基于功能影像学探讨百会治疗失眠的中枢机制

百会为治疗失眠的效穴,临床使用频率高。功能影像学,广义上包括多种成像技术,狭义主要指功能性磁共振成像(fMRI),数据分析方法分为功能分离和功能整合两类,试验设计方案包括任务态(Tb-fMRI)与静息态(Rs-fMRI),静息态因操作简便且能直观反映针刺持续和累积效应而被广泛应用。多项fMRI研究表明,失眠患者在视觉区、感觉运动区、情绪相关脑区等存在局部功能异常,针刺百会单穴或组穴可引起特定脑区如顶叶、额叶、颞叶等的改变,从而改善睡眠。针刺单穴百会主要集中在Rs-fMRI局部一致性(ReHo)、比率低频振幅(fALFF)研究,而针刺百会组穴研究从Rs-fMRI局部一致性(ReHo)、度中心度(DC)、种子连接(FC),以及Tb-fMRI比率低频振幅(fALFF)等方面展开,研究发现不同研究方法和穴位组合下的脑区激活改变存在差异,且针刺百会组穴所调控脑区多于单穴针刺,体现了百会对失眠、认知和情绪的调节作用以及腧穴间的协同作用。然而,针刺百会引起的中枢信号改变复杂,功能影像作为评估失眠的中枢指标虽有潜力,但仍需更规范、深入的研究。

不同针刺方法对缺血性中风患者静息态脑Reho信号的影响

目的:观察不同针刺方法对缺血性中风患者静息态脑Reho信号的影响。方法:选取西安市中医医院针灸科、神经内科2014年3月至2015年2月期间住院治疗的缺血性中风患者12例,随机分为电针组和普通针刺组,每组6例。所有患者均给予内科常规治疗,电针组在内科常规治疗的基础上加用电针治疗,普通针刺组在内科基础治疗上加用普通针刺治疗。采用BOLD-fMRI检测方法,比较两组患者治疗前后脑Reho信号的异同。结果:两组缺血性中风患者治疗前后比较,多个脑区Reho信号有所改善,其中电针组治疗后脑Reho信号改变明显。结论:电针及普通针刺均具有调节缺血性中风患者静息态脑Reho信号的功能,且电针治疗后脑Reho信号改变明显,或许电针对中风患者局部一致性改变是其作用机制。

Numerical simulation on reho-diecasting mould filling of an automobile master brake cylinder

An apparent viscosity model of semi-solid A356 aluminum alloy has been developed and the software Castsofl6.0 coupled with the model has been used to simulate the mould filling of an automobile master brake cylinder with the semi-solid A356 aluminum alloy slurry. The simulation results are in agreement with the practical filling process, indicating that the apparent viscosity model is feasible and can be used to simulate the mould filling of the semisolid A356 aluminum alloy slurry and can be used to optimize the filling process and the design of dies. A higher injection pressure, a higher ingate flow velocity of the semi-solid slurry, and a higher slurry temperature are advantageous to the mould filling of the automobile master brake cylinder.

Clinical and Therapeutic Aspects of Giant Fibroids at the Hôpital du Mali about 30 Cases

The fibroids affect 20% to 25% of women of reproductive age and are 3 to 9 times more common in black women. We’ll talk about giant fibroids (GFs) when uterine height reaches or exceeds the navel. We have initiated this study in order to report the epidemioclinical and therapeutic aspects of giant fibroids at the Hopital du Mali. A descriptive retro-prospective study, conducted in the service of gynecology of the Hopital du Mali from November 2017 to December 2018 were included in this study, any patients, regardless of their age, having developed a fibroid, the uterin e height of the patient reaching or exceeding the umbilicus on physical examination and who were on surgical treatment. We had collected 30 cases of GFs out of the 92 patients who had undergone myomectomies, with a frequency of 32.60%. The age group 25 - 29 years accounted for 46.6% with an average age of 35 years. Housewives represented 50% and nulligravida made up 33% of our patients. Desire to become pregnant was the main reason for consultation in 34.4% of cases. The uterine height was between 25 and 29 cm on physical examination in 46.66% of cases. Myomectomy was performed in 76.64% and hysterectomy in 23.3% of cases. The size of the nuclei after surgery was over 25 cm in 48.66% of our patients. Conclusion: The giant fibroid (GF) is a common cause of myomectomy. The treatment is either hysterectomy or myomectomy and depends on the indications.

Sacrospinous Fixation in the Gynecology Department of Hôpital du Mali

Sacrospinous fixation (SSF) or Richter’s intervention (RI) aims to treat genital prolapse by securing the posterior vaginal wall to the small sacrospinous ligament. It is performed by low approach and includes a dissection of the pararectal space, visual exposure of the sacrospinous ligament and a needle with strait needle holder with nonabsorbable threads. It is often associated with a more complex corrective procedure, including cystocele cure, vaginal hysterectomy and posterior myorrhaphy. The objective of this study is to report the results of SSF in the gynecology department of Hopital du Mali. A descriptive study was conducted from September 2014 to September 2015 concerning 37 patients operated on for uterine prolapse (UP). All patients with grade III UP were included in our study in whom a unilateral hysterectomy (UH) and sacrospinous fixation (SSF) were performed. All the patients were scheduled. Preoperatively they had benefited from an assessment and a pre-anesthetic consultation. Hospitalization of at least 24 hours prior to the operation was required. Postoperative follow-up was two years with a physical examination at 3 months, 9 months and 15 months, and phone calls between physical consultations. During the study period, we performed 37 RIs. The mean age of the patients was 48 years with extremes of 41 to 73 years. The large multiparity was found out in 35 cases (94.59%), the pauciparous were two with 3 deliveries for each. Long labor of more than 18 hours was found out in 9 patients (24.32%) and home delivery in 13 cases (35.13%). The duration of the occurrence of prolapse was at least two years and 35 patients were going through menopause. The type of anesthesia used for the surgery was spinal anesthesia for all patients. The average duration of the operation was 90 minutes. Complications occurred in three patients or 8.10% of cases, two cases of acute urine retention and one case of hematoma of the para-rectal space. The medium time of hospital stay was 5 days. The anatomical result was satisfactory in all patients. However, two patients presented with grade II rectocele one year after the operation. Sacrospinous fixation is a technique suitable for our patients who present with genital prolapse with extreme laxity of the suspension ligaments. Well done, it brings anatomical satisfaction and its complications are rare and slight.

Abdominal Trauma Management: About 62 Cases at the Department of General Surgery of Hôpital SominéDOLO de Mopti, Mali

We undertook a prospective and descriptive observational study on abdominal trauma from February 1, 2016 to August 31, 2017. The aim of this work was to identify the typology and management of abdominal trauma cases in our surgery department. Overall, abdominal trauma represented 3.54% (62/1751) of all surgeries during the study period. Among the 62 cases, men accounted for 59 and women for 3. The sex ratio was 19.67. The mean age was 24 ± 15 years. Road accidents were the most represented with 43.5% of cases. The couple of signs, hypovolemic shock and abdominal pain and decrease on blood pressure were the prominent clinical symptoms with 100.0%, and 50.0% of cases, respectively. Abdominal ultrasound and abdominal x-ray without contrast were performed in 67.0% and 18.0% of cases, respectively. Abdominal trauma was divided into two entities: contusion 68% and wounds 32%. Medical treatment was sufficient in 23.00% of cases. Laparotomy as a surgical approach was performed in 77.0% of cases. Local hemostasis plus drainage (27.08%), splenectomy (25.00%), suture (14.58%), hemostasis by tamponade (8.33%) and colostomy (2.08%) were undertaken as surgical procedures when it came to deal with contusions. Debridement of wounds plus suture and hemostasis by tamponade was performed in 18.73% and 4.16 cases, respectively. The most observed lesions were those of the spleen with 27.42% and those of the small bowel with 24.19%. The postoperative follow-up was straightforward in 83.33% of cases. The overall mortality was 4.17%.

Uterine Leiomyomas Surgery: Assessment of Five Years in the Gynecology Department of Hôpital du Mali

Uterine leiomyomas (myomas) are the most common benign tumors of the female genital tract. They affect 20% to 25% of women of childbearing age and are 3 to 9 times more common in black women. We initiated this study in order to report the socio-demographic aspects and the indications for leiomyomas surgery at Hôpital du Mali. This was a retro-prospective descriptive study, conducted in the gynecology department of Hôpital du Mali from January 1, 2015 to December 31, 2019. Any patients, regardless of their age, in whom a leiomyomas had been detected and surgically treated were included. We had collected 180 cases of surgery for leiomyomas out of 950 surgical procedures, with a frequency of 18.94%. The 36 - 45 age group represented 45% of our patients with an average age of 35 years. Nulligravida accounted for 48.9% and nulliparous (60%). The main reason for consultation was the desire to become pregnant (53.33%). A history of myomectomy was found out in 15.55% of patients. Pelvic ultrasound figured out 64.44% interstitial myomas. Myomectomy was performed in 88.88% of cases and hysterectomy in 11.12% of cases. Among our patients 39.37% had become pregnant. Operative complications were dominated by anemia 14.44%. Leiomyoma was the histological tissue found in all cases of myomectomy. The average duration of hospitalization was 3 days. Conclusion: Leiomyomas surgery is the first scheduled gynecological surgical activity. Laparotomy remains the primary route of entry. The indications are dominated by the desire for pregnancy.

Small Bowel Obstruction: Epidemiological, Clinical and Therapeutic Aspects in the General Surgery Department of Hôpital SominéDOLO de Mopti

Small bowel obstruction (SBO) is defined as a complete and persistent cessation of the transit of materials and gases. It occurs in a segment of the digestive tract located between the pylorus and the colorectal junction. We report an observational study which aims to describe the epidemiological, clinical and therapeutic aspects of small bowel obstruction. This study was carried out in the General Surgery Department of Hôpital Sominé DOLO de Mopti from October 1, 2016 to October 1, 2018. A total of 114 patients were recorded for whom the diagnosis was related to an occlusion. The median age was 37 years with extremes ranging from 6 months to 90 years. Male sex was predominant with a sex-ratio of 1.8. The frequency of small bowel occlusions over all occlusions was 74.03%. The most encountered clinical signs were as followed: abdominal pain (100%), vomiting (88.6%), cessation of materials and gas (79.9%) and meteorism (62.3%). All patients underwent medical imaging, the most common of which was an abdomen without preparation X-ray (AWP). On the etiological level, the main causes found postoperatively were: flanges and adhesion (55.2%), strangulated hernias (28.0%), acute intussusception (6.1%), small bowel volvulus (3.5%) and small bowel tumor (1.6%). Releasing the bridles was the most common surgery process (28.0%). The morbidity of the immediate follow-up was (13.1%) and the mortality was (7.0%). This high mortality is due to ignorance of the signs of seriousness and the socio-cultural barrier (decision of the patriarch to agree to a surgical intervention), the late use of hospital facility and the limited financial capability of the patients.

基于局部一致性分析经皮耳穴迷走神经刺激治疗超重/肥胖患者的临床疗效及中枢效应机制

【目的】探讨经皮耳穴迷走神经刺激(taVNS)对超重/肥胖患者的治疗效果,并分析其中枢效应机制。【方法】将26例超重/肥胖患者随机分为经皮耳穴迷走神经刺激试验组(简称taVNS组)12例和生活方式干预对照组(简称对照组)14例,对照组患者采用基于能量限制饮食模式(CRD)的线上生活方式干预,taVNS组患者在对照组的基础上采用taVNS治疗,每次治疗单侧耳朵(选择穴位包括脾点、内分泌点),每天早晚2次,每周治疗5 d,共治疗4周。观察2组患者治疗前后的体质量、体质量指数(BMI)、腰围等肥胖指标的变化情况,同时采集患者治疗后的脑部静息态磁共振功能成像(fMRI)数据,通过局部一致性(ReHo)的分析方法,观察taVNS对患者脑区ReHo的调节作用。【结果】(1)脱落情况方面:研究过程中,2组各脱落1例,最终共有24例患者(包括对照组13例和taVNS组11例)纳入观察指标的统计分析。(2)肥胖指标改善方面:治疗后,taVNS组患者的体质量、BMI、腰围均较治疗前下降(P<0.05),而对照组患者的体质量、BMI、腰围均较治疗前有下降趋势,但差异均无统计学意义(P>0.05);taVNS组对体质量、BMI、腰围等肥胖指标的改善作用均明显优于对照组,组间治疗后和治疗前后差值比较,差异均有统计学意义(P<0.05或P<0.01)。(3)fMRI结果方面:治疗后,taVNS组ReHo值大于对照组的脑区有左侧前额叶、额内侧回,对照组ReHo值大于taVNS组的脑区有右侧顶叶。提示与对照组比较,taVNS组左侧前额叶、额内侧回的ReHo增高,右侧顶叶的ReHo降低(P_(voxel)<0.001,P_(cluster)<0.05,FWE水平校正)。【结论】taVNS作为一种无创治疗手段,对超重/肥胖患者有一定的疗效,taVNS对左侧前额叶、额内侧回、右侧顶叶等相关区域功能的调节可能是其治疗肥胖的中枢效应机制。

伴有抑郁症状肝癌患者脑功能局部一致性研究

目的 结合静息态功能磁共振成像(resting-state functional magnetic resonance imaging, rs-fMRI)探讨抑郁症状对肝癌患者静息态局部一致性(Regional Homogeneity, ReHo)的影响。方法 使用1.5T MR扫描仪对21例肝癌伴抑郁症状、27例肝癌非抑郁患者进行扫描,并获得静息状态下的功能磁共振成像(rs-fMRI)。采用双样本t检验方法比较肝癌抑郁组和非抑郁组之间一般资料、ReHo的差异。结果 与肝癌非抑郁组相比,肝癌抑郁组左侧中央前回、海马旁回、岛叶、双侧前扣带回、额内侧回、右侧颞上回及海马的ReHo值显著增高,差异有统计学意义(P<0.05),双侧楔前叶、颞中回、小脑后叶、左侧额中回、右侧扣带回的ReHo值显著降低,差异有统计学意义(P<0.05)。结论 肝癌伴抑郁患者左侧(中央前回、海马旁回、岛叶、额中回)、双侧(前扣带回、额内侧回、楔前叶、颞中回、小脑后叶)、右侧(颞上回、海马、扣带回)存在异常自发神经活动表现。

医院药学工作中药特色技术的应用

2014年11月国家中医药管理局首次开启全国中药特色技术传承人才培训项目,目的在于培养一批热爱中医药事业、理论功底扎实、实践经验丰富、较全面的掌握中医药各方面知识、传承中药特色技术的骨干人才。以全国中药特色技术传承人才培训项目为依托,作者回顾游学经历,结合医院工作进行学习、思考和总结。将学习成果用于医院药学工作,以提高中药质量、提高中药特色服务能力,促进中药特色技术传承,更好地发展中医药事业。

档案精细化管理模式的质性分析与优化策略——以大型公立医院为切入

本文针对大型公立医院档案管理的精细化模式优化问题,通过质性分析揭示现有研究在实际操作中的问题与不足。通过对多家公立医院档案管理现状的调研,结合档案管理的理论框架,指出医院档案精细化管理的现实问题,包括档案分类繁杂、管理效率不高以及数据安全隐患等。在此基础上,提出了一系列优化策略,主要包括信息技术的深度应用、管理流程的标准化设计、建立“向新提质式”体系化管理机制以及人员要素专业化提升等。大型公立医院档案管理的精细化有助于提高管理效率、保障档案信息安全和发挥档案价值等,从医院视角为档案精细化管理模式的优化提供理论依据和实践建议。

“3、8、8链式整体因式优先法则”在极限计算中的应用

本文结合高等数学中经常出现的极限计算问题,分类、归纳、总结出一种比较简便且实用的求极限法则——“3、8、8链式整体因式优先法则”.具体阐述为:初学者求极限要分“三步走”,掌握“八种题型”,熟练应用“八种无穷小代换”.“链式整体”是在求极限的过程中,可以把某些代数式看成一个个“整体”,依据“整体”的取值,运用基本初等函数图像思维,一步步推导出最终结果,整个过程像“一条链子”.“因式优先”是在极限的计算过程中,只要是能求出极限的“因式”,为了方便后续计算极限,优先计算出此因式的极限.

高频重复经颅磁刺激治疗脑卒中患者单侧空间忽略的功能磁共振研究

目的:观察高频重复经颅磁刺激(r TMS)治疗脑卒中患者单侧空间忽略(USN)的临床疗效并调查r TMS疗效的神经影像学机制。方法:30例脑卒中后USN患者随机分为试验组和对照组各15例,两组患者均进行常规康复治疗;试验组给予额外的r TMS治疗,治疗强度为运动阈值的95%,频率10Hz,刺激点位于患侧右顶叶皮质区域(EEG 10-20标准的P4点),每次治疗10min,2次/d,连续治疗10天。观察治疗前及治疗10天后行为学表现和静息态f MRI改变情况。结果:和对照组相比,r TMS治疗后试验组USN症状明显改善(线段划销实验,P=0.038);图形删除测试,P=0.034;凯瑟琳-波哥量表,P<0.05);高频r TMS治疗可增强患侧脑区颞上回、额中回、顶上小叶、楔前叶及小脑前叶兴奋性,增强患侧半球的竞争抑制作用。结论:高频r TMS可明显改善脑卒中患者USN症状,并且可以使功能脑网络发生可塑性改变,平衡左右大脑半球兴奋性。

耳鸣患者静息态MR的局部区域一致性研究

目的研究耳鸣患者静息态fMRI的区域一致性(regional homogeneity,Reho)值脑区功能及中枢网络连接特点,从神经影像学及功能连接方面进一步阐明耳鸣的中枢发病机制。方法对18例耳鸣患者与20例年龄、性别相匹配的健康人群的分别行静息态功能性核磁共振(fMRI)检查,分析比较其Reho值变化,再将异常脑区或听觉中枢做为种子点行功能网络连接,研究耳鸣患者的脑区及功能网络连接变化。结果 ReHo表现为耳鸣组>正常组的脑区有双侧额下回、右侧颞中回、双侧中央后回;耳鸣组<正常组的脑区有小脑半球。经FWE严格校正后耳鸣组比对照组增强的区域为额下回(FWE P<0.05)减弱的区域为小脑前叶(FWE P<0.05,cluster level)。以额下回IFG作为种子点行功能连接,发现对照组>耳鸣组的区域为中脑(FWE,P<0.001)及右腹侧纹状体(FWE P<0.05,Small volume correction)。结论耳鸣的fMRI结果显示耳鸣患者的听觉中枢及非听觉中枢均在耳鸣中起重要作用,中枢功能连接提示耳鸣患者听觉脑区丘脑、颞中回与边缘系统海马旁回、岛叶等存在功能连接是导致耳鸣发生发展的原因之一。

足三里穴中枢神经网络作用机制的静息态脑功能磁共振成像研究

目的:应用静息态磁共振成像技术的局部一致性探讨足三里穴的中枢神经网络作用机制。方法:选择12名青年健康志愿者,于针刺足三里前及针刺足三里拔针后25 min分别进行静息态脑功能磁共振成像扫描,应用脑功能成像局部一致性(regional homogeneity,ReHo)方法处理功能磁共振(fMRI)成像数据。结果:针刺拔针后25 min后右侧额中回、左侧额上回、右侧颞上回、后扣带回、右侧中央旁小叶、右侧苍白球、右侧枕中回、左侧额内侧回等脑区的ReHo值较针刺前增高;双侧中央后回、左侧枕中回、左侧颞中回、左侧颞下回、左侧梭状回、左侧中央旁小叶、右侧额内侧回等脑区的ReHo值较针刺前减低(P<0.05,K值≥10)。结论:针刺足三里后额叶、颞叶、枕叶、扣带回相关脑区局部一致性发生改变,提示足三里的认知影响、镇痛及胃肠功能调节的中枢神经网络作用机制存在。

半固态AlSi7Mg铝合金的新型流变成形

采用新型流变成形技术,研究了压射比压与压射速度对半固态AlSi7Mg铝合金流变压铸过程的影响．结果表明:将低过热度浇注与短时弱电磁搅拌相结合,能制备出均匀的半固态AlSi7Mg铝合金浆料,适合流变压铸,流变成型参数范围较宽,有利于提高压铸件的质量．试片的璧厚、压射比压和压射速度都对半固态AlSi7Mg合金浆料的充填性有较大的影响．对于10 mm的试片,压射比压应≥15 MPa,压射速度应≥0．384 m／8;而对于5 mm的试片,压射比压应≥20 MPa,压射速度应≥1．152 m／8．

针刺足三里的静息态脑功能局部一致性研究

目的观察针刺足三里的静息态脑区功能局部一致性（Reho），探讨针刺穴位的作用机制。方法选择10例健康志愿者，其中男性4例，女性6例；年龄20～34岁，中位年龄23岁。利用GESigna HDxt3.0T磁共振成像系统对针刺前（对照组）、针刺足三里后分别进行静息态扫描，运用统计参数图（SPM8）软件，采用Reho的数据后处理方法，分析2组被试不同脑区Reho值的差异.并运用错误发现校正（FDR-corrected），得到有统计学差异的脑区。结果针刺足三里组与针刺前相比，Reho值增高的脑区有右侧前扣带回（8.17）、左侧额中回（4.84）；Reho值减低的脑区有左侧小脑半球（-7.75）、右侧后扣带回（-6.66）、左侧豆状核（-6.87）、右侧岛叶皮层（-7.57）、左侧胼胝体（-5.71）、左侧楔前叶（-4.68）、右侧额叶内侧回（-8.59）。结论针刺足三里后造成局部脑组织血氧水平信号同步性改变，提示针刺足三里不仅有特异的脑功能激活区.而且引起的脑功能活动存在Reho差异。