经后颅窝乙状窦后入路三叉神经微血管减压术的快速康复外科护理

目的 探讨快速康复外科 （FTS）理念在经后颅窝乙状窦后入路三叉神经微血管减压术围术期患者护理中的应用效果。方法 选择2018年1月~2019年1月我院收治并行经后颅窝乙状窦后入路三叉神经微血管减压患者100例，随机分成观察组和对照组，每组50例。对照组应用常规方法进行围术期护理，观察组应用FTS理念进行围术期护理。比较两组焦虑情况、术后并发症发生率、平均住院日及平均住院费用。结果 观察组轻度焦虑多于对照组，中、重度焦虑少于对照组（P＜0.05）；观察组术后并发症发生率低于对照组[恶心呕吐（4.00% vs 16.00%）、尿路感染（4.00% vs 18.00%）、颅内感染（0 vs 8.00%）、颅内血肿（2.00% vs 14.00%）和术后应激性疼痛（16.00% vs 34.00%）]，差异有统计学意义（P＜0.05）；观察组平均住院日和平均住院费用均低于对照组[（9.13±1.14）d vs（12.44±0.89）d]；[（2.15±0.66）万元 vs （3.05±0.61）万元]，差异有统计学意义（P＜0.05）。结论 应用FTS理念能缓解经后颅窝乙状窦后入路三叉神经微血管减压术患者术前紧张恐惧的心理，减少术后并发症，缩短患者住院日，降低住院费用，护理效果较好。     

免疫检查点抑制剂应用于晚期胃癌治疗的研究进展

我国属胃癌高发国家,且以进展期胃癌为主。以手术和化疗为主的多学科治疗无法有效改善晚期胃癌患者的预后。近年来,免疫检查点抑制剂类药物的疗效在诸多癌症中得到了证实,因此,该类药物在胃癌中的治疗效果也受到了广泛的关注。本文对近年来的相关研究成果进行综述,全面介绍了免疫检查点抑制剂类药物在胃癌治疗中的临床应用情况、联合用药情况以及不良反应。对于其他治疗均失败的晚期胃癌患者,PD-1抑制剂是一个可行的治疗选项,其代表药物派姆单抗是目前唯一被美国食品药品监督管理局批准应用于胃癌治疗的免疫抑制剂类药物,而我国国家食品药品监督管理总局尚未批准任何此类药物应用于胃癌的临床治疗。如何进一步提高治疗的客观缓解率,将会是后续临床和基础研究的一大焦点。     

Resting respiratory sinus arrhythmia moderates the association between social phobia symptoms and self‐reported physical symptoms

The present study sought to investigate the association between social phobia symptoms and self‐reported physical symptoms and the moderation effect of resting respiratory sinus arrhythmia (RSA) on this link. Data of 5‐min resting RSA, social phobia symptoms assessed by the Social Phobia Scale, and physical symptoms assessed by the Cohen–Hoberman Inventory of Physical Symptoms were collected from 167 undergraduate students. Results indicated that higher levels of social phobia symptoms were associated with higher levels of self‐reported physical symptoms. Resting RSA played the moderating role in the link between social phobia symptoms and self‐reported physical symptoms, such that social phobia symptoms were positively associated with self‐reported physical symptoms among individuals with low resting RSA, whereas this association was nonsignificant among individuals with high resting RSA. These findings suggest that high resting RSA as a physiological marker of better self‐regulation capacity might buffer the effect of social phobia symptoms on physical health.     

Mixed Reality Combined with Three‐Dimensional Printing Technology in Total Hip Arthroplasty: An Updated Review with a Preliminary Case Presentation

Three‐dimensional (3D) printing technology, virtual reality, and augmented reality technology have been used to help surgeons to complete complex total hip arthroplasty, while their respective shortcomings limit their further application. With the development of technology, mixed reality (MR) technology has been applied to improve the success rate of complicated hip arthroplasty because of its unique advantages. We presented a case of a 59‐year‐old man with an intertrochanteric fracture in the left femur, who had received a prior left hip fusion. After admission to our hospital, a left total hip arthroplasty was performed on the patient using a combination of MR technology and 3D printing technology. Before surgery, 3D reconstruction of a certain bony landmark exposed in the surgical area was first performed. Then a veneer part was designed according to the bony landmark and connected to a reference registration landmark outside the body through a connecting rod. After that, the series of parts were made into a holistic reference registration instrument using 3D printing technology, and the patient's data for bone and surrounding tissue, along with digital 3D information of the reference registration instrument, were imported into the head‐mounted display (HMD). During the operation, the disinfected reference registration instrument was installed on the selected bony landmark, and then the automatic real‐time registration was realized by HMD through recognizing the registration landmark on the reference registration instrument, whereby the patient's virtual bone and other anatomical structures were quickly and accurately superimposed on the real body of the patient. To the best of our knowledge, this is the first report to use MR combined with 3D printing technology in total hip arthroplasty.     

解剖锁定钢板联合同种异体腓骨治疗肱骨近端骨折疗效的Meta分析

文题释义：肱骨近端骨折：肱骨近端包括肱骨头及大结节、小结节，中老年人骨质疏松及低能量损伤可导致肱骨近端骨折。 同种异体腓骨：取自于人体异体，经过加工处理，去除其免疫原性，保留其骨性结构，可用于移植修复骨缺损，起到支撑作用。 背景：肱骨近端骨折是临床常见骨折，但对肱骨近端内侧柱缺乏支撑的骨折目前仍是治疗难点，并发症常见，失败率较高。 目的：比较解剖锁定钢板联合同种异体腓骨与单纯解剖锁定钢板治疗肱骨近端骨折的疗效。 方法：使用计算机检索PubMed、Embase、Cochrane Library、Google Scholar、中国知网、万方、维普数据库，检索时间均从建库到2020年2月。检索国内外关于对比研究解剖锁定钢板联合同种异体腓骨与单纯解剖锁定钢板治疗肱骨近端骨折疗效的文献。2名研究员根据纳入和排除标准分别独立筛选文献，提取数据，评估文献中的偏倚风险。纳入12篇相关文献使用RevMan 5.2软件将以下指标进行Meta分析，包括影像学数据、功能评分和并发症。结果与结论：①通过文献检索、根据纳入和排除标准，12篇文献纳入研究，其中11篇为回顾性队列研究，1篇为随机对照研究；纳入研究文献质量高，但GRADE证据质量级别较低。②共纳入958例患者，其中解剖锁定钢板联合同种异体腓骨组411例，单纯解剖锁定钢板组547例；③Meta分析结果显示，解剖锁定钢板联合同种异体腓骨组术后1年肱骨头高度差值(MD=-2.40，95%CI：-2.49至-2.31)、颈干角差值(MD= -6.14，95%CI：-6.62至-5.67)、目测类比评分(MD=-0.22，95%CI：-0.35至-0.08)、肩关节功能评分(MD=4.12，95%CI：2.18-6.06)，上肢伤残评分(MD=-10.32，95%CI：-13.44至-7.19)、术后2年的目测类比评分(MD=-0.37，95%CI：-0.55至-0.19)、肩关节功能评分(MD=5.07，95%CI：2.86-7.27)、总体并发症(OR=0.31，95%CI：0.20-0.48)及肱骨头螺钉切出(OR=0.25，95%CI：0.11-0.55)均明显优于单纯解剖锁定钢板组(P < 0.05)，肱骨头坏死(OR=0.94，95%CI：0.47-1.88)，两组间差异无显著性意义(P > 0.05)；④因此，较弱的证据提示，肱骨近端解剖锁定钢板联合同种异体腓骨治疗肱骨近端骨折的短期疗效优于解剖锁定钢板，可减少并发症的发生，促进功能恢复。ORCID: 0000-0002-8486-3932(阳运康) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

肝门部胆管癌的分型分期系统及其临床应用价值

肝门部胆管癌（hilar cholangiocarcinoma，HC）分型和分期系统较为庞杂，包括改良Bismuth-Corlette分型，Gazzaniga T分期，Blumgart T分期，美国纪念Sloan-Kattering癌症中心（Memorial Sloan Katering Cancer Center，MSKCC）T分期，Mayo分期系统，美国癌症联合委员会（American Joint Committee on Cancer，AJCC）和国际抗癌联盟（International Union Against Cancer，UICC）联合发布的TNM分期，欧洲肝胆胰协会分期（Consensus classification from the European Hepato-Pancreato-Biliary Association，EHPBA），以及日本肝胆胰外科学会（Japanese Society of Hepato-Biliary-Pancreatic Surgery，JSHBPS）分期，各分期系统所包含的内容差异较大，各具特色和优缺点，本文就HC常见的分型和分期系统及其在临床中的应用价值做一综述。