经皮肾镜气压弹道超声碎石在肾结石中的效果

目的 B超引导经皮肾镜气压弹道超声联合碎石治疗肾结石的临床效果。方法选择2017年9月-2018年9月医院收治的肾结石患者82例,按照抽签法的要求将其平均分成对照组(41例:B超引导经皮肾镜气压弹道超声治疗)与试验组(41例:输尿管软镜治疗),分析手术时间、住院时间、出血量、结石清除率、结石的残留率。结果试验组的手术时间、住院时间、出血量。优于对照组,数据比较有差异性,P<0.05。对照组的结石清除率高于试验组、结石的残留率低于试验组,相互比较有差异性,P<0.05。结论在肾结石实际治疗期,使用输尿管软镜钬激光碎石治疗方式。     

Surgical Helmets Used During Total Joint Arthroplasty Harbor Common Pathogens: A Cautionary Note

BackgroundThe use of personal-protection surgical helmet/hood systems is now a part of the standard surgical attire during arthroplasty in North America. There are no protocols for the disinfection of these helmets.MethodsThis is a prospective, single-center, observational study. Helmets worn by 44 members of the surgical team and foreheads of 44 corresponding surgical personnel were swabbed at three distinct time points. In addition, 16 helmets were treated with hypochlorite spray to determine if pathogens could be eliminated. Swabs obtained were processed for culture and next-generation sequencing (NGS).ResultsOf the 132 helmet samples, 97 (73%) yielded bacteria on culture and 94 (71%) had evidence of bacterial–deoxyribonucleic acid (DNA) on NGS. Of the swabs sent for bacterial identification at the three time points, at least one from each helmet was positive for a pathogen(s). Of the 132 forehead samples, 124 (93%) yielded bacteria on culture and 103 (78%) had evidence of bacterial-DNA on NGS. The most commonly identified organism from helmets was Cutibacterium acnes (86/132) on NGS and Staphylococcus epidermidis (47/132) on culture. The most commonly identified organism from the foreheads of surgical personnel was Cutibacterium acnes (100/132) on NGS and Staphylococcus epidermidis (70/132) on culture. Sanitization of helmets was totally effective; no swabs taken the following morning for culture and NGS identified any bacteria.ConclusionThis study demonstrates that surgical helmets worn during orthopedic procedures are contaminated with common pathogens that can potentially cause surgical site infections. The findings of this study should at the minimum compel us to develop protocols for the disinfection of these helmets.     

经输尿管硬镜钬激光碎石术与气压弹道碎石术治疗输尿管多发结石的临床研究

目的比较钬激光碎石术与气压弹道碎石术治疗单侧输尿管多发结石的临床效果和安全性。方法选择2008年11月-2014年12月该院收治的单侧输尿管多发结石患者45例,随机分为两组,钬激光组23例,气压弹道组22例。钬激光组采用输尿管镜下钬激光碎石术治疗,气压弹道组采用气压弹道碎石术治疗,比较两组患者的治疗效果和临床安全性。结果钬激光组手术时间为(57.6±9.3)min,住院时间为(2.3±1.1)d;气压弹道组手术时间为(68.0±11.7)min,住院时间为(3.6±1.5)d,两组比较差异有统计学意义(P0.05)。两组的碎石成功率、碎石总有效率均为100.00%。两组的结石排净率、术后并发症发生率差异无统计学意义(P0.05)。结论钬激光与气压弹道均可用于治疗单侧输尿管多发结石,钬激光碎石术更具有优势,值得临床推广应用。     

Contracting with Children and Helmet Distribution in the Emergency Department to Improve Bicycle Helmet Use

OBJECTIVES: To determine whether injury prevention counseling and behavioral counseling delivered in the emergency department (ED) could result in increases in self-reported bicycle helmet use. METHODS: The authors undertook a trial of counseling in 222 children recruited in an urban ED between August 2000 and October 2001. All consenting patients in the ED aged 5 to 15 years who did not have life-threatening conditions were eligible. One hundred nine children were assigned to the control group on the basis of attendance on an odd-numbered day, and they received a photocopied photograph of the hospital. One hundred thirteen children were assigned to the intervention group, and they received a personal counseling session and signed a contract promising to wear their bicycle helmets. In addition, 57 of the intervention children were assigned (based on having an even-numbered birthday) to be fitted with helmets if they did not already own them. Parents were telephoned four weeks after the ED encounter for follow-up. RESULTS: Follow-up data were obtained for 148 children (67% follow-up rate), of whom only 69 reported riding a bicycle in the four weeks after their ED visit. Of the final sample of 69 children, 38 belonged to one of the intervention groups, and 25 of these (66%) reported always wearing a helmet while cycling during the four weeks after their ED visit, versus 13 of 31 (42%) in the control group (odds ratio, 2.66; p < 0.05). The effect of the intervention was independent of whether the children owned a helmet at baseline. CONCLUSIONS: Injury prevention counseling in the ED using "The Injury Prevention Program" (TIPP) sheet, behavioral contracting, and helmet distribution may have a significant effect on reports of subsequent bike helmet use.     

158例良性前列腺增生并膀胱结石的疗效对比

目的探讨良性前列腺增生并膀胱结石的有效治疗方法。方法分别采用经尿道前列腺电切结合膀胱气压弹道碎石术(A组)、膀胱液电碎石术(B组)、小切口膀胱切开取石术(C组)治疗良性前列腺增生并膀胱结石158例。结果3组病例术后IPSS(国际前列腺症状评分)均较术前下降,Qmax(最大尿流率)均较术前提高(P<0.05)。A组和B组术后膀胱冲洗时间、留置尿管时间及住院时间分别为(26.6±4.9)h、(5.0±1.6)d、(6.2±1.4)d和(25.9±5.7)h、(4.9±1.7)d、(6.1±1.6)d,明显少于C组,有统计学意义(P<0.05)。A组和C组处理膀胱结石大小分别为(3.3±2.1)cm、(3.7±2.6)cm,明显大于B组(P<0.05)。结论3种手术方法均具有明显的临床效果,经尿道前列腺电切结合膀胱气压弹道碎石治疗良性前列腺增生并膀胱结石效果最好。     

气压弹道式体外冲击波联合玻璃酸钠治疗膝关节骨性关节炎的疗效观察

目的探讨气压弹道式体外冲击波联合玻璃酸钠治疗膝关节骨性关节炎的临床疗效。方法选择确诊膝关节骨性关节炎患者100例,随机分为单纯玻璃酸钠组(对照组)与冲击波联合玻璃酸钠组(联合组),分别给予单纯玻璃酸钠及冲击波联合玻璃酸钠膝关节腔内注射,每周1次,连续5次为一个疗程。观察治疗前及治疗后2、4、8、12和24周的VAS评分、Lysholm膝关节功能评分,评估患膝的功能改善状况及治疗有效率。结果治疗后联合组与对照组VAS评分均较治疗前下降(P<0.05),联合组下降更明显(P<0.05);膝关节功能评分两组均较治疗前升高(P<0.05),联合组升高更显著(P<0.05);联合组总有效率为96%,对照组为84%,两组比较差异有统计学意义(P<0.05)。结论冲击波联合玻璃酸钠治疗膝关节骨性关节炎临床疗效显著、安全性高,简单易行,值得临床推广。     

EFFECTS OF BICYCLE HELMET LAWS ON CHILDREN'S INJURIES

In recent years, many states and localities in the USA have enacted bicycle helmet laws. We estimate the effects of these laws on injuries requiring emergency department treatment. Using hospital‐level panel data and triple difference models, we find helmet laws are associated with reductions in bicycle‐related head injuries among children. However, laws also are associated with decreases in non‐head cycling injuries, as well as increases in head injuries from other wheeled sports. Thus, the observed reduction in bicycle‐related head injuries may be due to reductions in bicycle riding induced by the laws. Copyright © 2013 John Wiley & Sons, Ltd.     

钬激光碎石术与气压弹道碎石术治疗输尿管结石的对比研究

目的：比较钬激光碎石术与气压弹道碎石术治疗输尿管结石的临床效果和安全性。方法选择2013年11月~2014年12月本院收治的输尿管结石患者120例,随机分为两组,每组60例。观察组采用输尿管镜下钬激光碎石术治疗,对照组采用气压弹道碎石术治疗,比较两组患者的治疗效果和临床安全性。结果钬激光组的碎石成功率为96.7%,结石排净率为96.7%,手术时间为(47.6±9.6)min,住院时间为(2.4±1.2)d;气压弹道组的碎石成功率为93.3%,结石排净率为90.0%,手术时间为(50.3±11.9)min,住院时间为(3.5±1.4)d,两组比较差异有统计学意义(P<0.05)。钬激光组的术后并发症发生率为65.0%,气压弹道组的术后并发症发生率为66.7%,差异无统计学意义(P>0.05)。结论钬激光碎石术治疗输尿管结石的效果显著优于气压弹道碎石术,值得临床推广应用。     

TURP联合肾镜下气压弹道碎石术治疗前列腺增生合并膀胱结石

目的探讨经尿道前列腺电切术(TURP)联合肾镜下气压弹道碎石术治疗前列腺增生(BPH)合并膀胱结石的疗效和安全性。方法回顾性分析我院2009年7月—2013年12月行TURP联合肾镜下气压弹道碎石术治疗的67例BPH合并膀胱结石患者的临床资料,分析其疗效和不良事件发生情况。结果 67例手术均成功,无大出血、膀胱穿孔及前列腺电切综合征等严重并发症。手术时间35~85(58.7±14.0)min,碎石手术时间5~43(22.6±7.8)min,TURP手术时间25~65(40.3±10.4)min。术后随访5~58(28.3±14.1)个月,无远期并发症。结论 TURP联合肾镜下气压弹道碎石术治疗BPH合并膀胱结石安全、有效,手术时间短且并发症少,尤其适合基层医院采用。     

Are self‐reported risk‐taking behavior and helmet use associated with injury causes among skiers and snowboarders?

Over the last 10 years, ski helmet use has steadily increased worldwide. According to the “risk compensation theory,” however, studies found that up to one third of skiers and snowboarders self‐reported to engage in more risk taking when wearing a ski helmet. Therefore, to evaluate whether self‐reported risk taking and ski helmet use affect accident causes on ski slopes, more than 2000 injured skiers and snowboarders were interviewed during the 2011/2012 winter season about accident causes and potential intrinsic and extrinsic risk factors. Chi‐square tests revealed that ski helmet use did not significantly differ between self‐reported risky and cautious people (81% vs 83%). Multivariate regression analysis revealed younger age groups [odds ratios (ORs) 1.8–1.9, P < 005], male sex (OR 2.4, P < 0.001), Austrian nationality (2.2, P < 0.001), higher skill level (1.7, P < 0.001), and off‐slope skiing (OR 2.2, P = 0.060) to be predictive for a risky behavior on ski slopes. Neither the use of skis or snowboards nor accident causes were significantly associated with a riskier behavior on ski slopes. In conclusion, self‐reported risk‐taking behavior and ski helmet use seem not to be associated with accident causes leading to an injury among recreational skiers and snowboarders.