Malignant Cutaneous Adnexal Tumors and Role of SLNB

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Vaccine hesitancy around the globe: Analysis of three years of WHO/UNICEF Joint Reporting Form data-2015–2017

In order to gather a global picture of vaccine hesitancy and whether/how it is changing, an analysis was undertaken to review three years of data available as of June 2017 from the WHO/UNICEF Joint Report Form (JRF) to determine the reported rate of vaccine hesitancy across the globe, the cited reasons for hesitancy, if these varied by country income level and/or by WHO region and whether these reasons were based upon an assessment. The reported reasons were classified using the Strategic Advisory Group of Experts (SAGE) on Immunization matrix of hesitancy determinants (www.who.int/immunization/sage/meetings/2014/october/SAGE_working_group_revised_report_vaccine_hesitancy.pdf). Hesitancy was common, reported by >90% of countries. The list of cited reasons was long and covered 22 of 23 WHO determinants matrix categories. Even the most frequently cited category, risk- benefit (scientific evidence e.g. vaccine safety concerns), accounted for less than one quarter of all reasons cited. The reasons varied by country income level, by WHO region and over time and within a country. Thus based upon this JRF data, across the globe countries appear to understand the SAGE vaccine hesitancy definition and use it to report reasons for hesitancy. However, the rigour of the cited reasons could be improved as only just over 1/3 of countries reported that their reasons were assessment based, the rest were opinion based. With respect to any assessment in the previous five years, upper middle income countries were the least likely to have done an assessment. These analyses provided some of the evidence for the 2017 Assessment Report of the Global Vaccine Action Plan recommendation that each country develop a strategy to increase acceptance and demand for vaccination, which should include ongoing community engagement and trust-building, active hesitancy prevention, regular national assessment of vaccine concerns, and crisis response planning (www.who.int/immunization/sage/meetings/2017/october/1_GVAP_Assessment_report_web_version.pdf).     

前瞻性研究比较老年有移位的股骨颈骨折经内固定和关节置换的预后情况

目的 探讨比较关节置换与内固定治疗老年有移位的股骨颈骨折的预后情况.方法 将70例确诊为老年人移位性股骨颈骨折且具有可比性的临床资料随机分为两组,一组38例,将其命名为关节置换组,即使用关节置换术进行治疗;另一组32例,命名为内固定组,即使用内固定治疗股骨颈骨折.观察记录术中出血情况、手术时间、住院时间以及术后并发症、术后两年死亡人数、需再手术等情况并进行比较分析.结果 70位患者均顺利完成了手术.内固定组手术所用时间、术中出血情况明显少于传统组,差异有统计学意义(P＜0.05).但是内固定组的住院时间则比关节置换组要长,且关节置换组术后相关并发症、再手术、术后两年死亡人数等均明显少于内固定组,差异有统计学意义(P＜0.05).结论 两种手术方式各有其优越性,关节置换术具有术后并发症少、再手术率低、死亡人率低等优点,而内固定术与之相比则具有术中出血少、创伤小且便宜等优点.     

A simulated passive intervertebral motion task: observations of performance in a cross-sectional study

Abstract

Introduction: Passive motion palpation is an integral component in examination, diagnosis or classification, and treatment of persons with mechanical disorders of the cervical spine. If the magnitude of force application during passive movement assessment is associated with greater palpatory accuracy has not been established.

Methods: This investigation used a novel mechanical model as a basis for assessing the palpatory force of students and clinicians. The model included multiple palpable resistance and displacement levels similar to that observed in humans. The ability of the subjects to discriminate the various levels of resistance and displacement offered by the model was concurrently measured.

Results: Large variability occurred in the amount of force applied by the subjects in completing the palpatory examination. The data indicated no major differences in palpatory accuracy across the student and clinician groups with different training and experience levels beyond basic competency. Those subjects applying less force in the palpatory exam demonstrated greater accuracy of palpatory assessment with one measure.

Discussion: The data indicate training and experience had minimal relationship to palpatory interpretation precision beyond the basic level and individual natural discriminatory ability may be a factor in accuracy of palpatory skill. The results demonstrate remarkable inconsistency in palpatory force among examiners and suggest that palpatory accuracy may be related to less force application.     

Clinical and laboratory characteristics in septic arthritis patients with and without isolated germs

Background

The management of septic arthritis without bacteriological evidence is not well codified.

老年股骨颈骨折行保留关节囊人工髋关节置换术效果评价

目的：探讨分析保留关节囊人工髋关节置换术的临床效果。方法将120例老年股骨颈骨折患者随机分为实验组和对照组,两组各占全部患者的二分之一,对实验组患者采取保留关节囊人工髋关节置换术进行救治,对照组患者则采取不保留关节囊人工髋关节置换术进行救治。检测两组的治疗效果,并进行分析。结果治疗结束后,一个月后两组的Harris评分优良率有显著的统计学差异,一年半后,评分差异无统计学意义。实验组患者的皮肤切口、手术时间、下床活动时间及弃拐时间与对照组相比差异有统计学意义(P<0.05),实验组优于对照组。但二者在出血量、引流量两方面的差异并无统计学意义(P>0.05)。结论保留关节囊人工髋关节置换术治疗老年股骨颈骨折效果良好,值得在临床工作中推广应用。     

74例乳腺癌患者保乳手术联合放射治疗的临床效果分析

目的：对乳腺癌患者保乳手术联合放射治疗的临床效果进行分析。方法将该院2011年1月—2014年1月收治的74例乳腺癌患者随机分为两组,每组37例,观察组应用保乳手术联合放射治疗,参照组行乳癌根治术治疗,比较其效果。结果两组患者在临床疗效、远处转移、局部复发及1年后的生存情况的比较均差异无统计学意义（P＞0.05）。但观察组的美容效果优良率（91.89%）明显高于参照组（24.32%）,差异有统计学意义（P＜0.05）。结论乳腺癌患者保乳手术联合放射治疗的效果显著,值得推广。     

40例青光眼白内障联合手术治疗的临床探讨

目的：探讨巩膜瓣下隧道式小切口白内障囊外摘除、人工晶体植入、联合小梁切除术(以下简称联合手术)治疗青光眼合并白内障的临床疗效。方法选取该院40例青光眼合并白内障患者,随机分队对照组和观察组,每组20例。对照组采取常规手术治疗,观察组采取联合手术治疗。观察患者视力、眼压及前房角变化情况。结果观察组患者术后视力(0.5±0.3),眼压(17.2±5.0)及前房角(3.8±1.3);对照组患者术后视力(0.08±0.04),眼压(38.5±12.0),前房角(1.9±0.9);组间数据对比差异有统计学意义(P<0.05)。结论采用小切口非超声乳化青光眼白内障联合手术治疗青光眼白内障患者,术后患者视力显著提高,眼压和前房角明显改善,是治疗青光眼合并白内障的有效方法。