小型节能头灯的制做与应用

医院(特别是儿童医院)在日常的诊断和治疗护理工作中,需要在小局部范围、短时间光源照明.目前市场上各种医用头灯存在着价格昂贵,使用不方便;我院医护人员在加05年10月至2007年3月使用我院自行研制的节能头灯,采用现代电子技术,在夜间给病人注射、换药和其他治疗以及查房巡视等小范围用光场合,取得了良好的效果.     

Long-term clinical performance of flapless implant surgery compared to the conventional approach with flap elevation: A systematic review and meta-analysis

BACKGROUND The conventional implant approach involves flap elevation,which may result in increased soft tissue and bone loss and postoperative morbidity.The flapless surgical technique,aided by three-dimensional medical imaging equipment,is regarded as a possible alternative to the conventional approach to alleviate the above issues.Several studies have been performed regarding the role of flapless implant surgery.However,the results are inconsistent and there is no robust synthesis of long-term evidence to better inform surgeons regarding which type of surgical technique is more beneficial to the long-term prognosis of patients in need of implant insertion.AIM To compare the long-term clinical performance after flapless implant surgery to that after the conventional approach with flap elevation.METHODS PubMed,EMBASE,Cochrane Central Register of Controlled Trials,and grey literature databases were searched from inception to 23 September 2019.Randomised controlled trials(RCTs)and cohort studies comparing the long-term clinical performance after flapless implant surgery to that after the conventional approach over a follow-up of three years or more were included.Meta-analyses were conducted to estimate the odds ratios(ORs)or mean differences(MDs)and their 95%confidence intervals(CIs)between the long-term implant survival rate,marginal bone loss,and complication rate of the flapless and conventional groups.Subgroup analyses were carried out to account for the possible effects of the guided or free-hand method during flapless surgery.RESULTS Ten articles,including four RCTs and six cohort studies,satisfied the eligibility criteria and nine of them were included in the meta-analysis.There was no significant difference between the long-term implant survival rate[OR=1.30,95%CI(0.37,4.54),P=0.68],marginal bone loss[MD=0.01,95%CI(-0.42,0.44),P=0.97],and complication rate[OR=1.44,95%CI(0.77,2.68),P=0.25]after flapless implant surgery and the conventional approach.Moreover,subgroup analyses revealed that there was no statistically significant difference between the implant survival rate[guided:OR=1.52,95%CI(0.19,12.35),P=0.70];free-hand:n=1,could not be estimated,marginal bone loss[guided:MD=0.22,95%CI(-0.14,0.59),P=0.23;free-hand:MD=-0.27,95%CI(-1.10,0.57),P=0.53],or complication rate[guided:OR=1.16,95%CI(0.52,2.63),P=0.71;free-hand:OR=1.75,95%CI(0.66,4.63),P=0.26]in the flapless and conventional groups either with use of the surgical guide or by the free-hand method.CONCLUSION The flapless surgery and conventional approach had comparable clinical performance over three years or more.The guided or free-hand technique does not significantly affect the long-term outcomes of flapless surgery.     

Sustained complete response to erlotinib in squamous cell carcinoma of the head and neck:A case report

BACKGROUND Squamous cell carcinoma of head and neck(SCCHN) is the fifth most common cancer worldwide. Inhibition of epidermal growth factor receptor signaling has been shown to be a critical component of therapeutic option. Herein, we report a case of durable complete response to erlotinib.CASE SUMMARY An 81-year-old Caucasian male who presented with metastatic poorly differentiated squamous cell carcinoma of right cervical lymph nodes(levels 2 and 3). Imaging studies including(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(CT) and contrast-enhanced CT scan of neck and chest did not reveal any other disease elsewhere. Panendoscopic examination with random biopsy did not reveal malignant lesion in nasopharynx,oropharynx, and larynx. He underwent modified neck dissection and postoperative radiation. Within 2 mo after completion of radiation, he developed local recurrence at right neck, which was surgically removed. Two mo after the salvage surgery, he developed a second recurrence at right neck. Due to suboptimal performance status and his preference, he started erlotinib treatment.He achieved partial response after first 2 mo of erlotinib treatment, then complete response after total 6 mo of erlotinib treatment. He developed sever skin rash and diarrhea including Clostridium difficile infection during the course of erlotinib treatment requiring dose reduction and eventual discontinuation. He remained in complete remission for more than two years after discontinuation of erlotinib.CONCLUSION We report a case of metastatic SCCHN achieving durable complete response from erlotinib. Patient experienced skin rash and diarrhea toxicities which were likely predictors of his treatment response.     

Cervicogenic exophthalmos: Possible etiology and pathogenesis

BACKGROUND Unilateral exophthalmos is often caused by inflammation, neoplasm, infection,metabolic disease, vascular disorder and several other less common conditions.Reflex sympathetic dystrophy related to unilateral exophthalmos has not been reported in the past literature.CASE SUMMARY We describe a 45-year-old female with unilateral exophthalmos caused by reflex sympathetic dystrophy and its unexpected spontaneous disappearance after a standard anterior cervical discectomy and fixation operation with two PEEK interbody cages and a plate. To our surprise, the patient’s left unilateral exophthalmos improved spontaneously in the morning on postoperative day 2-with no relapse, without any further medication, as of seven years. We have named this condition "cervicogenic exophthalmos."CONCLUSION We would inform other clinicians that unilateral exophthalmos was caused not only by inflammation, vascular disorder, infection, neoplasm, or metabolic disease, but also by reflex sympathetic dystrophy related with cervicogenic spondylosis. To the best of our knowledge, ours is the first related case report and use of the term "cervicogenic exophthalmos" after reviewing previous literature.     

Photodynamic therapy as salvage therapy for residual microscopic cancer after ultra-low anterior resection: A case report

BACKGROUND The rate of positive resection margins(R1) in patients with low rectal cancer is substantial. Recommended remedies such as extended resection or chemoradiotherapy have their own serious drawbacks. It has been reported that photodynamic therapy(PDT) as a remedial treatment for esophageal cancer.Colorectal cancer and esophageal cancer has many similarities,however,PDT as a salvage therapy for rectal cancer is rare.CASE SUMMARY Here,we describe a 56-year-old man who was admitted to the hospital due to a 6-mo history of hemafecia,which had been aggravated for 1 mo. Colonoscopy revealed a 3 × 4 cm ulcerated mass in the rectum 4 cm from the anus.Preoperative pathological examination showed villous adenoma,moderate-tohigh-grade dysplasia,good differentiation,and invasion of the mucosal muscle.The patient had R1 after ultra-low anterior resection,but he refused extended resection and experienced severe liver function impairment after 3 cycles of chemotherapy. Ultimately,the patient underwent PDT to remove R1. After five years of follow-up,there was no liver function impairment,recurrence,metastasis,sexual dysfunction,or abnormal defecation function.CONCLUSION This is the first case worldwide in which R1 of rectal cancer were successfully treated by PDT.     

Endodontic management of the maxillary first molars with two root canals: A case report and review of the literature

BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively.Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography(CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope(DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition,each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.     

世界疼痛日——中国镇痛周暨建立疼痛科新闻发布会隆重召开中华医学会疼痛学分会第七届年会胜利闭幕

世界疼痛日中国镇痛周暨建立疼痛科新闻发布会、中华医学会疼痛学分会第七届年会于2007年10月12～16日在北京九华山庄隆重举行.全国人大副委员长中科院韩启德院士、原全国人大副委员长中科院吴阶平院士、卫生部陈啸宏副部长、卫生部医政司王羽司长、卫生部科教司刘雁飞司长、中华医学会吴明江常务副会长、原卫生部副部长中国医师协会殷大奎会长及有关方面的领导、专家及参加大会的疼痛医学专家代表约五百人参加了新闻发布会.     

读片窗及答案

病例 男,62岁.以"发现尿黄5天"为主诉入院.无发热、恶心及厌食等伴随症状.查体:血压150/100mmHg,巩膜轻度黄染,腹软无压痛,肝区无叩击痛,肝肋下未触及.实验室检查:血WBC 13.1×109/L,EO 5.2×109/L,占39.7%.TBIL 36.6μmol/L,DBIL 21.5μmol/L,UDBIL 15.1μmol/L.ALT 88U/L,GGT 201U/L.AFP及CEA阴性.HBsAb阳性,其余4项均阴性.     

结合中医理论对上呼吸道感染的护理

上呼吸道感染一年四季均可发病,但以冬春季节为多.此类病人病程一般在10 d以上,易反复,有的甚至迁延不愈达1个月以上,造成门诊输液量增加、交叉感染机会增多,在医治过程中医护人员也易感染.此病虽然不像癌症使人恐惧,但它的发病率高,有的1年内可发病3次～5次,给身体和生活造成很大的不便.此类病人的症状为鼻塞、流涕、喷嚏、咳嗽、咽干、咽痛、头痛、发热、乏力、全身不适等,护理一般采取对症施护:休息、保持室内空气清新、多饮水、清淡饮食等,而应用中医理论施护则更具体、更有效,对于疾病的痊愈会有极大的促进作用.     

伸缩式垂直升降护理机的适用性探讨

昏迷病人、截瘫病人、慢性消耗性疾病及脑卒中后遗症病人常伴有肢体瘫痪而长期卧床,生活不能自理,大小便失禁,易发生压疮,给病人带来极大痛苦,给家属带来繁重的负担[1].为解决这一难题,人们研究了一些护理器械,如"升降护理装置",这种护理装置由铁床、软布带、支架杆、绑绳钢筋、软网布、定滑轮组件、动滑轮组件、万向节连接件和钢丝绳组成.     

Seroconversion of HBsAG coincides with hepatitis A superinfection: A case report

BACKGROUND Hepatitis B virus(HBV)is a hepatotropic virus that can cause acute and chronic liver damage.According to the world health organization 257 million people are infected with chronic HBV infection worldwide.Super-infection with other hepadnaviruses,including hepatitis A virus(HAV),hepatitis C virus,hepatitis D virus,and hepatitis E virus is associated with increased risk of acute liver failure in patients with chronic HBV.CASE SUMMARY Here,we report a case of a 47-year old male patient with HBV-related compensated Child A cirrhosis,who presented with general fatigue,malaise and laboratory signs of acute hepatitis.Although the patient was regularly seen at a specialized university liver unit,the HAV vaccination status was unclear.Acute HAV super-infection was diagnosed by positive serological and polymerase chain reaction analysis.Following acute HAV super-infection,spontaneous HBsAg elimination and development of an anti-HBs titer were observed.CONCLUSION This case illustrates the importance of carefully checking the vaccination status.In our patient,unspecific immunological responses to HAV led to functional cure of HBV.     

Combined surgical and interventional treatment of tandem carotid artery and middle cerebral artery embolus: A case report

BACKGROUND The 2018 American Heart Association/American Stroke Association guidelines for early management of acute ischemic stroke recommend the use of retrievable stents for mechanical thrombectomy in patients with acute internal carotid artery or middle cerebral artery M1 occlusion that can be treated within 6 h from onset.For cases of carotid artery with ipsilateral middle cerebral artery tandem embolization, the operation is more complicated and challenging. We here report a case of a tandem embolism, and the anatomy of the aortic arch was complex.Direct carotid artery incision and thrombectomy can not only prevent the escape of the carotid embolus but also save time during establishment of the thrombectomy access.CASE SUMMARY The patient was a 70-year-old man. He was admitted to hospital due to sudden inability to speak and inability to move his right limb for 3 h. Imaging confirmed a diagnosis of a tandem embolism in the left carotid artery with left M1 occlusion.Carotid artery incision thrombectomy combined with stent thrombectomy was performed. The operation was successful, and 24 h later the patient was conscious and mentally competent but had motor aphasia. His bilateral limb muscle strength level was 5, and his neurologic severity scores score was 2.CONCLUSION Carotid artery incision thrombectomy combined with stenting for carotid artery plus cerebral artery tandem embolization is clinically feasible. For patients with a complicated aortic arch and an extremely tortuous carotid artery, carotid artery incision can be chosen to establish the interventional path.     

电针与西布曲明对肥胖大鼠脂肪细胞产物影响的差异

背景:针灸与药物均是治疗单纯性肥胖病的有效方法,电针与常用减肥药西布曲明影响肥胖机体脂肪细胞产物是否存在差异?目的:观察电针与常用减肥药西布曲明影响肥胖大鼠脂肪细胞产物的差异,以探讨针灸减肥的机制.设计:分层随机对照设计.单位:南京中医药大学针药结合实验室.材料:选用120只生后45 d雄性SD大鼠,由上海实验动物中心提供,实验过程中对动物的处置符合动物伦理学标准.盐酸西布曲明胶囊由太极集团涪陵制药厂生产,批号为国药准字X20010279;电针仪为韩氏LH402A穴位神经电刺激仪,由北京华卫产业开发公司生产.方法:实验于2004-1012006-11在南京中医药大学针药结合实验室和南京中医药大学实验动物中心完成.①高脂高能量饲料喂养100只SD雄性人鼠,选择食源性肥胖人鼠54只,分为电针组、药物组、肥胖组,每组18只,并以18只正常饲料大鼠为正常组.②电针组大鼠均以2/15 Hz,4 mA的电针治疗,针刺穴位为同侧的"后三里"、"内庭",每次针一侧2个穴位,隔日交替.以自制的束缚装置崮定,治疗时大鼠处于清醒而不剧烈挣扎状态,治疗时间15 min/d,每6天休息1 d,共观察49 d,治疗42次;药物组采用0.2g/L盐酸西布曲明溶液2.0mg/(kg·d)灌胃;正常组及肥胖组与针刺组同样束缚而不针刺.主要观察指标:①肥胖指标:检测各组大鼠体质量、体长、减重率及脂体比,生化比色法测定血清总胆固醇、高密度脂蛋白胆固醇及三酰甘油.②胰岛素敏感性指标:酶联免疫法测定空腹血清葡萄糖、胰岛素及胰岛素敏感指数.③脂肪细胞分泌调节物质水平:酶联免疫法测定血清抵抗素、瘦素、脂联素、肿瘤坏死因子α、白介素-6及其可溶性受体水平.结果:纳入大鼠120只,食源性肥胖大鼠模型成功54只及正常组18只均进入结果分析.①肥胖组大鼠体质量、体脂量、胆同醇、三酰甘油明显高于正常组,差异有统计学意义(P＜0.01).电针组大鼠体质量、体脂量、脂体比、胆固醇、三酰甘油低于肥胖组,差异有统计学意义(P＜0.01).药物组大鼠三酰甘油低于肥胖组,差异有统计学意义(P＜0.01).电针组减重率高于药物组,脂体比低于药物组,差异有显著性意义(P＜0.01).②肥胖组大鼠血糖、血清胰岛素明显高于正常组,胰岛素敏感指数低于正常组,差异均有统计学意义(P＜0.01).电针组及药物组血糖和胰岛素水平低于肥胖组,胰岛素敏感指数高于肥胖组,差异有统计学意义(P＜0.01).③电针组大鼠脂联素水半高于肥胖组,差异有统计学意义(P＜0.01).抵抗素、肿瘤坏死因子α水平均低于肥胖组,差异有统计学意义(P＜0.01).药物组大鼠抵抗素水平低于肥胖组,差异有统计学意义(P＜0.01).结论:电针在改变肥胖大鼠脂肪组织异常分泌的产物方面的作用较西布曲明更为明显,这可能是针灸减肥和防治肥胖相关疾病的重要机制之一.     

护理本科生毕业论文存在的问题及对策

[目的]了解护理本科生毕业论文存在的问题,为促进护理教学及毕业论文的指导工作提供依据.[方法]采用问卷调查法,对南京中医药大学2002级98名应届本科生进行毕业论文方面的调查.[结果]62.2%学生认为选题最为困难,83.6%的学生自己选题;论文初步写好后,提供过修改意见的71.4%是临床老师;94.9%的学生写的是综述.[结论]护理教学应不断改进,同时学校及实习医院应提供相关支持.     

Two-level percutaneous endoscopic lumbar discectomy for highly migrated upper lumbar disc herniation: A case report

BACKGROUND The technique of percutaneous endoscopic lumbar discectomy(PELD)as a transforaminal approach has been used to treat highly migrated lower lumbar disc herniations.However,due to the different anatomic characteristics of the upper lumbar spine,conventional transforaminal PELD may fail to remove the highly migrated upper lumbar disc nucleus pulposus.Therefore,the purpose of this study was to describe a novel surgical technique,two-level PELD,for the treatment of highly migrated upper lumbar disc herniations and to report its related clinical outcomes.CASE SUMMARY A 60-year-old male presented with a complaint of pain at his lower back and right lower limb.The patient received 3 mo of conservative treatments but the symptoms were not alleviated.Physical examination revealed a positive femoral nerve stretch test and a negative straight leg raise test for the right leg,and preoperative visual analog scale(VAS)score for the lower back was 6 points and for the right leg was 8 points.Magnetic resonance imaging(MRI)demonstrated L2-L3 disc herniation on the right side and the herniated nucleus pulposus migrated to the upper margin of L2 vertebral body.According to physical examination and imaging findings,surgery was the primary consideration.Therefore,the patient underwent surgical treatment with two-level PELD.The pain symptom was relieved and the VAS score for back and thigh pain was one point postoperatively.The patient was asymptomatic and follow-up MRI scan 1 year after operation revealed no residual nucleus pulposus.CONCLUSION Two-level PELD as a transforaminal approach can be a safe and effective procedure for highly migrated upper lumbar disc herniation.     

Computed tomography-based score model/nomogram for predicting technical and midterm outcomes in transjugular intrahepatic portosystemic shunt treatment for symptomatic portal cavernoma

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)may be technically difficult in patients with cavernous transformation of the portal vein(CTPV).Computed tomography(CT)is widely used for assessing the situation of the portal vein and its tributaries before TIPS,and an ultrasound-based Yerdel grading system has been developed,which is deemed useful for liver transplantation.Therefore,we hypothesized that a CT-based CTPV scoring system could be useful for predicting technical and midterm outcomes in TIPS treatment for symptomatic portal cavernoma.AIM To investigate the clinical significance of a CT-based score model/nomogram for predicting technical success and midterm outcome in TIPS treatment for symptomatic CTPV.METHODS Patients with symptomatic CTPV who had undergone TIPS from January 2010 to June 2017 were retrospectively analysed.The CTPV was graded with a score of 1-4 based on contrast-CT imaging findings of the diseased vessel.Outcome measures were technical success rate,stent patency rate,and midterm survival.Cohen’s kappa statistic,the Kaplan-Meier and log-rank tests,and uni-and multivariable analyses were performed.A nomogram was constructed and verified by calibration and decision curve analysis.RESULTS A total of 76 patients(45 men and 31 women;mean age,52.3±14.7 years)were enrolled in the study.The inter-reader agreement(κ)of the CTPV score was 0.81.TIPS was successfully placed in 78%of patients(59/76).The independent predictor of technical success was CTPV score(odds ratio[OR]=5.56,95%confidence interval[CI]:3.55-9.67,P=0.002).The independent predictors of primary TIPS patency were CTPV score and splenectomy(OR=9.22,95%CI:4.78-13.45,P=0.009;OR=4.67,95%CI:2.59-7.44,P=0.017).The survival rates differed significantly between the TIPS success and failure groups.The clinical nomogram was made up of patient age,model for end-stage liver disease score,and CTPV score.The calibration curves and decision curve analysis verified the usefulness of the CTPV score-based nomogram for clinical practice.CONCLUSION TIPS should be considered a safe and feasible therapy for patients with symptomatic CTPV.Furthermore,the CT-based score model/nomogram might aid interventional radiologists in therapeutic decision-making.     

Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome:Two case reports

BACKGROUND A swallowing disorder may occur following a brainstem stroke,especially one that occurs in the swallowing centers.Lateral medullary syndrome(referred to as LMS),a rare condition in which a vascular event occurs in the territory of the posterior inferior cerebellar artery or the vertebral artery,has been reported to lead to more severe and longer lasting dysphagia.CASE SUMMARY We report two patients with dysphagia due to LMS and propose a novel technique named hyoid-complex elevation and stimulation technique(known as HEST).The two patients had no other functional incapacity back into life,but nasogastric feeding was the only possible way for nutrition because of severe aspirations.Swallowing function was evaluated by functional oral intake scale,modified water swallow test,surface electromyographic signal associated with video fluorography swallowing study to assess the situation of aspiration,pharyngeal residue,pharyngeal peristalsis,upper esophageal opening and the ability of deglutition.Both patients were treated with the HEST method for dysphagia and recovered quickly.CONCLUSION HEST is effective for shortening the in-hospital time and improving the quality of life for patients with dysphagia who suffer from LMS and likely other strokes.     

Status,challenges, and future prospects of stem cell therapy in pelvic floor disorders

Pelvic floor disorders(PFDs)represent a group of common and frequentlyoccurring diseases that seriously affect the life quality of women,generally including stress urinary incontinence and pelvic organ prolapse.Surgery has been used as a treatment for PFD,but almost 30%of patients require subsequent surgery due to a high incidence of postoperative complications and high recurrence rates.Therefore,investigations of new therapeutic strategies are urgently needed.Stem cells possess strong multi-differentiation,self-renewal,immunomodulation,and angiogenesis abilities and they are able to differentiate into various cell types of pelvic floor tissues and thus provide a potential therapeutic approach for PFD.Recently,various studies using different autologous stem cells have achieved promising results by improving the pelvic ligament and muscle regeneration and conferring the tissue elasticity and strength to the damaged tissue in PFD,as well as reduced inflammatory reactions,collagen deposition,and foreign body reaction.However,with relatively high rates of complications such as bladder stone formation and wound infections,further studies are necessary to investigate the role of stem cells as maintainers of tissue homeostasis and modulators in early interventions including therapies using new stem cell sources,exosomes,and tissueengineering combined with stem cell-based implants,among others.This review describes the types of stem cells and the possible interaction mechanisms in PFD treatment,with the hope of providing more promising stem cell treatment strategies for PFD in the future.     

实用型静脉输液固定装置的制作与应用*

在静脉输液治疗中,危重、昏迷、躁动患者和儿科小患者以及精神失常患者由于失去自主控制能力,经常造成针头脱落、移位、漏液、皮下水肿、感染甚至组织坏死.为此,我们设计并制作静脉输液固定装置,经临床60例患者的应用,取得良好效果.现介绍如下.     

ERCP致胆管炎17例分析

目的进一步提高诊治性ERCP的疗效,减少胆管炎的并发症。方法回顾分析1993年以来该院开展ERCP684例的资料,其中诊断性ERCP491例,治疗性ERCP193例。结果有17例发生胆管炎,占2.49%,诊断性ERCP491例有9例患者并发胆管炎,占1.83%,治疗性ERCP193例患者中有8例并发胆管炎,占4.15%。结论胆道梗阻性病变、胆道慢性感染源存在是主要原因,检查严格无菌操作,及时有效进行胆道减压引流是预防胆管炎的关键。