脊髓损伤患者自主神经功能障碍的临床研究

目的:通过检测健康人群和不同节段脊髓损伤患者心率变异性（HRV），探讨脊髓损伤患者是否存在自主神经的功能障碍，以及不同节段脊髓损伤患者的自主神经的功能障碍程度是否相同。方法:依据脊髓损伤节段的不同将截瘫患者分为颈段及T1-5节段脊髓损伤组11例，T6-12脊髓损伤组7例， 腰髓损伤6例； 健康体检人群19例作为正常对照组。采用短程动态记录安静状态下心电图并进行HRV分析。结果:颈段及T1-5脊髓损伤组代表交感和迷走神经张力总合的低频检测结果301.41±358.60ms2较正常人群的620.19±333.36 ms2明显降低（P＜0.05），而且所有脊髓损伤组的低频/高频比值在C1-T5为1.66±1.00、T6-12为4.03±2.66、腰髓及以下为3.35±1.89，较正常人群的2.29±0.58明显异常（P＜0.05），同时不同脊髓损伤组之间的检测结果不存在显著性差异（P＞0.05）。结论:脊髓损伤患者存在自主神经的功能障碍，但不同节段脊髓损伤组之间的自主神经功能障碍不存在显著性差异。     

Auricular reconstruction of congenital microtia by using the modified Nagata method: Personal 10-Year experience with 1350 cases

Background

Total auricular reconstruction is currently one of the most challenging plastic surgery procedures. Herein, we present our 10-year experience with 1350 cases of ear reconstruction by using Nagata method with necessary improvement.

早期康复锻炼对老年心脏起搏器植入术后心肺功能改善及深静脉血栓预防的影响

目的 探究早期康复锻炼对老年心脏起搏器植入术后心肺功能及深静脉血栓形成的影响。 方法 选取2017年1月～2018年12月诊治的经心脏起搏器植入术106例患者作为研究对象,根据不同康复方案分为研究组（n=53）和对照组(n=53)。对照组实施常规康复护理,研究组实施早期康复锻炼护理。对比分析两组患者手术时间、下床正常活动时间、住院时间、心肺功能变化、并发症发生、生活质量以及治疗满意度。 结果 研究组患者下床正常活动时间和住院时间均明显少于对照组（P<0.01）。两组患者LVEF和FEV1/FVC术后1周和术后1个月与术前相比均明显增加,且术后1个月恢复情况优于术后1周;同时研究组患者恢复情况优于对照组患者（P<0.01）。研究组深静脉血栓发生率为3.77 %,明显低于对照组,且研究组并发症发生率明显低于对照组（P<0.01）。两组患者术后1周和1个月生活质量均明显好转,且研究组患者好转程度明显优于对照组（P<0.01）。研究组患者康复锻炼满意度明显高于对照组（P<0.01）。 结论 科学合理的早期康复锻炼不仅能有效改善心脏起搏器植入术的患者心肺功能,减少住院时间和下床正常活动时间,而且帮助患者降低深静脉血栓形成等并发症的发生情况。通过个性化早期康复锻炼提高患者生活质量和治疗满意度,提高了康复效果。     

冠状动脉CTA对冠状动脉粥样硬化性心脏病高危人群的随访观察价值

目的 探讨冠状动脉CT血管成像（CCTA）对冠状动脉粥样硬化性心脏病（简称冠心病）高危险因素人群（简称高危人群）的随访观察价值。方法 选取于我院接受CCTA检查且空腹血糖、血脂（甘油三酯、总胆固醇、高密度脂蛋白及低密度脂蛋白）等生化指标及体质量指数有2项或2项以上异常的80例患者,经临床干预后,间隔2年再次行CCTA检查,同时行上述生化指标及体质量指数检测,根据两次CCTA检查结果分为稳定组和进展组,并对2组两次生化指标、体质量指数及其变化率进行统计学分析。结果 稳定组60例,进展组20例。进展组第1次与第2次检查高密度脂蛋白水平差异有统计学意义（t=2.64,P=0.02）;稳定组第2次检查体质量指数、血糖、甘油三酯、总胆固醇及低密度脂蛋白明显小于第1次检查（t=2.10、2.68、3.45、4.26、5.90,P=0.04、0.01、0.001、0.000 1、0.000 1）;进展组第2次检查甘油三酯（t=2.39,P=0.02）和低密度脂蛋白高于稳定组第2次检查（t=3.98,P<0.000 1）;进展组血糖变化率高于稳定组（t=-2.04,P=0.045）。结论 CCTA对于随访观察高危人群冠心病有积极的指导意义,通过加强对冠心病危险因素的积极干预,改变不良生活习惯,可以有效延缓或阻止冠心病的发生及发展。     

Highly efficient and giant negative electrocaloric effect of a Nb and Sn co-doped lead zirconate titanate antiferroelectric film near room temperature

Adiabatic temperature variation (ΔT), coefficient of performance (COP) and electrocaloric coefficient (ΔT/ΔE) play important roles in evaluating the comprehensive performance of solid-state cooling technology based on the electrocaloric effect (ECE). A Nb and Sn co-doped lead zirconate titanate antiferroelectric film, Pb_0.99Nb_0.02(Zr_0.85Sn_0.13Ti_0.02)O₃ (PNZST), shows a highly efficient and giant negative ECE. The ΔT, |ΔT/ΔE| and COP are about −9.8 K, 0.0488 K cm kV⁻¹ and 35.53 at around 50 °C, respectively. The full width at half maximum of the ΔT peak is about 37 °C. Phenomenological analysis indicates that the highly efficient and giant negative ECE is associated with the first-order transition that has a discontinuous polarization change with increasing temperature.

A giant negative ECE of a PNZST film with a high electrocaloric coefficient and coefficient of performance near room temperature.     

Traumatology of the facial skeleton in octogenarian patients: A retrospective analysis of 96 cases

AimThe aim of this retrospective study was to evaluate the frequency and distribution of maxillofacial trauma patients over 80 years, with regard to type and environment of accidents as well as treatment and complications.Patients and methodsData for 94 patients (96 cases; aged 80–94 years) with maxillofacial fractures were retrospectively analysed.ResultsData of 30 male and 64 female patients with an average age of 85 years were analysed. In 90% of the study population, the cause of fractures was a fall, followed by traffic accidents (9%) and assault (1%). Seventy-two patients had fractures of the midface, 10 had factures of the mandible, 9 had fractures of both the midface and mandible and 5 had fractures of the neurocranium and midface. Surgical intervention was required in 57% of the patients. Post-operative complications were: four cases of diplopia, two cases of infected plates, four cases of lower eyelid ectropion and in one case a retrobulbar haematoma.ConclusionFacial trauma in the elderly can often be treated conservatively unless the patient complains of functional problems. Due to co-morbidities, special attention should be paid to hypertension, anticoagulant agents and the surgical approach.     

Magnetic resonance imaging applied to the diagnosis of perforation of the temporomandibular joint

ObjectiveTo investigate the diagnostic accuracy of magnetic resonance imaging (MRI) for perforation of temporomandibular joint (TMJ).MethodsConsecutive 1845 patients (2524 joints) diagnosed as internal derangement (ID) of TMJ were collected from April 2003 to March 2010 in our department. All the patients were examined by MRI and treated by arthroscopy or open surgeries. The findings of interpreting MRI were recorded as positive, suspicious and negative according to the MRI radiographic criteria. After comparing the findings of MRI with those of arthroscopy or open surgeries, the numbers of true positive, true negative, false positive and false negative were obtained. Through SPSS16.0, receiver operator characteristic curve (ROC curve) was made with 1-specificity as abscissa and the sensitivity as ordinate, and the area under the ROC curve was calculated. According to the area, the diagnostic value of MRI was evaluated.ResultsArthroscopic or open surgeries findings confirmed that 207 joints had disc perforation among all joints. MRI findings showed 189 joints were positive, 197 joints suspicious, and 2138 joints negative. The true positive accuracy of MRI findings was 102/189 while true negative accuracy was 2075/2138. 42 of the 197 suspicious joints had perforation. The area under the ROC curve was 0.808 (0.77, 0.85), P < 0.05.ConclusionWe concluded that MRI proved to be a good modality to diagnose disc perforation of TMJ, and the diagnostic result of disc perforation by MRI had certain guiding significance in our clinical work.     

髂内动脉化疗栓塞在极高危非肌层浸润性膀胱癌经尿道电切术后的应用及价值

【摘要】 目的 极高危非肌层浸润性膀胱癌具有很高的复发和进展风险。明确双侧髂内动脉化疗栓塞术（IAC）经尿道电切术后辅助措施的价值。方法 回顾性分析2015年1月至2017年12月收治的该类患者38例,均接受经尿道膀胱肿瘤电切术及术后规律膀胱灌注治疗（卡介苗或表柔吡星/吡柔吡星）,根据是否接受IAC分为IAC组及对照组。IAC组在电切术后2周内接受第1疗程IAC,再间隔3～4周行第2疗程IAC,化疗方案:顺铂60 mg/m2,吡柔比星25 mg/m2。术后随访指标包括无复发生存时间、随访期间进展率及切除膀胱率等。 结果 IAC组12例,对照组26例,平均随访时间 （30.1±12.4）个月。IAC组与对照组在主要观察指标上的比较如下:无复发生存时间 （20.3±14.1）个月比 （8.9±7.2）个月,（P=0.002）,1年无复发生存率66.7%比26.9%,（P=0.02）,2年无复发生存率33.3%比7.7%,（P=0.07）,随访期间进展率33.3%比46.2%,（P=0.46）,切除膀胱率25.0%比46.2%,（P=0.21）。结论 对于极高危非肌层浸润性膀胱癌患者,在经尿道电切术后辅助双侧髂内动脉化疗栓塞有助于延缓疾病的复发。