新型 H 形解剖钛板治疗髋臼后壁/后柱骨折

目的探讨新型 H 形解剖钛板治疗髋臼后壁/后柱骨折的疗效。方法2012 年 3 月—2019 年 4 月，应用新型 H 形解剖钛板治疗 46 例累及后壁/后柱的髋臼骨折患者。男 28 例，女 18 例；年龄 20～70 岁，平均 45.5 岁。致伤原因：交通事故伤 34 例，高处坠落伤 12 例。受伤至手术时间 2～14 d，平均 7 d。Letournel-Judet 分型：后壁骨折 12 例、后柱骨折 1 例、横形骨折 3 例、横形伴后壁骨折 9 例、后柱伴后壁骨折 8 例、前柱伴后半横形骨折 2 例、T 形骨折 3 例、双柱骨折 8 例。术后采用 Matta 评价标准评定骨折复位情况，Merle d’Aubign-Postel 评分标准评价髋关节功能。结果46 例均顺利完成手术；后路手术时间 60～120 min，平均 80 min；术中出血量 200～600 mL，平均 300 mL。术后切口均 Ⅰ 期愈合，无感染、下肢深静脉血栓形成、坐骨神经损伤等并发症发生。患者均获随访，随访时间 6～72 个月，平均 37 个月。骨折复位根据 Matta 评价标准评定，获解剖复位 40 例、满意复位 4 例、不满意复位 2 例，满意率为 95.7%（44/46）；骨折均愈合，愈合时间为 3～6 个月，平均 4.3 个月；随访期间无内固定失效发生。末次随访时 Merle d’Aubign-Postel 评分为 6～18 分，平均 15.5 分；其中优 38 例、良 4 例、可 2 例、差 2 例，优良率为 91.3%（42/46）。术后 4 例发生异位骨化，4 例发生创伤性关节炎，2 例发生股骨头坏死。结论对于累及后壁/后柱的髋臼骨折，新型 H 形解剖钛板可以提供牢固固定，术后骨折复位满意，髋关节功能恢复良好。     

福建省淡水溪蟹种类、地理分布及其携带并殖吸虫囊蚴

目的查清福建省淡水蟹类在34个各县市分布及其携带并殖吸虫情况。方法广泛收集各地溪蟹标本并鉴别种类,检查蟹体内感染并殖吸虫囊蚴种类与感染率。结果与结论发现在福建省已报告有福建华溪蟹等17种溪蟹和7种待报告的华南溪蟹属等新种。这些蟹体内发现感染有卫氏并殖等7种并殖吸虫囊蚴,总感染率为43.49%(3483/8009),显示福建省是一个并殖吸虫虫种和第二中间宿主淡水蟹类繁多的省份,人的感染也是此起彼伏的散在发生。     

地市级三甲综合性医院科研管理实践及对策分析

目的 了解地市级三甲综合医院科研现状,分析科研管理中存在的问题,为提升地市级三甲综合性医院的学科发展提出对策建议.方法 收集某地市级三甲综合性医院科研档案,对2016-2020年医院在"十三五"期间的科研管理、科研成果情况进行分析讨论.结果 "十三五"期间医院实施提升全院科研意识、健全科研制度、加大人才引进及经费投入等...     

Efficacy of extended antrum ablation based on substrate mapping plus pulmonary vein isolation in the treatment of atrial fibrillation

Introduction and objectivesPulmonary vein isolation (PVI) technique has become the cornerstone of atrial fibrillation (AF) catheter ablation. The objective of this study was to assess the efficacy and safety of extended antrum ablation based on electrophysiological substrate mapping plus PVI in AF patients who underwent cryoballoon ablation.MethodsIn this observational study, a total of 121 paroxysmal AF patients and 80 persistent AF patients who did not achieve the procedure endpoint after cryoballoon ablation received extra extended antrum ablation (EAA) based on electrophysiological substrate mapping via radiofrequency ablation (EAA group). As a control group (PVI group), among paroxysmal AF and persistent AF patients, we conducted a propensity score-matched cohort, in whom only PVI was completed.ResultsThe average follow-up time was 15.27±7.34 months. Compared with PVI group, paroxysmal AF patients in the EAA group had a significantly higher rate of AF-free survival (90.1% vs. 80.2%, p=0.027) and AF, atrial flutter, or atrial tachycardia (AFLAT) -free rate survival (89.3% vs. 79.3%, p=0.031). Persistent AF patients in the EAA group also had a significantly higher rate of AF-free survival (90.0% vs. 75.0%, p=0.016) and AFLAT-free survival (88.8% vs. 75.0%, p=0.029) than PVI group. Complication rates did not significantly differ between both groups, in either paroxysmal AF or persistent AF patients.ConclusionOur findings demonstrate that extra extended antrum ablation based on electrophysiological substrate mapping is effective and safe. Moreover, the strategy can improve the outcome of AF cryoablation.     

序贯血液净化治疗毒蕈中毒并横纹肌溶解症疗效观察

目的 观察和评价序贯血液净化治疗毒蕈中毒并横纹肌溶解的疗效.方法 22例急性毒草中毒并发横纹肌溶解症患者中,12例（治疗组）采用血液灌流（HP）联合持续性静脉血液滤过透析（CVVHDF）序贯性血液净化1周,10例（对照组）采用HP联合血液透析1周,比较两种血液净化模式治疗前后临床症状及肾功能、CK、CK-MB、LDH、GABA的变化.结果 治疗组经HP联合CVVHDF序贯血液净化1周后肌肉酸痛、茶色尿等症状明显改善,CK、CK-MB、LDH、GABA明显下降,优于对照组,差异有统计学意义（P＜0.05）.结论 HP联合CVVHDF是毒草中毒并横纹肌溶解的有效治疗方法.     

Comparison of Effectiveness and Safety in Treating Acute Acromioclavicular Joint Dislocation with Five Different Surgical Procedures: A Systematic Review and Network Meta-Analysis

This network meta-analysis aims to evaluate the comparative effectiveness and safety of suture anchors (SA), tendon grafts (TG), hook plates (HP), Tight-Rope (TR), and EndoButton (EB) in the treatment of acute acromioclavicular joint (ACJ) dislocation. The Embase, PubMed, and Web of Science databases were searched from their inception date to June 3, 2022. Studies included all eligible randomized controlled trials (RCTs) and cohort studies with the comparison of five different fixation systems among SA, TG, HP, TR, and EB were identified. All studies were reviewed, performed data extraction, and assessed the risk of bias independently by two reviewers. The primary outcomes are Constant–Murley score (CMS) improvement for assessing clinical efficacy, and complications. The second outcomes are visual analog scale (VAS) for assessing pain relief and the coracoclavicular distance (CCD) for assessing postoperative joint reduction. Version 2 of the revised Cochrane risk of bias tool for randomized trials (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) were used to assess the RCTs and non-randomized trials, respectively. The continuous outcomes were presented as mean differences (MD), and risk ratios (OR) were used for dichotomous outcomes, both with 95% confidence intervals (CI). Surface under the cumulative ranking curves (SUCRA) results were calculated to offer a ranking of each intervention. We identified 31 eligible trials, including 1687 patients in total. HP showed less CMS improvement than TR and EB in both the Network Meta-analysis (NMA) and pairwise meta-analysis. HP also showed less CMS improvement than SA in NMA. For pain relief, HP performed worse than TR both in pairwise meta-analysis and NMA. No significant differences were found for the measured value of CCD. Both TR and EB showed a lower incidence of complications than HP in pairwise meta-analysis. The rank of SUCRA for CMS improvement was as follows: SA, TR, EB, TG, and HP; for pain relief: TR, EB, TG, SA, and HP; for CCD: HP, TR, SA, EB, and TG. For complications, HP showed the highest rank, followed by TG, EB, TR, and SA. SA shows better clinical effectiveness and reliable safety in the treatment of acute ACJ dislocation. Although HP is the most widely used surgical option currently, it should be carefully taken into consideration for its high incidence of complications.