无痛内镜的护理安全管理探讨

目的 探讨无痛内镜的护理安全管理的临床意义。方法 选择护理安全管理实施前(2019年2～6月)和实施后(2019年7～11月)在我院消化内镜室进行无痛胃镜检查的患者160例作为研究对象,实施前后分别作为对照组和观察组,每组80例。对照组实施常规护理,观察组在对照组基础上实施严格的护理安全管理。比较两组患者的护理质量评分、检查后的不良反应发生率、对护理工作的满意度以及医务人员职业暴露发生率。结果 观察组患者的护理质量评分为(97.28±2.60)分,显著高于对照组的(90.74±2.59)分(P0.05)。观察组的患者不良反应发生率为5.00%,显著低于对照组的31.25%(P0.05)。观察组的患者对护理工作的满意度为98.75%,显著高于对照组的85.00%(P0.05)。观察组的医务人员职业暴露发生率为7.50%,显著低于对照组的25.00%(P0.05)。结论无痛胃镜检查时严格执行护理安全管理,能提高护理质量和患者的满意度,降低患者的不良反应和医务人员的职业暴露发生率。     

Current surgical strategies for treating spinal tumors: Results of a questionnaire survey among members of the German Spine Society (DWG)

PurposeQuestionnaire survey among the members of the German Spine Society (Deutsche Wirbelsäulen-Gesellschaft, DWG) to objectify oncological infrastructure and current standard of care in spinal tumor treatment in Germany.MethodsAll DWG-members were contacted via the society's e-mail and asked to respond in anonymized form to a related questionnaire. Questions were asked regarding surgical specialty, type of institution involved, numbers of spinal procedures, as well as questions on treatment for primary tumors, whether the respondent belonged to a tumor center, decision-making procedures for surgery, and the type of procedure.Results84 centers providing surgical treatment for spinal tumors in their departments were identified. 52.6% were carrying out more than 500 spinal procedures per year. There was a significant association (P ≤ 0.05) between the numbers of spinal surgeries, the number of treated tumor patients per year, the organisation in a tumor center and the treatment of primary tumors. 76% are part of a local tumor center for interdisciplinary decision making (i.e.surgical treatment and adjuvant therapy). 74% of the institutions stated that conventional postoperative radiotherapy is standardly administered in the case of secondary lesions, with 24% of them referring patients to external services for radiotherapy.ConclusionIn spite of often large numbers of spinal operations, the centers perform relatively small numbers of tumor operations, particularly for primary tumors. A nearly three-quarter majority of the departments are integrated into interdisciplinary tumor care. However, there is a marked number that do not belong to an interdisciplinary organisation. Further advances in multidisciplinarity and oncology training are a continuous issue to increase treatment quality in spinal tumor patients.     

绝经后骨质疏松人群发生椎体骨折的相关危险因素回归分析

目的分析绝经后骨质疏松人群发生椎体骨折相关危险因素。方法纳入2018年6月至2019年5月86例在我院就诊的绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)患者临床资料,其中单纯PMOP患者43例作为对照组,PMOP椎体骨折患者43例作为试验组。两组均进行临床一般资料收集,并完善骨密度、血清实验室指标等相关检查,对PMOP椎体骨折的相关危险因素作多因素回归分析。结果试验组L1~4、全髋及股骨颈骨密度均低于对照组,试验组HOMA-IR指数及糖尿病发生率均高于对照组,差异有统计学意义(P<0.05)。试验组与对照组血清骨钙素(bone gla-protein,BGP)[(14.5±5.07) ng/ml vs.(18.1±5.48) ng/ml]、Ⅰ型原胶原N-端前肽(procollagen type 1N-peptide,PINP)[(58.4±19.52) ng/ml vs.(41.7±20.16) ng/ml]、血清Ⅰ型胶原羧基端肽(type 1 collagen carboxy terminal peptide,β-CTX)[(0.5±0.26) ng/ml vs.(0.3±0.23) ng/ml]、血清25-(OH) D [(15.9±7.24) ng/ml vs.(21.4±8.06) ng/ml]、骨源性碱性磷酸酶(bone alkaline phosphatase,b ALP)[(20.1±6.85) ng/ml vs.(14.0±5.44) ng/ml]、血清雌二醇(serum estradiol,E2)[(33.6±5.21) pg/ml vs.(42.4±11.58) pg/ml]指标比较差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示,PINP、β-CTX、b ALP与PMOP椎体骨折呈正相关性,BGP、25-(OH) D与PMOP椎体骨折呈负相关性(P<0.05)。结论 PINP、β-CTX、b ALP、BGP、25-(OH) D是PMOP椎体骨折发生的危险因素,对预测及防治PMOP椎体骨折具有重要的指导意义。     

Double-balloon enteroscopy for retrieving retained small-bowel video capsule endoscopes: a systematic review

Abstract

Background and aim: Capsule retention is the most common adverse event associated with video capsule endoscopy. The use of double-balloon enteroscopy-assisted capsule endoscope retrieval has been increasingly reported in recent years. However, evidence is limited regarding its success rate, associated factors, and subsequent clinical outcomes.

Methods: A systematic review of relevant studies published before January 2019 was performed. Successful retrieval rate and associated factors, rate of endoscopic balloon dilation, and outcomes after double-balloon enteroscopy were summarized and pooled.

Results: Within 154 associated original articles, 12 including 150 cases of capsule retrieval by double-balloon enteroscopy were included. The estimated pooled successful retrieval rate was 86.5% (95% confidence interval, 75.6–95.1%). Anterograde approach and capsules retained in the jejunum or trapped by malignant strictures were associated with a higher successful retrieval rate than the retrograde approach (62/83 [74.7%] vs. 10/38 [26.3%], p?<?.001) and capsules retained in the ileum (41/41 [100.0%] vs. 43/58 [74.1%], p?<?.001) or trapped by benign strictures (21/21 [100.0%] vs. 65/83 [78.3%], p?=?.043). Endoscopic balloon dilation was performed in 38.8% (95% confidence interval, 22.3–56.3%) of patients with benign strictures. Two perforations (1.3%) were reported as severe adverse events after double-balloon enteroscopy. A significantly lower surgery rate was found among cases with successful video capsule removal compared with unsuccessful cases (7.2% vs. 38.5%, p?=?.002).

Conclusions: Double-balloon enteroscopy is feasible and safe for removing retained video capsule endoscopes, and its use could decrease the need for surgery in patients with benign strictures and facilitate subsequent surgery in patients with malignant strictures.     

Carbon fiber reinforced vs titanium implants for fixation in spinal metastases: A comparative clinical study about safety and effectiveness of the new “carbon-strategy”

In spinal oncology traditional titanium implants could significantly impair evaluation of postoperative imaging because of artifacts, potentially affecting proper planning and execution of radiotherapy and adequate radiological follow-up to rule out progression of the disease. This is why carbon fiber reinforced (CFR)-PEEK implants have been developed for spinal fixation. The advantages of this system include fewer artifacts on imaging, potentially improving the execution and quality of radiotherapy, with also a reduced scattering effect to neighboring tissues.A comparative clinical and radiological study between new CFR-PEEK and standard titanium implants is described. Data recorded for each case included patient demographics, clinical, radiological and surgical data, intra- and postoperative complications, follow-up information. The goal of this study was to verify the safety and effectiveness of CFR-PEEK devices compared to standard titanium implants.A total number of 78 patients were reviewed. 36 patients underwent CFR-PEEK fixation, while titanium implants were used for 42 patients. Functional recovery was obtained in both groups and registered at last follow-up in terms of axial pain and neurological status. No significative differences were found between the two groups in terms of post-operative clinical complications and hardware-related complications.CFR-PEEK implants constitute a feasible and effective way to restore stability in metastatic spine tumors. This study found a non inferior favorable profile in terms of intraoperative and postoperative complications and functional recovery, compared to titanium. Further prospective studies are needed to clarify the potential oncological advantage of their radiolucency.     

Clinically suspected concomitant spinal cord and vertebrobasilar infarctions caused by fibrocartilaginous embolism

Fibrocartilaginous embolism (FCE) is a rare and probably under diagnosed cause of spinal cord infarction presumably due to acute embolization of nucleus pulposus fragments into the spinal circulation. Concomitant cerebral involvement is much rarer and often asymptomatic. Although the definitive diagnosis is histologic, certain criteria have been proposed to support the diagnosis in living patients, such as absence of vascular risk factors, acute onset or antecedent of valsalva maneuver before the episode and the exclusion of potential differential diagnoses.A 56 years-old patient, without any medical history was referred for sudden back pain while carrying heavy load at work. Clinical examination showed a Brown-Sequard syndrome.Brain and spine MRI disclosed spinal cord infarction at the C4-C5 level associated with brain infarctions involving exclusively the vertebrobasilar circulation. The exhaustive etiological assessment was normal.In our case, the acute symptoms onset, the clinical and imaging data and lack of evidence for other plausible diagnoses in the setting of a valsalva-like maneuver are highly suggestive of FCE diagnosis.