益气养精法对老年肺癌患者肿瘤标志物、生存期影响研究

目的探究益气养精法对老年肺癌患者肿瘤标志物、生存期影响。方法研究纳入60例老年肺癌患者,均由本院2016年1月-2017年1月收治,采取随机数字表法将患者分为两组,对照组患者(30例)常规化疗治疗,观察组患者(30例)在化疗基础上联合益气养精法治疗,比较两组患者治疗效果、治疗前后癌胚抗原(carcino-embryonic antigen,CEA)及血清癌抗原125(serum oncoantigen 125,CA 125)肿瘤标志物水平、不良反应情况及患者2年生存率。结果观察组患治疗有效率高于对照组,P<0.05;治疗前,两组患者CEA及CA 125水平相当,P>0.05,治疗后均改善,观察组优于对照组,P<0.05;观察组患者不良反应与对照组相当,均较低,P>0.05;观察组患者2年生存率高于对照组,P<0.05。结论益气养精法治疗老年肺癌患者效果患者,患者症状改善,不良反应少,安全可靠,且患者2年生存率较高。     

Work-related injuries in the Australian education sector: A retrospective cohort study

IntroductionEducators are exposed to several work-related hazards. Evidence suggests musculoskeletal pain, psychological distress, and student-inflicted violence-related injuries are common. However, there is little evidence on the burden of workplace injury among Australian educators.AimTo compare incidence of injury claims and duration of compensated time off work between educators and non-educators, and associated factors.MethodsRetrospective cohort study of 1,559,676 Australian workers’ compensation claims, including 84,915 educator claims, lodged between July 2009 to June 2015, from the National Dataset for Compensation-based Statistics. Cases were included if aged 18+ years and working in the education sector less than 100 h per week. Negative binomial regression models estimated the relative risk of making a compensation claim and survival analyses calculated disability duration within educators by sex, age, injury type and mechanism, socioeconomic area, remoteness, and jurisdiction.ResultsCompared to non-educators, educators had lower rates of injury claims and shorter disability durations. However, educators had a higher rate of claims for mental health conditions and assault, with the highest risk being among those in special education and education aides. Among educators, injury claim rates were highest among special educators, education aides, and secondary educators.Discussion and ConclusionThough surveys indicate Australians in the education sector have higher incidences of work-related injuries, this study found lower incidence of injury claims and shorter disability durations than others. Educators’ injury-reporting and absenteeism behaviors may be constrained by ethical, social, and administrative attitudes. Educators had higher rates of claims for mental health and assault-related injury, particularly special educators, and education aides, which suggests a need for targeted prevention efforts.     

Why X-rays? The importance of radiographs in spine surgery

Despite the advances made in high-resolution spinal imaging, plain films (radiographs or x-rays) remain a cornerstone of evaluating and caring for spine patients in the preoperative, intraoperative, and postoperative settings. Although often undervalued when compared with more advanced imaging such as MRIs or CT scans, plain films provide surgeons invaluable information that other imaging modalities oftentimes cannot. In addition to their use during surgery for localization or evaluation of hardware placement, x-rays provide an overall image of a patient's spine, are useful in evaluating hardware complications, allow detailed assessment of alignment and stability and allow for repeated images in clinic during follow-up. Plain films continue to provide critical information that cannot be obtained with other imaging modalities, and they remain central to providing optimal care for spine patients.     

基于慢性肾脏病管理的精准分级诊疗应用实践

分级诊疗制度是优化基本医疗卫生制度的重要步骤,但落地实施时遇到阻碍,因存在转诊标准不一、空间不连贯和时间滞后等问题,医联体模式推进存在难度。上海市浦东新区人民医院联合7家社区卫生服务中心,构建了一套以信息化为支撑的川沙医联体慢性肾脏病（CKD）专病精准分级诊疗管理方案。以CKD病种为例,基于指南梳理CKD患者的疾病管理规律,建立医疗信息联通共享、转诊规则标准的CKD专病分级诊疗知识库,设计区域CKD专病分级诊疗系统,构建了基于医院-社区联动管理的专病分级诊疗一体化管理模型。且实证应用评价显示,基于CKD知识库的专病分级诊疗模式,可以精准定位易发和高危人群,及时筛查评估CKD早期患者,提升CKD患者的健康管理和诊疗效率。     

锁定接骨板弹性内固定治疗股骨远端骨折

目的探讨锁定接骨板弹性内固定治疗股骨远端骨折的疗效。方法2015 年 1 月—2016 年 6 月，采用锁定接骨板弹性内固定治疗股骨远端骨折 21 例。男 5 例，女 16 例；年龄 32～88 岁，平均 62 岁。摔伤 14 例，交通事故伤 5 例，高处坠落伤 2 例。左侧 13 例，右侧 8 例。闭合性骨折 20 例，开放性骨折 1 例。骨折根据 AO/OTA 分型：33-A1 型 5 例，33-A2 型 3 例，33-A3 型 8 例，33-C2 型 2 例，33-C3 型 3 例。受伤至手术时间 3～13 d，平均 6.5 d。结果术后患者切口均Ⅰ期愈合。18 例患者获随访，随访时间 12～24 个月，平均 16 个月。X 线片复查示骨折均愈合，愈合时间 8～24 周，平均 16.6 周；关节面恢复平整，下肢长度恢复。随访期间无螺钉松动、钢板断裂，无膝关节内外翻畸形，未出现明显膝关节僵硬。术后 6、12 个月间疼痛视觉模拟评分（VAS）比较，差异无统计学意义（P>0.05）；其余各时间点间比较，差异均有统计学意义（P<0.05）。术后 3、6、12 个月膝关节活动度较 1 个月时明显增大，比较差异均有统计学意义（P<0.05）；3、6、12 个月间比较，差异均无统计学意义（P>0.05）。各时间点间 Neer 评分比较，差异均有统计学意义（P<0.05）；术后 12 个月，按 Neer 评分标准评定膝关节功能，获优 12 例、良 6 例。 结论锁定接骨板弹性内固定治疗股骨远端骨折临床效果良好，是治疗该类型骨折的有效方法之一。     

高压氧联合地塞米松治疗突发性耳聋的疗效及相关影响因素分析

目的 分析高压氧联合地塞米松治疗突发性耳聋（SD）的疗效及相关影响因素。方法 回顾性分析 2014年 1 月—2016 年 12 月我院 200 例采用高压氧联合地塞米松治疗的 SD 患者的临床资料，根据疗效分为有效组（n=182 例）与无效组（n=18 例），比较 2 组性别、年龄、发病至就诊时间、耳别、听力损失、听力曲线类型、伴眩晕情况、伴耳鸣情况、合并疾病（高血压或糖尿病）、血浆黏度及血清 C 反应蛋白（CRP）等指标，并采用 Logistic 回归筛选影响SD 疗效的危险因素。结果 200 例患者经治疗后，总有效 182 例（91.00%），无效 18 例(9.00%）。有效组年龄>50岁、发病至就诊时间>7 d、听力损失≥60 dB、听力曲线类型为高频型或全聋型、伴眩晕、合并高血压、合并糖尿病、血浆黏度≥2 mPa·s、血清 CRP≥20 μmol/L 的比例明显低于无效组（P＜0.05）。Logistic 回归分析显示，年龄（>50 岁）、发病 至就诊时间（>7 d）、听力损失（≥60 dB）、听力曲线类型为高频型或全聋型、伴眩晕、合并高血压、合并糖尿病、血浆黏度（≥2 mPa·s）、血浆 CRP（≥20 μmol/L）为影响 SD 疗效的危险因素（P＜0.05）。结论 高压氧联合地塞米松是治疗SD 的有效方案，但影响其疗效的因素众多，临床治疗时有必要考虑患者临床与病理特征。     

血府逐瘀胶囊对重度血瘀证患者经皮冠状动脉介入治疗术后氯吡格雷抵抗的调节作用

目的 观察血府逐瘀胶囊联合氯吡格雷治疗氯吡格雷抵抗患者的效果,评价其改善氯吡格雷抵抗作用的效果。方法 经皮冠状动脉介入治疗（PCI）术后氯吡格雷抵抗患者80人,随机分组,分别给予3种药物治疗方案：A组用国产氯吡格雷（泰嘉）加用血府逐瘀胶囊;B组使用进口氯吡格雷（波立维）;C组用国产氯吡格雷（泰嘉）加用西洛他唑,连续3个月,采用血栓弹力图法检测干预后血小板抑制率。并随访患者半年,观察临床不良事件的发生率。结果 治疗3个月后,各组抑制率均有所提高,且均有显著差异（P<0.05）。A组对血小板抑制的有效率达40%,优于C组（33.33%）,与B组相当（40.74%）。对阿司匹林、氯吡格雷均不敏感的患者换用进口波立维对提高血小板抑制效果更佳;仅对氯吡格雷不敏感的患者加用血府逐瘀胶囊对血小板抑制有协同作用。随访半年后发现,联合使用血府逐瘀胶囊的时间延长可能会增强血小板抑制的效果,但并不增加出血及凝血功能异常等风险。结论 血府逐瘀胶囊对提高血小板抑制率有一定的作用,同时对出血风险影响较小。     

O型臂导航引导下经皮椎体成形术治疗中段胸椎骨质疏松性椎体压缩骨折的精准性及安全性

目的 探讨O型臂导航引导下经皮椎体成形术（percutaneous vertebroplasty,PVP）在治疗中段胸椎骨质疏松性椎体压缩骨折的精准性及安全性。方法 2019年12月—2021年8月复旦大学附属浦东医院骨科收治中段胸椎骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture,OVCF）患者15例（15个椎体）,男5例,女10例;年龄70~89岁,平均（76.7±5.8）岁。均采用O型臂导航引导下经单侧穿刺行PVP治疗。主要疗效指标：术中规划路径与实际路径的符合率,微创经皮开路器穿刺成功需要的次数,主要指标用于评价该手术操作的精准性。次要疗效指标包括：记录患者术前、术后2天以及末次随访时视觉模拟（visual analogue scale,VAS）疼痛评分,Oswestry功能障碍指数（Oswestry disability index,ODI）。同时记录患者的手术时间、骨水泥使用量、术中出血量及手术相关并发症发生情况等,测量并记录术前、术后2天及末次随访时伤椎前缘高度,次要指标用于评价该手术方案的临床疗效与安全性。结果 15例患者均顺利完成手术,术中规划路径与实际路径的符合率：优6例,良9例,优良率达100%,所有病例均为1次穿刺成功,无患者出现骨水泥渗漏或严重并发症。平均随访11.7个月。术前、术后2天及末次随访时患者VAS评分分别为7.2±0.7、2.3±0.5和1.9±0.5,患者ODI评分分别为68.1±4.0、23.6±4.3和23.0±4.6,患者伤椎前缘高度分别为（2.4±0.3）cm、（2.7±0.3）cm和（2.6±0.3）cm。术后2天患者VAS评分、ODI评分较术前明显改善（P<0.05）,术后2天及末次随访时患者伤椎前缘高度较术前均增加（P<0.05）。结论 O型臂导航引导下PVP治疗中段胸椎OVCF,可提高手术操作精准度及安全性,在治疗中段胸椎OCVF中可能具有较大的临床应用价值。     

LPS-pretreatment adipose-derived mesenchymal stromal cells promote wound healing in diabetic rats by improving angiogenesis

Mesenchymal stem cells (MSCs) play a key role in wound healing, and the advantages of pretreated MSCs in wound healing have previously been reported. In the present study, we investigated the impact of LPS pretreated human adipose-derived MSCs on skin wound healing in diabetic rats. We found that some improvements occurred through improving angiogenesis. Then, we scrutinized the impact of lipopolysaccharide (LPS) treatment on human adipose-derived MSCs in a high-glucose (HG) medium, as an in vitro diabetic model. In vivo findings revealed significant improvements in epithelialization and angiogenesis of diabetic wounds which received LPS pre-MSCs. Particularly, LPS pre-MSCs-treated diabetic wounds reached considerably higher percentages of wound closure. Also, the granulation tissue of these wounds had higher pronounced epithelialization and more vascularization compared with PBS-treated and MSCs-treated diabetic ones by CD31, VEGF, CD90, collagen 1, and collagen 3 immunostaining. Western-blots analyses indicated that LPS pre-MSCs led to the upregulation of vascular endothelial growth factor (VEGF) and DNMT1. In addition, significantly higher cell viability (proliferation/colonie), and elevated VEGF and DNMT1 protein expression were observed when MSCs were treated with LPS (10 ng/ml, 6 h) in HG culture media. Based on these findings, it is suggested that LPS pre-MSCs could promote wound repair and skin regeneration, in some major processes, via the improvement of cellular behaviors of MSCs in the diabetic microenvironment. The beneficial advantages of LPS treated with mesenchymal stem cells on wound healing may lead to establishing a novel approach as an alternative therapeutic procedure to cure chronic wounds in diabetic conditions.