Haemophilic Pseudotumour: Surgical Management of a Rare Case

Haemophilia is a common cause of genetically inherited bleeding disorders. Pseudotumours occur in 1–2 % of persons with severe forms of haemophilia. These are a result of repeated haemorrhage into soft tissues, subperiosteum or a site of bone fracture with inadequate resorption of the extravasated blood. There are a number of therapeutic alternatives for this dangerous condition: surgical removal, percutaneous management, irradiation, embolization etc. In this case report, we describe the natural history, clinical course and successful surgical management of a patient with haemophilia who presented with a massive pseudotumour. We also briefly review the relevant literature on the various therapeutic modalities that have been implemented in the management of this rare complication. Though surgeons may be averse to operate on haemophiliacs, primary surgical management as done in our case may prove to be the definitive treatment option for such patients.     

胎龄<28周早产儿动脉导管未闭的治疗进展

动脉导管未闭(PDA)是早产儿常见疾病,目前早产儿PDA的自然发展过程仍未完全明确,PDA发生的有些高危因素仍存在争议,对PDA是否进行药物、手术干预,以及何时进行药物、手术干预仍存在争议。尽管已经有相当多的证据证实动脉导管持续开放可能有害,但目前尚缺乏关闭导管治疗方案的远期益处或害处的相关证据。大多数临床试验旨在评估短期导管开放对患儿的影响。目前尚无评估动脉导管持续开放对早产儿死亡率及并发症影响的临床试验。近年来PDA治疗上最大的变化是减少对PDA的治疗。该文重点总结胎龄28周早产儿PDA的治疗策略。     

Pseudoquistes abdominales,una complicación rara de los sistemas de derivación ventrículo-peritoneal: revisión sistemática de la literatura

Since the first report in 1954, abdominal pseudocysts have been recognized as a particularly uncommon complication of ventriculoperitoneal shunts of CSF, so their etiology, diagnosis, and therapeutic management remain very controversial.Our objective is to offer a critical and updated systematic review of those controversial points, using a thorough search and review of the most relevant literature available.The clinical presentation of pseudocysts is normally through non-specific abdominal symptoms. The most validated etiology consists on the existence of a concomitant infection of the CSF shunt system, and so, treatment needs of antibiotherapy and total or partial substitution of the system. However, the pseudocyst itself doesn’t need an active treatment, except for some specific cases. This management, algorithmically presented in the present work, achieves a lower recurrence rate than other options, but this one is still important, and is also associated with other complications of those shunts related with several other factors which need to be taken in account.     

The Development and Operation of a Home Management System during the COVID-19 Pandemic: Experience of the Local Government Gyeonggi-do in Korea

During the three the coronavirus disease 2019 (COVID-19) surges in South Korea, there was a shortage of hospital beds for COVID-19 patients, and as a result, there were cases of death while waiting for hospitalization. To minimize the risk of death and to allow those confirmed with COVID-19 to safely wait for hospitalization at home, the local government of Gyeonggi-do in South Korea developed a novel home management system (HMS). The HMS team, comprised of doctors and nurses, was organized to operate HMS. HMS provided a two-way channel for the taskforce and patients to monitor the severity of patient''s condition and to provide healthcare counseling as needed. In addition, the HMS team cooperated with a triage/bed assignment team to expedite the response in case of an emergency, and managed a database of severity for real-time monitoring of patients. The HMS became operational for the first time in August 2020, initially managing only 181 patients; it currently manages a total of 3,707 patients. The HMS supplemented the government''s COVID-19 confirmed case management framework by managing patients waiting at home for hospitalization due to lack of hospital and residential treatment center beds. HMS also could contribute a sense of psychological stability in patients and prevented the situation from worsening by efficient management of hospital beds and reduction of workloads on public healthcare centers. To stabilize and improve the management of COVID-19 confirmed cases, governments should organically develop self-treatment and HMS, and implement a decisive division of roles within the local governments.     

妊娠期糖尿病孕妇血糖管理保护动机问卷的编制及信效度检验

目的 编制妊娠期糖尿病孕妇血糖管理保护动机问卷并检验其信效度。 方法 以保护动机理论为基础,根据《妊娠期糖尿病临床护理实践指南》,通过文献回顾、患者半结构式访谈、专家咨询编制问卷初稿。通过咨询7名专家及调查408例妊娠期糖尿病孕妇对问卷信效度进行检验。 结果 妊娠期糖尿病孕妇血糖管理保护动机问卷包含7个维度,共35个条目,问卷内容效度指数为0.976,Cronbach’s α系数为0.901,折半信度为0.965;各维度的Cron-bach’s α系数为0.850~0.953,折半信度为0.905~0.961。探索性因子分析共提取7个公因子,累计方差贡献率为75.32%。验证性因子分析显示,模型拟合度良好。 结论 妊娠期糖尿病孕妇血糖管理保护动机问卷具有良好的信效度,可用于妊娠期糖尿病孕妇血糖管理保护动机的评估及血糖管理行为的分析和预测。     

青年肺结核患者营养护理方案的构建及应用

目的 构建青年肺结核患者营养护理方案并评价其应用效果。 方法 通过文献分析、现况调查和专家会议法形成青年肺结核患者营养护理方案。选取某三级专科医院2019年8月1日—10月30日入院的青年肺结核患者为试验组,实施青年肺结核患者营养护理方案;选取2019年4月1日—6月30日入院的青年肺结核患者为对照组,实施常规营养护理;比较入院时、出院后1个月和出院后3个月两组营养指标、免疫指标和生活质量。 结果 入院时、出院后1个月和出院后3个月,试验组体重高于对照组（F_组间=12.955,F_时间=5.735,F_交互=36.713,均P<0.05）;出院后3个月,试验组CD3+、CD4+高于对照组（t=16.548,P=0.037;t=18.607,P=0.028）,生活质量总分高于对照组（t=5.351,P<0.001）,但生理功能维度、心理功能维度和社会功能维度的比较,差异无统计学差异（t=0.417,P=0.678;t=1.020,P=0.310;t=0.539,P=0.591）。 结论 青年肺结核患者营养护理方案可改善患者体重、免疫功能和生活质量,促进患者康复。     

运用全面质量管理构建血管神经病学高级人才管理平台

目的 运用信息化建设对血管神经病学高级人才进行系统化管理，在培养人才的基础上，提高人 才管理质量和效益。 方法 以首都医科大学附属北京天坛医院血管神经病学科为例，运用全面质量管理对高级人才进 行规范化管理，同时建立医院人才网络管理平台，实现数据共享，为信息积累和分析提供依据。 结果 在质量管理的基础上，理顺了业务流程，建立了多元化的人才培养机制，搭建了医院高级人 才网络管理平台，实现动态业务管理。 结论 医院在对血管神经病学高级人才进行质量管理中，体现了全面性和合理性，实现医院关于高 级人才的现代化、科学化、可持续化管理。     

经皮内镜椎间孔入路腰椎间盘切除术并发硬脊膜撕裂的综合处理及疗效分析

目的 探讨经皮内镜椎间孔入路腰椎间盘切除术（PETD）治疗腰椎间盘突出症并发硬脊膜撕裂的处理方法及预后。方法 回顾性分析2016年3月至2017年1月采用PETD治疗的236例腰椎间盘突出症的病例资料。结果 236例中，3例发生硬脊膜撕裂，发生率为1.3%(3/236)。2例术中诊断，其中1例术中转为显微镜下修补硬脊膜，1例术中未做处理；1例术后诊断，在显微镜下完成硬脊膜修补。3例随访12个月，末次随访时视觉模拟量表评分从术前8.0分降至1.7分，Oswestry功能障碍指数从82.1%降至17.8%，均无神经功能障碍等后遗症；改良MacNab评分2例为优，1例为良。结论 硬脊膜撕裂是PETD较为少见的并发症，应根据术中和术后情况，采取综合治疗措施，总体预后良好