超声引导下经皮穿刺引流治疗胰腺假性囊肿效果分析

目的探讨超声引导下经皮穿刺置管引流(PCD)治疗胰腺假性囊肿(PPC)的临床效果及应用价值。方法回顾性分析2002年1月至2009年12月,53例PPC(急性PPC 37例,慢性PPC 16例)行超声引导下PCD治疗的病例资料。所有PPC均先在超声引导下行PCD术,对引流液持续增多,囊肿无明显缩小者联合内镜、腹腔镜或开腹内引流术。结果 PCD穿刺成功率为100%,PPC单纯行PCD的总体治愈率为66%(35/53),其中急性PPC单纯行PCD的治愈率为89.2%(33/37);慢性PPC单纯行PCD的治愈率为12.5%(2/16)。对先行PCD失败者行囊肿和胰管造影检查示二者持续相通,联合内镜、腹腔镜或开腹内引流术,PPC均可完全治愈。结论 PCD治疗急性PPC效果满意,对慢性PPC成功率低,往往需联合其他微创引流技术。     

Objective Assessment of Resident Teaching Competency Through a Longitudinal,Clinically Integrated,Resident-as-Teacher Curriculum

ObjectiveCompetency-based training should be paired with objective assessments. To date, there has been limited objective assessment of resident-as-teacher curricula (RATC). We sought to assess the impact of a longitudinal RATC on postgraduate year-1 (PGY1) resident teaching competency using Observed Structured Teaching Encounters (OSTEs) for the skills of 1) brief didactic teaching [DT], 2) feedback [FB], and 3) precepting [PR].MethodsA controlled, prospective, educational study was conducted from May 2015 to June 2016. The RATC consisted of a workshop series with reinforcement of key skills (DT, FB) during clinical rotations. Intervention residents participated in the RATC and completed OSTEs at the beginning and end of the academic year. A control group, PGY1 residents that matriculated the year previously, completed the OSTEs before starting their PGY2 year. OSTEs were reviewed by 2 blinded study personnel. We assessed reliability between raters via intraclass correlation coefficients and differences in OSTE scores via least squared mean differences (LSMD).ResultsIn total, 92.5% (n = 37) of eligible control and 100% (n = 41) of eligible intervention residents participated. The OSTEs demonstrated excellent agreement between reviewers (DT: 0.99, FB: 0.89, PR: 0.98). A significant pre-post difference was demonstrated in the intervention group for DT (LSMD [95% confidence interval], 3.14 [2.49-3.79], P < .0001), FB (0.93 [0.49–1.37], P < .0001), and PR (0.64 [0.09–1.18], P < .022). A significant difference between the control and intervention groups was demonstrated for DT (3.00 [2.05–3.96], P < .0001).ConclusionsSkill-based OSTEs can be used to detect changes in residents’ teaching competency and may represent a potential component of programmatic evaluation of resident-as-teacher curricula.     

Psychotropic Medication Use in United States Pediatric Emergency Department Visits

Objective and BackgroundLittle is known about pediatric psychotropic medication use in the emergency department (ED), despite a rise in mental and behavioral health visits. This study describes psychotropic medication use in a nationally representative sample of pediatric mental and behavioral health ED visits over a 14-year period.MethodsWe conducted a cross-sectional analysis of pediatric (6–17 years) mental and behavioral health ED visits using the National Hospital Ambulatory Medical Care Survey, 2006–2019. We describe administration of psychotropic medications by medication type, diagnosis, and over time. Using multivariable survey-weighted logistic regression, we examine associations between medication administration and sociodemographics.ResultsA psychotropic medication was administered in 11.4% of the estimated 11,792,860 pediatric mental and behavioral health ED visits in our sample. Benzodiazepines were administered most frequently (4.9% of visits). Visits with anxiety disorders had the highest frequency of psychotropic medication use (26.7%). Visits by Black non-Hispanic patients had a 60% decreased odds of medication administration compared to visits for White non-Hispanic patients. Visits with public compared to private insurance had a 3.5 times increased odds of psychotropic polypharmacy. The proportion of visits in which a psychotropic medication was administered did not change statistically over time.ConclusionsA psychotropic medication was administered in 1 in 10 pediatric mental and behavioral health ED visits. Use differed by sociodemographics but did not change over time. As more youth seek mental and behavioral health care in the ED, we must better understand appropriate medication use to ensure quality and equitable care.     

Colon ischemia: A comprehensive review

The clinical and endoscopic features of colon ischemia (CI) are non-specific. CI is correctly identified at the time of presentation in only 9% of patients is. The true incidence is likely underestimated because many mild cases resolve spontaneously without medical treatment. Furthermore, since most cases of CI are transient, and no specific cause is detected they are often considered to be “idiopathic”. In the setting of severe CI correct diagnosis and prompt recognition and therapy as well as identification of underlying causes are crucial for a favourable outcome. Although less severe, mild cases may present with similar symptoms, the prognosis and management are completely different and managed conservatively rather than with surgery. Unfortunately, data from most studies and current guidelines do not provide recommendations on the long-term management of CI or about the need for endoscopic follow-up to detect the development chronic, recurrent and/or ischemic colonic strictures. In this review, we focus on the definition of CI, its aetiology, and patterns of presentation. We highlight the pharmacological and/or endoscopic management as determined severity of disease that allow for improved outcomes. Prompt recognition and treatment using a multidisciplinary approach are essential for successful management of severe CI because mortality rates are significantly higher when the diagnosis is delayed.     

Catalpol Promotes the Survival and VEGF Secretion of Bone Marrow-Derived Stem Cells and Their Role in Myocardial Repair After Myocardial Infarction in Rats

Bone mesenchymal stem cells (BMSCs) transplantation has been recognized as an effective method for the treatment of myocardial infarction (MI). However, its efficacy is always restricted by the low survival of transplanted BMSCs in the ischemic myocardium. The aim of this study was to investigate the effect of catalpol pre-treatment on the survival and vascular endothelial growth factor (VEGF) secretion of BMSCs under oxygen glucose deprivation (OGD) condition and their role in myocardial repair in a rat model of MI. According to our results, pre-treatment with catalpol enhanced VEGF secretion and survival of OGD-treated BMSCs. Moreover, the apoptosis of BMSCs induced by OGD was restrained by catalpol as evidenced by increased level of B-cell lymphoma-2 (Bcl-2) and decreased levels of BCL2-associated X (Bax) and cleaved caspase-3. In vivo study suggested that the survival of transplanted BMSCs was improved by catalpol pre-treatment. The myocardial fibrosis and apoptosis was further inhibited in catalpol pre-treated BMSCs group. Cardiac function detected by echocardiography was obviously improved by catalpol pre-treated BMSCs transplantation. Finally, angiogenesis and VEGF expression in the ischemic myocardium were significantly promoted in catalpol pre-treated BMSCs group. In conclusion, catalpol pre-treatment may facilitate the survival and VEGF secretion of BMSCs and improve their therapeutic effect on MI.     

Epidemiology of distal forearm fractures in Oslo, Norway

Summary The population of Oslo has the highest incidence of hip fracture reported. The present study shows that the overall incidence of distal forearm fractures in Oslo is higher than in other countries and has not changed significantly when comparing the incidence of 1998/99 with 1979. Introduction The population of Oslo has the highest incidence of hip fracture reported. The present study reports the incidence of distal forearm fracture in Oslo and the fracture rates of immigrants. Methods Patients aged ≥20 years resident in Oslo sustaining a distal forearm fracture in a one-year period in 1998/99 were identified using electronic diagnosis registers, patient protocols, and/or X-ray registers of the clinics in Oslo. Medical records were obtained and the diagnosis verified. The age- and sex-specific incidence rates were calculated and compared with those for 1979. Data on immigrant category and country of origin of the patients were obtained. Results The age-adjusted fracture rates per 10,000 for the age group ≥50 years were 109.8 and 25.4 in 1998/99 compared with 108.3 and 23.5 in 1979 for women and men, respectively (n.s.). The relative risk of fracture in Asians was 0.72 (95% CI 0.53–1.00) compared with ethnic Norwegians. Conclusions The overall incidence of distal forearm fractures in Oslo is higher than in other countries and has not changed significantly when comparing the incidence of 1998/99 with 1979. Furthermore, the present data suggest that Asian immigrants in Oslo have a slightly lower fracture risk than ethnic Norwegians.     

Current Patterns of Prehospital Trauma Care in Kampala,Uganda and the Feasibility of a Lay-First-Responder Training Program

Background  

Uganda currently has no organized prehospital emergency system. We sought to measure the current burden of injury seen by lay people in Kampala, Uganda and to determine the feasibility of a lay first-responder training program.     

Transthoracic pacing in cardiac asystole

A total of 139 patients had transthoracic pacemakers introduced via a subxiphoid approach for asystole during advanced CPR in the emergency department of a large urban teaching hospital over a calendar year. Two groups were examined retrospectively, A) 34 patients who presented asystolic, and B) 99 patients who presented with ventricular fibrillation that became asystole. Age, sex, and etiologies for cardiac arrest were similar in both groups; there were no survivors. The mean duration of asystole before pacemaker insertion was 4 min (group A) to 7 min (group B). Temporary electrical capture was obtained in six patients from group B, but electrical-mechanical association could not be achieved in any of these patients.     

强化健康教育对代谢综合征患者远期疗效的观察

目的评价强化健康教育对代谢综合征（metabolism syndroms，MS）患者的远期疗效。方法对106例MS的患者进行为期5年的强化教育和观察随访，观察受试者MS影响因素的控制情况和血管并发症的发生情况。结果强化教育后，受试者对MS治疗的态度、认知、依从性评分明显提高，患者血压、体重指数、空腹血糖、餐后血糖、三酰甘油、总胆固醇水平均明显降低（P均〈0．05）；心脑血管疾病总患病率均低于常规教育人群。结论强化教育能够提高MS患者治疗的达标率，降低远期心血管疾病并发症的发生率。