Laparoscopic bilateral inguinal hernia repair: Should it be the preferred technique?

Inguinal hernias are amongst the most common conditions requiring general surgical intervention. For decades, the preferred approach was the open repair. As laparoscopy became more popular and available and more surgeons became familiarized with this modality, laparoscopic inguinal hernia repair became an alternative. The aim of this study is to assess the effectiveness of laparoscopic inguinal repair, with a focus on bilateral inguinal hernias. Initial reports have shown promising clinical outcomes compared to those of conventional repair of bilateral hernias. However, there are only a few studies concerning laparoscopic repair of bilateral hernias. It is yet to be proven that laparoscopy is the “gold standard” in the treatment of bilateral inguinal hernias. So far, the choice of an inguinal hernia repair technique has been up to each surgeon, depending on their expertise and available resources after taking into consideration each patient’s needs.     

城镇污水综合排放消毒效果实验研究

用实验的方法观察城镇污水综合排放消毒前后效果。消毒前,菌落总数为48000(cuf/ml),总大肠菌和粪大肠菌群>16000(个/L)。消毒后,菌落总数灭活率90分钟达85.93％,总大肠菌群和粪大肠菌群30分钟灭活率达98％,经统计学处理,有极显著差异。结论 加入有效氯30mg/L,消毒30分钟能达到较好效果,提示城镇污水应有效地消毒后排放。     

广藿香药材及饮片质量标准提升研究

目的 修订和完善广藿香药材和饮片质量标准,为合理控制广藿香药材和饮片质量提供科学依据。方法 分别收集23批广藿香药材和32批饮片代表性样品,参照《中华人民共和国药典》2020年版广藿香项下标准修订叶片粉末的显微鉴别方法;简化薄层色谱鉴别前处理方法,建立以广藿香对照药材和百秋李醇对照品为对照的薄层色谱鉴别方法;改进含量测定项下供试品制备方法,修订药材指标性成分限度;新增广藿香饮片标准检查、浸出物和含量测定项。结果 建议显微鉴别中腺鳞头部细胞描述为“细胞壁多破裂而呈裂隙状”;薄层色谱方法中用石油醚超声提取、乙酸乙酯复溶代替原标准中提取挥发油的前处理方式,以5%茴香醛浓硫酸溶液为显色剂,所有样品与广藿香对照药材和百秋李醇对照品在同一位置显相同颜色的斑点,改进后方法前处理简单、展开效果好、斑点清晰;建议适当提高药材醇溶性浸出物限度,用乙醇作溶剂时不低于4.0%;采用无水乙醇替换毒性较大的三氯甲烷作为含量测定提取溶剂,方法学考察符合要求,23批广藿香药材百秋李醇质量分数和平均值分别为0.34%~0.92%、0.58%,建议药材标准中提高百秋李醇质量分数限度为0.22%;新增饮片检查项目,其中水分不得过14.0%,总灰分不得过11.0%,酸不溶性灰分不得过4.0%;新增饮片浸出物项目,限度同药材标准;新增饮片含量测定项,32批饮片中百秋李醇质量分数和平均值分别为0.12%~0.46%、0.29%,建议饮片中百秋李醇质量分数不低于0.20%。结论 所建立的方法操作简便可行、准确可靠、重复性好,新增项目和制订的标准限度合理,可用于广藿香药材和饮片的质量控制。     

女贞药用价值及其相关上市药品的研究进展

女贞Ligustrum lucidum是木犀科女贞属药用植物,其果实、叶、花等部位均可作为药用。女贞不同药用部位及单体成分具有多种功效,现已开发为多种制剂,既有中药单方制剂,也有以单体成分为主的化学药。大量研究表明,女贞相关药品被广泛用于治疗消化系统、免疫系统等疾病,且临床效果较好。通过对女贞不同药用部位的化学成分、临床应用及药理作用、女贞相关上市药品的工艺与质量、临床应用及基础研究进行综述,进而探讨女贞的潜在应用价值和开发前景,为女贞的综合开发与利用提供一定的参考。     

中药材及饮片质量等级标准研究思路和方法

中药质量评价作为保障中药材及饮片质量安全有效的有力手段,对维护人民群众身心健康、促进中药产业高质量发展具有重要意义。长久以来,中药质量多以法定检验标准为准入门槛进行低限控制,质量等级标准缺乏,致使中药质量仅能满足基本要求,而“优质优价”未能得到充分体现,导致“劣币驱逐良币”,市场公平严重受损,这很大程度影响了中药产业高质量发展。因此,开展中药质量优劣评价研究,构建中药质量等级标准体系对于全面落实“四个最严”要求、促进中医药传承创新发展、规范市场秩序、引导产业健康发展具有深远而重大的意义。对中药材质量评价现状进行概述,针对目前中药材质量评价的瓶颈问题,提出符合中医药特点的质量等级标准研究思路,包括关键质量控制指标确立、综合质量评价方法建立、质量等级标准验证等内容,以期为建立中药质量等级评价体系提供参考,助力中药产业高质量发展。     

完全右半肝-左半肝劈离式肝移植的临床应用:附四例报告

目的探讨完全右半肝-左半肝劈离式肝移植在成人-成人或成人-大体重儿童中的临床应用。方法回顾2019年1月至12月间首都医科大学附属北京友谊医院完成的4例完全右半肝-左半肝劈离式肝移植的供受者临床资料,分析劈离式肝移植的手术方式、冷缺血时间、手术时间、术中输血量,观察患者术后并发症及相关预后。结果4例完全右半肝-左半肝劈离式肝移植的受者包括3例成人和1例大体重儿童(45 kg),年龄范围14~48岁,体重范围45~61 kg,终末期肝病模型评分分别为21、12、41和30分。移植物质量与受者体质量比为0.85%~1.35%。冷缺血时间457~650 min,手术时长460~575 min。4例患者移植术后早期肝功能恢复顺利,均未出现小肝综合征。随访至术后6个月,其中1例出现胆道吻合口漏,经内镜逆行胰胆管造影术治疗后治愈;1例出现胆道狭窄,经皮肝穿刺胆道引流术治疗后反复胆道感染;1例术后6个月死于肺部感染。结论在严格病例选择的情况下,可以开展完全右半肝-左半肝劈离式肝移植。     

It’s the Culture!—How systemic and societal constructs impact well‐being

Pediatric anesthesiologists practice within a culture, a system, and a society. In this article, we provide an overview of the influence these have on the well‐being or the unwellness of pediatric anesthesiologists. The scope of these issues is broad and far‐reaching; thus, our goal has been to highlight those areas which would be likely to have the largest impact on well‐being if addressed fully by society, institutions, and leaders in our field. We discuss the burnout‐promoting aspects of medical education and training. We survey occupational factors, such as the high‐stake pediatric anesthesia environment, occupational health hazards, time pressure, and the reduction in physician autonomy. We then describe societal barriers, such as the marginalization of certain populations, the US system of malpractice litigation, the stigma surrounding psychiatric care, and some of the issues related to physician reimbursement in the United States. We conclude that in order to move forward, improving physician wellness must be a focus of society, of the medical system as a whole, and of individual departments and leaders in pediatric anesthesia.     

Pediatric Hand Injuries Requiring Closed Reduction at a Tertiary Pediatric Care Center

Background: Hand fractures and dislocations are common injuries in the pediatric population. This study aims to characterize the pediatric hand injuries that required closed reduction and identify those that required multiple reduction attempts. Methods: A retrospective cohort study was carried out in patients younger than 18 years of age with hand fractures or dislocations who underwent closed reduction in the emergency department (ED). Patients who ultimately required surgical reduction and fixation were not included. Results: Of the 310 hand injuries identified, 148 (114 fractures and 34 dislocations) underwent closed reduction in the ED; 7.4% of those required repeat reduction. Hand injuries that most often required repeat reduction included metacarpophalangeal joint dislocations (20.0%) and proximal phalanx neck (16.7%), metacarpal shaft (15.4%), metacarpal neck (6.2%), and proximal phalanx base (5.6%) fractures. No modifiable risk factors predicting the need for repeat reduction were identified. Conclusions: Some pediatric hand injuries are more likely to require repeat closed reduction by a hand surgeon. This retrospective study is the first step toward quality improvement as it provides opportunities for further research into the factors contributing to reductions that are unsuccessful at the first attempt. Identification of these factors and implementation of quality improvement measures are necessary to ensure the effective treatment of all pediatric hand injuries.     

原发性高血压患者防治依从性及血压控制达标调查

目的探讨原发性高血压患者防治依从性及血压控制达标情况,为控制原发性高血压的发展提供参考。方法选取2019年5月至2021年12月在庐江县中医院就诊的原发性高血压患者696例为研究对象,对患者进行问卷调查及体格调查,进一步分析不同人群特征、不同防治依从行为对血压控制达标的影响。结果696例原发性高血压患者中血压控制达标率为16.24%(113/696)。禁烟、限制饮酒、减少钠盐摄入、控制体重、适量运动、遵医嘱服药的依从性分别为24.86%、28.45%、64.51%、58.05%、66.38%、83.05%。多因素Logistic回归分析显示,年龄55~69岁(OR=1.567)、文化程度为高中/中专及以上(OR=2.849)、病程≤10年(OR=1.431)、禁烟依从性好(OR=1.852)、限制饮酒依从性好(OR=2.083)、减少钠盐摄入依从性好(OR=3.511)、控制体重依从性好(OR=1.145)、适量运动依从性好(OR=1.670)、遵医嘱服药依从性好(OR=1.399)的高血压患者血压控制达标的可能性较高。结论原发性高血压患者血压控制达标情况有待进一步提高,且与人群特征、防治依从项目密切相关,应针对重点人群、危险因素开展高血压综合防治,提高患者的防治依从性,促进血压控制达标。