Effect of electroacupuncture at different time points on postoperative urination function in patients with mixed hemorrhoids surgery / 中国针灸

OBJECTIVE@#To observe the effect of preoperative, intraoperative and postoperative electroacupuncture (EA) intervention on postoperative urination function in patients with mixed hemorrhoid surgery.@*METHODS@#A total of 240 patients with mixed hemorrhoid surgery under lumbar anesthesia were randomly divided into an EA preconditioning group (group A, 60 cases, 9 cases dropped off), an intraoperative EA group (group B, 60 cases, 4 cases dropped off), a postoperative EA group (group C, 60 cases, 6 cases dropped off), and a non-acupuncture group (group D, 60 cases, 3 cases dropped off). In the groups A, B and C, EA was exerted at Zhongliao (BL 33) and Huiyang (BL 35) , with disperse-dense wave, 4 Hz/20 Hz in frequency, and lasting 30 min, at 30 min before lumbar anesthesia, immediately after lumbar anesthesia and 6 h after surgery, respectively. No EA intervention was performed in the group D. The postoperative urination smoothness score in each group was observed 24 h after surgery. The first urination time, first urination volume, urine residual volume after first urination were recorded, and incidence of indwelling catheterization, postoperative visual analogue scale (VAS) score, number of remedial analgesia, and the incidence of postoperative nausea and vomiting were observed in each group.@*RESULTS@#In the groups A, B and C, the postoperative urination smoothness scores were superior to the group D (P<0.05), and the time of first urination was earlier than the group D (P<0.05). In the group C, the time of first urination was earlier than the group A and the group B (P<0.05), the first urination volume was higher than the group D (P<0.05), and the urine residual volume after first urination was lower than the group D (P<0.05). There was no significant difference in the incidence of indwelling catheterization and postoperative nausea and vomiting among the 4 groups (P>0.05). The VAS scores of the group A, B and C were lower than that in the group D (P<0.05), and the number of remedial analgesia cases was lower than that in the group D (P<0.05).@*CONCLUSION@#EA intervention could promote the recovery of urination function and relieve postoperative pain in patients with mixed hemorrhoids surgery. Early postoperative EA intervention is more conducive to the recovery of urination function.

Evidence-Based Optimization Research on the Timing of Traditional Chinese Medicine Intervention for Coronary Heart Disease: Trial Design and Thinking / 世界科学技术-中医药现代化

Traditional Chinese medicine (TCM) emphasizes treatment timing, and it believes that the timing of treatment is closely related to the curative effect. In the era of the Chinese and Western medicine combined application, it attaches new connotations on how to choose the timing of interventions. Defining the timing of intervention is one of the key links to make the best effect of Chinese medicine, and it is also the focus of clinical decision-making, which deserves research attention. This article expounded the significance of TCM intervention timing research, and pointed out that the alternative timing should be based on the baseline investigation and mechanism clues. This article also demonstrated some key points of intervention timing trial design, like the outcome indicators setting, sample size estimation, blinding and data analysis. With the examples of national key research and development program"evidence-based optimization and mechanism research of traditional Chinese medicine therapies for coronary artery disease (angina pectoris-myocardial infarction-heart failure) ", the timing of TCM intervention in myocardial infarction perioperative period and coronary heart disease related research cases aboard, we hope to provide reference for the intervention timing optimization research.

As duas vias do desamparo: uma contribuição clínica / The two ways of helplessness: a clinical contribution

A autora faz reflexões a partir de fragmentos clínicos que apontam para o desamparo humano, seja em sua condição básica unida à angústia originária (Urangst) referida por Freud, seja em situações posteriores de experiências circunstanciais de desamparo nas quais de alguma maneira já estão presentes sinais de angústia. Faz menção à característica de viver fora de si como algo proveniente de uma maternagem insuficiente à instalação do conflito psíquico. Levando em conta a dupla via transferencial, discorre sobre as dificuldades de abordagem com esses pacientes, exemplificando-as clinicamente. Faz referência aos sinais inconscientes de ansiedade que transparecem em suas falas, mesmo quando impedidos de se aproximarem de suas angústias primitivas. Sugere que estes sinais serão os pontos de partida para o conhecimento da experiência emocional presente na situação analítica. Procura mostrar que a condução exitosa dessas análises se alicerça na condição de paciência do analista, assim como em sua capacidade de percepção do timming adequado a suas comunicações. Indaga-se sobre as defesas usadas por eles, dissociação, negação, indiferença afetiva, como recursos conseguidos, ainda que muito precários, para a manutenção de uma organização psiconeurótica e que, como tais, devem ser cuidadosamente abordados.

The author reflects upon clinical fragments which point to human helplessness, in its basic condition united to original anguish (Urangst) as mentioned by Freud, in further situations of circumstantial experiences of helplessness in which signs of anguish are somehow already present. The author mentions the characteristic of living outside oneself as something originated by insufficient mothering in regard to the installment of the psychic conflict. Taking into account the double transferential way, she elaborates on the difficulties of approaching such patients, giving clinical examples. The author refers to the unconscious signs of anxiety that permeate the discourse, even when not able to approach to their primitive anguish. She suggests that those signs are the starting points for the understanding of emotional experience present in the analytic situation. She intends to demonstrate that the cornerstones for the success of those analyses are the patience of the analyst, and his capacity of realizing the adequate timing for interventions. The author questions herself about the defenses, such as dissociation, denial, affective indifference, used by the patients as acquired resources, yet precarious to maintain a psychoneurotic organization, which, as such, must be carefully approached.

La autora hace reflexiones a partir de fragmentos clínicos que apuntan hacia el desamparo humano, sea en su condición básica unida a la angustia originaria(Urangst) referida por Freud, sea en situaciones posteriores de experiencias circunstanciales de desamparo en las que de alguna manera ya están presentes señales de angustia. Menciona la característica de vivir fuera de sí como algo proveniente de un maternaje insuficiente a la instalación del conflicto psíquico. Tomando en cuenta la doble vía transferencial, discurre sobre las dificultades de enfoque con esos pacientes, ejemplificándolas clínicamente. Hace referencia a las señales inconscientes de ansiedad que trasparecen en sus palabras, aún cuando impedidos de acercarse a sus angustias primitivas. Sugiere que estas señales serán los puntos de partida del conocimiento de la experiencia emocional presente en la situación analítica. Busca mostrar que la conducción exitosa de esos análisis se fundamenta en la condición de paciencia del analista, así como en su capacidad de percepción del timing adecuado a sus comunicaciones. Se pregunta sobre las defensas usadas por ellos, disociación, negación, indiferencia afectiva, como recursos logrados, aunque muy precarios, para el mantenimiento de una organización psiconeurótica y que, como tales, deben ser cuidadosamente enfocados.