鼻内镜下鼻中隔偏曲矫正成型113例临床分析

目的探讨鼻内镜下鼻中隔偏曲的手术及疗效。方法鼻内镜下对113例鼻中隔偏曲患者行矫正成型术并做临床分析。结果鼻内镜下行鼻中隔偏曲矫正成型手术视野清楚,直观,创伤小,矫正彻底,安全,疗效确切。结论鼻内镜下鼻中隔偏曲矫正成型较传统鼻中隔偏曲黏膜下矫正手术安全,直观,创伤小,疗效确切。     

肘内侧小切口治疗儿童尺偏型肱骨髁上骨折

目的:探讨肘内小切口治疗儿童尺偏型肱骨髁上骨折的临床疗效。方法:选择尺偏型肱骨髁上骨折患儿72例,麻醉后,均采取肘内侧小切口切开复位克氏针内固定早期石膏托外固定治疗。结果:随访12～42个月切口全部一期愈合。评定术后肘关节功能,优良率达97.3%,且无一例出现肘内翻畸形。结论:采取肘内侧小切口切开复位克氏针内固定早期石膏托外固定治疗儿童尺偏型肱骨髁上骨折,具有切口隐蔽不影响外观、避免医源性尺神经损伤、防止术后并发肘内翻畸形、早期恢复肘关节功能四重优点。     

基于3D偏差分析的成人桡骨远端解剖对称性研究

目的　通过形态学测量方法评估成人桡骨远端解剖的对称性。 方法　采集15例正常志愿者的双侧前臂薄层CT扫描数据,对桡骨远端1/3的骨性结构进行三维重建,以模型体积和表面积作为目标参数对每一例志愿者左、右侧桡骨的三维模型进行解剖测量;进一步通过3D偏差分析方法完成双侧桡骨模型解剖对称性的定量化和可视化分析。 结果　左、右侧桡骨远端表面积最大差异小于5.6%（P=0.004）,体积差异小于9.1%（P=0.005）;3D偏差分析结果显示,受试者的最大平均负偏差为-0.40 mm,最大平均正偏差为0.34 mm;3D偏差较大的区域主要分布在桡骨远端的非关节面部位。 结论　成人桡骨远端在关节面形态方面具有高度的解剖对称性,临床上对于桡骨远端关节内骨折的外科解剖重建,采用健侧桡骨镜像模型作为参考对象有利于指导桡骨远端骨折的精准复位重建,这对于术后桡腕关节功能的恢复具有重要意义。     

The relationship between posterior septum deviation and depth of maxillopalatal arch

Objective

To investigate the relationship between depth of maxillopalatal arch and deviation of posterior septum.

Methods

This study is based on paranasal sinus CT (PNSCT) scan in the coronal plane evaluation, and sinus paranasal scans were obtained from the database. One-hundred and fifty PNSCT scans were randomly chosen among the PNSCT scans which belong to adult (18 and older) patients. All scans were divided to three different groups. The first group constituted by those patients who had more convex deviation. The second group had those patients with either crest or spur deviations. The last group (control group) had no septum deviation. The data collected from each group were statistically compared. Exclusion criteria: CT imaging which has a chronic sinusitis, nasal cavity mass, and nasal polyps. Main outcome measures: angle and distance measures were taken on maxillopalatal arch and posterior nasal septum.

Results

Strongly positive correlation between posterior septum deviation and depth of maxillopalatal arch was determined (r = 0.479, p = 0.001).

Conclusion

These findings suggest that posterior septum deviations are considered as a result of increase in maxillopalatal depth.     

鼻内窥镜改良鼻中隔成形术52例分析

目的:探讨鼻内窥镜下改良鼻中隔成形术的方法和疗效。方法:鼻中隔偏曲患者52例,在鼻内窥镜下行改良鼻中隔成形术。结果:术后随访6月,所有患都鼻中隔偏曲矫正,鼻中隔无穿孔发生。结论:内窥镜下改良鼻中隔成形术是治疗鼻中隔偏曲的安全有效有治疗方法。     

垂体瘤术后视野改变的临床分析

目的分析垂体瘤患者术后视野的改变情况。方法对620例（1240眼）垂体瘤患者术前及术后2周进行视野检查,并利用视野指数平均缺损（MD）量化比较分析。根据垂体瘤从确诊到手术的时间,将观察对象分为两组：1个月内者为A组,时间超过1个月者为B组。结果A组432例（864眼）视野有改善686眼（79．4％）,无改善178眼（20．4％）;B组188例（376眼）视野有改善223眼（59．3％）,无改善153眼（40．7％）。两组中1个月内手术组术后视野的改善情况较好。差异有统计学意义（χ^2=2．573,P〈0．05）。结论视野检查对垂体瘤诊断及手术具有重要意义,手术可明显改善患者视野情况,且手术时间越早,术后的视野恢复效果越好。     

鼻内镜辅助下的鼻中隔-鼻整形术

歪鼻常伴有鼻中隔偏曲,患者除了对外形不满意外,还会有鼻塞等功能障碍症状.这部分患者到鼻科就诊的目的是希望既能矫正歪鼻畸形又改善鼻腔通气功能.近年来,国内耳鼻喉科医生们不断探索鼻中隔一鼻整形的术式,鼻外进路、鼻内进路各有优势[1-2],并引入了鼻内镜技术[3],较之美容整形科的单纯外鼻整形更具有优势.我们在传统鼻中隔鼻成形术基础上,采用鼻内镜辅助的方式,重点在内镜下矫正鼻中隔偏曲并同期行鼻甲成形术,可以重新构建鼻腔结构,较好地改善了鼻腔通气功能,收到了外形与功能双满意的疗效.     

司法精神医学鉴定结论分歧的分析

目的:通过对司法精神医学专家委员会(专委会)鉴定案例的总结来分析司法精神医学鉴定中结论分歧的类别和原因.方法:对60例专委会鉴定案例的社会人口学和各次鉴定资料,先以专委会鉴定和初次鉴定结论分歧的类别分组并对有关资料进行对照分析,然后对两次鉴定之间的一致性进行检验.结果:初览诊断为精神发育迟滞者,两次鉴定结论以基本一致居多,而器质性精神障碍与精神分裂症的两次鉴定结论以完全不一致居多, 初鉴中人格障碍多为错误论断,论断有误多导致关览单位对结论的异议.结论:司法精神医学鉴定结论出现的分歧较多(51.4%),鉴定人员应不断提高业务水平,尽量减少失误.     

Effect of partial and total sleep deprivation on serum testosterone in healthy males: a systematic review and meta-analysis

BackgroundCurrently, there is no consensus on the effect of sleep deprivation on male serum testosterone. This systematic review and meta-analysis aimed to determine the association between partial/total sleep deprivation and male serum testosterone level.MethodsThe literature related to sleep deprivation and male serum testosterone in the PubMed, Embase, and Cochrane Library databases were searched from their inception to July 15, 2021. Data were pooled using the Stata 15 software. The results were presented as standard mean differences (SMDs) with their 95% confidence intervals (CIs).ResultsEighteen studies involving 252 men were included in the systematic review and meta-analysis. The findings revealed that short-term partial sleep deprivation had no significant effect on male serum testosterone (SMD = −0.22; 95% CI: −0.5, 0.06; P = 0.13), while total sleep deprivation reduced the male testosterone levels (SMD = −0.64; 95% CI: −0.87, −0.42; P < 0.001). According to the intervention duration of total sleep deprivation, subgroup analysis was conducted by a fixed-effects model. The results revealed that the serum testosterone was significantly decreased after 24 h total sleep deprivation (SMD = − 0.67; 95% CI = − 0.93, −0.42, P < 0.001), as well as 40–48 h total sleep deprivation (SMD = − 0.74; 95% CI = − 1.22, −0.26, P = 0.002).ConclusionsThis meta-analysis revealed that total sleep deprivation (more than or equal to 24 h) reduces the male testosterone levels, while short-term partial sleep deprivation has no significant effect on male serum testosterone. Sleep duration plays a pivotal role in maintaining male serum testosterone levels.     

Social and structural determinants and their associations with patient experience in the emergency department

BackgroundImproving patient experience and satisfaction in the emergency department (ED) is challenging but beneficial. Previous studies have shown an association between social and structural factors and patient satisfaction. This study examined the structural and social factors related to the ED patient experience among Jewish and Arab patients in a Jerusalem hospital.MethodsA cross-sectional study was conducted among ED patients in a Jerusalem hospital. Data were collected via questionnaires. The sample included 257 Jewish patients and 170 Arab patients. The outcome variable was a positive or negative ED experience.ResultsJewish and Arab patients had different factors related to ED experience. Cultural differences, including a language barrier and access to information, were associated with a negative experience among Arab patients. Among Jewish patients, frequent use of community health services was associated with a negative ED patient experience.ConclusionThis study shows an association between social and structural factors and patient experience, illustrating gaps for and vulnerability of different ethnic groups that affect their experience with healthcare services. Understanding these issues and implementing solutions formulated at the institutional and national levels can promote equity by providing structurally competent care.