中国居民膳食指南在内科住院患者健康教育中的应用

目的探讨《中国居民膳食指南》在住院患者健康教育中的应用效果。方法对64例住院患者应用《中国居民膳食指南》进行健康教育,并以问卷调查方式了解患者对健康教育知识掌握情况。结果健康教育后患者营养知识评分显著高于教育前(均P<0.01)。结论应用中国居民膳食指南对患者进行健康教育,可以有效提高患者饮食的合理性和科学性,为疾病的早日康复打下良好的基础。     

连续性血液净化对重症急性胰腺炎血浆炎症介质的影响

【摘要】　目的 探讨连续性血液净化(CBP)对重症急性胰腺炎(SAP)患者血浆炎症介质的影响。方法 对36例重症急性胰腺炎患者进行CBP治疗,使用ELISA法检测治疗前和治疗后24 h、48 h血浆TNF -α、IL -1β、IL -6、IL -8的浓度,并与同期健康人群做比较。结果 31例患者好转出院,存活率为86.1%,血生化指标明显改善;SAP患者血浆TNF -α、IL -1β、IL -6、IL -8浓度显著高于正常对照组,CBP治疗24 h后四种细胞因子明显低于治疗前水平(P<0.05),治疗48 h后有不同程度的回升,但仍低于治疗前水平(P<0.05)。结论 CBP可有效清除SAP患者血浆炎症介质,从而阻断全身炎症反应,改善预后。     

Ten Versus Five Polymorphonuclear Leukocytes as Threshold in Frozen Section Tests for Periprosthetic Infection: A Meta-Analysis

We objectively appraised available evidence regarding the threshold for the number of polymorphonuclear leukocytes required in frozen section tests used to diagnose periprosthetic infection. Pooled summary estimates for sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio (OR) were compared for ten and five polymorphonuclear leukocytes per high power field as the threshold. The total cohort included 1011 patients and the rate of infection was 19.2%. Although there was no difference in sensitivity or diagnostic OR, specificity was significantly higher for ten than for five polymorphonuclear leukocytes per high power field (p = 0.007) In sum, a threshold of 10 polymorphonuclear leukocytes is better for diagnosing periprosthetic infections.     

Robotic single-incision anterior resection for sigmoid colon cancer: access port creation and operative technique

Background

Potential morbidities related to multiport laparoscopic surgeries have led to the current excitement about single-incision laparoscopic techniques. However, multiport laparoscopy is technically demanding and ergonomically challenging. We present our technique of using the Alexis wound retractor and a surgical glove to fashion an access port and the da Vinci surgical robot to perform single-incision anterior resection.

Methods

Through a small transumbilical incision, an Alexis wound retractor and a surgical glove are fashioned as an access port. Appropriate trocars are then inserted through the cut fingertips of the glove and secured. A three-arm da Vinci robot with a 30° up-scope was used.

Results

Twenty-two patients (12 males, 10 females) with a mean age of 58.5 years (range = 35–70) underwent robotic single-incision anterior resection for sigmoid colon cancer with this technique. There was no conversion to open surgery and one case was converted to multiport surgery. The mean estimated blood loss was 24.5 ml (range = 5–230), the mean operating time was 167.5 min (range = 112–251), the median skin incision length was 4.7 cm (range = 4.2–8.0), the mean proximal and distal resection margins were 12.9 cm (range = 7.5–25.1) and 12.3 cm (range = 4.5–19.2), respectively, and the mean lymph node harvest was 16.8 (range = 0–42). The immediate postoperative pain score was 2.8 (range = 1–5) and on postoperative day 1 it was 1.4 (range = 1–3). The mean length of hospital stay was 6 days (range = 5–9).

Conclusion

Robotic single-incision anterior resection is a safe and viable option for selected patients. Merging the principles of reduced parietal trauma and better cosmesis with the ergonomic advantages of the robotic system is a novel evolution of single-incision laparoscopic surgery.     

Porous tantalum rod implant is an effective and safe choice for early-stage femoral head necrosis: a meta-analysis of clinical trials

Background and purpose

Femoral head necrosis (FHN) is a debilitating disease which seriously affects the patients’ quality of life, especially the young. The porous tantalum rod has the advantages of high volumetric porosity, low modulus of elasticity, and excellent osteoinduction, with exceptional biocompatibility and safety record in clinical application, which makes it an ideal choice for FHN patients. However, there has not been a systematic analysis for its efficacy and safety.

Methods

This meta-analysis of six randomized controlled trials and controlled clinical trials with 256 participants was performed to investigate the efficacy and safety of porous tantalum rod, by means of comparing with vascularized or non-vascularized bone grafting.

Results

Porous tantalum has its advantages in functional evaluation of Harris Hip Score, with a significant lower incidence of femoral head collapse. The surgical blood loss is low and the operative time is short with no increase in complication rate.

Interpretation

Our preliminary analysis provided that the porous tantalum rod was a less invasive method and was effective and well tolerant for early-stage FHN patients. Further specially designed clinical trials for long-term follow-up and socioeconomic assessment are needed before a final determination.