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目的探析中高频听力下降型突发性聋采取耳后注射甲强龙治疗的临床效果及可行性。方法选取2019年5月~2020年7月本院耳鼻喉科就诊的中高频听力下降型突发性聋患者,共纳入病例54例,以随机法分组,即常规组(n=27)和观察组(n=27),常规组予常规治疗,观察组采取耳后注射甲强龙,比较两组效果。结果观察组有效率相比于常规组显著提高(P<0.05);治疗3周后,观察组2000~8000Hz频率听力提高值与常规组比(P<0.05)。结论中高频听力下降型突发性聋采取耳后注射甲强龙治疗效果理想,值得推广。  相似文献   
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IntroductionOur aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs).MethodsData were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models.ResultsAmong 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL.ConclusionUse of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children.Level of evidenceIII.  相似文献   
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BackgroundPerianal abscesses and anal fistulas are common. The principle of intention-to-treat has not been considered in previous systemic reviews. Thus, the comparison between primary and post-recurrence management was confused, and the recommendation of primary treatment is obscure. The current study aims to identify the optimal initial treatment for pediatric patients.MethodsUsing PRISMA guidelines, studies were identified from MEDLINE, EMBASE, PubMed, Cochrane Library, and Google Scholar without any language or study design restriction. The inclusion criteria include original articles or articles with original data, studies of management for a perianal abscess with or without anal fistula, and patient age of <18 years. Patients with local malignancy, Crohn's disease, or other underlying predisposing conditions were excluded. Studies without analyzing recurrence, case series of <5, and irrelevant articles were excluded in the screening stage. Of the 124 screened articles, 14 articles had no full texts or detailed information. Articles written in a language other than English or Mandarin were translated by Google Translation first and confirmed with native speakers. After the eligibility process, studies that compared identified primary managements were then included in the qualitative synthesis.ResultsThirty-one studies involving 2507 pediatric patients met the inclusion criteria. The study design consisted of two prospective case series of 47 patients and retrospective cohort studies. No randomized control trials were identified. Meta-analyses for recurrence after initial management were performed with a random-effects model. Conservative treatment and drainage revealed no difference (Odds ratio [OR], 1.222; 95% Confidential interval [CI]: 0.615–2.427, p = 0.567). Conservative management had a higher risk of recurrence than surgery without statistical significance (OR 0.278, 95% CI: 0.109–0.707, p = 0.007). Compared with incision/drainage, surgery can prevent recurrence remarkably (OR 4.360, 95% CI: 1.761–10.792, p = 0.001). Subgroup analysis of different approaches within conservative treatment and operation was not performed for lacking information.ConclusionStrong recommendations cannot be made due to the lack of prospective or randomized controlled studies. However, the current study based on real primary management supports initial surgical intervention for pediatric patients with perianal abscesses and anal fistula to prevent recurrence.Level of evidenceType of study: Systemic review; Evidence level: Level II.  相似文献   
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ObjectiveThe use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement.ResultsThe expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively.ConclusionsAchieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.  相似文献   
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背景 我国居民精神障碍死亡相关流行病学分析较少,上海作为经济发达地区,居民健康信息化较为完善,能够为深层次分析居民更小分类的疾病特征和死亡原因提供数据支撑,且分析上海市女性精神障碍死亡情况及趋势有助于了解当地女性精神障碍疾病负担。 目的 分析2005—2021年上海市浦东新区女性居民精神障碍死亡情况及其趋势。 方法 整理2005—2021年浦东新区全人口户籍居民死因监测资料,采用粗死亡率、标化死亡率、减寿年数和减寿率等指标分析当地女性居民精神障碍死亡情况,并采用Joinpont回归模型计算年度变化百分比(APC)和平均年度变化百分比(AAPC)进行趋势分析。 结果 2005—2021年上海市浦东新区女性精神障碍死亡1 165例,占同期总死亡人数的0.32%,粗死亡率为4.82/10万,标化死亡率为1.85/10万。上海市浦东新区女性精神障碍粗死亡率2005—2012年呈下降趋势(APC=-13.05%,P=0.002),2012—2021年呈上升趋势(APC=7.66%,P=0.012);标化死亡率2005—2012年呈下降趋势(APC=-16.79%,P<0.001),2005—2021年整体呈下降趋势(AAPC=-4.93%,P=0.009);减寿率2005—2012年呈下降趋势(APC=-13.79%,P<0.001),2012—2021年呈上升趋势(APC=6.93%,P=0.011)。2005—2021年上海市浦东新区女性精神障碍死亡年龄为50.8~105.8岁,死亡年龄分布以≥80岁为主(79.48%),且≥80岁女性精神障碍死亡比例整体呈上升趋势(AAPC=0.98%,P=0.027);70~79岁女性精神障碍死亡比例为16.57%,其死亡比例(AAPC=-5.13%,P=0.026)、粗死亡率(AAPC=-7.20%,P=0.003)和减寿率(AAPC=-6.89%,P=0.005)整体均呈下降趋势。 结论 2005—2021年上海市浦东新区女性精神障碍标化死亡率整体呈下降趋势,但高龄(≥80岁)女性精神障碍死亡比例整体呈上升趋势。高龄女性居民精神障碍疾病负担值得当地重点关注,促进高龄女性精神健康有益于提高当地女性健康水平。  相似文献   
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Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status.AimTo evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD.This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form?, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured.Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p = 0.06) and severe (p = 0.005) PEW had lower HRQoL score [68 (52–75), 55 (45–72), 46 (43–58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p < 0.0001).As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.  相似文献   
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目的探究腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉对老年股骨粗隆间骨折患者麻醉效果的影响。方法选取本院2017年8月至2019年11月收治的94例老年股骨粗隆间骨折患者,按照随机数字表法分为对照组(n=48)和观察组(n=46)。对照组行蛛网膜下腔阻滞麻醉复合腰硬外麻醉,观察组行腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉。比较两组手术不同时间段血流动力学指标[平均动脉压(MAP)及心率(HR)]情况。结果 T1、T2、T3、T4时段,观察组MAP及HR水平均高于对照组,差异有统计学意义(P<0.05)。结论老年股骨粗隆间骨折患者经腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉更有利于稳定术中血流动力学指标。  相似文献   
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