腹腔镜免输精管分离腹股沟疝平片修补术的可行性研究

目的探讨腹腔镜免输精管分离腹股沟疝平片修补法的安全性与可行性。 方法回顾性分析2014年12月至2017年1月苏州大学附属第一医院普外科收治的352例男性腹股沟疝患者（其中单侧直疝75例,单侧斜疝162例,双侧斜疝67例,双侧直疝27例,单侧斜疝+直疝18例,单侧股疝3例）,所有患者均行腹腔镜免输精管分离腹股沟疝平片修补。统计手术时间及术中出血量、术后观察局部血肿、血清肿、疼痛、住院时间、复发及射精等指标。 结果352例患者均在腹腔镜下完成修补手术,共修补446例次,单侧发病手术时间为（105.2±12.6）min,双侧发病手术时间为（155.7±23.4）min,所有术中关闭腹膜切口时间为（12.5±2.3）min。术中出血量（2.3±0.57）ml,术后局部腹股沟区酸胀34例（9.66%）,疝囊积液26例（7.39%）,阴囊皮下气肿12例（3.41%）,余无其他并发症发生。术后住院（3.23±1.23）d,近期随访无复发,亦未出现射精异常病例。 结论腹腔镜免输精管分离腹股沟疝修补法免除了输精管及疝囊的分离,简化了腹膜前间隙的分离操作,是安全可行的手术方式。更重要的是有效避免了术中、术后对输精管的损伤和侵扰。     

脑卒中患者健康行为量表的编制及信效度检验

目的编制脑卒中患者健康行为量表并检验其信度效度,为脑卒中患者提供简易的专用健康行为评估工具。方法在中文版健康促进生活方式量表基础上,结合相关指南及文献编制脑卒中患者健康行为量表。对235例脑卒中患者进行问卷调查,采用SPSS17.0及Mplus7.0软件进行分析。结果量表的内容效度为0.850;总量表的同质性信度、分半信度、重测信度系数分别为0.878、0.801、0.845;探索性因子分析提取出6个公因子,共解释总变异量的69.073%。验证性因子分析模型的χ~2/df为1.355,比较拟合指数(CFI)为0.916,Tucker-Lewis指数(TLI)为0.903,标准化残差均方根(SRMR)为0.075,平均平方误差平方根(RMSEA)为0.054,P=0.303,模型精确拟合数据。结论编制的脑卒中患者健康行为量表具有较好的信度和效度,可作为脑卒中患者健康行为的测评工具。     

Targeted bone remodeling involves BMU steering as well as activation

Microdamage removal is an important function of bone remodeling. Experiments have repeatedly shown that remodeling of cortical bone by Basic Multicellular Units (BMUs) is initiated in response to microdamage, and this has become known as “targeted remodeling”. This paper considers the possibility that microdamage is not only able to activate new BMUs, but may also attract or “steer” existing BMUs as they continue to tunnel through the bone matrix. An initial analysis of the relationship of between mean microcrack length and BMU resorption space density in cortical bone indicates that BMUs have an effective area about 40 times greater than their actual cross-section. Interpreting this as evidence that the osteoclasts in a tunneling BMU are able to sense and steer toward microdamage, a model is developed for “BMU steering” based on the hypothesis that osteoclasts are guided not only in the principal stress direction, as proposed by Burger et al. (Burger, E.H., Klein-Nulend, J., Smit, T.H. Strain-derived canalicular fluid flow regulates osteoclast activity in a remodelling osteon–a proposal. J. Biomech 36 (2003) 1453–1459), but also toward microdamage, depending on its proximity.     

A renal biopsy yields sight as well as insight.

A 34-year-old woman presented with periorbital oedema and progressivevisual loss. Periorbital oedema was first observed 2 weeks beforeadmission, particularly in the mornings. Visual loss started5 days prior to admission. The patient was born in Thailand.She had a renal disease of unknown origin in 1974 and was treatedfor malaria     

Strength of tissue bonds as a function of surface apposition

Laser assisted vascular anastomoses have potential advantages over sutured anastomoses, but the mechanism of bonding is not understood. Current theories propose that the bonding process is primarily thermal, but recent work has implicated dehydration as an important factor. Bonds created by dehydration have shown similarities to argon laser bonds, but the wide range of scatter in bond strength warranted further investigation. This was addressed through creation of in vitro tissue bonds at 55°C. Following rehydration, bond integrity was evaluated by measurement of breaking strength. A progressive series of modifications was applied to bonding technique to investigate the effect of particular parameters on breaking strength. These included use of a microtome to cut smoother tissue faces, removal of inter-surface air gaps and varying the pressure applied to the bonding surfaces. Mean bond strength remained constant except when bonding under high pressure. Scatter in bond strength about the mean was markedly reduced by improving surface intimacy through removal of inter-surface air gaps.     

急诊科护士创伤后应激障碍与职业韧性及社会支持的相关性

目的探讨三级综合性医院急诊科护士创伤后应激障碍(PTSD)与职业韧性、社会支持及应对方式的关系。方法采用整群抽样法抽取无锡及昆山市5所三级综合性医院急诊科护士,应用PTSD自评量表(PTSD-SS)、职业韧性量表、社会支持评定量表和简易应对方式测定量表,对126名护士进行横断面调查。结果急诊护士PTSD检出率23.02%,PTSD总分46.65±6.28,不同年龄、工作年限、职称、职务、是否省级专科护士、承担中班夜班数护士PTSD评分比较,差异有统计学意义(均P0.05);急诊科护士创伤后应激障碍与职业韧性各维度、社会支持各维度以及积极应对呈负相关,与消极应对呈正相关(P0.05,P0.01)。结论需重视急诊科护士PTSD的状况,通过提升急诊护士的职业韧性的水平,增加社会支持,采取积极应对方式,以降低护士的PTSD水平。     

Maternally administered esmolol decreases fetal as well as maternal heart rate

Fetal heart rate was monitored during the administration of esmolol 100 μg/kg/min to a 36-year-old, 29-week pregnant woman who was undergoing craniotomy for surgical treatment of six cerebral aneurysms. During stable general anesthesia, sodium nitroprusside was administered to induce moderate hypotension; at the same time, esmolol was infused to control maternal tachycardia. Within minutes after starting the esmolol infusion, maternal heart rate decreased from 100 beats/minute to 65 beatslminute, and fetal heart rate decreased from 160 beatslminute to 130 beatslminute. Upon termination of the infusion 3 hours later, both maternal and fetal heart rate returned to preinfusion values. No adverse effects of esmolol infusion were noted in the mother or fetus.     

CT-Based Classification Systems for Intra-Articular Calcaneal Fractures: The Inter- and Intraobserver Variations as well as Integrality

The aim of this study was to measure the inter- and intraobserver variations as well as integrality of the Zwipp, Crosby-Fitzgibbons, Sanders, and Eastwood-Atkins classification systems based on more accurate CT scans. Five hundred and forty-nine patients with intra-articular calcaneal fractures from January 2018 to December 2019 taken from a database in our level-I trauma center (3 affiliated hospitals) were included. For each case, normative CT (1 mm slices) scans were available. Four different observers reviewed all CT scans 2 times according to these 4 most prevalent fracture classification systems (FCSs) within a 2-month interval. For these 4 FCSs, the kappa [κ] coefficient was used to evaluate interobserver reliability and intraobserver reproducibility, and the percentage that can be classified was used to indicate integrality. The κ values were measured for Zwipp (κ = 0.38 interobserver, κ = 0.61 intraobserver), Crosby-Fitzgibbons (κ = 0.48 interobserver, κ = 0.79 intraobserver), Sanders (κ = 0.40 interobserver, κ = 0.57 intraobserver), and Eastwood-Atkins (κ = 0.44 interobserver, κ = 0.72 intraobserver). Furthermore, the integralities were calculated for Zwipp (100%), Crosby-Fitzgibbons (100%), Sanders (92%) as well as Eastwood-Atkins (89.6%). Compared with previous literatures, CT scanning with higher accuracy can significantly improve intraobserver reproducibility of Zwipp and Eastwood-Atkins FCSs, but it has no positive effect on variability of Sanders FCS and interobserver reliability of Crosby-Fitzgibbons FCS. In terms of integrality, Zwipp and Crosby-Fitzgibbons FCSs appear to be superior to the other 2 FCSs.     

Blow as well as pull: an innovative technique for dealing with a rectal foreign body.

Removal of a rectal foreign body (FB) has become increasingly common in the recent times. Nature of rectal FB is limited only by the imagination of the patient concerned. Many techniques have been described for removal and various theories have been put forward to explain the mechanics of the procedure. We report a case where a new technique had been employed.     

Optimal feedback gains determination method for nominal reentry guidance

This paper presents a new method for solving feedback gains in guidance based on optimal control theory. The determination of feedback gains is a critical problem for nominal guidance, because landing precision benefits from appropriate feedback gains. The magnitude of the bank angle is determined by minimizing the total error of final altitude as well as downrange requirement to the landing site. The problem is formulated as an optimal control problem by means of the Pontryagin's maximum principle, and backward integration is used to solve the problem based on homogeneous property. The proposed approach not only can avoid linearizing the nonlinear dynamic equations, but also are applicable to different guidance equations. Validation shows that the proposed approach can provide consistent results with that of Apollo. Despite employment of nominal guidance in the entire reentry of lunar mission, the proposed approach demonstrates good performance in all simulation cases while subject to significant disturbances. Copyright © 2015 John Wiley & Sons, Ltd.     

Shoulder and head elevation improves laryngoscopic view for tracheal intubation in nonobese as well as obese individuals

Study ObjectiveTo determine whether shoulder and head elevation, such that the patient's ear lies at or higher than the sternum (“ramp”), improves laryngoscopic grade in adult patients of various body mass index (BMI) values.DesignProspective, unblinded study, with patients and laryngoscopists acting as their own controls.SettingOperating room of a university-affiliated hospital.Patients189 adult ASA physical status 1, 2, and 3 patients.InterventionsAfter performing a standard preoperative airway evaluation and inducing general anesthesia, the anesthetist performed and graded two laryngoscopies: one in the “ramp” position and one in the “sniff” position.MeasurementsPatient BMI, Mallampati airway class, thyromental distance, neck circumference, cervical extension ability, Cormack and Lehane laryngoscopic grade for each laryngoscopy, subjective lifting force required, and need for external laryngeal pressure were recorded.Main ResultsUse of the “ramp” provided significantly better or equal laryngoscopic views, relative to those with the “sniff” position, in the entire study population.ConclusionsShoulder and head elevation by any means that brings the patient's sternum onto the horizontal plane of the external auditory meatus maintains or improves laryngoscopic view significantly.     

单椎棘横突钢丝盘绕复位固定植骨融合治疗腰椎滑脱

目的：探讨单椎棘横突钢丝盘绕复位固定植骨融合治疗腰椎滑脱的疗效。方法：对２９例Ⅰ度、Ⅱ度腰椎滑脱病人,采用单椎体棘横突钢丝盘绕提拉或升高腰桥使滑脱椎体复位,并在钢丝下行椎板、横突间及峡部裂隙内植骨固定。结果：随诊６～１８个月,拍片证实复位固定满意,植骨全部愈合,腰部功能恢复快,取得了相当满意的效果。     

Relationship between tonsils and IgA nephropathy as well as indications of tonsillectomy

Although there are many papers about IgA nephropathy (IgAN) and tonsils, respectively, reviews about the relationship between tonsils, tonsillitis, tonsillectomy, and IgAN are limited. In this review, we introduced the structure, development, and function of tonsils, difference of tonsils with and without IgAN, consistency of both tonsillar IgA and glomerular IgA, the effect of tonsil stimulation, tonsil infection, and tonsillectomy on IgAN showed some evidences in which tonsils were closely related to IgAN and polymeric IgA1 deposited in glomerular mesangium were at least in part of tonsillar origin. Tonsillectomy can improve the urinary findings, keep stable renal function, improve mesangial proliferation and IgA deposit, have a favorable effect on long-tern renal survival in some IgAN patients, and do not cause significant immune deficiency and do not increase incidence of the upper respiratory tract infections, and can be used as a potentially effective treatment. The indications of tonsillectomy in patients with IgAN include mainly the deterioration of urinary findings after tonsillar infection, mild or moderate renal damage. However, tonsillectomy may not be enough and may not change the prognosis in IgAN patients with marked renal damage.