全关节镜下改良Broström术治疗慢性踝关节外侧不稳的临床疗效观察

目的 探讨全关节镜下改良Broström术治疗慢性踝关节外侧不稳的临床疗效。方法 回顾性研究。纳入2016年1月—2018年6月徐州市中心医院慢性踝关节外侧不稳患者33例(33侧),其中男20例、女13例,年龄16～55(30.3±5.7)岁;右侧22例,左侧11例。病程12~48(25.6±14.2)个月。受伤原因:扭伤28例,车祸伤5例。所有患者进行全关节镜下的改良Broström手术。术后定期随访,观察患者伤口愈合情况,并发症发生情况,观察踝关节活动情况,踝关节内翻应力试验、踝关节前抽屉试验检查踝关节稳定情况及步态。术后12个月采用疼痛视觉模拟评分法(VAS)评价踝关节疼痛情况,采用美国足踝外科协会(AOFAS)踝与后足评分和Karlsson 踝关节功能评分(KAFS)评价踝关节功能。对比患者手术前与术后12个月VAS、AOFAS、KAFS评分改善情况。结果 33例患者均顺利完成手术,手术时间35～80(50.3±12.6)min。术后患者切口均一期愈合,未出现伤口感染、神经损伤、血管损伤、肌腱损伤等并发症。33例患者均获得随访,随访时间12～40(25.0±10.7)个月。末次随访时,患者均无置入物排斥反应或线结反应;踝关节疼痛完全消失,关节活动度良好;踝关节内翻应力试验、踝关节前抽屉试验均阴性,未出现踝关节外侧不稳定,患者均恢复正常步态。术后12个月依据AOFAS评分标准,踝关节功能优27例、良6例;依据KAFS评分标准,踝关节功能优28例、良5例。术后12个月VAS评分由术前(6.02±1.93)分降低到(1.33±0.16)分,AOFAS评分由术前(61.75±13.08)分提高到(92.37±4.15)分,KAFS评分由术前(64.46±10.81)分提高到(93.19±5.58)分,差异均有统计学意义(t=12.765, -13.303, -12.346, P值均＜0.05)。结论 全关节镜下改良Broström术,手术创伤小,是一种治疗慢性踝关节外侧不稳的有效方法。     

腹主动脉瘤开放手术和腔内手术治疗的近期疗效分析

目的 对比分析腹主动脉瘤开放手术(OSR)与腔内修复手术(EVAR)的近期疗效。方法 回顾性研究。纳入2008年1月—2020年12月蚌埠医学院第一附属医院血管外科接受手术治疗的腹主动脉瘤患者118例,其中男102例、女16例,年龄(70.5±9.6)岁。根据手术治疗方式的不同,分为OSR组23例和EVAR组95例。观察指标:(1)比较两组患者的年龄、性别、不良生活习惯、合并症、瘤体最大径、复杂瘤颈形态等基线资料。(2)比较两组患者手术时间、术中出血量、术后禁饮食时间、术后卧床时间、住院时间,以及术后并发症和死亡发生情况。(3)术后定期复查CT血管成像(CTA),观察有无再干预、支架内血栓形成、支架内再狭窄、移植物感染、各型内漏等发生。结果 OSR组和EVAR组的基线资料比较差异均无统计学意义(P值均＞0.05)。患者均顺利完成手术。EVAR组的手术时间、术中出血量、术后禁饮食时间、术后卧床时间、住院时间均少于OSR组,分别为(141.15±22.97) min与(242.79±29.41) min、(34.32±16.08) mL与(443.93±109.58)mL、(14.26±3.34) h与(52.25±12.05)h、(4.07±0.63) d与(6.48±0.83)d、(21.88±1.78) d与(24.44±2.44)d,差异均有统计学意义(t=17.919、17.881、14.978、15.532、4.745,P值均＜0.05);两组患者围手术期并发症发生率及死亡率比较,差异均无统计学意义(P值均＞0.05)。患者均获随访1年,除EVAR组2例出现轻微Ⅱ型内漏外,均无严重并发症发生。结论 腹主动脉瘤的OSR和EVAR均能取得良好的近期治疗效果。与OSR相比较,EVAR手术时间更短,术中出血更少,术后禁饮食、卧床及住院时间更短,术后恢复更快。     

A systematic review of asymptomatic infections with COVID-19

Since the outbreak of coronavirus disease 2019 (COVID-19) in late December 2019, it has brought significant harm and challenges to over 200 countries and regions around the world. However, there is increasing evidence that many patients with COVID-19 are asymptomatic or have only mild symptoms, but they are able to transmit the virus to others. There are difficulties in screening for asymptomatic infections, which makes it more difficult for national prevention and control of this epidemic. This article reviews the characteristics, treatment, and outcomes of asymptomatic infections with COVID-19, hoping it would be helpful for early prevention and control of this severe public health threat worldwide.     

一例结节性硬化症家系的 TSC基因变异分析及产前诊断

目的:分析1个结节性硬化症(tuberous sclerosis complex,TSC)家系 TSC1和 TSC2基因变异位点并进行产前诊断。 方法:应用Sanger测序法分别对先证者及其家庭成员进行 TSC1和 TSC2基因变异检测分析。 结果:家...     

认知扭曲问卷中文版测评抑郁症患者的效度和信度

目的:探讨认知扭曲问卷(CDQ)中文版在抑郁症人群中的效度和信度。方法:选取抑郁症患者347例,其中145例(样本1)用于条目分析与探索性因子分析,202例(样本2)用于验证性因子分析;对所有样本进行信度分析,功能失调性态度量表(DAS)、负性自动思维问卷(ATQ)、贝克抑郁量表-Ⅱ(BDI-Ⅱ)、贝克焦虑量表(BAI)测评用以检验效标效度。选取样本1中48人间隔2周重测。结果:条目与总分相关均有统计学意义(均P<0.001);探索性因子分析获得3个公因子,累积贡献率为50.84%;三因子模型优于单因子模型(IFI=0.93,TLI=0.91,CFI=0.93,FMIN=0.76,RMSEA=0.06);CDQ总分与DAS、ATQ、BDI-Ⅱ、BAI总分均正相关(r=0.51、0.64、0.62、0.39,均P<0.01)。总量表的Cronbachα系数为0.85,3个因子的α分别为0.84、0.62、0.58;总量表重测相关系数(ICC)为0.85,3个因子的ICC分别为0.83、0.86、0.92。结论:认知扭曲问卷(CDQ)中文版测评抑郁症人群具有良好的效度和信度。     

The leptospiral major outer membrane protein LipL32 is a lipoprotein expressed during mammalian infection

We report the cloning of the gene encoding the 32-kDa lipoprotein, designated LipL32, the most prominent protein in the leptospiral protein profile. We obtained the N-terminal amino acid sequence of a staphylococcal V8 proteolytic-digest fragment to design an oligonucleotide probe. A Lambda-Zap II library containing EcoRI fragments of Leptospira kirschneri DNA was screened, and a 5.0-kb DNA fragment which contained the entire structural lipL32 gene was identified. Several lines of evidence indicate that LipL32 is lipid modified in a manner similar to that of other procaryotic lipoproteins. The deduced amino acid sequence of LipL32 would encode a 272-amino-acid polypeptide with a 19-amino-acid signal peptide, followed by a lipoprotein signal peptidase cleavage site. LipL32 is intrinsically labeled during incubation of L. kirschneri in media containing [(3)H]palmitate. The linkage of palmitate and the amino-terminal cysteine of LipL32 is acid labile. LipL32 is completely solubilized by Triton X-114 extraction of L. kirschneri; phase separation results in partitioning of LipL32 exclusively into the hydrophobic, detergent phase, indicating that it is a component of the leptospiral outer membrane. CaCl(2) (20 mM) must be present during phase separation for recovery of LipL32. LipL32 is expressed not only during cultivation but also during mammalian infection. Immunohistochemistry demonstrated intense LipL32 reactivity with L. kirschneri infecting proximal tubules of hamster kidneys. LipL32 is also a prominent immunogen during human leptospirosis. The sequence and expression of LipL32 is highly conserved among pathogenic Leptospira species. These findings indicate that LipL32 may be important in the pathogenesis, diagnosis, and prevention of leptospirosis.     

The effect of systematic variation in retrospective conduct disorder reports on antisocial personality disorder diagnoses

A diagnosis of antisocial personality disorder (ASPD) requires a conduct disorder (CD) diagnosis. A CD diagnosis is often obtained retrospectively. This study tested the influence of current behavior on CD recall and the association between recent behavior change and inconsistencies in contemporaneous and retrospective CD reports. Five hundred young adults reported ASPD; retrospective CD; current problem behavior; and, at ages 12 to 15 years, contemporaneous CD. True-positive, true-negative, false-positive, and false-negative CD and ASPD groups were identified. The results supported the hypotheses. Participants whose current behavior agreed with past behavior provided reliable retrospective CD reports. Inaccurate diagnoses occurred among participants whose current behavior was inconsistent with past behavior, either becoming more problematic (CD and ASPD false positives) or less problematic (CD and ASPD false negatives) over time.     

Comprehensive Assessment of Current Management Strategies for Patients With Diabetes and Chronic Limb-Threatening Ischemia

Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease. It is estimated that 60% of all nontraumatic lower-extremity amputations performed annually in the United States are in patients with diabetes and CLTI. The consequences of this condition are extraordinary, with substantial patient morbidity and mortality and high socioeconomic costs. Strategies that optimize the success of arterial revascularization in this unique patient population can have a substantial public health impact and improve patient outcomes. This article provides an up-to-date comprehensive assessment of management strategies for patients afflicted by both diabetes and CLTI.

More than 30 million Americans have diabetes and are presumably at higher risk of developing peripheral arterial disease (PAD) (1,2). Advanced PAD can manifest as chronic limb-threatening ischemia (CLTI), which is defined as limb pain at rest and/or the presence of ischemic ulceration or gangrene (3,4). CLTI affects ∼2 million Americans >40 years of age and is associated with higher risk of limb loss due to above-ankle (major) amputations (5–10). It is estimated that 60% of all nontraumatic lower-extremity amputations performed annually in the United States are in patients with diabetes and CLTI (11,12). These procedures are associated with substantial morbidity, considerable mortality, and high socioeconomic costs.On a per-patient basis, the cost of treating CLTI in patients with diabetes is higher than the treatment of both coronary artery disease (CAD) and cerebrovascular disease (13–15). These increased costs are likely the result of higher rates of hospital admissions, procedures, and complications. CLTI and its significant financial burdens are anticipated to increase as the preva-lence of diabetes continues to increase globally from 450 million living with diabetes in 2017 to an estimated 700 million by 2045 (16).Accordingly, strategies that optimize successful revascularization in patients with diabetes and CLTI can have a substantial public health impact and improve patient outcomes. Here, we review the medical and modern surgical management strategies for patients with diabetes and CLTI. We specifically reviewed studies with cohorts that were at least 50% patients with diabetes or CLTI, had subanalyses relevant for patients with diabetes or CLTI, and reported standard clinical outcomes relevant to patients with severe PAD.     

股深动脉第1穿动脉穿支皮瓣修复臀股部IV期压疮疗效

目的　探讨应用股深动脉第1穿动脉穿支皮瓣修复臀股部IV期压疮的可行性。 方法　2016年1月至2019年2月,本院手足创伤骨科收治9例臀股部IV期压疮患者,男3例,女6例,年龄26~68岁,平均46岁。截瘫原因：高处坠落伤4例,车祸伤3例,脑梗塞2例。清创后创面面积8 cm×5 cm~18 cm×9 cm。根据创面形状、大小及位置设计股深动脉第1穿动脉穿支皮瓣修复压疮创面,皮瓣面积为10 cm×7 cm~20 cm×10 cm。 结果　所有皮瓣成活,其中2例术后局部渗液较多,经积极保守换药治疗后,皮瓣恢复良好。9例获得6~24月随访,平均13月,皮瓣色泽良好,质地柔软,不影响日常生活,压疮未见复发。 结论　股深动脉第1穿动脉穿支皮瓣操作简便,血供可靠,可供组织量较多,是修复臀股部IV期压疮的较好选择。