弹性髓内钉治疗儿童四肢骨折的围手术期护理

目的：探讨儿童四肢骨折患者接受弹性髓内钉治疗期间的护理措施及护理效果。方法：选取2019年7月~2021年6月期间收治的50例儿童四肢骨折患者作为研究对象,分为观察组(综合护理干预)和对照组(常规护理)各25例,比较两组的护理效果。结果：观察组患儿的护理满意度(92.00%＞68.00%,χ_²=4.500)以及护理后的健康调查简表(SF-36)评分[(75.70±5.94)分＞(68.65±5.41)分,t=4.387]高于对照组(P＜0.05),观察组患儿的术后并发症发生率(4.00%＜32.00%,χ_²=4.878)以及护理后的疼痛VAS评分[(75.70±5.94)分＜(68.65±5.41)分,t=4.387]低于对照组(P＜0.05),观察组患儿的住院时间[(13.14±2.67)d＜(17.56±3.14)d,t=5.362]、骨伤愈合时间[(7.14±1.23)周＜(9.51±1.69)周,t=5.669]比对照组更短(P＜0.05)。结论：儿童四肢骨折患者接受弹性髓内钉治疗的过程中,为其提供综合、全面的围术期护理服务,可以有效降低手术风险,消除术后恢复期间的干扰因素,有助于加快病情恢复。     

针对性护理对过敏性紫癜患儿心理状态及并发症的影响研究

目的：探讨针对性护理在过敏性紫癜患儿中的实施效果,结合患儿的心理状态、并发症发生情况做出评价。方法：选取我院2019年8月~2021年10月期间收治的92例过敏性紫癜患儿作为研究对象,分为观察组(针对性护理)和对照组(常规护理)各46例,比较两组患儿的护理效果。结果：观察组患儿的并发症发生率(2.17%＜17.39%,χ_²=4.434)以及护理后焦虑自评量表(SAS)评分[(38.14±4.20)分＜(46.73±4.59)分,t=9.364]、抑郁自评量表(SDS)评分[(39.92±4.89)分＜(45.56±5.04)分,t=5.447]低于对照组(P＜0.05),观察组患儿的皮疹症状消失时间[(3.57±1.02)d＜(5.13±1.60)d,t=5.576]、关节疼痛消失时间[(3.89±1.15)d＜(5.27±1.44)d,t=5.076]、腹痛消失时间[(4.08±1.25)d＜(6.32±1.59),t=7.512]比对照组更短(P＜0.05)。结论：过敏性紫癜患儿的治疗恢复期间,实施针对性护理,可以有效消除负面心理和降低并发症的发生风险,进而加快病情康复。     

3.0T MRS对前列腺外周带癌的诊断价值及其与前列腺特异性抗原的相关性研究

目的 应用3.0T磁共振成像系统扩散张量成像(DTI)鉴别前列腺外周带癌和前列腺外周带良性病变,并确定正常前列腺的标准各向异性分数(FA)及表观扩散系数(ADC)。方法 收集接受前列腺DTI检查并经穿刺活检证实的20例患者(其中前列腺癌10例,良性前列腺病变10例),共获得10个外周带癌灶和15个外周带炎症或BPH 病灶。DTI均在Philips3.0T MR仪上完成,采用8通道心脏线圈,扫描序列包括轴位TSE T2WI及SS-EPIDTI序列,b值采用0 和700s/mm²。并对10名平均年龄30岁(25~35岁)的健康志愿者行DTI。采集数据后,利用Philips提供的FiberTrak后处理软件对图像进行后处理。测量各外周带病灶以及正常腺体外周带和中央腺体的ADC和FA值,对正常前列腺外周带、前列腺外周带良性病变及前列腺外周带癌灶的ADC和FA值行方差分析,并对外周带良性病变及外周带癌灶的ADC和FA值行ROC曲线分析以确定它们区分前列腺外周带良恶性病变的效能。同时评估正常前列腺外周带和中央腺体参数值是否存在不同。结果 前列腺外周带癌、前列腺外周带良性病变及正常前列腺外周带的ADC值分别为(0.972±0.116)×10^-3 mm²/s、(1.326±0.151)×10^-3 mm²/s和(1.696±0.104)×10^-3 mm²/s;FA 值分别为0.396±0.067、0.280±0.063和0.196±0.065,三组间差异均有统计学意义。ADC和FA区分前列腺外周带癌和前列腺外周带良性病变的ROC曲线下面积分别为0.903和0.862。ROC曲线ADC和FA值临界点分别取1.185×10^-3 mm²/s和0.341时,诊断的敏感度、特异度分别为90.9%、85.7%和85.7%、81.8%。正常前列腺中央腺体的ADC值[(1.181±0.048)×10^-3mm²/s]显著低于外周带[(1.696±0.104)×10^-3 mm²/s],中央区的FA值(0.368±0.046)显著高于外周带(0.196±0.065),差异有统计学意义。结论 利用3.0T MR系统进行前列腺DTI具有可行性,所得FA 和ADC值与前列腺的组织结构性质一致。DTI可能有助于鉴别前列腺良、恶性病变。     

社区护士中医护理适宜技术居家护理服务知信行调查

目的 了解社区护士对从事中医护理适宜技术居家护理服务的认知、态度和行为现状,分析相关影响因素。方法 采用整群抽样方法,于2023年1月至4月抽取淮安市城区及周边24家社区医院305名社区护士为调查对象,采用一般资料调查表收集社区护士的一般资料,采用自编《社区护士从事中医护理适宜技术居家护理服务知信行调查问卷》调查社区护士的知信行水平,并分析影响因素。结果 305名社区护士中医护理适宜技术居家护理服务知信行调查问卷总分为（112.13±18.46）分,其中知识维度（31.30±9.51）分,态度维度（44.30±6.96）分,行为维度得分为（28.16±7.89）分,工作年限、毕业院校类型、是否进行系统化中医护理培训是社区护士从事中医护理适宜技术居家护理服务知信行水平的影响因素。结论 社区护士对从事中医护理适宜技术居家护理服务的态度积极,需求迫切,但认知程度较低,行动力不强,故需加大培训和支持力度,以推广中医护理适宜技术居家护理服务。     

DWI联合1H-MRS多参数分析鉴别胶质瘤术后复发与放射性脑损伤

目的 探讨DWI联合¹H-MRS鉴别脑胶质瘤术后复发与放射性脑损伤的价值。 方法 对22例脑胶质瘤术后放疗后出现异常强化区的患者进行DWI、¹H-MRS检查。分析复发和放射性脑损伤的DWI与¹H-MRS表现,对复发、损伤、正常脑白质的ADC值及复发、损伤病灶的Cho、Cr、NAA峰高与Cho/Cr、Cho/NAA值进行统计学分析,并根据ROC曲线确定比值参数(rADC、Cho/Cr、Cho/NAA)的最佳诊断阈值及诊断准确率。 结果 损伤灶ADC值[(1476.40±453.74)mm²/s]高于复发灶[(987.62±309.93)mm²/s],差异有统计学意义(P＜0.05)。复发灶Cho/Cr(1.74±0.53)、Cho/NAA(2.39±1.21)高于损伤灶Cho/Cr(1.30±0.19)、Cho/NAA(1.16±0.41),差异有统计学意义(P均＜0.05)。最佳诊断阈值分别为:rADC(1.40)、Cho/Cr(1.51)和Cho/NAA(1.42),诊断准确率分别为:rADC(72.73%)、Cho/Cr(72.73%)、Cho/NAA(86.36%)、多参数评分系统(86.36%)。 结论 DWI联合¹H-MRS多参数分析可明显提高复发与损伤的鉴别诊断准确率,对放射性脑损伤的早期确诊具有重要应用价值。     

DWI定量测量诊断宫颈癌

目的 探讨DWI定量测量诊断宫颈癌的价值。方法 收集经手术病理证实为宫颈癌的患者93例,包括鳞癌66例(高分化1例,中分化56例,低分化9例)及腺癌27例(高分化3例,中分化21例,低分化3例),宫颈正常者20例。对所有受检者均行常规MR及DWI扫描,测量ROI的ADC值,并进行统计学分析。结果 宫颈癌的ADC值[(1.05±0.24)×10^-3 mm²/s]低于正常宫颈[(1.87±0.22)×10^-3 mm²/s;t=-14.08,P<0.05]。宫颈鳞癌的ADC值[(0.97±0.13)×10^-3 mm²/s]低于宫颈腺癌[(1.26±0.31)×10^-3 mm²/s;t=-4.79,P<0.05]。中分化宫颈鳞癌ADC值[(0.98±0.14)×10^-3 mm²/s]高于低分化宫颈鳞癌[(0.88±0.14)×10^-3 mm²/s;t=2.31,P<0.05]。以ADC<1.59×10^-3 mm²/s诊断宫颈癌时,敏感度为95.70%,特异度为100%。结论 DWI对宫颈癌的诊断具有较高价值,ADC值可鉴别宫颈鳞癌与宫颈腺癌,且可评价宫颈鳞癌的分化程度。     

中医医院临床护士对中医护理方案的认知与需求调查

[目的]了解临床护士对我院实施的13个中医护理方案的认知和培训需求情况。[方法]采取自行设计的调查问卷对我院8个科室152名临床护士进行调查。[结果]临床护士对于中医护理方案的认知得分为(4.21±2.7)分,但对于13个疾病的知晓率不高。护士对常见证候要点、特色技术的培训需求较高,得分分别为3.69分±2.3分、3.47分±1.7分;护士对常见疾病施护和健康指导的需求相对较低,得分分别为2.89分±2.6分、2.86分±3.4分。[结论]临床护士对中医护理方案的认知程度较高,但是对相关中医知识认知不高,需加强中医相关知识的培训。     

Twist、Slug基因在宫颈癌中的表达及与预后的关系

摘要:目的：探讨Twist、Slug基因在宫颈癌中的表达水平及与临床预后的关系。 方法：用实时定量PCR检测56例宫颈癌患者、120例宫颈上皮内瘤变(CIN)患者组织和血浆中Twist、Slug mRNA的表达,以35例正常宫颈及慢性宫颈炎组织和血浆作为对照。免疫组化染色检测Twist、Slug蛋白在宫颈癌组织中的表达,并分析其与宫颈癌复发的关系。 结果：对照组、CIN组、宫颈癌组组织中Twist mRNA表达水平分别为(1.98±0.48)×10^-3、(3.89±0.86)×10^-3、(6.53±1.25)×10^-3,血浆中Twist mRNA表达水平分别为(1.62±0.55)×10^-4、(1.76±0.68)×10^-4、(2.08±0.90) ×10^-4;3组组织中Slug mRNA表达水平分别为(1.33±0.32)×10^-2、(3.02±0.95)×10^-2、(4.69±1.02)×10^-2,血浆中Slug mRNA表达水平分别为(2.08±0.75)×10^-3、(2.30±0.78)×10^-3、(3.09±1.02)×10^-3;宫颈癌组、CIN组组织中Twist、SlugmRNA表达水平均高于对照组（F分别为46.69、55.30,P<0.01);宫颈癌组血浆中Twist、SlugmRNA 相对表达水平最高（F分别为10.56、17.97,P<0.01),且术前血浆中Twist、Slug相对表达水平高于术后2周的水平（t分别为2.12、2.03,P<0.05)。宫颈癌组Twist mRNA与SlugmRNA呈正相关（r=0.483, P<0.01）;免疫组化结果表明,宫颈癌组织Twist、Slug蛋白表达阳性率(55.4%、78.6%)高于对照组的表达阳性率(8.6%、37.1%)（χ²分别为20.15、15.80,P<0.01)。宫颈癌组Twist蛋白阳性者复发率高于Twist蛋白阴性者（29.0% vs 4.0%,χ²=5.91,P<0.05)。 结论:Twist、Slug基因在宫颈癌组织和血浆中表达上调,Twist阳性表达与宫颈癌的复发关系密切。     

磁共振弥散加权成像联合增强扫描诊断卵巢常见囊性肿瘤

目的 探讨MR DWI联合MR增强扫描对卵巢常见囊性肿瘤的诊断及鉴别诊断价值。方法 对80例经手术及病理证实的卵巢囊性肿瘤(其中卵巢囊腺癌35例,交界性卵巢囊腺瘤21例,卵巢囊腺瘤24例)患者行术前MR检查,分析肿瘤的DWI表现及强化特征,并进行统计学分析。结果 3种卵巢囊性肿瘤的侧别及大小差异均无统计学意义(P均>0.05)。卵巢囊腺癌的ADC值[(930.77±291.77)×10^-6 mm²/s]明显低于交界性卵巢囊腺瘤[(1 326.18±294.41)×10^-6 mm²/s,P<0.05]。卵巢囊腺瘤的ADC值[(1 932.64±295.35)×10^-6 mm²/s]明显高于其他两类型肿瘤(P<0.05)。增强扫描后,卵巢囊腺癌、交界性卵巢囊腺瘤及卵巢囊腺瘤明显强化率分别为91.43%(32/35)、57.14%(12/21)和12.50%(3/24)。将交界性肿瘤归入恶性肿瘤,ADC值对恶性病变诊断的敏感度和特异度分别为92.7%和91.7%,增强扫描对恶性病变诊断的敏感度、特异度分别为80.0%、87.5%,而两者联合的敏感度、特异度分别为96.4%、91.7%。结论 MR DWI联合MR增强扫描可反映卵巢囊性肿瘤的病理特点,对良性与非良性肿瘤的诊断及鉴别诊断具有重要意义。     

鼻咽癌原发灶18F-FDG和11C-胆碱显像的代谢特征

目的 探讨鼻咽癌原发灶¹⁸F-FDG和¹¹C-胆碱显像的代谢特征。方法 对35例病理确诊为原发鼻咽癌的病例行鼻咽部¹⁸F-FDG PET/CT 30 min和60 min显像,其中的20例在随后1~3天内行鼻咽部¹¹C-胆碱显像。分别测量不同显像条件下肿瘤原发灶(T)和非肿瘤区域(NT)的SUV_max,并计算和比较其T/NT比值。结果 ¹⁸F-FDG PET/CT显像:30 min、60 min T/NT比值的中位数分别为3.20与4.05,95%百分位数(单侧)分别为1.83和2.63;30 min、60 min T/NT比值( Ax-G ±s)分别是3.78±1.49和5.56±3.72,后者明显高于前者(P<0.05,t’=2.2649),增高幅度为47.09%。¹¹C-胆碱显像:T/NT的中位数是3.76, 95%百分位数(单侧)是2.00,T/NT是4.13±1.71。结论 鼻咽癌原发灶对¹⁸F-FDG和¹¹C-胆碱显像均高度敏感。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.