Gd-EOB-DTPA增强MRI评估功能性肝体积与肝功能Child-Pugh分级的相关性

目的：对比解剖性肝脏体积（ALV）和功能性肝脏体积（FLV）与肝功能Child-Pugh分级的相关性。方法：选择温州医科大学附属第二医院育英儿童医院2014年1月至2019年4月同时行增强CT和Gd-EOB-DTPA增强MRI扫描的肝硬化患者25例。对所有患者进行肝功能Child-Pugh评分，检测所有入组患者每个肝段的Gd-EOB-DTPA增强MRI平扫期和肝胆特异期的信号对比增强率（CER），以CT扫描的数据为基础利用MI-3DVS计算每个肝段的ALV和全肝的FLV。分析ALV和FLV与肝功能Child-Pugh分级的相关性。结果：肝功能Child-Pugh分级与ALV呈负相关（r=-0.792，P＜0.001），曲线拟合的决定系数（R2）=0.63；肝功能Child-Pugh分级与FLV亦呈负相关（r=-0.911，P＜0.001），曲线拟合的R2=0.80。FLV与肝功能Child-Pugh分级有更显著的负相关性。结论：结合Gd-EOB-DTPA增强MRI平扫期和肝胆特异期的信号CER和ALV计算所得的FLV较ALV能更好地反映肝脏的功能状态。     

快速康复护理、中医特色护理对卵巢癌的效果

目的分析快速康复护理联合中医特色护理在卵巢癌围手术期护理中应用效果。方法选择本院100例2018年7月-2019年2月卵巢癌患者。随机分组,快速康复护理组采取快速康复护理,快速康复护理联合中医特色护理组则采取快速康复护理联合中医针灸推拿护理。比较两组护理满意度;卵巢癌疼痛以及不良反应好转的时间;治疗前后患者中医证候积分、QOL量表评分值。结果快速康复护理联合中医特色护理组护理满意度、卵巢癌疼痛以及不良反应好转的时间、中医证候积分、QOL量表评分值相比较快速康复护理组更好,P <0.05。结论快速康复护理联合中医针灸推拿护理卵巢癌效果确切,可改善并发症和缓解疼痛,改善生存质量。     

Intermittent Internal Fixation With a Locking Plate to Preserve Epiphyseal Growth Function During Limb-Salvage Surgery in a Child With Osteosarcoma of the Distal Femur: A Case Report

Limb shortening is a problem associated with surgery for osteosarcoma of the lower extremity in adolescents, as the tumors frequently occur near the epiphysis. Herein we report the use of a less invasive stabilization system (LISS) and an intermittent fixation method to preserve the growth function of epiphysis in an 11-year-old patient with an osteosarcoma of the distal femur.The 11-year-old male presented with left knee enlargement and pain for 2 weeks, and magnetic resonance imaging (MRI) and biopsy were consistent with osteosarcoma of the left distal femur. After preoperative chemotherapy, en bloc tumor resection was performed with margins based on MRI findings preserving the epiphyseal growth plate, the tumor cavity was filled with inactivated bone and bone cement, and a LISS was used to stabilize the femur. Aggressive postoperative chemotherapy was given. Approximately 105 weeks after surgery radiography showed that the distal end of the plate had moved superior to the epiphysis along with bone growth. Locking screws were placed in the distal part of the LISS plate to stabilize the re-implanted bone, and external fixation was not needed.The patient was able to walk with the crutches 1 week postoperatively, and bear weight on the extremity 6 weeks postoperatively. At 6 years after surgery, the patient''s height had increased 52 cm, shortening of the affected limb was only 1 cm, and the circumference of the affected limb was 2 cm smaller than that of the contralateral limb. There was no significant discomfort in the affected limb, and there was no gait abnormality. The patient could jump and run, and could participate in sports including basketball and badminton to the same degree as his peers.In summary, the novel method of bone reconstruction and fixation provided good results in a child with an osteosarcoma of the distal femur. This fixation method preserves the osteogenic function of the epiphysis and restored bone integrity simultaneously, and provides good functional recovery.     

Surviving a stroke in South Africa: outcomes of home-based care in a low-resource rural setting

Background: Little is known of stroke outcomes in low- and middle-income countries with limited formal stroke rehabilitation services and of homebased-stroke services delivered within the primary health care (PHC) context by community health workers (CHWs).

Objectives: To describe and analyze the outcomes of patients with stroke from a rural PHC setting in the Western Cape, South Africa.

Methods: In a longitudinal survey, 93 stroke patients, referred to home and community-based care services (HCBC) between June 2015 and December 2017, were assessed at baseline, one month and three months. Changes in function (Barthel Index (BI)), caregiver strain (Caregiver Strain Index (CSI)), impact of environmental factors and satisfaction with stroke care were measured.

Results: HCBC was delayed, fragmented and brief (median session duration 20 minutes (IQR 15.0–30.0)). Although function improved significantly, dependence remained high: median BI score changed from 40.0 (IQR 15.0–70.0) to 62.5 (IQR 30.0–81.25) (p = .019). A third (33.0% (30/91)) of caregivers initially experienced strain and the median CSI score remained 3.0 (IQR 0.0–7.0) (p = .672). Overall, patient and caregiver satisfaction with HCBC was low with only 46.9% (31/66) of caregivers and 17.4% (12/69) of patients satisfied with all aspects of care. Only 47.6% of assistive product needs were met. Environmental factors negatively impacted on patient function and caregiving.

Conclusions: Clinical practice pathways and referral guidelines should be developed for the HCBC platform. Specific training of CHWs, focusing on how to educate, support and train family caregivers, provide assistive devices and refer to health services is needed.     

快速康复内窥镜椎间盘切除术治疗腰椎间盘突出症的临床观察

目的:探讨快速康复外科理念联合内窥镜椎间盘切除术治疗腰椎间盘突出症的疗效。方法:选取2018年4月—2019年4月本院收治的86例腰椎间盘突出症患者,随机分为两组,每组43例,对照组通过内窥镜椎间盘切除术治疗,观察组予以快速康复外科理念联合内窥镜椎间盘切除术治疗,对比两组疗效和并发症发生情况。结果:观察组并发症发生率(4.65%)较对照组(18.60%)低,差异有统计学意义(P 0.05);观察组下床活动时间、住院时间较对照组短,术后7天的疼痛评分较对照组低,差异有统计学意义(P 0.05);术后3个月,观察组的Oswestry功能障碍指数问卷表评分较对照组低,日本骨科协会评估治疗分数较对照组高,差异有统计学意义(P 0.05)。结论:探讨快速康复外科理念联合内窥镜椎间盘切除术治疗腰椎间盘突出症可减少并发症,缩短术后恢复时间,进而促进患者功能有效康复。     

The Relationship between Self-Efficacy,Functional Exercise Capacity and Physical Activity in People with COPD: A Systematic Review and Meta-Analyses

Abstract

The purpose of this study was to investigate the strength of the relationships between self-efficacy and (i) functional exercise capacity and (ii) physical activity in chronic obstructive pulmonary disease (COPD), and whether self-efficacy assessment type (i.e., COPD symptoms, exercise-task, exercise-barrier, general, falls) and physical activity assessment type (i.e., self-report vs. objective) are moderators. A systematic search of COPD and self-efficacy concepts was conducted using eight databases from inception to 23 January 2019. Studies were included if they provided correlation coefficients of the relationship between self-efficacy and functional exercise capacity or physical activity, were conducted in adults diagnosed with COPD, and were published in English-language journals. A total of 14 correlation coefficients were included in the self-efficacy and functional exercise capacity meta-analysis, and 16 in the self-efficacy and physical activity meta-analysis. Data were screened, reviewed, and extracted independently by two reviewers, with discrepancies resolved by a third reviewer. Stronger self-efficacy was associated with better functional exercise capacity (weighted r?=?0.38, 95%CI [0.25, 0.50]), and greater physical activity (weighted r?=?0.25, 95%CI [0.17, 0.34]). Exercise-task self-efficacy had the strongest relationship to functional exercise capacity (weighted r?=?0.64, 95% CI [0.51, 0.73]). For physical activity, the type of self-efficacy most strongly related was inconclusive. In COPD, self-efficacy has a relationship to functional exercise capacity and physical activity, the strength of which is influenced by the choice of self-efficacy measure. An understanding of these relationships will assist clinicians in selecting the self-efficacy measure most closely related to the outcome of interest.     

体医融合专门人才培养现状与优化路径

目前我国的体医融合已探索出以医院为平台的医院健康指导中心模式、以健身场所为平台的体育俱乐部健康指导模式、以社区为平台的健康监测中心模式和以体医融合健康产业为平台的产学研合作模式等4种运行模式。但总体来说我国体医融合尚处于起步阶段，优化体医融合专门人才培养模式成为体医深度融合发展的关键。研究表明，我国体医融合人才现行培养模式主要以在职培训为主，存在专门人才缺失严重、认证体系有待完善和人才培养模式单一等现实困境。同时提出加强顶层设计夯实体医融合人才培养体系，精心布局优化体医融合人才培养课程体系，强化引导完善体医融合舆论宣传体系，标准引领健全体医融合职业标准等优化路径，以期实现体医融合专门人才队伍的科学化和可持续化发展。