Indicadores de calidad en la atención dermatológica a pacientes con dermatitis atópica. Documento de consenso de la Academia Española de Dermatología y Venereología

No information is currently available on whether the available clinical practice guidelines on the management of atopic dermatitis are known or being applied in Spain. The aim of this study was to improve the care of patients with atopic dermatitis by developing a set of quality indicators based on existing clinical practice guidelines. Relevant clinical practice guidelines identified through a literature search were submitted to a panel of 11 specialists, who selected the highest quality guidelines using the AGREE (Appraisal of Guidelines for Research & Evaluation) II instrument. The panel then defined a subset of the recommendations supported by a high level of evidence and proposed a health care quality indicator for each one together with a standard for measuring degree of adherence. Consensus was achieved on 21 of the 150 proposed indicators using the modified Delphi method. The aim of implementing the indicators that achieved consensus in this study is to standardize the actions of health professionals providing care for patients with atopic dermatitis and ultimately to improve the quality of the care delivered.     

The “Chaperone Technique”: Valve-in-Valve TAVR Procedure With a Self-Expandable Valve Inside a Degenerated Sutureless Prosthesis

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MRI三维动脉自旋标记法对TIA的诊断价值

目的本研究拟运用MRI三维动脉自选标记法(3D-ASL),结合DWI及时间飞跃法MRA(3DTOF-MRA),探讨3D-ASL在TIA的诊断、血流灌注评估等方面的应用价值,为临床超早期诊断、治疗提供更多的理论依据。方法发病24 h内的TIA患者13例,入院时进行常规MRI、DWI、3D-TOF-MRA及3D-ASL扫描。观察所有患者MRA图,分析颅内血管及颈内动脉有无狭窄及异常,比较DWI所示梗死面积(SDWI)和全脑血流量(CBF)图上灌注异常面积(SASL)的差异,分别计算DWI和3D-ASL对TIA患者的检出率,并结合MRA分析造成脑组织血流灌注异常的原因。对于DWI阴性但ASL灌注异常,且MRA(或CTA)显示血管狭窄的患者,计算病灶侧和对侧相应区域的CBF值的比值(rCBF),比较rCBF与入院时(发病24 h内)的NIHSS、Glasgow昏迷评分量表(GCS)、mRS及神经内科临床评分量表(ABCD2)评分、患者发病时间以及一过性脑缺血症状发作持续时间有无相关性,并且比较分析rCBF值与MRA(或CTA)所示血管直径狭窄程度的相关性。结果(1)SASL>SDWI:13例TIA患者中,11例DWI未发现病灶,即SDWI=0,而SASL>0,且显示灌注减低;2例DWI阳性,但病灶面积仍SASL>SDWI。(2)3D-ASL对TIA的检出率明显高于DWI:DWI对TIA患者病灶的检出率为15%;3D-ASL对TIA患者病灶的检出率为69%。(3)rCBF与入院时(发病24 h内)的NIHSS、GCS、mRS及ABCD2评分的分值均无相关性;rCBF与患者发病时间及一过性脑缺血症状发作持续时间无相关性;rCBF值与MRA(或CTA)所示血管直径狭窄程度呈负相关关系(rs=-0.697,P=0.011)。结论3DASL与DWI相比,对TIA的诊断敏感性较高。及早行3D-ASL检查,并与DWI、MRA等序列联合应用,能更早发现灌注异常,并初步提示责任血管狭窄程度,为临床治疗提供科学依据。     

颈动脉穿刺溶栓桥接血管内技术治疗急性脑梗死的效果

目的 分析颈动脉穿刺溶栓桥接血管内技术治疗急性前循环供血区梗死的临床疗效。方法 选取2017年1月-2018年12月于本院诊治的急性前循环供血区梗死患者138例,观察组(69例)行颈动脉穿刺溶栓结合血管内技术治疗,对照组(69例)行静脉溶栓结合血管内技术治疗,比较患者的基线资料、诊治、并发症以及死亡情况; 采用改良脑梗死溶栓(Modified thrombolysis incerebral infarction,mTICI)量表评估血管再通情况,美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评估神经功能恢复情况,改良Rankin量表(Modifled Rankin scale,mRS)评估患者预后; 分析影响患者预后的危险因素。结果 与对照组比较,观察组发病至血管开通时间缩短,取栓次数减少(P<0.05),观察组血管成功再通率和mTICI分级高,术后30 d内NIHSS评分降低,术后90 d预后良好率高(P<0.05); 入院NIHSS评分≥15分、侧支代偿不良、取栓次数>3次、发病至血管再通时间>250 min均是导致患者预后不良的独立危险因素(P<0.05)。结论 颈动脉穿刺溶栓桥接血管内技术治疗急性脑梗死安全有效,可减少取栓次数,缩短发病至血管开通时间,进而提高血管成功再通率和血管再通程度,促进神经功能恢复,同时患者预后良好,未出现并发症和病死率的明显增加。     

应用Fast-fix 360全内缝合技术修复半月板Ramp区损伤的临床研究

目的探讨应用Fast-fix 360全关节内缝合技术修补半月板Ramp区损伤的方法和疗效。方法2016年10月至2018年4月,中部战区总医院骨科足踝与运动医学中心使用Fast-fix 360缝合技术修补经镜下确诊为内侧半月板Ramp区损伤病人15例,其中男14例,女1例,平均年龄为23.6岁,病人均合并前交叉韧带(anterior cruciate ligament,ACL)断裂,均予以一期行ACL自体腘绳肌单束重建,6例合并外侧半月板损伤亦同期处理。术后行膝关节标准化功能康复。收集病例手术时间、术中出血量、术后并发症情况;术前、术后半年、术后1年的Lysholm膝关节评分、国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分;术后半年、1年分别复查患膝关节MRI,评估Ramp区损伤修复情况。结果病人随访13~26个月(平均17.8个月)。手术时间为(90.8±21.4)min,术中出血量为(50.5±10.6)ml。术后2例病人移植肌腱供区伤口浅表感染,经延长换药后均愈合;无伤口深部感染及膝关节感染;未出现腘窝血管神经损伤情况。术后半年及1年的Lysholm膝关节评分、IKDC评分均显著高于术前,差异均有统计学意义(P均<0.05)。术后半年MRI评估Ramp区的愈合率为73.3%,术后1年其愈合率提高至86.7%。结论使用Fast-fix 360全关节内缝合技术修补半月板Ramp区损伤,同时一期重建ACL,可获得较满意的临床疗效,方法简单、手术时间短,可作为半月板Ramp区损伤的一种常规修复方法。     

Role of joint distraction in osteoarthritis of the knee: Basic science,principles and outcomes

The burden of knee osteoarthritis (OA) is increasing worldwide. Advanced tibiofemoral joint OA in young patients is particularly a problem with inferior results seen with total knee arthroplasty in this patient population. Knee joint distraction (KJD) has been evaluated recently as a joint preserving procedure for young patients with advanced tibiofemoral osteoarthritis, to delay the need for a primary total knee arthroplasty (TKA). This will decrease the risk for revision TKA later in life. KJD temporarily unloads the knee joint and keeps the tibia and femur separated over a course of 6 weeks. Outcomes of KJD appear promising. Through this article, the authors hope to share from their collective experience as well as the available literature on the basic science, principles of surgery and outcomes of KJD.     

杂交技术对难复性腹股沟疝治疗效果的前瞻性随机对照研究

目的对比杂交技术与单纯腹腔镜技术在难复性腹股沟疝修补术中的应用价值。 方法将2015年1月至2017年12月廊坊市第四人民医院收治的单侧难复性腹股沟疝患者共60例纳入本研究，采用随机法分为2组。其中试验组患者30例，采用杂交技术；对照组患者30例，采用腹腔镜技术。对比2组患者手术时间、气腹持续时间、术中出血量、住院时间、住院费用、术后并发症等指标。 结果对照组1例患者因腹腔镜下难以分离还纳，后转为开放手术，淘汰出组，其余患者均顺利完成手术。试验组单侧难复性腹股沟疝患者住院时间、住院费用、术后发热情况、异物感发生情况分别为（5.00±0.85）d、（10 901.8±830.22）元、5例（16.7%）、2例（6.7%），与对照组（5.00±0.82）d、（11 116.45±813.73）元、6例（20.7%）、2例（6.9%）比较，差异无统计学意义（P均>0.05）。试验组单侧难复性腹股沟疝患者手术时间、气腹持续时间、术中出血量、血清肿发生情况分别为（57.00±5.81）min、（36.30±4.90）min、（21.00±3.80）ml、1例（3.3%），与对照组（72.90±3.66）min、（65±4.43）min、（56.7±8.69）ml、7例（24.1%）比较，差异均有统计学意义（t=－6.544、－6.698、－6.678、χ²=5.450，P均<0.05）。 结论相对于腹腔镜技术，杂交技术治疗难复性腹股沟疝可减少手术时间、气腹持续时间和术中出血量，降低术后血清肿的发生，不会增加术后疝复发等并发症的风险和住院费用，具有较高的临床应用价值。     

Resultados preliminares de un trabajo multicéntrico a nivel nacional para el tratamiento de STUI secundario a hiperplasia benigna de próstata mediante el sistema con vapor de agua Rezūm®

Introduction and objectiveRezūm® system is a minimally invasive transurethral therapy that uses convective water vapor energy to ablate prostatic tissue. The objective is to report 1-year functional and security outcomes obtained by using this technique in real clinical practice.Material and methodsProspective study conducted in 5 Spanish hospitals for the treatment of LUTS secondary to BPH using the Rezūm® system. Patients with prostatic medium lobe (ML) and urethral catheter carriers were also included. Pre- and post-operative data were collected using IPSS, IIEF-5 and QoL questionnaires, flowmetry and post-void residual volume. Complications and retreatment rate at one-year follow-up were also reported.Results137 patients, including 64 with ML and 10 patients with urinary retention were treated. Median prostate volume was 50 cm³ (15-131). At 3 months follow-up, significant improvement was observed in IPSS (?6,37 points), Qmax (+4,95 mL/s) and QoL (?1,29); and was maintained until 12 months: ?10,78 points, +4,62 mL/s and ?2,73 respectively (p < 0.001). No significant changes were observed in the sexual sphere. All complications were mild (≤ Clavien II). Retreatment rate at one year was 4%.ConclusionShort-term results of this technique are promising, showing improvement in terms of functional outcomes, with no impact on the sexual sphere or complications. Longer term follow-up should include treatment durability and comparison to standard BPH treatments.