艾烟的作用与安全性评价＊

艾灸作为中医学最古老的疗法之一，作用多样，应用广泛，疗效显著。随着科技的发展，人们对灸法的认识逐渐深入，其中艾烟的相关研究也硕果累累，其安全性广受关注。通过对艾烟作用和安全性评价研究中取得的成果进行归纳分析，以期为艾灸临床安全应用提供指导。     

Er:YAG激光桩道预处理的研究进展

本文回顾了Er:YAG激光活化根管冲洗技术的最新研究进展,包括光子诱导光声流(photon initiated photoacoustic streaming,PIPS)技术和冲击波增强发射光声流(shock wave enhanced emission photoacoustic streaming,SWEEPS)技术,探讨Er:YAG激光预处理桩道的原理、优点以及对纤维桩粘接强度的影响,以期为临床选择适宜的桩道处理方法提供新思路。     

Brave Spaces in Discourse About Pregnant Persons’, Women’s,and Children’s Health

Discourse around implicit bias, intersectionality, and inequity in health care requires having conversations that may be uncomfortable. Within this space of discomfort, new understandings can occur. Reflecting on our own biases and assumptions is a moral obligation and a necessity to generate change. Health care settings may be a fitting forum to create and use brave spaces to have these conversations.     

小儿弱视采用多媒体训练与传统遮盖治疗的效果对比

目的分析小儿弱视采用多媒体训练与传统遮盖治疗的效果。方法 100例小儿弱视患儿,采用计算机随机法分为传统组和多媒体组,每组50例。传统组患儿采用传统遮盖治疗,多媒体组患儿采用多媒体训练。比较两组患儿治疗前后立体视觉情况、视力水平及治疗效果。结果多媒体组患儿治疗总有效率为94.00%(47/50),高于传统组的80.00%(40/50),差异具有统计学意义(P<0.05)。治疗后,多媒体组患儿立体视觉正常率为90.00%(45/50),高于传统组的74.00%(37/50),差异具有统计学意义(P<0.05)。治疗后,两组患儿视力水平均高于本组治疗前,且多媒体组患儿视力水平(0.93±0.12)高于传统组的(0.84±0.12),差异具有统计学意义(P<0.05)。结论小儿弱视采用多媒体训练与传统遮盖治疗的效果存在差异,多媒体训练可更好地改善患儿视力,值得推广和应用。     

优质护理模式在老年腹股沟嵌顿疝急诊手术中的应用

目的探讨优质护理模式在老年腹股沟嵌顿疝急诊手术中的应用效果。 方法选取2016年9月至2018年7月，琼海市中医院收治的腹股沟嵌顿疝老年患者116例，采用随机数字表法将患者分为观察组和对照组，每组58例。2组患者均行无张力疝修补术，对照组围手术期给予常规护理，观察组在此基础上采用优质护理模式。比较2组患者治疗前及出院后2周抑郁及焦虑状态、手术前后不同时间疼痛程度、住院期间护理质量及术后并发症发生情况。 结果与治疗前比较，出院后2周2组患者抑郁自评量表、焦虑自评量表评分均明显降低，且观察组明显低于对照组，差异有统计学意义（P<0.05）。术后6 h至3 d，2组患者视觉模拟评分均呈逐渐降低趋势，且术后6 h至3 d观察组VAS评分均明显低于对照组，差异有统计学意义（P<0.05）。观察组病情观察、护理技巧及并发症预防评分均明显高于对照组，差异有统计学意义（P<0.05）。观察组总并发症发生率明显低于对照组，差异有统计学意义（P<0.05）。 结论优质护理模式可以降低老年腹股沟嵌顿疝患者急诊手术后疼痛程度，缓解患者负性情绪，降低术后并发症发生风险，促进患者恢复。     

腹腔镜下疝囊高位结扎术中应用优质护理的效果分析

目的探讨优质护理在腹腔镜下疝囊高位结扎术中的应用效果。 方法选取2017年4月至2018年9月，解放军总医院第六医学中心收治的腹股沟疝患儿102例，采用随机数字表法将患儿分为观察组和对照组，每组51例。2组患儿均行腹腔镜下疝囊高位结扎术，对照组围手术期给予常规护理，观察组围手术期采用优质护理。比较2组手术相关临床参数、术后第2天腹胀程度、住院期间护理质量及术后并发症发生情况。 结果观察组术后肠鸣音恢复时间、术后肛门排气时间及自主下床活动时间均明显短于对照组，差异均有统计学意义（t=6.738、6.060、2.874，P均<0.001）。观察组总并发症发生率明显低于对照组，差异有统计学意义（χ²=4.747，P=0.029）。观察组腹胀评分明显低于对照组，差异有统计学意义（t=9.738，P<0.001）。观察组病房管理、病情观察、护理操作及并发症预防评分均明显高于对照组，差异均有统计学意义（t=5.546、7.237、13.106、7.014，P均<0.001）。 结论腹腔镜下疝囊高位结扎术围手术期实施优质护理可有效提升住院期间护理质量，缓解患儿术后腹胀程度，降低术后并发症发生风险，利于患儿术后恢复。     

超声引导下腹横肌平面阻滞联合喉罩通气全身麻醉在小儿腹股沟斜疝修补术中的应用

目的探究喉罩通气全身麻醉联合超声引导下腹横肌平面阻滞（TAPB）在小儿腹股沟斜疝手术中的应用。 方法选取2018年1至10月，成都市妇女儿童中心医院行疝囊高位结扎100例腹股沟斜疝患儿的临床资料，按随机数字表法将其分2组，每组患儿50例。对照组术中给予喉罩通气全身麻醉，观察组术中给予超声引导下TAPB联合喉罩通气全身麻醉。观察2组手术相关指标、血流动力学指标、小儿疼痛量表评分（FLACC）及不良反应发生情况。 结果观察组术后拔管时间、麻醉苏醒时间及住院时间分别为（6.27±1.86）min、（13.34±3.17）min及（2.26±0.14）d，与对照组（13.31±2.05）min、（19.86±3.48）及（3.15±1.17）d比较，差异有统计学意义（t=17.984、9.259、5.341，P均<0.001）。与T₁相比，观察组患儿T₂、T₃时段HR、SBP、DBP无显著变化，差异无统计学意义（P>0.05）；对照组HR无显著变化，差异无统计学意义（P>0.05），SBP、DBP逐渐升高，差异有统计学意义（P<0.05）。观察组T₁时段HR与对照组相比，差异无统计学意义（P>0.05），T₂、T₃时段显著低于对照组，差异有统计学意义（P<0.05）。观察组T₁时段SBP、DBP与对照组比较，差异无统计学意义（P>0.05），T₂、T₃时段显著低于对照组，差异有统计学意义（P<0.05）。观察组患儿在苏醒时、术后2 h、4 h及8 h FLACC评分分别为（2.3±0.6）分、（2.0±0.4）分、（1.6±0.5）分、（1.2±0.3）分，均低于对照组（3.0±0.5）分、（2.7±0.6）分、（2.2±0.3）分、（1.7±0.4）分，差异有统计学意义（t=40.170、47.114、57.940、49.999，P均<0.05）。观察组呕吐、咽痛、喉痉挛的发生情况分别为3（6.00%）、3（6.00%）、2（4.00%），均低于对照组10（20.00%）、11（22.00%）、9（18.00%），差异有统计学意义（χ²=4.332、5.316、5.005，P=0.037、0.021、0.025）。 结论在疝囊高位结扎术中采用超声引导下TAPB联合喉罩通气全身麻醉，能够更好地维持患儿血流动力学的稳定性，降低疼痛及不良反应的发生，值得临床推广应用。     

Acute traumatic quadrilateral space syndrome following scapula fracture

The acute tunnel syndrome of the quadrilateral space of Velpeau is a very rare entity in which the axillary nerve and the posterior humeral circumflex artery experience brutal compression in shoulder injuries. We report the case of a burst fracture of the right scapula with great displacement of the lateral border occasioning a total isolated paralysis of the right axillary nerve by axillary nerve compression. The lateral scapula border fracture was reduced and stabilized with neurolysis of the axillary nerve through a posterior approach. The recovery of the axillary nerve occurred in ten weeks. Our case is original, not only because of the rarity of isolated axillary nerve injury follwing scapula fractures without shoulder dislocation, but also because the compression of the axillary nerve by bone impingement could be undiagnosed and comprise prognosis.     

The influence of environmental and health indicators on premature mortality: An empirical analysis of the City of Toronto's 140 neighborhoods

The objective of this paper was to assess the link between premature mortality and a combination of neighbourhood contextual (environmental and health) and compositional (socioeconomic and demographic) characteristics. We statistically and spatially examined six environmental variables (ultrafine particles, carcinogenic and non-carcinogenic pollutants, pollution released to air, tree cover, and walkability index), six health service indicators (number health providers, breast, colorectal and cervical cancer screening uptake rates, student nutrition program uptake rates, and healthy food index), and eight socioeconomic indicators (total income, Gini coefficient, two age categories – below and above 40 years, proportion of females to males, visible minorities, Indigenous peoples, education, less than grade 9) among 140 neighbourhoods of the City of Toronto in Ontario (Canada). We applied principal component analysis to identify patterns and to reduce the number of explanatory variables into combined component axes that represent unique variation in these confounded and overlapping factors. We then applied regression analysis to model the relationship between the indices of enviro-health and socioeconomics and their potential relationship with premature mortality. Residual spatial analysis was used to investigate any remaining spatial structure (such as neighbourhoods with higher residual premature mortality rates). Neighbourhood Equity Index was correlated with our enviro-health and socioeconomic indices. Premature mortality within neighbourhoods was predicted by poor cancer screenings, pollution, lack of tree canopy, increased uptake of student nutrition programs and high walkability index. A negative association between premature mortality and pollution was associated low walkability index and presence of visible minorities within neighbourhoods. There was some unexplained residual spatial variation in our model of premature mortality - especially along the shores of Lake Ontario and in neighbourhoods with major highways or road corridors: premature mortality in Toronto neighbourhoods was higher than expected along highway-corridor neighbourhoods and shorelines. Our analysis revealed a significant relationship between neighbourhood contextual features – both environmental and health – and premature mortality, suggesting that these contextual components of neighbourhoods can predict rates of urban premature mortality in Toronto.