Surgical Strategies for Cervical Spinal Neurinomas

Cervical spinal neurinomas are benign tumors that arise from nerve roots. Based on their location, these tumors can also take the form of a dumbbell-shaped mass. Treatment strategies for these tumors have raised several controversial issues such as appropriate surgical indications and selection of surgical approaches for cervical dumbbell-shaped spinal neurinomas. In this report, we review previous literature and retrospectively analyze cervical spinal neurinoma cases that have been treated at our hospital. Surgical indications and approaches based on tumor location and severity are discussed in detail. Thus, with advances in neuroimaging and neurophysiological monitoring, we conclude that appropriate surgical approaches and intraoperative surgical manipulations should be chosen on a case-by-case basis.     

儿童桡骨颈骨折的治疗策略及研究进展

桡骨颈骨折是儿童桡骨近端骨折中一种常见的骨折类型,常伴发桡骨头骨折。目前对不同分型的儿童桡骨颈骨折治疗方案仍存在争议。如何早期选择合适有效的治疗方案,减少骨折治疗不当引发的后遗症,并提高治疗效果,对处于生长发育期的儿童具有重要的意义。针对桡骨颈骨折的发生机制、局部解剖及不同分型,总结相应的治疗方案和最新研究进展,以期为儿童桡骨颈骨折的治疗提供帮助。     

La psychiatrie dans ses rapports avec l’institutionnel et le familial. Réflexions sur le futur

Psychiatry, like all areas of existence, is made up of the different dimensions of time, the present, the past and the future. We will discuss the reflection on future trajectories in two areas corresponding to our experience : on the one hand, Psychiatry in the dynamics of various medical-educational and therapeutic establishments (rehabilitation, rehabilitation, socio-psychotherapy etc.) for the child, the adolescent the adult (diversified social protection). And on the other hand, the issues concerning the support of families in the light of our studies and our practice of university training of professionals. Of course, the future of our profession is dominated, as we know, by two main general areas : The regulation of problems and conceptions of ethics from the beginning to the end of life on the one hand, and on the other hand the consolidation of structuring Humanism in the midst of currents wanting to deploy transhumanism. In this study, we will start from concrete and conceptual current realities. From an Institutional point of view, we will focus on two important areas for the future. The need for continuity in the function of psychiatry and its practices even within the diversity of personal situations, even within the Institutions and in relation to the different clinical approaches carried out (from the youngest children to adults). And on the other hand, the importance of the coordination of psychiatric practices and conceptions in the face of the current fragmentation and compartmentalisation of practices. Psychotherapies have of course to respond to very specific and well adapted indications and this need for coordination is already well recalled. But it should certainly also correspond to modifications of the training programs of psychiatry developing versatility in future psychiatrists and taking more into account the plurivalence of people as well as the philosophical and anthropological reflection capable of promoting the most complex coordinations. From the point of view of family issues, faced with the constant worsening of disruptions, professionals will have to consider family situations in a different way, taking more into account the modalities of diverse pathological family expressions than is necessary. It will act more to consider systematically in the forms of ordinary models, but as manifestations of dysfunction and suffering for children and for adults, calling for diverse and specialized help. These considerations bring us to the urgent need for measures to prevent family disturbances in the development of modalities for structuring education for young people. All these areas will need to be further supported by general epistemological and anthropological conceptions. It will be a matter of further developing integrative epistemology capable of taking account the different psychological and psychopathological conceptions (development of the child psychologies of consciousness and the unconscious, cognitivism, systemic understanding, etc.) to take more into account the structuring anthropology allowing to consider the child, the teen ager and the adult in a constructive dynamic of all the physical, psychic, noetic and spiritual components of the personalities capable of helping them to regain control and meaning of their existence.     

我国护理人员流失的原因及对策

我国护理人员流失的原因主要包括个人因素、管理机制因素、护理风险因素和社会因素，提示应通过采取深化护理制度改革、提高待遇、实施人文关怀、加强人才培养和社会媒体宣传等根本措施解决护理人员的流失问题，改善我国护理人员流失现状。     

冠状动脉旁路移植术后手术部位感染风险预测模型及管理策略

目的:探讨影响冠状动脉旁路移植术(CABG)后手术部位感染的主要危险因素,并构建定量列线图风险预测模型,提出针对性管理策略。方法:回顾性总结2015年5月至2019年5月于南京医科大学附属盐城市第三人民医院接受CABG患者共302例作为模型组,比较感染与未感染者临床资料(主要包括性别、年龄、基础疾病史、体质指数、美国麻醉师协会(ASA)评分、常规皮肤准备、围术期抗菌药物不合理使用、手术时间>4 h、手术室探视和连续使用同一手术室),再经多因素Logistic回归分析筛选主要危险因素并构建列线图风险预测模型。纳入2019年6月至2020年12月共211例CABG患者作为验证组,接受感染管理策略。采用受试者工作曲线(ROC)分析列线图模型评估模型组与验证组感染发生的效能。结果:模型组共诊断11例患者发生感染(3.64%,11/302),单因素分析显示感染者年龄高于未感染者,且感染者基础疾病史(高血压和糖尿病)和肥胖者比例增高,ASA评分升高,常规皮肤准备方法、围术期抗菌药物不合理使用、手术时间>4 h、手术室探视、连续使用同一手术室比例均较未感染者增高(P均<0.05)。Logistic回归分析显示,高龄(OR=1.58、95%CI:1.12~2.53、P=0.011)、基础疾病史(OR=2.63、95%CI:2.12~3.06、P=0.001)、围术期抗菌药物不合理使用(OR=2.01、95%CI:1.55~2.69、P=0.002)、手术时间>4 h(OR=3.11、95%CI:2.68~3.59、P=0.001)和手术室探视(OR=1.24、95%CI:1.01~1.85、P=0.024)均为CABG术后手术部位感染的主要危险因素。应用R软件根据主要危险因素(高龄、基础疾病、抗菌药物不合理使用、手术时间>4 h、手术室探视)的权重(β值)进行定量赋值建立列线图模型。验证组共诊断感染者2例(0.95%,2/211),显著低于模型组(Fisher’s确切概率法,取单侧P=0.047)。ROC分析显示,列线图模型预测模型组和验证组发生感染的准确性分别为0.895和0.864;Hosmer-Lemeshow检验显示拟合度良好。结论:CABG术后手术部位感染的发生与多个临床因素有关,如高龄、基础疾病史、围术期抗菌药物不合理使用、手术时间>4 h和手术室探视,医护人员应充分认知并采取严格的感染管理措施以减少感染的发生。     

伴神经症状的骨质疏松性重度椎体压缩骨折的研究进展

骨质疏松性重度椎体压缩骨折（osteoporotic severe vertebral compression fractures,OSVCF）伴神经症状（neurological symptoms,NS）是骨质疏松椎体压缩性骨折一种严重的亚型。由于需要考虑各种因素,包括患者自身状况、神经损伤情况、脊柱畸形、骨质量及合并其他疾病,手术策略要复杂得多。对于伴有神经症状的骨质疏松性重度椎体压缩骨折更加需要整体把握,全面分析,制定适宜的手术策略。随着对伴有神经症状的OSVCF治疗研究的不断进展,采用综合治疗的方式以及个体化治疗理念深入人心。笔者就伴NS的OSVCF治疗的最新技术和研究进展作一综述。     

术前焦虑与围术期不良事件相关性的研究进展

术前焦虑是围术期患者最常见的临床问题之一。许多研究表明,术前焦虑与围术期不良事件的发生密切相关,如失眠、术后疼痛、术后恶心呕吐、术后谵妄等。术前焦虑与围术期不良事件发生机制的关联目前尚未完全清楚,可能涉及多个系统功能的调节紊乱。针对术前焦虑进行合理的干预或治疗,或将有助于减少围术期不良事件的发生。本文选择失眠、术后疼痛、术后恶心呕吐及术后谵妄等较为典型围术期不良事件,从术前焦虑与围术期不良事件的关系、发生机制及干预策略等角度予以综述。