Clinical implications of additional posterior fractures in combined anterior-posterior pelvic ring fractures in elderly patients

ObjectivesHistorically, pelvic ring fractures (PRF) are considered to occur predominantly in the anterior ring and therfore to be mechanically stable. Combined anterior and posterior (A + P) PRF are expected to be less mechanically stable and therefore to be associated with higher levels of pain and reduced mobility compared to isolated anterior fractures. The current study investigates the clinical relevance of combined A + P PRF in elderly patients.MethodsA prospective multicentre cohort study was conducted in patients >70 years of age with anterior PRF after low-energy trauma diagnosed on conventional radiographs. All patients underwent an additional CT-scan. Patients were divided into two groups; isolated anterior or combined A + P fractures. Patients were treated conservatively with adequate analgesia for at least one week. If patients could not be mobilised after conservative treatment, surgical fixation was performed. Numerical Rating Scale (NRS) pain scores, dependence on walking aids and Activities of Daily Living scores (ADL) were measured at 2–4 weeks, and 3, 6 and 12 months after fracture.Results102 patients (age 81.1 ± 7.6 years) were included. Isolated anterior fractures were diagnosed in 25 (24.5%) and A + P fractures in 77 (75.5%) patients. Baseline characteristics did not differ between the two groups. Most patients were successfully treated conservatively and 5 (4.9%) underwent percutaneous trans-iliac, trans-sacral screw fixation after failure of conservative treatment. At 2–4 weeks post trauma, patients with A + P fractures had similar median pain scores (3 (range 0–8) vs. 5 (0–10), p = 0.19) and ADL scores (85 (25–100) vs. 78.6 (5–100), p = 0.67), but were more dependent on walking aids (92.8% vs. 72.2%; p = 0.02) compared to patients with isolated anterior fractures. There were no significant differences at 3 months. At one year follow-up the median NRS pain and ADL scores for both fracture groups were 0 and 100, respectively. Mortality was 10.8%, and additional loss to follow-up was 17.6%.ConclusionsThe vast majority of elderly patients with PRF have combined A + P fractures. The clinical implications of additional posterior pelvic ring fractures in elderly patients appears to be limited.     

造口护理辅助用品在大便失禁患者中的应用

目的观察造口护理辅助用品(皮肤保护膜、造口护肤粉、改良一件式造口袋)对大便失禁相关性皮炎(IAD)的防治效果。方法选择2017年3月-2018年2月本院神经外科大便失禁患者31例作为观察组,使用造口护理辅助用品进行护理;采用回顾性对照方法,将2016年3月-2017年2月本院神经外科具有同质性的大便失禁患者30例作为对照组,使用氧化锌软膏联合一次性护理垫。观察两组患者IAD的发生时间、发生率、严重程度及治疗有效率。结果观察组患者IAD发生时间明显长于对照组,Ⅰ度皮炎4例,无Ⅱ、Ⅲ度皮炎发生,对照组Ⅰ度皮炎10例,Ⅱ度3例、Ⅲ度1例,观察组IAD的发生率为12.90%,明显低于对照组46.67%,严重程度明显轻于对照组,IAD治疗有效率达100.00%,较对照组42.86%明显提高,两组比较,均P<0.05,差异有统计学意义。结论大便失禁患者使用造口护理辅助用品可预防或延缓IAD发生,减轻IAD严重程度,提高IAD治疗效果。     

Measuring catastrophic medical expenditures: Reflections on three issues

In the “basic” approach, medical expenses are catastrophic if they exceed a prespecified percentage of consumption or income; the approach tells us if expenses cause a large percentage reduction in living standards. The ability‐to‐pay (ATP) approach defines expenses as catastrophic if they exceed a prespecified percentage of consumption less expenses on nonmedical necessities or an allowance for them. The paper argues that the ATP approach does not tell us whether expenses are large enough to undermine a household's ability to purchase nonmedical necessities. The paper compares the income‐based and consumption‐based variants of the basic approach, and shows that if the individual is a borrower after a health shock, the income‐based ratio will exceed the consumption‐based ratio, and both will exceed the more theoretically correct Flores et al. ratio; whereas if the individual continues to be a saver after a health shock, the ordering is reversed and the income‐based ratio may not overestimate Flores et al.'s ratio. Last, the paper proposes a lifetime money metric utility (LMMU) approach defining medical expenses as catastrophic in terms of their lifetime consequences. Under certain assumptions, the LMMU and Flores et al. approaches are identical, and neither requires data on how households finance their medical expenses.     

前节OCT评估V4c型后房型有晶体眼人工晶体植入术安全性的临床研究

目的探讨前节光学相干断层扫描(OCT)评估V4c型后房型有晶体眼人工晶体(ICL)植入术治疗超高度近视长期安全性的价值。方法 41例(78眼)>-9.0D的超高度近视进行V4c型ICL植入手术患者,测量术前及术后1、3、6、12个月的角膜内皮细胞计数,应用前节OCT及超声生物显微镜(UBM)检测患者术前睫状沟沟到沟距离(WTW)、中央前房深度(ACD)、小梁于虹膜夹角(TIA)及术后各时段拱高、ACD、TIA。分析手术安全性;比较患者术前及术后各时段角膜内皮细胞计数、前节OCT测量指标,术前不同测量方法各参数测量结果 , UBM与前节OCT各参数测量结果。结果所有患者手术顺利,术后4 h内13只眼(12例患者)一过性眼压升高,降眼压处理后至随访结束眼压均平稳,其余患者无其他手术并发症发生。术后1、3、6、12个月,患者角膜内皮细胞计数低于术前,差异具有统计学意义(P<0.05);术后1、3、6、12个月,患者前节OCT测量指标ACD低于术前、TIA小于术前,差异具有统计学意义(P<0.05);术后1、3、6、12个月,患者角膜内皮细胞计数及前节OCT测量指标ACD、TIA、拱高比较差异无统计学意义(P>0.05)。术前WTW应用卡尺手测、角膜地形图(ObscanⅡ)前节分析系统测量、Master、UBM及前节OCT测量结果分别为(11.80±0.36)、(11.75±0.37)、(12.26±1.17)、(11.94±0.41)、(11.91±0.38)mm, Master测量WTW与其他方式比较差异具有统计学意义(P<0.05);术前ACD应用ObscanⅡ前节分析系统测量、Master、UBM及前节OCT测量结果分别为(3.1±0.20)、(3.30±0.17)、(3.11±0.13)、(3.10±0.15)mm, Master测量结果与其他方式比较差异具有统计学意义(P<0.05);术前TIA应用UBM、前节OCT测量结果分别为(40.98±5.82)°、(40.92±5.65)°,比较差异无统计学意义(P>0.05)。术前及术后各时段,前节OCT及UBM测量ACD、TIA及拱高的测量结果比较差异无统计学意义(P>0.05)。结论 V4c型ICL植入术治疗超高度近视无论视力、ICL位置或是眼内情况稳定性均良好,无严重并发症,手术方式安全稳定。应用前节OCT观察术后ICL位置、前房深度及房角情况简易方便,准确无创。测量简单方便且精准,可作为术后常规随访的测量方式。     

Ocular Complications in Influenza Virus Infection

Purpose: To describe a case series of ocular complications associated with upper respiratory tract infections.

Methods: Four patients aged 21–61 years (three females, one male) had confirmed ocular complications connected with a general upper respiratory tract infection with myalgia and fever. Ophthalmological examination, including a visual acuity test, a slit-lamp exam, intraocular pressure measurements, fluorescein and indocyanine green angiography, optical coherence tomography (OCT), and diagnostic tests for influenza were performed in the patients (RT-PCR, HAI).

Results: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) was diagnosed in three patients and serous macular detachment (SME) in one. Influenza virus infection was confirmed by molecular biological methods (RT-PCR) or the hemagglutination inhibition test (HAI) in two patients. All patients were treated with systemic prednisone.

Conclusion: A coincidence between APMPPE and SME epitheliopathy and influenza virus infection was observed in different months of a given epidemic season.     

Pharyngeal airway space changes after maxillomandibular advancement: a five-year retrospective study

The aim of this study was to compare the alterations in three regions of the airway—nasopharynx, oropharynx, and hypopharynx—in relation to the area of the midsagittal plane, volume, and minimal axial area after maxillomandibular advancement (MMA) surgery. Thirty patients who had undergone MMA surgery were evaluated at four time points: preoperative (T0), immediately postoperative (T1), 1 year postoperative (T2), and ≥5 years postoperative (T3). All measurements were performed using computed tomography, analyzed in Dolphin Imaging 11.0 Premium 3D software. The area in the midsagittal plane presented a mean increase of 22.0% between T0 and T3 (P < 0.001), with the highest increase in the oropharynx (24.1%, P < 0.001). The total volumetric increase at T3 was 16.7% (P < 0.001), with the highest increase in the nasopharynx (15.7%; P < 0.001). The lowest minimal axial area was found for the oropharynx at all time points, and the highest increase in minimal axial area was found for the nasopharynx (114.9%; P < 0.001). MMA surgery showed the highest increase in upper posterior airway between T0 and T1, and this was followed by a progressive reduction until T3, but with a statistically significant increase at T3 compared with T0 in all cases.