Evaluation of the versatility of perforators-enhanced rhomboid flap technique for ischial sores reconstruction

Background: Prolonged pressure on the skin known as pressure sores, can cause frequent injuries to the skin and underlying tissues. However, several prevention approaches, including non-surgical and surgical management,are available. In flap surgery for pressure sores, a variety of flap types may be used;each offers certain benefits and some incidences of complications and recurrence. This study evaluated the versatility of the perforatorenhanced rhomboid flap technique for ischial sore construction.Methods: This prospective study was conducted in the Plastic Surgery Department of Fayoum University Hospital.The perforator-enhanced rhomboid flap technique was employed in 20 patients with ischial pressure sores who failed to respond to conservative treatment. A proper history was obtained and a preoperative arterial duplex was performed to determine the site of the prominent perforators for their preservation at the base of the flap.Postoperative follow-ups and evaluations were performed.Results: The mean age of the study group was 43.7 ± 13.1, ranging from 19 to 65 years. Moreover, 80% of the participants were males while 20% were female. The main etiology of the sores was paraplegia in 45% of cases.The mean surface area of sores was 24.8 ± 6.3 cm2. In 75% of cases, the color match of the flap was rated as excellent. Similarly, 70% of the patients rated flap thickness as excellent. In 55% of the cases, the scar appearance was deemed excellent. Overall satisfaction was reported as excellent by 40% of the patients, while only 5% reported poor satisfaction. Approximately, 10% of the cases were identified with seroma, and 30% had wound dehiscence of a mean size of 1.33 ± 0.98 cm and required around 6.8 ± 1.9 weeks to heal.Conclusion: The perforator-enhanced rhomboid flap technique is a versatile method for reconstructing ischial pressure sores owing to its technical ease, short operative time, reliable vascularity, aesthetic outcome, matching skin color, and short recovery time. The main limitations include large defects with large surface areas, lack of a nearby donor site for a rhomboid flap, and scarring from prior procedures around the sore.

Adaptive Swimming of Underwater Snake-like Robot in Different Underwater Environment

Hydrodynamic force is an important factor that affects the performance of underwater vehicle.Adapting to the current underwater environment by changing its shape is an important feature of underwater snake-like robots(USLR).An experiment was implemented to verify the swimming along the straight line of USLR.A simulation platform is also established for the analysis of the swimming of USLR.To figure out adaptive swimming of USLR to different underwater environments,the relationships between CPG parameters and maximum swimming speed have been discussed,and the switching between different swimming modes has been implemented.

Environmental Adaptive Control of a Snake-like Robot With Variable Stiffness Actuators

This work investigates adaptive stiffness control and motion optimization of a snake-like robot with variable stiffness actuators. The robot can vary its stiffness by controlling magnetorheological fluid(MRF) around actuators. In order to improve the robot's physical stability in complex environments, this work proposes an adaptive stiffness control strategy. This strategy is also useful for the robot to avoid disturbing caused by emergency situations such as collisions. In addition, to obtain optimal stiffness and reduce energy consumption, both torques of actuators and stiffness of the MRF braker are considered and optimized by using an evolutionary optimization algorithm. Simulations and experiments are conducted to verify the proposed adaptive stiffness control and optimization methods for a variable stiffness snake-like robots.

Logistic Regression Analysis and Nursing Interventions for High-risk Factors for Pressure Sores in Patients in a Surgical Intensive Care Unit

Objective： To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods： A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam- ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results： According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group （P〈0.05）. The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores （P〈0.05）. Conclusions： The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of decompression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.

Modeling and Control of Head of the Underwater Snake-like Robot Swimming

In order to solve oscillation of head of the underwater snake-like robot,the Central Pattern Generator( CPG)-based control scheme with head-controller was presented. The Kane dynamic model was constructed to be processed with a commercial package MotionGenesis Kane 5. 3,to which the proposed control scheme was applied. The relation between CPG parameters and orientation offset of head was investigated. The target orientation of head-controller was calculated through a convenient method. The advantage of this control scheme is that the head of the underwater snake-like robot remains in the forward direction during swimming. To prove the feasibility of the proposed methodology,two basic motion patterns,swimming along the straight line and swimming along the curved path,had been implemented in our simulation platform. The results showed that the simulation platform can imitate the swimming of the underwater snake-like robot and the head of the underwater snake-like robot remains in a fixed orientation directed towards the target. The oscillation of head's orientation is inhibited effectively.

Kinematic Research on Hinged Synchronous Universal Joint Applied for Snake-like Manipulator

The structure and motion principle of a hinged synchronous universal joint (HSUJ) is introduced, also whose kinematics is theoretically analyzed. As a result, a few kinematic characters of the HSUJ are obtained,which establish the foundation of its application for snake-like manipulator. Making use of the HSUJ ss actuating mechauism, the developed snake-like manipulator has the merits of small curve radius, fewer actuator, and small volume etc.

Knowledge presentation by the MNSM-based controller for swimming motion of a snake-like robot

A MNSM( mirror neuron system mechanism)-based controller is developed to present the swimming rhythm of a snake-like robot in Cartesian space. From engineering viewpoint,the proposed controller is composed of a neuron for rhythm angle and two neurons for motion knowledge in XY plane. The given knowledge is a rhythm curve for swimming motion of a snake-like robot. Experimental results show that the proposed controller can present the knowledge of swimming rhythm,which represents the corresponding control law to drive the snake-like robot to swim with different speeds and turning motion. This work provides a novel method to present the knowledge for swimming motion of snake-like robots.

Twist-related locomotion of a snake-like robot

As a hyper-redundant robot, a 3D snake-like robot can perform many other configurations and types of locomotion adapted to environment except for mimicking the natural snake locomotion. The natural snake locomotion usually limits locomotion capability of the robot because of inadequacy in the mechanism and actuation to imitate characters of natural snake such as the too many DOFs and the characteristics of the muscle. In order to apply snake-like robots to the unstructured environment, the researchers have designed many gaits for increasing the adaptability to a variety of surroundings. The twist-related locomotion is an effective gait achieved by jointly driving the pitching-DOF and yawing-DOF, with which the snakelike robot can move on rough ground and even climb up some obstacles. In dfis paper, the twist-related locomotion function is firstly solved, and simplified to be expressible by sine or cosine function. The 2D locomotion such as V-shape and U-shape is achieved. Also by applying it to the serpentine locomotion or other types of locomotion, the snake-like robot can complete composite locomotion that combines the serpentine locomotion or others with twist-related locomotion. Then we extend the twist-related locomotion to 3D space. Finally, the experimental results are presented to validate all above analyses.

Head Orientation Stability of Underwater Snake-Like Robot Swimming

In prior research,the orientation of head of the snake-like robot is changed according to the sinusoidal wave. To solve this problem,we propose Central Pattern Generator( CPG)-based control scheme with head-controller to stabilize the head of the underwater snake-like robot. The advantage of the CPG-based control scheme with head-controller is that the head of the underwater snake-like robot is direct to the target orientation during swimming. The relation between CPG parameters and orientation stability of head is discussed.The adaptation of the proposed method to environment changes is tested. The influences of CPG parameters and hydrodynamic forces on the orientation offset of head are investigated. The target orientation( the input of headcontroller) with an experimental optimization is calculated through a convenient method. To prove the feasibility of the proposed methodology,the different swimming modes have been implemented in our simulation platform.The results show that the oscillation of head's orientation is inhibited effectively,and the proposed method has strong adaptation to environment and CPG parameters changes.

无痛胃镜检查术后咽喉疼痛的发生情况和危险因素分析

目的探讨无痛胃镜检查术后咽喉疼痛的发生情况及其危险因素。方法选取2019年10月-2019年11月于该院内镜中心接受无痛胃镜检查术的连续门诊患者作为研究对象。采用课题组自行编订的调查问卷收集相关信息,从无痛胃镜检查术后24 h开始,每隔24 h进行一次电话随访,直至术后咽喉疼痛完全消失;采用数字分级评分法(NRS)评估术后咽喉疼痛严重程度,并记录持续时间;根据是否出现术后咽喉疼痛,将患者分为术后咽喉疼痛组(Ⅰ组)和非术后咽喉疼痛组(Ⅱ组),将两组组间比较差异有统计学意义的因素纳入多因素Logistic回归分析,筛选影响无痛胃镜检查术患者术后咽喉疼痛的独立危险因素。结果共608例患者完成研究,42例发生术后咽喉疼痛,发生率为6.91%,NRS评分为3.00(2.00,4.25)分,持续时间为24.0(10.0,48.0)h,最长时间为192 h(1例)。年龄及前3天疲劳程度是无痛胃镜检查术患者术后咽喉疼痛的独立影响因素:年龄每增加1岁,术后咽喉疼痛发生率减少2.60%;前3天疲劳程度为中度疲劳和重度疲劳,是术后咽喉疼痛的危险因素。结论无痛胃镜检查术后咽喉疼痛问题值得高度重视。年龄每增加1岁,无痛胃镜检查术后咽喉疼痛发生率减少2.60%;前3天疲劳程度为中度疲劳和重度疲劳,是无痛胃镜检查术后咽喉疼痛的危险因素。

记忆海绵垫对神经外科手术患者压疮预防的效果研究

目的探讨记忆海绵垫在神经外科手术患者压疮预防中的效果,为临床应用提供依据。方法将2022年6月1日至2023年12月30日在我院实施神经外科手术治疗的100例患者纳入临床研究,基于随机乱数表法分成研究组和对照组,均为50例;两组均实施系统围手术期护理,在术中研究组应用记忆海绵垫,对照组应用普通海绵垫。观察并记录两组术后压疮发生率,掌握受压部位疼痛发生情况,评估两组术后舒适度和患者护理总满意度。结果研究组术后当天、术后3 d压疮发生率均低于对照组(均P<0.05)。手术后,研究组的肩颈痛、腰背疼痛以及肢体麻木部位的发生率均低于对照组(均P<0.05)。术后3 d评测,研究组的生理、心理精神、社会文化、环境状态及总评分等舒适度评分,护理总满意度均高于对照组(均P<0.05)。结论在神经外科手术中应用记忆海绵垫,可有效预防和减少压疮发生,改善患者舒适度,提高护理满意度。

丹药在慢性疮面组织修复与重建中的作用机制

丹药是一种古老的中药制剂,是中医外科治疗慢性疮面的重要外治手段之一,广泛应用于各种慢性疮面的治疗。组织修复与重建是慢性疮面治疗的必要过程,但目前对丹药在慢性疮面组织修复与重建中的作用机制尚不明确。本文从丹药的传统应用及分类、活性成分、作用机制及临床应用等多个方面进行浅显论述,分析丹药优势和局限性,并展望未来丹药应用趋势和潜在研究方向,为慢性疮面的治疗提供新的思路。

敛疮膏治疗热毒壅滞型褥疮验案评析

文章列举自拟敛疮膏治疗热毒壅滞型褥疮验案两则,阐述热毒炽盛、气血壅滞是褥疮形成的重要病理变化。自拟敛疮膏方能清热凉血、解毒化瘀、敛疮生肌,是治疗热毒壅滞型褥疮的良方,其治疗热毒壅滞型褥疮的脉证特点为口干、发热、局部红肿热痛、皮肤破溃、舌红苔少或苔黄、脉数或滑。文章详述自拟敛疮膏治疗热毒壅滞型褥疮的内在机制并附验案两则,供同仁参考。同时,着重讨论了大黄在该方中的应用,提出大黄外用能清热解毒、活血通经、调和气血,药力平和而非寒凉过度,可以解毒、活血而不留瘀,即使是治疗高龄、体虚老人,只要用之合宜,亦能取得良效。

耳穴疗法联合普瑞巴林胶囊治疗气滞血瘀型带状疱疹后遗神经痛临床观察

目的分析耳穴疗法联合普瑞巴林胶囊治疗气滞血瘀型带状疱疹后遗神经痛(PHN)的临床效果。方法经随机方式把80例带状疱疹(HZ)住院患者归入对照组、治疗组,分别实施常规治护+普瑞巴林胶囊口服止痛疗法、常规治护+中医耳穴压豆+普瑞巴林胶囊口服止痛疗法,对比两组神经痛改善状况。结果在疼痛缓解方面,相较对照组,治疗组具有显著优势(P<0.05)。治疗组总有效率为90.00%(36/40),高于对照组的77.50%(31/40);治疗组的复发率为10.00%(4/40),低于对照组的22.50%(9/40)(P<0.05)。结论耳穴压豆+普瑞巴林胶囊疗法对于气滞血瘀型PHN的缓解有着积极作用,同时止痛效果相较单用普瑞巴林胶囊更具优势。

腹腔镜结直肠手术中气管导管套囊压力控制对术中血流动力学及术后咽喉痛的影响

目的:探讨腹腔镜结直肠手术中气管导管套囊压力控制对术中血流动力学及术后咽喉痛的影响。方法:选择行腹腔镜结直肠癌根治手术的患者94例。采用随机数字表将患者随机分为H组(导管套囊压力控制组,n=48)和L组(指感法组,n=46)。H组患者套囊压力控制在25~30 cmH2O,L组患者仅监测套囊压力。所有患者监测并记录麻醉诱导前(T0)、气管插管后(T1)、建立气腹前(T2)、建立气腹后(T3)、头低足高位后(T4)、气管拔管前(T5)、气管拔管后(T6)时间点的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP),以及T1~T5时间点的套囊压力和气道压力。同时调查患者术后2 h、12 h及24 h的咽痛、声嘶情况。结果:L组的HR、MAP、套囊压力在T1~T5均明显高于H组(P<0.05)。两组患者T3时的气道压力均明显上升(P<0.05),T4时均进一步升高(P<0.05),但两组间差异无统计学意义。H组术后2 h、12 h咽痛发生率低于L组(P<0.05)。两组患者术后声嘶发生率及严重程度差异无统计学意义(P>0.05)。结论:腹腔镜手术中,控制气管导管套囊压力可以降低术后咽痛的发生率,并保持术中血流动力学的相对稳定。

中药联合利妥昔单抗治疗寻常型天疱疮1例

天疱疮是一种自身免疫性大疱性皮肤病,寻常型天疱疮是其中病情较重的类型,临床治疗困难。近年来,临床使用利妥昔单抗治疗寻常型天疱疮取得较好效果,但该药临床常出现感染等不良反应。此文案例患者因惧怕糖皮质激素和免疫抑制剂的不良反应,选用中药联合利妥昔单抗治疗寻常型天疱疮,取得了良好效果,同时改善了患者体质,降低了感染发生可能性。

基于分布式系统的植保机智能与安全性能优化

针对植保机智能化程度和安全性能无法满足要求以及过多的信息资源造成植保机无法进行合理的任务分配问题,基于分布式系统对植保机进行了设计,并对其智能和安全性能进行优化。为了对多植保机进行调度,解决任务分配问题,对植保机的分布式系统软件进行了设计,包括建立植保机的一对多任务分配模型,并对模型进行人工免疫算法设计,以在较短的时间内得到最优的任务分配方式。为了验证植保机的性能,对植保机进行了多任务分配试验和智能变量喷洒试验,结果表明:植保机可根据飞行任务自动调整喷药量,实现智能变量喷洒,且可快速地对植保机进行任务分配。

基于脾肺同治探讨复发性脓疱疮发病机制及治疗思路

脓疱疮是一种儿童常见的感染性皮肤病,具有一定的传染性。因小儿稚阴稚阳的生理特点,素体娇弱、禀赋不耐,或正气相对不足,肌肤娇嫩,腠理不固,加之难以控制搔抓,皮疹更易播散,出现疾病反复发作,邪毒久羁,迁延难愈。小儿肝常有余,脾常不足,而脾为后天之本,脾肺两脏相互配合,互通互用,共同调节脏腑功能。因此可通过健脾固本,补益肺气,脾肺相协,共调脏腑,以促进疾病的恢复。故而在临证治疗脓疱疮反复发作中,特别对于儿童患者,更应时刻谨记顾护脾胃、补益肺气、脾肺同治的重要性。

两种评分系统评估急性脑梗死患者卧床期间压疮发生的研究

目的对比Braden量表、急性生理与慢性健康评分-Ⅱ(APACHE-Ⅱ)评估急性脑梗死患者卧床期间压疮风险的价值。方法选取70例急性脑梗死患者,患者清醒时,采用Braden量表、APACHE-Ⅱ量表评估患者卧床期间压疮发生风险,统计患者的一般资料和压疮发生情况,对比上述两种量表评估急性脑梗死患者压疮发生价值。结果70例急性脑梗死卧床期间发生压疮13例,占比18.57%,未发生压疮57例,占比81.43%;发生组Braden评分低于未发生组,APACHE-Ⅱ评分高于未发生组(P<0.05);绘制ROC曲线图结果显示,Braden量表和APACHE-Ⅱ量表评估急性脑梗死患者卧床期间压疮发生风险的AUC分别为0.814、0.832,评估价值较理想,且APACHE-Ⅱ量表的AUC大于Braden量表。结论相较于Braden量表,在急性脑梗死患者中应用APACHE-Ⅱ评估卧床期间压疮风险的价值更高。

“马刀侠瘿”论辨

《金匮要略·血痹虚劳病脉证并治》中“马刀”不是“刀”,是古代“蚌”或“蛤”的名称。“马刀”首见于《神农本草经》,《别录》称“马蛤”。“马刀侠瘿”,侠与“挟”通;“瘿”是发生在颌下与颈部夹间或腋下浅表部位的“瘤”或“疙瘩”。“侠瘿”属动宾结构,表达瘿瘤处在被夹持的状态。“马刀”本是名词,在此是形容词,作“瘿”的定语且前置,表述“瘿”像“马刀”(蚌)为长椭圆形,有一定硬度。在现代话语体系中,“马刀侠瘿”是表述颌下与颈部之间或腋下浅表部位“蛤样包块”或“蚌样肿块”,此与现代医学中的“菜花样肿块”“腊肠样包块”在表达形式上类同。