强直性脊柱炎骶髂关节CT表现特点(附31例分析)

目的:通过对31例强直性脊柱炎(AS)骶髂关节CT扫描,总结AS骶髂关节的CT表现。方法:31例临床确诊为AS的患者,男21例,女10例,年龄14~64岁,平均24.5岁。全部病例行双侧骶髂关节CT平扫,就其CT表现进行分析。结果:31例中有30例骶髂关节异常,其中Ⅰ级5例(16.1%),Ⅱ级7例(22.5%),Ⅲ级16例(51.6%),Ⅳ级2例(6.5%)。骶髂关节早期CT表现为对称性关节面骨皮质粗糙,局限性微小皮质破坏,但关节间隙正常;进展期为双侧骶髂关节面广泛骨皮质破坏,呈锯齿状或毛刷状,局部骨质硬化明显,关节间隙增宽;晚期为关节僵直,关节面下骨质疏松。结论:骶髂关节CT检查有助于AS的早期诊断,提高诊断准确性,其骶髂关节的CT表现对临床病情监测有重要价值。     

中频电治疗骶髂关节周围软组织劳损的疗效观察

1资料与方法1.1一般资料我科门诊收治骶髂关节周围软组织劳损患者62例,诊断标准符合“临床疾病诊断标准”[1]。主要表现为骶髂部疼痛,向臀部或大腿后放散,并伴有活动困难,骶髂关节周围有压痛。将患者随机分为2组,治疗组31例,男17例,女14例;年龄20—67岁,平均47.6±5.1岁;病程0.5—4.5年,平均1.8±1.3年。对照组31例,男16例,女15例;年龄21—65岁,平均45.9±4.3岁;病程1—5年,平均2.0±1.4年。两组患者的基本情况及病情表现,进行χ2检验,P值均>0.05,两组间差异无显著性意义,具有可比性。1.2方法治疗组采用电脑调制中频电疗仪(北京,K8832T型)…     

幼年与成年强直性脊柱炎临床特征的比较

16岁以前发病的强直性脊柱炎(AS)称为幼年强直性脊柱炎(JAS)。主要表现为附着点炎,外周关节炎、骶髂关节炎等关节的慢性炎症为主要特征的自身免疫性疾病,因JAS起病年龄的不同在临床表现上有其特征性表现。本研究对我院就诊的17例     

青少年型强直性脊柱炎的临床特征及影像学征象

目的分析青少年型强直性脊柱炎(JAS)的临床特征和影像学特点,提高JAS的诊断水平,减少致畸率;方法回顾性分析12例,前瞻性分析14例JAS临床特征和影像学征象。全部病例按美国风湿病协会诊断标准;其中前瞻性14例病例,10例初诊为Still's病,4例初诊为类风湿性关节炎,平均随诊2.3年;所有病例均行X线检查,18例行CT检查;8例行MRI检查。所有病例均累及下肢大关节,小关节不受累,仅1例累及上肢大关节。12例早期累及骶髂关节。其结果作卡方检验统计学处理。结果平均初诊年龄为9.3岁。发病起始年龄与病变程度有显著相关性,P<0.05,其进展较快,3例累及脊柱;发病病程长短与病变程度有显著的相关性,P<0.01。100%累及下肢大关节,累及关节数目平均为3.26个。结论JAS在临床和影像学上有其自身特征和规律。早期诊断,早期治疗可缓解疾病进程。     

强直性脊柱炎早期CT表现——白边征

目的 探讨强直性脊柱炎患者中骶髂关节白边征的形态学表现及临床意义。 方法 收集92例强直性脊柱炎患者,均接受骶髂关节CT检查,分析其影像学表现,并进行统计学分析。 结果 白边征表现为CT图像上骶髂关节髂骨关节面骨皮质带状、不均匀骨质致密区,骨缘不光滑。92例中,双侧骶髂关节受累84例(84/92,91.30%),单侧骶髂关节受累8例(8/92,8.70%);单纯髂骨面受累73例(73/92,79.35%)。骶髂关节炎Ⅰ级19例(19/92,20.65%),其中白边征9例(9/19,47.37%);Ⅱ级24例(24/92,26.09%),其中白边征13例(13/24,54.17%);Ⅲ级35例(35/92,38.04%),Ⅳ级14例(14/92,15.22%),均未见白边征。Ⅰ级、Ⅱ级及Ⅲ级以上骶髂关节炎中白边征出现率的差异有统计学意义(χ²=33.218,P<0.001)。 结论 骶髂关节白边征是AS的早期CT征象,可以考虑将其作为骶髂关节炎分级的参考指标。     

缬沙坦、硝苯吡啶治疗高血压肾损害的对比观察

对我院缬沙坦、硝苯吡啶治疗高血压肾损害的对比观察如下。1对象和方法1.1对象选择我院2002-05~2005-05内科专科门诊及住院治疗的高血压肾损害患者100例。随机分为治疗组两组:A组51例,其中男34例,女17例,男女之比为2∶1;年龄45~78(62.75±6.25)岁;病程1.5~14.5 a,平均(7.38±1.64)a。B组49例,其中男31例,女18例,男女之比为1.72∶1;年龄39~77(63.12±6.28)岁;病程1~13.8 a,平均(7.15±1.70)a。两组年龄、性别、病程基本相似,具有可比性(P>0.05)。诊断标准:(1)高血压病;(2)出现蛋白尿前一般已有4~5 a或以上持续血压升高(>140/90 mm Hg);(3)…     

骨、关节结核专题讲座 第11讲 骶髂关节结核

骶髂关节结核在临床上并不少见，约占全身骨关节结核的1％～4％。骶髂关节结核多见于青壮年，10岁以下儿童少见。我所1990年统计175例骶骼关节结核，发病年龄为8～64岁，21～30岁最多79例，占45．1％，各年龄组分布详见表1。骶髂关节结核女性多于男性，我所157例中男53例，女104例，男女之比约为1：2，这可能与女性骨盆较松弛有关。骶髂关节结核多为单侧发病，极少有双侧同时发病者。骶骼关节结核左右侧发病无明显差异。1病理骶髂关节结核病理分型同样可分为单纯滑膜、单纯骨型和全关节型三种。但临床上滑膜型国症状不叫显，X线又不易显示…     

能量多普勒超声检查骶髂关节对早期强直性脊柱炎的诊断价值

目的：评价能量多普勒与核磁共振对比,在早期强直性脊柱炎（Ankylosing Spondylitis,AS）患者骶髂关节炎诊断的价值。方法2012年1~12月间,绵阳市中心医院门诊及住院的病程＜2年的强直性脊柱炎患者共50例,强直性脊柱炎诊断根据1984年修订的纽约标准。其中男44例,女6例,年龄15～42（25±4）岁,病程6～24（12±6）个月。每例患者都采用MRI检查骶髂关节病变,记录活动性骶髂关节炎共92个。对每位患者的两侧骶髂关节进行彩色多普勒检查,能量多普勒显示骶髂关节区域的血流信号,并测量血流阻力指数（resistance index,RI）。结果50例患者的100个骶髂关节显示有血流信号的87个,1级36例,2级51例,能量多普勒超声在其中81个骶髂关节血流信号中测得RI,RI为0．38～0．71,平均值0．48±0．16。χ2分析1显示,能量多普勒与MRI在检出骶髂关节病变方面差异不具有统计学意义（P=0.249）。分析能量多普勒发现的骶髂关节血流阻力指数与CRP、ESR、BASDI评分的关系发现,患者的炎症指标越高、BASDI评分越高,骶髂关节血流阻力指数越低。结论能量多普勒检查骶髂关节病变可作为诊断早期强直性脊柱炎的重要辅助检查,低阻血流是提示活动性强直性脊柱炎骶髂关节病变的重要线索。     

强直性脊柱炎的康复护理

强直性脊柱炎 (Ankylosing Spondylitis, AS)是一种以侵犯脊柱、骶髂关节等为主的非特异性炎症,易导致脊柱强直、大关节畸形。胸廓活动度缩小,对病人危害很大。在中西医结合治疗中,加强康复护理对疗效有极积意义,现将我科收住 AS患者 57例总结,报道如下。 1 对象与方法 1.1 对象 本组患者 57例,男 52例,女 5例。年龄 12～ 45岁,平均 32岁。病程 3个月～ 5年。 X线片示单纯骶髂关节受累 22例,髂关节受累 11例;骶髂关节及髂关节均受累 10例;腰椎关节及椎体竹节样改变 14例。临床表现：腰骶部疼痛为主者 33例,腰骶部及双侧臀部…     

腰椎术后骶髂关节源性下腰痛的特点和治疗

目的探讨腰椎术后骶髂关节源性下腰痛的特点和治疗。方法 2006~2009年对64例腰椎术后骶髂关节源性下腰痛的患者进行回顾性研究。综合分析临床资料、体征及影像学表现,总结其临床特点,并予手法调整骶髂关节,辅予封闭术治疗,通过VAS、活动能力及改良Macnab标准来评定治疗疗效。结果随访8~42个月(平均22.7个月),患者治疗后的VAS评分(2.01±1.03)较治疗前(9.01±2.30)改善明显(P<0.01);活动能力评分(1.01±0.3)较治疗前(2.6±0.30)改善明显(P<0.01)。结论腰椎融合术后骶髂关节病变是引起术后下腰痛的重要原因之一,腰椎术后应力的改变导致的骶髂关节错位是骶髂关节源性下腰痛的主要原因。封闭是诊断骶髂关节源性下腰痛的最有效的方法,手法调整骶髂关节,辅予封闭术治疗该疾病的简单、安全、有效的方法。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

糖尿病视网膜病变筛查与防治中存在的问题及对策

目的探讨糖尿病视网膜病变(diabetic retinopathy,DR)患者筛查和防治中存在的问题及对策。方法以76例糖尿病DR患者为对象,调查未能早期接受眼科诊治的原因。结果存在问题主要是患者对DR防治知识不了解、血糖控制不理想、内科医生未建议进行专科检查等。结论眼科医护人员应密切与糖尿病专科的联系,尽早对DM患者进行DR健康教育,并开展社区DR防治工作。