肿瘤介入病房护理风险预案的制定及实施效果评价

目的 探讨护理风险预案的制定与实施在肿瘤介入病房中的作用.方法 总结肿瘤介入病房2008年3月至2009年12月的临床管理经验,结合文献资料分析,制定适合肿瘤介入病房的护理风险预案并实施,并比较实施前后护理质量综合考评、患者满意度、不良事件发生率,评价实施效果.结果 护理风险预案实施后,肿瘤介入病房护理质量综合考评在全院55个护理单元排名从(28.3±3.0)名上升至(5.9±1.2)名;患者满意率从(93.2±1.0)％上升至(98.5±0.4)％;不良事件发生率下降.结论 制定与实施护理风险预案,是肿瘤介入病房安全规范化管理的有效方法.     

Arthroscopic findings in the recurrent anterior instability of the shoulder

Background

A recurrent anterior shoulder dislocation consists of a variety of lesion types.

Objectives

To evaluate the pathological classification of recurrent anterior dislocation of the shoulder joint under arthroscopy.

Methods

Thirty-one patients with recurrent anterior shoulder dislocation were inspected by arthroscopy, including 23 males and 8 females, with a mean age of 35.1 (18–46) years. The patients were divided into two groups: 17 with shoulder dislocation and hyper-laxity (the hyper-laxity group) and 14 with only traumatic shoulder dislocation (the trauma group). All the patients were assessed by arthroscopy for pathological changes, and the differences in the pathological changes were compared between the two groups.

Results

All these 31 patients suffered from anteroinferior labrum injury. Twenty-five had Hill–Sachs injury; 27, bone or cartilage injury of anteroinferior glenoid; 16, SLAP injury; and 5, rotator cuff injury. Bankart injury occurred more in the trauma group, and anterior labroligamentous periosteal sleeve avulsion injury and glenolabral articular disruption injury were more in the hyper-laxity group. Bone or cartilage injury of anteroinferior glenoid was more noticed in the trauma group.

Conclusions

Significant differences are found under arthroscopy in the pathological changes of recurrent anterior shoulder dislocation between the purely traumatic group and the hyper-laxity group. The pathological changes in the trauma group were more severe than in the hyper-laxity group.     

新型冠状病毒肺炎疫情期间骨科急症处理原则的专家共识

自2019年12月以来,湖北省武汉市部分医院相继收治多个有华南海鲜市场暴露史的不明原因肺炎病例[1]。患者症状多为发热、乏力、干咳并逐渐出现呼吸困难,部分重症患者出现了急性呼吸窘迫综合征或脓毒症休克、甚至病死。2020年1月7日,我国研究人员首次从患者标本中检测出一种新型冠状病毒[2]。2020年1月20日,中华人民共和国国家卫生健康委员会发布2020年1号公告,将新型冠状病毒感染的肺炎纳入乙类传染病,并按照甲类传染病进行防疫、控制[3]。世界卫生组织将新型冠状病毒肺炎命名为"COVID-19"[4]。     

基于VIBE-Dixon技术的女性腰椎脂肪测量及其与骨密度的相关性

目的应用磁共振脂肪定量技术评估女性腰椎骨质疏松程度与骨密度(BMD)的相关性。方法将121名健康女性研究对象按年龄分为21～30岁组(n=17)、31～40岁组(n=11)、41～50岁组(n=24)、51～60岁组(n=63)、61～70岁组(n=6)。以DXA测量L_1-L_4椎体骨密度,以VIBE-Dixon技术测量L1-L4椎体骨髓脂肪分数。比较不同组间骨髓脂肪分数差异,同时分别对骨髓脂肪分数与BMD、年龄进行相关性分析。另外,分别对BMD、骨髓脂肪分数与绝经年限做相关性分析。结果组间差异有统计学意义(F值:14.541,P0.001)。骨髓脂肪分数与年龄之间存在相关性(r=0.659,P0.001);骨密度随脂肪分数上升呈下降趋势;随绝经年限的延长,BMD呈下降趋势,骨髓脂肪分数呈上升趋势。结论 VIBE-Dixon能定量测量妇女腰椎椎体脂肪含量,可间接评估骨质疏松程度;与DXA的结果具有相关性。     

Duodenal perforations after endoscopic retrograde cholangiopancreatography: experience and management

Abstract Objective: The aim of this study was to summary the experiences and lessons from periduodenal perforations related to endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). Methods: A retrospective review from 2004 to 2007 identified 9 patients (0.37%) of periduodenal perforation related to ERCP/EST. Charts were reviewed for the following parameters: clinical presentation of patients, ERCP findings, diagnostic methods, treatment (surgical or conservative procedures), complications, and outcome. Results: Nine patients who had periampullary perforations received ERCP/EST for common bile duct stones. Cannulation was considered difficult in 7 of 9 patients, and the precut technique was used. The diagnosis was made due to subcutaneous emphysema or peritonitis, and 3 patients received emergent operations (e.g., external biliary or retroperitoneal drainage), and 1 patient had a reoperation for a retroperitoneal sealed abscess. Their median length of hospital stay was 50 days. The other 6 were treated conservatively with nasal-duodenal and nasal-biliary drainage. Their median length of hospital stay was 13 days. There was no mortality. Conclusions: The precut technical may be a risk factor of duodenal perforation. Early diagnosis of duodenal perforation is essential for an optimum outcome, and subcutaneous emphysema may be a sensitive sign. Although the management of perforation after ERCP/EST is still controversial, a selective management is proposed, based on the features of classification type. Nevertheless, duodenal and biliary drainage is essential in both surgical and conservative therapy.     

川东北地区缓解期精神分裂症患者社会支持现状及影响因素

目的 调查川东北地区缓解期精神分裂症患者社会支持现状及影响因素,为改善其社会支持提供思路。方法选取2020年5月-9月在广元市、巴中市、达州市精神疾病防治机构就诊的符合《国际疾病分类（第10版）》（ICD-10）缓解期精神分裂症诊断标准的患者533例为调查对象,采用自编人口学及临床资料调查表和社会支持评定量表（SSRS）进行评定。分析缓解期精神分裂症患者社会支持现状及影响因素,特别分析医保二次报销对其社会支持度的影响。结果 (1)缓解期精神分裂症患者SSRS总评分及客观支持、主观支持、对支持的利用度评分均低于国内常模（t=5.065～30.382,P均<0.01）;(2)单因素分析显示,女性（t=-3.632）、退休（F=5.951）、已婚（F=5.951）、主要照料者为配偶（F=23.841）、家庭年收入>5 000元（F=15.892）、有经济收入（t=4.083）、门诊或互联网医院复诊（F=3.954）的患者,SSRS总评分更高（P<0.05或0.01）;(3)医保二次报销组SSRS总评分及各维度评分均高于非医保二次报销组（t=10.195～25.103,P均&...     

胃癌神经侵犯与预后的相关性分析

目的探讨胃癌神经侵犯(Perineural invasion PNI)与胃癌预后的相关性。方法回顾性分析328例胃癌根治术后患者的临床病理资料(根据2002年日本肿瘤协会公布的JGC-TNM分期标准),研究神经侵犯与胃癌临床病理参数的关系及其对胃癌预后的意义。结果χ2检验结果显示:胃癌神经侵犯与浸润深度、TNM分期及淋巴结转移均显著相关(P<0.05)。单因素分析显示:PNI(+)组患者的中位生存时间及5年生存率明显低于PNI(-)组患者(P=0.018),与胃癌患者预后密切相关。多因素COX回归分析显示神经侵犯不是影响胃癌术后患者生存的独立预后因素(P=0.238)。结论胃癌神经侵犯与胃癌患者预后有关,并提示预后不良,但不能作为判断胃癌患者预后的独立指标。     

T1 and T2 relaxivity of intracellular and extracellular USPIO at 1.5T and 3T clinical MR scanning

In this study we evaluated the effects of intracellular compartmentalization of the ultrasmall superparamagnetic iron oxide (USPIO) ferumoxtran-10 on its proton T1 and T2 relaxivities at 1.5 and 3T. Monocytes were labeled with ferumoxtran-10 by simple incubation. Decreasing quantities of ferumoxtran-10-labeled cells (2.5×10⁷-0.3×10⁷ cells/ml) and decreasing concentrations of free ferumoxtran-10 (without cells) in Ficoll solution were evaluated with 1.5 and 3T clinical magnetic resonance (MR) scanners. Pulse sequences comprised axial spin echo (SE) sequences with multiple TRs and fixed TE and SE sequences with fixed TR and increasing TEs. Signal intensity measurements were used to calculate T1 and T2 relaxation times of all samples, assuming a monoexponential signal decay. The iron content in all samples was determined by inductively coupled plasma atomic emission spectrometry and used for calculating relaxivities. Measurements at 1.5T and 3T showed higher T1 and T2 relaxivity values of free extracellular ferumoxtran-10 as opposed to intracellularly compartmentalized ferumoxtran-10, under the evaluated conditions of homogeneously dispersed contrast agents/cells in Ficoll solution and a cell density of up to 2.5×10⁷ cells/ml. At 3T, differences in T1-relaxivities between intra- and extracellular USPIO were smaller, while differences in USPIO T2-relaxivities were similar compared with 1.5T. In conclusion, cellular compartmentalization of ferumoxtran-10 changes proton relaxivity. This work was supported by a seed grant from the Department of Radiology, University of California of San Francisco.     

增生性瘢痕治疗研究进展

增生性瘢痕是创面修复过程中细胞外基质过度沉积的产物,具体的分子生物学水平发病机制尚不明确,临床治疗也缺乏可靠的标准。为此,笔者于本研究中将增生性瘢痕的治疗现状,尤其是注射中药制剂、基因调控和激光在增生性瘢痕治疗中所取得的研究成果进行了综述,旨在为增生性瘢痕治疗的进一步研究提供线索与思路。     

19例医源性疑似环杓关节半脱位的临床分析及其防治策略

目的 提高对围术期疑似环杓关节半脱位（arytenoid subluxation,AS）的诊断意识和预防治疗.方法 回顾患者的病历资料,分析19例疑似围术期AS患者的症状体征,找出可能的相关危险因素并提出一些防治策略.结果 19例疑似AS患者中,12例（63.1％）男性患者,7例（36.9％）女性患者.在全身麻醉后1 d～2d,患者出现声音嘶哑、喉咙疼痛等症状,经耳鼻喉科医师会诊或接受电子喉镜检查诊断为疑似AS.6例（31.5％）患者接受了环杓关节拨动术,其中2例（33.3％）患者接受2次拨动术.术后4例（66.7％）患者声音嘶哑得到改善,另外2例（33.3％）患者则没有明显改善.其余13例（68.4％）被嘱咐多做发声练习,未行特殊治疗.结论 病史及电子喉镜检查可诊断疑似AS,但确诊尚需喉肌电图检查.其治疗关键在于早期发现,早期诊断.关节复位术是该病首选治疗方法.另外,类固醇激素及消炎痛具有重要的辅助治疗作用.