脊柱侧凸病人融合术前和手术两年后背部肌肉的肌电分析

目的 脊柱融合是治疗脊柱侧凸的基本方法。脊柱的生物力学性质在融合后会发生改变,这种变化可能导致背部肌肉功能异常。本文研究脊柱侧凸患者脊柱融合手术前和手术两年后背部肌肉功能的改变。方法 采集和分析18例脊柱侧凸患者脊柱融合手术两年后背部四对肌肉的肌电信号,得到信号和平均方根值、中频值和肌电包络等参数,并和手术前进行比较。结果 手术两年后,病人肌电的幅度增加、中频值下降,同时部两侧肌电包络的对称性降低。结论 手术两年后患者背部肌肉的各项肌电参数发生的变化和废用性肌肉萎缩的特征一致,表明融合术两年后,脊柱侧凸患者的背部肌肉已经出现萎缩现象。     

Efficacy of corrective spinal orthoses on gait and energy consumption in scoliosis subjects: a literature review

Background: Adolescent idiopathic scoliosis (AIS) is a progressive growth disease that affects spinal anatomy, mobility, and left-right trunk symmetry. As a consequence, AIS can modify human gait. Spinal orthoses are a commonly used conservative method for the treatment of AIS.

Objective: This review evaluated the AIS spinal orthosis literature that involved gait and energy consumption evaluations.

Study design: Literature review.

Method: According to the population intervention comparison outcome measure methods and based on selected keywords, 10 studies met the inclusion criteria.

Results: People with AIS who wore a spinal orthosis, compared with able-bodied participants, walked slower with decreased hip and pelvic movements, decreased hip mediolateral forces, ground reaction force asymmetry, and excessive energy cost. Pelvis and hip frontal plane motion decreased when wearing an orthosis. Hip and pelvis movement symmetry improved when using an orthosis. Ankle and foot kinematics did not change with orthotic intervention. People with AIS continued to have excessive energy expenditure with an orthosis.

Conclusion: Spinal orthoses may be considered for improving the walking style, although energy cost does not decline following the orthotic intervention.

• Implications for Rehabilitations

• Problems related to scoliosis include reduced quality of life, disability, pain, postural alterations, sensory perturbations, standing instability and gait modifications.

• Wearing corrective spinal orthoses in AIS subjects produce a reduction in walking speed and cadence, increase in stride length and reduction of gait load asymmetry compared to without brace condition.

• Spinal orthoses do not decline excessive energy expenditure to walk versus without it.

     

青少年特发性脊柱侧凸患者术后麻痹性肠梗阻发生现状及影响因素分析

目的探讨青少年特发性脊柱侧凸(AIS)患者术后麻痹性肠梗阻(PI)的发生情况及影响因素,为临床护理干预措施的制订提供参考及依据。方法采用便利抽样法,于2019年1月—2020年6月选取在北京协和医院脊柱中心住院的93例AIS患者作为研究对象,收集患者一般资料、疾病及手术相关资料等,并记录术后PI发生情况。采用二项Logistic回归分析AIS患者术后PI发生的影响因素。结果41.9%(39/93)的患者发生术后PI,伴随厌食、腹胀、恶心、呕吐和腹痛的发生率分别为66.7%(26/39)、61.5%(24/39)、59.0%(23/39)、30.8%(12/39)和20.5%(8/39)。二项Logistic回归显示,直腿抬高运动(OR=3.582,P=0.023)、术后首次进食时间(OR=1.209,P=0.027)、质子泵抑制剂(OR=6.820,P=0.002)、截骨术(OR=5.516,P=0.007)是AIS患者术后PI发生的影响因素。结论AIS患者术后PI发生率较高,伴随症状主要表现为厌食、腹胀和恶心;直腿抬高运动、术后首次进食时间、质子泵抑制剂、截骨术是AIS患者术后PI发生的影响因素。     

内窥镜腰椎间盘术后椎间盘炎的原因及外科治疗

目的探讨腰椎间盘镜（MED）术后致腰椎间盘炎的原因、临床表现特点及微创外科治疗。方法2000年4月至2005年12月，1256例微创腰椎间盘摘除术致腰椎间盘炎6例，发病率0、63％。腰4、5椎间盘炎5例，腰5骶1椎间盘炎1例。所有患者均表现为术后疼痛持续加重，或临床症状缓解后再次出现腰骶部痉挛性剧痛和活动障碍。均伴有血沉（ESR）和C-反应蛋白（CRP）显著增高及MRI早期显著改变。6例腰椎间盘炎患者，2例采用非手术治疗，4例采用腹膜外小切口（3—4cm）椎间隙清创，自体髂骨植骨融合。结果平均随访时间19、7月，手术组的平均卧床时间3、2月，非手术组平均卧床时间7．5月，其腰痛缓解程度和椎间隙高度手术组优于非手术组。结论手术治疗是腰椎间盘炎的最好治疗方法。     

Investigation of multidirectional hip range of motion and hip motion asymmetry in individuals with idiopathic scoliosis with different curve patterns

BackgroundWhile some studies of the asymmetry of lower limbs in individuals with idiopathic scoliosis exist, there is a need for multidirectional studies conducted on hip joint range of motion and its relationship to curve patterns in idiopathic scoliosis.ObjectivesThis study analyzes the hip joint range of multidirectional motions, hip motion asymmetry and investigates them according to curve patterns in individuals with idiopathic scoliosis.MethodsThe sample included 108 females with idiopathic scoliosis. Participants were divided into three groups: double curves, single thoracic curve and single lumbar curve. The range of hip flexion and extension, abduction and adduction, and internal and external rotations were assessed actively and passively with a universal goniometer. The range of motion, left–right asymmetry and the mid-points of the ranges of motion were analyzed.ResultsThe passive range of the right hip abduction was higher in the thoracic curve group vs. the lumbar curve group. Active and passive ranges of hip extension were higher in the left hip vs. right hip. Active left–right asymmetry was higher than passive left–right asymmetry.ConclusionIndividuals with idiopathic scoliosis had different hip abduction motions according to curve pattern that originated from single curves. Left–right hip asymmetry was seen for the hip extension motion. Higher left–right asymmetry for active motion than passive motion in hip abduction may indicate a problem in motion perception in individuals with idiopathic scoliosis.     

Intonation patterns in older children with cerebral palsy before and after speech intervention

Purpose: This paper examined the production of intonation patterns in children with developmental dysarthria associated with cerebral palsy (CP) prior to and after speech intervention focussing on respiration and phonation. The study further sought to establish whether intonation performance might be related to changes in speech intelligibility.

Method: Intonation patterns were examined using connected speech samples of 15 older children with moderate to severe developmental dysarthria due to CP (9 females; age range: 11–18). Recordings were made prior to and after speech intervention based on a systems approach. Analyses are focussed on the use of intonation patterns, pitch accentuation and phrasing.

Result: Group analyses showed a significant increase in the use of rising intonation patterns after intervention. There were also some indications that this increase might have been related to gains in speech intelligibility for some of the children. No changes were observed regarding pitch accentuation and phrasing following intervention.

Conclusion: The findings highlight that changes can occur in the use of intonation patterns in children with dysarthria and CP following speech systems intervention. It is hypothesised that the emergence of the rising pattern in some of the children’s intonational inventories possibly reflected improved breath support and control of laryngeal muscles.     

食管癌病人手术前后生存质量调查

[目的 ]了解食管癌病人手术前后的生存质量状况 ,为护理干预提供依据。 [方法 ]应用《癌症疼痛及生存质量调查表》对 65例食管癌病人分别于术前、术后 1周、术后 3个月进行测评。 [结果 ]食管癌病人手术后生存质量明显下降 (P <0 .0 1) ,术后 3个月恢复到接近手术前水平。 [结论 ]针对病人不同病期给予心理支持、健康教育、舒适护理及康复指导等干预措施 ,可提高病人生存质量。     

活动性肺结核患者抗痨治疗前后PPD试验结果的分析

目的研究PPD试验结果强阳性作为潜伏性结核诊断指标的可行性。 方法选取2018年1月至8月在泰兴市人民医院住院，痰涂片抗酸杆菌（+）且PPD试验强阳性的继发性肺结核患者15例作为研究对象。抗痨治疗前行PPD试验检查，并记录其结果；抗痨满疗程，且临床判断肺结核治愈，在停药前再次行PPD试验，并记录结果，与抗痨前进行比较。 结果15例痰涂片阳性，且PPD试验强阳性肺结核患者抗痨治疗前PPD平均直径为22.35 mm。抗痨治疗满疗程，且临床判断治愈，停药前PPD试验结果，15例均为强阳性，平均直径为25.46 mm。 结论PPD试验强阳性通常见于活动性结核患者，本研究提示PPD试验强阳性也可发生于已治愈稳定的肺结核人群。故根据PPD试验强阳性诊断潜伏性结核感染推广预防性抗痨治疗需慎重。     

三维斑点追踪成像技术评价房间隔缺损患者封堵前后左心室整体应变

目的 探讨三维斑点追踪成像（3D-STI）技术定量评价房间隔缺损（ASD）患者封堵前后左心室整体应变。方法 选取介入封堵成功的继发孔型ASD患者35例,分别于术前、术后2天和1、3、6个月接受常规超声心动图检查及3D-STI检查。常规超声心动图检查获取左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVEDS）、左心室舒张末期容积（LVEDV）,左心室收缩末期容积（LVESV）、每搏量（SV）。采用3D-STI检查获取左心室整体纵向峰值应变（GPLS）、左心室整体圆周峰值应变（GPCS）、左心室整体径向峰值应变（GPRS）和左心室整体面积峰值应变（GPAS）。对术前与术后各时间点参数行统计学分析。结果 常规超声心动图检查示ASD患者术后各时间点LVEDD、LVEDS、LVEDV、LVESV、SV较术前增加（P均<0.05）,但术后2天、1、3、6个月间两两比较,差异无统计学意义（P>0.05）。3D-STI检查结果示ASD患者术后各时间点左心室GPLS、GPCS、GPRS、GPAS较术前增加（P均< 0.05）,且以术后2天增加最为明显,术后6个月GPLS、GPCS、GPAS较术后3个月增加（P均< 0.05）。结论 3D-STI技术可全面、准确地评价ASD患者封堵前后左心室心肌应变,较常规超声心动图可更客观、有效地评价术后左心室收缩功能变化。     

Three-dimensional color Doppler sonography and uterine artery arteriography of fibroids: assessment of changes in vascularity before and after embolization.

OBJECTIVE: To assess the accuracy of three-dimensional color Doppler sonography and uterine artery arteriography in depicting changes in fibroid vascularity before and after embolization. METHODS: Preembolization and postembolization three-dimensional color Doppler sonography and selective uterine artery arteriography were retrospectively compared in 15 patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Three-dimensional color Doppler sonography was performed by using a scanner with color power angiographic imaging capability. Vascularity was quantified by using an estimation of power-weighted pixel density as described by our group in previously published studies. Uterine artery arteriography was performed by using a standard selective microcatheter embolization technique. For purposes of comparison, fibroids were classified as either hypervascular or hypovascular relative to myometrial vascularity before and minutes to several hours after uterine artery embolization. Changes in fibroid vascularity (i.e., from hypervascular to hypovascular) as depicted by three-dimensional color Doppler sonography were compared with those shown on uterine artery arteriography and classified as being in agreement or disagreement. RESULTS: In 13 (87%) of 15 patients there was agreement; in 2 (13%) of 15 there was disagreement. In both cases of disagreement, three-dimensional color Doppler sonography showed collateral flow not depicted by uterine artery arteriography The mean reduction in quantitated vascularity after uterine artery embolization was 44% (range, 19%-78%). CONCLUSIONS: Three-dimensional color Doppler sonography accurately depicts fibroid vascularity and in some cases can reveal collateral flow not depicted by uterine artery arteriography.     

Work-related limitations and return-to-work experiences in prolonged fatigue: workers' perspectives before and after vocational treatment

Purpose.?To gain insight into fatigued workers' perspectives regarding work experience before and after receiving vocational rehabilitation (VR) treatments.

Method.?A qualitative survey was conducted using semi-structured interviews with 21 fatigued workers who attended an outpatient multi-component VR treatment. Six months after treatment, work-related limitations and employed VR strategies at work before treatment were explored. Next, VR treatment experiences regarding return-to-work (RTW) were explored. Two researchers performed partially independent, qualitative analyses that revealed topics, discussed by the project team, and organised into domains, categories and sub-categories.

Results.?Work-related limitations were: symptoms of prolonged fatigue, personal limitations (e.g. lack of self-reflection on individual capacity and limitations), interpersonal factors, activities and conditions at work and life/work imbalance. Before the treatment, VR strategies such as work adaptations, well-intentioned advice and support, and/or referral to psychological or physical care were employed. VR treatment experiences on RTW were: personal challenges (e.g. gained awareness and coping skills), improved activities during work, work adaptations and unresolved problems (e.g. remaining fatigue symptoms and sickness absence).

Conclusions.?New information about work experiences before and after multi-component VR treatments in workers with prolonged fatigue may help employers, occupational physicians and other caregivers to develop VR strategies that better meet individuals' needs.     

子宫内膜异位症患者药物保守治疗前后血清C反应蛋白水平比较研究

目的通过检测子宫内膜异位症患者(EMs)在药物保守治疗前后的血清超敏C反应蛋白(hsCRP)含量的变化,探讨子宫内膜异位症药物治疗的效果。方法检测Ems患者药物治疗前的血清hsCRP水平,半年后根据治疗转归结果的不同分为有效组(42例)、无效组(32例),并查hsCRP进行比较分析。结果治疗前,2组患者血清hsCRP水平均高于健康对照组(P<0.01),2组组间比较无明显差异。半年后2组hsCRP水平均下降,但仍高于健康对照组(P<0.01);与无效组比较,有效组下降较为明显(P<0.01)。结论 EMs患者存在慢性无菌性炎症状态,其hsCRP水平与病情严重程度呈正相关,hsCRP可作为判断其病情的一个生物学指标,内科药物保守治疗可缓解EMs患者症状,抑制炎症反应,但难以完全治愈。     

7例食管癌肉瘤的诊治分析

目的：探讨食管癌肉瘤的病理特征、临床特点和治疗方法。方法：对7例食管癌肉瘤患者的临床表现、术前影像学、内窥镜资料、外科治疗结果进行回顾性分析。结果：食管癌肉瘤患者的主要临床症状为逐渐加重的下咽不顺，平均病程4．1个月。好发于食管中段。多为息肉样腔内生长，有短蒂和食管壁相连，个别呈浸润生长。全组7例均行食管部分切除，无手术死亡及并发症。光镜下癌和肉瘤两种成分共存，腔内型者瘤体多以内瘤成分为主，癌多局限于蒂的基底部粘膜。全组术后随访6例，均健在。结论：食管癌肉瘤是一种侵袭性差，淋巴结转移率低，预后较好的肿瘤。手术切除是其主要的治疗方法。     

呼吸道真菌感染诊疗控制的科研前后比较分析

目的把握相关科研对于呼吸道真菌感染诊疗控制实际的客观作用，发现存在的问题，提出持续改进建议。方法将研究结论基本上尚未通报全院之前的1996～2001年定为“研前”时段，将研究结论陆续通报全院之后的2002～2006年定为“研后”时段，并对2个时段中出院时确诊有呼吸道真菌感染的全部住院患者的病历资料进行统计和分析。结果科研前、后的呼吸道真菌感染患病率分别为0．737％和0．687％，下降6．78％，x^2=1．39，P〉0．2；病死率分别为23．92％和17．39％，下降27．30％，x^2=7．81，P〈0．01。抗生素（不含抗真菌药物）使用率分别为100％和99．7％，其中单联分别为22．2％和12．9％，双联分别为63．6％和76．9％，三联或超过三联分别为14．3％和9．9％；皮质激素或／和免疫抑制药物使用率分别为29．7％和24．3％。其升降交错，总体差别不大。入院前真菌感染患者分别占36．91％和44．31％，上升20．05％，x^2=6．38，P〈0．02。结论呼吸道真菌感染病原学诊断标准和易患因素研究促进了医院真菌感染诊疗控制水平的明显提高。降低真菌感染患病率，必须进一步切实规范抗生素（包括抗真菌药物）或／和免疫抑制药物的合理使用。     

Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section

Background The effects of colloid loading after spinal anesthesia on hemodynamics in parturients during cesarean section have not been fully understood. This study tested the hypothesis that colloid loading after spinal blockade can reduce hypotension compared with preloading, and affect neonatal outcomes. Methods A prospective, randomized, double-blinded study was performed in 54 healthy parturients (ASA I or II) undergoing elective cesarean section. Patients were randomly allocated into one of three groups to receive rapid infusion of 6% hydroxyethylstarch (HES) (70 kDa/0.5) before spinal anesthesia (15 ml·kg⁻¹, HES preload group, n = 18), or rapid infusion of HES after induction of spinal anesthesia (15 ml·kg⁻¹, HES coload group, n = 18), or no rapid infusion (control, n = 18). The incidence of hypotension, and the amount of ephedrine used to treat hypotension was compared. Neonatal outcomes were also assessed by pH, base excess, lactate concentration, and Apgar scores. Results The incidence of hypotension was significantly lower in HES preload and HES coload groups than control group (P < 0.01). Although systolic blood pressure decreased after spinal blockade in all groups, the lowest SBP after spinal blockade until delivery was significantly higher in fluid loading groups than control (P < 0.001). Similarly, total dose of ephedrine to treat hypotension was lower in fluid loading groups (P < 0.001). Umbilical cord pH, umbilical lactate concentration, and the incidence of neonates with Apgar score <7 were similar. Conclusion Colloid loading after induction of spinal anesthesia was similarly effective in reducing hypo- tension compared with preloading in cesarean section. Nishikawa K, Yokoyama N, Saito S, Goto F. Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section. A part of the present study was presented at the Annual Meeting of the American Society of Anesthesiologists, October 23–27, 2004 in Las Vegas, Nevada, USA.     

原发性肝癌高强度聚焦超声治疗前后中医证型变化的研究

目的探讨原发性肝癌患者高强度聚焦超声治疗前后中医证型变化的规律及高强度聚焦超声治疗对中医证型的影响。方法对64例原发性肝癌患者行高强度聚焦超声治疗前后进行中医证候分型,常见有气虚、血虚、阴虚、气滞、血瘀、湿阻等证型。按治疗前2d、治疗后3d、治疗后1周3个时间段进行统计分析。结果气滞证和血瘀证在高强度聚焦超声治疗3d及治疗后1周与治疗前比较,差异有统计学意义(P<0.01);气虚证在高强度聚焦超声治疗后3d及治疗后1周与治疗前比较,差异有统计学意义(P<0.05);阴虚证在治疗后1周与治疗前及治疗后3d比较,差异均有统计学意义(P<0.05)。结论高强度聚焦超声治疗可有效改善原发性肝癌患者气滞证和血瘀证,但可能加重气虚证和阴虚证,故其无法改变原发性肝癌本虚标实的基本病理特点。     

肾细胞癌根治术后脑转移的治疗：8例报告并文献回顾

目的分析肾细胞癌根治性切除术后脑转移的临床特点、治疗方式及预后,探讨局部切除的作用及预后影响因素。 方法回顾性分析2005年3月至2019年5月北京大学第一医院神经外科收治的肾细胞癌脑转移患者的临床资料。对患者进行随访,并绘制生存曲线。 结果8例肾细胞癌脑转移患者,男性5例,女性3例,年龄42~70岁,中位年龄63岁。脑转移发生距肾癌根治时间7~103个月,中位时间41个月。8例患者共行9次手术,切除10个颅内转移灶。随访时间为38~204个月,中位随访时间为95个月。8例患者中死亡3例,生存5例。脑转移手术后总生存时间为6~86个月,中位生存时间23个月。 结论肾癌脑转移患者的预后较差,手术局部切除结合放疗能够达到满意的局部控制,并延长患者生存期。     

后路一期全脊椎切除并脊柱重建术中高发风险因素分析及护理对策

总结和分析了13例脊柱恶性肿瘤患者行后路一期全脊椎切除并钛网植骨、椎弓根钉系统重建脊柱手术的术中高发风险因素和护理配合要点.术中容易引起脊髓神经损伤、椎旁静脉丛破裂大出血、肿瘤细胞局部播散种植等风险,采取的护理配合措施包括改良手术器械、联合诱发电位监护脊髓功能、控制性降压、严格无瘤技术操作等.本组手术过程顺利,未发生医源性脊髓损伤和重要血管、脏器损伤等并发症.术后随访3～13个月,近期疗效满意,未发现肿瘤局部复发.     

非霍奇金淋巴瘤患者行外周血单个核细胞采集前后血细胞的变化及影响因素分析

目的 探索拟行CAR-T治疗的非霍奇金淋巴瘤患者以及健康供者使用血细胞分离机采集单个核细胞后血细胞的变化,探讨影响终产品单个核细胞数量的因素以更好的提高采集效率.方法 使用COM.TEC血细胞分离机采集23例非霍奇金淋巴瘤患者以及22例健康供者的单个核细胞,分别于采集前,采集后即刻抽取血样,检测红细胞(RBC)、白细胞...     

重症急性胰腺炎患者早期或晚期手术时外周血有核细胞Toll样受体表达差异及意义

目的　探讨重症急性胰腺炎患者早期或晚期手术时外周血单核细胞Toll样受体 2、 4mRNA的表达差异 ,及其与患者并发症发生率和预后的相关性。方法　随机选取重症急性胰腺炎患者 2 9例 ,分成早期或晚期手术组 ,于手术后第 5天分离外周血有核细胞 ,利用逆转录聚合酶联反应 (RT PCR)法检测TLR2、TLR4基因的变化 ,同时测量血浆内毒素水平的变化 ,并与并发症发生率和病死率的差别作相关性分析。结果　早期手术组与晚期组的病死率分别为 2 5 % (3/12 )和 5 % (1/17) ,χ2 =15 2 1,P <0 0 1;并发症发生率分别为 10 0 %和 35 % ,χ2 =5 34,P <0 0 5 ;TLR2mRNA的表达水平分别为 (119 82± 11 13)和(75 15± 6 34) (t =12 5 4 ,P <0 0 1) ;TLR4mRNA的表达水平为 (98 11± 5 16 )和 (6 5 5 4± 5 11) ,t =16 83,P <0 0 1;两组间内毒素水平分别为 (1 16± 0 10 )pg/L和 (1 0 9± 0 0 8)pg L ,t =1 83,P >0 0 5。结论　与晚期手术者比较 ,早期手术者外周血白细胞TLR4及TLR2mRNA表达水平增加 ,术后病死率和并发症发生率增加 ,说明早期手术可能通过再次炎症反应打击而加重了系统性器官损伤