单侧外固定治疗重度Pilon骨折的临床疗效探究

目的探讨单侧外固定治疗重度Pilon骨折的临床疗效。方法回顾性分析2017年6月-2018年12月南京中大医院江北院区骨科收治的重度Pilon骨折患者100例,男性54例,女性46例;年龄18~65岁,平均35.5岁;Ruedi-AllgowerⅡ型39例,Ⅲ型61例。按照不同固定方法分为常规固定组和单侧外固定组,各50例,比较两组患者住院时间、完全负重下地时间、骨折愈合时间,评价治疗前及治疗后3个月踝关节活动度、踝关节功能恢复情况、疼痛程度,并统计患者的治疗效果及并发症发生情况。结果单侧外固定组住院时间、完全负重下地时间、骨折愈合时间分别为(16.50±1.50)d、(132.56±10.25)d、(14.16±0.69)周,均短于常规固定组(19.25±2.35)d、(198.65±16.58)d、(17.58±1.50)周(t/P=6.975/0.001、23.970/0.001、14.650/0.001)。治疗后3个月,单侧外固定组踝关节Mazur评分为(85.67±6.59)分,显著高于常规固定组(62.78±3.45)分,VAS评分为(2.23±0.36)分,低于常规固定组(4.59±0.89)分(t/P=21.760/0.001、17.380/0.001);单侧外固定组患者踝关节活动度分别为(17.29±0.16)°、(28.36±1.23)°、(19.68±0.16)°、(16.89±2.12)°,均高于常规固定组(10.62±1.25)°、(21.57±2.58)°、(14.36±1.62)°、(14.25±0.57)°(t/P=37.430/0.001、16.800/0.001、23.110/0.001、8.503/0.001)。单侧外固定组治疗优良率为90.00%,显著高于常规固定组74.00%(χ^2/P=4.336/0.037)。单侧外固定组总并发症发生率为4.00%,显著低于常规固定组的18.00%(χ^2/P=5.005/0.025)。结论单侧外固定支架治疗重度Pilon骨折可有效减轻患者疼痛症状,提高患者踝关节活动度,恢复患者功能,治疗效果显著,安全性较高。     

Reducing sexual risk and promoting acceptance of men who have sex with men living with HIV in India: Outcomes and process evaluation of a pilot randomised multi-level intervention

ABSTRACT

HIV-positive men who have sex with men (HIV+MSM) in India need culturally-relevant interventions to promote safer sex. We tested a multi-level intervention among HIV+MSM that targeted individual, interpersonal, and community factors, based on the Social-Personal and Social Ecological Models. We conducted a 2?×?2 factorial RCT with 119 HIV+MSM randomised to receive either an individual-level intervention (ILI) using motivational interviewing to promote safer sex, a community-level intervention (CLI) to strengthen community norms toward safer sex and reduce stigma among MSM communities, a multi-level intervention combining the individual- and community-level interventions (ILI?+?CLI), or standard-of-care control. Participants completed pre- and post-intervention assessments of a composite sexual risk score and a process evaluation to assess fidelity and satisfaction. Out of the 119 HIV+MSM, 106 (89.0%) completed pre- and post-intervention assessments. Generalised Estimating Equation models showed that both CLI (Incidence Rate Ratio [IRR]?=?.67, 95% CI .47 to .96) and ILI?+?CLI (IRR?=?.66, 95% CI .48 to .91) groups had a statistically significant decrease in sexual risk compared to the standard-of-care. The interventions had high levels of fidelity and satisfaction. This pilot RCT demonstrated feasibility and potential effectiveness of a multi-level intervention that addresses individual, interpersonal and community-level contributors of sexual risk among HIV+MSM.     

Contrast circulation in adult fontan patients using MR Time Resolved Angiography: Application for CT pulmonary angiography

BackgroundWhen patients with Fontan circulation require a computed tomographic pulmonary angiogram (CTPA), there are significant challenges in achieving adequate contrast opacification due to the altered anatomical connections. This study used Time Resolved Angiography with Interleaved Stochastic Trajectories (TWIST) Magnetic Resonance Angiography (MRA) to examine contrast circulation in a cohort of patients with Fontan circulation who were having routine MRI follow up to inform the contrast timing of any subsequent CT.MethodsThis is a single centre, cross-sectional, observational, retrospective study. The time to peak (TTP) signal intensity from the MRA was recorded using regions of interest on the aorta, pulmonary arteries, cavae and Fontan conduit. Patients were grouped by ejection fraction, global longitudinal strain, indexed stroke volume and cardiac index to examine if these cardiac performance parameters affected the mean TTP. Statistical analysis was performed to find the mean TTP for each of the vessels, which was consequently compared between the different cardiac performance parameters.Results35 patients were included in the study. Mean TTP contrast enhancement was 31s in the thoracic aorta, 46s in the right pulmonary artery, 41s in the left pulmonary artery and 55s in the Fontan conduit. Cardiac performance shows no statistically significant relationship to the peak contrast enhancement whether measured by ejection fraction, global longitudinal strain, stroke volume index or cardiac index.ConclusionThe mean optimal timing for a single-phase examination of the Fontan circulation, following an upper limb injection, was 55 s following start of contrast injection irrespective of cardiac performance. In TWIST MRA, the IV bolus is 4–5 s duration. A longer bolus is required for CTA, around 20s, suggesting an additional delay will be required. We propose that an optimal single phase CTPA to be protocolled at 70 s following the start of contrast injection, assuming adequate iodinated contrast dose.     

磁锚定技术辅助腹腔镜阑尾切除术的实验研究

目的:验证自行设计加工的磁锚定装置在减戳孔腹腔镜阑尾切除术中应用的可行性。方法:设计加工适用于辅助减戳孔腹腔镜阑尾切除术的磁锚定装置,该装置包括内置抓钳和锚定磁体2个部分。以6只健康雄性Beagle犬为模型,用磁锚定装置代替传统腹腔镜阑尾切除术中的副操作孔抓钳,经主操作孔置入磁锚定内置抓钳并钳夹于阑尾尖部,体外放置锚定磁体,锚定磁体与内置抓钳的靶磁体相吸,移动锚定磁体即可改变内置抓钳的牵拉方向,从而有效牵拉暴露手术术野,完成减戳孔腹腔镜阑尾切除手术。记录手术操作时间、术中出血量,评价利用磁锚定装置进行阑尾切除时操作的安全性和可行性。结果:6只Beagle犬均顺利完成磁锚定技术辅助减戳孔腹腔镜阑尾切除,手术时间27~38 min,出血量均小于10 ml,术后实验犬状态良好,未出现并发症。结论:磁锚定装置用于减戳孔腹腔镜阑尾切除手术操作简单、安全可行,在相关设计进一步优化基础上,可尝试或试验性用于临床。     

髋关节抗生素骨水泥占位器的研究进展

感染可能是外科植入体如人工假体、髓内针、钢板的严重并发症。尽管围手术期给予适当的抗生素,但仍有相当数量患者术后发生假体周围感染(PJI)。感染的结果导致过度使用抗生素、假体移除、再手术和可能的截肢。当前,PJI通常很难预测、诊断和治疗,二期翻修术是治疗PJI的合理选择。本文仅对髋关节临时占位器(spacer)的有关研究进展作一综述。     

下肢静脉曲张术后并发静脉血栓的有效护理干预

目的:分析对下肢静脉曲张术后并发静脉血栓患者的有效护理干预措施。方法:以2019年6月~2019年6月我院收治的42例下肢静脉曲张患者为研究对象,随机分为两组,各21例,对照组常规护理,实验组实施有效护理干预,对比护理效果。结果:对照组下肢静脉曲张术后患者的并发深静脉血栓发生率高于实验组患者,差异具备统计学价值;实验组下肢静脉曲张术后患者的护理满意度高于对照组患者,差异显著且具备统计学意义。结论:下肢静脉曲张术后实施有效护理干预可降低并发静脉血栓发生率,同时提升患者护理满意度,有效改善患者预后,促进患者康复,也有利于维护良好的护患关系,因此应在临床实践中对有效护理干预进行推广与普及。     

The benefits and costs of changing treatment technique in electroconvulsive therapy due to insufficient improvement of a major depressive episode

BackgroundElectroconvulsive therapy (ECT) technique is often changed after insufficient improvement, yet there has been little research on switching strategies.ObjectiveTo document clinical outcome in ECT nonresponders who were received a second course using high dose, brief pulse, bifrontotemporal (HD BP BL) ECT, and compare relapse rates and cognitive effects relative to patients who received only one ECT course and as a function of the type of ECT first received.MethodsPatients were classified as receiving Weak, Strong, or HD BP BL ECT during three randomized trials at Columbia University. Nonresponders received HD BP BL ECT. In a separate multi-site trial, Optimization of ECT, patients were randomized to right unilateral or BL ECT and nonresponders also received further treatment with HD BP BL ECT.ResultsRemission rates with a second course of HD BP BL ECT were high in ECT nonresponders, approximately 60% and 40% in the Columbia University and Optimization of ECT studies, respectively. Clinical outcome was independent of the type of ECT first received. A second course with HD BP BL ECT resulted in greater retrograde amnesia immediately, two months, and six months following ECT.ConclusionsIn the largest samples of ECT nonresponders studied to date, a second course of ECT had marked antidepressant effects. Since the therapeutic effects were independent of the technique first administered, it is possible that many patients may benefit simply from longer courses of ECT. Randomized trials are needed to determine whether, when, and how to change treatment technique in ECT.     

Preoperative Prophylactic Antibiotics in Total Hip and Knee Arthroplasty: What,When, and How

Although there are numerous nonpatient-related factors that may help reduce infection risk, the proper use of prophylactic antibiotics is most responsible for reducing infection. The role of prophylactic antibiotics is to reduce early periprosthetic joint replacement, which is accomplished by having adequate antibiotic tissue levels at the time of skin incision. The goal of this section of the symposium is to review current antibiotic recommendations, how to manage patients with a self-reported penicillin allergy, review the use of dual antibiotics, discuss the use of antibiotics in the outpatient total joint setting, as well as very briefly discuss the administration of intraosseous antibiotics in knee arthroplasty.     

奥卡西平治疗良性癫痫伴中央颞区棘波患儿的临床疗效及对注意网络功能影响观察

【】目的：探究奥卡西平治疗良性癫痫伴中央颞区棘波患儿的临床疗效及对注意网络功能的影响。方法：选取2013年5月~2015年10月我院神经内科门诊及住院部接受治疗的90例良性癫痫伴中央颞区棘波患儿,采用随机数字法将其分为对照组和观察组,每组各45例,其中观察组给予奥卡西平进行治疗,对照组给予卡马西平进行治疗,治疗结束后比较两组患者治疗疗效和各类不良反应发生率,同时使用注意网络测试工具(ANT)对观察组患者患儿治疗前后的注意网络功能进行比较。结果：观察组患儿治疗后临床疗效优于对照组,但无显著差异(χ₂=2.196,P=0.138)；治疗后两组患儿脑电图异常放电情况得到明显改善,同时观察组患儿明显优于对照组(χ₂=5.415,P=0.020)；观察组患儿治疗后注意网络功能明显优于治疗前(P<0.05)；观察组患者的各类不良反应发生率显著低于对照组(P<0.05)。结论：虽然使用奥卡西平和卡马西平的治疗效果不存在显著差异,但奥卡西平对良性癫痫伴中央颞区棘波患儿却有明显的疗效,可改善患儿脑电图异常放电,降低不良反应发生率,同时能显著改善患儿的注意网络功能,在临床治疗中值得推广。