减少手术创伤始终是妇科肿瘤手术快速康复的决定性因素

减少手术创伤始终是快速康复的决定性因素,这一点在目前的加速康复外科研究尤其是复杂手术,如妇科肿瘤手术中尚未得到充分重视。尊重学习曲线、全面规划手术方案、总结失利经验、开展前瞻性研究是解决此问题的主要方案。本文着重讨论妇科肿瘤手术创伤对术后加速康复的影响及可能的改进措施。     

腹腔手术后重症患者心肌损伤的危险因素

目的探讨腹腔手术后重症患者心肌损伤的发生情况及可能的危险因素。方法回顾性分析北京大学人民医院2017年1月至2019年1月腹腔手术后重症患者的一般临床资料及心肌损伤情况,收集并观察基础病史、术中(手术时间、是否急诊手术、术中出血>800 ml和术中低血压等)及术后指标(改良氧合指数、血乳酸、急性肾损伤和术后24 h内使用升压药情况等)。根据术后是否发生心肌损伤,将患者分为心肌损伤组和非心肌损伤组,采用Logistic回归分析腹腔手术后重症患者心肌损伤的危险因素。结果在纳入的803例腹腔手术后重症患者中,心肌损伤发生率为17. 2%(138/803),而急性心肌梗死发生率仅为0. 9%(7/803)。单因素分析显示,慢性肾功能不全病史、手术时间、急诊手术、术中低血压、术后24 h内使用升压药、高APACHEⅡ评分及术后即刻急性肾损伤与术后重症患者心肌损伤相关(P<0. 05)。多因素回归分析显示,急诊手术(OR=3. 14,95%CI:1. 76～5. 60,P<0. 001)、术后24 h内使用升压药(OR=2. 26,95%CI:1. 23～4. 15,P=0. 008)、APACHEⅡ评分(OR=1. 05,95%CI:1. 01～1. 09,P=0. 008)和术后急性肾损伤(OR=3. 18,95%CI:1. 78～5. 69,P <0. 001)与腹腔手术后重症患者发生心肌损伤独立相关。结论重症患者腹腔手术后心肌损伤发生率高,急诊手术、术后24 h内使用升压药、高APACHEⅡ评分和术后急性肾损伤是导致腹腔手术后重症患者发生心肌损伤的独立危险因素。     

The relative effects of transection of the gustatory branches of the seventh and ninth cranial nerves on NaCl taste detection in rats.

Chorda tympani nerve (CT) transection in rats severely impairs NaCl taste detection. These rats can detect higher concentrations of NaCl, however, suggesting that remaining oral nerves maintain some salt sensibility. Rats were tested in a gustometer with a 2-response operant taste-detection task before and after sham surgery (n = 5), combined transection of the CT and the greater superficial petrosal nerves (GSP; 7x, n = 6), or transection of the glossopharyngeal nerve (GL; 9x, n = 4). Thresholds did not significantly change after sham surgery. Although the GL responds to NaCl and innervates nearly 60% of total taste buds, 9x surgery had no effect. However, 7x surgery increased NaCl detection threshold by ～2.5 log?? units, greater than that reported for CT transection alone. These results suggest that the GSP contributes to NaCl sensitivity in rats and also demonstrate that the GL and perhaps the superior laryngeal and lingual nerve proper can maintain some NaCl detectability at high concentrations. These findings confirm the primacy of the 7th nerve relative to the 9th nerve in sensibility of NaCl in the rat model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Estimating the costs of occupational injury in the United States

This article estimates workplace injury costs in the U.S. These costs have been studied in less detail than most injury costs. Our methods, which mostly use regularly published data, produce order-of-magnitude estimates. Overall, workplace injuries cost the U.S. an estimated $140 billion annually. This estimate includes $17 billion in medical and emergency services, $60 billion in lost productivity, $5 billion in insurance costs, and $62 billion in lost quality of life. One sixth of the societal costs result from the 3% of workplace injuries in motor vehicle crashes. Motor vehicle costs per injury are almost 6 times the workplace injury average.     

基于行人下肢防护的前保险杠改进分析

利用有限元方法,建立了小腿冲击器与汽车前部结构的碰撞模型,用以评价某款车保险杠系统对小腿损伤的影响。通过增加吸能部件、副保险杠加强板等方式减轻行人下肢的损伤,并通过正交试验设计研究了吸能部件的材料、吸能部件前后面之间的距离、副保险杠加强板的厚度以及副保险杠加强板前后面之间的距离对行人下肢损伤的影响。研究结果表明,经正交试验设计后的前保险杠系统能有效地减小小腿冲击器的胫骨加速度以及膝关节弯曲角度,使得下肢保护指标满足Eu-roNCAP法规要求。优化设计后的前保险杠系统更好的防护行人下肢的损伤。     

Police officer in-vehicle discomfort: Appointments carriage method and vehicle seat features

Musculoskeletal pain is commonly reported by police officers. A potential cause of officer discomfort is a mismatch between vehicle seats and the method used for carrying appointments. Twenty-five police officers rated their discomfort while seated in: (1) a standard police vehicle seat, and (2) a vehicle seat custom-designed for police use. Discomfort was recorded in both seats while wearing police appointments on: (1) a traditional appointments belt, and (2) a load-bearing vest/belt combination (LBV). Sitting in the standard vehicle seat and carrying appointments on a traditional appointments belt were both associated with significantly elevated discomfort. Four vehicle seat features were most implicated as contributing to discomfort: back rest bolster prominence; lumbar region support; seat cushion width; and seat cushion bolster depth. Authorising the carriage of appointments using a LBV is a lower cost solution with potential to reduce officer discomfort. Furthermore, the introduction of custom-designed vehicle seats should be considered.     

Duration of slip-resistant shoe usage and the rate of slipping in limited-service restaurants: results from a prospective and crossover study

Several studies have indicated that slip-resistant shoes may have a positive effect on reducing the risk of slips and falls, a leading cause of injury at work. Few studies, however, have examined how duration of shoe usage affects their slip-resistance properties. This study examined the association between the duration of slip-resistant shoes usage and the self-reported rate of slipping in limited-service restaurant workers. A total of 475 workers from 36 limited-service restaurants in the USA were recruited to participate in a 12-week prospective study of workplace slipping. Of the 475 participants, 83 reported changing to a new pair of shoes at least once during the 12-week follow-up. The results show that slip-resistant shoes worn for less than six months were moderately more effective than those worn for more than six months. Changing to a new pair of shoes among those wearing slip-resistant shoes at baseline was associated with a 55% reduction in the rate of slipping (RR = 0.45, 95% CI = 0.23–0.89). Further research is needed to develop criteria for the replacement of slip-resistant shoes.

Practitioner Summary: The duration of usage impacts the slip-resistance properties of slip-resistant shoes. Slip-resistant shoes worn for less than six months were moderately more effective in reducing slips than slip-resistant shoes worn for more than six months. Shoe use policies should not only encourage or require their use but also include guidance on replacing slip-resistant shoes at regular intervals.     

数据挖掘预测模型在脑损伤患者认知功能康复中的应用

为了更好地预测后天性脑损伤ABI(Acquired Brain Injury)患者认知功能康复的影响因素,提出基于决策树(DT)、多层感知器(MLP)和广义回归神经网络(GRNN)的三种预测模型。借助于10折交叉验证测试算法,通过专一性、灵敏度和精度分析以及混淆矩阵分析对模型的性能进行测试,从而获得新的知识以评估和改善认知功能康复过程中的有效性。实验结果表明,基于DT的模型的模拟结果明显比其他模型更为优越,预测平均精度可高达90.38%。     

环境镉致肾损伤与槲皮素应用时间的研究

实验研究了镉致急性肾损伤及槲皮素对肾损伤的保护作用.将雄性Wistar大鼠随机分成对照组、镉组、槲皮素治疗组,分别对各组大鼠进行生理盐水注射、氯化镉注射、氯化镉注射加槲皮素灌胃,然后测定镉致肾损伤指标:尿蛋白含量、血尿素氮(BUN)、尿乙酰氨基葡糖苷酶(NAG)、尿γ-L-谷氨酰转肽酶(γ-GT)、尿金属硫蛋白(UMT).研究结果表明:镉组与对照组相比,肾损伤指标含量显著增高;槲皮素治疗组与镉组相比,肾损伤指标含量显著降低,且随着应用槲皮素时间的增加,肾损伤指标含量逐渐恢复.因此,镉能够导致肾损伤,而槲皮素对镉致大鼠急性肾损伤具有保护作用,且其保护作用具有时间依赖性.     

The effect of floor slope on sub-maximal lifting capacity and technique

Inclined surfaces, where both the lifter and load are on the slope, may be encountered in a jobsite situation. The purpose of this study was to determine if facing up or down a sloped surface (10 degrees and 20 degrees ) would affect maximal acceptable weights of lift (MAWL) using a 10 min psychophysical approach with symmetric freestyle technique at 4 lifts/min. Seventeen healthy men and 18 women determined floor to knuckle height MAWL while facing uphill, downhill, and on a level surface. Motion capture was also performed to examine sagittal plane joint angles and foot placement relative to a milk crate. Slope did not alter MAWL (p>0.05) with the men lifting more than the women in every condition (p<0.001) (25 kg vs. 15 kg, respectively). Foot placement relative to the box was altered by slope such that both horizontal position behind and vertical position below the box increased as slope changed from the downhill to uphill conditions (both p<0.001). Forward torso lean as well as hip, knee, and ankle (plantar) flexion generally decreased as slope changed from the downhill to uphill conditions (all p<0.001). Torso and knee motion appeared to be protected compared to the other joints, changing the least. Though trends were the same in both sexes, interactions did exist in vertical foot position and hip angle (both p0.001). In conclusion, the body is highly adaptive to floor slope, maintaining MAWL at least in the short term. However, while slight technique differences exist between men and women, care should be taken by all when facing uphill due to the tendency to stand further from the load horizontally and when facing downhill due to increased torso lean.