微创治疗方法在输尿管上段结石中应用进展

输尿管上段结石为临床中常见泌尿系结石类型之一,如不能及时诊治,可引起重度积水、泌尿系感染,甚至脓毒血症,对患者肾功能、健康造成严重影响。随着微创治疗技术在泌尿系结石中应用,微创治疗方法能降低对患者造成治疗性创伤,降低相关并发症发生率,促进患者康复,了解临床中微创治疗输尿管上段结石方法,对临床中合理治疗输尿管上段结石有重要价值。     

Magnetic resonance elastography with guided pressure waves

Magnetic resonance elastography aims to non-invasively and remotely characterize the mechanical properties of living tissues. To quantitatively and regionally map the shear viscoelastic moduli in vivo, the technique must achieve proper mechanical excitation throughout the targeted tissues. Although it is straightforward, ante manibus, in close organs such as the liver or the breast, which practitioners clinically palpate already, it is somewhat fortunately highly challenging to trick the natural protective barriers of remote organs such as the brain. So far, mechanical waves have been induced in the latter by shaking the surrounding cranial bones. Here, the skull was circumvented by guiding pressure waves inside the subject's buccal cavity so mechanical waves could propagate from within through the brainstem up to the brain. Repeatable, reproducible and robust displacement fields were recorded in phantoms and in vivo by magnetic resonance elastography with guided pressure waves such that quantitative mechanical outcomes were extracted in the human brain.     

Impact of Food Intake on Liver Stiffness Determined by 2-D Shear Wave Elastography: Prospective Interventional Study in 100 Healthy Patients

The aim was to evaluate the influence of food intake on liver stiffness measurement (LSM), performed with 2-D shear wave elastography (Logiq E9, GE Medical Systems, Wauwatosa, WI, USA). One hundred healthy volunteers were prospectively enrolled. Mean age was 25.8 (19–55) y, and mean body mass index was 22.43 (17.3–30.8) kg/m². Patients fasted for at least 3 h and subsequently ingested a liquid meal of 800 kcal. Liver stiffness and portal vein velocity were measured before and after food intake. Food intake resulted in significantly higher LSM values compared with baseline LSM (5.74 ± 0.94 kPa vs. 4.80 ± 0.94 kPa, p < 0.001). On multiple linear regression analysis, body mass index was significantly positively correlated with the LSM increase after food intake (p?=?0.01). No correlation between the increase in LSM and the increase in post-prandial portal vein velocity was observed (r?=?0.09). In summary, food intake has a significant influence on LSM. There is an 11% risk of misclassifying non-fasting, healthy patients as having significant fibrosis.     

Effectiveness and safety of extracorporeal shock wave treatment for low back pain：a systematic review and meta-analysis of RCTs

This meta-analysis was designed to assess the effectiveness and safety of extracorporeal shock wave therapy (ESWT) for patients with low back pain (LBP). Pubmed, Embase, Cochrane's library, PEDro (Physiotherapy Evidence Database), China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched until December 2019 to identify studies assessing the effectiveness and safety of EPSW for LBP. The prime outcome is pain intensity measured by Visual Analog Scale (VAS) or numeric rating scale (NRS). Other outcomes included functional status, quality of life, psychological outcomes measured by Oswestry Disability Index (ODI), as well as the adverse events. Mean differences (MD) were calculated for continuous outcomes, while odd ratios (OR) were calculated for binary outcomes. Revman 5.3 software was used for statistical analysis. Five randomized controlled trials (RCTs) were finally included in this meta-analysis. The pooled mean difference in post-treatment pain scores was −2.37 (P ＜0.0001), indicating that post-treatment pain scores was significantly higher by 2.37 in control group than in ESWT group. At a mean follow-up time of 4–6 weeks, the pooled mean difference in ODI scores was −14.10 (P ＜0.00001), indicating that the pooled mean difference of post-treatment ODI scores was 14.10 higher in control group than in ESWT group. The use of ESWT is effective in alleviating pain and improving the general functional state for patients with LBP. However, more evidence was needed to verify its safety.     

Race to Beat the Heat: Climate Change Impacts Physical Activity

Climate change has led to increased frequency, intensity, and duration of extreme heat events with dire consequences for health. These are the deadliest of climate change impacts with preventable mortality from heat-related illnesses and increased threat to safe participation in physical activity and sports. Nurse practitioners can collaborate with community and professional sports health organizations to ensure evidence-based health and safety policies to reduce health-related risks. Adverse consequences on engagement in key health-promoting physical activity and sports may catalyze urgent action to address climate change.     

基于心肺运动试验客观定量评估的个体化运动在高血压患者中的应用

目的探讨基于心肺运动试验(CPET)客观定量评估的个体化运动在高血压患者中的应用及对血压、血压变异性、脂代谢和脉搏波波形特征的影响。方法选取2019年1月至2019年6月济宁医学院教职工中的40例高血压患者,男23例,女17例,年龄(48.5±4.6)岁,年龄范围为40~58岁。采用随机数表法将患者随机分为常规组和CPET组,每组20例。常规组给予常规生活方式干预,CPET组在常规组的基础上给予基于CPET客观定量评估的个体化运动。观察两组患者干预前后静息血压、血清低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、总胆固醇、甘油三酯、24 h收缩压标准差(24 hSSD)、24 h舒张压标准差(24 hDSD)、日间收缩压标准差(dSSD)、日间舒张压标准差(dDSD)、夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)和桡动脉脉搏波切迹幅度。结果 CPET组干预后收缩压[(126.8±8.2)mmHg(1 mmHg=0.133 kPa)]和舒张压[(75.3±6.1)mmHg]水平均低于常规组[(132.1±6.2)mmHg、(79.7±6.4)mmHg],差异有统计学意义(P<0.05)。CPET组患者干预后LDL-C[(2.2±0.5)mmol/L]、总胆固醇[(4.8±0.6)mmol/L]、甘油三酯[(1.2±0.4)mmol/L]水平均显著低于常规组[(3.4±0.4)mmol/L、(5.3±0.7)mmol/L、(1.8±0.3)mmol/L],HDL-C[(1.5±0.2)mmol/L]高于常规组[(1.1±0.1)mmol/L],差异均有统计学意义(P<0.05)。CPET组干预后24 hSSD[(10.3±4.3)mmHg]、dSSD[(11.6±3.8)mmHg]、nSSD[(9.5±4.1)mmHg]、24 hDSD[(9.7±2.8)mmHg]、dDSD[(11.2±3.3)mmHg]、nDSD[(8.2±2.8)mmHg]水平低于常规组[(13.4±5.4)mmHg、(14.3±4.8)mmHg、(12.1±3.4)mmHg、(12.4±3.4)mmHg、(13.0±4.2)mmHg、(10.1±3.8)mmHg],差异有统计学意义(P<0.05)。CPET组干预后脉搏波切迹幅度高于常规组,差异有统计学意义(P<0.05)。结论基于CPET客观定量评估的个体化运动用于高血压干预可改善患者的血压控制效果,降低血压变异性,改善脂代谢,增加脉搏波切迹幅度,改善血管弹性水平,具有临床推广价值。