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抚顺医院男科周晚报顺城人民医院有泌尿科吗

2020年01月28日 05:36:35来源:时空乐园

More than a decade ago, a 43-year-old woman went to a surgeon for a hysterectomy. She was put under, and everything seemed to be going according to plan, until, for a horrible interval, her anesthesia stopped working. She couldn#39;t open her eyes or move her fingers. She tried to breathe, but even that most basic reflex didn#39;t seem to work; a tube was lodged in her throat. She was awake and aware on the operating table, but frozen and unable to tell anyone what was happening.十多年前的一天,外科医生们正在对一名43岁的女性进行子宫切除术。患者在麻醉下失去了意识,所有的一切似乎都按部就班有条不紊——直到她身上的麻醉突然失效了一段时间,她无法睁开眼睛,无法动一动手指。她试图呼吸,可即使是这样最基本的反射也不能正常进行;一根管子卡在她的喉咙里。她的神智清醒着,知道自己正在手术台上,只是一动也不能动,不能向任何人诉说发生了多么可怕的事情。Studies of anesthesia awareness are full of such horror stories, because administering anesthesia is a tightrope walk. Too much can kill. But too little can leave a patient aware of the procedure and unable to communicate that awareness. For every 1,000 people who undergo general anesthesia, there will be one or two who are not as unconscious as they seem — people who remember their doctors talking, and who are aware of the surgeon#39;s knife, even while their bodies remain catatonic and passive. For the unlucky 0.13 percent for whom anesthesia goes awry, there#39;s not really a good preventive. That#39;s because successful anesthetization requires complete unconsciousness, and consciousness isn#39;t something we can measure.在关于麻醉觉醒(anesthesia awareness)的研究里,充满了此类恐怖故事,这是由于给予麻醉的确是一项令麻醉医师如履薄冰的棘手任务。用药过量可以致人于死地。但药量不足却可能使患者在手术中醒来,而无法向其他人诉说自己的困境。每1000名接受全身麻醉的患者中,平均会有一或两人(0.13%)不幸并非如表面所见的那样不省人事——他们记得医生们的交谈,感觉得到外科医生的刀划过血肉,尽管此时他们的身体仍然毫无知觉,被动地任人摆弄。目前还没有什么真正有效的方法可以防止麻醉过程中出现这种岔子。因为,成功的麻醉需要实现完全无意识,而我们现有的技术还无法对意识加以衡量。There are tools that anesthesiologists use to get a pretty good idea of how well their drugs are working, but these systems are imperfect. For most patients receiving inhaled anesthesia, they#39;re no better at spotting awareness than dosing metrics developed half a century ago, says George Mashour, a professor of anesthesiology at the University of Michigan Medical School. There are two intertwined mysteries at work, Mashour told me: First, we don#39;t totally understand how anesthetics work, at least not on a neurological basis. Second, we really don#39;t understand consciousness — how the brain creates it, or even what, exactly, it is.现在已经有一些工具可以帮助麻醉医师较好地把握自己所用药物的效力,但这些系统还不够完善。密歇根大学医学院(University of Michigan Medical School)的麻醉学教授乔治·马舒尔(George Mashour)表示,对于大多数接受吸入麻醉的患者而言,尚无比半个世纪前研发的用药剂量指标效果更好的知觉观察方法。马舒尔还告诉我,在麻醉工作中存在着两个相互交织的未解谜团:首先,我们并不完全了解麻醉的工作机制,至少在神经学基础的层面上是如此。其次,我们对意识也没有实现真正的理解——大脑如何创造了意识,以及,“意识”的确切定义究竟是什么。Lacking a way to measure consciousness directly, anesthesiologists monitor for proxies of it — the presence of certain types of brain waves, physical responses and sensitivity to pain — and adjust the dosage if they arise. To improve on this method, neuroscientists are searching for what they call neural correlates of consciousness — changes in brain function as a person transitions from being apparently conscious to apparently unconscious. The more they know about these, the better they hope to understand what consciousness is.由于无法直接对意识加以测量,麻醉师们只好退而求其次,监测意识的替代物——特定类型的脑电波、生理反应和疼痛敏感度的存在情况,并在上述指标升高时增加麻醉剂量。此外,为了改善这一方法,神经科学家正试图寻找“意识的神经机制”(neural correlates of consciousness),即,人在从明显的意识知觉状态转变为明显无意识状态的过程中脑功能的改变。他们认为,对此了解得越深入,就越有希望解开意识之谜。Michael Alkire, associate professor of anesthesiology at the University of California, Irvine, was one of the first people involved in the search for neural correlates of consciousness, back in the 1990s. He#39;s particularly excited now about a study published in August by an international team of researchers based at the University of S?o Paulo and the University of Wisconsin, Madison. They compared the brain activity of patients from the full spectrum of consciousness — awake, asleep, drugged with anesthetics, in comas or suffering from ;locked-in syndrome,; in which the body appears trapped in a comalike state but the brain is active and aware. The researchers stimulated these subjects#39; brains with a magnetic field and used EEG to trace the pulse#39;s path. The brains we might think of as conscious and those we think of as unconscious reacted to the stimulus in distinct ways. ;If the patient is awake, the electrical ‘ping#39; can travel all around the brain,; Alkire said. ;But if they#39;re unconscious, the ‘ping#39;tends to stay localized and just fades away like a sonar blip.;关于意识的神经机制的研究兴起于20世纪90年代。美国加州大学欧文分校(University of California, Irvine)的麻醉学副教授迈克尔·阿尔基尔(Michael Alkire)是最早参与此类研究的科学家之一。八月份由圣保罗大学(University of S?o Paulo)和威斯康星大学麦迪逊分校(University of Wisconsin, Madison)的研究人员组成的国际研究团队发表了一项研究,令他格外兴奋。该研究比较了患者在整个意识谱系——醒觉、睡眠、接受麻醉剂后、昏迷或罹患“闭锁综合征”(此时,患者的躯体陷入类似昏迷的状态,但大脑仍在活动且醒觉)——的多种状态下大脑活动的异同。研究人员采用磁场来刺激受试者们的大脑,并使用脑电图(EEG)跟踪了脑电脉冲的路径。结果显示,在我们通常认定为有意识或无意识的大脑中,这些刺激引起的反应方式截然不同。“如果患者处于醒觉状态,电脉冲信号可以传遍整个大脑,”阿尔基尔说。“但是,如果他们失去了意识,脉冲信号往往只在局部短暂停留,然后便如昙花一现般消失无踪。”This finding excites Alkire because it bolsters an existing theory of how consciousness works. Mashour, who also studies neural correlates of consciousness, has repeatedly found evidence that — contrary to conventional- wisdom — sensory networks in the brains of unconscious people remain locally functional, but intrabrain communication has broken down. The neighborhood#39;s lights are on, in other words, but the Internet and phone lines have all been cut.这些研究结果令阿尔基尔十分振奋,因为它很好地持了一个现有的意识运作理论。在马舒尔对意识的神经机制进行研究的过程中,与传统观点相背离的据一再出现,这些据表明,在无意识者的大脑中,感觉网络仍在局部地发挥作用,只是大脑内部的通信系统完全崩坏了。换句话说,邻近街区的灯照常亮着,可互联网和电话线都被切断了。The S?o Paulo-Madison study could be showing that unconsciousness is what happens when different parts of the brain can#39;t connect: The signal simply dies. This also suggests that anesthetics work best when they cut those lines of communication. What#39;s more, it provides insight into a vexing question: How can the entirety of human experience arise from tiny electrical impulses?这项圣保罗-麦迪逊研究显示,无意识是大脑的不同部位间失去联系的外在表现:只是信号无法传递而已。它还表明,当麻醉剂恰好切断那些通信线路时,麻醉效果最好。更重要的是,该研究为我们探讨一个深奥的问题提供了启示:人类的体验作为一个整体,是如何从微小的电脉冲中诞生的?Neuroscientists do know that consciousness does not reside in any one part of the brain — there is no region where all information is aggregated together — but they don#39;t know much more than that. Consciousness is difficult to study by its very nature, so it has been left mostly to philosophers for the last hundred years — and they don#39;t agree on much. For instance, the philosopher John Searle describes consciousness as a purely subjective experience — what you have when you wake up in the morning, and what disappears when you fall asleep at night (or die, depending on how bad your day was). The philosopher Daniel Dennett wrote a book called ;Consciousness Explained,; which plays down the subjective experience of consciousness so much that critics dubbed it ;consciousness explained away.;神经科学家已然确知,意识并不存在于大脑的任何一个特定部位——并没有一个脑区专司汇总所有的信息——但他们所知的也仅限于此。意识的本质使其难以进行直接研究,因此,在过去的一百年中这一领域的绝大部分都是哲学家们的舞台,可惜他们各执己见,没有达成多少一致意见。例如,哲学家约翰·塞尔(John Searle)将意识描述成了一种纯粹的主观体验——当你在早晨醒来时,你就获得了意识;等你在夜间入睡(或者死亡,这取决于你这一天过得怎么样)时它便消失了。而在哲学家丹尼尔·丹尼特(Daniel Dennett)撰写的名为《意识的解释》(Consciousness Explained)论著中,则大大贬低了意识的主观体验,以至有家戏称这本书“把意识给解释没了”。Scientists largely ignored these sorts of debates for most of the 20th century. But in 1994, an interdisciplinary conference at the University of Arizona brought them together for the first time. That conference led to ongoing research studying the links between anesthesia and consciousness. Stuart Hameroff, an anesthesiologist and the director of the school#39;s Center for Consciousness Studies, was an organizer of the conference. Anesthesia, he told me, is a great example of why scientists have to think about consciousness. It#39;s not enough, he said, just to assume your patient is unconscious because she doesn#39;t respond to pain.在20世纪的绝大部分时间里,科学家们在很大程度上一直对这些争论视若无睹。但是,1994年美国亚利桑那大学(University of Arizona)举行的一场跨学科会议第一次将科学家和哲学家们聚在了一起。这次会议引发人们就麻醉和意识之间的联系展开了持续的研究。该校意识研究中心(Center for Consciousness Studies)的主任斯图尔特·哈姆鲁夫(Stuart Hameroff)是这次会议的组织者。他告诉我,麻醉是可解释科学家们为何需要思考意识问题的绝佳例子。他说,单凭患者无法对疼痛作出反应并不足以判定他已经失去了意识。That#39;s because, while you need a brain to have consciousness, you might not need a brain to experience pain. In the 1990s, scientists ran tests on rats and goats, studying how the effects of anesthetics changed as different parts of the brain were intentionally damaged or removed. The amount of the drugs necessary to prevent the animals from moving in response to pain didn#39;t change as the cortex, the thalamus and the brain stem were destroyed. ;Turns out, they were measuring a spinal-cord reflex, which is a much more primitive thing and has nothing to do with consciousness,; Hameroff said. Outward signs of consciousness may or not may not have anything to do with actual awareness.这是因为,虽然保持意识需要大脑,但感受痛苦却未必需要大脑的参与。20世纪90年代,科学家们在大鼠和山羊身上进行试验,他们故意损伤或去除了不同的大脑部位,然后研究麻醉剂的作用发生了怎样的改变。当皮层、丘脑和脑干受损后,要防止动物因疼痛而挣扎所需的药物剂量并没有发生改变。“事实明,他们之前检测的只是脊髓反射,这是一种非常原始的反应,跟意识没有任何关系,”哈姆鲁夫说。意识的外在表现与真正的觉醒状态之间可能存在关联,也可能完全是两码事。In everyday life, it#39;s nearly impossible to ever know whether someone is conscious or not, Hameroff said, even if it seems glaringly obvious. Philosophers are fond of pointing out that, for all you know, you#39;re surrounded by people who appear to be fully conscious but who experience none of it subjectively. (They frequently trot out these beings for thought experiments and call them ;philosophical zombies.;) But for those under anesthesia and the knife, such sophistry offers little solace.在日常生活中,想要确知某个人的意识状态几乎是不可能的,哈姆鲁夫说,尽管它似乎是如此显而易见。哲学家们很喜欢这样讲:你只知道你周围的人看起来都具有完整的意识,但没有一个人对此有任何主观体验。(他们经常在这些人面前炫耀所谓的“思想实验”,并称他们为“哲学僵尸”。)只是对于那些身在麻醉和手术刀下的患者而言,这样的诡辩起不到什么宽慰效果。Increasingly, research on what happens to the brain under anesthesia suggests that the synthesis and integration of information among many different parts of the brain is the best measure of consciousness. Some people, Mashour said, go so far as to say that this communication among regions is consciousness itself. Our subjective experience of the world might arise as a byproduct of the brain#39;s piecing together different sensory inputs.有越来越多关于麻醉状态下大脑功能的研究表明,对来自大脑多个不同部位的信息加以综合的能力是衡量意识的最佳指标。马舒尔指出,有些人甚至认为这种不同脑区之间的通讯交流就是意识本身。我们对世界的主观体验很可能是大脑试图拼凑不同的感觉输入信息时产生的副产物。It#39;s easy to see the connections between this idea and the ;ping; study. When the brain falls asleep, drifts into a coma or comes under the influence of anesthetic drugs, the ability to synthesize information disappears, though the brain doesn#39;t cease to function. Figuring out a method for measuring intrabrain communication will be crucial for preventing operating-table awareness.很容易看出,上述观点与脑电脉冲研究之间存在一定关联。当大脑陷入熟睡、昏迷或麻醉药物的影响之下时,虽然它并没有停止运作,但其综合信息的能力却消失了。找出一种可测定脑内通讯的方法对于防止患者在手术台上醒觉至关重要。In the June 2013 issue of the journal Anesthesiology, Mashour proposed just that: a monitor that focuses on the brain#39;s ability to communicate within itself. It#39;s similar to the ;ping; study but tracks a different signal. Activity in conscious brains has been shown to loop between sensory areas (the visual cortex in the rear of the brain, for example) and the higher-level parts of the brain associated with processing information (like the temporal lobe, just behind your ears). Mashour and others call this ;recurrent processing;: Signals travel from the sensory areas to the processing areas and back again. When somebody is unconscious, the recurrent proc-essing disappears. Mashour#39;s study showed that this pattern — or lack thereof — is present in the brains of people anesthetized with three different classes of drugs. It#39;s not just a side effect of one kind of medication. His work suggests that anesthesia monitors might be more effective if, rather than measuring the presence of electrical waves produced bythe brain, they monitor how electrical signals move around the brain.在2013年6月的《麻醉学》(Anesthesiology)杂志上,马舒尔建议:使用一台监测仪来专门监测大脑内部的通讯能力。这与脑电脉冲研究有点类似,但它们跟踪的是不同的信号。研究显示,在意识清醒的大脑中,感觉区(例如,大脑后部的视觉皮层)与信息加工相关的高级区域(比如位于耳后侧的颞叶)之间存在脑部活动环路。马舒尔等称其为“回返加工”:信号从感觉区进入加工区,然后再返回感觉区。在人失去意识后,这种“回返加工”也随之烟消云散。马舒尔的研究表明,在三种不同类别药物的麻醉下,人的大脑中都呈现了这种模式的存在和缺失。这并不是某一种药物的副作用。这项工作表明,如果麻醉监测器能够监测电信号如何在大脑之中传送,可能会比单纯测定大脑是否产生电波更为有效。Should such a device be developed, it would be good news not only for those 0.13 percent of patients but also for fans of Enlightenment philosophy. Mashour told me that the synthetic model of consciousness dates back to Immanuel Kant — his ;Critique of Pure Reason; might be vindicated by neuroscience. ;Kant said there has to be some process that takes individual processing and connects it together into a unified experience,; Mashour said. ;Over the years, we#39;ve teased out the parts of the brain necessary for appreciating vision, color, motion. They#39;re all mediated by different brain areas. But how does the brain put all that together into single perception?; For Kant, this was clear long before EEG monitors and anesthetics. ;Without this synthesis,; he wrote in 1781, ;the manifold would not be united in one consciousness.;如果能够开发这样的设备,对于那0.13%的不幸患者以及启蒙哲学的粉丝们都是大好消息。马舒尔告诉我,意识的综合模式最早可以追溯到伊曼纽尔·康德(Immanuel Kant)——他的《纯粹理性批判》(Critique of Pure Reason)或可因神经科学的发展而获得平反。“康德认为,必有一定的过程将单独的信息整理加工,使其彼此联系并结合为一体,即成为经验,”马舒尔说。“多年来,我们已经逐步确定景象、色和运动的评鉴由大脑的不同区域所介导。然而,大脑是如何将它们整合为统一的感知印象的?”康德所处的时代远在脑电监测仪及麻醉剂的发明和使用之前,1781年,他写道,很明显,“如果没有这种综合作用,多姿多而散乱的感觉信息将不可能在一个意识中实现统一。” /201410/336958。

  • Two questions for you: 1.) Are you overweight? 2.) Are you happy about it? If you answered “Yes” to #1 and “No” to #2 then we have good news for you: understanding the reasons why you are fat can help you lose that weight faster。问你两个问题: 1. 你超重了吗? 2. 这样你开心吗? 如果你第一个的问题的回答是肯定的,而第二个问题是否定的,那我们给你带来了好消息:明白自己为什么这么胖可以帮助你更快地减肥。The National Weight Control Registry (NWCR) tracks over 10,000 individuals who have lost significant amounts of weight and kept it off for long periods of time. People who don’t adopt the following behaviors are more likely to be overweight or obese. Here are the 5 reasons why you might be fat:美国国家体重控制登记处(NWCR)长期追踪调查了1万名减重明显而且保持下去的人。那些没有养成以下习惯的人更有可能超重或者肥胖。下面就是你为什么长胖的五大原因:1. You don’t eat breakfast你不吃早餐According to the NWCR research, 78 percent of people who were successful at losing weight and keeping it off reported regularly eating breakfast every day of the week. Only 4 percent of healthy people never eat breakfast. So here’s the deal: make yourself a healthy breakfast every morning. Choose foods like fresh fruit, smoothies, eggs, coffee (sans cream and sugar), tea, and whole grains。根据NWCR的研究,78%成功减肥并且保持下去的人每天都规律地吃早餐。健康人士中只有4%从不吃早饭。所以办法就是:每天早晨给自己做一份健康早餐。可以选择新鲜水果、果汁、鸡蛋、咖啡(不加奶油和糖)、茶和全谷物食品。2. You don’t weigh yourself enough你没有经常给自己称体重75 percent of people who maintain a healthy weight weigh themselves at least once a week. If you’re struggling to get rid of those love handles, then buy a scale and weigh yourself a few times a week. This will help you stick with your health goals and see measurable progress。75%保持健康体重的人每周至少给自己称重一次。如果你正在为减掉腰部赘肉努力,那就买一个秤,每周称几次体重。这有助于你坚持自己的健康目标,而且能够看到可以衡量的进步。3. You watch too much TV你看电视的时间太多了Here’s one of the biggest reasons why you might be fat: too many hours in front of the television. 62 of people on the NWCR registry watch less than 10 hours of TV per week. Get up off the couch and get some exercise instead。你长胖的最大原因之一就是,看电视的时间太多了。NWCR追踪的减肥成功人士当中,62%的人每周看电视的时间不到10小时。离开沙发,做点运动吧。4. You don’t exercise enough你缺乏锻炼Speaking of exercise, 90 percent of healthy folks exercise an average of 1 hour per day. Don’t think you have time for exercise? These tips will make you think otherwise。说到锻炼,90%的健康人士平均每天锻炼1小时。觉得自己没有时间锻炼?这些小贴士会改变你的想法。5. You don’t eat healthy enough你的饮食不够健康This one should be obvious. The biggest reason why most people are fat is because of what they eat. Good healthy habits start with a good diet. Eat more whole, natural, unprocessed foods like these:这一点应该很明显。大多数人长胖的最大原因都在于吃。良好的健康习惯从健康饮食开始。多吃一些完整、自然、未经加工的食物,比如:Fruits and veggies水果和蔬菜Nuts and seeds坚果和瓜子Lean meats and eggs from pasture-raised animals来自食草动物的瘦肉和蛋Healthy fats from olive oil, coconut oil, and dark chocolate来自橄榄油和椰子油的健康油脂、黑巧克力Whole grains全谷物HOW TO LOSE WEIGHT?如何减肥?Losing weight is tough. For most people, it requires a change in diet, a change in exercise habits, and a change in attitude. Here’s how you can accomplish all three:减肥是一件苦差事。对大多数人来说,这要求他们在饮食、锻炼习惯和态度上做出改变。下面这些建议告诉你该如何完成这三种改变:1. Set healthy goals设定健康的目标If you’re overweight and want to change that, the first step is deciding what your target weight is. Write down your goal and set a date that you want to accomplish that goal by。如果你已经超重,而且想要改变,第一步就是确定自己的目标体重。写下你的目标和你想要实现目标的日期。2. Start small从小事做起Making major behavior modifications isn’t something that happens overnight. So start with 1-2 things per week and work up from there. Commit to eating 5 servings of vegetables a day and exercising 2 days a week for the first week, then add a little more each week。你不可能一夜之间让自己的行为习惯做出巨大改变。所以每周改变一两件事,就从这开始。第一周保每天吃5种蔬菜,锻炼两天,然后每周增加一点。3. Track what you eat and how much you exercise跟踪记录你的饮食和运动量Now it’s time to start working toward that goal. The best way to stick with your diet and exercise regimen is to track it. There are plenty of websites and apps that allow you to do this. Or you can do it the old fashioned way and keep a written food and exercise journal. Find what works for you and write down what you’ve accomplished every day。现在可以朝着目标开始努力了。坚持饮食和锻炼习惯的最好办法就是跟踪记录。有很多网站和手机应用都可以帮助你完成记录。或者你也可以用老办法,手写饮食和锻炼日志。找出对你有效的办法,记录下你每天完成的内容。4. Evaluate and adjust评估和调整Every month you should take a look at your goal and see what type of progress you’ve made toward accomplishing it. If you’re not where you want to be, make minor adjustments. Try doing different exercises or cutting back on certain types of foods that you may be eating too much of. Losing weight and keeping it off is a highly personal thing. Find what works for you and stick with it。每个月你都应该审视一下自己的目标,看看你在实现目标的道路上取得了哪些进步。如果你还没有达到自己的要求,做一些小的调整。尝试不同的锻炼方法,或者减少某种吃的太多的食物摄入。减肥并且保持下去是因人而异的。找出对自己有用的办法,并且坚持下去。 /201311/263415。
  • 1. Cable TV1. 有线电视Cable television#39;s heyday is over. Subscribers have been declining since 2004, and analysts say there#39;s no end in sight. Roughly 54.8 million households currently pay for cable TV, down 3.3% from 2012 and down 17.6% from a decade prior, according to research firm IHS. Cable companies are expected to shed roughly 1.3 million subscribers in 2014.有线电视的黄金时代已经结束了。有线电视用户2004年以来一直在减少,分析师称,预计这种态势还将继续保持下去。研究公司IHS的数据显示,目前约有5,480万个家庭付费收看有线电视,较2012年减少3.3%,较十年前减少17.6%。预计在2014年有线电视公司将损失约130万用户。The decline is due in part to so-called cord-cutters: consumers who are canceling cable and transitioning to lower-cost services, such as Hulu and Netflix (NASDAQ:NFLX) , which provide much of the same programming at a fraction of the price. Using an Internet connection, consumers can stream many cable shows, news programs and sports games, as well as movies, directly to their TVs. Some channels#39; websites also provide viewers access to their shows. (MarketWatch recently launched a calculator - Are you y to cut the cord? - that allows consumers to find the shows they normally watch through such lower-cost options.)有线电视用户的减少在一定程度上要归因于所谓的“剪线族”(cord-cutter):这些消费者取消有线务,转向Hulu和Netflix等费用较低的务,后者提供的节目与有线电视基本相同,但价格要便宜得多。通过互联网连接,用户可以将许多有线电视节目、新闻报道、体育比赛和电影直接串流到电视上观看。一些电视频道还允许观众通过其网站收看节目。(MarketWatch近期推出了一个名为“你为剪线做好准备了吗?”的计算工具,可让消费者通过这类费用较低的选择方案找到他们通常收看的节目)These services are mostly beneficial for people who do not mind watching shows after they#39;ve aired and are willing to part with most live programming.这些务主要适合那些不介意观看非实时节目,愿意与大多数直播节目挥手告别的人士。 /201401/272944。
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