基于跟骨前部外侧壁和载距突解剖分区的载距突精准置钉技术的应用研究

目的评价基于跟骨前部外侧壁和载距突解剖分区的载距突精准置钉应用于Sanders Ⅱ、Ⅲ型跟骨骨折治疗的效果。方法按"四分法"把跟骨前部外侧壁分为前上区(S1)、前下区(S2)、后上区(S3)和后下区(S4), 用于标定进钉点;"三段法"把载距突分为前段、中段和后段, 用以标定置钉靶点。标本做CT扫描和Mimics建模, 在3D虚拟模型上从跟骨前部外侧壁每个区分别向载距突组配1枚螺钉, 其中S1和S2靶点是载距突内侧前段与中段交点P1, S3和S4靶点是中段与后段交点P2, 观察螺钉是否位于骨性通道内。回顾性分析2017年1月至2021年1月徐州医科大学附属宿迁医院收治的72例Sanders Ⅱ、Ⅲ型跟骨骨折患者资料, 根据不同的载距突置钉法把患者分为解剖分区组和3D打印组。解剖分区组32例, 男25例, 女7例;年龄24～60岁, 基于解剖分区法置钉。3D打印组40例, 男31例, 女9例;年龄25～58岁, 采用3D打印辅助置钉。比较解剖分区组置钉参数与实际值的差异, 比较两组间置钉总数、平均置钉数、螺钉分布和置钉准确率。结果在标本上从S1和S2向P1、S3和S4向P2虚拟置钉, 螺...     

从少阳论治新型冠状病毒感染后咳嗽

[目的]探索新型冠状病毒（简称新冠病毒）感染后咳嗽的中医诊疗思路。[方法]从少阳的生理病理入手,阐述少阳的病位特点,少阳与痰饮水湿的关系,分析新冠病毒感染后咳嗽的临床症候,将其与少阳证联系,并总结相应的治法,列举临床验案一则加以佐证。[结果]新冠病毒感染急性期解表不彻底,邪传少阳,是咳嗽迁延不愈的主要原因,而在咳嗽的亚急性期与慢性期又多兼有痰饮水湿等病邪。新冠病毒感染后咳嗽多伴有气道痒、咽干咽痒、口苦或口中乏味、嗅觉味觉减退、头晕,有的还伴有阳后焦虑,兼具少阳病的特点。因此新冠病毒感染后咳嗽可从少阳论治,其中少阳太阳合病、少阳夹饮、少阳湿热较为常见,还有部分表现为少阳少阴合病。所附医案辨证属于少阳太阳夹饮咳嗽,治以和解少阳、外散风寒、温化水饮之法,咳嗽明显改善。[结论]新冠病毒感染后咳嗽多为邪犯少阳所致,与痰饮水湿关系密切,治疗上需同时辨识少阳与他经合病以及病邪兼夹等情况,为临床提供思路。     

精神科医生对伴有自杀意念和自杀未遂抑郁症患者的诊疗现况调查

目的 基于精神科医生视角，调查我国伴有自杀意念和自杀未遂的抑郁症患者的疾病特征、治疗现状以及目前临床诊疗中未被满足的需求。方法 本研究为横断面研究。采用便利抽样法，于2020年12月至2021年1月选取在我国24个省/直辖市的三甲综合医院或精神专科医院精神科工作的医生为研究对象。基于文献回顾和临床实践设计电子调查问卷，由专家顾问委员会审核完成问卷设计，采用该问卷收集医生的基本信息、接诊抑郁症患者的构成、接诊的伴自杀意念和自杀未遂抑郁症患者的临床特征、对伴自杀意念和自杀未遂患者的临床诊疗现况、医生与患者的临床需求和期望。本研究发放问卷317份，回收有效问卷209份，有效问卷回收率为65.9%。结果 分别有29.2%(61/209)和10.0%(21/209)的医生认为其接诊的抑郁症患者中，>50%有自杀意念和自杀未遂；而认为住院抑郁症患者>50%有自杀意念和自杀未遂的医生分别占58.4%(122/209)和16.3%(34/209)。46.9%(98/209)的医生认为有自杀意念的抑郁症患者会发展出现自杀未遂的比例在10%～30%。医生认为自杀未遂常见的风险因素包括既往自杀史...     

空腹血糖、脂代谢指标与无症状高血压人群心电图ST-T改变关系及其诊断价值研究

目的:探讨空腹血糖(FBG)、脂代谢指标与无症状高血压人群心电图ST-T改变的关系及其诊断价值。方法:选取体检发现为无症状高血压患者557例，根据患者心电图ST-T是否改变分为正常组(456例)和异常组(101例)。比较两组患者一般资料、收缩压(SBP)、舒张压(DBP)和心率(HR)变化。比较两组白细胞(WBC)、红细胞(RBC)、血小板(PLT)、中性粒细胞(NEU)计数。比较两组血清肝肾功能指标[尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、谷丙转氨酶(ALT)、谷草转氨酶(AST)]、FBG和脂代谢指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]。采用受试者工作特征(ROC)曲线分析FBG、脂代谢指标对无症状高血压人群心电图ST-T改变的诊断价值。采用Logistic回归分析无症状高血压人群ST-T改变的影响因素。结果:异常组女性比例、年龄高于正常组，HR低于正常组(均P<0.05)。两组患者WBC、RBC、PLT和NEU计数比较差异无统计学意义(均P>0.05)。异常组患者FBG、TC、TG、LDL-C...     

洪波“顺气化浊、培元宁嗽”法辨治难治性慢性咳嗽经验

<正>洪波主任医师，乃宁波市名中医、宁波市名中医药专家学术经验继承工作指导老师，浙江中医药大学兼职教授，宁波市非物质文化遗产“钟氏内科”传承人，从事临床工作30余年，中西医并重，在辨治难治性慢性咳嗽方面具有独特的见解与方法。     

伴混合特征抑郁症和双相障碍患者的静息态低频振荡振幅差异

目的 基于低频振荡振幅（ALFF）分析方法，探讨抑郁症、伴混合特征的抑郁症（MMF）、伴混合特征的双相障碍（BMF）和双相障碍患者之间局部自发脑活动的差异。方法 收集2021年6—12月就诊于首都医科大学附属北京安定医院门诊符合DSM-5诊断标准的20例抑郁症、15例MMF、20例BMF、25例双相障碍患者，以及40名性别和年龄与各组患者匹配的健康对照者的静息态功能磁共振数据和一般资料。影像数据预处理后，计算个体ALFF图，采用单因素方差分析和事后检验比较5组受试者局部自发脑活动的差异。结果 单因素方差分析结果显示，5组受试者的左侧颞下回（k=372,P<0.001）、左侧中缝核（k=271,P<0.001）、右侧前扣带和旁扣带回（k=193,P<0.001）、右侧颞中回（k=149,P<0.001）、右内侧额上回（k=117,P<0.001）、右侧小脑crus 2区（k=68,P=0.009）、右侧颞下回（k=63,P=0.014）和左侧颞中回（k=49,P=0.048）的ALFF值比较，差异有统计学意义（P均簇水平FWE校正）。事后检验结果显示，双相障...     

An applied research on precise sustentacular screw placement based on anatomical division of the anterior lateral wall of calcaneus and the sustentaculum tali北大核心CSCD

Objective To evaluate our novel path based on anatomical division of the anterior lateral wall of calcaneus and the sustentaculum tali for precise sustentacular screw placement in the surgical treatment of calcaneal fractures of Sanders types Ⅱ and Ⅲ. Methods The anterior lateral wall of the calcaneus was divided into the anterior-superior zone S1, the anterior-inferior zone S2, the posterior-superior zone S3 and the posterior-inferior zone S4 for demarcation of the screw insertion points by our method of Four Zones, and into the front, middle and rear sections by our method of Three Sections for demarcation of the screw target points. The specimens were scanned by CT and modeled by Mimics. On the 3D virtual model of the calcaneus, one screw was placed from each zone of the anterior lateral wall of the calcaneus to the sustentaculum tali body. The screw placement target for S1 and S2 was the medial intersection point P1 of the front and middle sections of the sustentaculum tali, and that for S3 and S4 was the medial intersection point P2 of the middle and rear sections of the sustentaculum tali. It was observed whether the screws were placed in the bone channel. A total of 72 patients were included who had been admitted to Department of Orthopaedics, Suqian Hospital Affiliated to Xuzhou Medical University for calcaneal fractures of Sanders types Ⅱ and Ⅲ from January 2017 to January 2021. They were divided into an anatomical division group and a 3D printing group according to their screw placement method for the sustentaculum tali. In the anatomical division group of 32 patients subjected to screw placement based on our anatomical division, there were 25 males and 7 females, aged from 24 to 60 years; in the 3D printing group of 40 patients subjected to screw placement assisted by 3D printing, there were 31 males and 9 females, aged from 25 to 58 years. The disparities between the parameters of sustentacular screw placement and the actual values were compared in the anatomical division group, and the total number of screws, screws on average, distribution of screws, and accuracy of screw placement were compared between the 2 groups. Results All the screws which were virtually placed in the specimens of the calcaneus from S1 and S2 to P1 and from S3 and S4 to P2 passed through the bony channel, with no perforation into the tarsal sinus. There was no significant difference in the general date between the anatomical division group and the 3D printing group, showing they were comparable (P > 0.05). In the anatomical division group, a total of 52 screws were placed to the sustentaculum tali with an average of (1.63 ± 0.48) screws per patient, and 2 screws were placed in 20 patients, yielding an accuracy rate of screw placement of 92.3% (48/52). There were no statistically significant differences between the parameters and the actual values of screw placement in the anatomical division group (P > 0.05). In the 3D printing group, a total of 63 screws were placed to the sustentaculum tali with an average of (1.58 ± 0.49) screws per patient, and 2 screws were placed in 23 patients, yielding an accuracy rate of screw placement of 93.7% (59/63). There were no significant differences in the above comparisons between the anatomical division group and the 3D printing group (P > 0.05). Conclusion In the surgical treatment of calcaneal fractures of Sanders types Ⅱ and Ⅲ, the sustentacular screw placement based on our anatomical division of the anterior lateral wall of the calcaneus and the sustentaculum tali can lead to similar clinical accuracy as 3D printing-assisted screw placement does. © 2022 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

二维斑点追踪成像对原发性干燥综合征患者右心室功能的评估

目的 应用二维斑点追踪成像(2D-STI)技术评估原发性干燥综合征(pSS)患者的右心室功能变化。方法 选取原发性干燥综合征(pSS)患者30例为病例组，健康志愿者30例为对照组。常规超声测量参数：右心室面积变化分数(RVFAC)、三尖瓣环收缩期峰值速度(S′)、三尖瓣环收缩期位移(TAPSE);由组织多普勒频谱法计算右心室Tei指数。2D-STI测量参数：右心室游离壁长轴应变(RVFWSL),基底段、中间段、心尖段右心室游离壁长轴应变(Basal RVFWSL、Mid RVFWSL、Apical RVFWSL)。比较上述两组参数的差异，并评价应变参数的诊断效能。结果 pSS病例组与对照组常规超声参数RVFAC、S′、TAPSE、Tei指数均无统计学意义。与对照组相比，pSS病例组RVFWSL、Basal RVFWSL、Mid RVFWSL、Apical RVFWSL的绝对值均减小，差异有统计学意义(P值分别为0.000、0.001、0.000、0.000)。相关性分析得出，pSS患者的病程与RVFWSL、Mid RVFWSL呈正相关(分别为r=0.720,P=0.000和r=0.40...     

2010—2019年广州市鼻咽癌发病率与空气污染物灰色关联分析

目的 探讨空气污染物与广州市鼻咽癌发病风险之间的关系。方法 收集广州市2010—2019年鼻咽癌发病数据与1999—2019年空气污染物(NO₂、SO₂和PM₁₀)数据，采用Joinpoint回归分析鼻咽癌发病率变化趋势。使用灰色关联分析计算灰色相对关联度、灰色绝对关联度和灰色综合关联度，并分析空气污染物诱发鼻咽癌的潜伏期。结果 广州市鼻咽癌中标率平均每年下降2.83%(AAPC=-2.83%,P<0.05),其中男性平均每年下降1.64%(AAPC=-1.64%,P=0.07),女性平均每年下降3.84%(AAPC=-3.84%,P<0.01)。广州市鼻咽癌中标率与NO₂、SO₂和PM₁₀的综合关联度分别为0.78、0.71和0.75,关联度排序为NO₂、PM₁₀、 SO₂。广州市鼻咽癌中标率与NO₂、SO₂和PM₁₀