延期手术治疗复杂Pilon 骨折体会

目的:探讨延期手术治疗Rued-AllgowerⅢ型Pilon 骨折的临床疗效.方法:自2007 年1月至2010 年10 月应用延期手术治疗Rued-AllgowerⅢ型Pilon 骨折20 例,其中男性15 例,女性5 例,年龄25-60 岁,平均40.5 岁,开放性骨折6 例,闭合性骨折14 例,合并腓骨骨折16 例,均给予延期切开复位内固定治疗.结果:随访时间为0.5-4.0 年,平均3 年,全部获得骨性愈合,无骨不连存在,骨折愈合时间2-6 个月,平均3 个月,按照Mazur 等制定的踝关节评分系统,其中优7 例,良10 例,可2例,差1 例,优良率95%.无一例出现骨外露、深部感染、骨折移位畸形等并发症.结论:延期手术治疗Rued-AllgowerⅢ型Pilon 骨折能有效减少并发症和良好的恢复踝关节功能,     

Top-down visual activity underlying VSTM and preparatory attention

Attention and visual short-term memory (VSTM) are both associated with top-down activity in visual cortex. To-be-remembered visual input triggers persistent activity in visual cortex, and preparatory attention elicits visual activity in anticipation of an expected target stimulus. This brief review considers similarities, and differences, in top-down visual activity underlying VSTM maintenance and preparatory attention. The extant evidence suggests that top-down visual activity provides a common neural substrate for VSTM maintenance and preparatory attention, however the precise neural implementation depends on the specific task parameters. A similar neurobiological framework may also apply to other high-level visual phenomena, including visual imagery and awareness.     

增城地区脑梗死患者就诊延迟的影响因素分析

目的探索造成脑梗死急性期就诊延迟的相关因素,从而寻找可能的解决办法。方法采用问卷调查的方法,随机选取2008年9月至2010年6月来院就诊的280例急性脑梗死患者,采用t检验、2检验和Logistic回归模型分析就诊延迟的相关因素。结果全部脑梗死患者均经头颅CT/MRI证实,与就诊延迟最重要的相关因素是患者对脑梗死的认识,其次分别为抵院方式、发病地点距医院距离。结论导致急性脑梗死患者就诊延迟的相关因素很多,其中最重要原因是患者对脑梗死早期诊治认识不足,加强公众相关医学知识教育对减少这些因素的影响将具有重要意义。     

病案归档的回顾性调查

目的探寻提高临床科室出院病案三日归档率的对策。方法采取抽样法对2011年11月和2012年4月的出院病人病案三日内归档情况进行统计和分析。结果采取改进措施后,内科增幅最高的科室达到了92.53%,平均增幅75.40%;外科增幅最高的科室达到了97.44%,平均增幅83.17%。部分科室三日归档率达到100%。结论医院各级部门提高病案管理重视程度、信息资料科成立品质管理小组、健全病案管理制度、加强病案室与其它科室工作交流是提高病案三日内归档率行之有效的措施。     

Factors Related to Prehospital Time Delay in Acute ST-Segment Elevation Myocardial Infarction

Despite recent successful efforts to shorten the door-to-balloon time in patients with acute ST-segment elevation myocardial infarction (STEMI), prehospital delay remains unaffected. Nonetheless, the factors associated with prehospital delay have not been clearly identified in Korea. We retrospectively evaluated 423 patients with STEMI. The mean symptom onset-to-door time was 255 ± 285 (median: 150) min. The patients were analyzed in two groups according to symptom onset-to-door time (short delay group: ≤ 180 min vs long delay group: > 180 min). Inhospital mortality was significantly higher in long delay group (6.9% vs 2.8%; P = 0.048). Among sociodemographic and clinical variables, diabetes, low educational level, triage via other hospital, use of private transport and night time onset were more prevalent in long delay group (21% vs 30%; P = 0.038, 47% vs 59%; P = 0.013, 72% vs 82%; P = 0.027, 25% vs 41%; P < 0.001 and 33% vs 48%; P = 0.002, respectively). In multivariate analysis, low educational level (1.66 [1.08-2.56]; P = 0.021), symptom onset during night time (1.97 [1.27-3.04]; P = 0.002), triage via other hospital (1.83 [1.58-5.10]; P = 0.001) and private transport were significantly associated with prehospital delay (3.02 [1.81-5.06]; P < 0.001). In conclusion, prehospital delay is more frequent in patients with low educational level, symptom onset during night time, triage via other hospitals, and private transport, and is associated with higher inhospital mortality.     

Neural and behavioral mechanisms of impulsive choice in alcohol use disorder

Background: Alcohol dependence has repeatedly been associated with impulsive choice, or the inability to choose large delayed rewards over smaller, but more immediate rewards. However, the neural basis of impulsive choice in alcohol use disorders (AUDs) is not well understood. Methods: One hundred fifty‐one individuals with a range of alcohol use from social drinking to severe alcohol dependence completed a delay discounting task while undergoing functional magnetic resonance imaging. Participants received customized trials designed to ensure an approximately equivalent number of immediate responses. Results: Delaying gratification recruited regions involved in cognitive control, conflict monitoring, and the interpretation of somatic states. Individuals with more severe alcohol use problems showed increased discounting of delayed rewards and greater activation in several regions including supplementary motor area, insula/orbitofrontal cortex, inferior frontal gyrus, and the precuneus. Conclusions: These results suggest that impulsive choice in alcohol dependence is the result of functional anomolies in widely distributed, but interconnected brain regions involved in cognitive and emotional control. Furthermore, our results suggest that the neural mechanisms of impulsive choice in AUD both overlaps with that observed in previous studies, and shows that individuals with AUD recruit additional mechanisms when making intertemporal choices.     

Does delayed initiation of adjuvant chemotherapy following the curative resection affect the survival outcome of gastric cancer patients: A systematic review and meta-analysis

BackgroundAdjuvant chemotherapy(AC) following the curative resection could improve the survival outcome of advanced gastric cancer(GC) patients. However, there is no specific timing interval from radical surgery to initiation of AC. Whether delayed initiation of AC could affect the survival outcome of these patients remains unclear. In this study, we performed a systematic review and meta-analysis to evaluate the relationship between delaying AC and the survival outcome of GC patients.MethodsPubMed, Embase and Cochrane Library databases were systematically searched for eligible studies that evaluated the relationship between time to AC and survival outcome. Survival data for HR and 95% CI were extracted and converted to a regression coefficient(β) corresponding to a continuous representation per 4-week delay of AC. Individual adjusted β were combined using a fixed-effects or random-effects model. Heterogeneity was assessed by I² statistic and publication bias was detected using standard error-based funnel plots.ResultsA total of 11 eligible studies involving 6,017 patients were included in this meta-analysis. Eight studies evaluated the impact of delaying AC on overall survival(OS) and five evaluated the impact of delaying AC on disease-free survival(DFS). The pooled results demonstrated that the initiation of AC per 4-week delay was associated with a significant decrease in OS(HR:1.05, 95% CI: 1.03–1.08, P < 0.001; I² = 18.5%) and DFS (HR:1.06, 95% CI: 1.02–1.10, P = 0.001; I² = 40.6%).ConclusionThe initiation of AC per 4-week delay was associated with worse survival outcomes in GC patients. If physical status and postoperative recovery were appropriated, GC patients should be recommended to receive adjuvant chemotherapy timely.