经尺骨鹰嘴操纵杆辅助闭合复位技术治疗儿童Gartland Ⅳ型肱骨髁上骨折手术潜在风险因素的对比研究

目的与闭合复位经皮克氏针固定 (closed reduction and percutaneous pinning,CRPP)相比,探讨经尺骨鹰嘴操纵杆辅助闭合复位治疗Gartland Ⅳ型肱骨髁上骨折患儿手术潜在风险因素并比较两种治疗方式的临床效果。方法回顾性分析2012年1月至2019年1月,手术治疗39例Gartland Ⅳ型肱骨髁上骨折患儿的临床资料。其中,男27例 (69.23%),女12例(30.77%),平均年龄(6.68±2.52) (2~13) 岁。23 例(58.97%)Gartland Ⅳ型骨折单纯采用 CRPP治疗(CRPP组);16例(41.03%) 实施经尺骨鹰嘴操纵杆技术辅助闭合复位技术治疗 (操纵杆组)。计量资料采用配对样本t检验、计数资料采用false检验和 Fisher 确切概率法比较两组手术时间、透视次数、术中冠状面Baumann角和矢状面侧位肱头角之间的差异;末次随访时与正常对侧比较两组复位质量、肘关节功能以及并发症之间的差异。结果所有患儿平均随访 (1.98±1.43) 年,术后4~6周均获骨折愈合。CRPP组平均手术时间 (48.59±15.75)min,透视次数(49.65±23.83) 次,操纵杆组分别为(27.17±9.68)min 和(24.25±5.92) 次,与 CRPP组比较,操纵杆组平均手术时间和透视次数缩短 21 min和下降 25 次,两组相比差异均有统计学意义(P<0.05)。术中复位固定后 CRPP组Baumann角(78.54±0.55) °,操纵杆组为(73.21±1.03) °,两组相比差异有统计学意义(P<0.05),操纵杆组术中冠状面复位质量优于 CRPP组。所有患儿矢状面侧位肱头角均恢复正常。末次随访时,CRPP组患侧Baumann角(77.13±2.20) °,正常对侧 (74.17±4.17) °,操纵杆组分别为 (72.69±1.70) °和 (73.38±3.48) °,操纵杆组最终冠状面复位质量优于 CRPP组 (P<0.05);两组Flynn标准评定肘关节功能优良率和运动范围相似。两组均没有切开复位和术后即刻并发症发生。结论使用经尺骨鹰嘴操纵杆辅助闭合复位技术治疗患儿Gartland Ⅳ型肱骨髁上骨折可以缩短手术时间、减少放射暴露、提高复位质量和节省医疗资源,在降低手术潜在风险因素方面具有明显优势。     

腹腔镜手术对早期卵巢癌患者疗效及应激反应的影响

目的探讨腹腔镜手术对早期卵巢癌患者疗效及应激反应的影响。方法依据手术方式将140例卵巢癌患者分为观察组和对照组,每组70例,对照组患者接受开腹肿瘤细胞减灭术治疗,观察组患者接受腹腔镜肿瘤细胞减灭术治疗。比较两组患者的手术相关指标、手术前后应激反应指标[皮质醇、促肾上腺皮质激素(ACTH)及肾上腺素]水平、并发症发生情况、随访20个月的短期疗效及肿瘤复发情况。结果观察组患者手术时间、肠道恢复时间、手术切口长度和住院时间均明显短于对照组患者,术中出血量明显低于对照组患者,差异均有统计学意义(P﹤0.01)。术后,两组患者皮质醇、ACTH及肾上腺素水平均高于本组术前,且观察组患者皮质醇、ACTH及肾上腺素水平均低于对照组患者,差异均有统计学意义(P﹤0.05)。两组患者并发症发生率、生存率和复发率比较,差异均无统计学意义(P﹥0.05)。结论腹腔镜肿瘤细胞减灭术治疗早期卵巢癌患者短期疗效较好,且手术创伤小,对患者应激刺激较小,有助于患者的术后恢复。     

Khat use and mental illness: a critical review

Khat has been used as a stimulant plant in many parts of Africa and the Arabian Peninsula for centuries. Its current use among particular migrant communities in Europe and elsewhere has caused alarm among policy makers and health care professionals. In the United Kingdom, the debate over the psychiatric and social implications of khat use has led to a demand for stricter legal control of this stimulant plant. This paper (a) provides a historical overview of khat use, and (b) reviews the evidence for the existence of a causal link between khat use and mental illness. To do so, we undertook a detailed search of social and medical science databases for case reports, qualitative and quantitative articles on khat use and mental illness from 1945 to 2006. The validity and reliability of the studies that met our inclusion criteria were examined. Lastly, although highlighting health concerns about khat use we suggest that the debate about this popular drug in migrant populations carries elements of a 'moral panic'. There is a need for improved research on khat use and its possible association with psychiatric disorders.     

解剖型锁定钢板治疗锁骨骨折的疗效

〔摘 要〕 目的：分析对锁骨骨折患者行解剖型锁定钢板治疗方式的临床疗效。方法：选择常州市中医院 2016 年 1 月至 2020 年 1 月期间收治的 50 例锁骨骨折患者,按随机分组法分为观察组（36 例,接受解剖型锁定钢板治疗方式）和对照组 （14 例,接受传统手法复位治疗方式）。比较两组患者治疗效果、创伤愈合情况。结果：观察组患者治疗总有效率为 100.00 %, 高于对照组的 85.71%,差异具有统计学意义（P ＜ 0.05）;观察组患者并发症总发生率为 2.78 %,低于对照组的 21.43 %, 差异具有统计学意义（P ＜ 0.05）;观察组所需康复时间为（1.84 ± 0.54）个月,短于对照组的（2.15 ± 0.61）个月,差异 具有统计学意义（P ＜ 0.05）。结论：对锁骨骨折患者行解剖型锁定钢板治疗方式,可帮助患者骨折处骨骼进行固定,使 其处于较稳定的愈合状态,缩短患者的恢复时间,提升其整体的治疗效果,有效减少骨不连等并发症的发生率,确保患者 外形的美观。     

Prevalence of Usutu and West Nile virus antibodies in human sera,Modena, Italy, 2012

A collection of 3069 human sera collected in the area of the municipality of Modena, Emilia Romagna, Italy, was retrospectively investigated for specific antibodies against Usutu (USUV) and West Nile viruses (WNV). All the samples resulting positive using a preliminary screening test were analyzed with the plaque reduction neutralization test. Overall, 24 sera were confirmed as positive for USUV (0.78%) and 13 for WNV (0.42%). The results suggest that in 2012, USUV was circulating more than WNV in North‐eastern Italy.     

中药配合手法复位小夹板外固定治疗桡骨远端骨折疗效观察

目的:探讨中药配合手法复位小夹板外固定治疗桡骨远端骨折的临床疗效。方法:选取2017年4月—2018年3月桡骨远端骨折患者112例,随机分为2组,各56例。对照组采取手法复位小夹板外固定治疗,观察组采取温阳健骨汤+手法复位小夹板外固定治疗,对比2组临床疗效、疼痛程度、疼痛缓解时间、消肿时间及骨折愈合时间。结果:对照组治疗有效率较观察组低,差异有统计学意义;治疗1周、2周及4周后,观察组VAS评分均较对照组低,差异有统计学意义;与对照组相比,观察组疼痛缓解时间、消肿时间及骨折愈合时间更短,差异有统计学意义。结论:桡骨远端骨折患者采用中药配合手法复位小夹板外固定治疗可有效提升临床疗效,减轻患者疼痛,促进骨折愈合。     

Virus inactivation of plasma-derived proteins by pasteurization in the presence of guanidine hydrochloride

BACKGROUND: Viruses, among them parvovirus B19 and other small, nonenveloped viruses, may be present in human blood and may contaminate plasma-derived therapeutics. Efficient inactivation or removal of such viruses, especially parvoviruses, represents a current problem and corresponding technologies are under investigation. In this report, such a technology is described. STUDY DESIGN AND METHODS: A recently developed pasteurization of human apolipoprotein A-I (apoA-I), which is performed at 60 degrees C for 10 hours in the presence of guanidine hydrochloride (GdnHCl), was validated by using a series of model viruses, including members of the families parvoviridae and picornaviridae. The model viruses were spiked into the apoA-I- and GdnHCl-containing solutions, and virus inactivation was evaluated by infectivity assays in cell cultures. The mechanism of virus inactivation was studied by virus sedimentation analysis using the picornavirus model. RESULTS: All viruses tested were inactivated to levels below the limit of detection, although different inactivation kinetics were obtained for the different viruses. The mechanism of virus inactivation by this pasteurization was disassembly of the virus particles into single proteins or small noninfectious viral subunits. CONCLUSION: The pasteurization validated in this report has the potential to inactivate a wide range of transfusion-relevant viruses including parvoviruses and picornaviruses.     

不同吸痰方式对急性呼吸窘迫综合征血流动力学影响的实验研究

目的研究更适宜急性呼吸窘迫综合征(ARDS)机械通气气管内吸痰的方式。方法采用静脉注射油酸制备动物ARDS模型;每只犬随机选择使用开放式气管内吸痰(OS)和密闭式气管内吸痰(CS)2种吸痰方式。于吸痰前后记录血流动力学等监测指标的数据。结果OS和CS后,犬平均肺动脉压(MPAP)与吸痰前比较均明显升高(P<0.05);OS后平均动脉压(MAP)显著升高(P<0.05)。结论OS、CS均可影响血流动力学的稳定。本研究提示,在护理工作中,对ARDS机械通气者应重视吸痰引起的继发性损害,加强吸痰前后血流动力学等监测。     

WBC reduction in RBC concentrates by prestorage filtration: multicenter experience

BACKGROUND: As universal leukocyte (WBC) reduction (ULR) is being considered as a new standard, few data are available on the performance of WBC-reduction filtration in routine practice. The performance of WBC-reduction in RBCs, using varied filtration practices, in meeting the current FDA requirement (<5 x 10(6)), Council of Europe (EC) recommendation, the proposed FDA requirement (<1 x 10(6)), and a more stringent proposal (<5 x 10(5)) for residual WBCs per RBC unit was assessed and compared. STUDY DESIGN AND METHODS: Participating facilities were the 11 sites of the Viral Activation Transfusion Study (VATS), a prospective study of the impact of transfusion with and without WBC-reduction on survival and HIV viral load in HIV-1-infected patients. Patients randomly assigned to undergo WBC reduction were required to receive RBCs < or =14 days old that had undergone prestorage (within 72 hours of collection) WBC-reduction filtration by a method devised to achieve a postfiltration WBC count of <5 x 10(6). Residual WBC quantitation was performed by PCR in the central VATS laboratory by using frozen WBC-reduced RBC samples obtained at issue for transfusion. RESULTS: A total of 1869 WBC-reduced RBC units were studied. Filtration practices varied within and between sites. There were significant differences in mean residual WBC counts at the 11 sites (p<0.001). Among the WBC-reduced RBC units, 0.8 percent exceeded 5 x 10(6) WBCs per unit, 8.3 percent exceeded 1 x 10(6) WBCs per unit, and 14.3 percent exceeded 5 x 10(5) WBCs per unit. CONCLUSION: Residual WBCs in WBC-reduced RBC units vary within and between sites. WBC reduction was successful, in that over 99 percent and 91 percent of VATS WBC-reduced RBC units met US and EC thresholds, respectively. However, the small but measurable failure rate indicates that not every unit will meet these guidelines.     

小儿急性肠套叠空气灌肠整复失败原因分析

目的 探讨肠套叠空气灌肠整复的影响因素，提高肠套叠压力整复操作的安全性。方法 回顾性分析近5年来经我科诊治的217例小儿急性肠套叠的影像学、临床资料及未能整复的21例的手术病理改变。结果 整复失败21例手术所见：复杂型套叠15例、回结型套叠6例；术后病理改变：肠管坏死2例、器质性肠套叠1例、肠壁严重充血水肿18例。灌肠术中无一例并发穿孔。结论 整复失败与病程长、肠壁严重充血水肿及肠管坏死、患者年龄小、复杂型肠套叠、肠道畸形等有关。X线示套头大、分叶状，压力灌肠时显示“嵌顿征”、“绞窄征”及“弹簧套”等难以整复的重要征象。